bluuebunny/crossref_metadata_2025_split huggingface dataset:
Work Where You Live or Live Where You Work? Resident Work and Sleep Patterns While on “Home Call”
Authors: Mitchell David T. , Koppin Noa G. , Talanker Michael T. , Bhadkamkar Mohin A. , Marques Erik S. , Greives Matthew R. , Hopkins David C. 
Published: September 2024

Background:
Unlike in-house call, the Accreditation Council for Graduate Medical Education (ACGME) does not require a postcall day for “home call” shifts. Despite this, we hypothesize that on-call residents are still in the hospital for the majority of their shift despite having the luxury of home call and, thus, are not protected by ACGME postcall duty hour regulations.

Methods:
A prospective single center survey study was conducted by surveying junior and senior residents who completed overnight call shifts from January 2023 to April 2023 at one of the busiest level 1 trauma centers in the United States. Data include number of trips into the hospital, hours spent in the hospital, and hours of sleep.

Results:
Response rate was 195 of 200 (97.5%) total call shifts from 7 pm to 7 am the next morning. Junior residents reported an average of 3.25, 3.92, and 0.73 hours of sleep when on hand call, face call, and triple call (hand + face + general), respectively. Senior residents reported an average of 4.18 and 4.75 hours of sleep for hand and face call, respectively.

Conclusions:
Hours of sleep when taking home call varies widely based on type of call. Junior residents reported significantly decreased sleep and more time in the hospital when taking hand, face, and triple call compared with general call alone. Senior residents reported that both hand and face call result in significantly decreased hours of sleep compared with general call alone. These results highlight the need to discuss ACGME protection for residents taking home call.
Case report: incarcerated gestational uterine rectal prolapse managed with manual reduction and Thiersch procedure
Authors: Buote Jacob , Regush Lexy , Irvine Kyle , Manz Joren , Adey Kaitlin 
Published: September 2024

Introduction and Importance:Incarcerated gestational uterine rectal prolapse is a rare obstetrical complication, with only three other cases reported worldwide. Risk factors for uterine incarceration and anal sphincter deficiency are predisposing factors. The authors report a case of gestational uterine rectal prolapse with successful reduction and prevention, discuss previous approaches and provide recommendations for future cases.Case Presentation:A 33-year-old G5P3 woman presented with a 9 h history of an incarcerated 14-week gestational uterine rectal prolapse, which occurred following a bowel movement. Examination revealed prolapsed rectal lumen containing a gravid uterus with a live fetus demonstrated using point-of-care ultrasound. Under general anesthesia in the left lateral decubitus position, the prolapse was successfully reduced manually and the anal sphincter was secured with a Thiersch perianal encirclement procedure. The pregnancy remained uncomplicated, and she delivered a viable infant via Cesarean section at term.Discussion:This case report is unique in that there have only been three other published reports worldwide and we successfully employ the use manual reduction and placement of a Thiersch encirclement in the management of our case. Manual reduction under general anesthesia in the left lateral decubitus position is noninvasive and was shown to optimally manage gestational uterine rectal prolapse. A Thiersch perianal encirclement procedure coupled with aggressive bowel care was shown to be successful at prevention of recurrence of rectal prolapse in pregnancy following reduction.Conclusion:Manual reduction under general anesthesia and Thiersch encirclement is an effective management for incarcerated gestational rectal prolapse.
Intraoperative measurement technique for improved accuracy of femoral offset and leg length in total hip replacement: a retrospective cohort study
Authors: Geller-Hinich Maayan , Reshef Noam , Ben Natan Merav , Rothem David E. 
Published: September 2024

Introduction:
Restoration of limb length equality and femoral offset is critical for the success of total hip replacement (THR). The purpose of this study was to investigate the efficacy of a novel intraoperative measurement technique in minimizing errors in leg length and offset in THR.

Methods:
This retrospective cohort study included 50 consecutive patients who underwent THR. All surgeries were performed by the same orthopedic surgeon, using the posterior approach. In all patients, the same technique of intraoperative measurement of the femoral offset and limb length was used, which entailed calculation of the distances between reference points on the ischium, greater trochanter, and the screwdriver. Measurements were collected from radiographic imaging data and surgical reports.

