bluuebunny/crossref_metadata_2025_split huggingface dataset:
From Expressing Human Milk to Breastfeeding—An Essential Element in the Journey to Motherhood of Mothers of Prematurely Born Infants
Authors: Brødsgaard Anne , Andersen Bente Lund , Skaaning Diana , Petersen Mette 
Published: December 2021

Background:Lactation and breastfeeding present an extraordinary challenge for mothers of prematurely born infants.Purpose:To explore the significance of and the circumstances that affect lactation for mothers of premature infants.Methods:A qualitative exploratory study based on single, in-depth, semistructured interviews with 16 purposefully sampled mothers of premature infants admitted to the neonatal intensive care unit (NICU). Data were analyzed using content analysis. The study was reported according to Standards for Reporting Qualitative Research.Findings:The overall theme was “From expressing human milk to breastfeeding—an essential element in the journey to motherhood.” The theme emerged from 3 categories: the birth preparation time has been interrupted; expressing human milk is essential for lactation; and the motherhood journey encompasses breastfeeding. The analysis also revealed that the categories were impacted by initiating, performing, and maintaining lactation and further influenced by inhibitors and promoters.Implications for Practice:The promoters for performing milk expression and breastfeeding should be stimulated and the inhibitors should be eliminated. The achievement of “zero separation” and mother–infant couplet care in the NICU would be beneficial. In order for mothers to maintain successful lactation, it is essential that they receive supportive around-the-clock access to health professionals with expertise in lactation and breastfeeding until exclusive breastfeeding is well established.Implications for Research:The study highlights the need to investigate mother–infant as one entity rather than separately as mother and infant.
Early Advanced Weight-Bearing After Periarticular Fractures: A Randomized Trial Comparing Antigravity Treadmill Therapy Versus Standard of Care
Authors: Stinner Daniel J. , Rivera Jessica C. , Smith Christopher S. , Weiss David B. , Hymes Robert A. , Matuszewski Paul E. , Gary Joshua L. , Morshed Saam , Schmidt Andrew H. , Wilken Jason M. , Archer Kristin R. , Bailey Lane , Kleihege Jacquelyn , McLaughlin Kevin H. , Thompson Richard E. , Chung Suna , Remenapp Craig , MacKenzie Ellen J. , Reider Lisa ,   on behalf of METRC
Published: December 2021

Summary:
In current clinical practice, weight-bearing is typically restricted for up to 12 weeks after definitive fixation of lower extremity periarticular fractures. However, muscle atrophy resulting from restricting weight-bearing has a deleterious effect on bone healing and overall limb function. Antigravity treadmill therapy may improve recovery by allowing patients to safely load the limb during therapy, thereby reducing the negative consequences of prolonged non–weight-bearing while avoiding complications associated with premature return to full weight-bearing. This article describes a multicenter randomized controlled trial comparing outcomes after a 10-week antigravity treadmill therapy program versus standard of care in adult patients with periarticular fractures of the knee and distal tibia. The primary hypothesis is that, compared with patients receiving standard of care, patients receiving antigravity treadmill therapy will report better function 6 months after definitive treatment.
Long-Term Consequences of Major Extremity Trauma: A Pilot Study
Authors: Castillo Renan C. , Carlini Anthony R. , Chaffee Trisha , Bosse Michael J. , O'Toole Robert V. , Kleweno Conor P. , McKinley Todd O. , Agel Julie , Higgins Thomas F. , Morshed Saam , Staguhn Elena D. , Aaron Rachel V. , Reider Lisa , Wu Albert W. , MacKenzie Ellen J. ,   on behalf of METRC
Published: December 2021

Summary:
Limited data are available on the longer-term physical and psychosocial consequences after major extremity trauma apart from literature on the consequences after major limb amputation. The existing literature suggests that although variations in outcome exist, a significant proportion of service members and civilians sustaining major limb trauma will have less than optimal outcomes or health and rehabilitation needs over their life course. The proposed pilot study will address this gap in current research by locating and consenting METRC participants with the period of 5–7 years postinjury, identifying potential participation barriers and appropriate use of incentives, and conducting the follow-up examination at several data collection sites. The resulting data will inform the primary objective of refining and developing specific hypotheses to determine the design, scope, and feasibility of the main long-term consequences of major extremity trauma. Three METRC enrollment centers will contact past participants to achieve the goal of completing an interview, select patient-reported outcomes, perform a medical record review, and conduct an in-person clinic visit that will consist of a physical examination, blood draw, and x-ray of the study injury area. If successful, it will be possible to design studies to further examine these effects and develop future therapeutic interventions.
Amlodipine Improves Spinal Cord Injury Repair by Inhibiting Motoneuronal Apoptosis Through Autophagy Upregulation
Authors: Huang Yang , Ren Hao , Gao Xiang , Cai Danyang , Shan Huajian , Bai Jinyu , Sheng Lei , Jin Yong , Zhou Xiaozhong 
Published: December 2021

