bluuebunny/crossref_metadata_2025_split huggingface dataset:
Modic Change
Authors: Applebaum Ariella , Nessim Adam , Cho Woojin 
Published: March 2021

Study Design:
This was a literature review.

Objective:
The objective of this study was to review the pathogenesis, prevalence, clinical associations, diagnostic modalities, and treatment options for patients with lower back pain (LBP) associated with Modic change (MC).

Summary of Background Data:
Vertebral body endplates are located between the intervertebral disk and adjacent vertebral body. Despite their crucial roles in nutrition and biomechanical stability, vertebral endplates are extremely susceptible to mechanical failure. Studies examining the events leading to disk degeneration have shown that failure often begins at the endplates. Endplate degeneration with subchondral bone marrow changes were originally noticed on magnetic resonance imaging. These magnetic resonance imaging signal changes were classified as MC.

Methods:
A literature review was conducted on the history, etiology, risk factors, diagnostic modalities, and treatment of LBP with MC.

Results:
Type 1 MC refers to the presence of increased vascularization and bone marrow edema within the vertebral body. Type 2 MC involves fatty marrow replacement within the vertebral body. Type 3 MC reflects subchondral bone sclerosis. Despite the original classification, research has supported the notion that MCs possess a transitional nature. Furthermore, type 1 MCs have been strongly associated with inflammation and severe LBP, while types 2 and 3 tend to be more stable and demonstrate less refractory pain. With a strong association to LBP, understanding the etiology of MC is crucial to optimal treatment planning. Various etiologic theories have been proposed including autoimmunity, mechanics, infection, and genetic factors.

Conclusions:
With the aging nature of the population, MC has emerged as an extremely prevalent issue. Research into the pathogenesis of MC is important for planning preventative and therapeutic strategies. Such strategies may include rehabilitation, surgical fixation, stabilization, steroid or cement injection, or antibiotics. Improved diagnostic methods in clinical practice are thus critical to properly identify patients suffering from MC, plan early intervention, and hasten return to functioning.
Adult Intestinal Intussusception
Authors: Cerdán Santacruz Carlos , García Septiem Javier 
Published: March 2021

CASE SUMMARY
A 37-year-old woman with no relevant past medical history presented to the emergency department after a 2-day-long period of crampy abdominal pain with an inability for oral intake because of persistent vomiting. The physical examination was unremarkable. Abdominal CT scan with water-soluble oral contrast revealed an ileocecal intussusception (Fig. 1). Because the patient was hemodynamically stable and no abdominal tenderness was found, a delayed surgical intervention was planned with laparoscopic approach. During intervention, the intestinal invagination was reduced, a cecal neoplasm suspected, and a right hemicolectomy with complete mesocolic excision was performed (Fig. 2). Postoperative recovery was uneventful, with discharge on postoperative day 5. The definite pathological report showed well-differentiated colon adenocarcinoma pT2N1aMx, with 1 of 49 positive lymph nodes.
Usefulness of a Skin Graft Obtained from the Bilateral Nasolabial Folds for a Skin Defect following Resection of a Malignant Tumor at the Nasal Tip
Authors: Osugi Ikuko , Inagawa Kiichi , Ebisudani Syougo , Hara Naoki 
Published: March 2021

Summary:
The cosmetic appeal of the nose is very important, as it is a structure located at the center of the face. Hence, the removal of nasal tumors requires matching aesthetic subunits for the ensuing reconstruction. This procedure often creates large defects that require skin grafts or local flaps for repair. If a large skin graft is required, harvesting of flaps from the head and neck region might have some limitations. Although flaps from the forehead can cover a wide range of facial defects, the skin properties of the forehead differ from those of the rest of the face. Moreover, early postoperative flap deformation may be due to the flap volume and the need for multiple surgeries, leading to vertical forehead scarring. Particularly, vertical forehead scars are more noticeable in Asians than in Westerners. Previously, grafts have been harvested from a unilateral nasolabial fold, but these grafts were small and resulted in asymmetry. Herein, we describe the case of a 67-year-old man with a basal cell carcinoma of the nasal tip, in which closure of the large defect was achieved through excision matching of the aesthetic unit by using skin harvested from bilateral nasolabial folds.
Effectiveness of placebo interventions for patients with nonspecific low back pain: a systematic review and meta-analysis
Authors: Strijkers Rob H.W. , Schreijenberg Marco , Gerger Heike , Koes Bart W. , Chiarotto Alessandro 
Published: March 2021

