bluuebunny/crossref_metadata_2025_split huggingface dataset:
Surgical Deroofing and Trichloroacetic Acid Application: A Novel Treatment for Digital Mucous Cysts
Authors: Jung Yeon Woo , Jung Jin Woong , Ryu Hyang Joo , Oh Byung Ho 
Published: October 2024

BACKGROUND
Digital mucous cysts (DMCs) are benign cysts located in digital interphalangeal joints or the proximal nail fold. Despite various treatments, standardized guidelines are lacking, and recurrence rates remain high.

OBJECTIVE
This study evaluates the efficacy and safety of a novel treatment combining surgical deroofing with trichloroacetic acid application.

MATERIALS AND METHODS
This study was conducted on 27 patients with DMCs treated from 2019 to 2022. Clinical features and therapeutic responses were documented with photographic records at the initial presentation and follow-ups. Histopathological examinations confirmed diagnoses and classified histopathological types.

RESULTS
Among 27 lesions, 20 were within the proximal nail fold, 7 were beneath the proximal nail fold; 26 were ganglionic, and 1 was myxomatous. Four patients required multiple treatments within 6 months due to recurrences. Long-term follow-up showed clinical improvement in all patients: 17 achieved complete remission, and 8 showed partial improvement. The treatment was effective regardless of cyst type, with minimal complications and mild postoperative pain resolving within days.

CONCLUSION
The combination of surgical deroofing and trichloroacetic acid application minimizes complications and enhances efficacy. It allows for repetitive treatments in case of recurrence, making it a viable option for managing persistent DMCs, with favorable outcomes and minimal complications.
Secondary Multiple Evanescent White Dot Syndrome in a patient with North Carolina Macular Dystrophy
Authors: Bommakanti Nikhil , Procopio Rebecca , Pulido Jose S. 
Published: October 2024

Purpose:
To describe a novel case of secondary multiple evanescent white dot syndrome in a patient with North Carolina Macular Dystrophy (NCMD).

Methods:
The patient was evaluated with ultra-widefield color and autofluorescence imaging, fluorescein angiography, and spectral-domain optical coherence tomography.

Results:
A 43-year-old man with longstanding blurred vision in both eyes acutely developed glare in the right eye after an upper respiratory illness. He had chorioretinal atrophy in both eyes consistent with North Carolina Macular Dystrophy, which was later confirmed by genetic testing. He alsyo had white spots in the macula of the right eye consistent with secondary MEWDS. The diagnosis of secondary MEWDS was confirmed with fundus autofluorescence and fluorescein angiography, as well as a negative infectious workup. His symptoms and the retinal lesions had resolved by 11 weeks and after a short course of oral corticosteroids.

Conclusion:
Prior studies have suggested a link between disruption of the RPE/Bruch’s membrane complex and secondary MEWDS. This report describes the first case of secondary MEWDS after NCMD and provides further support for this association.
Promoting multidisciplinary pain management in low- and middle-income countries—challenges and achievements
Authors: Cardosa Mary Suma 
Published: October 2024

Abstract
The burden of pain in low- and middle income countries (LMICs) is high and expected to rise further with their ageing populations. Multidisciplinary pain management approaches based on the biopsychosocial model of pain have been shown to be effective in reducing pain-related distress and disability, but these approaches are still lacking in many LMICs due to various factors, including low levels of awareness about the role of multidisciplinary pain clinics, lack of prioritisation for pain services, and lack of healthcare professionals trained in pain management. The International Association for the Study of Pain (IASP) has several educational programs to promote multidisciplinary pain management in LMICs, in the form of education grants, pain fellowships, pain camps and, most recently, the development of a Multidisciplinary Pain Centre Toolkit. This article describes the various educational programs, focusing on Southeast Asia, that demonstrate how targeted educational programs which include skills training, follow-up and mentorship, can translate into the formation of new multidisciplinary pain management services in settings with limited resources.
Strengthening the pain care ecosystem to support equitable, person-centered, high-value musculoskeletal pain care
Authors: Slater Helen , Briggs Andrew M. 
Published: October 2024