Study Design.
The effect of amlodipine (AM) on spinal cord injury (SCI) and autophagy was researched by establishing ventral spinal cord cells (VSC4.1) oxygen and glucose deprivation model and SCI mice model.

Objective.
To determine the neuroprotective effects of AM by upregulating autophagy during SCI repair.

Summary of Background Data.
AM, an antihypertensive medication, has been shown in several studies to inhibit neuronal apoptosis and exert neuroprotective effects in various central nervous system diseases. However, its effects on SCI are unexplored. Autophagy could inhibit cell apoptosis, which has been shown to promote SCI repair. However, the role of AM in autophagy remains unclear.

Methods.
We examined the relationship between AM, apoptosis, and autophagy in ventral spinal cord cells and the injured spinal cords of C57BL/6 female mice respectively, following histological, behavioral, microscopic, immunofluorescence, and western blotting analyses.

Results.
We found that AM could inhibit motor neuronal apoptosis in vitro. Furthermore, AM promoted locomotor recovery by upregulating autophagy and alleviating apoptosis, neuronal loss, and spinal cord damage after SCI.

Conclusion.
AM inhibited motoneuronal apoptosis by upregulating autophagy to improve SCI recovery.
No Benefit with Preservation of Midline Structures in Decompression for Lumbar Spinal Stenosis
Authors: Elmqvist Erik , Lindhagen Lars , Försth Peter 
Published: December 2021

Study Design.
Observational cohort study.

Objective.
The aim of this study was to investigate whether preservation of the midline structures is associated with a better clinical outcome compared to classic central decompression for lumbar spinal stenosis (LSS).

Summary of Background Data.
The classic surgical procedure for LSS is a central, facet joint sparing decompressive laminectomy (LE). Alternative approaches have been developed to preserve the midline structures. The effect of the alternative techniques compared to LE remains unclear.

Methods.
All patients >50 years of age who underwent decompression surgery for LSS without concomitant fusion in the National Swedish Spine Registry (Swespine) from December 31, 2015 until October 6, 2017 were included in this study based on surgeon-reported data and patient questionnaires before and 2 years postoperatively. Propensity score matching was used to compare decompression with preservation of midline structures with patients who underwent LE. The primary outcome was the Oswestry Disability Index (ODI) and secondary outcomes were the Numeric Rating Scale (NRS) for leg and back pain, EuroQol-5 Dimensions (EQ-5D), Global Assessment (GA), patient satisfaction and rate of subsequent surgery.

Results.
Some 3339 patients completed a 2-year follow-up. Of these, 2974 (89%) had decompression with LE and 365 underwent midline preserving surgery. Baseline scores were comparable between the groups. Mean ODI improvement at follow-up was 16.6 (SD = 20.0) in the LE group and 16.9 (SD = 20.2) in the midline preserving surgery group. In the propensity score-matched analysis the difference in improved ODI was 0.53 (95% confidence interval, CI −1.71 to 2.76; P = 0.64). The proportion of patients who showed a decreased ODI score of at least our defined minimal clinically important difference (=8) was 68.3% after LE and 67.0% after preserving the midline structures (P = 0.73). No significant differences were found in the improvement of NRS for leg and back pain, EQ-5D, GA or patient satisfaction. The rate of subsequent surgery was 5.5% after LE and 4.9% after midline preserving surgery without a significant difference in the propensity score-matched analysis (hazard ratio, HR 0.87; 95% CI 0.49–1.54; P = 0.64).

Conclusion.
In this study on decompression techniques for LSS, there was no benefit in preserving the midline structures compared to LE 2 years after decompression. The conclusion is that the surgeon is free to choose the surgical method that is thought most suitable for the patient and the condition with which the patient presents.

