bluuebunny/crossref_metadata_2025_split huggingface dataset:
Intravenous Versus Locally Injected Tranexamic Acid in a Fragility Hip Fracture Population: A Retrospective Review
Authors: Davis Stephen L. , Solomito Matthew J. , Kumar Mandeep 
Published: December 2023

OBJECTIVE:
Evaluate differences between blood transfusion and complication rates among fragility hip fracture patients treated with locally injected (Local) versus intravenous (IV) tranexamic acid (TXA).
METHODS

Design:
Retrospective comparative cohort

Setting:
Tertiary referral orthopedic specialty hospital; Level I trauma center

Patient Selection Criteria:
Patients aged 50 years and over who underwent surgical treatment for a proximal femur fragility fracture (OTA/AO 31A and 31B). between March 2018 and April 2022 with or without the use of local TXA during wound closure or IV TXA.

Outcome Measures and Comparisons:
Post-operative blood transfusion, venous thromboembolism (VTE), surgical site infections (SSI), and 30-day readmissions compared between those who received IV TXA, Local TXA, and controls that did not receive any TXA.

RESULTS:
746 patients (258 received IV TXA, 252 received Local TXA, and 236 control that did not receive any TXA) were studied. Both Local and IV TXA groups received fewer blood transfusion versus controls. IV TXA was associated with a transfusion rate reduction of 12% compared to Local TXA (p<0.001). Regression analysis indicated that IV TXA reduced the odds of a post-operative blood transfusion by 48% compared to Local TXA (p=0.017). There were no differences in complication rates among the groups; however, patients receiving IV TXA had a significantly lower 30-day readmission rate (5%) than the control (13.9%) or Local (13.8%) TXA groups (p=0.001).

CONCLUSION:
Intravenous TXA significantly reduced the risk of postoperative transfusion compared to controls and patients receiving Local TXA. There was no increased risk of complications, and a lower 30-day readmission was observed for the IV TXA group. IV TXA appears to be a safe and effective way to reduce post-operative blood transfusion in patients with fragility hip fractures.

Level of Evidence:
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
Diabetes Mellitus and Poor Glycemic Control Are Associated With a Higher Risk of Lumbar Spinal Stenosis
Authors: Shemesh Shai , Laks Asaf , Cohen Itzik , Turjeman Adi , Blecher Ronen , Kadar Assaf 
Published: December 2023

Study Design.
A large-scale retrospective case-control study.

Objective.
Examine diabetes as a risk factor for lumbar spinal stenosis (LSS) development and evaluate the impact of diabetes duration, glycemic control, and associated complications on this risk.

Summary of Background Data.
Diabetes mellitus, a multiorgan disorder impacting various connective tissues, induces histological changes in spinal structures, particularly the ligamentum flavum. While clinical studies suggest a higher incidence of LSS in diabetic patients, substantial epidemiological research on the likelihood of LSS diagnosis in individuals with diabetes is scarce.

Materials and Methods.
Using nationwide data, a total of 49,576 patients diagnosed with LSS based on International Classification of Diseases-10 codes were matched with controls of the same number based on age and sex. Employing a multivariable logistic regression model, the study assessed for the association between spinal stenosis and diabetes, while adjusting for confounders.

Results.
We found a higher likelihood of LSS diagnosis in diabetic patients [odds ratio (OR) 1.39, 95% CI: 1.36 – 1.43, P<0.001]. Those with hemoglobin A1c ≥7% and ≥1 diabetes-related complication also had an elevated likelihood (OR: 1.19, 95% CI: 1.08–1.31, P=0.001). Prolonged diabetes exposure increased the risk. Diabetes diagnosis reduced median survival by around 4.5 years for both stenosis and nonstenosis patients; spinal stenosis diagnosis alone minimally impacted survival. Relative to individuals diagnosed with diabetes mellitus at the age of 65 or older, the OR for developing LSS were 1.22 (95% CI: 1.18–1.27, P<0.001) when DM was diagnosed at 50 to 65 years old and 1.67 (95% CI: 1.56–1.79, P<0.001) for those under 50 years old. Multivariate analysis revealed a significantly increased risk of all-cause mortality in patients with DM and spinal stenosis (hazard ratio: 1.36, 95% CI: 1.29–1.44, P<0.001) and those with DM without stenosis (hazard ratio: 1.49, 95% CI: 1.41–1.57, P<0.001) compared with controls.

