bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effect of Epidermoid Cysts on the Efficacy of Intralesional Corticosteroid Therapy for Hypertrophic Scars and Keloids: A Prospective Pilot Study
Authors: Xu Qiuyun , Bao Chengbei , Liu Jian , Zou Ying , Zhu Yanting , Shen Shuyi , Fang Fang , Wang Songyu , Lin Mengting , Huang Jinwen , Gong Ting , Cheng Bo , Huang Zugen , Ji Chao 
Published: November 2023

BACKGROUND
Patients with hypertrophic scars (HSs) or keloids occasionally have epidermoid cysts (ECs), and the effect of ECs on the effectiveness of intralesional corticosteroids (ILCs) treatment in these patients has not been reported.

OBJECTIVE
This study aims to evaluate the influence of ECs on the outcomes of ILCs treatment in patients with HSs or keloids.

MATERIALS AND METHODS
This prospective study included 572 patients with keloids (n = 461) or HSs (n = 111). Patients received intralesional triamcinolone acetonide injection (0.05 mL/injection) at a concentration of 40 mg/mL and every 28 days for 4 sessions, with a 1-year follow-up.

RESULTS
A higher incidence of ECs was observed in keloid patients (16.92%) compared with HSs patients (7.21%). Keloid patients with ECs were older (p = .008) and had a longer disease duration (p = .0148), higher Vancouver scar scale (VSS) scores (p = .04), and greater thickness (p = .006). Keloid patients with ECs showed less improvement in VSS scores (p < .0001) and thickness (p < .0001) after ILCs treatment, with a higher recurrence rate (p < .0001). The overall complication rate in keloid patients with ECs after ILCs treatment was 49.51%.

CONCLUSION
Epidermoid cysts under keloids were associated with a poor response to ILCs therapy. Therefore, it is recommended to incorporate ultrasonography as a routine examination for keloid patients to aid in better decision making in clinical practice.
The Controversy and Value of Mohs Micrographic Surgery for Melanoma and Melanoma in Situ on the Trunk and Extremities
Authors: Zitelli John A. , Stiegel Evan , Brodland David G. 
Published: November 2023

BACKGROUNDThe use of Mohs surgery for melanoma on the trunk and extremities is not supported in the guidelines of dermatology, but is widely used in the real world.OBJECTIVEThe purpose of this article is to expose the value of Mohs surgery for melanoma on the trunk and extremities for consideration of updating the guidelines.MATERIALS AND METHODSThis was a retrospective review of a prospectively maintained database 7 to identify patients whose melanomas would likely have recurred using standard surgical margins. A prediction model was used to evaluate the value of Mohs surgery.RESULTSThe model predicted that 2,847 (2%) patients with melanoma on the trunk and extremities would likely recur each year with standard surgical margins even after re-excision when positive margins were identified, compared with 0.1% after Mohs surgery. This likely would result in the upstaging of 27% of melanoma in situ patients and 13% of patients with invasive melanoma. The upstaging would also result in a decrease in melanoma-specific survival and the death of 1% of patients with true local recurrences of melanoma.CONCLUSIONMohs surgery has value for melanoma on the trunk and extremities by minimizing local recurrence and death from disease progression.
Correlations among Core Outcomes in Menopause-recommended vasomotor symptom outcomes in MsFLASH trials
Authors: Carpenter Janet S. , Larson Joseph C. , Hunter Myra S. , Lensen Sarah , Chen Chen X. , Guthrie Katherine A. 
Published: November 2023

Abstract

Objective
This study aimed to advance understanding of vasomotor symptom (VMS) outcomes measurement using pooled data from three Menopause Strategies Finding Lasting Answers to Symptoms and Health (MsFLASH) trials.

Methods
Participants self-reported VMS frequency, severity, and bother using daily diaries; completed standardized measures of VMS interference, insomnia severity, and sleep quality/disturbance; and completed four treatment satisfaction items. Analyses included descriptive statistics, Pearson correlations (baseline pooled sample, posttreatment pooled sample, posttreatment placebo only), t tests, and analysis of variance.

