bluuebunny/crossref_metadata_2025_split huggingface dataset:
Early and Late Outcomes of Cardiovascular Surgery in Patients With Ehlers-Danlos Syndrome
Authors: Elsisy Mohamed F. , Pochettino Alberto , Dearani Joseph A. , Bower Thomas C. , McBane Robert D. , Graham Gabriel C. , Deyle David R. , Bonnichsen Crystal R. , Stephens Elizabeth H. 
Published: November 2021

Background Cardiovascular surgical outcomes reports are few for vascular type IV of Ehlers- Danlos Syndrome (vEDS) compared to non-vascular types I-III (nEDS). Methods To define cardiovascular surgical outcomes among adult patients (≥18 years) with EDS types, a review of our institution's in-house STS Adult Cardiac Surgery Database-compliant software and electronic medical records from Mayo Clinic (1993–2019) was performed. Outcomes were compared for vEDS patients and nEDS patients. Demographics, baseline characteristics, operative, in-hospital complications and follow-up vital status were analyzed. Results Over the study time frame, 48 EDS patients underwent surgery (mean age 52.6 ± 14.6 years; 48% females). Of these, 17 patients had vEDS and 31 patients had nEDS. Six patients (12.5%) underwent prior sternotomy. Urgent or emergent surgery was performed in 10 patients (20.8%). Aortic (vEDS 76.5% vs. nEDS 16.1%) and mitral procedures (vEDS 11.8% vs. nEDS 48.4%) were the two most common cardiovascular surgeries performed (p < .01 and p = .007, respectively). Cardiopulmonary bypass time (CPB) (165 ± 18 vs. 90 ± 13 min; p = .015) and aortic cross clamp times (140 ± 14 vs. 62 ± 10 min; p < .001) were longer for vEDS patients. There was 1 (2.1%) early and 7 (14.6%) late deaths; 6 among vEDS and 2 among nEDS patients. Survival at 5 (80% vs. 93%), 10 (45% vs. 84%) and 15 years (45% vs. 84%) was lower in patients with vEDS (p = .015 for each comparison). Conclusion Cardiovascular surgeries are significantly more complex with longer bypass and cross clamp times for type IV vEDS compared to nEDS patients. Reduced overall survival underscores the complexity and fragility of vEDS patients.
Comparison of 2 Fasciotomes for Treatment of Patients With Chronic Exertional Compartment Syndrome of the Anterior Leg
Authors: de Bruijn Johan A. , van Zantvoort Aniek P.M. , Hundscheid Henricus P.H. , Hoogeveen Adwin R. , van Eerten Percy , Teijink Joep A.W. , Scheltinga Marc R. 
Published: November 2021

Background: Chronic exertional compartment syndrome (CECS) of the anterior leg compartment (ant-CECS) is frequently treated with a minimally invasive fasciotomy. Several operative techniques and operative devices exist, but none have been compared in a systematic and randomized manner. Purpose: To compare efficacy, safety, and postoperative pain of a novel operative device (FascioMax fasciotome) with a widely accepted device created by Due and Nordstrand (Due fasciotome) during a minimally invasive fasciotomy for ant-CECS. Study Design: Randomized controlled trial; Level of evidence, 2. Methods: Patients with bilateral isolated ant-CECS between October 2013 and April 2018 underwent a minimally invasive fasciotomy using the FascioMax fasciotome in 1 leg and the Due fasciotome in the contralateral leg in a single operative session. Symptom reduction at 3 to 6 months and >1 year, postoperative pain within the first 2 weeks, peri- and postoperative complications, and ability to regain sports were assessed using diaries, physical examination, and timed questionnaires. Results: Included in the study were 50 patients (66% female; median age, 22 years [range, 18-65 years]). No differences between the devices were found in terms of perioperative complications (both had none), minor postoperative complications including hematoma and superficial wound infection (overall complication rate: FascioMax, 8% vs Due, 6%), or reduction of CECS-associated symptoms at rest and during exercise. At long-term follow-up (>1 year), 82% of the patients were able to regain their desired type of sport, and 67% (33/49) were able to exercise at a level that was comparable with or higher than before their CECS-associated symptoms started. Conclusion: Both the FascioMax and the Due performed similarly in terms of efficacy, safety, and levels of pain within the first 2 weeks postoperatively. Registration: NL4274; Netherlands Trial Register.
Evidence-Based Management and Factors Associated With Return to Play After Acute Hamstring Injury in Athletes: A Systematic Review
Authors: Rudisill Samuel S. , Kucharik Michael P. , Varady Nathan H. , Martin Scott D. 
Published: November 2021

