bluuebunny/crossref_metadata_2025_split huggingface dataset:
Safety and clinical efficacy of EUS–guided pelvic abscess drainage
Authors: Al Khaldi Maher , Ponomarev Alexander , Richard Carole , Dagbert François , Sebajang Herawaty , Schwenter Frank , Wassef Ramses , De Broux Éric , Ratelle Richard , Paquin Sarto C. , Sahai Anand V. , Loungnarath Rasmy 
Published: October 2023

Abstract

Background and Objectives
EUS is a potential alternative for the drainage of abscesses. The aim of this study was to determine if EUS-guided pelvic abscess drainage is technically feasible, safe, and a valid option for abscess resolution.

Methods
We conducted a retrospective review from 2002 to 2020 at a single quaternary institution. EUS–guided pelvic abscess drainage via the transrectal route was performed in all patients with or without drain/stent placement. Technical and clinical success of EUS-guided pelvic abscess drainage was analyzed. Descriptive analyses and Fisher exact test were performed.

Results
Sixty consecutive patients were included in the study (53.5% male; mean age, 53.8 ± 17.9 years). Pelvic abscesses occurred mainly postoperatively (33 cases; 60.0%) and from complicated diverticulitis (14 cases; 23.3%). Mean diameter was 6.5 ± 2.4 cm (80% unilocular). Drainage was performed with EUS-guided stent placement (double-pigtail plastic or lumen-apposing metal) in 74.5% of cases and with aspiration alone for the remainder. Technical success occurred in 58 cases (97%). Of those with long-term follow-up after EUS-guided pelvic abscess drainage (n = 55; 91.7%), complete abscess resolution occurred in 72.7% of all cases. Recurrence occurred in 8 cases (14.5%) and persisted in 7 patients (12.5%), 7 of which were successfully retreated with EUS-guided pelvic abscess drainage. Accounting for these successful reinterventions, the overall rate of abscess resolution was 85.5%. Abscess resolution rate improved with drain placement (83%). Accounting for 7 repeat EUS-guided pelvic abscess drainages, overall abscess resolution improved. Two deaths occurred (3.4%) because of sepsis from failed source control in patients who had previously failed medical, radiological, and surgical treatment.

Conclusions
EUS–guided pelvic abscess drainage is technically feasible, safe, and an effective alternative to radiological or open surgical drainage. It also offers favorable clinical outcomes in different clinical situations.
Nuck Cyst Presenting as a Recidive Inguinal Hernia: A Rare Case Treated in Plastic Surgery
Authors: Gesuete Francesco P. , Molle Marcello , Izzo Paolo , Izzo Sara , Gubitosi Adelmo , Nicoletti Giovanni F. , Ferraro Giuseppe A. 
Published: October 2023

Summary:
The canal of Nuck is the female equivalent to the male processus vaginalis. Due to its rarity and the lack of awareness among physicians, a cyst in the canal of Nuck is a seldom-encountered entity in clinical practice and is commonly misdiagnosed. We report on a case of 42-year-old woman who presented with a painful swelling at her right groin and skin hypertrophy of the abdomen. The patient underwent successful open herniorrhaphy with excision of the cyst and mesh repair of the inguinal canal. The results were excellent both in the aesthetic and functional terms. In 1 month, there was a complete recovery with a return to social life. The 3-month healing score was 3 of 13 on the Vancouver Scar Scale. The technique is effective and reproducible. The patient’s aesthetic and functional outcomes were excellent. In the following 6 months of follow-up, there were no recurrences or late complications.
Development and evaluation of a virtual reality driving test for patients with cirrhosis
Authors: Gairing Simon J. , Schleicher Eva M. , Kaps Leonard , Schulte-Beerbuehl Sophia , Steiner Kristina , Labenz Joachim , Schattenberg Jörn M. , Galle Peter R. , Wörns Marcus-Alexander , Labenz Christian 
Published: October 2023

Background:
Patients with cirrhosis and especially those with HE may have impaired driving skills and may be prone to car accidents. This proof-of-concept study aimed to develop and evaluate the applicability of a virtual reality (VR)–based driving test in patients with cirrhosis. Additionally, the association between the results in the VR test and car accidents was investigated.

