bluuebunny/crossref_metadata_2025_split huggingface dataset:
Posterior Tibial Slope is Increased in Patients With Tibial Tubercle Fractures and Osgood-Schlatter Disease
Authors: Sheppard Evan Drew , Ramamurti Pradip , Stake Seth , Stadecker Monica , Rana Md Sohel , Oetgen Matthew E. , Young Megan L. , Martin Benjamin D. 
Published: March 2021

Background:
Osgood-Schlatter disease (OSD) and tibial tubercle fractures are pathologies that affect the tibial tubercle apophysis in preadolescents and adolescents. Anatomic alignment of the proximal tibia may explain why some children develop OSD or sustain tibial tubercle fractures and some do not. Recent data has shown an association between posterior tibial slope angle (PTSA) and both OSD and proximal tibia physeal fractures. In this study, we compare radiographic parameters between patients with non-OSD knee pain, knees with OSD, and knees with tibial tubercle fracture to elucidate a difference between these groups.

Methods:
Patients treated for OSD, tibial tubercle fractures, and knee pain, from 2012 to 2018, were retrospectively reviewed. Radiographic parameters for each study group included PTSA, anatomic lateral distal femoral angle, anatomic medial proximal tibial angle, patellar articular height, and the distance from the inferior aspect of the patellar articular surface. Caton-Deschamps index was then calculated. Demographic data was collected including age, sex, and body mass index. Demographic and radiographic data was compared using analysis of variance tests, χ2 tests, 2-sample t tests, and multiple linear regression.

Results:
Two hundred fifty-one knees in 229 patients met inclusion criteria for the study. In all, 76% were male and the average age of the overall cohort was 14 years old. In patients with tibial tubercle fractures, the majority of fractures were Ogden type 3b (65%). After controlling for demographic variability, average PTSA in the fracture cohort was significantly greater than that in the control cohort (β=3.49, P<0.001). The OSD cohort had a significantly greater posterior slope (β=3.14) than the control cohort (P<0.001). There was no statistically significant difference between the fracture and OSD cohorts. There was also no difference in Caton-Deschamps index between the 2 study groups when compared with the control group.

Conclusion:
This study demonstrates that patients with tibial tubercle fractures and patients with OSD have an increased PTSA when compared with the control group. This information adds to the body of evidence that increased tibial slope places the proximal tibial physis under abnormal stress which may contribute to the development of pathologic conditions of proximal tibia such as OSD and tibial tubercle fractures.

Level of Evidence:
Level III; retrospective comparative study.
Recent data on adipose tissue, insulin resistance, diabetes and dyslipidaemia in antiretroviral therapy controlled HIV-infected persons
Authors: Capeau Jacqueline , Lagathu Claire , Béréziat Véronique , Fève Bruno 
Published: March 2021

Purpose of review
Increased total body fat with truncal redistribution is common in antiretroviral therapy (ART)-controlled persons living with HIV(PLWH), leading to insulin resistance, prediabetes/diabetes and dyslipidaemia. We address these topics here.

Recent findings
Most antiretrovirals are associated with gain in trunk fat, including visceral adipose tissue (VAT). Protease-inhibitors could inhibit white fat ability to dissipate energy (i.e. beiging) favouring fat gain. Expansion of VAT is associated with a pro-inflammatory profile linked to the tryptophan-kynurenine pathway and CD4+ subtypes. ART-associated increased adipose tissue (AT) quantity leads to decreased AT density, insulin resistance and dyslipidaemia that could be improved by lifestyle modifications.
PLWH present high level of insulin resistance, regardless of their treatment, and a higher prevalence of prediabetes, but not diabetes, than noninfected persons. Otherwise, HbA1c values appear inaccurate to diagnose prediabetes/diabetes in PLWH.
ART-related-dyslipidaemia is characterized by elevated LDL-C and/or high triglycerides and reduced HDL-C. Whereas treatment with protease inhibitors generally results in worsened lipid values, treatment with integrase-strand-transfer-inhibitors is associated with a better profile. Tenofovir-alafenamide is associated with higher lipid levels than tenofovir-disoproxil-fumarate. Treatment of LDL-C-dyslipidaemia could benefit, in statin-insufficiently controlled patients, from the class of proprotein-convertase-subtilsin-kenin-type-9 (PCSK-9) inhibitors.

