bluuebunny/crossref_metadata_2025_split huggingface dataset:
Arterial Stiffness Assessed by Cardio-Ankle Vascular Index in Patients With Abdominal Aortic Aneurysm and Its Alterations After Treatment
Authors: Mylonas Spyridon N. , Moulakakis Konstantinos G. , Kadoglou Nikolaos , Antonopoulos Constantinos , Kotsis Thomas E. , Kakisis John , Katsenis Konstantinos , Liapis Christos 
Published: June 2021

Purpose: The aim of the present study was to investigate a potential difference on the arterial stiffness among aneurysm patients and non-aneurysm controls, as well as to explore potential changes between patients treated either with endovascular or open repair. Materials and Methods: A 110 patients with an infrarenal AAA were prospectively enrolled in this study. Fifty-six patients received an EVAR, whereas 54 patients received an open surgical repair. Moreover, 103 gender and age-matched subjects without AAA served as controls. The cardio-ankle vascular index (CAVI) was applied for measurement of the arterial stiffness. Results: CAVI values were statistically higher in the AAA patients when compared with control subjects. Although at 48 hours postoperatively the CAVI values were increased in both groups when compared to baseline values, the difference in CAVI had a tendency to be higher in the open group compared to the endovascular group. At 6 months of follow up the CAVI values returned to the baseline for the patients of the open repair group. However, in the endovascular group CAVI values remained higher when compared with the baseline values. Conclusion: Patients with AAAs demonstrated a higher value of CAVI compared to healthy controls. A significant increase of arterial stiffness in both groups during the immediate postoperative period was documented. The increase in arterial stiffness remained significant at 6 months in EVAR patients. Further studies are needed to elucidate the impact of a decreased aortic compliance after stentgraft implantation on the cardiac function of patients with AAA.
Revision periarterial sympathectomy for recurrent digital ischaemia: a report with 11 patients
Authors: Rudolph Megan , Butler Katherine , Prabhu Shamit , Browne Donald , Koman L. Andrew , Li Zhongyu 
Published: June 2021

Following periarterial sympathectomy, patients with recurrent digital ischemia due to vasospastic or vaso-occlusive disease have few remaining treatment options. We performed a retrospective review from 1997 to 2019 to determine the safety and efficacy of revision periarterial sympathectomy. Eleven patients were identified who underwent revision periarterial sympathectomy, performed on average 84 months after their initial procedure. Preoperatively, all patients had worsening ischemic pain and five had non-healing digital ulcers. Revision digital periarterial sympathectomy alone was performed in seven patients, while four had a more extensive sympathectomy. Mean follow-up after revision was 23 months (range 3 to 76). Eight patients had symptomatic improvement and four healed their digital ulcers. Three patients developed new ulcers during follow-up, of which two healed with conservative management and one required three digital amputations. Revision periarterial sympathectomy is effective in providing symptomatic improvement and digital ulcer healing with minimal postoperative complications. Level of evidence: IV
Accuracy of CGM Systems During Continuous and Interval Exercise in Adults with Type 1 Diabetes
Authors: Da Prato G. , Pasquini S. , Rinaldi E. , Lucianer T. , Donà S. , Santi L. , Negri C. , Bonora E. , Moghetti P. , Trombetta M. 
Published: June 2021

Background: continuous glucose monitoring systems (CGMs) play an important role in the management of T1D, but their accuracy may reduce during rapid glucose excursions. The aim of study was to assess the accuracy of recent rt-CGMs available in Italy, in subjects with T1D during 2 sessions of physical activity: moderate continuous (CON) and interval exercise (IE). Method: we recruited 22 patients with T1D, on CSII associated or integrated with a CGM, to which a second different sensor was applied. Data recorded by CGMs were compared with the corresponding plasma glucose (PG) values, measured every 5 minutes with the glucose analyzer. To assess the accuracy of the CGMs, we evaluated the Sensor Bias (SB), the Mean Absolute Relative Difference (MARD) and the Clarke error grid (CEG). Results: a total of 2355 plasma-sensor glucose paired points were collected. Both average plasma and interstitial glucose concentrations did not significantly differ during CON and IE. During CON: 1. PG change at the end of exercise was greater than during IE ( P = .034); 2. all sensors overestimated PG more than during IE, as shown by SB ( P < .001) and MARD ( P < .001) comparisons. Classifying the performance according to the CEG, significant differences were found between the 2 sessions in distribution of points in A and B zones. Conclusions: the exercise affects the accuracy of currently available CGMs, especially during CON, suggesting, in this circumstance, the need to maintain blood glucose in a “prudent” range, above that generally recommended. Further studies are needed to investigate additional types of activities.
Renovating Healthcare Facility Maintenance Planning: A Case Study From Walter Reed National Military Medical Center (WRNMMC)
Authors: Spear Bryan , Kinart Angela C. , Beauvais Brad , Kim Forest S. 
Published: June 2021

