bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Conceptualization and Derivation of the Cervical Lordosis Distribution Index
Authors: Passias Peter G. , Williamson Tyler K. , Dave Pooja , Smith Justin S. , Krol Oscar , Lafage Renaud , Line Breton , Diebo Bassel G. , Daniels Alan H. , Klineberg Eric O. , Eastlack Robert K. , Bess Shay , Schwab Frank J. , Shaffrey Christopher I. , Lafage Virginie , Ames Christopher P. ,   on behalf of the International Spine Study Group
Published: September 2024

Study Design/Setting.
Retrospective cohort.

Objective.
Tailor correction of cervical deformity by incorporating the cervical apex into a distribution index [Cervical Lordosis Distribution Index (CLDI)] to maximize clinical outcomes while lowering rates of junctional failure.

Background.
Yilgor and colleagues developed the lumbar Lordosis Distribution Index to individualize the pelvic mismatch to each patient’s pelvic incidence. The cervical lordosis distribution in relation to its apex has not been characterized.

Patients and Methods.
Cervical deformity patients with complete 2Y data were included. The optimal outcome is defined by no distal junctional failure (DJF), and meeting “good clinical outcome (GCO)” criteria by Virk and colleagues: [meeting 2 of 3: (1) a Neck Disability Index <20 or meeting minimally clinically important difference, (2) modified Japanese Orthopedic Association ≥14, (3) an Numerical Rating Scale–neck ≤5 or improved by 2 or more points]. C2-T2 lordosis was divided into cranial (C2 to apex) and caudal (apex to T2) arches postoperatively. A CLDI was developed by dividing the cranial lordotic arch (C2 to apex) by the total segment (C2-T2) and multiplying by 100. Cross-tabulations developed categories for CLDI producing the highest χ2 values for achieving optimal outcomes at 2 years and outcomes were assessed by multivariable analysis controlling for significant confounders.

Results.
Eighty-four cervical deformity patients were included. Cervical apex distribution postoperatively was: 1% C3, 42% C4, 30% C5, and 27% C6. The mean CLDI was 117 ± 138. Mean cranial lordosis was 23.2 ± 12.5°. Using cross-tabulations, a CLDI between 70 and 90 was defined as “‘aligned.” The χ2 test revealed significant differences among CLDI categories for distal junctional kyphosis, DJF, GCO, and optimal outcome (all P < 0.05). Patients aligned in CLDI were less likely to develop distal junctional kyphosis [odds ratio (OR): 0.1, (0.01–0.88)], more likely to achieve GCO [OR: 3.9, (1.2-13.2)] and optimal outcome [OR: 7.9, (2.1-29.3)] at 2 years. Patients aligned in CLDI developed DJF at a rate of 0%.

Conclusion.
The CLDI, classified through the cranial segment, takes each unique cervical apex into account and tailors correction to the patient to better achieve GCOs and minimize catastrophic complications after cervical deformity surgery.

Level of Evidence.
Level III.
Oral Tranexamic Acid for Prevention and Treatment of Postinflammatory Hyperpigmentation
Authors: Minasyan Marine , Hogan Sara , Lal Karan 
Published: September 2024

BACKGROUND
Postinflammatory hyperpigmentation (PIH) is a skin disorder characterized by hyperpigmentation resulting from heightened inflammation and/or damage to the basement membrane, melanocytes, and keratinocytes, leading to abnormal and excessive pigment deposition. Oral tranexamic acid (TXA), originally used as an antifibrinolytic for managing excessive bleeding, has garnered attention for its demonstrated safety and efficacy in treating melasma. There is a growing body of evidence regarding the use of TXA in the treatment of PIH.

OBJECTIVE
To review the mechanism of action of oral TXA in treating PIH and examine the use of oral TXA in preventing and/or treating PIH associated with laser-based and light-based treatments in individuals with skin color.

METHODS
Review of relevant articles from 2000 to present found in the Cochrane Library, PubMed, Embase, and Google Scholar, regarding the use of oral TXA in the treatment of PIH.

RESULTS
Studies reviewed investigated the efficacy of oral tranexamic acid (TXA) in treating postinflammatory hyperpigmentation (PIH) and use in preventing PIH when used in conjunction with other treatments. All studies demonstrated significant improvement in PIH without significant adverse effects and side effects.