Results:
The mean preoperative+intraoperative limb length discrepancy was −1.7 mm (SD=5.9), with a range of −8 to +4 mm. The mean postoperative limb length discrepancy was 1 mm (SD=4.3), with a range of −4 to +5 mm. The mean difference between the preoperative+intraoperative and postoperative measurements was 1 mm (P=0.004). The mean preoperative+intraoperative femoral offset was 36.5 mm (SD=5.4), with a range of 29.6 to 47.6 mm. The mean postoperative femoral offset was 40.10 mm, with a range of 30.8 to 50.0 mm. The mean difference between the premeasurement+intrameasurement and the postoperative measurement was 3.6 mm.

Conclusion:
This study presented an intraoperative measurement technique that is simple, low-cost, and requires minimal equipment. This technique was found to be effective in minimizing errors in femoral offset and leg length after THR.
Quality of life and patient satisfaction after single-port endoscopic thoracic sympathectomy for primary focal hyperhidrosis: a follow-up of 250 patients
Authors: Majeed Zryan S. , Baram Aram , Izac Ashur Y. 
Published: September 2024

Background:
If left untreated, severe types of primary focal hyperhidrosis (PFH) would have a negative impact on the quality of life (QoL) of the affected person. This study aimed to determine the efficacy of an endoscopic thoracic sympathectomy (ETS) and the degree of improvement in QoL and satisfaction after surgery. The intraoperative and postoperative complications were evaluated, especially compensatory hyperhidrosis (CH). We hypothesized that the selected sympathectomy levels will neither prevent nor reduce CH.

Methods:
A single-center retrospective study of 250 adult patients diagnosed with bilateral PFH underwent ETS of the second, third, and fourth thoracic sympathetic ganglion. We compared preoperative and postoperative hyperhidrosis severity score (HDSS) and QoL using Pearson correlation. The rate of CH and other complications during follow-up of 4 years were recorded.

Results:
Among 250 patients, 217 had a preoperative HDSS of three and 33 patients had a score of 4, when compared postoperatively HDSS was 0 in 145 patients (58%), one in 82 patients (32.8%), two in 22 patients (8.8%), and score 3 in one patient (0.4%) (P=0.097). QoL before operation in 201 patients was very bad (80.4%), while postoperatively, QoL was much better in 206 patients (82.4%) (P=0.0001). CH was seen only in 27 patients (10.8%), and only one was severe.

Conclusion:
ETS is safe and effective for severe cases of PFH. Sympathectomy at second, third, and fourth ganglion levels has an excellent outcome and higher patient satisfaction with minimal perioperative complications, including CH.
A combined four-point atlantoaxial fixation using Magerl and Harms techniques for the treatment of C1-C2 instability: a case report
Authors: Haddadi Kaveh , Hosseini Seyed M. , Javadian Siavash , Kargar-Soleimanabad Saeed 
Published: September 2024

Background:
The instability of the first and second cervical vertebral complexes (C1-C2) can have a variety of etiologies, generally involving the C1-C2 axis and associated soft tissues.

Case Presentation:
A 52-year-old man presented to our emergency department with cervical spine pain and limited range of motion following cervical spine trauma from a fall. The computed tomography scan with good reconstruction showed a complex C2 fracture. After obtaining informed consent, a combined C1 lateral mass-C2 pedicular screw fixation and C1-C2 transarticular screw rod fixation were applied as a four-point fixation technique to achieve immediate rigid immobilization of the C1-C2 motion segment.

Conclusion:
Transarticular screw fixation is an effective technique for the fusion of atlantoaxial complex that provides good fusion rates and is particularly important in patients at risk of nonunion. Nonetheless, a complementary fixation and grafting system is required to improve the integrity of the technique. The authors conclude that combined C1 lateral mass-C2 pedicular screw fixation (Harms techniques), and C1-C2 transarticular polyaxial screw rod fixation is a novel and effective four-point fixation technique to achieve immediate rigid immobilization of the C1-C2 motion segment. Further biomechanical studies should be performed to substantiate our clinical results.
Hepatocellular carcinoma revealed par bone metastasis: three cases report
Authors: Niasse Abdou , Ndiaye Papa I. , Mané Maimouna , Ndiaye Abdoulaye , Dieng Papa S. , Sall Fallou , Gaye Ahmadou , Niang Abdou , Konaté Ibrahima 
Published: September 2024

Introduction and importance:
Bone metastases from hepatocellular carcinoma (HCC) are rare. They are exceptionally revealing. The elective sites are the vertebrae, the ribs, and the sternum. Treatment remains palliative most often, which makes the prognosis very poor.