Methods:
A short driving test using a VR head–mounted display (HTC Vive Pro Eye) was developed to simulate five hazardous situations. The patient has to pull the brake when the hazardous situations occur. The time from triggering the event to pressing the brake is recorded as reaction time. Total reaction time (TRT) is defined as the combined reaction time to all 5 events. Car accidents were assessed retrospectively (previous 12 months) and patients were followed prospectively for 6 months. Minimal HE (MHE) was diagnosed using Psychometric Hepatic Encephalopathy Score.

Results:
In total, 112 outpatients with cirrhosis and 52 controls without cirrhosis were recruited. MHE was detected in 14% (n = 15). Patients with cirrhosis and MHE (5.67 s) had higher TRTs compared to patients without MHE (5.02 s) and controls without cirrhosis above the age of 50 (4.98 s) (MHE vs. no MHE or controls p<0.01, no MHE vs. controls: not significant). Seven patients reported car accidents during the twelve months prior to study inclusion. TRTs were numerically higher in patients with reported car accidents (p = 0.099). When patients who stopped driving for HE-related/cirrhosis-related reasons (n = 14) were added to the group of patients with accidents, then a longer TRT was significantly associated with the modeled outcome in univariable (p<0.01) and multivariable analyses (OR 2.83, p<0.01). Two car accidents occurred during follow-up. Both patients had TRTs above the 90th percentile.

Conclusions:
The VR driving test is easy and rapid to perform in patients with cirrhosis and could be helpful as a point-of-care tool for predicting car accidents.
Long Term Use of Anti-Vascular Endothelial Growth Factor Therapy for Neovascular Age-Related Macular Degeneration
Authors: Begaj Tedi , Jeong Daeun , Park Jong G. , Runner Margaret M. , Capone Antonio , Dass A. Bawa , Drenser Kimberly A. , Faia Lisa J. , Farley Nathan D. , Garretson Bruce. R. , Hassan Tarek S. , Mahmoud Tamer H. , Margherio Alan , Raphaelian Paul V. , Randhawa Sandeep , Ruby Alan J. , Sneed Scott , Rao Prethy , Wolfe Jeremy D. , Williams George A. 
Published: October 2023

Abstract

Purpose:
While pivotal trials have demonstrated efficacy of anti-vascular endothelial growth factor (VEGF) therapy in neovascular age-related macular degeneration (nAMD), there is a paucity of clinical data about the long term (>5 years) treatment.

Methods:
Retrospective analysis of all patients with nAMD who were actively treated, had received >40 anti-VEGF injections, and were followed for ≥5 years. Snellen corrected visual acuity (SCVA), initial drug choice, and times elapsed between treatment were collected. Rates of endophthalmitis and outcomes of submacular hemorrhage were also evaluated.

Results:
A total of 88 patients (162 eyes) met the inclusion criteria: the average patient was 86.3 years with an average follow up period of 7.6 years. The average total number of injections per eye was 69 (18.0 std dev); a total of 11,208 injections were given throughout the study period and 6 (0.05%) cases of endophthalmitis were observed. Overall, there was a clinical and statistical difference in average SCVA at injections #2,#3, #4, #5, #6, #10 and #20, as compared with baseline (p=0.03, p<0.01, p=0.02, p<0.01, p=0.01, p=0.01, p<0.01, respectively). Patients in the SCVA 20/20-20/40 subgroup maintained vision until injection #30. Seven eyes experienced a visually significant submacular hemorrhage.