Level of Evidence: 3
Increased Cervical Spinal Instability is Associated With the Development of Proximal-type Cervical Spondylotic Amyotrophy
Authors: Ishiwata Sho , Lizuka Yoichi , Takasawa Eiji , Mieda Tokue , Kakuta Yohei , Tomomatsu Yusuke , Honda Akira , Ito Shunsuke , Inomata Kazuhiro , Chikuda Hirotaka 
Published: December 2021

Study Design.
Retrospective cohort study.

Objectives.
We aimed to clarify the clinical relationship between the etiology of proximal-type cervical spondylotic amyotrophy (CSA) and cervical sagittal alignment and instability.

Summary of Background Data.
Although several researchers have discussed hypotheses regarding the etiology of CSA, the trigger and mechanism underlying the onset remain unclear.

Methods.
We retrospectively analyzed 52 proximal-type CSA patients (CSA group) and 60 control patients (Control group). The following data were collected: age; sex; cervical lordosis (CL); T1 slope (TS); TS-CL; C2-7 sagittal vertical axis (SVA) on x-ray in the neutral position; flexion angle; extension angle and range of motion (ROM) of C3/4, C4/5 and C5/6; and C3/4, C4/5 and C5/6 instability (translation of >3 mm for adjacent segmental segments) on dynamic x-ray.

Results.
Compared with the Control group, the CSA group was associated with an older age (mean age, 67.6 vs. 61.1 years’ old, P= 0.029) and male sex (78.8% vs. 50.0%, P= 0.002). In the CSA group, the radiographic parameters showed smaller C4/5 and C5/6 extension angles and C5/6 ROM values and a greater C3/4 flexion angle than the Control group. Furthermore, compared with the Control group, the CSA group was associated with C3/4 instability (13.5% vs. 3.3%, P=0.049) and C4/5 (21.2% vs. 3.3%, P = 0.003). A logistic regression analysis, with adjusting for the age and sex, showed that the C3/4 flexion angle (odds ratio [OR], 1.2; 95% confidence interval [CI], 1.08– 1.40, P=0.002), C3/4 instability (OR, 7.3; 95% CI 1.25–42.96, P=0.027) and C4/5 instability (OR, 8.1; 95% CI, 1.56–42.19, P= 0.012) were independent risk factors of CSA.

Conclusion.
This study suggested that a wide C3/4 flexion angle and high C3/4 or C4/5 spinal instability were closely associated with the etiology of proximal-type CSA.
Does the Distal Level Really Matter in the Setting of Health-Related Quality of Life? Assessment of a Series of Adolescent Idiopathic Scoliosis Patients at More Than 7 Years Following Surgery
Authors: Marie-Hardy Laura , Besse Micaela , Chatelain Léonard , Pannier Stéphanie , Glorion Christophe , Ferrero Emmanuelle 
Published: December 2021

Study Design.
Retrospective longitudinal study

Objective.
The main goal of this study was to measure the disability after AIS correction, according to the LIV.

Summary of Background Data.
Adolescent idiopathic scoliosis (AIS) is a three-dimensional deformity of the spine that may require surgical correction. If the upper and lower instrumented levels (UIV and LIV) of these fusions are defined by the characteristics of the curve, the long-term consequences of the LIV choices are still partially unknown.

Methods.
This retrospective longitudinal study collected demographic, radiologic (Lenke classification, Cobb angle), and surgical data (approach, LIV, UIV) on 116 patients operated for AIS fusion on a specialized pediatric spine center were collected. All participants answered SRS30, SF12, lumbar and leg pain Visual Analogue Scales (VAS) at last follow-up. Statistical analysis between LIV (T12L1, L2, L3 or L4L5) and clinical data at last follow-up was realized.

Results.
The mean follow-up was 87months. The mean increase of back pain VAS per UIV level was 9 mm. No statistically significant difference between the different LIV was found, for SRS30 or SF12 MCS (mental component scale). There was a statistically significant difference between L3 UIV and L4L5 UIV for SF-12 PCS (physical component scale); (P = 0.03).

Conclusion.
The long-term consequences of LIV choice mostly affect levels distal to L3. If the LIV is mostly defined by the characteristics of the curve, one level caudally corresponds to +9 mm of back pain VAS at 7 years of follow-up. Surgeons may be aware of the long-term consequence of LIV choice and patients be informed.
Immunomodulation for hepatocellular carcinoma therapy: current challenges
Authors: Macek Jilkova Zuzana , Ghelfi Julien , Decaens Thomas 
Published: December 2021

Purpose of review
The emergence of novel immunotherapies, such as immune-checkpoint inhibitors has changed the landscape of systemic cancer treatment. In hepatocellular carcinoma (HCC) patients, despite initial enthusiasm, the proportion of responders to immune-checkpoint inhibitors remains low. We provide a brief update of this rapidly evolving field, with specific focus on the development in the field of predictive factors and the immunomodulation induced by locoregional therapies.

