bluuebunny/crossref_metadata_2025_split huggingface dataset:
Osteoporotic Fractures: What Orthopaedic Surgeons Can Do to Prevent the Next Fall and the Next Fracture?
Authors: Nguyen Mai P. , Gannon Nicholas P. , Miller Anna N. 
Published: September 2021

Summary:
Falls are the leading cause of injuries for geriatric patients, causing significant morbidity and mortality. Orthopaedic surgeons should take an active role in decreasing patient falls, improving patient bone health, and initiate care to prevent subsequent fracture. In this manuscript, we outline 5 areas for orthopaedic surgeons to intervene and prevent the next fall: (1) patient education; (2) modifying environment/home safety measures; (3) medical fall risk assessment; (4) bone health evaluation and optimization; and (5) physical/occupational therapy.
Current emerging MRI tools for radionecrosis and pseudoprogression diagnosis
Authors: Nichelli Lucia , Casagranda Stefano 
Published: September 2021

Purpose of review
This review aims to cover current MRI techniques for assessing treatment response in brain tumors, with a focus on radio-induced lesions.

Recent findings
Pseudoprogression and radionecrosis are common radiological entities after brain tumor irradiation and are difficult to distinguish from real progression, with major consequences on daily patient care. To date, shortcomings of conventional MRI have been largely recognized but morphological sequences are still used in official response assessment criteria. Several complementary advanced techniques have been proposed but none of them have been validated, hampering their clinical use. Among advanced MRI, brain perfusion measures increase diagnostic accuracy, especially when added with spectroscopy and susceptibility-weighted imaging. However, lack of reproducibility, because of several hard-to-control variables, is still a major limitation for their standardization in routine protocols. Amide Proton Transfer is an emerging molecular imaging technique that promises to offer new metrics by indirectly quantifying intracellular mobile proteins and peptide concentration. Preliminary studies suggest that this noncontrast sequence may add key biomarkers in tumor evaluation, especially in posttherapeutic settings.

Summary
Benefits and pitfalls of conventional and advanced imaging on posttreatment assessment are discussed and the potential added value of APT in this clinicoradiological evolving scenario is introduced.
Using Medial Fasciocutaneous Flap to Reconstruct Tissue Defect at Achilles Tendon Area
Authors: Nguyen Tuan Anh , Duong Manh Hung , Vu Thinh Huu , Nguyen Duong Thai Thuy 
Published: September 2021

Summary:
A 49-year-old man presented with skin necrosis and soft tissue defects at the right Achilles tendon area after tendon rupture repair. The posterior tibial artery was also damaged. We performed a reconstruction using a medial fasciocutaneous flap (and distally based pedicle). After 2 weeks, the wound healed, and the tissue defect was overcome. We found that the medial fasciocutaneous flap at the posterior leg can be raised easily and can be a simple choice to resolve tissue defects in the Achilles tendon area. This type of flap can help reconstruct tissue defects in acute wounds early.
Liberal versus Modified Intraoperative Fluid Management in Abdominal-flap Breast Reconstructions. A Clinical Study
Authors: Sjöberg Thomas , Numan Anmar , de Weerd Louis 
Published: September 2021

Background:
The outcome of reconstructive microsurgery is influenced by the intraoperative anesthetic regimen. The aim of this study was to compare the impact on the intra- and postoperative complication rates of our modified fluid management (MFM) protocol with a previously used liberal fluid management protocol in abdominal-flap breast reconstructions.

Methods:
This retrospective study analyzed adverse events related to secondary unilateral abdominal-flap breast reconstructions in two patient cohorts, one with a liberal fluid management protocol and one with a MFM protocol. In the MFM protocol, intravenous fluid resuscitation was restricted and colloid use was minimized. Both noradrenaline and propofol were implemented as standard in the MFM protocol. The primary endpoints were surgical and medical complications, as observed intraoperatively or postoperatively, during or shortly after the hospital stay.

Results:
Of the 214 patients included in the study, 172 patients followed the MFM protocol. Prior radiotherapy was more frequent in the MFM protocol. Surgical procedures to achieve venous superdrainage were more often used in the MFM cohort. Intraoperative as well as postoperative complications occurred significantly more frequently in the liberal fluid management cohort and were specifically associated with partial and total flap failures. Prior radiotherapy, additional venous drainage, or choice of inhalation agent did not have an observable impact on outcome.