Results
Participants were mostly postmenopausal (82.9%) and a mean of 54.5 years old. VMS frequency was fairly correlated with severity, bother, and interference for pooled baseline and placebo posttreatment samples (r values = 0.21-0.39, P values < 0.001) and moderately correlated with severity, bother, and interference for pooled posttreatment (r values = 0.40-0.44, P values < 0.001). VMS severity, bother, and interference were moderately correlated (r values = 0.37-0.48, P values < 0.001), with one exception. VMS severity and bother were strongly correlated (r values = 0.90-0.92, P values < 0.001). VMS interference was moderately correlated with insomnia (r values = 0.45-0.54, P values < 0.001) and fairly to moderately correlated with sleep quality/disturbance (r values = 0.31-0.44, P values < 0.001). Other VMS outcomes were weakly to fairly correlated with insomnia (r values = 0.07-0.33, P values < 0.001 to < 0.05) and sleep quality/disturbance (r values = 0.06-0.26, P values < 0.001 to > 0.05). Greater improvement in VMS and sleep over time was associated with higher treatment satisfaction (P values < 0.001).

Conclusions
This pooled analysis advances understanding of VMS outcomes measurement and has implications for selecting measures and creating future research.
Perioperative complications of using freezing nitrogen ethanol composite to treat bone tumors: Clinical experience from a single center
Authors: Chen Yi-Chou , Chen Chao-Ming , Chen Kuan-Lin , Wang Pai-Han , Chen Cheng-Fong , Wu Po-Kuei , Chen Wei-Ming 
Published: November 2023

Background:
The cryoablation efficacy of semisolid freezing nitrogen ethanol composite (FNEC) has been demonstrated. We aimed to investigate the feasibility of adjuvant FNEC–assisted cryoablation in different bone cavity types by assessing the perioperative complication rates.

Methods:
The medical charts of patients who received intraoperative adjuvant cryoablation using semisolid FNEC for bone tumors from December 2013 to January 2018 were reviewed. The bone cavities were categorized into three types according to liquid spill potential (type 1, able to hold liquid without limb manipulation; type 2, required extensive limb manipulation to retain liquid; type 3, unable to retain liquid). The overall complication rate and the complication rates stratified by bone cavity type were determined.

Results:
Among the 76 patients, 30.3%, 57.9%, and 11.8% had type 1, 2, and 3 bone cavities, respectively. The mean follow-up time for perioperative complications was 43.5 ± 24.1 days. Five patients experienced complications, including two cases of skin damage, two cases of skin infection, and one case of fracture, yielding an overall perioperative complication rate of 6.4%. All cases of skin damage and skin infection were superficial and manageable by oral antibiotics. The patient with a pathologic fracture recovered well after being treated with open reduction and plate fixation. No neuropraxia was noted within the first few days postsurgery in any patient. The complication rates in type 1, 2, and 3 bone cavities were 13%, 4.6%, and 0%, respectively.

Conclusion:
All bone cavity types had a low incidence of perioperative complications after treatment with adjuvant FNEC–assisted cryoablation. Semisolid FNEC–assisted cryoablation is a feasible alternative to overcome the liquid spill potential in bone cavities resulting from tumor resection and intralesional curettage.
“You Have to Rob Peter to Pay Paul So Your Kid Can Breathe”
Authors: Galbraith Alison A. , Faugno Elena , Cripps Lauren A. , Przywara Kathryn M. , Wright Davene R. , Gilkey Melissa B. 
Published: November 2023

Background:Economic analyses often focus narrowly on individual patients’ health care use, while overlooking the growing economic burden of out-of-pocket costs for health care on other family medical and household needs.Objective:The aim of this study was to explore intrafamilial trade-offs families make when paying for asthma care.Research Design:In 2018, we conducted telephone interviews with 59 commercially insured adults who had asthma and/or had a child with asthma. We analyzed data qualitatively via thematic content analysis.Participants:Our purposive sample included participants with high-deductible and no/low-deductible health plans. We recruited participants through a national asthma advocacy organization and a large nonprofit regional health plan.Measures:Our semistructured interview guide explored domains related to asthma adherence and cost burden, cost management strategies, and trade-offs.Results:Participants reported that they tried to prioritize paying for asthma care, even at the expense of their family’s overall financial well-being. When facing conflicting demands, participants described making trade-offs between asthma care and other health and nonmedical needs based on several criteria: (1) short-term needs versus longer term financial health; (2) needs of children over adults; (3) acuity of the condition; (4) effectiveness of treatment; and (5) availability of lower cost alternatives.Conclusions:Our findings suggest that cost-sharing for asthma care often has negative financial consequences for families that traditional, individually focused economic analyses are unlikely to capture. This work highlights the need for patient-centered research to evaluate the impact of health care costs at the family level, holistically measuring short-term and long-term family financial outcomes that extend beyond health care use alone.
Differences in Health Care Utilization of High-Need and High-Cost Patients of Federally Funded Health Centers Versus Other Primary Care Providers
Authors: Pourat Nadereh , Chen Xiao , Lu Connie , Zhou Weihao , Yu-Lefler Helen , Benjamin Troyana , Hoang Hank , Sripipatana Alek 
Published: November 2023