Conclusions.
Diabetic patients with prolonged disease, poor glycemic control, and diabetes-related complications face an elevated risk of developing LSS. Recognizing the reciprocal adverse relationship between these conditions is crucial in clinical practice and designing public health measures for managing both conditions.

Level of Evidence.
4.
Comparison of the efficacy of intranasal atomised dexmedetomidine versus intranasal atomised ketamine as a premedication for sedation and anxiolysis in children undergoing spinal dysraphism surgery
Authors: Hebbar K Chethan , Reddy Ashwini , Luthra Ankur , Chauhan Rajeev , Meena Shyam C. , Tripathi Manjul 
Published: December 2023

BACKGROUNDPreoperative anxiety leads to adverse clinical outcomes and long-term maladaptive behavioural changes. The role of intranasal atomised dexmedetomidine and atomised ketamine as premedication to produce sedation and anxiolysis in paediatric neurosurgical patients has not been extensively studied.OBJECTIVETo study the efficacy of intranasal atomised dexmedetomidine and intranasal atomised ketamine as premedication in producing sedation and facilitating smooth induction in children undergoing spinal dysraphism surgery.DESIGNA prospective randomised double-blind trial.SETTINGA tertiary teaching hospital.PATIENTSSixty-four children aged 1 to 10 years undergoing spinal dysraphism surgeryMETHODSChildren were randomised to receive intranasal atomised dexmedetomidine 2.5 μg kg−1(Group D,n = 32) and intranasal atomised ketamine 5 mg kg−1(Group K,n = 32) 30 min before surgery.OUTCOMES MEASUREDThe primary outcome was to compare the level of sedation in both groups using the University of Michigan Sedation Score (UMSS). The secondary outcomes included an assessment of the ease of parental separation, intravenous cannulation and satisfactory mask acceptance along with perioperative vitals (heart rate, blood pressure and oxygen saturation). The incidence of emergence agitation and time to discharge were also noted.RESULTSThe degree of sedation was significantly better in Group D as compared to Group K at 20 min (UMSS, 1.55 ± 0.51versus1.13 ± 0.34, difference, −0.406; 95% CI, −0.621 to −0.191;P = 0.0001) and 30 min (2.32 ± 0.6versus1.94 ± 0.50, difference, −0.374; 95% CI, −0.650 to −0.100;P = 0.007). The ease of parental separation, venous cannulation and mask acceptance (P = 0.83, 0.418 and 0.100 respectively) were comparable in both groups. The heart rate was lower in group D at 10, 20 and 30 min post-drug administration but was clinically insignificant. The incidence of emergence agitation and time to discharge was also similar with no adverse events reported.CONCLUSIONIntranasal atomised dexmedetomidine produces greater sedation as compared to intranasal atomised ketamine with comparable ease of parental separation, venous cannulation and mask acceptance with no adverse effects.
Outcomes of Digit Replantation in Children: A Systematic Review
Authors: Huang Ryan S. , Mihalache Andrew , Hasan Asad , Wong Riff Karen W.Y. 
Published: December 2023

Background:
Children have been suggested to benefit from digit replantation due to a greater neurogenerative capacity. We aimed to conduct a systematic review on digit replantation in children to provide a comprehensive overview of survival rates and functional outcomes.

Methods:
A systematic literature search was conducted on Ovid MEDLINE, Embase, and the Cochrane Controlled Register of Trials for studies published between 1980 and 2023. We included peer-reviewed studies reporting on digit survival rates in pediatric patients under the age of 18 years who underwent single or multiple digit replantations distal to the metacarpophalangeal joint. Preoperative, intraoperative, and postoperative outcomes were extracted, and pooled estimates were derived using univariable analysis.

Results:
Twenty-two studies reporting on 761 patients and 814 digit replantations were included in our study. Most replantations occurred in the index (n = 74), Tamai zone I (n = 168), and from clean-cut injuries (n = 190). The mean survival rate was 76% (n = 618/814), with a mean range of motion at the distal interphalangeal joint ranging from 64 degrees to 90 degrees and two-point discrimination ranging from 3.8 mm to 6.4 mm. Compared with clean-cut injuries, digit replantations from avulsion [odds ratio (OR), 0.81; 95% confidence interval (CI), 0.74–0.89] or crush (OR, 0.71; 95% CI, 0.59–0.82) injuries were associated with a lower odds of survival. Digit replantations performed with two venous (OR, 1.43, 95% CI; 1.28–1.59) or arterial anastomoses (OR, 1.65; 95% CI, 1.48–1.81) were associated with a higher odds of survival.

