bluuebunny/crossref_metadata_2025_split huggingface dataset:
Management of Infected Galactocele and Breast Implant with Uninterrupted Breastfeeding
Authors: Kornfeld Hannah , Johnson Arianne , Soares Marc , Mitchell Katrina 
Published: November 2021

Summary:
Infected breast implants during lactation present a rare but challenging clinical scenario that may result in early cessation of breastfeeding and unnecessary morbidity to mother and infant. We present the case of a 39-year-old African American primigravid woman with a history of bilateral retropectoral textured implants placed three years prior. Five days after delivering a healthy, full-term infant via cesarean section, she sought evaluation for nipple pain and trauma. She was instructed to use a nipple shield and pump every 2–3 hours in addition to breastfeeding, which resulted in iatrogenic hyperlactation. One week postpartum, the patient was started on antibiotics for presumed mastitis. Ultrasound demonstrated a complex fluid collection at the 12 o’clock periareolar position, as well as peri-implant fluid. She subsequently underwent aspirations of a periareolar complex galactocele and aspirations of peri-implant fluid. She continued on antibiotics without improvement. The patient proceeded to implant removal and definitive drainage of the galactocele at four months postpartum. Throughout her course, the patient provided her infant with exclusive breastmilk, including breastfeeding in the perioperative area of the operating room. This case demonstrates an example of safe surgical removal of infected breast implants and management of an infected galactocele without interruption of breastfeeding.
Application of hyperglycemia/diabetes-derived polygenic risk scores on the risk of poor outcomes after an ischemic stroke
Authors: Chen Yu-Lun , Chi Nai-Fang , Chiou Hung-Yi , Hu Chaur-Jong , Jeng Jiann-Shing , Tang Sung-Chun , Lin Huey-Juan , Hsieh Yi-Chen ,   on behalf of the Formosa Stroke Genetic Consortium
Published: November 2021

Background:
Unfavorable prognoses are often accompanied for hyperglycemic stroke patients. This study aimed to construct a hyperglycemia/diabetes-derived polygenic risk score (PRS) to improve the predictive performance for poor outcome risks after a stroke and to evaluate its potential clinical application.

Methods:
A hospital-based cohort study was conducted including 1320 first-ever acute ischemic stroke (AIS) patients and 1210 patients who completed the follow-up at 3 months. PRSs were calculated for hyperglycemia/diabetes mellitus using results from genome-wide association studies in Asians. An unfavorable functional outcome was defined as a modified Rankin Scale score of ≥3 at 3, 6, and 12 months of follow-up. The prediction of a poor prognosis was evaluated using measures of model discrimination, calibration, and net reclassification improvement (NRI).

Results:
The second to fourth PRS quartiles (≥Q2) were significantly associated with higher risks of unfavorable outcomes at 3 months compared with the first quartile as the reference group after adjusting for age, baseline stroke severity, hypertension, diabetes, dyslipidemia, smoking, heart disease, and ischemic stroke subtype (p for trend <0.0001). The addition of the PRS to traditional risk predictors of poor outcomes after an AIS significantly improved the model fit (likelihood ratio test p < 0.0001) and enhanced measures of reclassification (NRI, 0.245; 95% confidence interval [CI], 0.195-0.596). The corrected C-index for the PRS combining traditional risk factors at 3 months after a stroke was 0.899 (95% CI, 0.878-0.980). Among hyperglycemic AIS patients, those who did not take an antidiabetic drug and whose PRS was ≥Q2 had higher risks of an unfavorable outcome at 3 months compared with patients who took the medicine.

Conclusion:
The hyperglycemia/diabetes-derived PRS was associated with poor outcomes after an AIS, but further studies are needed to validate its use for clinical applications.
Predictability of the preoperative lateral fulcrum radiograph of success in one-level vertebroplasty to treat painful osteoporotic vertebral fracture
Authors: Chang Yu-Chuan , Yao Yu-Cheng , Lin Hsi-Hsien , Wang Shih-Tien , Chang Ming-Chau , Chou Po-Hsin 
Published: November 2021

Background:
Restoration of height or angle has been reported following vertebroplasty (VP). The purpose of the study was to investigate the predictive value of the preoperative lateral fulcrum radiograph (LFR) of success in one-level VP for painful osteoporotic vertebral fracture.

Methods:
From January 2017 to January 2018, 71 patients (mean age, 76 years) receiving VP were retrospectively analyzed. Painful vertebra was defined as pseudarthrosis or edematous change in magnetic resonance imaging (MRI) scan. Fulcrum flexibility (FF) and fulcrum restoration index (FRI) of the vertebral wedge angle (VWA), regional kyphotic angle (RKA), and anterior vertebral body height (AVBH) were investigated. Back pain was evaluated using a visual analogue scale.