Abstract
Little is known about the effectiveness of placebo interventions in patients with nonspecific low back pain (LBP). This systematic review assessed the magnitude of the effects of placebo interventions as compared to no intervention in randomized controlled trials (RCTs) including patients with LBP. Embase, MEDLINE (Ovid), and Cochrane CENTRAL databases were searched from inception to December 5, 2019. Randomized controlled trials comparing placebo intervention vs no intervention in adult patients with nonspecific LBP were included. Pain intensity, physical functioning, and health-related quality of life measured at short-term, medium-term, and long-term follow-up were the outcomes of this review. Twenty-one randomized controlled trials were included; one concerning acute LBP and one subacute LBP, whereas 19 studies reported on chronic LBP. In chronic LBP, placebo interventions were more effective than no intervention at short-term follow-up for pain intensity (standardized mean difference = −0.37, 95% confidence interval [CI] = −0.55 to −0.18, moderate-quality evidence), physical functioning (standardized mean difference −0.19, 95% CI = −0.39-0.01, moderate-quality evidence), and physical quality of life (mean difference = −2.71, 95% CI = −4.71-0.71, high-quality evidence), respectively. These effects were not significant at medium-term follow-up, and no data were available at long-term follow-up. These results show placebo interventions are more effective than no intervention at short-term follow-up in patients with chronic LBP. However, the magnitude of the effects is probably not clinically relevant (approximately 8 points on a 0-100 pain scale). Future research should identify effect modifiers and causal mechanisms explaining the short-term effects of placebo interventions in patients with chronic LBP.
Barriers to HIV Care by Viral Suppression Status Among US Adults With HIV: Findings From the Centers for Disease Control and Prevention Medical Monitoring Project
Authors: Dasgupta Sharoda , Tie Yunfeng , Beer Linda , Fagan Jennifer , Weiser John 
Published: March 2021

Abstract
Failure to maintain viral suppression may be attributed to suboptimal care engagement. Using data collected during 2015–2018, we describe nationally representative estimates of engagement in care among US adults with diagnosed HIV, overall and by viral suppression. Of those who felt they did not receive enough care, we described detailed information on barriers to care by viral suppression. We reported weighted percentages and evaluated differences between groups using Rao-Scott chi-square tests (p < .05). Persons who were not virally suppressed were less likely to be retained in care (57.3 vs. 90.8%). Common barriers to care included life circumstances that impeded receipt of care (50.0%), financial barriers (34.5%), and not feeling sick enough to take medicine (32.0%). Barriers to care varied by viral suppression status, and people who were not virally suppressed were more likely to report more than one barrier to care. These findings demonstrate that barriers can be multifaceted; addressing barriers to care by expanding comprehensive care models in HIV care settings could improve clinical outcomes among people with HIV.
Competency frameworks for nurse practitioner residency and fellowship programs: Comparison, analysis, and recommendations
Authors: Kesten Karen S. , Beebe Sarah L. 
Published: March 2021

ABSTRACT
Nurse practitioner (NP) education has followed the pattern of other health professions in recent years to place an emphasis on competency-based education. In recent years, postgraduate NP residency/fellowship programs to achieve competence and successful transition to practice have emerged and flourished. Currently, there is no standard competency framework in use for NP residency/fellowship programs in the United States, despite numerous published frameworks available. This article aimed to provide a comprehensive analysis of competency frameworks for NP education and to summarize and compare the competency frameworks used in NP education and residency/fellowship programs. Recommendations were sought for standardization of these competencies to create consistent evaluation and outcome measurements. Seven competency frameworks used across NP education and residency/fellowship programs were reviewed and compared in table format. Commonalities, differences, and themes were extracted from this comparison. There were more similarities than differences between the competency frameworks; however, common themes emerged as the emphasis on patient-centered, evidence-based practice, systems-based and quality improvement, and interprofessional practice and teamwork. The American Association of Colleges of Nursing Common Advanced Practice Registered Nurse Doctoral-Level Competencies, published in 2017, provided the most current, inclusive, comprehensive, and complete set of competencies for NPs at the time of graduation; however, they have not defined a progression indicator for postgraduate NP competency evaluation. This review of the competencies emphasizes (a) the need for consistent and consensus-based standards and (b) areas that NP education and residency/fellowship programs can strengthen to assess their ability to describe observable, measurable competencies. Instruments to evaluate competencies are recommended.
Inhaled gases as novel neuroprotective therapies in the postcardiac arrest period
Authors: Magliocca Aurora , Fries Michael 
Published: March 2021

Purpose of review
The purpose of this review is to summarize recent advances about inhaled gases as novel neuroprotective agents in the postcardiac arrest period.

