bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effect of preoperative oral nutritional supplements on clinical outcomes in patients undergoing surgery for gastrointestinal cancer: A systematic review and meta-analysis
Authors: Zou QingHua , Yin ZhaoChuan , Ding LiLi , Ruan Jiang , Zhao GuoYun , Wang XiaoQiong , Li YiJun , Xu QingWen , Gong XueJing , Liu WenShuo , Shi KaiWen , Li WeiMing 
Published: September 2024

Background:
The clinical benefit of preoperative oral nutritional supplements (ONS) in patients undergoing surgery for gastrointestinal cancer remains controversial.

Objective:
To evaluate the effect of preoperative ONS on postoperative clinical outcomes in patients with gastrointestinal cancer.

Methods:
We searched PubMed, EMBASE, Web of Science, Cochrane Library, Scopus, and the Chinese National Knowledge Infrastructure databases for randomized controlled trials evaluating preoperative ONS in patients undergoing surgery for gastrointestinal cancer from inception until April 2024. Two researchers independently assessed the quality of the included literature and performed statistical analyses using Review Manager 5.4 software.

Results:
A total of 12 eligible studies with 1201 patients (600 ONS group and 601 control group) were included in this meta-analysis. Compared with a normal diet, preoperative ONS effectively reduced infectious complications (odds ratio = 0.63; 95% confidence interval [CI], 0.40–0.98; P = .04), white blood cell count (mean difference [MD] = −0.66; 95% CI, −1.04 to −0.28; P = .0007), C-reactive protein (MD = −0.26; 95% CI, −0.33 to −0.19; P < .00001), and markedly improved albumin levels (MD = 1.71; 95% CI, 0.97–2.46; P < .00001), prealbumin (MD = 24.80; 95% CI, 1.72–47.88; P = .04), immunoglobulin G (MD = 0.86; 95% CI, 0.44–1.28; P < .00001), CD4 T lymphocyte cells (MD = 3.06; 95% CI, 2.21–3.92; P < .00001), and CD4 T lymphocyte cells/CD8 T lymphocyte cells (MD = 0.33; 95% CI, 0.10–0.56; P = .004). However, there were no significant differences between the 2 groups in terms of noninfectious complications (odds ratio = 0.77; 95% CI, 0.39–1.53; P = .46), immunoglobulin A (MD = −0.21; 95% CI, −0.44 to 0.02; P = .08) or length of hospital stay (MD = −0.04; 95% CI, −0.71 to 0.64; P = .92).

Conclusion:
Preoperative ONS may effectively reduce postoperative infectious complications, improve postoperative nutritional status and immune function, and relieve the inflammatory response in gastrointestinal cancer patients. Therefore, we recommend that preoperative nutrition could be optimized with ONS in patients undergoing gastrointestinal cancer surgery.
Large-cell neuroendocrine carcinoma of the bile duct: Case report of surgical treatment and adjuvant chemotherapy of 2 cases
Authors: Seo Chang Ho , Choi Ho Joong 
Published: September 2024

Rationale:
Neuroendocrine carcinoma originating from extrahepatic bile duct is very rare, and only a few cases have been reported. Because of its scarcity of incidence, not much is known about the disease but for its aggressiveness and poor prognosis.

Patient concerns:
In this report, we present 2 cases of large cell neuroendocrine carcinoma (LCNEC) originating from extrahepatic bile duct. Case 1: a 60-year-old woman presented with jaundice but no abdominal pain. Case 2: a 67-year-old man also presented with jaundice, along with abdominal discomfort and appetite loss.

Diagnoses:
Case 1: LCNEC with a focal adenocarcinoma component (pT2aN1M0, pStage IIIB). Case 2: LCNEC with a focal adenocarcinoma component (pT1N1M0, pStage IIB).

Interventions:
Case 1: the patient underwent left hepatectomy and caudatectomy with hepaticojejunostomy, followed by 6 cycles of adjuvant chemotherapy (etoposide and cisplatin). Case 2: the patient underwent laparoscopic pylorus–preserving pancreatoduodenectomy, followed by 6 cycles of adjuvant chemotherapy (etoposide and cisplatin).

