bluuebunny/crossref_metadata_2025_split huggingface dataset:
Limb Lengthening for Congenital Deficiencies Using External Fixation Combined With Flexible Intramedullary Nailing: A Multicenter Study
Authors: Popkov Arnold , Pietrzak Szymon , Antonov Alexander , Parol Tomasz , Lazović Mikan , Podeszwa David , Popkov Dmitry 
Published: March 2021

Background:
Hydroxyapatite (HA) coated flexible intramedullary nailing (FIN) stimulates osteogenic activity. The role of HA-coated intramedullary nails remains unclear in normal bone lengthening. The goal of this study was to quantify the influence of FIN on the External Fixation Index (EFI) in patients with congenital lower limb discrepancy.

Methods:
Patients with femoral deficiency and fibular hemimelia underwent lengthening by the combined technique of external fixation with titanium (Ti) FIN or HA coated FIN and returned for follow-up at least 12 months after frame removal.

Results:
Seventy patients (mean age of 12.6 y) were included: 19 monofocal femoral lengthenings, 35 tibial monofocal lengthenings, 16 tibial bifocal lengthenings. The mean EFI’s for those treated with and without HA-coated nails were not significantly different. The Conover posthoc analysis did not reveal a significant influence of the type of FIN on EFI in any subgroup. However, 2-way analysis of variance revealed simultaneous effects of nail types and age on the EFI in tibial bifocal lengthening.
Significant positive correlation between the ratio “nail diameter/medullary shaft diameter” and EFI in tibial bifocal non–HA-coated FIN lengthening, and a significant positive correlation between age and EFI for femoral non–HA-coated FIN lengthening, tibial monofocal and bifocal HA-coated FIN lengthening were revealed.
There were 4 cases of fracture at lengthening site required unscheduled surgery. In the non–HA-coated group, there was a statistically significant negative correlation between nail diameter and fracture occurrence at the lengthening site after frame removal. A ratio of <0.15 likely does not ensure required mechanical stability and support.

Conclusions:
Both Ti-nail and HA-coated nail lengthening provide good and excellent outcomes for femoral and tibial monosegmental lengthening procedures and ensure reduced EFI. In congenital disorders which were not associated with abnormal bone, there are no differences with regard to EFI using HA-coated or non–HA-coated FIN. The ratio of “elastic Ti-nail diameter/medullary canal diameter at narrowest site” <0.15 seems to be associated with higher risk of fracture at the lengthening site after frame removal.
Early Opioid Consumption Patterns After Anterior Cervical Spine Surgery
Authors: Lovecchio Francis , Premkumar Ajay , Steinhaus Michael , Alexander Koo , Mejia Dianna , Yoo Joon S. , Lafage Virginie , Iyer Sravisht , Huang Russel , Lebl Darren , Qureshi Sheeraz , Kim Han Jo , Singh Kern , Albert Todd 
Published: March 2021

Study Design:
This is a prospective observational study.

Objective:
The aim was to record daily opioid use and pain levels after 1-level or 2-level anterior cervical discectomy and fusion (ACDF) or cervical disc arthroplasty (CDA).

Summary of Background Data:
Data to inform opioid prescription guidelines following ACDF or CDA is lacking. Understanding postoperative opioid consumption behaviors is critical to provide appropriate postdischarge prescriptions.

Methods:
Patients undergoing 1-level or 2-level primary ACDF or CDA were consecutively enrolled at 2 participating institutions between March 2018 and March 2019. Patients with opioid dependence (defined as daily use ≥6 mo before surgery) were excluded. Starting postoperative day 1, daily opioid use and numeric pain rating scale pain levels were collected through a Health Insurance Portability and Accountability Act-compliant, automated text-messaging system. To facilitate clinical applications, opioid use was converted from oral morphine equivalents into “pills” (oxycodone 5 mg equivalents). After 6 weeks or upon patient-reported cessation of opioid use, final survey questions were asked. Refill data were verified from the state prescription registry. Risk factors for patients in top quartile of consumption were analyzed.

Results:
Of 57 patients, 48 completed the daily queries (84.2%). Mean age of the patient sample was 50.2±10.9 years. Thirty-two patients (66.7%) underwent ACDF and 16 CDA (33.3%); 64.6% one level; 35.4% two levels. Median postdischarge use was 6.7 pills (range: 0–160). Cumulative opioid use did not vary between the 1-level and 2-level groups (median pill consumption, 10 interquartile range: 1.3–31.3 vs. 4 interquartile range: 0–18, respectively, P=0.085). Thirteen patients (27.1%) did not use any opioids after discharge. Of those patients that took opioids after discharge, half ceased opioids by postoperative day 8. Preoperative intermittent opioid use was associated with the top quartile of opioid consumption (9.1% vs. 50%, P=0.006).