Case presentation:
We report three cases of vertebral metastases revealing HCC. Their management consisted of a laparoscopic biopsy followed by decompressive radiotherapy, supportive care in two cases, and sorafenib in one case. Median survival was 3 and 6 months, respectively. These observations allowed us to carry out a review of the literature on this particular clinical entity and to take stock of the therapeutic modalities.

Clinical discussion:
The discovery of HCC at the stage of bone metastases is rare. The prognosis is bad. The biopsy is justified by the rarity of these metastases. Radiotherapy on metastases improves quality of life without extending survival.

Conclusion:
Lytic bone lesions on HCC should suggest secondary localizations. Their prognosis remains bleak since the treatment is often only palliative.
Prevalence, causes, and early outcomes of shunt revisions at a tertiary hospital in Northern Tanzania: a cross-sectional study
Authors: Machaku Dennis , Chilonga Kondo , George Johnston , Rabiel Happiness 
Published: September 2024

Background:
The mainstay treatment for patients with hydrocephalus is surgical, with ventriculoperitoneal shunt (VPS) placement being a routine practice in hospitals with limited resources and workforce. Nonetheless, avoidable complications following VPS placements are still evident, compounding significant patient morbidity and mortality. We review an analysis of the causes and outcomes of the shunt revisions.

Methods:
A cross-sectional study was carried out at a tertiary hospital between March 2020 and March 2023. It included 263 patients who underwent initial VPS surgeries. Postoperatively, the patients had routine follow-up care for 3 months, at which time their characteristics in relation to shunt complications were evaluated. SPSS, version 26, was utilized to analyze the data that had been gathered.

Results:
VPS revisions were performed on 90 of 263 patients, a prevalence of 34.2%. Of the revisions, the majority (92.2%) were pediatric patients. Females made up 52.2% of the patients. The most common reason for revisions was shunt infection (50%), followed by malposition (27.8%), blockage (15.6%), and shunt dislocation (6.7%). Surgical site infection increased the likelihood of shunt revision by 29.8%. Shunt revision was 31% more likely in operations lasting longer than 45 min. Intraoperative involvement of a junior surgical trainee raised the possibility of revision by 25%, and a revised VPS system is 13.2 times more likely to fail, integrating into longer hospital stays.

Conclusion:
The emphasis on lengthy surgeries and a surgeon’s skill as risk factors for revisions demonstrates a need for change in surgical practice to enhance surgical outcomes. Given the high likelihood of re-revisions after VPS revisions, it is suggested that the surgical practice of the index operation be enhanced to reduce complications. These findings serve as an initial guide for developing interventional techniques to enhance good surgical outcomes.
Exploring drug utilization patterns in postoperative patients to combat post-surgical complication: a descriptive cross-sectional study
Authors: Palikhey Anjan , Sharma Satya Prakash , Lamsal Ashish , Shrivastava Amit Kumar , Shrestha Laxmi , Banjade Dilip Sharma , Thapaliya Ishwor 
Published: September 2024

Background:
Post-surgical pharmacotherapy with multiple agents is marked in the modern indoor hospital context to prevent postoperative infections, pain, nausea, and vomiting. The primary objective of this research was to assess postoperative patients’ drug use patterns using WHO indicators.

Method:
A descriptive cross-sectional study was done among 385 postoperative patients of the surgery ward in the hospital over six months from (22 November 2022 to 2 May 2023) after IRC approval. Data regarding prescribed drugs were obtained and recorded in structured case proforma using the patient’s treatment cardex. The different drug use indicators provided by the WHO were used to analyze the data.

Results:
Of the total 385 Patients, the commonest cause of hospitalization was elective lower segment caesarean section (93.2%), followed by appendicitis (3.6%). Analgesics (21.82%), antimicrobials (21.48%), anti-ulcer (10.81%), and anti-emetic (15.06%) were the most commonly prescribed drugs. Metronidazole (97.66%) was the most commonly prescribed drug among antimicrobials, followed by Ceftriaxone (77.4%). The average number of drugs per prescription was 9.17, and the average number of antibiotics per prescription was 1.97. The percentage of generic drugs and national essential medicine list prescriptions was 19.64% and 59.25%, respectively.

