bluuebunny/crossref_metadata_2025_split huggingface dataset:
Upper Limb Lengthening in Achondroplasia Using Unilateral External Fixation
Authors: Arenas-Miquelez Antonio , Arbeloa-Gutierrez Lucas , Amaya Martín , Vázquez Blanca , De Pablos Fernández Julio 
Published: February 2021

Purpose:
The purpose of this study was to analyze the long-term results of humeral lengthening in achondroplastic patients and make suggestions on the most appropriate surgical technique to improve patient outcomes.

Methods:
Fifty-four humeral lengthening procedures performed in 27 achondroplastic patients were reviewed. Elongations were performed by means of callotasis with unilateral external fixation. Inclusion criteria were: achondroplastic patients under 17 years without prior arm operations and minimum follow-up of 36 months.

Results:
Fifty humeri in 25 patients (13 men and 12 women), aged between 9 and 17 years, met the inclusion criteria. Mean humeral lengthening was 8.82 cm (range: 5 to 10.5 cm), which represented an elongation of 54.80% (range: 46% to 63%) of the original length. The healing index was 0.91 months (range: 0.72 to 1.4 mo) per centimeter gained. Shoulder and elbow range of motion and stability were preserved in 47 limbs. Noncomplicated cases consistently experienced a significant functional improvement in the performance of activities of daily living such as putting on footwear and personal hygiene. Short-term complications included 11 pin-tract infections, 1 radial nerve neuropraxia, and 1 failure of the regenerated bone formation. None of these complications prevented from completion of treatment. Long-term complications included 2 cases of nonunion, 3 elbow flexion contractures, and 2 cases of psychological dissatisfaction, all of them in 4 patients. Factors associated with long-term complications were intraoperative fragment displacement and distal humeral osteotomy. No fractures of the regenerated bone were identified in the long term.

Conclusions:
Callotasis with unilateral external fixation is a reliable and well-tolerated procedure for humeral lengthening in achondroplastic patients, with an acceptable complication rate. Guided fixator placement and a proximal humeral osteotomy are strongly recommended technical tips as they may help prevent complications and improve outcomes.

Level of Evidence:
Level IV—case series.
The Pediatric Open Supracondylar Fracture: Associated Injuries and Surgical Management
Authors: Armstrong Douglas G. , Monahan Kevin , Lehman Erik B. , Hennrikus William L. 
Published: February 2021

Background:
While supracondylar (SC) fractures are relatively common in children, the incidence of open injuries is believed to be only 1%. Two prior studies on open SC fractures in children reported an increased incidence of vascular injuries. The purposes of our study were to clarify the incidence, associated conditions, and current treatment for open SC fractures.

Methods:
The Pennsylvania Trauma Outcome Study database was queried. Subjects age 25 to 156 months old admitted to trauma centers between January 2000 and December 2015 with a SC fracture were included. Controls were those with closed fractures and the study group, those with open injuries. Study variables were age, sex, weight, injury severity score, length of stay (LOS), nerve injury, ipsilateral forearm fracture, compartment syndrome/fasciotomy, requirement for a vascular procedure. Other variables were mode of treatment, provisional reduction, repeat reduction, time interval between referring facility admission and operation, and time from emergency department admission to operation.

Results:
A total of 4308 subjects were included, 104 (2.4%) of whom had an open SC fracture. LOS was 2 days for the study group versus 1 day for controls (P<0.001). Open SC fractures were more likely than closed to be associated with a nerve injury (13.5% vs. 3.7%), ipsilateral forearm fracture (18.3% vs. 6.4%) and/or a vascular procedure (6.7% vs. 0.3%) (P<0.001). 5.9% of those in the study group required repeat surgery compared with 0.4% for controls (P<0.001). Time from emergency department admission to operation was 3.2 versus 10.3 hours (P<0.001).

Conclusions:
We report the largest series to date of open SC fractures in children. Surgeons caring for such patients should be aware of their increased risks for both associated injuries and potential requirement for vascular reconstruction. The majority of children with an open SC fracture are managed with 1 operation and in the absence of vascular injury, seldom require an extended LOS.