Conclusions:
Our systematic review suggests that digit replantation may be a viable option in children. Further research is required to explore functionality after digit replantation in diverse pediatric populations.
A randomized trial of mailed outreach with behavioral economic interventions to improve liver cancer surveillance
Authors: Mehta Shivan J. , McDonald Caitlin , Reitz Catherine , Kastuar Shivani , Snider Christopher K. , Okorie Evelyn , McNelis Kiernan , Shaikh Hamzah , Cook Tessa S. , Goldberg David S. , Rothstein Kenneth 
Published: December 2023

Background:
Surveillance rates for HCC remain limited in patients with cirrhosis. We evaluated whether opt-out mailed outreach increased uptake with or without a $20 unconditional incentive.

Methods:
This was a pragmatic randomized controlled trial in an urban academic health system including adult patients with cirrhosis or advanced fibrosis, at least 1 visit to a specialty practice in the past 2 years and no surveillance in the last 7 months. Patients were randomized in a 1:2:2 ratio to (1) usual care, (2) a mailed letter with a signed order for an ultrasound, or (3) a mailed letter with an order and a $20 unconditional incentive. The main outcome was the proportion with completion of ultrasound within 6 months.

Results:
Among the 562 patients included, the mean age was 62.1 (SD 11.1); 56.8% were male, 51.1% had Medicare, and 40.6% were Black. At 6 months, 27.6% (95% CI: 19.5–35.7) completed ultrasound in the Usual care arm, 54.5% (95% CI: 47.9–61.0) in the Letter + Order arm, and 54.1% (95% CI: 47.5–60.6) in the Letter + Order + Incentive arm. There was a significant increase in the Letter + Order arm compared to Usual care (absolute difference of 26.9%; 95% CI: 16.5–37.3; p<0.001), but no significant increase in the Letter + Order + Incentive arm compared to Letter + Order (absolute difference of −0.4; 95% CI: −9.7 to 8.8; p=0.93).

Conclusions:
There was an increase in HCC surveillance from mailed outreach with opt-out framing and a signed order slip, but no increase in response to the financial incentive.
Perioperative care of nipple-areola complex-sparing mastectomy and one-stage breast reconstruction via endoscopic axillary approach for ductal carcinoma in situ: A case report
Authors: Zhang Li-Xia , Zhang Li , Jiang Li-Li , MI Hui , Lingling Dong 
Published: December 2023

Rationale:
Breast cancer represents a prevalent malignancy that primarily impacts women, with pronounced consequences on their overarching health. The major therapeutic approach, encompassing surgical procedures, can often culminate in mastectomy, potentially inciting psychological turmoil and disorders.

Patient concerns:
A patient was admitted to our facility on May 5, 2023, precipitated by the discovery of bilateral breast masses during a routine physical examination conducted 3 days before admission.

Diagnosis:
The breasts were symmetric, with the right nipple inverted and a palpable mass in the upper outer quadrant of the right breast, measuring approximately 5 cm × 4 cm. The mass was firm with indistinct borders, relatively regular morphology, poor mobility, and no tenderness. Outpatient color Doppler ultrasound revealed heterogeneous echogenicity in the right breast, classified as Breast Imaging Reporting and Data System (BI-RADS) category 0, along with multiple ductal dilatations. The left breast exhibited a hypoechoic area (BI-RADS 3), indicative of proliferative changes. Radiographic mammography confirmed diffuse changes in the right breast (BI-RADS 0) and proliferative signs in the left breast (BI-RADS 2). Biopsy results reveal significant atypical ductal hyperplasia consistent with intermediate-grade ductal carcinoma in situ. This patient was diagnosed as ductal carcinoma in situ of the right breast (cTisN0M0 and Stage 0), accompanied by a left breast mass.

Interventions:
On May 15, 2023, the patient was readmitted for further surgical intervention. Following relevant auxiliary examinations, the patient underwent nipple-areola complex-sparing radical mastectomy for the right breast, sentinel lymph node biopsy in the right axillary area, prosthesis-based breast reconstruction for the right breast, and microrotatotomy of the left breast mass on the left side on May 17.

Outcomes:
The patient made a successful recovery under scrupulous perioperative supervision and was discharged 7 days post-surgery.

