bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Relation of the Anterior Ethmoidal Foramen to the Cranial Base
Authors: Cunha Barbara Salomao A. , Garcia Denny Marcos , Cruz Antonio Augusto V. 
Published: July 2023

Purpose:
To perform a radiological analysis of the relation of the anterior ethmoidal foramen (AEF) to the cranial base and olfactory fossa (OF).

Methods:
Retrospective analysis of computed tomography coronal scans of 35 orbits of 35 patients with Graves orbitopathy. Following a standard multiplanar reconstruction of the orbit, the authors measured the vertical and the horizontal distances of the AEF to the cranial base and to the lateral border of the OF, respectively. The height of the OF was measured at the level of the AEF and at the position of Keros classification. The presence of supraorbital ethmoid cells (SOEC) was also recorded.

Results:
The vertical distance of the AEF to the cranial base ranged from 0.1 to 7.3 mm with a mean = 2.5 mm (SD = 2.17). In 47.5% of the orbits the foramen was adjacent (<1 mm) to the cranial base. The horizontal distance of the AEF to the lateral border of the OF ranged from 2.3 to 9.5 mm (mean = 5.4 mm, SD = 1.98). The presence of an SOEC (n = 12) increased significantly both the distance from the AEF to the cranial base and to the lateral border of the OF. The height of the OF at the level of AEF is not correlated with the depth of the OF at the level of Keros classification.

Conclusions:
In the absence of supraorbital pneumatization, the AEF location is a dangerous landmark for the upper limit of the transconjunctival medial wall decompression.
Prevalence and Impact of Poststroke Fatigue on Patient Outcomes in the First 6 Months After Stroke: A Systematic Review and Meta-analysis
Authors: Paudel Sulochana Koirala , Rolls Kaye , Green Heidi , Fernandez Ritin 
Published: July 2023

ABSTRACTBACKGROUND:Post-stroke fatigue (PSF) is one of the most pervasive and debilitating symptoms after stroke and has a negative impact on activities of daily living (ADLs) and health-related quality of life (HRQoL) of stroke survivors. However, to date, no study has systematically reviewed the prevalence of PSF at different points in time after stroke.OBJECTIVE:The aim of this study was to investigate the prevalence of PSF and its impact on ADLs and HRQoL in the first 6 months post stroke.METHOD:CINAHL, MEDLINE, Scopus, Google Scholar, and Index to Theses were searched from 1983 to August 2022 for studies published in English. Studies were included if they were conducted on adults 18 years and older, and were observational, correlational, and quantitative components of mixed methods reporting on PSF, ADLs, and HRQoL post stroke.RESULTS:Thirty studies were included in this review, and all had a high methodological quality. The pooled prevalence of PSF at 1 to 6 weeks was 49.5%; at 3 months, it was 41.9%; and at 6 months, it was 43.4%. A negative correlation between PSF and ADLs was observed at 1, 2, and 4 to 6 weeks, and at 3 and 6 months post stroke. A significant negative correlation between PSF and HRQoL was observed within the first week (r= −0.40,P< .05) and at 3 and 6 months post stroke. The results at 3 and 6 months post stroke were inclusive.CONCLUSION: The prevalence of PSF in the first 6 weeks, particularly in the first 2 weeks after stroke, is high and has a significant negative impact on stroke survivors' ADLs and HRQoL. Only a limited number of studies assessed PSF within the first 2 weeks after stroke.
Evaluating the Usability and Equivalence of Electronic Patient-Reported Outcome Measures for Individuals with a Lower-Limb Amputation
Authors: Maronati Rachel , Rigot Stephanie K. , Mummidisetty Chaithanya K. , Jayaraman Chandrasekaran , Hoppe-Ludwig Shenan , Jayaraman Arun 
Published: July 2023

ABSTRACT

Introduction
Electronic versions of patient-reported outcome measures (PROMs) seem to have a clear administrative logging advantage to traditional paper versions. However, most of them have not been formally evaluated for their suitability to replace paper outcome measures for assessment of individuals with lower-limb amputations. The aim of this study is to examine the usability and equivalence of electronic to paper versions of PROMs suitable for use in prosthetic clinical care and research for persons with lower-limb loss.

