bluuebunny/crossref_metadata_2025_split huggingface dataset:
Physical examination and CT to assess thoracic injury in 137 cats presented to UK referral hospitals after trauma
Authors: Mansbridge Nicola , Kallis Giorgio , He Jinjing , Pearce Isabelle , Fenner Joy 
Published: February 2024

Objectives The aim of the study was to describe clinical examination and thoracic CT (TCT) findings in cats after trauma, and to identify physical examination findings associated with both abnormalities on TCT and the need for therapeutic interventions. Methods A multicentre, retrospective, observational study was conducted. Cats admitted to the participating hospitals with a history of blunt trauma and that underwent TCT were eligible. Data were collected on signalment, history, physical examination, TCT findings and subsequent interventions. Results In total, 137 cats were included. Road traffic accidents (RTAs) were the most frequently reported cause of trauma (69%). Tachypnoea (32%), pale mucous membranes (22%) and dyspnoea (20%) were the most common abnormal findings on thoracic examination. The most frequently identified thoracic pathologies on TCT were atelectasis (34%), pulmonary contusions (33%), pneumothorax (29%) and pleural effusion (20%). Thoracocentesis was the most commonly performed intervention (12%), followed by chest drain placement (7%). A total of 45 (33%) cats had no physical examination abnormalities but did have abnormalities detected on TCT; six of these cats required interventions. Increasing numbers of thoracic abnormalities on clinical examination were associated with increasing likelihood of having abnormal findings on TCT (odds ratio [OR] 2.04, 95% confidence interval [CI] 1.21–3.44, P = 0.008) and of requiring an intervention (OR 1.82, 95% CI 1.32–2.51, P <0.001). Conclusions and relevance RTAs were the most common reported cause of blunt trauma. Atelectasis, pulmonary contusions and pneumothorax were the most common abnormalities identified on TCT, and thoracic drainage was the most utilised intervention. TCT may be useful in identifying cats with normal thoracic physical examination findings that have significant thoracic pathology, and a high number of abnormal findings on thoracic examination should raise suspicion for both minor and major thoracic pathology. The results of this study can be used to assist in selecting appropriate cases for TCT after blunt trauma.
Ionized hypercalcemia can resolve with nutritional modification in cats with idiopathic hypercalcemia or chronic kidney disease
Authors: Ehrlich Margot R , Rudinsky Adam J , Chew Dennis J , Parker Valerie J 
Published: February 2024

Case series summary Cats with ionized hypercalcemia that were fed diets with either more than 200 mg calcium per 100 kilocalories (kcal), a calcium:phosphorus (Ca:P) ratio greater than 1.4:1 or both, based on diet history, were included in this case series. Ionized hypercalcemia was documented at least twice in all cats before enrollment. Cats were referred for evaluation of ionized hypercalcemia (n = 5) or were incidentally found to have ionized hypercalcemia (n = 5). After medical workups, cats were diagnosed with either idiopathic hypercalcemia (IHC; n = 7) or chronic kidney disease (n = 3). Cats receiving medications to treat IHC (eg, alendronate, corticosteroids) were excluded. Nutritional recommendations were made to transition the cats to diets with less than 200 mg calcium per 100 kcal and a Ca:P ratio less than 1.4:1. Ionized calcium (iCa) concentrations were rechecked in all cats, with a median recheck time of 9 weeks (range 3–20). Of the 10 cats, nine (90%) had a decrease in iCa. Of the 10 cats, six (60%) became normocalcemic after the diet change, three (30%) had a partial response and one (10%) did not respond. Of the four cats that did not achieve normocalcemia with a change in diet, two (50%) received chia seeds (1–2 g per day), and at the next recheck, both cats’ iCa concentrations had normalized. Three cats had a long-term follow-up. Ionized normocalcemia was maintained for at least two consecutive follow-up visits over a median follow-up period of 33 weeks (range 12–34). Relevance and novel information Dietary calcium concentrations and the dietary Ca:P ratio appear to be important variables in considering nutritional approaches for hypercalcemic cats.
Management and risk of upgrade of atypical ductal hyperplasia in the breast: A population-based retrospective cohort study
Authors: Wadsten Charlotta , Rask Gunilla 
Published: February 2024