Conclusions:
The nAMD cohort herein received on average 8 anti-VEGF injections per year for approximately 8 years; eyes with good (≥20/40) initial baseline vision maintained their VA while eyes with worse SCVA (≤20/50) had a robust initial improvement that diminished with time. Most patients were maintained on the same initial drug of choice and the rate of endo11phthalmitis was low.
Presentations & factors affecting outcome of rhegmatogenous retinal detachment with choroidal detachment – An Indo-Taiwanese study
Authors: Dave Vivek Pravin , Chou Hung-Da , Kiri Hardik , Ieng Fok Chak , Hwang Yih-Shiou , Wu Wei-Chi , Chen Kuan-Jen , Das Anthony Vipin , Pathengay Avinash , Pappuru Rajeev Reddy , Lai Chi-Chun 
Published: October 2023

Abstract

Objective
To report the clinical settings, management and factors associated with outcomes of rhegmatogenous retinal detachment with concurrent choroidal detachment (RRDCD)

Methods
Retrospective, consecutive, multicenter case series from January 2014 to January 2021 were included. Cases were from a tertiary eye care center in India and Taiwan.

Results
Overall 303 eyes were included. Mean age was 43.72±20.64 years (median 46). Best-corrected presenting visual acuity was 1.79±0.92 logMAR (median 2.10) (Snellen 20/1233). Forty-four patients (17.91%) received pre-operative steroids. Final visual acuity was 1.33±0.94 logMAR (median 1.10) (Snellen 20/427). Favorable anatomic outcome was seen in 200/303 (66%) while favorable functional outcome was seen in 128/303 (42.20%). Factors predicting favorable anatomic outcome were absence of phakic lens status (OR 2.76) absence of PVR worse than grade A (OR 7.69), use of pre-operative steroids (OR 4.50) and use of an encircling band (3.85). Factors predicting favorable functional outcome were better presenting visual acuity (OR 3.03), absence of phakic lens status (OR 4.93), absence of PVR worse than grade A (OR 10.41) and use of pre-operative steroids (OR 7.24).

Conclusions
Administration of pre-operative steroids, use of an encircling band during surgery and pseudophakic status of the eye were found to have better outcomes in RRDCD.
Association of metformin use with risk of newly onset neovascular age-related macular degeneration development
Authors: Khanna Saira , Shaw Lincoln , Hyman Max J. , Zhang Jason , Hariprasad Seenu , Soo Jackie , Flores Andrea , Skondra Dimitra 
Published: October 2023

Abstract

Purpose:
To investigate if metformin use reduces the odds of developing new neovascular AMD (nAMD).

Methods:
This is a case-control study of 86,930 subjects with new diagnoses of nAMD and 86,918 matched controls using the Merative™ Marketscan® Research Databases. Subjects were analyzed using multivariable conditional logistic regression to identify the risks of various exposures on developing nAMD. A subgroup analysis of 22,117 diabetic cases and 21,616 diabetic controls was also performed.

Results:
Metformin use was associated with reduced odds ratio (OR) of developing nAMD (OR 0.95, 95% confidence interval 0.91-0.98) in full sample and diabetic cohort particularly in patients without any diabetic retinopathy (DR) —an effect that persisted after Bonferroni correction. In the diabetic cohort without DR, reduced OR was observed at 24-month cumulative doses of 1 to 300g, 301 to 630g, and 631 to 1080g.

Conclusions:
Metformin use was associated with reduced OR of nAMD, particularly in patients without DR. The protective effect was noted for 24-month cumulative doses below 1080g. Metformin may be a novel preventive strategy for nAMD.
Retinal Optical Coherence Tomography Imaging Biomarkers: A Review of the Literature
Authors: Pandya Bhadra U. , Grinton Michael , Mandelcorn Efrem D. , Felfeli Tina 
Published: October 2023

Abstract

Purpose:
This literature review aims to summarize novel optical coherence tomography (OCT) imaging biomarkers that have recently been described in the literature and are frequently encountered clinically.

Methods:
The literature was reviewed to identify novel OCT biomarkers reported to date. A descriptive summary of all terms and representative illustrations were provided to highlight the most relevant features.