Outcomes:
Case 1: liver metastasis was detected 6 months postoperatively, and despite multiple chemotherapy regimens, the patient died 24 months post-surgery. Case 2: liver metastasis was detected 23 months postoperatively. The patient is still alive 36 months post-surgery after receiving multiple chemotherapy regimens and radiotherapy.

Lessons:
Given the rarity of LCNEC, it is essential to continue collecting and reporting additional case studies to build a more comprehensive understanding of the disease. Although the prognosis for LCNEC is generally poor, the use of a multidisciplinary approach and further research will be critical in developing more effective treatment strategies in the future.
Left anomalous coronary artery originating from the opposite sinus causes acute myocardial infarction with syncope in a young woman: A case report
Authors: Zhang Cheng , Shi Dan 
Published: September 2024

Rationale:
The left anomalous coronary artery originating from the opposite sinus represents a distinct subtype of anomalous coronary arteries originating from the opposite sinus. A comprehensive overview encompassing clinical characteristics, diagnostic approaches, and treatment modalities for this condition is presented herein.

Patient concerns:
The patient, a 17-year-old female, was admitted to the hospital due to chest pain and syncope following multiple exercises.

Diagnoses:
After conducting an electrocardiogram, myocardial injury markers, and echocardiography, she was diagnosed with acute myocardial infarction complicated by syncope. Further examinations including coronary angiography, coronary computed tomography angiography, and cardiac magnetic resonance imaging revealed an anomalous origin of the coronary artery with the left coronary artery (LCA) arising from the right sinus and exhibited intramural course.

Interventions:
The coronary “unroofing” technique was admitted according to her characteristics. The patient achieved successful recovery after surgery with no recurrence of chest pain or syncope during 1 year of follow-up.

Outcomes:
Anomalous origin of the LCA is a rare congenital anatomical anomaly. Surgical intervention represents the primary approach for subsequent management of symptomatic anomalous origin of the coronary artery. Importantly, individuals with anomalous origin of the LCA from the right coronary sinus are at potential risk of sudden cardiac death.

Lessons:
Therefore, enhancing diagnostic precision and actively pursuing surgical treatment in confirmed diagnoses can effectively mitigate myocardial ischemia and prevent instances of sudden cardiac death among adolescents and athletes.
Longitudinal Fatigue Symptoms and Inflammatory Markers in African American Adults With Hypertension and Obstructive Sleep Apnea
Authors: Giordano Nicholas A. , Houser Madelyn C. , Pelkmans Jordan , Pasquel Francisco J. , Pak Victoria , Rogers Ann E. , Yeager Katherine A. , Mucha Susan , Schmitt Matthew , Miller Andrew H. 
Published: September 2024

Background
There is a dearth of research inclusive of African American adults living with obstructive sleep apnea (OSA) despite differences in symptom presentations compared to non-Hispanic White patient populations. Less is known regarding the potential effect of comorbidities, including hypertension, on commonly reported symptoms, such as fatigue, and their association with inflammatory biomarkers.

Objective
This longitudinal pilot study aimed to characterize fatigue symptom presentations among African American adults newly diagnosed with OSA and discern peripheral blood analytes linked to symptoms while accounting for co-occurring hypertension.

Methods
African American adults newly diagnosed with OSA with and without co-occurring hypertension were approached by study staff and recruited following their diagnostic visit with sleep medicine clinicians at two health systems and followed over 6 months after commencing continuous positive airway pressure treatment. Patient-Reported Outcomes Measurement Information System Fatigue surveys and plasma were collected every 3 months from 29 participants. Mixed-effects models examined changes in fatigue symptom presentations over time while accounting for plasma-based analytes and hypertension status.

Results
Despite higher fatigue symptom severity upon diagnosis, participants with co-occurring hypertension reported greater improvements in fatigue scores after commencing continuous positive airway pressure treatment for up to 6 months than those without hypertension. Inverse correlations were observed between fatigue scores, C-reactive protein, matrix metalloproteinase-8, and osteoprotegerin analyte levels among participants with/without hypertension. Across all participants, changes in interleukin-6 were associated with changes in fatigue scores in the first 3 months after diagnosis.