Lessons:
The axillary approach for endoscopic mammary gland excision and immediate implant reconstruction permits patients to preserve the esthetics of the female form while undergoing conventional medical treatment. This methodology considerably enhances the psychophysical health of the patients, thereby marking it as an advantageous practice worthy of broad dissemination in the medical community.
A case of brain arteriovenous malformation treated by high-pressure cooker technique assisted with anhydrous alcohol embolization: A case report
Authors: Zhang Cui , Wang Qingbo , Li Chenglong , Li Zefu 
Published: December 2023

Rationale:
Brain arteriovenous malformations (BAVMs) are a relatively rare but very dangerous developmental abnormality of the blood vessels. Intracranial hemorrhage is the most common clinical manifestation of BAVMs, and has a high rate of rebleeding, disability, and mortality, which has a serious impact on patients’ quality of life and working ability. Endovascular intervention was a new technique that emerged in recent years. Anhydrous ethanol embolization has been used with satisfactory results in the treatment of peripheral arteriovenous malformations, but there is a lack of practice in the treatment of BAVMs. We tried to treat BAVMs by embolizing malformed vessels with anhydrous alcohol in order to provide a safe and effective treatment for more patients with BAVMs.

Patient concerns:
The patient was admitted to our hospital in the emergency department with “sudden onset of headache for more than 4 hours.” At the time of admission, the patient was clearly conscious, not mentally alert, spoke fluently, and had a normal level of orientations. The direct and indirect responses to light were blunted. The patient’s muscle strength, muscle tone, and sensation of the extremities were normal. National Institute of Health stroke scale score was 1. Head computed tomography at the onset suggested a right occipital hemorrhage and hematoma formation.

Diagnoses:
Brain arteriovenous malformations (BAVMs) were suspected based on preoperative imaging findings.

Interventions:
After obtaining the consent of the patient and their family members, we performed whole brain angiography to determine the location of the lesion, and then, with the help of high-pressure cooker technology, targeted embolization of interventional BAVM was performed. The high-pressure cooker technology was achieved through spring coils, and the embolic material was anhydrous ethanol.

Outcomes:
The surgery was successful, and the patient recovered well without recurrence.

Lesson:
The successful performance of this surgery illustrates the feasibility of anhydrous ethanol-targeted ablation for BAVMs.
Refractory hypotension and coronary artery spasm induced by antipsychotic drugs: A challenging case and treatment consideration: A case report and literature review
Authors: Song Kang , Ji Yang , Zhao Kun , Han Xiaorong , Jian Chuanmin , Liu Song 
Published: December 2023

Rationale:
Coronary artery spasms may result from supply–demand mismatch due to hypotension. Norepinephrine is more effective in ameliorating antipsychotic-induced refractory hypotension.

Patient concerns:
Postoperative difficult-to-correct hypoperfusion occurs in patients with comorbid depression and coronary spasm; the use of norepinephrine and epinephrine for rapidly raising blood pressure needs to be considered.

Diagnoses:
Electrocardiogram is an auxiliary tool and Digital Substraction Angiography is the gold standard for the diagnosis.

Interventions:
Surgery and correct choice of raising blood pressure are the main treatment methods.

Outcomes:
Hypotension induced by the use of antipsychotics after angiography is difficult to correct with dobutamine, and the above scenario is relatively rare in the clinic, where norepinephrine could be a potential therapeutic option.

Lessons:
Based on the lessons learnt from this case, caution must be exercised when dealing with patients on multiple antipsychotics during the perioperative period, while pressor-boosting medications should not be limited to conventional drugs such as dopamine. Norepinephrine may be more effective in dealing with difficult-to-correct hypoperfusion.
Crossmatch assays in transplantation: Physical or virtual?: A review
Authors: Rocha Yermis , Jaramillo Andrés , Neumann Jorge , Hacke Katrin , Palou Eduard , Torres Juan 
Published: December 2023

The value of the crossmatch test in assessing pretransplant immunological risk is vital for clinical decisions, ranging from the indication of the transplant to the guidance of induction protocols and treatment with immunosuppressants. The crossmatch tests in transplantation can be physical or virtual, each with its advantages and limitations. Currently, the virtual crossmatch stands out for its sensitivity and specificity compared to the physical tests. Additionally, the virtual crossmatch can be performed in less time, allowing for a reduction in cold ischemia time. It shows a good correlation with the results of physical tests and does not negatively impact graft survival.
Proper communication between clinicians and the transplant immunology laboratory will lead to a deeper understanding of each patient’s immunological profile, better donor–recipient selection, and improved graft survival.
A patient with Owren disease requires pancreatic surgery: A case report
Authors: Jun Yang , Ming Qiu , Nai-Wen Luo , Lei Cao , Yu-Dong Fan , Shu-Guang Wang , Yao Wang 
Published: December 2023

Rationale:
Coagulation factor V deficiency is rare, and perioperative management of patients with this condition is particularly important, especially during major abdominal surgery. We present a case of a patient with pancreatic duct stones combined with coagulation factor V deficiency. We share our perioperative management experience.