Results:
37 OCT terminologies were identified. The vitreomacular interface disorders group included the four stages of ERM, macular pseudohole, tractional LH, degenerative LH, cotton ball sign, and foveal crack sign. The AMD group included outer retinal tubulation, multi-layered pigment epithelial detachment, pre-choroidal cleft, onion sign, double-layer sign, complete outer retinal atrophy, complete RPE and outer retinal atrophy, and reticular pseudodrusen. Uveitic disorders group consisted of bacillary layer detachment, syphilis placoid, rain cloud sign, and pitchfork sign. The disorders relating to toxicity group included flying saucer sign and MEK inhibitor-associated retinopathy. The disorders associated with systemic conditions group included choroidal nodules and needle sign. The pachychoroid spectrum group included pachychoroid and brush border pattern. The vascular disorders group included pearl necklace sign, diffuse retinal thickening, disorganization of retinal inner layers, INL microcysts, hyperreflective retinal spots, paracentral acute middle maculopathy, and acute macular neuroretinopathy. The miscellaneous group included omega sign (ω), macular telangiectasia (type 2), and omega sign (Ω).

Discussion:
37 OCT terminologies were summarized and detailed illustrations consolidating the features of each biomarker were included. A nuanced understanding of OCT biomarkers and their clinical significance is essential due to their predictive and prognostic value.
Neuronal–immune axis alters pain and sensory afferent damage during dental pulp injury
Authors: Erdogan Ozge , Michot Benoit , Xia Jinya , Alabdulaaly Lama , Yesares Rubi Pilar , Ha Vivian , Chiu Isaac M. , Gibbs Jennifer L. 
Published: October 2023

Abstract
Dental pulp tissue is densely innervated by afferent fibers of the trigeminal ganglion. When bacteria cause dental decay near the pulpal tissue, a strong neuronal and immune response occurs, creating pulpitis, which is associated with severe pain and pulp tissue damage. Neuroimmune interactions have the potential to modulate both the pain and pathological outcome of pulpitis. We first investigated the role of the neuropeptide calcitonin gene-related peptide (CGRP), released from peptidergic sensory afferents, in dental pain and immune responses by using Calca knockout (Calca−/−) and wild-type (Calca+/+) mice, in a model of pulpitis by creating a mechanical exposure of the dental pulp horn. We found that the neuropeptide CGRP, facilitated the recruitment of myeloid cells into the pulp while also increasing spontaneous pain-like behavior 20% to 25% at an early time point. Moreover, when we depleted neutrophils and monocytes, we found that there was 20% to 30% more sensory afferent loss and increased presence of bacteria in deeper parts of the tissue, whereas there was a significant reduction in mechanical pain response scores compared with the control group at a later time point. Overall, we showed that there is a crosstalk between peptidergic neurons and neutrophils in the pulp, modulating the pain and inflammatory outcomes of the disease.
Evaluation of adrenal masses using 18F-FDOPA PET/CT in patients suspected with pheochromocytoma
Authors: Kim Soo Jeong , Park Cheol-Young , Kwon Hyemi , Kim Young Hwan 
Published: October 2023

Objective
Pheochromocytomas (PHEOs) are chromaffin cell-derived adrenal tumors. 6-[18F]-L-fluoro-L-3, 4-dihydroxyphenylalanine (18F-FDOPA) is a radiotracer taken up in neuroendocrine chromaffin cells via the L-type amino-acid transporter. 18F-FDOPA is useful in patients with PHEO. However, more information about the use of 18F-FDOPA PET/CT scan is needed. Thus, the current study investigated various PET parameters on preoperative 18F-FDOPA PET/CT scan.

Methods
The 18F-FDOPA PET/CT scan findings of 29 patients who underwent adrenalectomy after PET/CT scans were evaluated according to their pathologic diagnosis. Thereafter, the patients were classified under different risk groups which were compared based on the Grading System for Adrenal Pheochromocytoma and Paraganglioma (GAPP).