Background: International guidelines recommend open surgery for atypical ductal hyperplasia (ADH) in the breast due to risk of underestimating malignant disease. Considering the ongoing randomized trials of active surveillance of low-risk ductal carcinoma in situ (DCIS), it seems reasonable to define a low-risk group of women with ADH where a conservative approach is appropriate. The aim here was to evaluate the management and risk for upgrade of lesions diagnosed as ADH in percutaneous breast biopsies in two Swedish hospitals. Methods: All women with a screen-detected or symptomatic breast lesion breast imaging-reporting and data system (BI-RADS) 2–4 and a percutaneous biopsy showing ADH between 2013 and 2022 at Sundsvall Hospital and Umeå University Hospital were included. Information regarding imaging, histopathology, clinical features, and management was retrieved from medical records. Odds ratio (OR) and 95% confidence intervals (CI) for upgrade to malignant diagnosis after surgery were calculated by logistic regression analysis. Results: Altogether, 101 women were included with a mean age 56.1 (range 36–93) years. Most women were selected from the national mammography screening program due to microcalcifications. Biopsies were performed with vacuum-assisted biopsy (60.4%) or core-needle biopsy (39.6%). Forty-eight women (47.5%) underwent surgery, of which 11 were upgraded to DCIS, and 7 to invasive breast cancer (upgrade rate 37.5%). Among the 53 women managed conservatively (median follow-up 74 months), one woman (1.9%) developed subsequent ipsilateral DCIS. The combined upgrade rate was 18.8%. No clinical variable statistically significantly correlating to risk of upgrade was identified. Conclusions: The upgrade rate of 37.5% in women undergoing surgery compared to an estimated 5-year risk of ipsilateral malignancy at 1.9% in women managed conservatively indicate that non-surgical management of select women with ADH is feasible. Research should focus on defining reproducible criteria differentiating high-risk from low-risk ADH.
Midterm Outcomes of Multicenter Castor Single-Branch Stent Graft Use in the Treatment of Thoracic Aortic Diseases
Authors: Ren Jianli , Chen Yonghui , E Erdemutu , Ma Ming , Liu Zongwei , Zhu Jiechang , Wang Shuaishuai , Bi Jiaxue , Li Peng , Dai Xiangchen 
Published: February 2024

Purpose: The aim of this study was to evaluate the midterm efficacy and safety of a single-branch Castor stent graft in the treatment of thoracic aortic disease. Materials and Methods: Clinical data of 106 patients with thoracic aortic disease treated with Castor single-branch stent graft at 3 centers were collected between May 2018 and June 2023. The indicators included technical success, stent-related complication, reintervention, retrograde dissection, endoleak, distal stent graft–induced entry (dSINE), branch patency, and mortality. The outcomes of the Castor stent graft for multibranch reconstruction above the arch was also analyzed. Results: The technical success was 98.1% (104/106), while the surgical success was 93.4% (99/106). The reintervention was 2.8% (3/106), consisting of a case of retrograde type A dissection, an endoleak, and a dSINE. The retrograde dissection was 1.9% (2/106), while type I endoleak was 1.9% (2/106). The new dSINE was 2.8% (3/106), and the branch patency rate was 100%. The mortality was 1.9% (2/106). The mean follow-up time was 29.1±17.7 months. The 2-year post-surgery cumulative survival rate was 91.0%±3.1%, while the cumulative branch patency rate was 96.2%±2.2%. In addition, the cumulative freedom from stent-related reintervention rate was 93.2%±2.8%. A comparison showed no significant difference in the stent-related complication, branch patency, endoleak, reintervention, and mortality when the proximal end of the Castor stent graft was anchored to zones 1 or 2 of the aorta. Conclusion: Castor single-branch stent graft showed favorable early and midterm outcomes in the treatment of thoracic aortic disease. In addition, it was feasible to combine Castor stent graft with other advanced techniques for multibranch aortic arch reconstruction. Clinical Impact The Castor single-branch stent graft was approval by the Chinese Food and Drug Administration in 2017. However, there were few studies on the mid-term outcomes for thoracic aortic disease after launching, which mainly focused on small single-center retrospective study. In the study, we assessed the mid-term outcomes of Castor stent graft through multi-center cases, Castor stent graft combined with other advanced techniques (such as fenestration and hybrid) for multi-branch reconstruction of aortic arch were also conducted. We found Castor single-branch stent graft showed favorable early and mid-term outcomes in the treatment of thoracic aortic disease. Additionally, it was feasible to combine Castor stent graft with other advanced technique for multi-branch aortic arch reconstruction. As an off-the-shelf branched stent graft with a wide range of models, it could be also used in most emergent situation. The Castor stent graft was expected to become more widely used in the future.
Impact of antifibrotic therapy on disease progression, all-cause mortality, and risk of acute exacerbation in non-IPF fibrosing interstitial lung diseases: evidence from a meta-analysis of randomized controlled trials and prospective controlled studies
Authors: Li De-yu , Liu Xin , Huang Jing-yi , Hang Wen-lu , Yu Gu-ran , Xu Yong 
Published: February 2024