Background:
Primary care providers (PCP) differ in their ability to address the needs and reduce use of costly services among complex Medicaid beneficiaries. Among PCPs, Health Resources and Services Administration (HRSA)-funded health centers (HCs) are shown to provide high-value care.

Objective:
We compared health care utilization of complex Medicaid managed care beneficiaries whose PCPs were HCs versus 3 other groups.

Research Design:
Cross-sectional study using propensity score matching comparing health care use by provider type, controlling for demographics, health status, and other covariates.

Subjects:
California Medicaid administrative data for complex adult managed care beneficiaries with at least 1 primary care visit in 2018.

Measures:
Primary and specialty care evaluation & management visits and services; emergency department (ED) visits; and hospitalizations. PCPs included HCs, clinics not funded by HRSA, solo, and group practice providers.

Results:
HRSA-funded HCs had lower predicted rates of specialty evaluation & management and other services than all others; lower predicted probability of any ED visits than clinics not funded by HRSA [54% (95% CI: 53%–55%) vs. 56% (95% CI: 55%–57%)] and group practice providers [51% (95% CI: 51%–52%) vs. 52% (95% CI: 52%–53%)]; and lower PP of any hospitalizations than solo [20% (95% CI: 19%–20%) vs. 23% (95% CI: 22%–24%)] and group practice providers [21% (95% CI: 20%–21%) vs. 24% (95% CI: 23%–24%)].

Conclusions:
Differences in HC care delivery and practices were associated with lower use of specialty, ED, and hospitalization visits compared with other PCPs for complex Medicaid managed care beneficiaries. Understanding the underlying reasons for these utilization differences may promote better outcomes among these patients.
Let's stop talking about ‘citrate toxicity’
Authors: Israni Avantika , Goldfarb David S. 
Published: November 2023

Purpose of review
Continuous renal replacement therapy (CRRT) is a vital medical intervention used in critically ill patients with acute kidney injury (AKI). One of the key components of adequate clearance with CRRT is the use of anticoagulants to prevent clotting of the extracorporeal circuit. Regional citrate anticoagulation is the most often recommended modality. The term ‘citrate toxicity’ is used to describe potential adverse effects of accumulation of citrate and subsequent hypocalcemia. However, citrate is itself not inherently toxic. The term and diagnosis of citrate toxicity are questioned in this review.

Recent findings
Citrate is being increasingly used for regional anticoagulation of the CRRT circuit. Citrate accumulation is infrequent and can cause hypocalcemia and metabolic alkalosis, which are potential adverse effects. Citrate itself, however, is not a toxic molecule. The term ‘citrate toxicity’ has been used to denote hypocalcemia and metabolic acidosis. However, citrate administration is well known to cause systemic and urinary alkalinization and under certain circumstances, metabolic alkalosis, but is not associated itself with any ‘toxic’ effects.
We review the existing literature and debunk the perceived toxicity of citrate. We delve into the metabolism and clearance of citrate and question current data suggesting metabolic acidosis occurs as the result of citrate accumulation.