Conclusions:
The incidence of adverse events during and after autologous breast reconstructive procedures was reduced with the introduction of an MFM protocol. Strict intraoperative fluid control combined with norepinephrine and propofol was both beneficial and safe.
THE PROPHYLAXIS OF FELLOW-EYE RETINAL DETACHMENT IN STICKLER SYNDROME
Authors: Ripandelli Guido , Rossi Tommaso , Pesci Francesca R. , Cecere Michela , Stirpe Mario 
Published: September 2021

Purpose:
To evaluate retrospectively if scleral buckling combined or not to cryopexy reduces fellow-eye retinal detachment (RD) in Stickler syndrome patients who lost their first eye due to RD.

Methods:
Retrospective review of 52 Stickler syndrome patients who received a 6-mm wide, 360° encircling scleral buckling. Thirty-nine (75%; Cryo + Group) also received cryo treatment, whereas the reminder 13/52 (25% Cryo − Group) did not.

Results:
Average follow-up was 15.6 ± 2.41 years. Five patients (5/52; 9.6%) developed a retinal detachment 2.6 ± 0.55 years after prophylactic treatment, respectively, 0/39 patients in the Cryo + Group and 5/13 in the Cryo − Group (P < 0.001). All five RD eyes were successfully reattached through revised episcleral surgery and adjunctive cryo treatment. Postop refraction changed an average −1.9 ± 0.74 diopters and best corrected visual acuity at the end of follow-up was 20/25 (0.1 ± 0.07 logarithm of the minimum angle of resolution), not significantly different from the rest of sample population who did not develop RD in their fellow eye.

Conclusion:
Cryopexy significantly reduced the risk of RD in Stickler syndrome patients undergoing scleral buckling. If RD ensues, the presence of scleral buckling may ease surgical repair and improve final outcome.
Risk factors and nursing countermeasures of postoperative pulmonary infection in patients with breast cancer
Authors: Xie Jinqin , Li Yanmei , Qiu Manxia , Liu Xin , Zhou Shuai , Jiang Jinfang 
Published: September 2021

Abstract
It is necessary to elucidate the potential risk factors of pulmonary infection to provide references for the management of breast cancer.
Our study was a retrospective design, patients who underwent modified radical mastectomy for breast cancer in our department of breast surgery from January 2019 to November 2020 were included. The personal and clinical data of included patients with and without pulmonary infection were compared.
A total of 234 patients with radical mastectomy were included, the incidence of pulmonary infection was 15.38% with 95%confidence interval (CI) 11.42% to 18.98%. There were significant differences in the age, body mass index, diabetes, duration of surgery, combined radiotherapy and chemotherapy, and duration of drainage between patients with and without pulmonary infections (all P < .05). Logistic regression analysis indicated that age ≥55 years (odds ratio [OR] 2.128, 95%CI 1.105–3.426), body mass index ≥ 24 kg/m2(OR 2.344, 95%CI 1.031–3.299), diabetes (OR 2.835, 95%CI 1.132–4.552), duration of surgery ≥120 minutes (OR 1.394, 95%CI 1.012–1.044), combined radiotherapy and chemotherapy (OR 3.122, 95%CI 1.124–5.273), duration of drainage ≥5 days (OR 1.851, 95%CI 1.112–2.045) might be the independent risk factors of pulmonary infection in patients after radical mastectomy(all P < .05). Pseudomonas aeruginosa and Klebsiella pneumoniae are the most commonly seen bacteria.
The incidence of postoperative pulmonary infections in breast cancer patients is high, and there are many associated risk factors. The perioperative management of patients should be strengthened targeted on those risk factors in clinical practice.
A cross-sectional analysis of diagnosis and management of chronic obstructive pulmonary disease in people living with HIV
Authors: Zifodya Jerry S. , Triplette Matthew , Shahrir Shahida , Attia Engi F. , Akgun Kathleen M. , Soo Hoo Guy W. , Rodriguez-Barradas Maria C. , Wongtrakool Cherry , Huang Laurence , Crothers Kristina 
Published: September 2021