Abstract
Improving health and wellbeing outcomes for people experiencing chronic musculoskeletal pain requires collective efforts across multiple levels of a healthcare ecosystem. System-wide barriers to care equity must however be addressed (eg, lack of co-designed services; overuse of low value care/underuse of high value care; inadequate health workforce; inappropriate funding models; inequitable access to medicines and technologies; inadequate research and innovation). In this narrative review, utilizing a systems’ thinking framework, we synthesize novel insights on chronic musculoskeletal pain research contextualized through the lens of this complex, interconnected system, the “pain care ecosystem.” We examine the application of systems strengthening research to build capacity across this ecosystem to support equitable person-centred care and healthy ageing across the lifespan. This dynamic ecosystem is characterized by three interconnected levels. At its centre is the person experiencing chronic musculoskeletal pain (micro-level). This level is connected with health services and health workforce operating to co-design and deliver person-centred care (meso-level), underpinned further upstream by contemporary health and social care systems (macro-level context). We provide emerging evidence for how we, and others, are working towards building ecosystem resilience to support quality musculoskeletal pain care: at the macro-level (eg, informing musculoskeletal policy and health strategy priorities); at the meso-level (eg, service co-design across care settings; health workforce capacity); and downstream, at the micro-level (eg, person-centred care). We outline the mechanisms and methodologies utilized and explain the outcomes, insights and impact of this research, supported by real world examples extending from Australian to global settings.
Utility of a Smart Device Infrared Camera in Localizing Acute Pediatric Long Bone Fractures
Authors: Korattiyil Manju , Long Rachel , Guiner Alessandra , Huang Rong , Nesiama Jo-Ann 
Published: October 2024

Background
Musculoskeletal injuries are one of the top 10 reasons children present to the emergency department (ED). Infrared thermal imaging (IRT) is a noninvasive and nonradiating imaging modality that can detect subtle temperature differences. IRT may be used to detect the presence of musculoskeletal injury.

Objective
This study aimed to assess the utility of a smart device infrared camera attachment's ability to localize acute pediatric long bone fractures in patients less than 5 years of age.

Methods
This was a prospective pilot study comparing thermal imagery on an injured extremity to radiographs. All IRT images were obtained via an iPad with an infrared camera attachment. Using two different IRT images (Hi/Lo and Span and Level), the area of maximum temperature (T
max) was identified and compared to radiographs.

Results
A total of 31 patients were enrolled in the study. Twenty-four (77.50%) were identified as having fractures, and 7 (22.50%) did not have any fractures. IRT correctly identified an injury in the fracture group 91.67% of the time when using the Span and Level IRT image compared to standard x-rays (P < 0.0002). When using the Span and Level image to identify T
max to localize a fracture on x-ray, sensitivity is 0.92, specificity is 0.86, positive predictive value is 0.96, and negative predictive value is 0.75. A receiver operating characteristic (ROC) curve was completed with area under the curve (AUC) being 0.89.

Conclusions
This pilot study shows that the use of smart device infrared camera attachments is feasible and has promising results in fracture localization. This could allow for a decrease in radiographs and be particularly useful in resource-limited areas.
Validation of a holistic composite outcome measure for the evaluation of chronic pain interventions
Authors: Taylor Rod S. , Neville Quinton , Mullin Christopher M. , Mekhail Nagy A. , Kallewaard Jan W. , Hayek Salim , Pope Jason E. , Hunter Corey W. , Costandi Shrif J. , Kapural Leonardo , Gilmore Christopher A. , Petersen Erika A. , Patel Kiran V. , Eldabe Sam , Levy Robert M. , Gilligan Christopher , Durbhakula Shravani , Abd-Elsayed Alaa , Bedder Marshall , Buchanan Patrick , Hanson Erin , Leitner Angela , Soliday Nicole , Duarte Rui V. , Clauw Daniel J. , Nurmikko Turo J. 
Published: October 2024

Abstract

Introduction:
Chronic pain is a personal experience influenced by multiple biopsychosocial factors. Using a pain intensity measure alone to assess the effectiveness of a chronic pain intervention fails to fully evaluate its impact on the multifaceted chronic pain experience. The holistic minimal clinically important difference (MCID) is a composite outcome developed to provide a comprehensive assessment of chronic pain in response to intervention, across 5 outcome domains: pain intensity, health-related quality of life, sleep quality, physical, and emotional function. To focus on domains where the individual need is greatest, the holistic MCID reflects the cumulative MCID averaged over only the domains where subjects were impaired preintervention.

Objectives:
To assess the internal and construct validity of the Holistic MCID score to inform its future use as an evidence-based tool.

