bluuebunny/crossref_metadata_2025_split huggingface dataset:
Immediate Pneumothorax Diagnosis by Surgical Residents Using Portable Ultrasound
Authors: Bar Alon , Lin Guy , Lazar Li Or , Blanka-Deak Judit , Khalayleh Harbi , Pines Guy 
Published: January 2021

Objective Feasibility of diagnosis of pneumothorax using handheld ultrasound by non-radiologists shows inconsistent results. The aim of this study is to evaluate the feasibility and accuracy of portable ultrasound for immediate diagnosis of pneumothorax by general surgery residents who underwent short training. Methods Patients who presented to the emergency department of a university hospital with suspected pneumothorax between 10/2018 and 12/2019 were included in the study. Patients underwent ultrasound in 2 points of each hemithorax. Sensitivity and specificity for pneumothorax diagnosis by ultrasound and physical examination were calculated and compared with chest computed tomography (CT). Patients in whom a chest tube was placed prior to ultrasound examination and those who did not undergo a CT scan were excluded from the study. Results A total of 85 patients met the inclusion criteria. Mean age was 40.7 ± 20.2 years. Pneumothorax was found among 46 patients (54%) per chest CT, and of these, 21 (46%) underwent chest tube placement following imaging. Ultrasound showed the highest sensitivity and specificity (95.6% [95% confidence interval {CI} 85.16% to 99.47%] and 97.44% [95% CI 86.40% to 99.67%], respectively). Chest x-ray had the lowest sensitivity (47.8% [95% CI 32.89% to 63.05%]) for pneumothorax detection. Physical examination showed a moderate sensitivity and specificity (82.6% [95% CI 68.58% to 92.18%] and 77.89% [95% CI 60.67% to 88.87%], respectively) for the diagnosis of pneumothorax. Conclusions We found high accuracy rates of 2-point ultrasound in immediate pneumothorax diagnosis when performed by surgical residents who underwent a short ultrasound training. This is a fast and repeatable test, and has the potential for successful implementation in prehospital and military scenarios as well, minimizing unnecessary chest tube placements.
Endovascular electrothrombosis: A promising alternative for basilar artery perforator aneurysm treatment
Authors: Ma Hongyu , Zhao Rui , Fang Yibin , Li Qiang , Yang Pengfei , Huang Qinghai , Xu Yi , Hong Bo , Liu Jian-Min 
Published: January 2021

Background Basilar artery perforator aneurysms (BAPAs) are rare. Traditional surgical clipping and endovascular coiling have proven to be challenging. We present three patients treated with endovascular electrothrombosis and describe the characteristics of this new approach. Methods Three patients presented with subarachnoid hemorrhages (SAHs). Cerebral angiography identified BAPAs. Endovascular electrothrombosis was performed after obtaining informed consent. We placed the microwire into the sac of the aneurysms through the microcatheter and connected its proximal tip to the Solitaire stent detachment system. Electrothrombosis was conducted using 1.0 mA current. Results Two aneurysms were successfully occluded without treatment-related complication. The third one failed and converted to endovascular coiling using a 1.3-F microcatheter. The patient suffered brainstem infarction and finally died of severe SAH. At follow-up, the two patients were neurologically intact and angiography showed total occlusion of both aneurysms. Conclusion Endovascular electrothrombosis might be a potential alternative to traditional treatment for BAPAs. Close follow-up with caution should be mandatory. More research is needed to confirm its safety and efficacy.
Triglyceride-glucose index is associated with early neurological deterioration in single subcortical infarction: Early prognosis in single subcortical infarctions
Authors: Nam Ki-Woong , Kang Min K , Jeong Han-Yeong , Kim Tae J , Lee Eung-Joon , Bae Jeonghoon , Jeon Kipyoung , Jung Keun-Hwa , Ko Sang-Bae , Yoon Byung-Woo 
Published: January 2021

