bluuebunny/crossref_metadata_2025_split huggingface dataset:
Botox Injections in Paraspinal Muscles Result in Low Maximal Specific Force and Shortening Velocity in Fast but Not Slow Skinned Muscle Fibers
Authors: Joumaa Venus , Boldt Kevin R. , Han Sang Kuy , Chun Keyoung Jin , Herzog Walter 
Published: July 2021

Study Design.
Basic science, experimental animal study.

Objective.
To determine the effects of Botulinum toxin type A (BTX-A) injections on the mechanical properties of skinned muscle fibers (cells) of rabbit paraspinal muscles.

Summary of Background Data.
BTX-A has been widely used in the treatment of disorders of muscle hyperactivity, such as spasticity, dystonia, and back pain. However, BTX-A injection has been shown to cause muscle atrophy, fat infiltration, and decreased force output in target muscles, but its potential effects on the contractile machinery and force production on the cellular level remain unknown.

Methods.
Nineteen-month-old, male New Zealand White Rabbits received either saline or BTX-A injections into the paraspinal muscles, equally distributed along the left and right sides of the spine at T12, L1, and L2 at 0, 8, 12, 16, 20, and 24 weeks. Magnetic resonance imaging was used to quantify muscle crosssectional area and structural changes before and at 28 weeks following the initial injection. Skinned fibers isolated from the paraspinal muscles were tested for their active and passive force-length relationships, unloaded shortening velocity, and myosin heavy chain isoforms.

Results.
BTX-A injections led to significant fat infiltration within the injected muscles and a greater proportion of IIa to IIx fibers. Isolated fast fibers from BTX-A injected animals had lower active force and unloaded shortening velocity compared with fibers from saline-injected control animals. Force and velocity properties were not different between groups for the slow fibers.

Conclusion.
Injection of BTX-A into the paraspinal rabbit muscles leads to significant alterations in the contractile properties of fast, but not slow, fibers.

Level of Evidence: N/A
Awake Regional Anesthesia for Upper Limb Orthopedic Surgery During the COVID-19 Pandemic: Tips, Tricks, and Results
Authors: Chui Karen , Hashem Medhat , Ahad Nurul , Kapoor Akhil , Mazis Georgios , Chin Kuen Foo 
Published: July 2021

Background:
The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which causes COVID-19 illness, is mainly transmitted because of close contact with respiratory droplets and airborne particles. Aerosol-generating procedures during general anesthesia can increase the risk of COVID-19 transmission. An effective alternative to general anesthesia for upper limb orthopedic surgery is regional anesthesia (RA) using brachial plexus block.

Materials and Methods:
Seventy-eight patients who received a brachial plexus block for upper limb trauma and elective operations before and during the COVID-19 pandemic, from 2017 to 2020, were included in this study. A protocol was devised for patient positioning, draping and equipment positioning for each location group—shoulder and upper arm; elbow and forearm; and distal extremities.

Results:
RA was effective for upper limb surgery in 77 of 78 (98.7%) patients. Sixty-five patients (83.3%) were discharged the same day, with the average time from leaving the operating theater to discharge from hospital of 2.8 hours. No postoperative complications were recorded, and no patient nor staff member contracted COVID-19 infection 2 weeks after the operation.

Conclusion:
We demonstrate the efficacy of awake RA for upper limb orthopedic procedures. We share our tips and tricks for implementing this into clinical practice and discuss the specific advantages of RA in the context of the COVID-19 global pandemic.
The Ilizarov Fixator: A Treatment for Relapsed Clubfoot, an Observational Study
Authors: Najafi Arvin , Seif Ehsan , Azarsina Salman , Baghdadi Taghi , Zareie Mohammad 
Published: July 2021

Purpose:
The Clubfoot, or the Congenital Talipes Equinovarus, is the most common congenital orthopedic disease, with 1 or 2 cases reported per 1000 live births. The purpose of this study is to assess the efficacy of the treatment of the complex equinovarus deformity of the feet, using the Ilizarov technique.