Patient concerns:
A 31-year-old man presented with recurrent upper abdominal pain for 2 years.

Diagnoses:
The diagnosis of pancreatic duct stones in the patient has been established through abdominal computed tomography and magnetic resonance imaging examinations. The diagnosis of factor V deficiency was initially identified through coagulation function tests, revealing significant prolongation of both aPTT and PT. Subsequent testing of coagulation factors and inhibitors demonstrated that the patient has a deficiency in coagulation factor V. Finally, genetic testing revealed that the factor V deficiency in this case is hereditary.

Interventions:
The patient underwent a partial resection of the pancreatic head, and FFP was infused 1 hour before surgery. 600 mL of FFP was instilled 1 hour before the start of surgery along with 10 U of cryoprecipitate. and 600 ml of FFP were added during surgery. Postoperative treatment included intermittent FFP supplemental infusion in the first 5 days after surgery while monitoring the coagulation function.

Outcomes:
The patient underwent a successful surgery without any abnormal bleeding or oozing during the procedure. The postoperative recovery was smooth, with no abnormal bleeding.

Lessons:
Patients with a deficiency of coagulation factor V are not contraindicated for surgery. Appropriate Fresh Frozen Plasma (FFP) replacement therapy can ensure the safe conduct of the surgical procedure. For patients with abnormal blood coagulation function, we recommend testing for coagulation factors and inhibitors, as well as performing genetic testing for abnormal coagulation factors, which can provide guidance on marriage and childbirth.
Endophthalmitis associated with Staphylococcus cohnii after vitrectomy and silicone oil insertion: A case report
Authors: Zhang Yuqiu 
Published: December 2023

Background:
To report a case of endophthalmitis in a silicone oil (SO)-filled eye associated with Staphylococcus cohnii. After vitrectomy, the environment for bacterial growth in the eye is removed, and SO has antibacterial effect on a variety of microorganisms. Endophthalmitis is seen in about 0.040% cases after pars plana vitrectomy and is even more uncommon in cases where SO is used.

Methods:
The patient was diagnosed as endophthalmitis and admitted to our hospital for emergency. The main concern is if intraocular infection can be controlled and the visual prognosis. In this case, multiple intravitreal antibiotics injection and anterior chamber washout were performed. Not only that, phacoemulsification was performed.

Results:
Hypopyon became less after 3 operations were performed. The infection was under control finally.

Conclusion:
To the best of our knowledge, it is the first report of S. cohnii endophthalmitis in an SO-filled globe of an middle-aged patient. It is important to treat infective endophthalmitis with antibiotics promptly. Delayed therapy may affect the visual prognosis.
Prenatal diagnosis of microcephaly through combined MRI and ultrasonography: Analysis of a case series
Authors: Pei Shu-ping , Guan Hai-lian , Jin Feng 
Published: December 2023

Introduction:
Intrauterine microcephaly is a complex and lifelong condition that poses significant ethical challenges for clinicians and parents. The prognosis of microcephaly is highly variable and depends on the underlying cause and severity. In addition, microcephaly is often associated with various comorbidities, including intellectual disability, developmental delay, and epilepsy. Ultrasonography (US) is currently the most commonly used imaging modality for detecting microcephaly in the second trimester of pregnancy. However, antenatal brain magnetic resonance imaging (MRI) is increasingly being used as a more sensitive tool to identify structural abnormalities that may suggest a specific diagnosis. In this study, we report a case series of microcephaly diagnosed through the combination of MRI and US.

Patient concerns:
How to utilize a combination of MRI and US to screen for fetal microcephaly.

Diagnosis:
Based on the results of US and MRI examinations, patient 1 was found to have other craniocerebral malformations, patient 2 demonstrated macrogyria, and patient 3 exhibited skull irregularities.

Interventions:
The pregnancies of all 3 patients were terminated through the induction of labor by injecting Rivanol into the amniotic cavity.

Outcomes:
The 3 patients were discharged after a period of observation.

Conclusion:
US is an important tool for diagnosing fetal microcephaly. However, MRI can overcome the limitations of US and detect additional brain structural abnormalities, thereby providing more specific and valuable prenatal diagnostic information. Therefore, combining MRI and US has significant diagnostic value for fetal microcephaly.