Purpose: This article documents the development and implementation of a new approach for health facilities construction and maintenance planning, the use of a Facilities and Clinical Coordination (FCC) Council, at Walter Reed National Military Medical Center (WRNMMC). Background: WRNMMC is preparing for the largest and most complex renovation project in recent Department of Defense history. There is sparse documentation demonstrating stepwise frameworks for the implementation of effective and efficient health facilities maintenance management tools and techniques. Method: This study discusses the development and evaluation of the FCC Council. Clarity to the literature sources guiding the development of the FCC Council is provided, followed by the survey approach undertaken to assess Council efficacy based on participants’ perceptions. Data are analyzed using descriptive and inferential statistics. Results: Our study suggests routine cross-functional synchronous FCC Council meetings improve perceptions of safety and communication, encourage teamwork, and are more productive when conducted using synchronous rather than asynchronous communication. Clinician participants strongly supported the face-to-face meeting approach and considered such meetings more effective as they are perceived to maintain staff and patient safety as a constant organizational focus. Conclusion: The FCC’s perceived effectiveness toward improving healthcare facilities maintenance planning centers on engaged leadership, the inclusion of diverse subject matter experts, and structured group facilitation. Our results inform health facilities planners of the value the FCC Council brings to an organization by helping to develop organizational buy-in for major facilities renovation projects.
Clear cell urethral adenocarcinoma – a case report of an exceptional response to immunotherapy in a metastatic rare tumour
Authors: Cowzer Darren , Mulligan Karen , Glennon Kate , Hegarty Nicholas , Walsh Tom , McCaffrey John A 
Published: June 2021

Primary clear cell adenocarcinoma of the urethra is extremely rare. Given the rarity of these tumours there is no high-level evidence available to guide treatments. Localized disease is typically treated with primary surgery or concurrent chemo-radiotherapy. In the advanced disease setting treatment options are limited and decisions are based on evidence in disease subtypes where similarities exist. Immuno-oncology and the use of checkpoint inhibitors, particularly for metastatic disease has transformed clinical practice over the past few years and patient outcomes continue to improve as a result of their introduction. Here we report the first case, to our knowledge, of a patient with advanced primary clear cell adenocarcinoma of the urethra who had a dramatic and almost complete response to anti-PD-1 therapy in the fourth line setting. Level of evidence: 4
Do weather parameters affect emergency room visits due to acute urinary retention?
Authors: Golomb Dor , Ehrlich Yaron , Lifshitz David , Stav Nir , Halfon Noam , Porat Amos , Goldberg Hanan 
Published: June 2021