Conclusion:
Given that most patients use few opioids, patients could be offered the option of a 12 oxycodone 5 mg (90 oral morphine equivalents) discharge prescription, accompanied by education on appropriate opioid use and disposal.
Systemic treatment of metastatic squamous cell carcinoma of the head and neck: proposal for management changes
Authors: Peyrade Frédéric , Borel Christian , Daste Amaury , Even Carolie , Saada-Bouzid Esma , Guigay Joël 
Published: March 2021

Purpose of review
Worldwide, head and neck carcinomas account for 5% of all malignancies. Two-thirds of patients relapse after initial multimodal therapy. Until early 2010, the median overall survival (OS) of metastatic patients was about 10 months.

Recent findings
New drugs have been incorporated in patient management, thus enabling an increase in OS. Several first and second line protocols are now available but the lack of direct comparison makes the choice difficult between them.

Summary
This work aims to define the comprehensive medical management of patients with relapsing head and neck carcinoma. In September 2020, the French head and neck groups GORTEC, Unicancer head and Neck group, GROCC and GETTEC decided to promote a one-day meeting to propose how to incorporate these new regimens in first and second line treatment for recurrent and metastatic head and neck cancer (R/M SCCHNC). Twelve French medical oncologist involved in the management of R/M SCCHNC for more than 10 years examined the literature and proposed a simple and practical management based on five criteria: age, delay from last platinum injection, combined positive score expression level, FIT or UNFIT patient according to physician decision, fast response needed or not.
Adverse effects from selected antidotes commonly used in poisonings
Authors: Hoegberg Lotte C.G. , Boegevig Soeren 
Published: March 2021

Summary
The number of specific antidotes available is low compared to the wide range of substances, of natural or synthetic origin, able to produce toxic symptoms in the human body. Some of these antidotes being very specific in target and effect, e.g., antagonism at the μ-opioid receptors by naloxone in an opioid overdose, other antidotes being unspecific, e.g., glucagon or atropine in the case of betablocker poisoning or activated charcoal with its ability reduce absorption of a wide range of toxic substances. In the following, we present four important antidotes (N-acetylcysteine, deferoxamine, methylene blue and physostigmine) and focus on some of their reported potentially severe adverse effects.
Effects of exogenous melatonin on sleep quality and menopausal symptoms in menopausal women: a systematic review and meta-analysis of randomized controlled trials
Authors: Yi Mingyu , Wang Sixue , Wu Ting , Zhang Xinyue , Jiang Li , Fang Xiaoling 
Published: March 2021

Abstract

Importance:
Because of the bothersome symptoms during women's menopausal period and the severe side effects of hormone therapy, it is meaningful to find new breakthroughs in improving menopausal women's quality of life.

Objective:
We performed a systematic review and meta-analysis of randomized controlled trials (RCTs) evaluating melatonin intake on the improvement of sleep quality, general menopausal symptom, mood states, as well as interaction of estradiol levels and body mass index (BMI) in menopausal women.

Evidence Review:
We used the search terms “melatonin” together with “menopause” or “post-menopause” or “peri-menopause” in multiple databases online including PubMed, Web of Science, Embase, Clinical trial, Cochrane Library, and China National Knowledge Infrastructure from the first publication year to October 2020. Interesting data included characteristics of the study design, study participants, intervention, and outcome measures. Risk of biases in RCTs was evaluated with the Cochrane tool. Fixed-effect models and random-effect models were used for meta-analysis according to heterogeneity. Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed in our study.

Findings:
Eight cohorts (n = 812) evaluating the effects of melatonin in menopausal women were included. Melatonin was used in every study with differences existing in dose (1 mg - 5 mg) and duration (3 to 12 mo). Improved physical symptoms (standard mean difference [SMD] −0.376; 95% CI, −0.599 to −0.153, P = 0.001) merged in four RCTs. Melatonin treatment resulted in no benefits to sleep quality (SMD −0.659; 95% CI, −1.535 to 0.217, P = 0.141) and general menopause symptoms (SMD −0.625; 95% CI, −1.354 to 0.105, P = 0.093) in four and three RCTs, respectively. More specifically, melatonin did not solve the psychological (SMD −0.026; 95% CI, −0.372 to 0.321, P = 0.884, I

2
= 70.3%), sexual (SMD −0.661; 95% CI, −1.416 to 0.093, P = 0.086) and vasomotor (SMD −0.256; 95% CI, −0.701 to 0.188, P = 0.258) issues. No significant changes were observed in anxiety (SMD 0.018; 95% CI, −0.519 to 0.556, P = 0.946), depression (SMD 0.133; 95% CI, −0.435 to 0.702, P = 0.646), BMI (weighted mean difference 0.029 kg/m2; 95% CI, −0.183 to 0.240, P = 0.790) or estradiol levels (weighted mean difference 0.016 pg/mL; 95% CI, −1.220 to 1.252, P = 0.980).