Summary
Lifestyle modifications are mandatory to reduce fat and improve dysglycaemia/dyslipidaemia. New drugs can efficiently control diabetes and LDL-C-dyslipidaemia.
Resumed ovarian function and pregnancy in early menopausal women by whole dimension subcortical ovarian administration of platelet-rich plasma and gonadotropins
Authors: Hsu Chao Chin , Hsu Isabel , Hsu Leonard , Chiu Yi Jen , Dorjee Sonam 
Published: March 2021

Abstract

Objective:
This study was designed to investigate if whole dimension subcortical ovarian administration of platelet-rich plasma with gonadotropin, in proximity to most ovarian follicles, is effective in restoring ovarian functions in women during early menopause.

Methods:
Platelet-rich plasma, prepared from 40 mL of autologous peripheral blood using the buffy coat method, was injected into extended subcortical area of bilateral ovaries along with recombinant follicle-stimulating hormone (rFSH) (Gonal-F 300IU) under laparoscopic guidance. The posttreatment ovarian folliculogenesis and serum levels of FSH, luteinizing hormone (LH), and estradiol were followed up for 6 months at weekly to monthly intervals. IVF was carried out in women resuming ovulatory functions.

Results:
Twelve early menopausal women with mean age of 44.42 ± 2.84 were enrolled. After treatment, 11 women resumed their menstrual period in 37.1 ± 23.5 days. Their average serum FSH was 70.47 ± 20.92 and 26.22 ± 17.55 IU/L, luteinizing hormone was 34.81 ± 11.86 and 14.3 ± 12.8 IU/L, before and after treatment, respectively. The mid-cycle E2 was 251.1 ± 143.8 pg/mL. Ten oocyte retrievals were carried out among six participants, four of them received controlled ovarian stimulation and another two using natural ovulation cycles. Thirteen mature eggs were retrieved which were then ICSI fertilized to obtain 10 normally fertilized 2PN oocytes. Two participants had cleavage stage embryos transferred of which one achieved clinical pregnancy.

Conclusions:
Whole dimension subcortical ovarian administration of platelet-rich plasma with gonadotropin was shown to restore ovarian functions, at least temporarily, and could increase the probability of pregnancy using autologous oocytes in women with early menopause.
Wide-awake Local Anesthesia with No Tourniquet: An Updated Review
Authors: Kurtzman Joey S. , Etcheson Jennifer I. , Koehler Steven M. 
Published: March 2021

Background:
The wide-awake local anesthesia with no tourniquet (WALANT) technique has become popularized for various hand/upper extremity procedures. Before surgery, patients receive local anesthetic, consisting of lidocaine with epinephrine, and remain awake for the entire procedure. The purpose of this review was to investigate the advantages, diverse application, outcomes, cost benefits, use in challenging environments, patient considerations, and contraindications associated with WALANT.

Methods:
A comprehensive review of the literature on the WALANT technique was conducted. Search terms included: WALANT, wide-awake surgery, no tourniquet, local anesthesia, hand, wrist, cost, and safety.

Results:
The WALANT technique has proven to be successful for common procedures such as flexor tendon repair, tendon transfer, trigger finger releases, Depuytren disease, and simple bony procedures. Recently, the use of WALANT has expanded to more extensive soft-tissue repair, fracture management, and bony manipulation. Advantages include negating preoperative evaluation and testing for anesthesia clearance, eliminating risk of monitored anesthesia care, removal of anesthesia providers and ancillary staff, significant cost savings, and less waste produced. Intraoperative evaluations can be performed through active patient participation, and postoperative recovery and monitoring time are reduced. WALANT is associated with high patient satisfaction rates and low infection rates.

Conclusions:
The WALANT technique has proven to be valuable to both patients and providers, optimizing patient satisfaction and providing substantial healthcare savings. As its application continues to grow, current literature suggests positive outcomes.
The Farnesoid X Receptor Agonist Tropifexor Prevents Liver Damage in Parenteral Nutrition‐fed Neonatal Piglets
Authors: Liu Yang , Xiao Yongtao , Chen Shanshan , Tian Xinbei , Wang Weipeng , Wang Ying , Cai Wei 
Published: March 2021