Objective: This study aimed to describe the effects of the various climate parameters on emergency room (ER) visits due to acute urinary retention (AUR). Patients and methods: This was a single-center retrospective analysis of the ER data of visits due to AUR in males and females between 2010 and 2017. We incorporated ER registries with data from the national meteorological service. Using multivariable logistic regression analyses, we assessed associations between climate parameters and the incidence of AUR. Results: A total of 1917 patients were admitted to the ER due to AUR during the study period, of whom 1706 (89%) were males and211 (11%) were females. Most AURs occurred in patients >70 years of age, with males on average being older than women (72.8 vs. 70.1 years old, p=0.01). Multivariable logistic regression analyses demonstrated that females had more AURs than men (odds ratio (OR)=1.3, 95% confidence interval (CI) 1.1–1.9, p=0.04) in spring. In all seasons except winter, a higher maximal temperature was associated with an increased risk of AUR, while in winter, a lower temperature was associated with an increased risk (OR=0.654, 95% CI 0.602–0.711, p<0.0001). Additionally, the following were associated with an increased AUR risk: increased wind speed and lower heat index during the spring, increased precipitation and a lower heat index during the autumn, and a higher heat index in the winter. Conclusions: Our data suggest that weather parameters might be associated with an increased AUR incidence in a Mediterranean coastline area, with maximal ambient temperature, wind speed, heat index, and precipitation playing a potential role. Level of evidence: 6.
Cervical Spine Immobilization in Patients With a Geriatric Facial Structure: The Influence of a Geriatric Mandible Structure on the Immobilization Quality Using a Cervical Collar
Authors: Jung Matthias K. , Grützner Paul A. , Schneider Niko R. E. , Keil Holger , Kreinest Michael 
Published: June 2021

Introduction: Demographic changes have resulted in an increase in injuries among geriatric patients. For these patients, a rigid cervical collar is crucial for immobilizing the cervical spine. However, evidence suggests that patients with a geriatric facial structure require a different means of immobilization than patients with an adult facial structure. This study aimed to analyze the remaining motion of the immobilized cervical spine based on facial structure. Materials and Methods: This study was performed on 8 fresh human cadavers. Facial structure was evaluated via ascertaining the mandibular angle by computer tomography. A mandibular angle below 130°, belongs to the adult facial structure group ( n = 4) and a mandibular angle above 130°, belongs to the geriatric facial structure group ( n = 4). The flexion and lateral bending of the immobilized cervical spine were analyzed in both groups using a wireless motion tracker system. Results: A flexion of up to 19.0° was measured in the adult facial structure group. The mean flexion in the adult vs. geriatric facial structure groups were 14.5° vs. 6.5° (ranges: 9.0-19.0 vs. 5.0-7.0°), respectively. Thus, cervical spine motion was ( p = 0.0286) significantly more reduced in the adult facial structure group. No ( p = 0.0571) significant difference was oberserved in the mean lateral bending of the adult facial structure group (14.5°) compared to the geriatric facial structure group (7.5°). Conclusion: Emergency medical service personnel should therefore follow current guidelines and recommendations and perform cervical spine immobilization with a cervical collar, including in patients with a geriatric facial structure.
Open-wedge high tibial osteotomy in patients with discoid lateral meniscus
Authors: Kim Hee-June , Shin Ji-Yeon , Lee Hyun-Joo , Jung Chul-Hee , Park Kyeong-Hyeon , Oh Chang-Wug , Kyung Hee-Soo 
Published: June 2021

Background: There are concerns about the progression of the lateral osteoarthritis (OA) should be taken into account when high tibial osteotomy (HTO) is performed in patients with discoid lateral meniscus (LM). This study evaluated the clinical results of HTO in patients with discoid LM and elucidated factors affecting the results. Methods: This study evaluated 32 female patients with varus deformity and medial OA. Patients with discoid LM (8 patients) or without discoid LM (24 patients) underwent open-wedge HTO. The mean age was 53.5 years and the mean follow-up period was 35 months. Clinical results, including the Hospital for Special Surgery (HSS) score, Knee Society knee score (KS) and function score (FS), were evaluated. The progression of OA in the lateral compartment was also evaluated. Finally, we evaluated the factors affecting the clinical results and OA progression in the lateral compartment. Results: Between two groups, all clinical scores were not different (p = 0.964, 0.963, and 0.559, respectively). Three of eight patients (37.5%) in the discoid group developed OA in the lateral compartment, whereas 2 of 24 patients (8.3%) in the control group developed such; however, this was not significantly different (p = 0.085). In discoid group, patients with undercorrection has higher KS relative to patients with acceptable correction (p = 0.044). Other clinical results and OA change in the lateral compartment were not affected by evaluated factors. Conclusions: Patients who underwent open-wedge HTO showed the satisfactory clinical results and lateral OA progression regardless of the presence or absence discoid LM. However, when discoid LM was present, patients with undercorrection showed higher KS in comparison with patients with acceptable correction.
Clinical and Functional Outcomes After Operative and Nonoperative Treatment of Distal Biceps Brachii Tendon Ruptures in a Consecutive Case Series
Authors: Berthold Daniel P. , Muench Lukas N. , Cusano Antonio , Uyeki Colin L. , Slater Maria , Tamburini Lisa M. , Geyer Stephanie , Cote Mark P. , Arciero Robert A. , Mazzocca Augustus D. 
Published: June 2021