Background The research about the influence of triglyceride-glucose index on early prognosis in stroke is lacking. Aims In this study, we evaluated the association between triglyceride-glucose index and early neurological deterioration in patients with single subcortical infarctions. Methods Consecutive patients with single subcortical infarctions within 72 h of symptom onset between 2011 and 2015. Early neurological deterioration was defined as an increase of ≥2 in the total NIHSS score or ≥1 in the motor NIHSS score. The triglyceride-glucose index was calculated using the log scale of fasting triglyceride (mg/dL) × fasting glucose (mg/dL)/2. Results A total of 305 patients with single subcortical infarctions were evaluated. In multivariable analysis, the triglyceride-glucose index (adjusted odds ratio [aOR] = 2.94, 95% confidence interval [CI] = 1.58–5.45) and age (aOR = 1.05, 95% CI = 1.01–1.09) were associated with early neurological deterioration. In subgroup analysis according to the type of single subcortical infarctions, only patients with proximal single subcortical infarctions showed a significant association between the triglyceride-glucose index and early neurological deterioration (aOR = 2.92, 95% CI = 1.35–6.29). On the other hand, there was no statistical significance in patients with distal single subcortical infarctions. Patients with untreated diabetes also showed the close association between the triglyceride-glucose index and early neurological deterioration (aOR = 3.94, 95% CI = 1.47–10.52). Conclusions The triglyceride-glucose index was associated with early neurological deterioration in single subcortical infarctions. This association differed depending on the location of lesion and the presence of untreated diabetes.
Outcomes of 173 metacarpal and phalangeal fractures treated by intramedullary headless screw fixation with a 4-year follow-up
Authors: Poggetti Andrea , Fagetti Alessandro , Lauri Giulio , Cherubino Mario , Borelli Pier P. , Pfanner Sandra 
Published: January 2021

Surgical treatment of extra-articular metacarpal and phalangeal fractures should be considered when there is instability or in patients with high demand. To overcome the issues related to the use of Kirschner wires, external fixators, and open reduction and internal fixation procedures, intramedullary headless screw fixation (IHSF) is an alternative technique to achieve primary fracture stability and early return to daily activities. We report the data of the Italian Multicentric Intra-Medullary Experience, which includes 173 cases of extra-articular unstable fractures (38 phalanges and 135 metacarpals) treated with the IHSF. After surgery, patients underwent early mobilization without splinting. The results confirm the reliability of IHSF in cases with non-articular involvement, showing a good recovery rate in terms of bone healing and range of motion. Level of evidence: IV
Real-world comparative safety and efficacy of tenecteplase versus alteplase in acute ischemic stroke patients with large vessel occlusion
Authors: Psychogios Klearchos , Palaiodimou Lina , Katsanos Aristeidis H. , Magoufis Georgios , Safouris Apostolos , Kargiotis Odysseas , Spiliopoulos Stavros , Papageorgiou Ermioni , Theodorou Aikaterini , Voumvourakis Konstantinos , Broutzos Elias , Stamboulis Elefterios , Tsivgoulis Georgios 
Published: January 2021

Background and aims: Tenecteplase has recently emerged as an alternative thrombolytic agent in acute ischemic stroke (AIS) patients with large vessel occlusion (LVO), possibly superior in achieving early reperfusion compared with alteplase. We aimed to compare the safety and efficacy of intravenous tenecteplase with intravenous alteplase for AIS patients with LVO in everyday clinical practice settings. Methods: We prospectively evaluated patients with AIS due to LVO, treated with intravenous thrombolysis (IVT) with or without mechanical thrombectomy in two tertiary stroke centers. Patients were treated with standard-dose alteplase (0.9 mg/kg) or 0.25 mg/kg tenecteplase. Safety outcomes included prevalence of symptomatic intracranial hemorrhage (sICH) and mortality. Efficacy outcomes included averted thrombectomy, major neurological improvement at 24 h (defined as decrease in baseline NIHSS score of 8 points or greater) and functional status on discharge and on 3 months assessed by modified Rankin Scale (mRS). Results: Nineteen AIS patients with LVO received tenecteplase and 39 received alteplase. We observed a non-significant higher rate of averted thrombectomies (32% versus 18%, p = 0.243) and a non-significant higher rate of sICH (16% versus 5%, p = 0.201) in the tenecteplase group. The rate of 24 h major neurological improvement was higher in the tenecteplase group (64% versus 33%, p = 0.046) but this was marginally attenuated in multivariable analyses (adjusted OR 10.22, 95% CI: 0.73–142.98; p = 0.084). Discharge mRS, 3-months mRS, and 3-month functional independence (mRS scores of 0–2) did not differ ( p > 0.2) between the two groups. The rates of 3-month mortality (11% versus 18%, p = 0.703) were similar in the two groups. No independent association between thrombolytic agent and safety or efficacy outcomes emerged in multivariable regression analyses. Conclusion: The present pilot observational study highlights that AIS patients with LVO treated with 0.25 mg/kg bolus administration of tenecteplase had increased likelihood to achieve early neurological improvement compared with AIS patients treated with alteplase, but this association was attenuated after adjustment for potential confounders. There were no significant differences in 3-month functional or safety outcomes between the two groups. This preliminary real-world observation requires independent confirmation in larger, multicenter studies.
An Interactive Web Application for the Statistical Analysis of Continuous Glucose Monitoring Data in Epidemiological Studies
Authors: De Livera Alysha M. , Shaw Jonathan E. , Cohen Neale , Reutens Anne , Salim Agus 
Published: January 2021