ABSTRACTObjectives:Intestinal failure‐associated liver disease (IFALD) is a life‐threatening complication for patients with intestinal failure who receive long‐term parenteral nutrition (PN). We evaluated the effects of the farnesoid X receptor agonist tropifexor on a neonatal piglet model of IFALD fed with PN.Methods:The piglets received PN and tropifexor for 14 days, then levels of liver enzymes, bile acid metabolism, inflammation, and intestinal barrier markers were assessed using quantitative real‐time PCR. Fibroblast growth factor (FGF) 19 serum levels were determined using enzyme‐linked immunosorbent assays. Bile acids were determined in liver, serum, and intestinal contents, and the microbiome was sequenced in different intestinal segments.Results:The PN model was established in newborn piglets. The levels of serum liver enzymes, pro‐inflammatory factors, and oxidative stress increased in the livers of piglets fed with PN, but not in those fed with PN and tropifexor. Tropifexor stimulated FGF19 expression in ileal epithelial cells, increased portal FGF19 levels, then inhibited cholesterol 7α‐hydroxylase expression in the liver. Tropifexor increased the relative abundance of bacteria associated with bile salt hydrolase and 7α‐dehydrogenation in the contents of ileum and altered the composition of bile acids in serum, liver, and intestinal contents. Tropifexor also inhibited intestinal inflammation, alleviated intestinal mucosal atrophy, and improved the intestinal barrier.Conclusions:Tropifexor might prevent liver damage in neonatal piglets receiving PN by altering the composition of intestinal microbiota and bile acids. Tropifexor also alleviates intestinal inflammation and preserves the intestinal barrier.
Health Literacy, Health Confidence, and Simulation
Authors: Morley Colleen M. , Levin Scott A. 
Published: March 2021

Purpose/Objectives:
The vision for this project was to create an inpatient education intervention to better prepare patients with chronic medical conditions for more effective self-management after discharge using a Skills Simulation Experience and focused one-on-one structured education format in a circuit-based intervention. As an interdisciplinary intervention, the health care team presents standardized education in a circuit training presentation to allow for one-on-one interaction with health care professionals, using multiple teaching/learning strategies, to assist the participant in acquiring or reinforcing skills needed to successfully self-manage his or her conditions postdischarge.

Primary Practice Setting(s):
West Suburban Medical Center (WSMC) is owned by Pipeline Health and is located on the west side of Chicago, IL. WSMC is a 118-year-old community-based teaching facility that has collaboration with a local Federally Qualified Health Center, providing clinic space on-site as well as clinical rotations for OB/GYN. WSMC serves 2 very diverse neighborhoods, Oak Park, IL, home of Frank Lloyd Wright and Ernest Hemingway, and the Austin neighborhood of Chicago, which ranks 11th out of the 77 Chicago communities in violent crime.

Findings/Conclusions:
Data collected included the following:

Implications for Case Management Practice:
Safety-Net Accountable Health Model Partnership Drives Inpatient Connection to Outpatient Social Services, Reducing Readmissions in a Population Experiencing Homelessness
Authors: Rhodes Heather Marie , Simon Heather Lynn , Hume Hillary G. , Strief Dawn , Knutson Alex , Webber Michael C. , Robertshaw Danielle Christine 
Published: March 2021

Purpose of Study:
To evaluate whether screening for homelessness during hospitalization and deploying outpatient care managers (CMs) to the inpatient setting to rapidly connect patients to community social services reduce hospital readmissions.

Primary Practice Setting:
A large safety-net hospital in Minnesota.

Methodology and Sample:
A quality improvement pilot proactively engaged hospitalized adults experiencing homelessness and enrolled in the Hennepin Health Accountable Health Model (HH AHM). Patients were screened for homelessness using a novel housing indicator tool, and eligible patients were visited in the hospital by HH AHM community CMs. If patients chose to pursue offered services, they were added to the CM's caseload with whom they met while hospitalized. Outcomes were compared between those patients who engaged in community case management initiated in the hospital (intervention group) and those who declined services or were discharged prior to an inpatient CM visit (control group). Chi-square, Fisher's exact, independent-samples t test, and Mann–Whitney U tests were conducted, as appropriate.

Results:
Seventy-two patients were included in the intervention group and 61 patients were included in the control group. Both groups were primarily English-speaking, African/African American and Native American men in their early to mid-40s. In total, 5.6% and 18% of intervention and control patients were readmitted to the hospital within 30 days. Of note, claims data confirmed that no readmissions occurred at outside hospitals in the first 9 months of the program. Twelve (16.7%) intervention patients were housed over the course of the study period, 5 occurring in the first 6 weeks.