Background: Patients with ruptures of the distal biceps brachii tendon (DBBT) have traditionally been treated via surgical repair, despite limited patient data on nonoperative management. Purpose/Hypothesis: To determine the clinical and functional outcomes for patients with partial and complete DBBT injuries treated nonoperatively or surgically through an anatomic single-incision technique. We hypothesized that there would be no difference in outcomes in patients treated with nonoperative or operative management. Study Design: Cohort study; Level of evidence, 3. Methods: A retrospective chart review identified all patients with a partial or complete DBBT injury sustained between 2003 and 2017. Surgically treated patients underwent DBBT repair using an anatomic single-incision technique. Nonoperative management consisted of formal physical therapy. The following clinical outcome measures were included for analysis: American Shoulder and Elbow Surgeons (ASES) score; the Disabilities of the Arm, Shoulder and Hand (DASH) upper extremity patient questionnaire; the Single Assessment Numeric Evaluation (SANE) score; and the 36-Item Short Form Health Survey. Results: A total of 60 patients (mean ± SD age, 47.8 ± 11.5 years; range, 18-70 years) sustained DBBT ruptures (38 complete and 22 partial) during the study period. Of patients with complete DBBT, 34 were treated operatively and 4 nonoperatively; of those with partial DBBT, 11 were treated operatively and 11 nonoperatively. At a mean follow-up of 5.4 ± 4.0 years (range, 0.5-16.6 years), patients with complete DBBT ruptures achieved overall similar improvements with respect to mean ASES pain, ASES function, SANE, and DASH scores, regardless of whether they were treated operatively or nonoperatively. Subjective satisfaction and functional scores were comparable between the groups. Similarly, at a mean follow-up of 4.1 ± 3.8 years (range, 0.5-11.3 years), patients with partial DBBT injuries had improved mean ASES pain, ASES function, SANE, and DASH scores, regardless of operative or nonoperative treatment. Subjective satisfaction and functional scores were comparable between these groups. For those treated surgically, 5 patients (11.1%) sustained a surgical postoperative complication. Conclusion: In our case series, patients were able to achieve satisfactory outcomes regardless of whether they were treated nonoperatively or with an anatomic single-incision approach for complete or partial DBBT ruptures.
Is Antiplatelet Therapy Contraindicated After Platelet-Rich Plasma Treatment? A Narrative Review
Authors: Magruder Matthew , Rodeo Scott A. 
Published: June 2021

Background: Antiplatelet therapies are often withheld before and after platelet-rich plasma product (PRPP) administration due to theoretical concerns that therapies that inhibit the function of platelets would inhibit the effects of PRPP. Purpose/Hypothesis: The purpose of this study was to evaluate the effect that antiplatelet therapies have on the ability of PRPP to stimulate wound healing and tissue regeneration. Our hypothesis was that antiplatelet therapies would have highly heterogeneous effects on the biological activity of PRPP. Study Design: Narrative review. Methods: The Medline database was searched via PubMed to identify all studies related to PRPP and antiplatelet therapies, yielding 1417 publications. After the search was confined to articles published after 1995, there were 901 articles remaining. All abstracts were then screened to identify animal or human clinical studies that focused on growth factor or inflammatory cytokine production or treatment outcomes. We limited our analysis to studies reporting on orthopaedic pathologies and in vitro studies of antiplatelet therapies. Ultimately, 12 articles fit the search criteria. Results: The majority of studies reported on the use of nonsteroidal anti-inflammatory drugs as antiplatelet therapy. The majority of studies were in vitro analyses of growth factors, inflammatory cytokines, or cell viability, whereas 1 study examined clinical outcomes in an animal model. None of the studies investigated clinical outcomes in humans. All of the studies showed no effect or mixed effects of antiplatelet therapies on PRPP efficacy. One study showed PRPP recovery to baseline function after a 1-week washout period. Conclusion: The literature did not provide support for the common clinical practice of withholding antiplatelet therapies in patients being treated with PRPP.
Influential Articles on Pediatric and Adolescent Anterior Cruciate Ligament Injuries: A Bibliometric Analysis
Authors: Allahabadi Sachin , Feeley Sonali E. , Lansdown Drew A. , Pandya Nirav K. , Feeley Brian T. 
Published: June 2021