Recent findings
Inhaled gases, as nitric oxide (NO) and molecular hydrogen (H2), and noble gases as xenon (Xe) and argon (Ar) have shown neuroprotective properties after resuscitation. In experimental settings, the protective effect of these gases has been demonstrated in both in-vitro studies and animal models of cardiac arrest. They attenuate neuronal degeneration and improve neurological function after resuscitation acting on different pathophysiological pathways. Safety of both Xe and H2 after cardiac arrest has been reported in phase 1 clinical trials. A randomized phase 2 clinical trial showed the neuroprotective effects of Xe, combined with targeted temperature management. Xe inhalation for 24 h after resuscitation preserves white matter integrity as measured by fractional anisotropy of diffusion tensor MRI.

Summary
Inhaled gases, as Xe, Ar, NO, and H2 have consistently shown neuroprotective effects in experimental studies. Ventilation with these gases appears to be well tolerated in pigs and in preliminary human trials. Results from phase 2 and 3 clinical trials are needed to assess their efficacy in the treatment of postcardiac arrest brain injury.
The Epidemiology of Annular Pancreas in the United States
Authors: Alkhayyat Motasem , Bachour Salam , Abou Saleh Mohannad , Abureesh Mohammad , Almomani Ashraf , Simons-Linares C. Roberto , Mansoor Emad , Sandhu Dalbir , Bhatt Amit , Chahal Prabhleen 
Published: March 2021

Background and Aims:
Annular pancreas is a rare congenital condition where the second part of the duodenum is encircled by pancreatic tissue. There is a scarcity of data on its natural history therefore, we aimed to evaluate the epidemiology of annular pancreas and identify underlying associations using a large database.

Methods:
A multi-institutional database (Explorys) was surveyed. A cohort of patients with a Systematized Nomenclature of Medicine—Clinical Terms diagnosis of “MRI, CT, EUS and/or ERCP” between April 2015 and April 2020 was identified. Subsequently a cohort of patients with history of “annular pancreas” was identified.

Results:
There were a total of 40,075,980 individuals in the database with 6,162,600 (15.38%) who had an magnetic resonance imaging, computed tomography, endoscopic retrograde cholangiopancreatography, and/or endoscopic ultrasound. There were 210 (3.4/100,000) had a diagnosis of annular pancreas. When compared with the control group, patients with annular pancreas were more likely to have a history of alcohol use, smoking, acute pancreatitis, chronic pancreatitis, gastritis, duodenitis, jaundice, and gastrointestinal outlet obstruction.

Conclusions:
This is the largest study evaluating the epidemiology of annular pancreas. We found the estimated prevalence rate of annular pancreas to be 3.4/100,000 in those who had abdominal imaging. Annular pancreas was more likely to be diagnosed in patients with symptoms pertaining to acute or chronic pancreatitis, biliary, and gastric outlet obstruction.
End-of-Life Care in Taiwan: Single-Center Retrospective Study of Modes of Death*
Authors: Wu En-Ting , Wang Ching-Chia , Huang Shu-Chien , Chen Chieh-Ho , Jou Shiann-Tarng , Chen Yih-Charng , Wu Mei-Hwan , Lu Frank Leigh 
Published: March 2021

OBJECTIVES:
Medical advances and the National Health Insurance coverage in Taiwan mean that mortality in the PICU is low. This study describes change in modes of death and end-of-life care in a single center, 2011–2017.

SETTING:
Multidisciplinary PICU in a tertiary referral Children’s Hospital in Taiwan.

PATIENTS:
There were 316 deaths in PICU patients.

INTERVENTIONS:
Palliative care consultation in the PICU service occurred after the 2013 “Hospice Palliative Care Act” revision.