Materials and Methods:
In a prospective case series study from January 2012 to April 2016, 32 patients (35 feet) with rigid and complicated club feet have been included. The Ilizarov technique was applied in order to treat the mentioned deformity. These patients had no other congenital anomalies or systemic diseases. Outcomes were evaluated using the International Clubfoot Study Group (ICFSG) scoring system.

Results:
All of the patients were between 8 and 14 years of age, with the mean age of 10.9 years old. The mean of preoperative ICFSG score, morphological score, functional score, and radiologic score were 21.25±7, 6.2±2.4, 13.6±3.2, and 6.8±3.6, respectively. The postoperative mentioned scores were 11.88±6.18, 3.4±1.8, 4.7±2.1, and 3.8±1.9, respectively. The difference in the ICFSG scores before and after treatment was statistically significant (P=0.001).

Conclusion:
The Ilizarov technique can be considered as an efficient and successful treatment for recurrent or neglected clubfoot deformities, since it has provided satisfactory results.
Awake Venovenous Extracorporeal Membrane Oxygenation for Coronavirus Disease 2019 Acute Respiratory Failure
Authors: Assanangkornchai Nawaporn , Slobod Douglas , Qutob Rayan , Tam May , Shahin Jason , Samoukovic Gordan 
Published: July 2021

OBJECTIVES:
Implantation of venovenous extracorporeal membrane oxygenation as an alternative to invasive mechanical ventilation, an “awake approach,” may facilitate a lung- and diaphragm-protective ventilatory strategies without the associated harms of endotracheal intubation, positive pressure ventilation, and continuous sedation. This report presents the characteristics and outcomes of the patients treated with the awake venovenous extracorporeal membrane oxygenation approach.

DESIGN:
Retrospective case series.

SETTING:
Monocenter study.

PATIENTS:
Severe acute respiratory syndrome coronavirus 2 patients with acute respiratory failure treated with venovenous extracorporeal membrane oxygenation instead of invasive mechanical ventilation from March 2020 to March 2021.

INTERVENTIONS:
None.

MEASUREMENTS AND MAIN RESULTS:
Physiologic and laboratory data were collected at admission to the ICU, prior to and after venovenous extracorporeal membrane oxygenation implantation, and at decannulation. Seven patients were treated with venovenous extracorporeal membrane oxygenation instead of invasive mechanical ventilation due to hypoxemia with a median Pao
2/Fio
2 ratio at implantation of 76 (interquartile range, 59–92). Four patients in the awake group subsequently required invasive mechanical ventilation, and only one patient (14.3%) died. There were no significant complications attributed venovenous extracorporeal membrane oxygenation.

CONCLUSIONS:
This report demonstrates that in a selected group of patients, an “awake” venovenous extracorporeal membrane oxygenation approach is feasible and may result in favorable outcomes.
Retained Placenta Creta After Selective Fetal Reduction in Twin Pregnancy: A Case Report
Authors: Zheng Weiran , Yang Xinrui , Zhu Yuchun , Yan Jie , Yang Huixia 
Published: July 2021

Abstract
Placenta accreta spectrum (PAS) disorders are severe obstetric complications and can cause life-threatening hemorrhage, hysterectomy, or even death. PAS disorders in one of dichorionic diamniotic twins are rare to be seen in clinical practice and lack of standard management strategies. We reported a case of retained placenta creta after selective fetal reduction in one of dichorionic diamniotic twins. A 32-year-old woman with a history of cesarean section was diagnosed with placenta increta in one of dichorionic diamniotic twins at 16  weeks of gestation. After discussion, the couple required to be hospitalized for selective fetal reduction. She received selective termination by ultrasound-guided single fetal intracardiac injection of potassium chloride. The follow-up prenatal ultrasound examinations detected the placenta of the reduced fetus did not stop invade the myometrium of the uterus but developed from placenta increta to placenta percreta. The patient was diagnosed with placental percreta by prenatal ultrasound signs and surgical findings. The patient underwent scheduled cesarean delivery at 34+5 gestational weeks. The outcome of maternal and fetal was satisfactory for our elaborate operation and optimal management. PAS disorders are severe obstetric complications with an increasing incidence. Combined with twin pregnancy makes PAS disorders more intractable. We should learn that selective fetal reduction probably cannot solve it thoroughly. Intensive and standard management is essential to promote maternal and fetal outcomes.
Evaluation of Dual-port versus Single-port Tissue Expanders in Postmastectomy Breast Reconstruction
Authors: Parmeshwar Nisha , Piper Merisa , Viner Jennifer , Foster Robert , Kim Esther A. 
Published: July 2021

Background
Immediate tissue expander placement in postmastectomy breast reconstruction can be complicated by seroma or infection, requiring further imaging studies or interventions. This study compares dual-port tissue expanders, with both an aspiration and expansion port, with single-port expanders in terms of postoperative complications and further interventions.