Conclusions:
Melatonin seems to improve physical symptoms in menopausal women, but the general menopausal symptoms, sleep quality, mood state, estradiol levels, and BMI did not improve under melatonin intervention. However, multiple large-scale clinical randomized trials are needed to validate our conclusions.
Salvaging the Unsalvageable: Negative Pressure Wound Therapy for Severe Infection of Prosthetic Breast Reconstruction
Authors: Meybodi Farid , Sedaghat Negin , Elder Elisabeth , French James , Adams Kristian , Hsu Jeremy , Kanesalingam Kavitha , Brennan Meagan 
Published: March 2021

Background:
Severe infections of implant-based breast reconstruction are challenging to treat. Traditional management is removal of the implant with a further attempt at reconstruction months later once the infection has settled. This study evaluates an alternative management protocol using negative pressure wound therapy with instillation (NPWTi).

Methods:
Consecutive patients with severe peri-prosthetic infection following breast reconstruction were managed using the Implant Salvage Protocol: removal of the prosthesis with application of a NPWTi dressing, changed every 3 days until a negative culture was obtained. A new prosthesis was then placed in the pocket. Data were collected on patient demographics, microbiological, hospital/operative information, and overall success of salvage. Descriptive statistics were used for analysis.

Results:
In total, 30 breast prostheses in 28 patients were treated for severe peri-prosthetic infection. Twenty-five (83%) implants were salvaged. Mean time from initial reconstruction surgery to presentation was 49.5 days (median 23, range 7–420). Mean hospital stay was 11.5 days (median 12.0, range 6–22), mean number of returns to the operating theater was 3.7 (median 3.0, range 2–7), and mean number of days to negative culture was 5.2 (median 4.0, range 1–14). The most common organisms were methicillin-sensitive Staphylococcus aureus (n = 9) and Serratia marcescens (n = 4). Most had a tissue expander (n = 24, 80%) or implant (n = 5, 16.7%) placed at the completion of therapy. There was no record of capsular contracture nor recurrent infection during follow-up (mean 39.4 months, range 6–74 months).

Conclusion:
An estimated 83% of prosthetic breast reconstructions with severe infection were successfully salvaged using NPWTi.
Relationship of Body Mass Index With Fuchs Endothelial Corneal Dystrophy Severity and TCF4 CTG18.1 Trinucleotide Repeat Expansion
Authors: Kinariwala Bhumi B. , Xu Timothy T. , Baratz Keith H. , Aleff Ross A. , Patel Sanjay V. , Maguire Leo J. , Fautsch Michael P. , Wieben Eric D. , Millen Amy E. , Patel Sangita P. 
Published: March 2021

Purpose:
To investigate the association of body mass index (BMI) with Fuchs endothelial corneal dystrophy (FECD) severity and TCF4 CTG18.1 expansion.

Methods:
A total of 343 patients with FECD were enrolled from the Mayo Clinic. FECD severity was graded by slit-lamp biomicroscopy. BMI values were obtained from the electronic medical records. DNA extracted from leukocytes was analyzed for CTG18.1 expansion length, with ≥40 repeats considered expanded. Wilcoxon signed-rank tests were used to compare FECD grade and CTG18.1 expansion length in patients by BMI (<25, ≥25 to <30, and ≥30 kg/m2). FECD grade was regressed on age, sex, BMI, and CTG18.1 expansion and, separately, BMI on CTG18.1 expansion. Models were investigated for effect modification by age and sex with an interaction term of P < 0.05 considered statistically significant.

Results:
When examining the association between BMI and FECD, there was a significant interaction between BMI and sex (P for interaction = 0.004). When controlling for age and CTG18.1 expansion, a positive association was observed between BMI and FECD grade in women, but not in men. In addition, BMI was not associated with CTG18.1 expansion when controlling for age and sex.