Motivation: Continuous glucose monitoring (CGM) systems are an essential part of novel technology in diabetes management and care. CGM studies have become increasingly popular among researchers, healthcare professionals, and people with diabetes due to the large amount of useful information that can be collected using CGM systems. The analysis of the data from these studies for research purposes, however, remains a challenge due to the characteristics and large volume of the data. Results: Currently, there are no publicly available interactive software applications that can perform statistical analyses and visualization of data from CGM studies. With the rapidly increasing popularity of CGM studies, such an application is becoming necessary for anyone who works with these large CGM datasets, in particular for those with little background in programming or statistics. CGMStatsAnalyser is a publicly available, user-friendly, web-based application, which can be used to interactively visualize, summarize, and statistically analyze voluminous and complex CGM datasets together with the subject characteristics with ease.
Hallux Varus Correction With Extensor Hallucis Longus Tendon Transfer and Reverse Scarf Osteotomy
Authors: Koh Don Thong Siang , Chong Keen Wai , Yeo Nicholas Eng Meng 
Published: January 2021

Introduction Hallux varus is the medial deviation of the hallux. Although rare, it can cause discomfort, functional weakness, difficulty with shoe wear, and dissatisfactory cosmesis. This study reports 3 cases of hallux varus treated using extensor hallucis longus (EHL) tendon transfer with or without the use of reverse scarf osteotomy (RSO). Methods This cases series studies the technique of using EHL tendon transfer and the role for RSO in the surgical correction of hallux varus. Indication for RSO included osseous overcorrection in the index hallux valgus surgery or as an adjunct when EHL tendon transfer alone was unable to restore alignment. Patients were followed-up for 24 months and their postoperative outcomes were recorded. Results All patients were female between the ages 55 to 67 years. Radiological parameters after surgery improved in all patients. The mean hallux-valgus angle was corrected from −23.7 ± 3.5° to −3.2 ± 2.0° postoperatively ( P < .05). Intermetatarsal angle was increased from 5.0 ± 1.9° to 6.7 ± 1.0° ( P = .065). Distal metatarsal articular angle improved from −28.9 ± 7.6° to −7.8 ± 3.7° ( P < .05). Mean American Orthopaedic Foot and Ankle Society scores improved from 37 ± 24 to 75 ± 9 ( P = .064) at 24 months. In addition, visual analogue scale pain scores reduced from 5 ± 1.5 to 1 ± 1 ( P < .05). All patients reported being satisfied with the procedure, and no complications were reported at 24 months after surgery. Conclusion Hallux varus correction using EHL tendon transfer with or without RSO appears to provide satisfactory results at 24 months. Levels of Evidence Level V: Expert opinion, Techniques
Relationship Between the Lateral Plantar Artery and the Retrograde Intramedullary Nail During Tibiotalar and Subtalar Arthrodesis: A Fresh Cadaveric Study
Authors: Tonogai Ichiro , Tsuruo Yoshihiro , Sairyo Koichi 
Published: January 2021