CONCLUSION
Oral tranexamic acid is emerging as a safe and effective treatment in the prevention and treatment of postinflammatory hyperpigmentation.
Integrated ubiquitomics characterization of hepatocellular carcinomas
Authors: Lin Xiao-Tong , Luo Yuan-Deng , Mao Cui , Gong Yi , Hou Yu , Zhang Lei-Da , Gu Yong-Peng , Wu Di , Zhang Jie , Zhang Yu-Jun , Tan De-Hong , Xie Chuan-Ming 
Published: September 2024

Background and Aims:
Patients with aggressive HCC have limited therapeutic options. Therefore, a better understanding of HCC pathogenesis is needed to improve treatment. Genomic studies of HCC have improved our understanding of cancer biology. However, the ubiquitomic characteristics of HCC remain poorly understood. We aimed to reveal the ubiquitomic characteristics of HCC and provide clinical feature biomarkers of the aggressive HCC that may be used for diagnosis or therapy in the clinic.

Approach and Results:
The comprehensive proteomic, phosphoproteomic, and ubiquitomic analyses were performed on tumors and adjacent normal liver tissues from 85 patients with HCC. HCCs displayed overexpression of drugable targets CBR1-S151 and CPNE1-S55. COL4A1, LAMC1, and LAMA4 were highly expressed in the disease free survival-poor patients. Phosphoproteomic and ubiquitomic features of HCC revealed cross talk in metabolism and metastasis. Ubiquitomics predicted diverse prognosis and clarified HCC subtype-specific proteomic signatures. Expression of biomarkers TUBA1A, BHMT2, BHMT, and ACY1 exhibited differential ubiquitination levels and displayed high prognostic risk scores, suggesting that targeting these proteins or their modified forms may be beneficial for future clinical treatment. We validated that TUBA1A K370 deubiquitination drove severe HCC and labeled an aggressive subtype of HCCs. TUBA1A K370 deubiquitination was at least partly attributed to protein kinase B-mediated USP14 activation in HCC. Notably, targeting AKT-USP14-TUBA1A complex promoted TUBA1A degradation and blocked liver tumorigenesis in vivo.

Conclusions:
This study expands our knowledge of ubiquitomic signatures, biomarkers, and potential therapeutic targets in HCC.
Corticosteroids for Managing Pediatric Sepsis and Septic Shock: A Systematic Review and Meta-analysis
Authors: Deng Jiawen , Bedri Nefissa , Zuo Qi Kang , Azab Maryam , Chang Oswin , Virdi Riya , Hung Jay , Venugopal Kaden , Tahir Umair , Heybati Kiyan 
Published: September 2024

Objective:
To assess the efficacy and safety of corticosteroids for the management of pediatric sepsis and septic shock.

Data Sources:
Ovid MEDLINE, Ovid Embase, CENTRAL, Web of Science (Core Collection) and China National Knowledge Infrastructure were systematically searched up to September 2023. Preprint servers, clinical trial registries and the reference sections of previous reviews were hand-searched.

Study Selection:
Randomized controlled trials that enrolled pediatric sepsis, septic shock or systemic inflammatory response syndrome patients, compared the use of corticosteroid regimens against standard sepsis care and reported eligible outcomes were included. Title/abstract and full-text screening were conducted in-duplicate.

Data Extraction:
Eligible articles were extracted using a standardized form in-duplicate. Outcomes extracted include mortality incidence, hospital and pediatric intensive care unit length of stay, duration of shock, incidence of adverse events and serious adverse events and incidence of corticosteroid-related adverse events. The risk of bias was assessed using the Revised Cochrane Risk of Bias Tool for Assessing Randomized Trials.

Data Synthesis:
Random-effects meta-analyses were conducted, and the quality of evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluations approach. Sixteen randomized controlled trials (N = 973) were included. Corticosteroid use may be associated with reduced mortality risks (risk ratio: 0.65, 95% CI: 0.50–0.85), shorter length of hospital stay (MD: −3.76 days, 95% CI: −6.66 to −0.86), and shorter pediatric intensive care unit length of stay (MD −2.34 days, 95% CI: −3.14 to −1.53 days). Corticosteroid use may be associated with gastrointestinal bleeding but not a higher risk of secondary infection. No studies reported on serious adverse events. All findings were based on low to very low quality of evidence.