Discussion
Findings indicate that hypertension is linked to increased fatigue upon diagnosis of OSA in this sample of African American adults. Fatigue in persons with hypertension improved after treatment in this sample. These hypothesis-generating findings can inform future interventional studies aimed at improving fatigue among persons with OSA while leveraging markers linked to fatigue symptom severity as potential objective markers of improvements. Further research on the role of inflammatory markers, such as IL-6, on fatigue symptom presentations is warranted in persons with OSA.
Isolated Primary Central Nervous System Lymphoma of the Optic Nerve
Authors: Jain Keertana , Volpe Nicholas J. , Dixit Karan 
Published: September 2024

Introduction:
Optic nerve involvement in primary central nervous system lymphoma (PCNSL) has been reported only a few times in the literature, with generally dismal outcomes. We focused on an extremely rare presentation of PCNSL in an immunocompetent patient with isolated manifestations of the optic nerve.

Case Report:
A 72-year-old man presented with subacute vision loss in his left eye and optic disc swelling. Initial magnetic resonance imaging (MRI) of the orbits revealed a T2 hyperintense signal with enhancement of the left prechiasmatic optic nerve, suggestive of optic neuritis. He experienced visual improvement after 6 weeks of prednisone. However, 2 months after steroid tapering, he presented with worsening left-eye vision loss and new right-eye vision loss with imaging showing a peripherally enhancing chiasm lesion. A biopsy of the left optic nerve confirmed diffuse large B-cell lymphoma and negative systemic imaging was consistent with PCNSL. He was treated with high-dose methotrexate, rituximab, procarbazine vincristine (R-MVP), and cytarabine (AraC) with some visual improvement in the right eye and resolution of previously seen enhancement on MRI. The patient is in remission with no further deterioration of his vision.

Conclusion:
This is the first reported case of isolated optic nerve involvement with a durable response to chemotherapy. This case emphasizes the importance of considering malignancy and maintaining a low threshold for optic nerve biopsy in patients with atypical cases of severe steroid-refractory vision loss with enhancement or enlargement of the optic nerve on MRI. Standard chemotherapy regimens for PCNSL can potentially achieve a curative response in these patients.
Accessibility of Criteria to Exit Cervical Cancer Screening at Age 65 Years in the Electronic Health Record
Authors: Alimena Stephanie , Lykken Jacquelyn M. , Tiro Jasmin A. , Chubak Jessica , Haas Jennifer S. , Werner Claudia , Kobrin Sarah C. , Silver Michelle I. , Perkins Rebecca B. , Feldman Sarah 
Published: September 2024

OBJECTIVE:
To describe the proportion of patients with documentation of meeting cervical cancer screening exit criteria in the medical record and to estimate the incidence of cancer and high-grade precancerous lesions after age 65 years detected by the end of the study period, by screening exit eligibility.

METHODS:
We conducted a retrospective analysis of patients who turned 66 years old between 2010 and 2019 at two large health care systems located in Dallas, Texas, and Boston, Massachusetts, from the METRICS (MultilEvel opTimization of the ceRvIcal Cancer Screening process in diverse Settings & populations) Research Center, part of the PROSPR II (Population-based Research to Optimize the Screening Process) consortium. The primary outcomes were 1) the percentage of patients who were eligible for screening exit at age 66 years after adequate documented negative screening history (at least three consecutive negative cytology test results or two consecutive negative human papillomavirus [HPV] test or co-test results [cytology+HPV testing] within the prior 10 years) and 2) the worst pathology or cytology outcome documented in the cohort after age 65 years.

RESULTS:
Among 42,393 people who turned 66 years old while in the METRICS cohort, approximately 75.7% (n=32,094) were not eligible to exit screening at age 66 years, primarily because too few screening tests were documented (n=29,354, 91.5% of those ineligible). Furthermore, only 4,037 patients at both sites had 10 years of prior observation within the health care system, meaning data from current and prior health care delivery sites would be needed to assess exit eligibility for more than 90% of the cohort. Patients remained in the cohort after their 66th birthday on average for 3.8 years (interquartile range 2.0–6.5 years), and most (79.3%) had no subsequent evaluation after their 66th birthday. Among those ineligible to exit due to insufficient screening history, 83.7% were not subsequently screened. Of the 16.3% who were screened, 90 (1.9%) were diagnosed with cancer or high-grade precancerous lesions, including 34 (0.7%) who were diagnosed with cervical cancer. By contrast, among patients eligible to exit with sufficient screening history, 34.3% had at least one subsequent cytology or pathology result or both, and high-grade precancerous lesions or cervical cancer were diagnosed in only 0.6% (n=16).