Level of Evidence:
Level III—retrospective cohort study.
Nail Plate Fixation Technique to Optimize Indirect Reduction and Fixation of Proximal Tibia Fractures
Authors: Obey Mitchel R. , Berkes Marschall B. 
Published: February 2021

Purpose:
Treatment of proximal quarter and fifth tibia fractures can be very difficult. Intramedullary nailing is associated with predictable apex anterior angular and translational deformities as well as coronal plane displacement. This can be combated with blocking screws, but they can be difficult to place precisely and perhaps not feasible in cases of metaphyseal comminution. Achieving and maintaining a reduction is relatively easy with plate fixation, particularly with precontoured anatomic plates; however, plate fixation may be suboptimal particularly in unreliable patients. The goal was to describe our technique involving minimally invasive plating of proximal tibia fractures to achieve an indirection reduction followed by intramedullary nailing.

Materials and Methods:
Describe the step-by-step surgical technique for fixation of proximal tibia fractures with a nail plate construct. All patients who underwent this technique for fixation of a proximal tibia fracture at our institution between July 1, 2017, and October 1, 2019 were reviewed to evaluate clinical and radiographic outcomes.

Results:
Six patients (7 tibias) with a mean age of 51.6 years were identified. The mean follow-up was 148 days. At the time of the final follow-up, we observed a union of all fractures without loss of reduction or alignment, and there were no instances of implant failure or complications.

Conclusion:
This technique for fixation of proximal tibia fractures can reliably achieve and maintain alignment and provide optimal fixation in these challenging fractures with good outcomes.
The Role of Metformin in Treating Preeclampsia
Authors: Cheng Decui , Zhou Xuexin , Xu Xianming 
Published: February 2021

Abstract
Preeclampsia (PE) is a principal cause of maternal and newborn mortality that poses financial and physical burdens to tens of thousands of families each year. Unfortunately, there is no effective management to arrest the progression of this disease unless delivery. Therefore, standardized management or preventive treatments are needed urgently. PE is closely associated with placental hypoxia, which increases the secretion of soluble fms-like tyrosine kinase 1 (sFlt-1) as well as soluble endoglin (sEng) into the maternal circulation. Metformin has been found to inhibit those anti-angiogenic factors so it might be a candidate to prevent or treat PE. Women who are diagnosed with gestational diabetes mellitus (GDM) are more likely to have complications of hypertension or PE, so this review aims to demonstrate that the application of metformin in GDM might prevent the onset or progression of PE complicated with GDM.
Syncytiotrophoblast Derived Extracellular Vesicles in Relation to Preeclampsia
Authors: Cooke William R. , Jones Gabriel D. , Redman Christopher W.G. , Vatish Manu 
Published: February 2021

Abstract
The syncytiotrophoblast, a fused single-cell layer between mother and fetus, constitutively releases extracellular vesicles (STBEV) directly into the maternal circulation. STBEV contain a variety of proteins and RNA which can be targeted to specific cells. In preeclampsia, asymptomatic placental oxidative stress is a precursor to later multi-organ dysfunction in the mother. Increased STBEV release in preeclampsia is considered a manifestation of syncytiotrophoblast stress, which may play a key role in signaling between fetus and mother. STBEV release in preeclampsia changes, both in terms of volume and content. In this review, we outline the latest advances in STBEV isolation and detection. We consider evidence for differential STBEV release, protein cargo and RNA content in preeclampsia, highlighting common pitfalls in study design. We summarise studies to date demonstrating STBEV actions on target cells. Ultimately, we consider how STBEV fit into the pathophysiology of the heterogeneous syndrome of preeclampsia. The key unifying concept in early- and late-onset preeclampsia is syncytiotrophoblast stress. We submit that STBEV are the key stress signal in preeclampsia. We believe that further investigation of STBEV release, content, and actions may offer valuable insights into preeclampsia pathophysiology and potential new clinical diagnostics and therapeutic targets.
Untimed Efavirenz Drug Levels After Switching From Brand to Generic Formulations: A Short Communication
Authors: Watson Birgit E. , Atkinson Kieran , Auyeung Kathleen , Baynes Katherine A. , Lepik Katherine J. , Toy Junine , Sereda Paul , Barrios Rolando , Brumme Chanson J. 
Published: February 2021

Background:
In British Columbia, antiretrovirals are distributed at no cost to patients via a publicly funded program, using generic formulations if available. A generic efavirenz-emtricitabine-tenofovir DF (EFV-FTC-TDF) combination pill became available in April 2018. The authors compared EFV untimed drug levels in subjects switching from brand to generic EFV-FTC-TDF.