Methods:
This validation study was undertaken using data from the EVOKE trial with 111 patients up to 24-month follow-up. Internal consistency of the holistic MCID was assessed using Cronbach alpha statistic and dimensional exploration using principal component analysis.

Results:
The holistic MCID measure demonstrated strong internal consistency with Cronbach alpha >0.7 at all follow-ups. Principal component analysis showed one overarching holistic dimension to be present in the composite. Construct validity was demonstrated by an increase in the holistic MCID score being associated with both increased Patients' Global Impression of Change, EuroQol visual analogue scale score, and each of the outcome domains in a “leave-one-out” analysis (all P < 0.001).

Conclusion:
The holistic MCID provides a valid measure for the comprehensive, personalized assessment of response after a chronic pain intervention. The validity of the holistic MCID requires further confirmation in other chronic pain populations and with different interventions.
Efficacy of adding ketamine to levobupivacaine in paravertebral block on acute and chronic pain in thoracotomy: a randomized controlled double-blinded trial
Authors: Moharam Saad Ahmed , Elshikh Amgad , Abdelbadie Mohamed , Ibrahim Ahmed Mohamed , Shaheen Mostafa Mohamed Khedr , ElSharkawy Mohammed Said 
Published: October 2024

Abstract

Background:
The inappropriate management of pain after thoracotomy results in serious complications. Several adjuvants have been added to the thoracic paravertebral block (TPVB) to enhance its effects. This work aimed to evaluate the effect of adding ketamine to TPVB on thoracotomy-related acute and chronic pain.

Methods:
This randomized controlled double-blinded trial included 60 patients scheduled for open thoracotomy. Patients were equally randomized into 2 groups: group K: received TPVB + 1 mL ketamine (50 mg). Group C (n = 30): received TPVB (19 mL of 0.5% levobupivacaine + 1 mL normal saline) as a control arm.

Results:
Group K exhibited a significant delay in requesting analgesia, required less morphine in the first 24 and 48 hours, and reported lower numerical rating scale at rest and at deep breathing at various time points compared with the control group. However, both groups were comparable in post-thoracotomy pain syndrome and the incidence of complications at 2 months and 3 months.

Conclusions:
Adding ketamine to TPVB resulted in better analgesia as demonstrated by significantly delayed time to first rescue analgesia, lower total amount of consumed opioid, and pain score without considerable effect on chronic pain and complications in patients undergoing thoracotomy.
Exploring the Relationship Between Hospital Patient Safety Culture and Performance on Measures of Hospital-Acquired Conditions
Authors: Noghrehchi Pejmon , Hefner Jennifer L. , Stegall Hendrik , Walker Daniel M. 
Published: October 2024

Objective
The aim of the study is to examine the relationship between hospital perceptions of patient safety culture and the incidence of hospital-acquired conditions (HACs) included in Medicare’s HAC Reduction Program utilizing updated and standardized metrics.

Methods
The pooled cross-sectional study design utilized the 2018 and 2021 datasets from (1) the Agency for Healthcare Research and Quality’s Hospital Survey on Patient Safety Culture (HSOPS), (2) the American Hospital Association’s annual survey, and (3) the Center for Medicare and Medicaid’s Hospital Compare dataset. The final analytic sample included 131 acute care, nonfederal, U.S. facilities. Multivariable linear regression models were used to compare the HSOPS domains of patient safety culture to CMS’s HAC metrics.

Results
Controlling for hospital structural and patient-mix characteristics, hospitals with higher staff-reported ratings of overall patient safety culture (‘overall perceptions of patient safety’ and ‘patient safety grade’) had significantly lower rates of HACs, including total HAC rate, catheter-associated urinary tract infections, and central line-associated blood stream infections (P’s < 0.000–0.044). Higher HSOPS domain scores were variably associated with lower HAC rates, with consistently significant associations found for domains related to nonpunitive, open communication (P’s < 0.05).