CONCLUSION:
Data documented in the medical record are often insufficient to meet guidelines for exiting cervical cancer screening.
Biomechanical effect between conventional and 3-dimensional printed customized foot orthoses on medial longitudinal arch support and rearfoot angle in adults with flexible flatfeet
Authors: Praewpipat Bongkoch , Ehara Yoshihiro , Kosorn Wasana , Nampichai Nutdanai 
Published: September 2024

Background:
Customized foot orthoses are used to treat flexible flatfoot regarding medial longitudinal arch (MLA) support, alignment correction, and pain management. Recently, 3-dimensional (3D) printing orthosis has become the focus of discussion regarding function and manufacturing. We aimed to investigate differences in biomechanical effects between flat insole (Flat), conventional foot orthosis (Cinsole), and 3D printed foot orthosis (3Dinsole) use on MLA support and rearfoot alignment during walking in adult flexible flatfeet.

Methods:
Twelve men with flexible flatfoot were recruited. Data were collected and analyzed using a Vicon motion capture system under 3 trial conditions: Flat and >1 month after using Cinsole and 3Dinsole. Repeated-measures analysis of variance with Bonferroni post hoc tests was used to compare kinematics variables, foot pain, and satisfaction.

Result:
Dynamic navicular drop significantly reduced with the use of the Cinsole and 3Dinsole compared with Flat (P < 0.001; ηp2 = 0.65). The maximum rearfoot eversion angle with the use of the Cinsole and 3Dinsole significantly reduced from Flat (P < 0.001; ηp2 = 0.56). Foot pain score significantly decreased after using foot orthoses; satisfaction between Cinsole and 3Dinsole was not significantly different.

Conclusions:
Thus, Cinsole and 3Dinsole are effective alternative treatments of MLA support and rearfoot alignment in adults with flexible flatfoot. 3D printing is a future technology with potential to replace conventional production methods. However, material characteristics, design, and manufacturing process can affect treatment outcomes; hence, our results may not represent all variations of 3D printed foot orthoses.
Evaluation of Rehabilitation Techniques for Traumatic Ulnar Nerve Injuries After Surgical Repair
Authors: Sim Danielle , Kuo Keith T. , Rodriguez-Silva Waldemar , Seal Stella , Filippi Lourdes , Tuffaha Sami , Elhelali Ala 
Published: September 2024

Background
Traumatic ulnar nerve injuries often result in significant loss of motor and sensory function, negatively impacting patients' quality of life. Physical rehabilitation is crucial for recovery, but standardized treatment protocols are lacking. This study aims to systematically review rehabilitation techniques to identify future research direction and improve existing protocols for ulnar nerve injury patients.

Methods
PubMed, Embase, CINAHL, Cochrane CENTRAL, Web of Science, and Scopus were queried from inception until July 31, 2023. Articles containing axonotmesis or neurotmesis injuries of the ulnar nerve were included. Reviews, opinions, editorials, technical reports without clinical outcomes, conference abstracts, non-English text, nonhuman studies, and studies without adult patients were excluded. Three independent reviewers performed screening and data extraction using Covidence, and risk of bias assessments utilizing Cochrane and JBI tools. Because of article heterogeneity, a narrative review was conducted. The protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO) database, registration number CRD42023442016.

Results
This systematic review included one randomized controlled trial and four observational studies (103 patients), which exhibited differences in study quality. Overall, motor and sensory outcomes improved after rehabilitation. Rehabilitation techniques varied widely, and early sensory reeducation appeared to improve sensory function. Only two studies included patient-reported outcomes.

Conclusions
Diverse rehabilitation techniques are used to address ulnar nerve injuries. The low number of included studies, differences in study quality, and small sample size underscore the need for larger and more inclusive studies to improve functional recovery after ulnar nerve injuries. Future research should consider the impact of patient and injury characteristics to develop comprehensive treatment guidelines for these patients.
Resuscitative endovascular balloon occlusion of the aorta in the patient with obesity
Authors: Loe Mallory , Broome Jacob M. , Mueller Lauren , Simpson John T. , Tatum Danielle , McGrew Patrick , Taghavi Sharven , Jackson-Weaver Olan , DuBose Joseph , Duchesne Juan 
Published: September 2024

BACKGROUND
Palpation of anatomic landmarks is difficult in patients with obesity, which could increase difficulty of achieving femoral access and resuscitative endovascular balloon occlusion of the aorta (REBOA) placement. The primary aim of this study was to examine the association between obesity and successful REBOA placement. We hypothesized that higher body mass index (BMI) would decrease first-attempt success and increase time to successful aortic occlusion (AO).