Methods:
Archived plasma HIV viral load samples were identified for consenting participants who switched from brand to generic EFV-FTC-TDF; 3 preswitch and 2–3 postswitch samples, collected ≥1 month apart were assessed for each subject. “Untimed” EFV concentrations with unknown dosing and collection time were assessed using a validated liquid chromatography–tandem mass spectrometry method. Participants' mean, minimum, and maximum EFV levels were compared using the Wilcoxon signed rank test. Participants with EFV levels in the range associated with lower risks of virologic failure and central nervous system toxicity (1000–4000 ng/mL), preswitch and postswitch, were enumerated.

Results:
EFV levels were assessed in 297 preswitch and 249 postswitch samples from 99 participants, having exposure to brand and generic EFV for a median of 103 (Q1-Q3: 87–116) and 10.3 (Q1-Q3: 8.9–11.7) months, respectively. The final brand sample was collected at a median of 98 days preswitch; the first generic sample was collected at a median of 133 days postswitch. No significant differences were observed in participant mean EFV levels before (median 1968 ng/mL; Q1-Q3: 1534–2878 ng/mL) and after (median 1987 ng/mL; Q1-Q3: 1521–2834 ng/mL) switch (P = 0.85). Eighty participants had mean EFV levels within the 1000–4000 ng/mL range on the brand drug, of which 74 remained within this range postswitch.

Conclusions:
There were no statistically significant differences between untimed EFV levels in patients switching from the brand to generic EFV combination pill. Given the long elimination half-life of EFV, untimed drug levels may be a convenient way to estimate product bioequivalence.
Is it time for prenatal chromosomal-microarray analysis to all women? A review of the diagnostic yield in structurally normal fetuses
Authors: Daum Hagit , Stern Shira , Shkedi-Rafid Shiri 
Published: February 2021

Purpose of review
Chromosomal-microarray analysis (CMA) is the first-tier test in pregnancies with structural malformations. Accumulating data show that pathogenic copy number variants (CNVs) can also be identified in structurally normal fetuses. We set out to summarize the published data on the diagnostic yield of CMA in structurally normal fetuses.

Recent findings
Six studies summarize a total of 29,612 prenatal CMAs performed in structurally normal fetuses. The incidence of highly penetrant pathogenic/likely pathogenic CNVs is 0.4–2.5%. Variability was demonstrated in the timing of CMA testing and type of CNVs classified as pathogenic. The incidence of variants of uncertain significance is 0.4–5.4%. The prevalence of susceptibility loci is 0.3–0.7% when specified, and the incidence of CNVs associated with late onset disease is 0.1%.

Summary
With a frequency of abnormal CNVs of 1:40 to 1:250 in structurally normal fetuses, it is recommended that all pregnant women be informed of the possibility to have CMA performed, even in the absence of malformations. Information should also be provided about uncertain and secondary findings.
A Clinician’s Guide to Polycultural Psychiatry
Authors: Yager Joel 
Published: February 2021

Abstract
Patients and families each present unique microcultures, mixing and blending numerous broadly conceptualized cultural identity groups. Within individuals and families, cultural identities are experienced and enacted as complex matrices of intersecting identities that, to varying degrees, complement, assimilate, accommodate, or clash. In these patterns, individuals’ relationships to cultures are not necessarily categorically distinct (“multicultural”). Instead, they are often “polycultural,” defined as partial and plural; rather than interpreting different cultural traditions as separate and independent, they are, within the lives of individuals and families, better understood as systems that interact with and influence one another.
Cultural identity groups extend beyond those traditionally considered by transcultural psychiatry—that is, beyond ethnic, racial, and language groups. They encompass (in alphabetical order) educational, ethnic, extended family, gender-oriented, generational, geographic, language and dialect, organizational, physical or psychiatric disability, political, professional, racial, religious, sect, social class, and vocational identity groups, among others. Simplistic assumptions and generalities about identity groups risk cultural stereotyping that may negatively bias clinical assessments. Therefore, practitioners striving for cultural sensitivity need to adopt nuanced strategies for approaching broad polycultural identity questions in clinical practice. Accordingly, this article suggests frameworks and strategies for (1) assessing and confronting one’s own cultural preconceptions and prejudices, and (2) developing etic (objective quantitative data) and emic (insiders’ experiential worldviews) perspectives pertinent to clinical anthropathology. Both etic and emic perspectives are necessary for polyculturally nuanced, respectful, comprehensive inquiries pertinent to patients’ and family’s health beliefs, psychiatric difficulties, and health practices. Supplementary material from the DSM-5 section on cultural formulation is adapted and discussed, along with the implications of polycultural psychiatry for education and training in psychiatry.
A Close Look at the Clinical Efficacy of Rho-Associated Protein Kinase Inhibitor Eye Drops for Fuchs Endothelial Corneal Dystrophy
Authors: Kinoshita Shigeru , Colby Kathryn A. , Kruse Friedrich E. 
Published: February 2021