Discussion and conclusion:
Polypharmacy was very common, particularly in the case of antimicrobial agents. Urgent steps like specific guidelines, training, and monitoring of drug use are needed to correct some irrational approaches and reduce the cost of treatment. Similarly, prescriptions should be encouraged according to the national essential list of medicines.
Comparison Between the Veillon and the Symons–Fanning CT Classification Systems for Otosclerosis
Authors: Pinto João Viana , Almeida Ana Isabel , Andrade António , Vales Fernando , Moura Carla Pinto , Marques Pedro 
Published: September 2024

Objective
To analyze the correlation between outcomes of stapes surgery and preoperative and postoperative audiometric results with different radiological staging classifications such as the Veillon classification (VC) and the Symons–Fanning classification (SFC).

Study Design
Retrospective observational study.

Setting
One tertiary hospital center.

Patients
Adult patients submitted to stapes surgery due to otosclerosis from January 2017 to December 2022.

Intervention
Evaluation of different radiological classifications such as the VC and SFC.

Main Outcome Measures
Preoperative and postoperative pure-tone audiometric data, outcomes of stapes surgery success (closure of the ABG, rates of AC threshold less than or equal to 30 dB), and postoperative sensorineural hearing loss.

Results
A total of 87 patients and 97 operated ears were included. The SFC was associated with preoperative BC (p = 0.041) and AC (p = 0.018) and postoperative BC (p = 0.026) with an increase in thresholds with higher radiological stages. The VC was associated with postoperative AC (p = 0.045) with an increase in AC thresholds with increasing radiological stages. Lastly, both the VC (p = 0.032) and the SFC (p = 0.023) were associated with a decrease in rates of postoperative AC thresholds ≤30 dB with higher radiological stages.

Conclusions
The SFC seems to be more useful to predict preoperative AC and BC and postoperative BC. On the contrary, the VC was more useful to predict postoperative AC. Both scales were similarly associated with the rate of AC thresholds ≤30 dB.
When to Start Computer-Based Auditory Training After Cochlear Implantation: Effects on Quality of Life and Speech Recognition
Authors: Dornhoffer James R. , Shannon Christian , Hernandez-Herrara Gabriel A. , Schvartz-Leyzac Kara C. , Dubno Judy R. , McRackan Theodore R. 
Published: September 2024

Objective
Computer-based auditory training (CBAT) has been shown to improve outcomes in adult cochlear implant (CI) users. This study evaluates in new CI users whether starting CBAT within 3 months of activation or later impacts CI outcomes.

Study Design
Prospective natural experiment.

Setting
Tertiary academic medical center.

Patients
Sixty-five new adult CI users.

Interventions
CBAT use over the first-year postactivation.

Main Outcome Measures
Speech recognition scores and CIQOL-35 Profile score improvements between CI recipients who started CBAT resources early (<3 mo) and late (3–12 mo) postactivation.

Results
A total of 43 CI recipients started using CBAT within 3 months postactivation (early) and 22 after 3 months (late). Patients who used CBAT within 3 months postactivation showed significantly greater improvement in consonant-nucleus-consonant words (CNCw) (48.3 ± 24.2% vs 27.8 ± 24.9%; d = 0.84), AzBio Sentences in quiet (55.1 ± 28.0% vs 35.7 ± 36.5%; d = 0.62), and CIQOL-35 listening domain scores (18.2 ± 16.3 vs 6.9 ± 12.9, d = 0.73 [0.023, 1.43]), at 3 months postactivation, compared to those who had not yet initiated CBAT. However, by 12 months postactivation, after which all CI recipients had started CBAT, there were no differences observed between patients who started CBAT early or late in speech recognition scores (CNCw: d = 0.26 [−0.35, 0.88]; AzBio: d = 0.37 [−0.23, 0.97]) or in any CIQOL global or domain score (d-range = 0.014–0.47).