Background: Nintedanib and pirfenidone are preferred pharmacological therapies for patients with idiopathic pulmonary fibrosis (IPF). However, evidence favoring antifibrotic therapy in patients with non-IPF fibrosing interstitial lung diseases (ILD) is limited. Objective: To investigate the effects of antifibrotic therapy on disease progression, all-cause mortality, and acute exacerbation (AE) risk in patients with non-IPF fibrosing ILDs. Design: Meta-analysis. Data sources and methods: Electronic databases were searched for articles published before 28 February 2023. Studies that evaluated the efficacy of antifibrotic agents in patients with fibrosing ILDs were selected. The primary outcome was the disease progression risk, and the secondary outcomes included all-cause mortality and AE risk. The GRADE criteria were used for the certainty of evidence assessment. Results: Nine studies with 1990 participants were included. Antifibrotic therapy reduced the rate of patients with disease progression (five trials with 1741 subjects; relative risk (RR), 0.56; 95% CI, 0.42–0.75; p < 0.0001; I2 = 0; high-certainty evidence). Antifibrotic therapy did not significantly decrease all-cause mortality (nine trials with 1990 subjects; RR, 0.76; 95% CI, 0.55–1.03; p = 0.08; I2 = 0; low-certainty evidence). However, in patients with progressive fibrosing ILDs (PF-ILD), antifibrotic therapy decreased all-cause mortality (four trials with 1100 subjects; RR, 0.69; 95% CI, 0.48–0.98; p = 0.04; I2 = 0; low-certainty evidence). Conclusion: Our study supports the use of antifibrotic agents in patients with PF-ILDs, which could slow disease progression and decrease all-cause mortality. Trial registration: This study protocol was registered with PROSPERO (registration number: CRD42023411272).
Adolescent Healthcare Access: A Qualitative Study of Provider Perspectives
Authors: Garney Whitney R. , Flores Sara A. , Garcia Kristen M. , Panjwani Sonya , Wilson Kelly L. 
Published: February 2024

Introduction: Adolescent access to quality healthcare is key to prevention and early intervention for health risk behaviors. This paper provides a healthcare provider perspective on barriers and facilitators to youth accessing care. Methods: Five focus groups were conducted from November to December 2020 with providers from a variety of healthcare settings. Participants were asked to describe their respective adolescent patient populations, adolescent-specific health concerns, and organizational accommodations specific for youth services. Transcripts were analyzed using Inductive Thematic Analysis and themes were grouped using a social-ecological framework. Results: At an individual level, providers noted that an adolescent’s knowledge and ability to navigate services varied greatly across settings. Providers identified provider trust and parent/guardian support as key interpersonal factors that support adolescents’ access to services. Organizational factors included bureaucratic barriers and the clinic’s reputation among youth. Community factors centered on mistrust within healthcare systems and stigmatization of seeking certain types of services. Participants also described how state-level policies influence parent/guardian consent requirements, which can limit adolescents’ access to care. Conclusion: Adolescent access to and utilization of healthcare in the United States is a complex problem requiring systems-level change. Healthcare organizations and providers have the opportunity and capacity to positively influence adolescents’ healthcare access and experiences, however a lack of standardized, clinic-level priorities and guidelines can limit adolescent-centered care.
Meniscal Repair in the Setting of Revision Anterior Cruciate Ligament Reconstruction: 6-Year Follow-up Results from the MARS Cohort
Authors:   MARS Group, Fox Jake 
Published: February 2024