Abstract:
The current understanding on the clinical efficacy of Rho-associated protein kinase (ROCK) inhibitor for treating Fuchs endothelial corneal dystrophy is summarized to clarify whether the “off-label” ROCK-inhibitor eye-drop application are appropriate. ROCK-inhibitor eye drops may eventually be deemed a cutting-edge therapy for Fuchs endothelial corneal dystrophy patients with acute corneal endothelial defect.
Penetrating Keratoplasty in Infants With Peters Anomaly: Visual and Graft Outcomes
Authors: Lin Qi , Li Li , Sun Yajie , Miao Sen , Li Xu , Shi Wei , Pan Zhiqiang 
Published: February 2021

Purpose:
To determine the prevalence of survival of corneal grafts and visual outcomes of primary penetrating keratoplasty (PK) in infants with Peters anomaly (PA) in Beijing, China.

Methods:
Twenty-nine patients (37 eyes) with PA who underwent PK before the age of 1 year were included. Optical correction for all eyes and occlusion therapy of amblyopia for a unilateral opacity were performed 2 weeks after suture removal. All infants underwent assessment of visual acuity after surgery using Teller Acuity Cards. Survival probabilities were estimated using the Kaplan–Meier method and log-rank test. Visual outcomes and prognosis factors were analyzed using the χ2 test.

Results:
The mean age of 29 infants undergoing primary PK was 5.7 ± 2.3 months. The mean follow-up duration was 18.0 ± 3.0 months. Twenty-seven (73.0%) of 37 grafts retained full clarity at final follow-up. Visual acuity above ambulatory was achieved in 67.6% (25/37) and >20/260 was achieved in 48.6% (18/37) of cases. Of all surgical indications, vascularized PA I (50.0%, 6/12) and PA II (18.2%, 2/11) showed a lower proportion achieving visual acuity >20/260 than nonvascularized PA I (71.4%, 10/14) (P = 0.030 < 0.05). There was no significant difference in the prevalence of graft survival and vision outcome between infants younger than 6 months and older than >6 months.

Conclusions:
For infants with PA who underwent PK, the prevalence of graft survival and visual acuity were related mainly to the indication. The main risk factors were corneal vascularization and an abnormal lens.
Ocular Pain Symptoms in Individuals With and Without a History of Refractive Surgery: Results From a Cross-Sectional Survey
Authors: Baksh Brandon S. , Morkin Melina , Felix Elizabeth , Karp Carol L. , Galor Anat 
Published: February 2021

Purpose:
This study characterized ocular pain symptoms in individuals with and without a history of refractive surgery (RS) using a cross-sectional survey of individuals with ocular pain.

Methods:
A link to an anonymous survey was posted on a corneal neuralgia Facebook group that included individuals with ocular pain from any etiology and sent to individuals seen in our clinic with ocular pain. The survey asked about medical history, ocular pain symptoms (using standardized questionnaires), and treatment responses. Respondents were split into 2 groups based on a history of RS.

Results:
One hundred one individuals responded to the survey. The mean age for all respondents was 41.6 ± 15.6 years, and 50% reported a history of RS. A total of 46% of individuals with a history of RS reported that their ocular pain started within 1 month of surgery, with median pain duration of 36 (interquartile range 22–84) months. The median Dry Eye Questionnaire-5 (range 0–22) scores were 16 and 15 for the RS and no-RS groups, respectively. Most individuals in both groups characterized their pain as burning (score ≥1: RS, 86%; no-RS, 80%) and reported evoked pain to wind, light, or temperature (score ≥1: RS, 97%; no-RS, 85%). Fifty-nine of 101 individuals responded to treatment questions. Individuals in both groups reported >30% improvement in pain symptoms with some topical and systemic approaches.