Results
In terms of histopathologic results after surgery, 24 patients presented with PHEO. The remaining 5 patients were diagnosed with adrenal cortical adenomas or adrenal medullary hyperplasia. The maximum standardized uptake value, mean standardized uptake value, tumor-to-liver ratio, and tumor-to-contralateral adrenal gland ratio of PHEOs on preoperative 18F-FDOPA PET/CT scan were higher than those of other tumors. The metabolic tumor volume (MTV) and total lesion uptake of PHEOs in the intermediate-risk group (n = 19) were higher than those in the low-risk group (n = 5). The MTV and total lesion uptake were significantly correlated with the GAPP score.

Conclusion
Preoperative 18F-FDOPA PET/CT is helpful to identifying PHEOs. In addition, imaging interpretation using the standardized uptake value of the suspected tumor or the tumor-to-liver/contralateral adrenal gland ratio can be effective. The metabolic parameters of PHEOs are positively correlated with the GAPP score.
Should we reconsider blocking the thyroid for 123I-Ioflupane studies in elderly patients: quantifying radiation dose to the unblocked thyroid and implications for clinical practice
Authors: Morton D. William A. , Vennart Nicholas , Slinger Harry , Gannon Mark , Razvi Salman , Bartholomew Peter 
Published: October 2023

Objectives
To measure the absorbed dose to the thyroid in patients injected with 123I-Ioflupane where the thyroid was not blocked with prophylaxis to investigate whether thyroid blocking should be limited to younger patients. This risk from the additional absorbed dose to the thyroid was then compared to the risk from iodine overdose through ingestion of the iodide prophylaxis, resulting in iodine-induced hyper/hypothyroidism (IIH).

Methods
A cohort of patients (n = 30) who did not receive thyroid prophylaxis underwent static thyroid imaging 3 h after 123I-Ioflupane administration. The measured thyroidal uptake of free 123I was then extrapolated to peak uptake time (24 h post-administration). This value was used to calculate cumulated activity in the thyroid and thus thyroid-thyroid absorbed dose D(r

thy

←r

thy
) using the relevant S-value in the MIRD method.

Results
Mean D(r

thy

←r

thy
) was found to be 13.6 mGy with an SD of 8.8 mGy; this would contribute an additional 0.5 mSv to the effective dose.

Conclusion
ARSAC recommends in its Notes for Guidance prophylactic thyroid blocking if the absorbed dose to the thyroid is >50 mGy; the maximum thyroid dose in this study cohort was 36.3 mGy. With risk from IIH and its associated cardiac complications increasing with age, this study suggests that iodide prophylaxis with 123I-Ioflupane should be reconsidered for elderly patient.
Medicinal grade opium tincture for severe diarrhea: effect revisited in observational study
Authors: Dahlgren David , Hellström Per M. 
Published: October 2023

Purpose of review
Chronic diarrhea is a common disorder that interferes with normal daily activities and results in poor quality of life. Fecal urgency and incontinence often necessitate clinical consultation, but the pathophysiological mechanisms are difficult to differentiate in a clinical setting. Therefore, drugs targeting the opioid receptors, such as diphenoxylate and loperamide, are typically used, as they reduce both gut motility and secretion.

Recent findings
For severe diarrhea, morphine-containing extemporaneous opium tincture drops have recently been reprofiled to a pharmaceutical. The drug is indicated for severe diarrhea in adults when other antidiarrheals do not give sufficient fecal emptying control. The pronounced effect is due to the liquid formulation with rapid onset as a drug dissolution step is avoided. A recent prospective, noninterventional study (CLARIFY) of patients treated with opioid drops demonstrates a rapid and sustained therapeutic effect. Tolerance does not develop for the antidiarrheal effect and no dependence was observed after discontinuation.