Results:
The 30 males and 41 females were followed for an average of 21 months. The sensitivity of LFR and MRI to detect pseudarthrosis was 92% and 97%, respectively. Preoperative FF of VWA, RKA, and AVBH was 52.4%, 58.3%, and 60%, respectively, indicating similar potential restoration ability. Postoperative average FRI for VWA, RKA, and AVBH was 1.29 ± 2.98, 0.46 ± 1.16, and 1.04 ± 1.68, respectively. Final average FRI was 0.94 ± 2.96, −0.03 ± 2.25, and 0.6 ± 2.04, respectively. VWA and AVBH had better immediate restoration, and VWA had better final maintenance. All parameters progressive lost significant levels of restoration to similar degrees but without increase in back pain.

Conclusion:
LFR can help with evaluation for pseudarthrosis and the restoration effect of VP. VP had better immediate restoration of VWA and AVBH and better final VWA maintenance.
HMGB1 Inhibitor Effectively Alleviates Psoriasis-Like Lesions and Inflammatory Cytokines in K14-VEGF Transgenic Mice
Authors: Fu Li-Xin , Yin Bin , Cao Na , Qin Sha , Lei Xiao-Yu , Chen Tao , Guo Zai-Pei 
Published: November 2021

Objective:
Anti-high-mobility group box 1 (HMGB1) is involved in the pathogenesis of many inflammatory and autoimmune diseases, including psoriasis. The present study aimed to investigate the therapeutic effects of HMGB1 monoclonal antibody (mAb) in keratin 14 (K14)-vascular endothelial growth factor (VEGF) transgenic homozygous mice.

Methods:
Twelve VEGF transgenic mice were randomly divided into two groups of six mice each: the anti-HMGB1 mAb group and the immune complex (IC) mAb group. The mice underwent intraperitoneal injection of anti-HMGB1 mAb or IC mAb once every 2 days for a total of three treatments. Compare the lesions on the ears of the mice and evaluate the severity of the lesions using the baseline and clinical scores on the last day of treatment. The changes in psoriasis-like lesions, cellular infiltration of T cells, dendritic cells, and neutrophils were detected by hematoxylin–eosin staining and immunohistochemistry. The mRNA expression of the inflammatory cytokines, including interleukin (IL)-6, tumor necrosis factor-α, interferon-γ, and IL-17 in the lesions were assessed by real-time quantitative polymerase chain reaction. The number of γ
δ T cells in the lesions of two groups were detected by flow cytometry. The t test was used to compare their differences.

Results:
The anti-HMGB1 mAb effectively ameliorated the clinical skin lesions. The clinical scores in the anti-HMGB1 mAb group were lower than those in the IC mAb group (6.00 ± 0.52 vs. 10.83 ± 0.48, P < 0.001). Histopathologic changes and improvements in the K14-VEGF transgenic homozygous mice were evident after three treatments. The scores of mice in the anti-HMGB1 mAb group were significantly lower than those in the IC mAb group (3.25 ± 0.71 vs. 6.95 ± 0.83, P = 0.0033). The average epidermal thickness in the anti-HMGB1 mAb group was reduced by about 45% when compared with that in the IC mAb group (32.15 ± 7.08 vs. 64.69 ± 7.93, P = 0.0054). Moreover, anti-HMGB1 mAb also decreased the number of infiltrating CD3+ T cells, myeloperoxidase-positive neutrophils, and CD11c+ dendritic cells. The ratio of ear skin γ
δ T cells was reduced in anti-HMGB1 mAb treated group. The mRNA expression of IL-6, tumor necrosis factor-α, interferon-γ, and IL-17 in the anti-HMGB1 mAb group were significantly reduced when compared with IC mAb group (0.36 ± 0.070 vs.1.98 ± 0.62, P = 0.0148; 6.43 ± 1.37 vs. 13.80 ± 1.33, P = 0.0006; 2.62 ± 0.83 vs. 7.77 ± 1.32, P = 0.0026; 4.69 ± 1.13 vs.11.41 ± 1.92, P = 0.0054).