Conclusions:
While corticosteroids show promise for managing pediatric sepsis and septic shock, the question of how to select the best candidate and the most optimal regimen remains unanswered. Future trials need to focus on assessing corticosteroid-related adverse events and stratifying patient inclusion by sepsis subphenotypes.
Phakic intraocular lens exchange due to severe uveitis/inflammation: case report
Authors: Cerqueira Silva Alvaro Filipe , Ferreira Mendes José Carlos , Dourado Araújo Leite Ricardo Jorge , Lopes Franqueira Pereira Nuno Filipe , Monteiro Tiago Pacheco Teixeira 
Published: September 2024

Introduction:
Phakic intraocular lenses (IOLs) provide excellent visual and refractive outcomes with a high safety profile. This report illustrates a case of a rare episode of severe anterior segment inflammation after iris-claw foldable lens implantation, which required surgical reintervention.

Patient and Clinical Findings:
A 22-year-old woman was submitted to Artiflex implantation for the correction of myopia. Three months postoperatively, a severe anterior segment inflammation developed with pigment deposition, pupillary membrane formation, and decreased visual acuity in the left eye.

Diagnosis, Intervention, and Outcomes:
Given the nonresponse to medical treatment (topical and systemic corticosteroid for 3 months), surgical explantation of the IOL with peeling of a pigmentary membrane over the crystalline lens was performed. During a 24-month follow-up period, the patient was monitored to exclude the development of cataract or glaucoma. Afterward, an implantable collamer lens was implanted with an uneventful intraoperative and postoperative period. During the long-term follow-up, no further pigment dispersion, uveitis, or cataract was described.

Conclusions:
Persistent anterior uveitis with pigmentary membrane formation after iris-claw lens implantation is a rare complication. IOL explantation needs to be considered to prevent further sequelae after severe uveitis when the situation is unresponsive to medical treatment.
Ascaris in infected pancreatic pancreatic necrosum: a case report of an intraoperative surprise
Authors: Regmi Parbatraj , Deo Kunal Bikram , Gautam Sujan , Yogi Barurendra Raj , Sah Bed Prakash , Adhikary Shailesh 
Published: September 2024

Introduction and importance:
Ascariasis lumbricoides is a common gastrointestinal tract helminthic disease in developing countries and is also a cause of hepatobiliary and pancreatic disease in endemic areas of the world. Involvement of the pancreatic duct by worms and associated pancreatitis is less common than the hepatic and biliary involvement.

Case presentation:
A 38-year-old patient was admitted with a diagnosis of alcohol-induced acute pancreatitis and managed conservatively. However, the patient’s condition worsened after 2 weeks, and a CT scan revealed an acute necrotic collection with gas foci. After failed percutaneous pigtail catheter drainage, laparotomy was performed, revealing a necrotic collection in the right paracolic gutter, with the entire area frozen and a worm observed in the necrosum. The colon and small bowel were intact without perforation. The suspicion arose that the worm might have either migrated from a duodenal perforation, which had possibly sealed after the acute phase, or migrated from the major pancreatic duct. Debridement of easily accessible necrotic tissues was performed, and the patient was admitted to the intensive care unit (ICU). Unfortunately, the patient tested positive for COVID-19, and a few days later, blood was observed in the drain. Re-exploration revealed diffuse blood oozing, and the abdomen was closed with packing.

Conclusion:
The route of ascaris migration to necrosum or its association with severe acute pancreatitis needs to be ensured in endemic areas. Cautious use of antihelminthic therapy in endemic areas could prevent fatal pancreatobiliary complications and its associated mortality.
Effect of transcutaneous electrical nerve stimulation on maximum mouth opening after orthognathic surgery: a randomised controlled trial
Authors: Alam Mostafa , Tabrizi Reza , Mohammadikhah Meysam , Farzan Ava , Moslemi Hamidreza , Farzan Avishan , Farzan Ramyar 
Published: September 2024

Background:
The present study aims to determine the effect of transcutaneous electrical nerve stimulation (TENS) on maximum mouth opening (MMO) after orthognathic surgery.

Materials and methods:
This study is a randomised clinical trial. The samples of this study were class III patients who are candidates for Le Fort I osteotomy surgery for maxillary advancement and bilateral sagittal split osteotomy (BSSO) for mandibular setback surgery due to the lack of maxilla growth and mandibular prognathism using the Dalpont method. On the day following surgery, the intervention group received TENS physiotherapy and instructions to take analgesics. In the control group, patients only received analgesics. MMO was measured in both groups using a digital caliper preoperatively, 1 month, and 6 months postoperatively.