Implications for Case Management Practice:
The Social Determinants of Mental Health
Authors: Fink-Samnick Ellen 
Published: March 2021

Purpose:
The social determinants of health are a well-established health care industry priority. Robust data associated with psychosocial circumstances for populations validate poor health outcomes. However, another domain begs for inclusion and industry attention. A mental health chasm has emerged amid a post-COVID-19 landscape fraught with escalating health disparities, morbidity, and mortality. Themes of trauma, diversity, equity, and inclusion are major organizational imperatives. As a result, an expanded focus on the social determinants of mental health (SDoMH) mandates dedicated perspective. Part 1, of this 2 article series, on the SDoMH will provide distinct understanding of relevant industry terminology, historical drivers, and macro factors that influence mental health, along with health disparities. In addition, this article will set the foundation to advance the industry's quality compass, the Triple/Quadruple Aim.

Learning Outcomes:

After reading this article, learners will be able to:
define the social determinants of mental health (SDoMH);distinguish them from the social determinants of health (SDoH);explore foundational concepts related to the SDoMH;understand upstream drivers of the SDoMH; andpresent evidence that validates attention to the wholistic health triad.

Finding/Conclusion:
Access to quality wholistic health care encompasses pathophysiology, psychopathology, and psychosocial circumstances, and is a considerable challenge across populations. Mental health, along with health disparities, has been fueled by enduring systematic racism that has facilitated inadequate funding, poor reimbursement, decreased treatment options, and pervasive stigma across diverse patient populations (e.g., race, ethnicity, gender, sexual orientation, familial status, disability, socioeconomic status). These SDoMH mandate a critical fresh lens by case management to ensure the most proactive and comprehensive approach to care. To achieve the successful outcomes mandated by this approach, the industry's quality compass, the Triple/Quadruple Aim must be expanded to include a Quintile Aim of wholistic health equity.

Implications for Case Management Practice:
Case management's unique transdisciplinary composition has the workforce well positioned to effect grand change in population health perspectives. Wider attention to clinical and fiscal outcomes for health and mental health inequities mandates innovative approaches to patient care, which encompass a wholistic health triad of pathophysiology, psychopathology, and psychosocial circumstances.
Two Symptoms to Triage Acute Concussions
Authors: Robinson Michael , Johnson Andrew M. , Fischer Lisa K. , MacKenzie Heather M. 
Published: March 2021

ObjectiveThe objective was to examine the 22 variables from the Sport Concussion Assessment Tool’s 5th Edition Symptom Evaluation using a decision tree analysis to identify those most likely to predict prolonged recovery after a sport-related concussion.DesignA cross-sectional design was used in this study. A total of 273 patients (52% men; mean age, 21 ± 7.6 yrs) initially assessed by either an emergency medicine or sport medicine physician within 14 days of concussion (mean, 6 ± 4 days) were included. The 22 symptoms from the Sport Concussion Assessment Tool’s 5th Edition were included in a decision tree analysis performed using RStudio and the R package rpart. The decision tree was generated using a complexity parameter of 0.045, post hoc pruning was conducted with rpart, and the package carat was used to assess the final decision tree’s accuracy, sensitivity and specificity.ResultsOf the 22 variables, only 2 contributed toward the predictive splits: Feeling like “in a fog” and Sadness. The confusion matrix yielded a statistically significant accuracy of 0.7636 (P[accuracy > no information rate] = 0.00009678), sensitivity of 0.6429, specificity of 0.8889, positive predictive value of 0.8571, and negative predictive value of 0.7059.ConclusionsDecision tree analysis yielded a statistically significant decision tree model that can be used clinically to identify patients at initial presentation who are at a higher risk of having prolonged symptoms lasting 28 days or more postconcussion.
Feasibility and Therapeutic Potential of Peptide Receptor Radionuclide Therapy for High-Grade Gliomas
Authors: Nemati Reza , Shooli Hossein , Rekabpour Seyed Javad , Ahmadzadehfar Hojjat , Jafari Esmail , Ravanbod Mohammad Reza , Amini AbdolLatif , Nemati Ali , Ghasemi Mohammad , Keshmiri Saeid , Dadgar Habibollah , Assadi Majid 
Published: March 2021

Purpose
This pilot study tested the principle that 177Lu-DOTATATE may be applied to patients with high-grade gliomas (HGGs) that are either inoperable or refractory to the standard conventional treatments and also assessed whether this approach could be a viable therapeutic plan in this dilemma.