Background Tibiotalocalcaneal (TTC) arthrodesis with retrograde intramedullary nailing has become established. Iatrogenic injury to the vasculature (eg, lateral plantar artery [LPA] pseudoaneurysm) during insertion of the nail has been reported. The aim of this study was to identify the safe zone that avoids injury to the LPA during TTC arthrodesis. Methods The retrograde lateral curved nail entry point should be in line with the midpoint of the tibial medullary canal and the lateral column of the calcaneus. Enhanced 3-dimensional computed tomography scans of 26 fresh cadaveric feet were assessed. The closest distance between the LPA and the edge of the nail entry point was measured in the plantar view. Results The closest mean distance between the LPA and the edge of the nail entry point was 6.7 mm for all 26 feet, 12.8 mm for 3 feet (11.5%) in which the LPA did not cross the medial wall of the calcaneus, 8.1 mm for 9 (34.1%) in which the point where the LPA crossed the medial wall of the calcaneus was anterior to the center of the nail entry point, and 4.2 mm for 14 (53.8%) feet in which this point was posterior to the center of the nail entry point. Conclusions Care should be taken to avoid the LPA during reaming at the nail entry point, especially when the point where the LPA crosses the medial wall of the calcaneus is posterior to the center of the nail entry point. Levels of Evidence: IV, cadaveric study
Early Hydromyelia as a Rare Complication of Tuberculous Meningitis
Authors: Ghavami Kimia , Chen Tychicus 
Published: January 2021

Syringomyelia is an uncommon late complication of tuberculous meningitis with a latency period of up to 18 years. Acute hydromyelia is exceedingly rare with few case reports occuring within the first 6 weeks. We present a case and magnetic resonance imaging of a 38-year-old immunocompetent woman with this rare complication of early hydromyelia due to tuberculous meningitis which responded to ventriculoperitoneal shunting, highlighting that early detection and treatment may improve prognosis.
Infrapatellar Fat Pads–Derived Stem Cell Is a Favorable Cell Source for Articular Cartilage Tissue Engineering: An In Vitro and Ex Vivo Study Based on 3D Organized Self-Assembled Biomimetic Scaffold
Authors: Wang Chen-Chie , Chen Ing-Ho , Yang Ya-Ting , Chen Yi-Ru , Yang Kai-Chiang 
Published: January 2021

Objective Adipose tissue–derived stem cells (ASCs) are a promising source of cells for articular cartilage regeneration. However, ASCs isolated from different adipose tissue depots have heterogeneous cell characterizations and differentiation potential when cultured in 3-dimensional (3D) niches. Design We compared the chondrogenicity of ASCs isolated from infrapatellar fat pads (IPFPs) and subcutaneous fat pads (SCFPs) in 3D gelatin-based biomimetic matrix. Results The IPFP-ASC-differentiated chondrocytes had higher ACAN, COL2A1, COL10, SOX6, SOX9, ChM-1, and MIA-3 mRNA levels and lower COL1A1 and VEGF levels than the SCFP-ASCs in 3D matrix. The difference in mRNA profile may have contributed to activation of the Akt, p38, RhoA, and JNK signaling pathways in the IPFP-ASCs. The chondrocytes differentiated from IPFP-ASCs had pronounced glycosaminoglycan and collagen type II production and a high chondroitin-6-sulfate/chondroitin-4-sulfate ratio with less polymerization of β-actin filaments. In an ex vivo mice model, magnetic resonance imaging revealed a shorter T2 relaxation time, indicating that more abundant extracellular matrix was secreted in the IPFP-ASC–matrix group. Histological examinations revealed that the IPFP-ASC matrix had higher chondrogenic efficacy of new cartilaginous tissue generation as evident in collagen type II and S-100 staining. Conclusion. ASCs isolated from IPFPs may be better candidates for cartilage regeneration, highlighting the translational potential of cartilage tissue engineering using the IPFP-ASC matrix technique.
Joint Surface Lesions in the Knee Treated with an Acellular Aragonite-Based Scaffold: A 3-Year Follow-Up Case Series
Authors: Van Genechten Wouter , Vuylsteke Kristien , Struijk Caroline , Swinnen Linus , Verdonk Peter 
Published: January 2021