Summary
This mini-review discusses the use of opium derivates for treatment of diarrhea, with an emphasis on opium drops as a new medicinal grade opium for the use as additional treatment of severe diarrhea, emphasizing its mechanism of action and evaluation of the risk—benefit ratio in the clinical setting.
Comparing the effect of tissue adhesive and suturing material on collagen I/III ratio in abdominal skin wounds: an experimental study
Authors: Sofii Imam , Fauzi Aditya Rifqi 
Published: October 2023

Background:
The skin closure procedure should be technically simple, acceptable, quick, and cost-effective. Sutures remain the technique’s mainstay, however tissue adhesive is becoming more used in clinical practice. Collagen ratios of types I and III play a significant role as postoperative wound healing parameters. Here, the authors aim to examine the collagen I/III ratio of tissue adhesive vs. non-absorbable sutures for abdominal skin closure in Wistar albino rats.

Material and methods:
The authors allocated 20 rats into four experimental groups. Wounds in groups 1 and 3 were sealed with tissue adhesive (cyanoacrylate), while those in groups 2 and 4 were closed using suture material (monofilament non-absorbable nylon). Groups 1 and 2 were sacrificed on postoperative day (POD) 4, while those in groups 3 and 4 were euthanized on POD 7. Skin samples (1×0.5 cm) were collected for analysis, and the collagen I/III ratios were determined using immunohistochemistry staining techniques.

Results:
The levels of collagen I and III expression did not exhibit statistically significant differences between tissue adhesive and nylon suture groups at either POD 4 (P=0.052, P=0.513) or POD 7 (P=0.125, P=0.80). Similarly, the collagen I/III ratio did not significantly differ between the two groups at POD 4 (1.23±2.26 vs. 0.70±0.24; P=0.47) or POD 7 (0.68±0.96 vs. 0.77±1.22; P=0.857).

Conclusions:
There were no statistical significance difference in collagen I/III ratio between the tissue adhesive and suture material groups, suggesting that the choice of wound closure material may not influence the abdominal skin closure.
Application of green mussel (Perna viridis) shells hydroxyapatite on osteocalcin levels and osteoblast cells in rabbit femur bone defect
Authors: Putra Rafika Syah , Widyastiti Nyoman Suci , Budijitno Selamat , Muniroh Muflihatul , Novriansyah Robin , Alwi Luqman , Adiputra Putu Anda Tusta 
Published: October 2023

Background:
Bovine hydroxyapatite (HA) used for bone grafts is relatively expensive, necessitating the development of alternative sources. Alternative HA materials derived from green mussel shells with smaller molecular sizes are inexpensive and abundantly available throughout Indonesian waters. The purpose of this study is to investigate the effect of green mussel shells HA on bone healing.

Methods:
This post-test-only experimental research used male rabbits with femoral defects divided into three groups randomly: K (no treatment), P1 (bovine HA treatment), and P2 (green mussel shell HA treatment). The osteocalcin level was assessed biochemically while osteoblast cells were histopathologically at the second, fourth, and sixth weeks. Statistic tests were used to assess differences between groups and periods with statistical significance P<0.05.

Results:
Nine rabbits in each group showed significant differences between groups K, P1, and P2 in term osteocalcin levels at week 2 (2.60, 4.53±0.12, 4.47±0.23; P=0.046), week 4 (5.13±0.12, 8.53±0.12, 7.47±0.12; P=0.025), and week 6 (8.20, 11.93±0.23, 10.93±0.31, P=0.023), while in term osteoblast cells only at week 6 (16.33±3.46, 26.10±3.52, 30.40±3.29; P=0.006). The osteocalcin level and osteoblast increased significantly between groups K and P1/P2 from the initial trial until the last week. Osteoblast cells in the groups P1/P2 increased significantly, especially at week 6.

Conclusion:
Green mussel shell HA has the biochemical effectiveness of osteocalcin and can increase osteoblast cells comparable to bovine HA, which can enhance bone healing.