Methods
In this cross-sectional study, 10 participants remotely completed the following PROMs online and then on paper: Orthotic and Prosthetic User Survey (OPUS), Modified Falls Efficacy Scale (MFES), Prosthetic Evaluation Questionnaire (PEQ), Patient Health Questionnaire–9 (PHQ-9), and Community Participation Indicators (CPI). Participants also answered open-ended and standardized questions regarding the usability of the electronic surveys. Wilcoxon signed rank tests, comparisons to minimum detectable change, intraclass correlation coefficients, and Bland-Altman plots were used to evaluate differences between the two survey versions, meaningful changes in scores, reliability, and systematic biases, respectively.

Results
Electronic surveys had fewer missing or ambiguous responses than paper surveys; however, the PEQ Social Burdens subscale could not be evaluated due to error in the creation of the electronic survey. No significant differences were found between scores of the two versions for any of the measures, but multiple participants had meaningful changes in the Appearance and Sounds PEQ subscales. All measures demonstrated acceptable reliability between versions, except the Appearance, Perceived Response, and Sounds subscales of the PEQ. No systematic biases in scores or usability concerns were found for any measures.

Conclusions
This study analysis showed that most of the electronic PROMs studied are easily used and demonstrate equivalence to the paper versions. However, the PEQ Appearance, Perceived Response, Sounds, and Social Burden subscales require further evaluation.

Clinical Relevance
Except for the PEQ, electronic versions of the PROMs in this study can likely be used interchangeably with paper versions among individuals with lower-limb loss.
Presbycusis and Hearing Preservation in Observed Vestibular Schwannomas
Authors: Brennan Julia R. , Sharma Rahul , Lindquist Nathan R. , Cass Nathan D. , Krishnapura Shreyas G. , Kloosterman Nicole , Perkins Elizabeth , Bennett Marc L. , O'Malley Matthew R. , Haynes David S. , Tawfik Kareem O. 
Published: July 2023

Objective
We reviewed a cohort of patients with untreated sporadic vestibular schwannoma (VS) and examined the relationship between high-frequency hearing loss (HFHL) in the non-VS ear and long-term hearing outcomes in the VS-affected ear. We hypothesized that the progression of HFHL is associated with accelerated hearing decline in sporadic VS.

Study Design
Retrospective cohort study.

Setting
Tertiary center.

Patients
We studied 102 patients with sporadic VS diagnosed from 1999 to 2015 with ≥5 years of observation (median, 6.92; interquartile range, 5.85–9.29). Sixty-six patients had AAO-HNS class A/B hearing at presentation and were included in analysis.

Interventions
Audiometry, serial magnetic resonance imaging for observation of VS.

Main Outcome Measures
Four-frequency pure tone average (PTA) and word recognition scores (WRS) in the VS-affected ear. Decline in high-frequency PTA (average of thresholds at 4000, 6000, and 8,000 Hz) was defined as ≥10 dB during the study period. Decline in WRS was defined as ≥10%.

Results
Compared with those without, patients with progressive HFHL in the non-VS ear were more likely to experience a decline in WRS in the VS ear (80% vs. 54%, p = 0.031). However, the same group showed no difference (52% vs. 41%, p = 0.40) in decline in PTA of the VS ear.

Conclusions
Patients with observed VS who experience progressive HFHL in the non-VS ear are more likely to experience significant declines in speech understanding in the VS-affected ear over time. Patients with a history of presbycusis may have an increased risk of losing serviceable hearing because of sporadic VS.
Evaluating the Efficacy and Pharmacoeconomics of Semaglutide and Tirzepatide in the Setting of Obesity
Authors: Nguyen Timothy , Wong Elaine , Cope Rebecca 
Published: July 2023