Conclusion:
HMGB1 blockade (anti-HMGB1 mAb) reduced leukocyte infiltration and suppressed inflammatory cytokine expression in this K14-VEGF transgenic mouse model, markedly reducing the severity of the psoriasis-like lesions. HMGB1 blockade might serve as a potential target for the treatment of psoriasis.
Optimized scheme for paired transverse corrective forces in S-shaped scoliosis via ultrasound and application in Chêneau brace: a pilot study
Authors: Wang Li , Xia Nan , Wang Chun , Zheng Qian , Ma Christina Zonghao , Youssef Ahmed S. A. , Zhang Chao , Deng Youbin , Zhu Guoli , Huang Xiaolin 
Published: November 2021

Background:
There is currently no consensus on the optimal positions of the transverse corrective forces (TCFs) for scoliosis braces.

Objectives:
This study aimed to explore an optimal scheme of placing paired TCF for S-shaped adolescent idiopathic scoliosis and its feasibility in Chêneau brace (CB) treatment.

Study design:
Cross-over feasibility pilot trial.

Methods:
Ten S-shaped adolescent idiopathic scoliosis participants were invited to receive four tests with different paired TCF positions under ultrasound. The positions of the paired TCF were test 1: thoracic apical vertebra (AV), lumbar AV; test 2: 2 cm inferior to thoracic AV, lumbar AV; test 3: thoracic AV, 2 cm superior to lumbar AV; and test 4: 2 cm inferior to thoracic AV, 2 cm superior to lumbar AV. The test scheme with the highest mean in-force correction rate (IFCR) for the thoracic spinous process angle (SPA) was further applied in the CB fabrication of 4 additional participants.

Results:
A significant higher mean IFCR of the thoracic SPA of 63.6% was found in test 2 (P < 0.001), which also contributed to its higher overall IFCR of the SPA of 64.6% (P = 0.001). Moreover, the mean in-brace correction rates for the thoracic and overall curves in CB were 46.4% and 51.8%, respectively. No adverse events were reported.

Conclusions:
Placing paired TCF at the lumbar AV and 2 cm inferior to the thoracic AV achieved better treatment efficacy than other schemes. The practical application of this scheme on the CB was feasible.
The Risk of Postoperative Complications After Major Elective Surgery in Active or Resolved COVID-19 in the United States
Authors: Deng John Z. , Chan Janine S. , Potter Alexandra L. , Chen Ya-Wen , Sandhu Harpal S. , Panda Nikhil , Chang David C. , Yang Chi-Fu Jeffrey 
Published: November 2021

Objective:
To assess the association between the timing of surgery relative to the development of Covid-19 and the risks of postoperative complications.

Summary Background Data:
It is unknown whether patients who recovered from Covid-19 and then underwent a major elective operation have an increased risk of developing postoperative complications.

Methods:
The risk of postoperative complications for patients with Covid-19 undergoing 18 major types of elective operations in the Covid-19 Research Database was evaluated using multivariable logistic regression. Patients were grouped by time of surgery relative to SARS-CoV-2 infection; that is, surgery performed: (1) before January 1, 2020 (“pre-Covid-19”), (2) 0 to 4 weeks after SARS-CoV-2 infection (“peri-Covid-19”), (3) 4 to 8 weeks after infection (“early post-Covid-19”), and (4) ≥8 weeks after infection (“late post-Covid-19”).

Results:
Of the 5479 patients who met study criteria, patients with peri-Covid-19 had an elevated risk of developing postoperative pneumonia [adjusted odds ratio (aOR), 6.46; 95% confidence interval (CI): 4.06–10.27], respiratory failure (aOR, 3.36; 95% CI: 2.22–5.10), pulmonary embolism (aOR, 2.73; 95% CI: 1.35–5.53), and sepsis (aOR, 3.67; 95% CI: 2.18–6.16) when compared to pre-Covid-19 patients. Early post-Covid-19 patients had an increased risk of developing postoperative pneumonia when compared to pre-Covid-19 patients (aOR, 2.44; 95% CI: 1.20–4.96). Late post-Covid-19 patients did not have an increased risk of postoperative complications when compared to pre-Covid-19 patients.

Conclusions:
Major, elective surgery 0 to 4 weeks after SARS-CoV-2 infection is associated with an increased risk of postoperative complications. Surgery performed 4 to 8 weeks after SARS-CoV-2 infection is still associated with an increased risk of postoperative pneumonia, whereas surgery 8 weeks after Covid-19 diagnosis is not associated with increased complications.
Multi-institutional Validation Study of Cyst Fluid Protein Biomarkers in Patients With Cystic Lesions of the Pancreas
Authors: McIntyre Caitlin A. , Rodrigues Clifton , Santharaman Aadhithyaraman Vaithiya , Goldman Debra A. , Javed Ammar A. , Ciprani Debora , Pang Nan , Lokshin Anna , Gonen Mithat , Al Efishat Mohammad A. , He Jin , Burkhart Richard , Burns William , Weiss Matthew , D’Angelica Michael I. , Kingham T. Peter , Balachandran Vinod P. , Drebin Jeffrey A. , Jarnagin William R. , Lillemoe Keith D. , Brugge William , Casey Brenna , Lennon Anne Marie , Schattner Mark , Wolfgang Christopher L. , del Castillo Carlos Fernandez , Allen Peter J. 
Published: November 2021

Objective:
Prospective evaluation of 2 clinical-molecular models in patients with unknown pathology who underwent endoscopic ultrasound with fine-needle aspiration (EUS-FNA) for a cystic lesion of the pancreas.