Methods:
Patients with immediate tissue expander placement from March 2019 to March 2020 were reviewed. Complications included seroma, infection, hematoma, necrosis, and malposition of the expander. Further intervention included aspiration, ultrasound imaging, interventional radiology (IR) drainage, or return to operating room.

Results:
In total, 128 dual-port expanders were compared with 125 single-port expanders. Patients with single-port expanders were younger (P = 0.022) and of lower BMI (P = 0.01). There were no significant differences in key complications between these groups. In multivariate analysis, single-port expanders had a 3.4× higher odds of postoperative ultrasound imaging when controlling for texture, placement, and age (P = 0.01). Mean time to IR drain placement in the dual-port group was approximately 30 days after placement in single port (51.1 versus 21.4 days, P = 0.013). Thirty-four percent of dual-port expanders had at least one aspiration in clinic performed by plastic surgery, versus 2% of single port that required ultrasound-guided aspiration (P < 0.001).

Conclusions:
There were no differences in key postoperative complications between the two expander cohorts. Dual-port expanders significantly reduced postoperative ultrasound imaging, and delayed IR drain placement. The added convenience of clinic aspirations likely reduced costs related to utilization of resources from other departments.
Contraception use among HIV-positive women attending ART clinic: a cross-sectional study in Halibet Referral Hospital
Authors: Idris Idris M. , Wolday Samuel J. , Hassan Diyae N. , Tekle Luwam R. , Yemane Luna , Ahferom Saron , Andemariam Million 
Published: July 2021

Background:
Providing preferred methods of contraceptive for human immunodeficiency virus (HIV)-positive women and avoiding unintended pregnancy is one of the primary means of preventing mother to child transmission of HIV. This study assessed the prevalence of contraceptive use and method preference among HIV-positive women in Halibet Referral Hospital, Asmara, Eritrea.

Patients and methods:
A descriptive and analytical cross-sectional study was conducted among HIV-positive women in Halibet Referral Hospital, Asmara. Data were collected by interviewing HIV-positive women using a pretested and structured questionnaire. A binary logistic regression model was used to identify factors associated with contraceptive use, and odd ratio with 95% confidence interval was calculated to measure the strength of association.

Results:
A total of 196 women living with HIV were interviewed. The mean age of the study participants was 39.1 years (SD±6 y). The prevalence of current contraceptive use was 16.8%. The preferred and most commonly used contraceptive methods were male condom (45.5%) and injectable (36.4%). Younger age [adjusted odds ratio: 1.6 (1.1, 7.8), P=0.04], Married [adjusted odds ratio: 2.1 (1.4, 7.7), P=0.001], having more than 4 child [1.5 (1.1, 9.3), P=0.03], contraception counselling [1.8 (1.1, 5.4), P=0.02] were the only factors influencing contraception use.

Conclusion:
Utilization of contraceptives among the participants was low (16.8%). Being young, married, regularly counselled about contraceptives, and having more than 4 children were factors facilitating contraceptive use. Policy makers should design counselling programs to increase utilization of contraceptives among HIV positive women.
Transcatheter treatment of severe tricuspid regurgitation
Authors: Gupta Tanush , Wyler von Ballmoos Moritz C. , Goel Sachin S. 
Published: July 2021

Purpose of review
Severe tricuspid regurgitation is a commonly prevalent valvular heart disease that is an independent adverse prognostic marker. However, the majority of patients with tricuspid regurgitation are managed medically; isolated tricuspid valve surgery is rarely performed, partly owing to high associated in-hospital mortality. Therefore, several transcatheter tricuspid valve interventions (TTVIs) that have been developed over the last few years to address this unmet clinical need.