Abstract
Chronic obstructive pulmonary disease (COPD) is common in people living with HIV (PLWH). We sought to evaluate the appropriateness of COPD diagnosis and management in PLWH, comparing results to HIV-uninfected persons.
We conducted a cross-sectional analysis of Veterans enrolled in the Examinations of HIV-Associated Lung Emphysema study, in which all participants underwent spirometry at enrollment and reported respiratory symptoms on self-completed surveys. Primary outcomes were misdiagnosis and under-diagnosis of COPD, and the frequency and appropriateness of inhaler prescriptions. Misdiagnosis was defined as having an International Classification of Diseases (ICD)-9 diagnosis of COPD without spirometric airflow limitation (post-bronchodilator forced expiratory volume in 1-second [FEV1]/Forced vital capacity [FVC] < 0.7). Under-diagnosis was defined as having spirometry-defined COPD without a prior ICD-9 diagnosis.
The analytic cohort included 183 PLWH and 152 HIV-uninfected participants. Of 25 PLWH with an ICD-9 diagnosis of COPD, 56% were misdiagnosed. Of 38 PLWH with spirometry-defined COPD, 71% were under-diagnosed. In PLWH under-diagnosed with COPD, 85% reported respiratory symptoms. Among PLWH with an ICD-9 COPD diagnosis as well as in those with spirometry-defined COPD, long-acting inhalers, particularly long-acting bronchodilators (both beta-agonists and muscarinic antagonists) were prescribed infrequently even in symptomatic individuals. Inhaled corticosteroids were the most frequently prescribed long-acting inhaler in PLWH (28%). Results were overall similar amongst the HIV-uninfected.
COPD was frequently misdiagnosed and under-diagnosed in PLWH, similar to uninfected-veterans. Among PLWH with COPD and a likely indication for therapy, long-acting inhalers were prescribed infrequently, particularly guideline-concordant, first-line long-acting bronchodilators. Although not a first-line controller therapy for COPD, inhaled corticosteroids were prescribed more often.
Microarray analysis of hub genes and pathways in damaged cartilage tissues of knee
Authors: Aoqierbatu  , Luo Aqilatu , Shi Yuting , Na Yuyan , Tuo Ya 
Published: September 2021

Abstract
The aim of this study was to identify genes and functional pathways associated with damaged cartilage tissues of knee using microarray analysis.
The gene expression profile GSE129147 including including 10 knee cartilage tissues from damaged side and 10 knee nonweight-bearing healthy cartilage was downloaded and bioinformatics analysis was made.
A total of 182 differentially-expressed genes including 123 up-regulated and 59 down-regulated genes were identified from the GSE129147 dataset. Gene ontology and pathway enrichment analysis confirmed that extracellular matrix organization, collagen catabolic process, antigen processing and presentation of peptide or polysaccharide antigen, and endocytic vesicle membrane were strongly associated with cartilage injury. Furthermore, 10 hub differentially-expressed genes with a higher connectivity degree in protein–protein interactions network were found such as POSTN, FBN1, LOX, insulin-like growth factor binding proteins3, C3AR1, MMP2, ITGAM, CDKN2A, COL1A1, COL5A1.
These hub genes and pathways provide a new perspective for revealing the potential pathological mechanisms and therapy strategy of cartilage injury.
A randomized crossover pilot study comparing the efficacy of an auto-demand oxygen delivery system with that of a conventional demand oxygen delivery system in patients with chronic respiratory failure
Authors: Otoshi Takehiro , Nagano Tatsuya , Murakami Sae , Omori Takashi , Hazama Daisuke , Katsurada Naoko , Yamamoto Masatsugu , Tachihara Motoko , Nishimura Yoshihiro , Kobayashi Kazuyuki 
Published: September 2021

Abstract

Introduction
: When using portable oxygen, a demand oxygen delivery system (DODS), which senses the beginning of inhalation and delivers a bolus of oxygen, is often used. However, conventional DODS may not supply sufficient oxygen when reduced tidal flow fails to trigger the flow sensor. Recently, “auto-DODS,” which detects the negative pressure of inhalation and switches among 3 trigger sensitivity levels (standard, high, and extra high), has been developed to improve the efficacy of oxygenation. An auto-DODS can also supply pulsed-flow oxygen when it detects apnea, whereas a conventional DODS has only standard sensitivity. This randomized, open-label, crossover pilot study compared the performance of an auto-DODS with that of a conventional DODS.