Conclusions:
BMI was positively associated with FECD severity among women but not men. There was no significant association between BMI and CTG18.1 expansion. These findings suggest that increased BMI is potentially a modifiable risk factor for FECD disease progression among women.
Patient satisfaction with dabigatrean and warfarin for stroke prevention in atrial fibrillation: Taiwan PASSION study
Authors: Lee Chun-Wei , Liu Ming-En , Lee Tsung-Ming , Chang Rei-Yeuh , Huang Chun-Yao , Hu Yu-Feng , Yeh Hung-I 
Published: March 2021

Background:
Patient satisfaction with oral anticoagulant (OAC) therapy is an important metric of care quality and has been associated with higher medication persistence. Among OACs, dabigatran has been shown to be non-inferior to vitamin K antagonists (VKAs) with increased ease of use for stroke prevention in patients with atrial fibrillation (AF). In this study, we sought to evaluate the expectations, convenience, and satisfaction of Taiwanese AF patients on dabigatran and VKA therapies as well as associated clinical outcomes.

Methods:
Patients with AF (paroxysmal, persistent, or permanent) receiving OAC medication from outpatient facilities were enrolled in 24 hospitals across Taiwan. Cohort A consisted of 139 patients switched from VKA to dabigatran, while cohort B was comprised of 1113 patients on newly initiated OAC therapy (VKA, 54). The Perception of Anticoagulant Treatment Questionnaire was distributed, and responses on a five-point Likert scale were aggregated and analyzed across demographic groups.

Results:
In cohort A, convenience and satisfaction scores continued to increase at follow-up and significantly higher, compared to baseline, but both treatments scored similarly in cohort B. In cohort B, the two highest expectation scores were that the OAC would be “easy to take” and could be “taken independently.” On the other hand, the patients were relatively less concerned about the side effects and cost of therapy before taking the OAC. For dabigatran-receiving patients, there were 1.1 stroke-related events per 100 patient-years and 3.0 bleeding-related events per 100 patient-years.

Conclusion:
In Taiwanese patients with AF and initially treated with VKA, switched to dabigatran resulted in higher convenience and treatment satisfaction. For those patients on newly initiated OAC treatment, VKA and dabigatran convenience and satisfaction scores were similar.
Predictors of delayed extubation following lung resection: Focusing on preoperative pulmonary function and incentive spirometry
Authors: Ko Hsin-Kuo , Liu Ching-Yi , Ho Li-Ing , Chen Pei-Ku , Shie Huei-Guan 
Published: March 2021

Background:
Delayed extubation is one of postoperative pulmonary complications (PPCs). Preoperative pulmonary function test (PFT) is an important assessment for patients undergoing lung resection. Volume-oriented incentive spirometry (IS) is one of physiotherapies to prevent PPCs. Preoperative PFT and IS volume (IS-v) can reflect the physiologic conditions of respiratory system in patients planning to undergo lung resection. However, the relationship between preoperative PFT/IS-v and delayed extubation in patients undergoing lung resection remains unclear. The study investigated the risk factors and impact of delayed extubation after lung resection. We aimed to achieve early recognition of patients being at a higher risk for developing postoperative delayed extubation after lung resection.

Methods:
This retrospective observational 4-year cohort study was conducted in a medical center, Taiwan. A total of 353 enrolled patients receiving thoracic surgery for lung resection were further categorized into the delayed extubation (n = 142, 40%) and non-delayed extubation (n = 211, 60%) groups.

Results:
In multivariate logistic regression analyses, age >65 years (adjusted odds ratio [AOR]: 2.60; 95% confidence interval [CI], 1.52-4.45), American Society of Anesthesiologists score >2 (AOR: 1.72; 95% CI, 1.05-2.82), anesthesia time >6hrs (AOR: 1.80; 95% CI, 1.13-2.88), pneumonectomy (AOR: 5.58; 95% CI, 1.62-19.19), and IS-v/inspiratory capacity (IC) ratio (AOR: 2.07; 95% CI, 1.16-3.68) were associated with delayed extubation after lung resection (all p < 0.05). Patients with delayed extubation were significantly associated with a higher proportion of other pulmonary complications, reintubation, mortality, and prolonged intensive care unit and hospital stays.

Conclusion:
Older age, poor general health status, longer anesthesia time, pneumonectomy, and IS-v/IC ratio could be the independent factors predictive for delayed extubation after lung resection, which was in turn associated with worse outcomes. Preoperative PFT and IS-v were valuable for early recognition of patients being at a higher risk for developing postoperative delayed extubation after lung resection.
Monitoring Enables Progress
Authors: Yogev Dotan , Shosberger Adi , Nehemia Chen , Harel Sasha , Yerushalmy‐Feler Anat , Ledder Oren , Orlanski‐Meyer Esther , Assa Amit , Slae Mordechai , Kori Michal , Elenberg Yigal , Shaoul Ron , Zifman Eyal , Shamaly Hussein , Berkowitz Drora , Sarit Peleg , Yerushalmi Baruch , Broide Efrat , On Avi , Elkayam Orit , Bayan Hino , Gorodnichenko Anna , Pinsk Vered , Shouval Dror S. , Turner Dan 
Published: March 2021