Recent findings
The early experience with TTVI has shown that most devices can be safely implanted with excellent rates of technical success and acceptable safety outcomes. Most TTVI recipients have significant improvement in tricuspid regurgitation severity, functional class, and quality of life. Recent retrospective data also suggest mortality benefit of TTVI compared with medical management. There are several issues that need to be addressed prior to widespread adoption of TTVI, including more effective tricuspid regurgitation reduction and need for longer term efficacy data.

Summary
TTVI has emerged as an attractive treatment option for management of high-risk patients with tricuspid regurgitation. In this review, we will discuss the anatomical considerations specific to tricuspid valve, patient selection, preprocedure planning, and summarize the current evidence and future perspectives on TTVI.
The cardiac surgeon's guide to artificial intelligence
Authors: Nedadur Rashmi , Wang Bo , Yanagawa Bobby 
Published: July 2021

Purpose of review
Artificial intelligence is the ability for machines to perform intelligent tasks. Artificial intelligence is already penetrating many aspects of medicine including cardiac surgery. Here, we offer a platform introduction to artificial intelligence for cardiac surgeons to understand the implementations of this transformative tool.

Recent findings
Artificial intelligence has contributed greatly to the automation of cardiac imaging, including echocardiography, cardiac computed tomography, cardiac MRI and most recently, in radiomics. There are also several artificial intelligence based clinical prediction tools that predict complex outcomes after cardiac surgery. Waveform analysis, specifically, automated electrocardiogram analysis, has seen significant strides with promise in wearables and remote monitoring. Experimentally, artificial intelligence has also entered the operating room in the form of augmented reality and automated robotic surgery.

Summary
Artificial intelligence has many potential exciting applications in cardiac surgery. It can streamline physician workload and help make medicine more human again by placing the physician back at the bedside. Here, we offer cardiac surgeons an introduction to this transformative tool so that they may actively participate in creating clinically relevant implementations to improve our practice.
Time-temperature Thresholds and Safety Factors for Thermal Hazards from Radiofrequency Energy above 6 GHz
Authors: Foster Kenneth R. , Ziskin Marvin C. , Balzano Quirino 
Published: July 2021

Abstract
Two major sets of exposure limits for radiofrequency (RF) radiation, those of the International Commission on Nonionizing Radiation Protection (ICNIRP 2020) and the Institute of Electrical and Electronics Engineers (IEEE C95.1–2019), have recently been revised and updated with significant changes in limits above 6 GHz through the millimeter wave (mm-wave) band (30–300 GHz). This review compares available data on thermal damage and pain from exposure to RF energy above 6 GHz with corresponding data from infrared energy and other heat sources and estimates safety factors that are incorporated in the IEEE and ICNIRP RF exposure limits. The benchmarks for damage are the same as used in ICNIRP IR limits: minimal epithelial damage to cornea and first-degree burn (erythema in skin observable within 48 h after exposure). The data suggest that limiting thermal hazard to skin is cutaneous pain for exposure durations less than ≈20 min and thermal damage for longer exposures. Limitations on available data and thermal models are noted. However, data on RF and IR thermal damage and pain thresholds show that exposures far above current ICNIRP and IEEE limits would be required to produce thermally hazardous effects. This review focuses exclusively on thermal hazards from RF exposures above 6 GHz to skin and the cornea, which are the most exposed tissues in the considered frequency range.
Artificial intelligence-based predictions in neovascular age-related macular degeneration
Authors: Ferrara Daniela , Newton Elizabeth M. , Lee Aaron Y. 
Published: July 2021

Purpose of review
Predicting treatment response and optimizing treatment regimen in patients with neovascular age-related macular degeneration (nAMD) remains challenging. Artificial intelligence-based tools have the potential to increase confidence in clinical development of new therapeutics, facilitate individual prognostic predictions, and ultimately inform treatment decisions in clinical practice.