Background: Considering the lengthy recovery and high recurrence risk after a hamstring injury, effective rehabilitation and accurate prognosis are fundamental to timely and safe return to play (RTP) for athletes. Purpose: To analyze methods of rehabilitation for acute proximal and muscular hamstring injuries and summarize prognostic factors associated with RTP. Study Design: Systematic review; Level of evidence, 4. Methods: In August 2020, MEDLINE, CINAHL, Cochrane Central Register of Controlled Trials, and SPORTDiscus were queried for studies examining management and factors affecting RTP after acute hamstring injury. Included were randomized controlled trials, cohort studies, case-control studies, and case series appraising treatment effects on RTP, reinjury rate, strength, flexibility, hamstrings-to-quadriceps ratio, or functional assessment, as well as studies associating clinical and magnetic resonance imaging factors with RTP. Risk of bias was assessed using the Cochrane Risk-of-Bias Tool for Randomized Trials or the Methodological Index for Non-Randomized Studies (MINORS). Results: Of 1289 identified articles, 75 were included. The comparative and noncomparative studies earned MINORS scores of 18.8 ± 1.3 and 11.4 ± 3.4, respectively, and 12 of the 17 randomized controlled trials exhibited low risk of bias. Collectively, studies of muscular injury included younger patients and a greater proportion of male athletes compared with studies of proximal injury. Surgery for proximal hamstring ruptures achieved superior outcomes to nonoperative treatment, whereas physiotherapy incorporating eccentric training, progressive agility, and trunk stabilization restored function and hastened RTP after muscular injuries. Platelet-rich plasma injection for muscular injury yielded inconsistent results. The following initial clinical findings were associated with delayed RTP: greater passive knee extension of the uninjured leg, greater knee extension peak torque angle, biceps femoris injury, greater pain at injury and initial examination, “popping” sound, bruising, and pain on resisted knee flexion. Imaging factors associated with delayed RTP included magnetic resonance imaging-positive injury, longer lesion relative to patient height, greater muscle/tendon involvement, complete central tendon or myotendinous junction rupture, and greater number of muscles injured. Conclusion: Surgery enabled earlier RTP and improved strength and flexibility for proximal hamstring injuries, while muscular injuries were effectively managed nonoperatively. Rehabilitation and athlete expectations may be managed by considering several suitable prognostic factors derived from initial clinical and imaging examination.
Midterm Outcomes, Complications, and Return to Sports After Medial Collateral Ligament and Posterior Oblique Ligament Reconstruction for Medial Knee Instability: A Systematic Review
Authors: D’Ambrosi Riccardo , Corona Katia , Guerra Germano , Cerciello Simone , Ursino Nicola , Cavaignac Etienne , Vieira Thais D. , Sonnery-Cottet Bertrand 
Published: November 2021

Background: In cases of multiple ligaments or medial collateral ligament (MCL) reconstruction, restoring the native anatomy of the posterior oblique ligament (POL) to address chronic valgus instability has been attracting increased attention. Purpose: To review the current literature on postoperative outcomes, complications, and return to sports after superficial MCL-POL (sMCL-POL) reconstruction to restore medial knee integrity. Study Design: Systematic review; Level of evidence, 4. Methods: A systematic review was conducted based on the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Two independent reviewers searched the PubMed, Scopus, Embase, and Cochrane Library databases using the terms “posterior oblique ligament,” “posteromedial corner of the knee,” and “reconstruction.” Included were studies that reported postoperative clinical and functional outcomes in patients who had undergone a combined sMCL-POL reconstruction for medial knee instability. The authors evaluated surgical technique, rehabilitation protocol, postoperative outcomes (Lysholm, International Knee Documentation Committee [IKDC], and Tegner scores and valgus stress radiograph), and return to sports and complication rates across the included studies. Results: A total of 6 studies were reviewed. The cohort consisted of 199 patients (121 men and 78 women), with a mean age of 32.7 ± 3.9 years (range, 27.4-36.6 years). The Lysholm and IKDC scores improved from pre- to postoperatively (Lysholm, from 67.2 ± 20.4 to 89.4 ± 3; IKDC, from 45.8 ± 2.1 to 84.8 ± 7.5). The Tegner score produced satisfactory results, from a preoperative mean of 3.3 ± 2.4 to 6.3 ± 0.9 postoperatively. The medial joint opening on valgus stress radiographs ranged from 7.5 ± 1.1 mm preoperatively to 3 ± 3.1 mm postoperatively. After passing activity-specific functional and clinical tests, 88% to 91.3% of the patients were reported to have returned to recreational sports within 6 to 12 months postoperatively, whereas 10% of the patients developed postoperative complications. Conclusion: Satisfactory clinical and functional outcomes, a high rate of return to recreational sports, and a low rate of postoperative complications were reported after an sMCL-POL reconstruction to restore medial knee integrity.
Comparing Sex-Specific Outcomes After Medial Patellofemoral Ligament Reconstruction for Patellar Instability: A Systematic Review
Authors: Fancher A.J. , Hinkle A.J. , Vopat M.L. , Templeton K. , Tarakemeh A. , Vopat B.G. , Mulcahey M.K. 
Published: November 2021