Objective The study aimed to evaluate the clinical outcome and repair capacity of a cell-free aragonite-based scaffold in patients with an isolated symptomatic joint surface lesion (JSL) of the knee. Design Thirteen patients (age 33.5 ± 8.9; female 23%; body mass index 25.3 ± 3.4, K/L [Kellgren-Lawrence] 1.8) with a JSL (2.6 ± 1.7 cm2 [1.0-7.5 cm2]) of the distal femur were enrolled in a single-center prospective case series. Safety and clinical outcome was assessed by the KOOS (Knee Injury and Osteoarthritis Outcome Score), IKDC (International Knee Documentation Committee), Lysholm, and Tegner activity scale at baseline and 6, 12, 18, 24, and 36 months follow-up. The MOCART 2.0 and scaffold integration were evaluated on magnetic resonance imaging at 12, 24, and 36 months postoperatively. Results Primary outcome (KOOS pain) improved with 36.5 ± 14.7 points at 12 months ( P = 0.002) and 41.2 ± 14.7 points at 36 months ( P = 0.002) follow-up. Similar increasing trends were observed for the other KOOS subscales, IKDC, and Lysholm score, which were significantly better at each follow-up time point relative to baseline ( P < 0.05). Activity level increased from 2.75 ± 1.6 to 4.6 ± 2.2 points at final follow-up ( P = 0.07). The MOCART was 61.7 ± 12.6 at 12 months and 72.9 ± 13.0 at 36 months postoperatively. Sixty-six to 100% implant integration and remodeling was observed in 73.3% cases at 36 months. No serious adverse events were reported. Conclusion The study demonstrated that the biphasic aragonite-based scaffold is a safe and clinically effective implant for treating small-medium sized JSLs of the distal femur in a young and active patient cohort. The implant showed satisfying osteointegration and restoration of the osteochondral unit up to 3 years postimplantation.
Knowledge and attitudes of Vietnamese high school students towards cardiopulmonary resuscitation: Results from a pilot student-led cross-country bystander training workshop
Authors: Yeow Marcus Wei Xuan , Ng Julia Yu Xin , Nguyen Van Hinh , Quan Anh Dung , Le Huyen Trang , Nguyen Thi Nga , Le Anh Tuan , Li Zisheng , Tang Jonathan Zhe Ying , Koh Dow Rhoon , Hwang Jeff Yi-Fu 
Published: January 2021

Objectives: This is a first-of-its-kind cross-country collaboration between medical students from Singapore and Vietnam in conducting a cardiopulmonary resuscitation (CPR) workshop for Vietnamese high school students. Our objective was to assess the effectiveness of CPR training in improving students’ knowledge and attitudes towards CPR. Methods: The CPR workshop was conducted using active learning methods, including interactive lecture session, games, small group demonstration and hands-on practice on the mannequin. Knowledge and attitudes towards CPR were studied using a standardised questionnaire administered at three time points: before the workshop (TP1), immediately after the workshop (TP2) and three months after the workshop (TP3). Results: There was an improvement in the median knowledge score from 6.5/14 at TP1 to 13/14 at TP2 ( p<0.001) which was sustained at TP3 (10/14). Willingness and confidence in performing CPR on strangers increased from TP1 to TP2. From TP2 to TP3, however, there was a decrease in willingness to perform CPR on all groups, though confidence in performing CPR remained high at TP3. The most-cited concern about performing CPR was a lack of skills and knowledge. Most participants picked formal training courses to increase confidence in performing CPR. Conclusions: The CPR training was effective in improving the knowledge and attitudes of high school students towards CPR. Our study supports expanding this workshop to train more students in basic cardiac life support in the community and further collaboration internationally between medical schools in order to increase the number of students in the community competent in performing CPR.
Risk assessment of preterm birth through identification and stratification of pregnancies using a real-time scoring algorithm
Authors: Shields Lisa BE , Weymouth Clayton , Bramer Kevin L , Robinson Scott , McGee Donna , Richards Lori , Ogle Corey , Shields Christopher B 
Published: January 2021

Introduction: Preterm birth poses a significant challenge. This study evaluated a real-time scoring algorithm to identify and stratify pregnancies to indicate preterm birth. Methods: All claims data of pregnant women were reviewed between 1 January 2014 and 31 October 2018 in Kentucky. Results: A total of 29,166 unique women who were matched to a live newborn were documented, with the pregnancy identified during the first trimester in 54.1% of women. Negative predictive values, sensitivity, and positive likelihood ratios increased from the first to third trimesters as pregnant women who were matched to a live newborn had more visits with their physicians. The area under the receiving-operating characteristics curve on test data classifying preterm birth was 0.59 for pregnancies identified during the first trimester, 0.62 for pregnancies identified in the second trimester, and 0.73 for pregnancies identified in the third trimester. Conclusions: This study presents a real-time scoring algorithm of indicating preterm birth in the first trimester of gestation which permits stratification of pregnancies to provide more efficient early care management.