Summary
In conclusion, this article calls into question prevailing concerns about ‘citrate toxicity’. We emphasize the need for a more nuanced understanding of its safety profile. We recommend discarding the term ‘citrate toxicity’ in favor of another frequently used, but more meaningful term: ‘citrate accumulation’.
Tibiofemoral Dislocation Management in a Rural High School Football Scenario
Authors: Miller Drew , Richards Jarod , Nyland John 
Published: November 2023

ObjectiveThis study evaluated the knowledge and preparedness of athletic trainers (ATs) for diagnosing and managing an anterior tibiofemoral knee dislocation in a rural or limited-resource high school football setting scenario. The study hypothesis was that more experienced ATs would display greater preparedness than less experienced ATs. A secondary objective was to develop evidence-based guidelines to help the AT provide better emergency triage care.MethodsThis prospective cross-sectional study distributed a rural high school football game scenario survey electronically to a random sample of 2000 certified ATs to determine their perceptions of readiness to diagnose and manage an anterior tibiofemoral knee dislocation with signs or symptoms of possible popliteal artery injury.ResultsA total of 249 surveys (12.5%) were completed. Years of athletic training experience were ≤5 years (n = 82, group 1) and ≥6 years (n = 167, group 2). Both groups perceived that they could not “rule out” an arterial injury and had similar “red flag” sign and symptom rankings. Group 2 perceived a more serious situation than group 1 (77.5 ± 15 vs 70.8 ± 14,P< 0.0001) and were more likely to activate the emergency action plan (74.5 ± 25 vs 64.4 ± 26,P= 0.005). Both groups were “neutral” about their ability to diagnose the condition or manage the case, had poor ankle-brachial index test familiarity, and agreed that evidence-based guidance was needed.ConclusionsMore experienced ATs perceived a more serious situation than less experienced ATs and were more likely to activate the emergency action plan. Both groups were neutral about their ability to diagnose the condition or manage the case, had poor ankle-brachial index test familiarity, and agreed that they would benefit from evidence-based guidance. Proposed guidelines provide the AT with a more measured, evidence-based index of suspicion for potential popliteal artery injury in anterior tibiofemoral dislocation cases. This will complement existing hospital emergency department–based management algorithms, decreasing the likelihood of this condition progressing to limb loss or death.
Disparities in Gynecologic Cancers
Authors: Lee Nita K. , Tiro Jasmin A. , Odunsi Kunle 
Published: November 2023

Abstract
Gynecologic cancer disparities have different trends by cancer type and by sociodemographic/economic factors. We highlight disparities in the United States arising due to poor delivery of cancer care across the continuum from primary prevention, detection, and diagnosis through treatment and identify opportunities to eliminate/reduce disparities to achieve cancer health equity. Our review documents the persistent racial and ethnic disparities in cervical, ovarian, and uterine cancer outcomes, with Black patients experiencing the worst outcomes, and notes literature investigating social determinants of health, particularly access to care. Although timely delivery of screening and diagnostic evaluation is of paramount importance for cervical cancer, efforts for ovarian and uterine cancer need to focus on timely recognition of symptoms, diagnostic evaluation, and delivery of guideline-concordant cancer treatment, including tumor biomarker and somatic/germline genetic testing.
Oncology Physician Workforce Diversity
Authors: Deville Curtiland , Charles-Obi Kenechukwu , Santos Patricia Mae G. , Mattes Malcolm D. , Hussaini Syed M. Qasim 
Published: November 2023

Abstract
This chapter will discuss (1) the rationale for physician workforce diversity and inclusion in oncology; (2) current and historical physician workforce demographic trends in oncology, including workforce data at various training and career levels, such as graduate medical education and as academic faculty or practicing physicians; (3) reported barriers and challenges to diversity and inclusion in oncology, such as exposure, access, preparation, mentorship, socioeconomic burdens, and interpersonal, structural, systemic bias; and (4) potential interventions and evidence-based solutions to increase diversity, equity, and inclusion and mitigate bias in the oncology physician workforce.
Longitudinal Assessment of Bone Mineral Density in Women Living With and Without HIV Across Reproductive Phases
Authors: Swann Shayda A. , King Elizabeth M. , Prior Jerilynn C. , Berger Claudie , Mayer Ulrike , Pick Neora , Campbell Amber R. , Côté Hélène C. F. , Murray Melanie C. M. ,   the CIHR Team on Cellular Aging and HIV Comorbidities in Women and Children (CARMA, CTN 277)
Published: November 2023

Background:
Women living with HIV commonly experience low areal bone mineral density (BMD), but whether this is affected by low ovarian hormonal states (prolonged amenorrhea or menopause) is unknown. We compared rates of BMD loss between women living with HIV and HIV-negative control women and investigated its association with low ovarian hormonal states.