Background: The impact of patient sex on outcomes after medial patellofemoral ligament ligament reconstruction (MPFLR) has not been well studied. Purpose: To conduct a systematic review to determine sex-based differences in outcomes after MPFLR for patellar instability and the proportion of studies examining this as a primary or secondary purpose. Study Design: Systematic review; Level of evidence, 4. Methods: A systematic review was performed using the PubMed, Cochrane Library, PubMed Central, Ovid, and Embase databases according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Studies were included if they were written in English, were performed on humans, consisted of patients who underwent MPFLR with allograft or autograft, evaluated at least 1 of the selected outcomes comparing male and female patients, and had statistical analysis available for relevant findings. Excluded were case reports, review studies or systematic reviews, studies that did not evaluate at least 1 sex-specific outcome, studies that included other injuries associated with patellofemoral instability injury, cadaveric studies, and those in which patients underwent concomitant procedures. Results: The initial search yielded 3470 studies; 2647 studies remained after removing duplicates. Of the 401 studies that underwent full-text review, 10 met all inclusion criteria and were included for quantitative analysis. A meta-analysis could not be performed given the heterogeneity within the data set. Of the 2647 studies evaluated in this study, only 2 (0.08%) studies examined the impact of patient sex on MPFLR outcomes as a primary purpose and only 8 (0.30%) studies explored it as a secondary purpose. Conclusion: Only 0.38% of the articles compared outcomes between male and female patients after MPFLR. The limited data available were too heterogenous to draw any concrete conclusions about the impact of patient sex on outcomes after MPFLR. Further research in this area is warranted, as findings may influence treatment plans and improve patient outcomes.
Lateral Patellofemoral Ligament Reconstruction With a Hamstring Allograft
Authors: Huddleston Hailey P. , Dandu Navya , Bodendorfer Blake M. , Yanke Adam B. 
Published: November 2021

Background: Medial patellar instability is rare but may occur after lateral retinacular release. The lateral patellofemoral ligament is a significant stabilizer for medial and lateral patellar displacement, and soft tissue–based reconstruction may restore its stabilizing effect. Indications: Lateral patellofemoral ligament reconstruction (LPFLR) is indicated for patellar instability failing exhaustive nonoperative measures. Technique Description: Diagnostic arthroscopy for medial patellofemoral ligament (MPFL) status, patellar tracking, chondral status, and postoperative changes of lateral retinacular release is conducted. A 5-cm incision is made between the midpoint of the patella and the lateral epicondyle, or a single midline incision can be used if performing a concomitant MPFL reconstruction. Dissection is carried down to the lateral retinaculum and capsule, and two 1-cm incisions are made at the distal and proximal patella through the patellar and quadriceps tendon, respectively. The lateral epicondyle is then directly palpated, and two 1-cm incisions are made directly anterior and posterior to the epicondyle into the iliotibial band in full extension. A hamstring allograft is then shuttled in a V-shaped configuration from the quadriceps tendon through the iliotibial band and finally to the patellar tendon. Excess graft is trimmed and doubled over proximally and distally to replicate the normal (or contralateral) 0° to 15° of patellar eversion. Trial resting length and tension is set with temporary sutures through the proximal and distal doubled graft in full extension. The knee is taken through full range of motion to ensure there is no graft tightening in flexion or loosening in full extension. Eversion and patellar translation are then examined. Heavy nonabsorbable sutures are used to set length of the doubled allograft proximally and distally. Results: Case series of LPFLR have demonstrated significant improvements in patients’ pain, Lysholm score and Knee Injury and Osteoarthritis Outcome Score, and kinesiophobia with no instability events and normal range of motion at short-term follow-up. Discussion/Conclusion: Medial patellar instability can occur following lateral retinacular release and patients experiencing instability despite nonoperative treatment are likely to benefit from a soft tissue–based LPFLR. Although other nongraft-based techniques may confer similar outcomes, the authors find it more reliable to perform a lateral reconstruction as described.
Why not to use punch biopsies in formalin-fixed paraffin-embedded samples of prostate cancer tissue for DNA and RNA extraction?
Authors: Parra-Medina Rafael , Ramírez-Clavijo Sandra 
Published: November 2021