Methods
: We recruited patients with chronic obstructive pulmonary disease (COPD) or interstitial pneumonia receiving long-term oxygen therapy. Interventions were performed on 2 different days for each participant. On each day, an auto-DODS or a conventional DODS were tested at rest for 30 minutes and during the 6-minute walk test. The primary outcome was mean oxygen saturation (SpO2). Secondary outcomes were the ratios of time for each sensitivity level and pulsed-flow oxygen when using the auto-DODS, total time desaturated below SpO2 90%, percentage of time desaturated below SpO2 90%, minimum SpO2, mean and maximum pulse rate, six-minute walk distance, recovery time after 6-minute walk test, modified Borg scale, comfort, and discomfort index.

Results
: When using the auto-DODS at rest, a high or extra high sensitivity level was observed in addition to standard sensitivity in 6 of 8 participants. During the 6-minute walk test, only standard sensitivity was observed in 6 participants. Mean SpO2 differences between the auto-DODS and conventional DODS at rest and during the 6-minute walk test were −0.6 [−4.5, 3.4] and 0.0 [−2.5, 2.5] ([95% confidence interval]), respectively, neither of which were significant (P = .73 and P = .99). There were no significant differences in secondary outcomes. There were no adverse events when using the auto-DODS.

Conclusions
: This study showed that the auto-DODS did not show superiority in oxygenation either at rest or during exercise compared to a conventional DODS. The auto-DODS was shown to supply oxygen safely and detect inhalations with various trigger sensitivities.
Cervical lymphatic malformations amenable to transhairline robotic surgical excision in children
Authors: Lin Han-Jie , Lin Frank Cheau-Feng , Yang Tsung-Lin , Chang Chun-Hsiang , Kao Chia-Hui , Tsai Stella Chin-Shaw 
Published: September 2021

Abstract
Lymphatic malformations are rare benign malformations that predominantly occur in the head and neck region. The advent of surgical robots in head and neck surgery may provide beneficial outcomes for pediatric patients. Here, we describe our experiences with transhairline incisions for robot-assisted surgical resection of cervical lymphatic malformations in pediatric patients.
In this prospective longitudinal cohort study, we recruited consecutive patients under 18 years of age who were diagnosed with congenital cervical lymphatic malformations and scheduled for transhairline approach robotic surgery at a single medical center. We documented the docking times, console times, surgical results, complications, and postoperative follow-up outcomes.
The studied patients included 2 with mixed-type lymphatic malformations and 2 with macrocystic-type lymphatic malformations. In all 4 patients, the incision was hidden in the hairline; the incision length was <5 cm in 3 patients but was extended to 6 cm in 1 patient. Elevating the skin flap and securely positioning it with Yang retractor took <1 hour in all cases. The mean docking time was 5.5 minutes, and the mean console time was 1 hour and 46 minutes. All 4 surgeries were completed endoscopically with the robot. The average total drainage volume in the postoperative period was 21.75 mL. No patients required tracheotomy or nasogastric feeding tubes. Neither were adverse surgery-associated neurovascular sequelae observed. All 4 patients were successfully treated for their lymphatic malformations, primarily with robotic surgical excisions.
Cervical lymphatic malformations in pediatric patients could be accessed, properly visualized, and safely resected with transhairline-approach robotic surgery. Transhairline-approach robotic surgery is an innovative method for meeting clinical needs and addressing esthetic concerns.
A novel system for teaching the in-plane vascular access technique
Authors: Kikuchi Mami , Asao Takayuki , Tokumine Joho , Lefor Alan Kawarai , Matsushima Hisao , Andoh Hideaki , Tanaka Kazumi , Kanamoto Masafumi , Ideno Yuki 
Published: September 2021