Objectives: Meniscal preservation has been demonstrated to contribute to long term knee health and has been a successful intervention in the isolated and ACL reconstructed patient. The long-term results of meniscus repair in the setting of revision ACL reconstruction have yet to be documented. The purpose of this study is to report the incidence of meniscal repair failures at 6-year follow-up in a cohort of patients who underwent concurrent revision ACL reconstruction and meniscal repair. Methods: All revision ACL reconstructions with concomitant meniscal repair cases from a multicenter group between 2006 and 2011 were selected. Six-year follow-up was obtained by both phone and email to determine whether any subsequent surgery had occurred to either knee since their initial revision ACL reconstruction. If so, operative reports were obtained, whenever possible, to verify pathologic condition and treatment. Results: In total, 221 patients from 1234 revision ACL reconstructions underwent concurrent meniscal repairs (18% of the cohort). There were 238 repairs performed: 173 medial and 65 lateral. The vast majority of these repairs (n=181; 76%) were performed with an all-inside technique. Baseline patient and surgical characteristics of this group are reported (Tables 1, 2). Six-year surgical follow-up was obtained on 77% (171/221) of the cohort. Overall, the meniscal repair failure rate defined as reoperation was 13% (31/235) at 6 years. Of the 31 failures, 28 were medial (24 all-inside, 4 inside-out; 16% failure rate) and 3 were lateral (2 all-inside, 1 inside-out; 4.6% failure rate; Table 2). Three medial failures were treated in conjunction with a subsequent repeat revision reconstruction. The mean (SD) time to failure for the medial repairs was 2.6 (1.7) years, while the time to failure for the lateral repairs was 1.6 (1.8) years. Medial tears underwent reoperation for failure at a statistically significant higher rate than lateral tears (16% versus 4.6%; p<0.001). Conclusions: Meniscus repair in the revision ACL setting is a successful treatment option when clinically indicated with low failure rates. At 6-year follow-up, overall meniscal failure rate as defined by reoperation was 13% in this revision cohort. Failure rates for medial tears (16%) were higher than for lateral tears (4.6%), which aligns with previous studies both in the revision and primary setting.
Mosaicplasty/Osteochondral Autograft Transfer Remains a Durable Solution for Symptomatic Chondral Defects of the Knee: Two to Ten-Year Follow-up Analysis
Authors: Khorana Arjun , Ramkumar Prem , Williams Riley , Amoo-Achampong Kelms 
Published: February 2024

Objectives: Little to no long-term data exist following mosaicplasty/osteochondral autograft transfer (OATS). The purpose was to assess the long-term outcomes of osteochondral autograft transfer in terms of patient-reported outcomes, reoperation rates, and conversion to arthroplasty. Methods: Between September 1999 through April 2021, 63 patients who underwent mosaicplasty were queried from an institutional cartilage registry with patient reported outcome measures (PROMs), including the 36-Item Short Form Survey (SF-36), the Knee Outcome Survey Activities of Daily Living Scale (KOS-ADLS), and the International Knee Documentation Committee Subjective Knee Form (IKDC) for OATS surgical procedures from the practice of six fellowship-trained knee specialists. Inclusion criteria were patients treated with mosaicplasty with preoperative PROMs and minimum two-year follow-up. Exclusion criteria were prior ipsilateral surgical procedures, advanced osteoarthritis, revision cartilage procedures, inflammatory arthropathy, or loss to follow-up. The preoperative and minimum two-year clinical outcomes with respect to the SF-36 score, reoperation rates, and conversion to arthroplasty were analyzed Results: Mean age was 27.4 ± 12.4 years and 20/63 (31.7%) were female with a mean follow-up of 5.7 ± 3.2 years. The mean lesion size was 2.3 ± 1.6 cm2 requiring a mean of 2.2 ± 1.3 autograft plugs. Mean IKDC and KOS-ADL increased from 46.4 ± 15.1 and 64.4 ± 16.3 preoperatively to 70.4 ± 22.6 and 83.8 ± 11.7, respectively, at 10-year follow-up. A total of 69% and 67% surpassed the MCID and SCB1,2, respectively, for IKDC at 2-year follow-up; similarly, 60% and 33.3% surpassed MCID and SCB, respectively, for IKDC at 10-year follow-up. The overall reoperation rate was 28.6% at a mean of 43.8 years with partial meniscectomy, chondroplasty, and loose body removal most commonly performed. Two patients required arthroplasty conversion. Conclusions: OATS remains a durable knee preserving cartilage repair operation with low incidence of reoperation 10 years following index procedure.
Establishing a Resident-Driven Three-Dimensional Printing Lab Within an Academic Institution
Authors: Kamenko Srdjan , Shepard Elizabeth , Ferry Andrew M. , Hathaway Brynn A. , Berli Jens U. , Mueller Reid V. 
Published: February 2024