Conclusions
Our relatively robust results suggest that while patient safety culture may not be the only strategy necessary to improve HAC rates, it needs to be aligned with other efforts to improve quality and safety. This underscores the importance of cultivating a culture of psychological safety that promotes open feedback and communication about errors.
Multifocal Hemorrhagic Choriocarcinoma With Diffuse Pancreatic FDG Uptake on 18F-FDG PET/CT
Authors: Dai Sheng , Dong Youwen 
Published: October 2024

Abstract
Choriocarcinoma is a rare and highly malignant trophoblastic tumor. We present a case involving a 30-year-old woman with abdominal pain, hemoptysis, and elevated serum amylase levels. Initial clinical suspicion included acute pancreatitis. Noncontrast and contrast-enhanced CT revealed hemorrhagic and hypervascular lesions in the lungs, pancreas, liver, and kidneys. 18F-FDG PET/CT showed diffuse pancreatic enlargement with increased FDG uptake (SUVmax, 5.3), consistent with malignancy. Histopathology confirmed choriocarcinoma with elevated HCG levels. Following chemotherapy, HCG levels declined, indicating a positive therapeutic response. 18F-FDG PET/CT effectively detected choriocarcinoma and assessed its systemic involvement.
Reversal of Basal Ganglia Hypermetabolism Following Surgical Removal of Adrenocorticotropic Hormone–Producing Lung Carcinoid in a Patient of Cushing Syndrome With Unusual Presentation of Acute Psychosis
Authors: Malhotra Gaurav , Kasaliwal Rajeev , Rupani Karishma , Lila Anurag R. , Upadhye Trupti , Bandgar Tushar , Shah Nalini S. 
Published: October 2024

Abstract
A 34-year-old woman who presented with severe psychosis and clinical features of Cushing syndrome underwent 18F-FDG PET/CT that revealed hypermetabolic lung lesion along with predominantly increased metabolism of bilateral basal ganglia, a scintigraphic correlate of acute psychosis. The lesion was surgically excised and histopathologically proven to be adrenocorticotropic hormone–producing lung carcinoid. Posttreatment 18F-FDG PET scan showed restoration of normal brain metabolism with complete reversal of psychosis. Even though rare, one should be aware of psychosis as an initial presentation of Cushing syndrome and use of 18F-FDG PET/CT for mapping brain metabolism as shown in this case.
Leadership Lingo
Authors: Brara Amrita , Chang Chloe , Kerins Joanne , Smith Samantha E. , Tallentire Victoria R. 
Published: October 2024

Introduction
Leadership in medical emergencies is variable and frequently suboptimal, contributing to poor patient care and outcomes. Simulation training can improve leadership in both simulated practice and real clinical emergencies. Thoughtful debriefing is essential. However, unclear language around leadership limits facilitators' capacity for transformative reflective discussion.

Methods
Internal medicine trainees participated in simulated medical emergency scenarios. Video recordings of consenting participants were analyzed using template analysis. A priori codes from existing literature formed an initial coding template. This was modified with inductive codes from the observed behaviors to develop a taxonomy of leadership behaviors in simulated medical emergencies. The taxonomy was then transformed into an infographic, to be used as a leadership debriefing tool.

Results
The taxonomy of leadership behaviors consisted of the following 4 themes: Structuring, Decision making, Supporting, and Communicating. Structuring behaviors shaped the team, ensuring that the right people were in the right place at the right time. Decision-making behaviors steered the team, setting a direction and course of action. Communicating behaviors connected the team, sharing valuable information. Supporting behaviors nurtured the team, guiding team members to perform at their optimum level.

Conclusions
Debriefing-as-imagined is not always debriefing-as-done. A shared language of leadership can connect educators and learners, advancing critical debriefing conversations and enabling facilitators to drive meaningful reflective discussion. The use of infographics in simulation offers an opportunity to support educators in facilitating complex debriefing conversations.
RSYD-BASIC: a bioinformatics pipeline for Routine Sequence analYsis and Data processing of BActerial iSolates for clInical miCrobiology
Authors: Steinke Kat , Thomsen Karina Gravgaard , Hoegh Silje Vermedal , Larsen Sanne Løkkegaard , Kubel Vilhelmsen Karina , Jensen Thøger Gorm , Skov Marianne Nielsine , Sydenham Thomas Vognbjerg 
Published: October 2024