MEASUREMENTS AND MAIN RESULTS:
In the whole cohort, 22 of 316 patients (7%) were determined as “death by neurologic criteria”. There were 94 of 316 patients (30%) who had an event needing cardiopulmonary resuscitation within 24 hours of death: 17 of these patients (17/94; 18%) died after failed cardiopulmonary resuscitation without a do-not-resuscitate order, and the other 77 of 94 patients (82%) had a do-not-resuscitate order after cardiopulmonary resuscitation. Overall, there were 200 of 316 patients (63%) who had a do-not-resuscitate order and were entered into the palliative program: 169 of 200 (85%) died after life-sustaining treatment was limited, and the other 31 of 200 (15%) died after life-sustaining treatment was withdrawn. From 2011 to 2017, the time-trend in end-of-life care showed the following associations: 1) a decrease in PICU mortality utilization rate, from 22% to 7% (p < 0.001); 2) a decrease in use of catecholamine infusions after do-not-resuscitate consent, from 87% to 47% (p = 0.001), in patients having limitation in life-sustaining treatment; and 3) an increase in withdrawal of life-sustaining treatment, from 4% to 31% (p < 0.001).

CONCLUSIONS:
In our practice in a single PICU-center in Taiwan, we have seen that the integration of a palliative care consultation service, developed after the revision of a national “Palliative Care Act,” was associated with increased willingness to accept withdrawal of life-sustaining treatment and a lowered PICU care intensity at the end-of-life.
Mucosal immunity to severe acute respiratory syndrome coronavirus 2 infection
Authors: Fröberg Janeri , Diavatopoulos Dimitri A. 
Published: March 2021

Purpose of review
Despite its crucial role in protection against viral infections, mucosal immunity has been largely understudied in the context of coronavirus disease 2019 (COVID-19). This review outlines the current evidence about the role of mucosal immune responses in the clearance of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, as well as potential mucosal mechanisms of protection against (re-)infection.

Recent findings
The angiotensin-converting enzyme 2 cellular entry receptor for SARS-CoV-2 is most highly expressed in the upper respiratory tract and most SARS-CoV-2 shedding occurs from the upper respiratory tract. Viral shedding peaks early during infection around the onset of symptoms, before dropping rapidly in most individuals within 7 days of symptom onset, suggesting mucosal inhibition of viral infection. Serum and mucosal immunoglobulin G and immunoglobulin M responses were found to be strongly correlated in infected patients, whereas correlations were much weaker for immunoglobulin A (IgA). Mucosal IgA responses have been detected in infected cases in the absence of serum antibody responses, with mucosal antibody levels correlating strongly with virus neutralization. Bulk and single-cell RNA sequencing analysis of nasopharyngeal swabs and bronchoalveolar lavage samples of COVID-19 patients revealed the induction of mucosal chemokine and cytokine genes, complement pathways, Janus Kinase/Signal Transducer and Activator of Transcription signaling and cytotoxic T cells.

Summary
Although most clinical studies focus on antibodies and cellular immunity in peripheral blood, mucosal immune responses in the respiratory tract play a key role in the early restriction of viral replication and the clearance of SARS-CoV-2. Identification of mucosal biomarkers associated with viral clearance will allow monitoring of infection-induced immunity. Further studies are needed to understand how the systemic immunological endpoints measured in vaccination studies translate to mucosal protection against SARS-CoV-2 infection.
The returned traveler with neurologic manifestations: could my patient have a parasite?
Authors: Coyle Christina M. 
Published: March 2021

Purpose of review
The present review focuses on parasitic infections of the central nervous system (CNS) that can affect the international traveler.

Recent findings
The epidemiology of imported parasitic infections is changing and clinicians are treating increasing numbers of returned travelers with parasitic infections in the CNS with which they are not familiar.

Summary
The epidemiology, life cycle, clinical manifestations, diagnosis, and treatment of parasites that affect the CNS will be discussed.
Inpatient Versus Outpatient Operative Management of Isolated Facial Fractures
Authors: Ali Barkat , Choi EunHo Eunice , Barlas Venus , Morrell Nathan T. 
Published: March 2021

Background:
Patients with isolated facial fractures requiring operative fixation can be managed on an inpatient or outpatient basis. The goal of this study was to compare the safety of each approach using a large multi-institutional database.