Summary of Background Data:
Preoperative prediction of histologic subtype (mucinous vs nonmucinous) and grade of dysplasia in patients with pancreatic cystic neoplasms is challenging. Our group has previously published 2 clinical-molecular nomograms for intraductal papillary mucinous neoplasms (IPMN) that incorporated both clinical/radiographic features and cyst fluid protein markers (sFASL, CA72-4, MMP9, IL-4).

Methods:
This multiinstitutional study enrolled patients who underwent EUS-FNA for a cystic lesion of the pancreas. Treatment recommendations regarding resection were based on standard clinical, radiographic, and endoscopic features. Predicted probabilities of high-risk IPMN (high-grade dysplasia/invasive cancer) were calculated using the previously developed clinical-molecular nomograms.

Results:
Cyst fluid was obtained from 100 patients who underwent diagnostic EUS-FNA. Within this group there were 35 patients who underwent resection, and 65 were monitored radiographically. Within the group that underwent resection, 26 had low-risk IPMN or benign non-IPMN lesions, and 9 had high-risk IPMN. Within the surveillance group, no patient progressed to resection or developed cancer after a median follow-up of 12months (range: 0.5–38). Using the clinical/radiographic nomogram alone, 2 out of 9 patients with high-risk IPMN had a predicted probability >0.5. In the clinical-molecular models, 6 of 9 patients in model 1, and 6 of 9 in model 2, had scores >0.5.

Conclusions:
This prospective study of patients with unknown cyst pathology further demonstrates the importance of cyst fluid protein analysis in the preoperative identification of patients with high-risk IPMN. Longer follow-up is necessary to determine if this model will be useful in clinical practice.
Thromboelastometry fails to detect autoheparinization after major trauma and hemorrhagic shock
Authors: Zipperle Johannes , Oberladstätter Daniel , Weichselbaum Nadja , Schlimp Christoph J. , Hofmann Nikolaus , Iapichino Giacomo , Voelckel Wolfgang , Ziegler Bernhard , Grottke Oliver , Osuchowski Marcin , Schöchl Herbert 
Published: November 2021

BACKGROUND
Heparan sulfate is an integral component of the glycocalyx that provides an anticoagulant layer close to the endothelium. Hypoperfusion, inflammation, and sympathoadrenal activation following major trauma result in glycocalyx shedding and subsequent release of heparan sulfate into the bloodstream. The possible anticoagulant effect of this “autoheparinization” has been suggested as a potential driver of trauma-induced coagulopathy. We investigated whether thromboelastometry can be used to detect trauma-induced autoheparinization.

METHODS
This study comprised three parts. First, in a retrospective clinical study of 264 major trauma patients, the clotting time (CT) in the intrinsic activation (INTEM) and intrinsic activation plus heparinase (HEPTEM) assays were evaluated upon emergency room admission. Second, in an in vivo experimental rat model of hemorrhagic-traumatic shock, the release of heparan sulfate was investigated with INTEM and HEPTEM analyses of whole blood. Third, in vitro spiking of whole blood from healthy volunteers was undertaken to assess the effects of clinically relevant quantities of heparan sulfate and heparin on CT in the INTEM and HEPTEM assays.

RESULTS
In the first part, severe injury and hemorrhagic shock was not associated with any increases in INTEM CT versus HEPTEM CT. Part 2 showed that an approximate threefold increase in heparan sulfate resulting from hemorrhagic traumatic shock in rats did not prolong INTEM CT, and no significant differences between INTEM CT and HEPTEM CT were observed. Third, spiking of whole blood with heparan sulfate had no impact on INTEM CT, whereas heparin elicited significant prolongation of INTEM CT.

CONCLUSION
Despite structural similarity between heparan sulfate and heparin, the amounts of heparan sulfate shed in response to trauma did not exert an anticoagulant effect that was measurable by the intrinsically activated CT in thromboelastometry. The extent to which heparan sulfate contributes to trauma-induced coagulopathy has yet to be elucidated.