Setting:
Women living with HIV were enrolled from Vancouver Canada and controls from 9 Canadian sites.

Methods:
This longitudinal analysis included age-matched women living with HIV in the Children and Women: AntiRetrovirals and Markers of Aging cohort and controls in the population-based Canadian Multicentre Osteoporosis Study. Rate of change/year in BMD at the total hip and lumbar spine (L1–L4) between 3 and 5 years was compared between groups, adjusting for sociodemographic and clinical variables.

Results:
Ninety-two women living with HIV (median [interquartile range] age: 49.5 [41.6–54.1] years and body mass index: 24.1 [20.7–30.8] kg/m2) and 278 controls (age: 49.0 [43.0–55.0] years and body mass index: 25.8 [22.9–30.6] kg/m2) were included. Total hip BMD loss was associated with HIV (β: −0.003 [95% CI: −0.006 to −0.0001] g/cm2/yr), menopause (β: −0.007 [−0.01 to −0.005] g/cm2/yr), and smoking (β: −0.003 [−0.006 to −0.0002] g/cm2/yr); BMD gain was linked with higher body mass index (β: 0.0002 [0.0007–0.0004] g/cm2/yr). Menopause was associated with losing L1–L4 BMD (β: −0.01 [−0.01 to −0.006] g/cm2/yr). Amenorrhea was not associated with BMD loss.

Conclusions:
HIV and menopause negatively influenced total hip BMD. These data suggest women living with HIV require hip BMD monitoring as they age.
Reevaluating Thrombocytosis as a Risk Factor in Free Flap Surgery
Authors: Fisher Alec Hayes , Jones India , Malta Kiana , Arnold Alexander , Nelson Zach J. , Bonawitz Steven 
Published: November 2023

Introduction
Thrombocytosis, defined as a platelet count >400,000, has been implicated as a risk factor in free flap failure. Despite proposed mechanisms of pedicle thrombosis, recent studies have suggested that thrombocytosis has no effect on free tissue transfer viability. Risk factors that may compromise successful free tissue transfer should be understood and elucidated, with particular attention to thrombocytosis and its conflicting evidence in the literature. We hypothesize that thrombocytosis has no bearing on free flap success or the rates of pedicle thrombosis.

Methods
Our institution performed a retrospective chart review on all patients who underwent free flap reconstruction over the past 6 years. Patient demographics, medical history, type and location of free tissue transfer, preoperative platelets, postoperative platelets, and flap outcomes and complications (wound dehiscence, infection, hematoma, seroma, and need for blood transfusion) were recorded. Independent t test, Mann-Whitney U tests, χ
2 test, and Fisher exact tests were used to determine P values to compare flap outcomes in patients with thrombocytosis (platelet count >400,000) and those with platelet counts less than 400,000.

Results
In our 502-patient cohort, 71 were found to have a platelet count >400,000 (35 preoperatively and 36 postoperatively) and 431 patients had platelet counts <400,000. There were 42 reconstructive failures (flap success rate of 91.6%) and 111 returns to the operating room (OR). For patients with postoperative thrombocytosis, 24 flaps returned to the OR (44.4%), whereas in patients without thrombocytosis, 87 flaps returned to the OR (19.4%; P < 0.001). In patients with postoperative thrombocytosis, 10 OR returns were due to pedicle venous thrombosis (18.5%), in comparison to 10 returns for venous thrombosis in those with normal platelets (2.2%; P < 0.001). There was a small difference in free flap success rates between those with postoperative thrombocytosis and normal platelets, 88.7% versus 92.11%; however, this was not statistically significant (P = 0.71). The thrombocytosis group had a higher incidence of overall postoperative complications (P = 0.002).

Conclusions
Thrombocytosis has historically been cited as a risk factor for free flap reconstruction failure with recent conflicting evidence in the literature. In patients with postoperative thrombocytosis, we found an increased risk of venous thrombosis; however, this did not result in increased flap failure. There was an increase in postoperative complications, which corresponds with National Surgical Quality Improvement Program data reported in the literature. We suspect that thrombocytosis is not a harbinger of free flap failure but rather a marker for overall inflammation, which may confer a higher rate of venous thrombosis requiring reoperation and postoperative complications.