Abstract
The long-axis in-plane approach is amenable to ultrasound-guided central venous catheterization. However, the long-axis in-plane approach is considered difficult to learn because the needle should remain visible in the ultrasound beam during the procedure. We developed a novel competency-based modular system to acquire the skills for the long-axis in-plane approach. The purpose of this study is to evaluate the efficacy of this system.
The study was approved by the local ethics committee. Participants performed ultrasound guided venous catheterization (pre-test), attended a 2-hour hands-on session with the teaching system and were then evaluated again (posttest). The teaching system is a simulator device consisting of an ultrasound probe, a simulated vessel, a needle, and an endoscope connected to a computer to visualize the image inside the simulated vessel. The success rate, visualization of the needle tip, and puncture accuracy were measured before and after training. The puncture accuracy was determined by evaluating the distance of the needle tip and needle shaft from the center of a simulated vessel. Primary outcomes were the success rate and the puncture accuracy. The secondary outcome was needle tip visualization. McNemar test was used to analyze success rate and needle tip visualization. Tukey test was used to analyze puncture accuracy. A P value <.05 was considered statistically significant.
Forty-seven participants were enrolled in this study. The success rate was significantly increased (pre-test 79%, posttest 94%, P = .04). Ultrasound images from 42 participants were analyzed for puncture accuracy. Puncture accuracy significantly increased for needle tip distance (P = .03), but not shaft distance (P = .1). The needle tip visualization was significantly improved (P = .02).
A novel competency-based teaching system was constructed in a step-by-step manner, which improved needle tip visualization and puncture accuracy, with a higher success rate.
Twenty-seven-gauge endoilluminator-assisted scleral buckling using a wide-field viewing system
Authors: Nam Ki Yup , Lim Hyung Bin , Kim Min Su , Kim Jung Yeul 
Published: September 2021

Abstract

Rationale:
We report a new scleral buckling technique using a 27-gauge endoilluminator and a wide-field viewing system to overcome the limitations of conventional indirect ophthalmoscope-methods and “chandelier-assisted” surgery.

Patient concerns:
A 26-year-old female patient visited the local clinic for floaters and lower visual field defects in her left eye that had occurred 5 days prior.

Diagnoses:
On fundus examination, upper retinal detachment without macular involvement and an atrophic hole was observed in her left eye.

Interventions:
Under general anesthesia and after perilimbal conjunctival incision, extraocular muscle isolation, and traction with black silk, a 27-gauge trocar-cannula was inserted 90° away from the retinal break, 4 mm away from the limbus. Under wide-field viewing using a contact lens, the fundus was observed through a surgical microscope. Retinal break was evaluated and cryopexy was performed with careful movement of the endoilluminator, paying attention to damage to the lens. The surgeon could accurately and freely control the direction of the illumination tip to obtain a brighter view of the region of interest.

Outcomes:
There were no complications associated with trocar cannula incision or the illuminator. The retina was successfully reattached.

Lessons:
Twenty seven gauge endoilluminator-assisted scleral buckling is an easy and safe procedure and provides better control over and free adjustment of the light direction, thus overcoming the limitations of chandelier-assisted surgery.
Prognostic implication of systemic inflammatory state on antiplatelet effect in patients after percutaneous coronary intervention for ST-elevation myocardial infarction
Authors: Jiang Hairui , Wang Hao , Liang Bo , Sun Lanchun , Bai Lianjie 
Published: September 2021

Abstract
Patients with ST-elevation myocardial infarction (STEMI) show an inflammatory response. The level of systemic inflammation is known to affect platelet aggregation function and antiplatelet therapy, which leads to different clinical prognosis. This study aims to evaluate the prognostic implication of systemic inflammatory state in patients with STEMI undergoing percutaneous coronary intervention.
In this study, 203 patients with STEMI who underwent primary percutaneous coronary intervention were included. The patients were divided into 3 groups based on the inflammation levels assessed by tertiles of high-sensitivity C-reactive protein (hs-CRP) level on admission. Platelet aggregation evaluation was performed by residual platelet reactivity, which was assessed by the value of residual ADP-induced light transmittance aggregometry after clopidogrel maintenance dose therapy and in follow-up. Major adverse cardiac events (MACEs) were defined to include all-cause mortality, cardiovascular mortality, reinfarction, target vessel revascularization (TVR), cardiopulmonary resuscitation, advanced heart failure, ventricular fibrillation or ventricular tachycardia, and atrioventricular block.
Levels of white blood cell was observed to be significantly higher at high tertile levels. Residual ADP-induced platelet aggregation was significantly higher at high tertile levels after clopidogrel maintenance dose therapy and in follow-up. Multivariate analysis identified that reperfusion time, alanine aminotransferase, platelet count, ADP-induced light transmittance aggregometry in follow-up and hs-CRP was independent predictors of MACEs. Platelet inhibition function of clopidogrel decreases progressively at different inflammation levels. The different levels of hs-CRP were demonstrated to be associated with MACEs at follow-up assessments.
The presence of hs-CRP was not only significantly associated with platelet inhibition function, but was also a prognostic marker in STEMI.