LEVEL OF EVIDENCE
Prognostic and Epidemiologic; Level III.
In-hospital outcomes in autogenous vein versus synthetic graft interposition for traumatic arterial injury: A propensity-matched cohort from PROOVIT
Authors: Stonko David P. , Betzold Richard D. , Abdou Hossam , Edwards Joseph , Azar Faris K. , Elansary Noha N. , Treffalls Rebecca N. , Savidge Samuel G. , DuBose Joseph J. , Feliciano David V. , Morrison Jonathan J. 
Published: November 2021

BACKGROUND
The ideal conduit for traumatic arterial repair is controversial. Autologous vein was compared with synthetic interposition grafts in the acute setting. The primary outcome was in-hospital reoperation or endovascular intervention.

METHODS
The American Association for the Surgery of Trauma PROspective Observational Vascular Injury Treatment registry from November 2013 to January 2019 was queried for arterial injuries requiring interposition vein or graft repair. Patients with no recorded Injury Severity Score were excluded, and multiple imputation was used for other missing data. Patients treated with synthetic grafts (SGs) were propensity matched to patients with vein grafts (VGs) to account for preoperative differences.

RESULTS
Four hundred sixty from 19 institutions were identified, with 402 undergoing VG and 58 SG. In the SG group, 45 were PTFE grafts, 5 were Dacron, and 8 had other conduits. The SG group was more severely injured at admission with more gunshot wounds and higher mean Injury Severity Score, lactate, and first-24-hour transfusion requirement. In addition, the SG cohort had significantly lower admission systolic blood pressure, pH, and hemoglobin. After propensity matching, 51 patients with SG were matched with 87 patients with VG. There were no differences in demographics, clinical parameters, or diagnostic evaluation techniques postmatch. The need for reoperation or endovascular intervention between the matched groups was equivalent (18%; p = 0.8). There was no difference in any secondary outcome including thrombosis, stenosis, pseudoaneurysm, infection, or embolic event, and hospital and intensive care unit length of stay were the same.

CONCLUSION
American Association for the Surgery of Trauma PROspective Observational Vascular Injury Treatment registry data demonstrate that SGs are used in more critically ill patients. After controlling for relevant clinical factors and propensity matching, there is no in-hospital difference in rate of reoperation or endovascular intervention, or any secondary outcome between VG and SG.

LEVEL OF EVIDENCE
Prognostic and Epidemiolgic, Level III.
Understanding the geography of trauma: Combining spatial analysis and funnel plots to create comprehensive spatial injury profiles
Authors: Abraham Peter J. , Crowley Brandon M. , Moore Dylana , Stephens Shannon W. , Minor Michael , Griffin Russell L. , Hashmi Zain , Holcomb John B. , Kerby Jeffrey D. , Jansen Jan O. 
Published: November 2021

BACKGROUND
Understanding geographic patterns of injury is essential to operating an effective trauma system and targeting injury prevention. Choropleth maps are helpful in showing spatial relationships but are unable to provide estimates of spread or degrees of confidence. Funnel plots overcome this issue and are a recommended graphical aid for comparisons that allow quantification of precision. The purpose of this project was to demonstrate the complementary roles of choropleth maps and funnel plots in providing a thorough representation of geographic trauma data.

METHODS
This is a retrospective analysis of emergency medical service transport data of adult patients in Alabama from July 2015 to June 2020. Choropleth maps of case volume and observed-to-expected ratios of incidence were created using US Census Bureau data. Funnel plots were created to relate incidence rate to county population. Subgroup analyses included patients with critical physiology, penetrating, blunt, and burn injuries.

RESULTS
We identified 65,247 trauma incidents during the study period. The overall statewide incidence rate was 133 per 10,000 persons. The highest number of incidents occurred in the most populous counties (Jefferson, 10,768; Mobile, 5,642). Choropleth maps for overall incidence and subgroups highlighted that spatial distribution of overall case volume and observed-to-expected ratios are not always congruent. Funnel plots identified possible and probable outliers, and revealed skewed or otherwise unique patterns among injury subgroups.

CONCLUSION
This study demonstrates the complementarity of choropleth maps and funnel plots in describing trauma patterns. Comprehensive geospatial analyses may help guide a data-driven approach to trauma system optimization and injury prevention. Combining maps of case counts, incidence, and funnel plots helps to not only identify geographic trends in data but also quantify outliers and display how far results fall outside the expected range. The combination of these tools provides a more comprehensive geospatial analysis than either tool could provide on its own.

LEVEL OF EVIDENCE
Prognostic and Epidemiologic; Level IV.