AbstractExtraction of DNA and RNA from formalin-fixed paraffin-embedded (FFPE) tissue blocks is a critical process in molecular oncology testing. Using FFPE, it is possible to choose the portion of tissue to study, taking into account the cell morphology, storage stability and storage conditions at room temperature, and make retrospective studies with clinical and pathological information. In prostate cancer tissue, in contrast with macroscopic tumors, it is not easy to identify the tumor; therefore, it is very important to make a microscopic diagnosis. We do not recommend punching this tissue because it can choose normal tissue for molecular analysis. In the present article we review the differences between punch biopsy and microdissection.
The impact of height on the spread of spinal anesthesia and stress response in parturients undergoing caesarean section: a prospective observational study
Authors: She Ying-Jun , Liu Wen-Xing , Wang Ling-Yu , Ou Xin-Xu , Liang Hui-Hong , Lei Dong-Xu 
Published: November 2021

Abstract
Background
The spread of spinal anesthesia was influenced by many factors, and the effect of body height on spinal anesthesia is still arguable. This study aimed to explore the impact of height on the spread of spinal anesthesia and the stress response in parturients.

Methods
A total of ninety-seven parturients were allocated into two groups according to their height: the shorter group (body height was shorter than 158 cm) and taller group (body height was taller than 165 cm). Spinal anesthesia was performed with the same amount of 12 mg plain ropivacaine in mothers of different heights. The primary outcome of the study was the success or failure of the spinal anesthesia. The secondary outcomes of the study were stress response, time to T6 sensory level, the incidence of hypotension, the satisfaction of abdominal muscle relaxation and patient VAS scores.

Results
The rate of successful spinal anesthesia in the shorter group was significantly higher than that in the taller group (p = 0.02). The increase of maternal cortisol level in the shorter group was lower than that in the taller group at skin closure (p = 0.001). The incidence of hypotension (p = 0.013), time to T6 sensory block (p = 0.005), the quality of abdominal muscle relaxation (p <  0.001), and VAS values in stretching abdominal muscles and uterine exteriorization (p <  0.001) in the shorter group were significantly different from those in the taller group. Multivariate analysis showed that vertebral column length (p <  0.001), abdominal girth (p = 0.022), amniotic fluid index (p = 0.022) were significantly associated with successful spinal anesthesia.

Conclusions
It’s difficult to use a single factor to predict the spread of spinal anesthesia. Patient’s vertebral column length, amniotic fluid index and abdominal girth were the high determinant factors for predicting the spread of spinal anesthesia.

Trials registration
ChiCTR-ROC-17012030 (Chictr.org.cn), registered on 18/07/2017.
Impact of extent of coronary artery disease and percutaneous revascularization assessed by the SYNTAX score on outcomes following transcatheter aortic valve replacement
Authors: Stephan Tilman , Thoma Eva , Rattka Manuel , Felbel Dominik , Buckert Dominik , Rottbauer Wolfgang , Gonska Birgid , Markovic Sinisa 
Published: November 2021

Abstract
Objectives
The aim of the study was to analyze the impact of concomitant coronary artery disease (CAD) assessed by the SYNTAX score (SS) and periprocedural percutaneous coronary intervention (PCI) on outcomes after transcatheter aortic valve replacement (TAVR).

Background
Due to controversial data regarding the effect of CAD on outcomes after TAVR, proper revascularization strategies remain a matter of debate.

Methods
553 patients with severe aortic stenosis undergoing TAVR were included in this study. SS was calculated for each patient at baseline and after PCI. Primary outcome was one-year all-cause mortality.