Recent findings
Even if the immune contexture of HCC before the treatment remains the most promising predictive marker for response to immunotherapies, recent findings show that the cause of HCC may have also a key role. Specific inflammatory mechanisms induced by NASH may result in limited efficacy of immunotherapy compared with viral HCC. Other recent findings showed that percutaneous ablations are responsible for intratumoral immune changes and systemic immune system activation that may help to prevent recurrence when combined with immunotherapies. In case of multifocal HCC, transarterial therapies (TACE and SIRT) may help to turn a cold tumor type to a hot tumor type and could be associated with immune-checkpoint inhibitors to improve outcomes.

Summary
The future HCC management will focus on patient stratification for specific immunotherapies depending on the signature and cause of HCC and the best combined approaches in which locoregional therapies may play a pivotal role.
Purple urine bag syndrome: An unusual manifestation of urinary tract infection, our experience at a tertiary care center
Authors: Neniwal Vishal Kumar , Swain Samir , Rulaniya Suresh Kumar , Hota Datteswar , Agarwal Piyush , Yadav Praveen Kumar 
Published: December 2021

Abstract

Background
Purple urine bag syndrome (PUBS) is an unusual condition in which a purple discoloration of urine and bag occurs in people with urinary catheters. People with purple urine usually do not complain of any symptoms. The purple discoloration of the urine bag is often the only finding, frequently noted by caregivers.

Materials and methods
This prospective observational study was conducted at our tertiary care institute from June 2018 to May 2020. A total of 46 patients with PUBS were included in this study. The objective of our study was to record the prevalence of each predisposing factor and to correlate the pathological mechanism through which the PUBS is manifested.

Results
The mean age of PUBS patients was 67.4years and 67.4% were males. Most patients of PUBS (60.9%) had a urethral catheter, while there was percutaneous nephrostomy in 26.1% patients and 13% patients had a percutaneous suprapubic cystostomy catheter. Among the patients, 69.65% were bedridden or in an institutionalized situation, 73.9% were suffering from chronic constipation, 21.7% were associated with dementia, and 47.8% were cerebrovascular accidents with hemiparesis patients. In addition, 93.5% of patients presented with alkaline urine and 3 patients with acidic urine. The most common bacteria isolated in urine culture were E coli and Pseudomonas.

Conclusions
Urinary catheter associated urinary tract infection and PUBS is most commonly documented in females, but our study showed that it is more common in males. The appearance of a purple bag does not depend on the material and type of the catheter or the catheterization method. In addition, no correlation was found between the microorganisms isolated from the environment and patients’ urine.
Trichloroacetic Acid Paint for Boxcar and Polymorphic Acne Scars
Authors: Sun Cong , Lim Davin 
Published: December 2021

BACKGROUND
Scarring is a common complication of acne vulgaris with a significant impact on the psychological well-being of patients. Focal application of high concentration trichloroacetic acid (TCA) has been proven efficacious in treating ice-pick scars, but the utility in other scar types is understudied.

OBJECTIVE
The aim of this study is to evaluate the efficacy and safety of 90% TCA in boxcar and polymorphic acne scars using a novel brush applicator.

MATERIALS AND METHODS
Forty-one patients with acne scars were recruited for treatment of boxcar and polymorphic scar with 90% TCA applied with a cosmetic brush. Each patient received 3 treatment sessions spaced between 7 and 9 weeks apart.

RESULTS
All participants had good to excellent outcomes as per Jacob and colleagues grading. Patients with skin Type 3 to 6 had more excellent outcomes (13 patient, 59%) than patients of skin type 1 to 2 (9 patients, 41%). Two participants (5%) had postprocedural complications. Five participants (14%) were on concomitant isotretinoin with no appreciable increase in reepithelialization time or rate of complications.