Background: The understanding of pediatric anterior cruciate ligament (ACL) injuries and optimal treatment has evolved significantly. Influential articles have been previously evaluated using article citations to determine impact. Purpose: To identify and characterize the 50 most cited and recent influential articles relating to pediatric and adolescent ACL injuries, to examine trends in publication characteristics, and to evaluate correlations of study citations with quality of evidence. Study Design: Cross-sectional study. Methods: The top 50 most cited articles on pediatric and adolescent ACL injuries were gathered using the Web of Science and Scopus online databases by averaging the number of citations from each database. Articles from recent years were also aggregated and sorted by citation density (citations/year). Publication and study characteristics were recorded. Level of evidence and methodologic quality were assessed where applicable using the modified Coleman Methodology Score (mCMS), modified Jadad scale, and Methodological Index for Non-Randomized Studies (MINORS). Spearman correlation was used to evaluate the association between citation data and level of evidence or methodologic quality scorings. Results: The top 50 cited papers had a mean of 117.5 ± 58.8 citations (range, 58.5-288.5 citations), with a mean citation density of 9.4 ± 5.4 citations per year (range, 2.9-25.8 citations/year); 80% were published in 2000 or later, and 6% were considered basic science. Articles were mainly level 4 evidence (27/42; 64.3%), and none was level 1. There were moderate, significant associations between publication year and level of evidence ( r S = −0.45; P = .0030) and citation density and publication year ( r S = 0.59; P < .001). Mean methodologic quality scores were as follows: mCMS, 53 ± 7.2 (range, 39-68); modified Jadad scale, 3.2 ± 1.1 (range, 2-6); and MINORS, 11.2 ± 3.2 (range, 6-20). There was a significant, strong correlation between rank of mean citations and modified Jadad scale ( r S = 0.76; P < .0001), suggesting poorer score associated with more mean citations. Conclusion: Influential articles on pediatric and adolescent ACL injuries were relatively recent, with a low proportion of basic science–type articles. Most of the studies had a lower evidence level and poor methodologic quality scores. Higher methodologic quality did not correlate positively with citation data.
Sonographic Assessment of Renal Volume in Normotensive Pregnant Women and Women With Pregnancy-Induced Hypertension in Enugu Metropolis
Authors: Ugochinyere Idigo Felicitas , Chiamaka Nwankwo Sylvia , Obinna Abonyi Everistus , Chukwunyelu Anakwue Angel-Mary , Amechi Agbo Julius 
Published: June 2021

Objective: Renal volume (RV) assessment during obstetric sonography is rarely considered in our locality. Understanding the changes in RV in both normotensive pregnant (NP) and pregnancy-induced hypertensive (PIH) women is important in making correct diagnosis regarding pregnancy outcome. This study is aimed at determining the RV in NP and PIH women and correlating RV with fetal gestational age (FGA), body mass index (BMI), and parity in NP women. Materials and Methods: This cross-sectional study involved 450 patients recruited at a Tertiary Hospital. A pilot study was done to determine the interobserver variability in RV measurement. RV was calculated using the following formula: L × W × AP × 0.523. Parity, BMI, and blood pressure were documented, while FGA was calculated as an average of FGAs obtained from the measurements of fetal biometric parameters. Results: Mean RV of PIH women was significantly higher than that of NP women ( P < .05). RV shows a positive significant relationship with BMI and FGA, while it shows a negative relationship with parity in NP ( P < .05). Conclusion: Reference range values of RV were generated for clinical use in our locality, while there is statistically significant difference between RV in NP and PIH women.