Methods:
The American College of Surgeons’ National Surgical Quality Improvement Project was reviewed for facial fractures between 2005 and 2018. Groups were identified using inpatient and outpatient status as designated in the database. Patients who required additional procedures, concurrent procedures, or other emergency procedures were excluded. Descriptive statistics were used for group comparisons and logistic regression models were used to identify risk factors for complications.

Results:
We identified 4240 patients who underwent operative fixation of isolated facial fractures. The majority of these cases (67.9%) were done on an outpatient basis. Compared to those in the outpatient group, patients in the inpatient group were older, had more medical comorbidities, had higher wound class, and had higher American Society of Anesthesiologists class. Complication (5.9% versus 2.3%), reoperation (4.3% versus 1.7%), and readmission (5.7% versus 2.5%) rates were all higher in the inpatient group (P < 0.01). By logistic regression analysis, the odds ratios for complications, reoperation, and readmission were higher in the inpatient group. After adjusting for imbalanced preoperative patient characteristics, the increased risk of complications [odds ratio (OR) = 1.728, confidence interval (CI) 1.146–2.606, P = 0.01] and the increased risk of reoperation (OR = 2.302, CI 1.435–3.692, P = 0.01) in the inpatient group persisted, while the risk of readmission (OR = 1.684, CI 0.981–2.891, P = 0.06) no longer showed statistical significance between the inpatient and outpatient groups.

Conclusions:
Inpatient operative management of isolated facial fractures is associated with an increased risk of complications and a 2-fold increased risk of reoperation, though no increased risk of readmission.
Frontal Sinus Fractures: A Review on Etiology and Management Emphasizing Minimally Invasive and Endoscopic Techniques
Authors: Langlie Jake , Kim Minji , Thaller Seth R. 
Published: March 2021

Abstract
In spite of a long and tortuous history of the acute management of frontal sinus fractures, current optimal management remains steeped in controversy. These fractures are frequently produced by excessive forces and are often accompanied with other injuries. However, disruption of the nasofrontal duct persists as essential to maintain proper sinus function and should guide current management. Although there has never been any distinct procedure defining optimal outcomes, proper treatment is contingent on precise diagnosis culled from a complete history, physical examination, and imaging studies. This is further augmented by the surgeon's intraoperative findings. Reconstruction will ultimately rest on the degree of disruption of the anterior and posterior sinus walls, as well as the status and function of the nasofrontal ducts. For these reasons, current management continues to be challenging and evolving. Thus, this review will discuss the etiology and clinical presentation of frontal sinus fractures, the current complications arising in the subject, and the evolution of treatment options towards a more conservative and endoscopic approach to care.
A Composite Tissue Flap for Double-Eyelid Blepharoplasty in Asian Patients: A Retrospective Study
Authors: Fu Xiujun , Zhou Xianyu , Sun Di , Gu Chuan 
Published: March 2021

Abstract
Double-eyelid blepharoplasty, the procedure to create supratarsal crease, has been one of the most popular cosmetic operations in Asia for many years. This study aimed to assess the effectiveness and safety of a surgical procedure using a composite tissue flap for double-eyelid blepharoplasty. A surgical technique was introduced and patients having blepharoplasty with this technique from January 2017 to August 2019 were retrospectively studied. In this technique, a composite tissue flap consisted of the posterior septum and levator aponeurosis was formed and fixed with orbicularis oculi muscle and tarsus. The cosmetic outcomes, patient satisfaction, and complications from the documented medical records were analyzed. Eighty female and 1 male patients had blepharoplasty with the proposed technique and were followed up from 6 months to 42 months. Six patients were found to have mild blepharoptosis. As for cosmetic outcomes, 71patients were graded as good, 7 patients were graded as fair, and only 1 patient was graded as poor. Those patients who were not graded as good had visible scarring, shallow eyelid crease, or asymmetry. The overall patient satisfaction was as high as 95.1%. Mild hematoma formation occurred in 3 patients and no infection or blepharoptosis was observed. One patient complained of asymmetry and 2 patients complained of unilateral crease fading as the complications. The technique is effective to develop durable and natural-looking double eyelids with minimal complications. It could also be an option for mild ptotic patients who ask for double-eyelid blepharoplasty.