Conclusions:
Individuals with a history of RS developed ocular pain soon after surgery, which persisted for years. Symptom profiles were similar between those with and without RS. Topical and systemic approaches can treat pain in both groups.
Cutaneous Radiation-Associated Angiosarcoma After Cervical Cancer Treatment: A Case Report
Authors: Xu Cong-Cong , Zhang Wei , Chen Hao 
Published: February 2021

Abstract

Introduction:
Cutaneous radiation-associated (cRAA) angiosarcoma is a rare malignant neoplasm derived from vascular endothelial cells, but a relatively commonly recognized complication of radiation therapy.
Here, we present a patient with cRAA, who undergone radiochemotherapy for cervical cancer 11 years ago.

Case presentation:
A 48-year-old woman presented with a 6-month history of painless purple skin plaques and nodules on her lower abdomen and right thigh. The patient had undergone radiochemotherapy for cervical cancer 11 years ago. A skin biopsy showed a diffuse proliferation of irregular anastomosing dilated vascular structures with atypical endothelial cells. She was diagnosed as cRAA according to clinical and histological manifestations.

Discussion:
cRAA is a rare malignant neoplasm but it is a complication of radiation therapy. The incidence of cRAA has increased in recent years. Clinical and pathological manifestations are highly varied. Radical resection is the preferred treatment.

Conclusion:
Patients with suspicious violaceous lesions should undergo biopsy. Clinical suspicion and pathological examination are of the utmost importance for cRAA.
Agriculture Exposure and Time to Pregnancy Among Women Enrolled in the French Prospective Cohort AGRICAN
Authors: Pons Romain , Boulanger Mathilde , Tual Séverine , Busson Amandine , Renier Marine , Perrier Stéphanie , Levêque-Morlais Noémie , Marcotullio Elisabeth , Baldi Isabelle , Lebailly Pierre 
Published: February 2021

Objectives:
In few retrospective studies, prolonged time-to-pregnancy (TTP) was observed for women exposed to pesticides especially in flower production. The present study investigated time-to-pregnancy in the AGRICAN cohort.

Methods:
Analyses were performed on 616 women reporting a pregnancy (2005 to 2017), and data on agricultural activities performed before the last pregnancy was retrospectively collected. Fecundability odds ratios (fOR) were estimated using a discrete time analogue of Cox proportional hazard model adjusted on maternal and paternal age, body mass index (BMI), and alcohol consumption.

Results:
A decrease in fecundability was non-significantly associated with farm work (adjusted fOR = 0.86; 95% confidence interval [CI]: 0.71 to 1.05). Decreases were also observed for nightwork (afOR = 0.75; 95% CI: 0.49 to 1.15) and exposure to vibrations (afOR = 0.68; 95% CI: 0.43 to 1.09).

Conclusion:
Women working on a farm before conception appeared to experience a longer TTP. Negative associations were suggested for some agricultural activities and working conditions.
Use of Vinegar and Water to Identify COVID-19 Cases During a Workplace Entrance Screening Protocol
Authors: Kalia Nimisha , Moraga Jessica Aguilar , Manzanares Max , Friede Vanessa , Kusti Mohannad , Bernacki Edward J. , Tao Xuguang (Grant) 
Published: February 2021

Objective:
To evaluate an empirical olfactory test to identify COVID-19 cases during a workplace entrance screening.

Method:
An active screening for olfactory dysfunction using water and vinegar was conducted in April to June 2020 among 4120 meat packing workers in Latin America.

Results:
The sensitivity and specificity of the active olfactory screening examination were 41.2% and 85.3%, respectively, using reverse transcription polymerase chain reaction (RT-PCR) tests as a gold standard. 10.6% of employees who tested positive for COVID-19 had an olfactory dysfunction as their only symptom. These individuals would not have been identified with standard workplace screening measures including temperature screening.

Conclusion:
Active screening for olfactory dysfunction may serve as a valuable tool to both identify potential COVID-19 infections and exclude those who do not have infection and should be a part of parallel algorithm combined with standard workplace entrance screening procedures.