Results
60.2% of patients (N = 333) exhibited CAD with a mean SS of 10.8 ± 8.8. Of those, 120 patients (36.0%) received periprocedural PCI. In the treatment group, mean SS was decreased from 14.9 ± 9.1 to 6.3 ± 6.7. Patients with concomitant CAD suffered more frequently from myocardial infarction (MI) post TAVR compared to those without CAD (2.1% vs. 0.0%; P < 0.01). In the CAD cohort, MI rates were comparable between patients with and without PCI (2.2% vs. 2.5%; P = 0.71). Regarding SS, patients with a residual SS < 8 showed significant lower rates of one-year mortality (9.0% vs. 18.2%; P = 0.016) and MACCE (16.5% vs. 32.2%; P = 0.001). Besides left bundle brunch, predictors for an increased one-year mortality were a residual SS ≥ 8 in the CAD group (OR = 3.17; P = 0.011) and a EuroSCORE ≥ 4% in the entire study population (OR = 2.18; P = 0.017).

Conclusion
Our results suggest that a residual SS-guided revascularization strategy may improve prognosis after TAVR in patients with concomitant CAD. PCI aiming for a residual SS < 8 was associated with improved one-year clinical outcomes.
Inverse correlation between serum irisin and cardiovascular risk factors among Chinese overweight/obese population
Authors: Liu Ruoyi , Zhang Qiao , Peng Nianchun , Xu Shujing , Zhang Miao , Hu Ying , Chen Zhengyi , Tang Kun , He Xi , Li Yi , Shi Lixin 
Published: November 2021

Abstract
Background
Irisin is a novel myokine associated with obesity, which is a traditional cardiovascular risk factor (CVRF). The present study aimed to investigate the association between serum irisin and a single CVRF as well as the clustering of CVRFs among Chinese overweight/obese population.

Methods
A total of 98 overweight and 93 obese subjects without clinical treatments were enrolled in this study. Subjects were then divided into two groups, based on the serum irisin level: a low irisin group (1.10–13.44 ng/ml) and a high irisin group (13.49–29.9 ng/ml). The clustering of CVRFs, smoking, diabetes mellitus, dyslipidemia and hypertension, was classified as 0, 1, 2 and ≥ 3 CVRFs. The demographic and baseline clinical characteristics of all participants were collected and serum irisin was measured.

Results
The high serum irisin group had significantly higher high-density lipoprotein cholesterol but lower fasting plasma glucose than the low serum irisin group. Additionally, the high serum irisin group had a significantly lower prevalence of smoking, diabetes mellitus and dyslipidemia than the low serum irisin group. Increased serum irisin was significantly associated with a reduced risk of smoking and dyslipidemia in both the unadjusted and adjusted models. Furthermore, high serum irisin significantly reduced the risk of the prevalence of 1, 2 and ≥ 3 CVRFs.

Conclusions
among the Chinese overweight/obese populations, high serum irisin is negatively associated with smoking, dyslipidemia and the clustering of CVRFs. Thus, high serum irisin is potentially associated with a low risk of cardiovascular diseases in the Chinese overweight/obese population.
Nonspecific symptoms dominate at first contact to emergency healthcare services among cases with invasive meningococcal disease
Authors: Hovmand Nichlas , Christensen Helle Collatz , Lundbo Lene Fogt , Sandholdt Håkon , Kronborg Gitte , Darsø Perle , Anhøj Jacob , Blomberg Stig Nikolaj Fasmer , Bisgaard Asmus Thun , Benfield Thomas 
Published: November 2021

Abstract
Background
An early appropriate response is the cornerstone of treatment for invasive meningococcal disease. Little evidence exists on how cases with invasive meningococcal disease present at first contact to emergency medical services.

Methods
Retrospective observational study of cases presenting with invasive meningococcal disease from January 1st of 2016 to December 31st of 2020 in the Capital Region of Denmark with a catchment area population of 1,800,000. A single medical emergency center provides services to the region. Data was collected from emergency medical services’ call audio files, data from the call receiver registrations, registrations from ambulance personal and electronic health record data from the hospitalization.

Results
Of 1527 cases suspected of meningitis, 38 had invasive meningococcal disease and had been in contact with the emergency service. Most contacts were to the medical helpline rather than the emergency call center at initial contact to emergency medical services. All were hospitalized within 12 h. At initial contact, fever was present in 28 (74%) of 38 cases, while specific symptoms such as headache (n=12 (32%)), a rash or petechiae (n=9 (23%)) and stiffness of the neck (n=4 (11%)) varied and were infrequent. Cases younger than 18 years of age were more often male and more often presented with fever and rash/petechiae. Only 4 (11%) received prehospital antibiotic treatment.

Conclusions
Cases with invasive meningococcal disease presented with fever and unspecific symptoms. Although few were acutely ill at their initial contact, all were admitted within 12 h. We suggest that all feverish cases should be systematically asked about specific symptoms and should be wary of symptom progression to optimize the early management if cases with invasive meningococcal disease.