Recent findings
To date, most advances in applying artificial intelligence to nAMD have focused on facilitating image analysis, particularly for automated segmentation, extraction, and quantification of imaging-based features from optical coherence tomography (OCT) images. No studies in our literature search evaluated whether artificial intelligence could predict the treatment regimen required for an optimal visual response for an individual patient. Challenges identified for developing artificial intelligence-based models for nAMD include the limited number of large datasets with high-quality OCT data, limiting the patient populations included in model development; lack of counterfactual data to inform how individual patients may have fared with an alternative treatment strategy; and absence of OCT data standards, impairing the development of models usable across devices.

Summary
Artificial intelligence has the potential to enable powerful prognostic tools for a complex nAMD treatment landscape; however, additional work remains before these tools are applicable to informing treatment decisions for nAMD in clinical practice.
Clinical and histopathological findings in the dead bag syndrome
Authors: Culp Catherine , Qu Phillip , Jones Jason , Fram Nicole , Ogawa Gregory , Masket Samuel , Mamalis Nick , Werner Liliana 
Published: July 2021

Purpose:
To describe the findings of a recently described syndrome, the dead bag syndrome, in which the capsular bag appears to be clear many years postoperatively, becoming diaphanous and floppy and unable to support the intraocular lens (IOL) within it.

Setting:
John A. Moran Eye Center, University of Utah, Salt Lake City, Utah.

Design:
Case series with clinicopathological correlation.

Methods:
Of 10 cases suspected to represent a dead bag syndrome, 8 IOLs and 7 capsular bags were removed because of subluxation or dislocation. The 7 capsular bags available for analysis were fixed in formalin and submitted to histopathological examination (hematoxylin–eosin and Masson trichrome stains). The associated explanted IOLs in 5 cases were also examined microscopically.

Results:
Histopathologic examination of the 7 capsular bags showed capsular thinning and/or splitting. Lens epithelial cells (LECs) were completely absent on 2 specimens, whereas the other 5 specimens had rare LECs on the inner surface of the capsule. Explanted IOLs were 3-piece silicone IOLs or single-piece hydrophobic acrylic IOLs. 1 IOL optic showed a small amount of granular pigment deposition, but the optics of the other 4 IOLs were unremarkable.

Conclusions:
In this syndrome, there seems to be an absence of secondary proliferation of LECs and fibrotic changes. The capsule shows some signs of degradation, such as thinning and/or splitting. Weakness of zonular attachments seems to be an associated finding, with subsequent in-the-bag IOL dislocation. Further studies are necessary to ascertain the etiology of this condition.
Evaluating the stability of opioid efficacy over 12 months in patients with chronic noncancer pain who initially demonstrate benefit from extended release oxycodone or hydrocodone: harmonization of Food and Drug Administration patient-level drug safety study data
Authors: Farrar John T. , Bilker Warren B. , Cochetti Philip T. , Argoff Charles E. , Haythornthwaite Jennifer , Katz Nathaniel P. , Gilron Ian 
Published: July 2021

Abstract:
Opioids relieve acute pain, but there is little evidence to support the stability of the benefit over long-term treatment of chronic noncancer pain. Previous systematic reviews consider only group level published data which did not provide adequate detail. Our goal was to use patient-level data to explore the stability of pain, opioid dose, and either physical function or pain interference in patients treated for 12 months with abuse deterrent formulations of oxycodone and hydrocodone. All available studies in the Food and Drug Administration Document Archiving, Reporting, and Regulatory Tracking System were included. Patient-level demographics, baseline data, exposure, and outcomes were harmonized. Individual patient slopes were calculated from a linear model of pain, physical function, and pain interference to determine response over time. Opioid dose was summarized by change between baseline and the final month of observation. Patients with stable or less pain, stable or lower opioid dose, and stable or better physical function (where available) met our prespecified criteria for maintaining long-term benefit from chronic opioids. Of the complete data set of 3192 patients, 1422 (44.5%) maintained their pain level and opioid dose. In a secondary analysis of 985 patients with a measured physical function, 338 (34.3%) maintained their physical function in addition to pain and opioid dose. Of 2040 patients with pain interference measured, 788 (38.6%) met criteria in addition. In a carefully controlled environment, about one-third of patients successfully titrated on opioids to treat chronic noncancer pain demonstrated continued benefit for up to 12 months.