ABSTRACTObjectives:In this quality improvement program, named quality in pediatric inflammatory bowel disease, we constructed a nation‐wide platform that prospectively recorded clinically important quality indicators in pediatric inflammatory bowel diseases (PIBD), aiming at improving clinical management across the country.Methods:Representatives of all 21 PIBD facilities in Israel formed a Delphi group to select quality indicators (process and outcomes), recorded prospectively over 2 years in children with Crohn's disease 2–18 years of age seen in the outpatient clinics. Monthly anonymized reports were distributed to all centers, allowing comparison and improvement. Trends were analyzed using the Mann‐Kendall test, reporting τ (tau) values.Results:The indicators of 3254 visits from 1709 patients were recorded from September 2017 to September 2019 (mean age 14.7 ± 3.1 years, median disease duration 1.8 years (interquartile range 0.69–4.02)). An increase in three of five process indicators was demonstrated: obtaining drug levels of anti‐tumor necrosis factor (TNF) (τ = 0.4; P = 0.005), utilization of fecal calprotectin (τ = 0.38; P = 0.008) and bone density testing (τ = 0.45; P = 0.002). Among outcome indicators, three of nine improved as measured during the preceding year: calprotectin <300 μg/mg (τ = 0.35; P = 0.015), and “resolution of inflammation” defined as a composite of endoscopy, imaging and fecal calprotectin (τ = 0.39; P = 0.007). Endoscopic healing reached borderline significance (τ = 0.28; P = 0.055). An increase in the use of biologics throughout the study was observed (τ = 0.47; P = 0.001) with a concurrent decrease in the use of immunomodulators (τ = −0.47; P = 0.001).Conclusions:Quality improvement nationwide programs can be implemented with limited resources while facilitating standardization of care, and may be associated with improvements in measured indicators.
Does Exercise Increase Vestibular and Ocular Motor Symptom Detection After Sport-Related Concussion?
Authors: Popovich Michael , Almeida Andrea , Lorincz Matthew , Eckner James T. , Freeman Jeremiah , Streicher Nicholas , Alsalaheen Bara 
Published: March 2021

Background and Purpose:
Postconcussive vestibular and ocular motor symptoms are common and contribute to longer recovery. The Vestibular/Ocular Motor Screening (VOMS) is used to detect such symptoms, but a VOMS performed at rest may miss symptoms that are only provoked by exertion. Supervised exercise challenges (SECs) have been shown to detect concussion-related symptoms provoked by physical exertion. The purpose of this study was to determine whether athletes undergoing an SEC will exhibit greater symptom provocation with the VOMS compared to a VOMS performed at rest prior to an SEC.

Methods:
Thirty-six athletes (58.3% male) between ages 10 and 18 years and within 30 days of concussion were included. All participants completed VOMS assessments at rest and immediately after an SEC. VOMS total symptom score increases were calculated for both pre- and post-SEC assessments compared using Wilcoxon ranked sum tests. The frequencies of positive assessments for each VOMS item were compared using McNemar's test.

Results:
There were significant increases in post-SEC symptom provocation scores compared with pre-SEC scores for all VOMS items. The post-SEC VOMS identified 29 participants (80.6%) as positive in at least 1 VOMS item compared with 21 participants (58.3%) identified as positive pre-SEC (P = 0.008). For all VOMS items, the post-SEC VOMS identified participants who were previously negative on a pre-SEC VOMS but became positive after the SEC.

Discussion and Conclusions:
An SEC performed prior to a VOMS assessment may increase the detection of vestibular and ocular motor symptoms that may be missed if the VOMS was performed only at rest.

Video Abstract available for more insight from the authors (see the Video Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A342).
Improved Gonorrhea and Chlamydia Testing Among Men Who Have Sex With Men Living With HIV Through Implementation of Self-Collected Tests
Authors: Park Ina U. , Reminick Dominique , Schapiro Jeffrey M. , Hurley Leo B. , Hare Charles Brad , Slome Sally , Flamm Jason A. , Anderson Alexandra , Silverberg Michael J. , Allerton Michael W. 
Published: March 2021

Abstract
We implemented self-collected gonorrhea/chlamydia testing in 17 medical centers in California serving men who have sex with men living with HIV. From 2012 to 2018, gonorrhea/chlamydia testing increased from 45.2% to 63.4%. Among those tested, rectal testing increased from 42.0% to 77.3%; pharyngeal testing increased from 31.0% to 79.9% (all, P
trend < 0.0001).