CONCLUSION
Focal 90% TCA with a cosmetic brush applicator is safe and effective in treating boxcar and polymorphic scars. The clinical outcome is good to excellent with low rates of complication.
The Efficacy of Pulsed Dye Laser Treatment for Acne Vulgaris: A Systemic Review and Meta-Analysis
Authors: Yang Ting-Hua , Li Chien-Nien , Huang Yu-Chen 
Published: December 2021

BACKGROUND
Previous reports have shown that pulsed dye laser (PDL) is promising for the treatment of acne; however, results provide conflicting evidence.

OBJECTIVE
To determine the efficacy of PDL in treating acne vulgaris.

METHODS
A systematic review and meta-analysis of studies published before March 31, 2020 was conducted. Randomized controlled trials and case series were analyzed. The meta-analysis estimated the standardized mean difference (SMD) in acne severity score changes in patients treated by PDL versus control and also the SMD of the acne severity scores and comedone counts changes before and after PDL treatment.

RESULTS
Eleven studies were included in this systematic review. Six studies were included in the meta-analysis. Pulsed dye laser treatment was not found to be superior to the control group in treating acne vulgaris (SMD: −0.285; 95% confidence interval [CI], −0.886 to 0.317). However, single-arm studies revealed a significantly improved acne severity score after PDL therapy (SMD, −1.321; 95% CI, −2.057 to −0.586), especially when a multiple-session treatment and a longer pulse duration were employed. The comedone counts were significantly decreased after PDL therapy (SMD, −0.596; 95% CI, −1.137 to −0.054).

CONCLUSION
When treatment consisted of 4 or more sessions or longer pulse duration, PDL could significantly decrease the acne severity score.
Three-Dimensional Computed Tomographic Study of the Supratrochlear Artery and Supraorbital Artery to Determine Arterial Variations and Their Relationship
Authors: Liao Zhi-Feng , Cong Li-Yao , Hong Wei-Jin , Luo Cheng-En , Luo Sheng-Kang 
Published: December 2021

BACKGROUND
The forehead has high risks associated with filler injection considering its highly complex vascular system. This study aims to thoroughly describe the anatomical variations and relationships between the supratrochlear artery (STA) and supraorbital artery (SOA).

MATERIALS AND METHODS
We studied 56 cadaveric heads by computed tomography after contrast-agent injection.

RESULTS
The deep branch of the STA originated in the deep superior orbital arcade and the ophthalmic artery (OA), whereas that of the SOA originated at 3 locations: the deep superior orbital arcade, deep superior orbital artery, and OA. The superficial branch of the STA also had 3 origins: the superficial superior orbital arcade, OA, and angular artery, whereas the superficial branch of the SOA had 2 origins: the superficial superior orbital arcade and OA. Based on the relationship between the STA and SOA, 2 main arterial distribution patterns were observed in both superficial and deep layer arteries: STA/SOA connected pattern and STA/SOA disconnected pattern, of which the latter pattern has 3 subtypes.

CONCLUSION
The forehead arteries have complex origins. The relationship of the supratrochlear and supraorbital arteries could be categorized into 2 main patterns. The study elucidated the complexity of the forehead vasculature.
Risk Factors That Are Associated With Outliers in Mohs Micrographic Surgery in the National Medicare Population, 2018
Authors: Aggarwal Pushkar , Neltner Scott A. , Fleischer Alan B. 
Published: December 2021

BACKGROUND
Physician variation exists in the mean number of stages performed per Mohs micrographic surgery (MMS) case. Physicians who are outliers in medical practice may be leading to a higher health care cost burden.

OBJECTIVE
To identify factors that influence being a high outlier in the mean stages per MMS case.

MATERIALS AND METHODS
The study comprised a retrospective analysis of 2018 data from physicians who billed Medicare Part B for Current Procedural Terminology (CPT) 17311 and 17312 (MMS of the head, neck, hands, feet, or genitalia) and/or CPT 17313 and 17314 (MMS of the trunk, arms, or legs).

RESULTS
For CPT 17311 and 17312, the odds ratio for being an outlier for a physician in a solo practice relative to a multiphysician facility is 2.4 (1.6–3.8), for a physician who is not an American College of Mohs Surgery (ACMS) member relative to a ACMS member is 2.0 (1.2–3.2), and for a practice located in the West, Northeast, and South is 7.7 (2.8–21.6), 6.2 (2.1–18.6), and 1.8 (0.6–5.4), respectively, relative to in the Midwest.

CONCLUSION
Physicians who are practicing solo, practicing in the West or Northeast, and are not ACMS members are more likely to be a high outlier in the mean stages per MMS case.