Background
Whole genome sequencing of bacterial isolates is increasingly becoming routine in clinical microbiology; however, subsequent analysis often needs to be started by a bioinformatician even for comprehensive pipelines. To increase the robustness of our workflow and free up bioinformatician work hours for development and advanced analysis, we aimed to produce a robust, customizable bioinformatic pipeline for bacterial genome assembly and routine analysis results that could be initiated by non-bioinformaticians.
Results
We introduce the RSYD-BASIC pipeline for bacterial isolate sequence analysis and provide a demonstration of its functionality with two datasets composed of publicly available sequences, in which comparable results are obtained in most cases. In some instances, the pipeline provided additional information, corresponding to in vitro results where these could be obtained. In routine use at our department, the pipeline has already yielded clinically relevant results, allowing us to type a variety of bacterial pathogens isolated in our clinical laboratory. We also demonstrate how RSYD-BASIC results aided in disproving a potential outbreak.
Conclusion
With the RSYD-BASIC pipeline, we present a configurable reads-to-results analysis pipeline operated by non-expert users that greatly eases investigation of potential outbreaks by expert end-users. Results obtained with publicly available sequences show comparable performance to the original methods, while underlining the importance of standardized methods.
The mechanism of bacterial defense system DdmDE fromLactobacillus casei
Authors: Huang Pingping , Yan Purui , Guo Lijie , Fei Wenying , Li Zhaoxing , Liu Jingxian , Kong Jianping , Yao Yue , Lu Meiling , Xiao Yibei , Chen Meirong 
Published: October 2024

AbstractBacteria has developed a diverse array of defense mechanisms to protect against invasion by mobile genetic elements. Recent study identified a bacterial defense module DdmDE system which encodes a helicase-nuclease fusion protein DdmD and a putative prokaryotic Argonaute-like protein DdmE, imposing fitness advantages to the bacteria by eliminating invasive plasmids. However, the mechanistic basis of how DdmDE system detects and degrades plasmids is not fully understood. Here, by studying the DdmDE system fromLactobacillus casei(LcDdmDE), we found that LcDdmD is able to degrade ssDNA and nick plasmids in the presence of Mn2+, and it exhibits 5’-3’ DNA helicase activity in a ssDNA length-dependent mechanism. Meanwhile, LcDdmD serves as a sensor that utilizes DNA guide to recognize target DNA. We determined the cryo-EM structures of LcDdmD dimer bound with fork DNA, guide/target DNA-bound LcDdmE, and the complex of LcDdmDE-bubble DNA in intermediate state as well as active state. Together with functional analysis, we revealed the working mechanism of LcDdmDE system. In such a scenario, guided by ssDNA, LcDdmE recruits auto-inhibited LcDdmD dimer loading onto DNA target. Through substantial conformational changes, LcDdmD dimer dissociates into active monomer and unwind duplex for plasmid degradation. Our study provides structural insights into the mechanism of DdmDE, presenting pAgo-directed plasmid degradation by the allosterically regulated helicase-nuclease.
Regulatory Changes in the Fatty Acid ElongaseeloFUnderlie the Evolution of Sex-specific Pheromone Profiles inDrosophila prolongata
Authors: Luo Yige , Takau Ayumi , Li Jiaxun , Fan Tiezheng , Hopkins Ben R. , Le Yvonne , Ramirez Santiago R. , Matsuo Takashi , Kopp Artyom 
Published: October 2024

AbstractPheromones play a key role in regulating sexual behavior throughout the animal kingdom. InDrosophilaand other insects, many cuticular hydrocarbons (CHCs) are sexually dimorphic, and some are known to perform pheromonal functions. However, the genetic control of sex-specific CHC production is not understood outside of the model speciesD. melanogaster. A recent evolutionary change is found inD. prolongata, which, compared to its closest relatives, shows greatly increased sexual dimorphism in both CHCs and the chemosensory system responsible for their perception. A key transition involves a male-specific increase in the proportion of long-chain CHCs. PerfumingD. prolongatafemales with the male-biased CHCs reduces copulation success, suggesting that these compounds function as sex pheromones. The evolutionary change in CHC profiles correlates with a male-specific increase in the expression of multiple genes involved in CHC biosynthesis, including fatty acid elongases and reductases and other key enzymes. In particular,elongase F, which is responsible for producing female-specific pheromones inD. melanogaster, is strongly upregulated inD. prolongatamales compared both to females and to males of the sibling species. Induced mutations ineloFreduce the amount of long-chain CHCs, resulting in a partial feminization of pheromone profiles inD. prolongatamales while having minimal effect in females. Transgenic experiments show that sex-biased expression ofeloFis caused in part by a putative transposable element insertion in its regulatory region. These results reveal one of the genetic mechanisms responsible for a recent evolutionary change in sexual communication.