Background: Three-dimensional (3D) modeling and printing technologies have been increasingly used throughout healthcare for research, educational, and clinical purposes. Despite the benefits associated with their use in surgical training, the literature poorly outlines the value of establishing an in-house, resident-driven 3D printing lab. Herein, we outline our quantifiable experience with our 3D printing lab and outline all necessary components needed to establish a lab such that the reader can replicate our experience at their institution. Additionally, we outline the process of creating a 3D-printed model from patient imaging with supplementary tutorial videos. Methods: A retrospective review of all 3D-printed models created in our in-house 3D printing lab since its creation in 2022 was performed. 3D-printed models that were utilized for formal educational or clinical purposes were included in this study. All 3D-printed models were created using the Raise3D 2 Pro. Cost estimates associated with each print were collected from the printer’s cost estimation function. Results: A total of 14 3D-printed models met the inclusion criteria for our study. Of these, 4 (28.6%) were utilized for patient and/or resident education with the remaining 10 (71.4%) being used in patient care. By and large, the average cost of educational 3D-printed models was greater than clinical models ($12.00 vs $1.50, respectively). Ten 3D-printed models of mandibular fractures were successfully used to pre-bend plates prior to reconstructive surgery, and minimal intraoperative adjustment of the plate was required for each case. The processes of establishing a 3D printing lab along with creating a 3D-printed model from patient imaging are outlined. Conclusion: Establishing a 3D printing lab is an attainable feat for most institutions. High-value clinical and educational tools can be created for a reasonable price once the initial overhead costs of establishing a lab are covered.
Three-dimensional printed models can reduce costs and surgical time for complex proximal humeral fractures: preoperative planning, patient satisfaction, and improved resident skills
Authors: Fidanza Andrea , Caggiari Gianfilippo , Di Petrillo Francesco , Fiori Enrico , Momoli Alberto , Logroscino Giandomenico 
Published: February 2024

Abstract
Background
Proximal humeral fractures (PHFs) are still controversial with regards to treatment and are difficult to classify. The study’s objective is to show that preoperative planning performed while handling a three-dimensional (3D) printed anatomical model of the fracture can ensure a better understanding of trauma for both surgeons and patients.

Materials and methods
Twenty patients (group A, cases) with complex PHF were evaluated preoperatively by reproducing life-size, full-touch 3D anatomical models. Intraoperative blood loss, radiographic controls, duration of surgery, and clinical outcomes of patients in group A were compared with 20 patients (group B, controls) who underwent standard preoperative evaluation. Additionally, senior surgeons and residents, as well as group A patients, answered a questionnaire to evaluate innovative preoperative planning and patient compliance. Cost analysis was evaluated.

Results
Intraoperative radiography controls and length of operation were significantly shorter in group A. There were no differences in clinical outcomes or blood loss. Patients claim a better understanding of the trauma suffered and the proposed treatment. Surgeons assert that the planning of the definitive operation with 3D models has had a good impact. The development of this tool has been well received by the residents. The surgery was reduced in length by 15%, resulting in savings of about EUR 400 for each intervention.

Conclusions
Fewer intraoperative radiography checks, shorter surgeries, and better patient compliance reduce radiation exposure for patients and healthcare staff, enhance surgical outcomes while reducing expenses, and lower the risk of medicolegal claims.

Level of evidence
Level I, prospective randomized case–control study.