Conclusions
Auditory training with self-directed computer software (CBAT) may yield speech recognition and quality-of-life benefits for new adult CI recipients. While early users showed greater improvement in outcomes at 3 months postactivation than users who started later, both groups achieved similar benefits by 12 months postactivation.
Correlation between 18F-FDG PET/CT metabolic parameters and microvascular invasion before liver transplantation in patients with hepatocellular carcinoma
Authors: Wu Fan , Cao Guohong , Lu Jinlan , Ye Shengli , Tang Xin 
Published: September 2024

Background
Microvascular infiltration (MVI) before liver transplantation (LT) in patients with hepatocellular carcinoma (HCC) is associated with postoperative tumor recurrence and survival. MVI is mainly assessed by pathological analysis of tissue samples, which is invasive and heterogeneous. PET/computed tomography (PET/CT) with 18F-labeled fluorodeoxyglucose (18F-FDG) as a tracer has been widely used in the examination of malignant tumors. This study investigated the association between 18F-FDG PET/CT metabolic parameters and MVI before LT in HCC patients.

Methods
About 124 HCC patients who had 18F-FDG PET/CT examination before LT were included. The patients’ clinicopathological features and 18F-FDG PET/CT metabolic parameters were recorded. Correlations between clinicopathological features, 18F-FDG PET/CT metabolic parameters, and MVI were analyzed. ROC curve was used to determine the optimal diagnostic cutoff value, area under the curve (AUC), sensitivity, and specificity for predictors of MVI.

Result
In total 72 (58.06%) patients were detected with MVI among the 124 HCC patients. Univariate analysis showed that tumor size (P = 0.001), T stage (P < 0.001), maximum standardized uptake value (SUVmax) (P < 0.001), minimum standardized uptake value (SUVmin) (P = 0.031), mean standardized uptake value (SUVmean) (P = 0.001), peak standardized uptake value (SUVpeak) (P = 0.001), tumor-to-liver ratio (SUVratio) (P = 0.010), total lesion glycolysis (TLG) (P = 0.006), metabolic tumor volume (MTV) (P = 0.011) and MVI were significantly different. Multivariate logistic regression showed that tumor size (P = 0.018), T stage (P = 0.017), TLG (P = 0.023), and MTV (P = 0.015) were independent predictors of MVI. In the receiver operating characteristic curve, TLG predicted MVI with an AUC value of 0.645. MTV predicted MVI with an AUC value of 0.635. Patients with tumor size ≥5 cm, T3-4, TLG > 400.67, and MTV > 80.58 had a higher incidence of MVI.

Conclusion

18F-FDG PET/CT metabolic parameters correlate with MVI and may be used as a noninvasive technique to predict MVI before LT in HCC patients.
The Diagnostic Performance of Large Language Models and General Radiologists in Thoracic Radiology Cases
Authors: Gunes Yasin Celal , Cesur Turay 
Published: September 2024

Purpose:To investigate and compare the diagnostic performance of 10 different large language models (LLMs) and 2 board-certified general radiologists in thoracic radiology cases published by The Society of Thoracic Radiology.Materials and Methods:We collected publicly available 124 “Case of the Month” from the Society of Thoracic Radiology website between March 2012 and December 2023. Medical history and imaging findings were input into LLMs for diagnosis and differential diagnosis, while radiologists independently visually provided their assessments. Cases were categorized anatomically (parenchyma, airways, mediastinum-pleura-chest wall, and vascular) and further classified as specific or nonspecific for radiologic diagnosis. Diagnostic accuracy and differential diagnosis scores (DDxScore) were analyzed using the χ2, Kruskal-Wallis, Wilcoxon, McNemar, and Mann-WhitneyUtests.Results:Among the 124 cases, Claude 3 Opus showed the highest diagnostic accuracy (70.29%), followed by ChatGPT 4/Google Gemini 1.5 Pro (59.75%), Meta Llama 3 70b (57.3%), ChatGPT 3.5 (53.2%), outperforming radiologists (52.4% and 41.1%) and other LLMs (P<0.05). Claude 3 Opus DDxScore was significantly better than other LLMs and radiologists, except ChatGPT 3.5 (P<0.05). All LLMs and radiologists showed greater accuracy in specific cases (P<0.05), with no DDxScore difference for Perplexity and Google Bard based on specificity (P>0.05). There were no significant differences between LLMs and radiologists in the diagnostic accuracy of anatomic subgroups (P>0.05), except for Meta Llama 3 70b in the vascular cases (P=0.040).Conclusions:Claude 3 Opus outperformed other LLMs and radiologists in text-based thoracic radiology cases. LLMs hold great promise for clinical decision systems under proper medical supervision.