Methods
In this prospective study, 16 subjects experiencing HGGs that were either inoperable or refractory to the standard conventional treatments were included. All the patients checked for somatostatin receptor expression on the tumors. The patients were treated with 1 to 4 cycles of IV 177Lu-DOTATATE. The primary end point was radiological response after peptide receptor radionuclide therapy, and the secondary end point was improved quality of life using Karnofsky Performance Score and Eastern Cooperative Oncology Group score.

Results
In total, 16 subjects (10 males and 6 females) with a mean age of 55.68 ± 13.17 years (26–73 years) participated in the study. Of them, 8 patients were new HGG cases, and 8 patients had recurrent tumors. The participants’ responses to treatments were complete remission in 12.5% of (n = 2), partial remission in 31.25% (n = 5), disease stability in 18.7% (n = 3), and disease progression in 37.5% (n = 6). In total, pretreatment and posttreatment Karnofsky Performance Score and Eastern Cooperative Oncology Group scores did not improved (P > 0.05). The patients were followed up from 1 month to 26 months (median, 3 months).

Conclusions
This preliminary result suggests that peptide receptor radionuclide therapy using 177Lu-DOTATATE may be associated with positive effects in patients with HGGs (grade III–IV). However, this approach should be evaluated in a more homogeneous group of patients with more favorable performance status.
Inflammatory Arthritis Induced by Anti-Programmed Death-1 Shown in 68Ga-FAPI PET/CT in a Patient With Esophageal Carcinoma
Authors: Luo Yaping , Pan Qingqing , Yang Huaxia , Li Fang , Zhang Fengchun 
Published: March 2021

Abstract
A 30-year-old woman with esophageal squamous cell carcinoma experienced joint pain and swelling in bilateral knees, wrists, and hand joints during the course of neoadjuvant immunochemotherapy. She underwent 18F-FDG and 68Ga-FAPI PET/CT for response assessment of the tumor and evaluating her arthritis. 68Ga-FAPI PET/CT detected intense uptake in multiple joints, consistent with her polyarthritis. However, these joints showed only mild FDG uptake. The tumor was in complete response, and her polyarthritis was considered as inflammatory arthritis induced by anti-PD1.
A biomimetic shock model on the effect of endothelial aging on vascular barrier properties
Authors: Carge Michael J. , Liberati David M. , Diebel Lawrence N. 
Published: March 2021

BACKGROUND
Aging is characterized by a decline in cellular function, which has an adverse effect on the biologic response to injury. Both aging and trauma/hemorrhagic shock (T/HS) increase oxidative stress which impairs the vascular endothelium (EC) and glycocalyx (EG). The additive effect of aging on EC and EG damage following T/HS are unknown. This was studied in an in vitro model.

METHODS
Confluent endothelial cell monolayers from primary aortic endothelial cells from 10-week-old mice (“young” cells) or primary aortic cells from 65-week-old mice (“aged” cells) were established in microfluidic devices (MFDs) and perfused at constant shear conditions overnight. Mouse endothelial cell monolayers were then exposed to hypoxia/reoxygenation alone and/or epinephrine or norepinephrine. Endothelial glycocalyx degradation was indexed as well as subsequent endothelial injury/activation.

RESULTS
Aged endothelial cells showed increase glycocalyx shedding and subsequent loss of glycocalyx thickness. This lead to a more pronounced level of EC injury/activation compared with young endothelial cells. Although exposure to biomimetic shock conditions exacerbated both endothelial glycocalyx shedding and endothelial injury in both aged and young endothelial cells, the effect was significantly more pronounced in aged cells.

CONCLUSION
Advanced age is associated with worse outcomes in severely injured trauma patients. Our study demonstrates that there is increased EG shedding and a diminished EG layer in aged compared to “young” endothelial cell layers. Biomimetic shock conditions lead to an even greater impairment of the endothelial glycocalyx in aged versus young endothelial cell monolayers. It appears that these effects are a consequence of aging related oxidative stress at both baseline and shock conditions. This exacerbates shock-induced endotheliopathy and may contribute to untoward effects on patient outcomes in this population.