Results:
A total of 82 patients participated in this study, who were divided into two groups of 41, intervention and control. The difference in the mean MMO in different periods after surgery of the intervention group (F=59733.350, P<0.001) and the control group (F=32.480, P<0.001) was significant. The pattern of MMO increase over time was not the same in the two groups. There was a steeper slope in the increase of MMO in the intervention group than in the control group.

Conclusion:
It can be concluded from the results of this study, that the use of TENS after orthognathic surgery can be effective along with analgesics in reducing pain intensity and, subsequently, recovery in MMO in the short term.
Resolution of infertility following hydatid cyst removal: a case report
Authors: Warasna Haya Jebreen Mohammed , Abuzaina Khalil N. , Fakhouri Sulaiman N. , Shahin Farah Bilal Yousef , Awad Bashar Yaser Hasan , Awad Mohammad Yaser Hasan , Banat Mohamad A. , Smerat Mohammad I. 
Published: September 2024

Introduction and importance:
Human echinococcosis, also known as ‘hydatid cyst,’ constitutes a zoonotic parasitic disease attributed to Echinococcus granulosus or Echinococcus multilocularis. Primary afflictions occur in the liver and lungs, whilst the implication of alternative organs remains infrequent. The clinical presentation can vary, and large cysts may cause compression symptoms and complications. This case involved a 21-year-old Palestinian female with three large hydatid cysts in the liver, causing compression of adjacent structures and unique clinical manifestations.

Case presentation:
A female aged 21 arrived with signs of heart palpitations, shortness of breath, tiredness, and pain in the right upper abdomen, alongside a background of infertility. During routine pre-IVF ultrasound, three liver hydatid cysts were unexpectedly found, leading to a referral to the surgical department. Laboratory tests and imaging confirmed this diagnosis. The surgery involved cyst aspiration, hypertonic saline injection, and marsupialization. Post-surgical complications were managed as they occurred. The symptoms lessened afterward, and a successful pregnancy was achieved 9 months post-surgery.

Clinical discussion:
Zoonotic infection by cystic echinococcosis (CE) primarily engages the liver and lungs. The progression of symptoms is contingent upon cyst placement and resultant pressure on adjacent tissues. Diagnosis requires imaging alongside serological assays, while large cysts necessitate surgical intervention.

Conclusion:
The presented case underscores the complexity of managing multiple extensive liver hydatid cysts, highlighting the necessity to consider hydatid disease amidst patients presenting with indeterminate symptoms, particularly within endemic zones. An extensive surgical strategy produced positive outcomes, illustrating the significance of prompt intervention for symptom alleviation and sustained patient health.
Gastrointestinal LCH: a rare manifestation of Langerhans cell histiocytosis
Authors: Thapaliya Ishwor , Basnet Bishal , Banjade Dilip Sharma , Kantha Adesh , Mijar Sujan 
Published: September 2024

Introduction:
Langerhans cell histiocytosis (LCH) is a rare neoplasm marked by the proliferation of Langerhans cells, primarily affecting children under 2 years old. Gastrointestinal (GI) involvement in LCH is uncommon and often part of widespread disease.

Case Presentation:
We report a 16-year-old female with a history of LCH, previously treated with 6-mercaptopurine and vinblastine, who presented with bloody diarrhoea, abdominal pain, and vomiting. Examination revealed hypopigmented skin lesions, lymphadenopathy, and hepatosplenomegaly. Laboratory tests indicated anaemia and eosinophilia, and colonoscopy was suggestive of GI LCH.

Discussion:
Gastrointestinal LCH often presents with nonspecific symptoms. It is crucial to maintain a high degree of suspicion for GI LCH in atypical GI presentations, as treatment outcomes can be challenging if diagnosed late or misdiagnosed.