METHODS
A review of the Aortic Occlusion for Resuscitation in Trauma and Acute Care Surgery (AORTA) registry was performed on patients who underwent REBOA placement with initiation systolic blood pressure >0 mm Hg from years 2013–2022. Patients were excluded if they received cardiopulmonary resuscitation on arrival, underwent open AO, or missing data entries for variables of interest. Body mass index categorization was as follows: non-obese (<30), class I (30–34.9), class II (35–39.9), and class III (40+) obesity. Patients were also stratified by access technique, including use of palpation or ultrasound guidance.

RESULTS
Inclusion criteria were met by 410 patients. On binary analysis, no primary outcomes of interest, including rate of success, time to placement, or mortality, were significantly impacted by BMI. Among BMI subgroups, there was no statistical difference in injury severity, admission systolic blood pressure (SBP), or augmented SBP. At initiation of aortic occlusion, patients with class II and class III obesity had higher median SBP compared with non- and class I obese patients (p = 0.03). Body mass index subgroup did not impact likelihood of first-attempt success or conversion to open procedure. When stratified by access technique, there was no difference in success rates, time to success or mortality between groups.

CONCLUSION
Body habitus did not impact success of REBOA placement, time to successful AO, or mortality. Further, ultrasound guidance was not superior to landmark palpation for arterial access. Following traumatic injury without hemodynamic collapse, obesity should not deter providers from considering REBOA placement.

LEVEL OF EVIDENCE
Therapeutic/Care Management; Level IV.
When more is more: Utilizing finite element analysis to assess chest wall injury stability after surgical stabilization of all rib fractures versus only a portion of the rib fractures
Authors: Bauman Zachary M. , Herrman Sven , Cantrell Emily , Khan Hason , Koval Gregory , Evans Charity H. , Kamien Andrew , Cemaj Samuel , Sheppard Olabisi , Lamb Gina , Veatch Jessica , Matos Mike , Nguyen Jonathan , White Thomas W. 
Published: September 2024

BACKGROUND
Surgical stabilization of rib fractures (SSRF) continues to gain acceptance. Controversary exists around the number of rib fractures needing stabilization. We sought to analyze chest wall stability (CWS) after SSRF using finite element analysis (FEA) modeling in various rib fracture patterns, hypothesizing not stabilizing all fractures leaves the chest wall unstable.

METHODS
FEA thoracic model development was described previously. Two fracture patterns with three case scenarios each were defined for right ribs 4 to 9. Fracture Pattern 1; Case 1–all 6 ribs with lateral fractures and no stabilization; Case 2—all six fractures stabilized; Case 3–only fractures 5 to 7 were stabilized. Fracture Pattern 2; Case 4–all six ribs fractured in a flail pattern (anterior-lateral and posterior-lateral) and no stabilization; Case 5—all 12 fractures stabilized; Case 6—only six anterior-lateral fractures were stabilized. Three assessment criteria were used to quantify thoracic motion: normalized mean absolute error (NMAE), normalized root mean square error (NRMSE), and normalized interfragmentary motion (NIFM).

RESULTS
Fracture Pattern 1: Case 1—NMAE and NRMSE analysis demonstrated significant loss of CWS up to 50% with left axial rotation; Case 2—CWS almost completely returned to nonfractured state; Case 3—CWS loss up to 37%. Fracture Pattern 2: Case 4—up to 49% of CWS lost with right axial rotation; Case 5—less than 3% CWS lost; Case 6—over 40% CWS lost. For both fracture patterns, when stabilizing all fractures, NIFM decreased by 95%. In Case 3, NIFM decreased by 56% and in Case 6, NIFM increased by 1% at the non-stabilized fracture line.

CONCLUSION
Stabilizing all rib fractures significantly improves CWS. Not stabilizing both fractures of a flail segment worsens motion at the non-stabilized fractures.

LEVEL OF EVIDENCE
Therapeutic/Care Management; Level IV.