Conclusion:
GI symptoms in LCH are rare but may occur in isolation. Early diagnosis and treatment are crucial to reduce morbidity and improve prognosis.
Mortality association with extremity trauma and transferring patients for higher level of care
Authors: Malkoc Aldin , Miao Xinfei , Pillai Kathryn , Salami Neda , Lai Catherine , GnanaDev Raja , Glover Keith , Woodward Brandon , Schwartz Samuel 
Published: September 2024

Introduction:
Rising healthcare costs and reduced Medicaid reimbursements pose lasting challenges for trauma centers. Various studies have highlighted the adverse effect of these cost-related circumstances on trauma center survival and the need for local hospitals to transfer patients to tertiary and quaternary care centers. Our study seeks to assess the relationship between patient transfer status to a higher-level health center and its association with mortality.

Methods:
A total of 19 417 patients were identified, of which 15 317 patients presented directly to the higher level health center, and 3830 patients who transferred from 49 different outside hospitals within a 500-mile radius. Data collection was collected from the receiving higher level of care hospital trauma registry. IBM SPSS version 23 was used to analyze the data. A 1:1 propensity-matched analysis based on age, sex, and injury severity score yielded 3566 patients that presented directly to ARMC and 3566 patients who were transferred to ARMC for a higher level of care. Amongst various factors we considered mechanism of injury, response levels, arrival methods, and transfusion of blood products.

Results:
The univariate analysis of the propensity-matched analysis demonstrated 88% blunt injury in the nontransferred group and 82% in the transferred group (P<0.001). Overall, hospital mortality was 3% in nontransferred patients versus 4% in the transferred group (P<0.001). A multivariate logistic regression demonstrated mortality is more likely in patients with higher injury severity scores [odd ratio (OD) 2.351 (1.029–1.082), P<0.001] and lack of packed red blood cell (pRBC) transfusions received within first 4 h [OD 6.852 (3.525–13.318), P=0.001].

Conclusion:
The transfer of trauma patients with extremity injuries to level 1 trauma centers has significant implications on patient outcomes. In our retrospective observational cohort study, the authors noted increased mortality among patients with higher injury severity scores, penetrating injuries, pRBC administration within the first 4 h of hospitalization, and among patient transfers.
Case report: Lemmel syndrome-aggravated by consumption of fatty food
Authors: Pokharel Selene , Gurung Ram B. , Khadka Saurav , Shrestha Sneha , Upadhyaya Prashant 
Published: September 2024

Introduction and importance:
One of the very rare causes of obstructive jaundice, Lemmel’s syndrome, is caused due to biliary mechanical compression by a juxtapapillary diverticulum. It is defined as obstructive jaundice due to juxtapapillary diverticulum in the absence of cholelithiasis, periampullary tumours, or other detectable obstacles. It is an extremely rare syndrome; therefore, studies need to be done for proper diagnosis and management.

Case presentation:
Our patient, a 73-year-old woman, gave a history of recent acute right hypochondriac pain that had subsided the day before. Lab investigations were performed and liver enzymes were found to be significantly raised. An endoscopy followed by an endoscopic ultrasound was performed for further diagnosis, which showed the diverticulum outpouching from the duodenum. MRCP was then performed, which revealed a dilated common bile duct and common hepatic duct, with tapering at the distal end, most likely to be a stricture. Lemmel syndrome was identified based on the clinical presentation and imaging results. A dilated common bile duct, and two large duodenal diverticula with interdiverticular papilla was discovered during the patient’s endoscopic ultrasound, which was performed by the gastrointestinal team.

Clinical discussion:
Duodenal diverticula are the second most common site of diverticula after the colon with an incidence of 1–5% in radiological series. Lemmel’s syndrome is a rare cause of obstructive jaundice associated with juxtapapillary diverticulum. With a low incidence rate, only a few cases of Lemmel’s syndrome are reported with the first case reported in 1934 by Lemmel. Imaging techniques such as barium meal, EUS, ERCP, or magnetic resonance cholangiopancreatography are used to confirm the diagnosis. Our observations demonstrate that the diverticulum, which is often found on the medial wall of the second half of the duodenum and contains bezoar, compresses the distal common bile duct laterally. Nowadays, ERCP and EUS are used to confirm the diagnosis. Only symptomatic periampullary duodenal diverticulum (PDD) requires conservative or surgical therapy. The first line of treatment for biliopancreatic PDD problems is endoscopic sphincterotomy, which is 95% effective.

Conclusion:
Lemmel syndrome occurs due to the compression of the common bile duct by a duodenal diverticulum. Imaging, including CT scans, and MRCP are important for the diagnosis of this syndrome. Treatment modalities are not the same for each patient, however.