Background:Obesity is a major and growing public health concern. The associated cost for obesity and its related comorbidities is approximately 30% of US health care expenditures annually. As additional pharmacotherapeutic options join the market to combat obesity, it is important to understand the financial impact it may have on overall health care costs. This article explores the efficacy and pharmacoeconomics of incretin mimetics, semaglutide and tirzepatide, in the setting of obesity.Area of Uncertainty:The cost of incretin mimetics (semaglutide and tirzepatide) and its overall impact on obesity management within the health care arena is being explored. The cost comparison of these medications is to be determined; however, it may represent an added cost to the total US health care expenditures.Data Sources:A PubMed and Google Scholar search was conducted using various search terms (eg, semaglutide, tirzepatide, pharmacoeconomics, and obesity).Therapeutic Advances:Based on the data reviewed, both semaglutide and tirzepatide are effective medication options for obesity management. Obesity-related management expenditures exceed $173 billion for the US health care system annually. The cost needed to treat for 1% of weight loss with semaglutide and tirzepatide was reported as $1845 and $985, respectively. More than 40% of adults (60 years or older) experience obesity. If 1%, 5%, or 10% of this population is treated with semaglutide, the annual Medicare costs will translate to excess of $2.6 billion, $13.3 billion, and $26.8 billion, respectively. Tirzepatide is not yet approved in the United States for obesity and its financial impact remains to be seen.Conclusions:Obesity is associated with burdensome health complications and costs. Semaglutide and tirzepatide are effective drug options for the management of obesity. The cost of these medications will no doubt present a challenge to the total health care expenditures, although the cost–benefit ratio may ultimately be favorable.
Daridorexant, an Orexin Receptor Antagonist for the Management of Insomnia
Authors: Najib Jadwiga , Toderika Yuliana , Dima Lorena 
Published: July 2023

Background:
Insomnia is a common sleep disorder that is diagnosed primarily by patients' subjective reported symptoms. Daridorexant is a new dual orexin receptor antagonist that was recently approved by Food and Drug Administration for insomnia characterized by difficulty falling asleep and/or maintaining sleep.

Mechanism of Action, Pharmacodynamics, and Pharmacokinetics:
The orexin neuropeptide signaling system plays a role in wakefulness, and blocking the wake-promoting neuropeptides results in diminished wake signaling, thus exerting a sedative effect using an entirely different mechanism of action than the classical sleep promoting agents. The drug has quick onset of action, high volume of distribution, and high protein binding. Pharmacokinetics and pharmacodynamic parameters were similar in patients of different sex and age and were not significantly affected by race, body size, or mild-to-moderate kidney impairment. Dose limitation to 25 mg in moderate liver impairment and no use in severe liver impairment are recommended. The drug undergoes hepatic CYP3A4 metabolism; thus, caution with strong CYP3A4 inhibitors and inducers is warranted.

Clinical Trials:
The drug was approved based on phase 3 trials involving study 1 and study 2. Study 1 noted daridorexant at doses of 25 and 50 mg demonstrated a statistically significant improvement in wake time after sleep onset, latency to persistent sleep, and self-reported total sleep time against placebo at months 1 and 3. Similarly in study 2, compared with placebo, the 25 mg dose demonstrated statistically significant improvement in wake time after sleep onset, latency to persistent sleep, and self-reported total sleep time at months 1 and 3. Treatment-emergent adverse events were similar for daridorexant and placebo, with nasopharyngitis and headache most frequently reported.

Therapeutic Advance:
Daridorexant is a novel agent with demonstrated efficacy in sleep onset and maintenance and decrease in daytime sedation. Preliminary results from a 1-year extension study note similar incidences of mild-to-moderate side effects as noted in previous trials. Further studies are needed to establish its place in the pharmacological treatment of insomnia.
Churn in Supplemental Nutrition Assistance Program
Authors: Xie Liyang , O’Connor Jason , Albert Steven , Gary-Webb Tiffany , Sharbaugh Michael , Donohue Julie M. , Ennis Molly , Hutcheson Deborah , Cole Evan S. 
Published: July 2023

Background:
The Supplemental Nutrition Assistance Program (SNAP) provides financial assistance to low-income individuals and families to help them purchase food. However, when participants experience short-term disenrollment from the program, known as churn, it can disrupt their health care usage patterns or result in acute health care needs due to the loss of financial benefits and time burden required to reapply for SNAP.

Objective:
The objective of this study was to examine the changes in health care expenditures and acute care utilization during periods of SNAP churn compared with nonchurn periods among those who churn during the study period.

Research Design:
Longitudinal analysis of Pennsylvania Medicaid claims data for enrollees participating in SNAP between 2016 and 2018 using individual fixed-effects models. We add to the literature by estimating whether these changes varied based on the amount of SNAP benefit lost, or differed between adults and children.

Results:
We found that SNAP churn was associated with reductions in pharmacy and primary care spending across all SNAP benefit levels and age groups. Specifically, our findings indicate a reduction of 4%–6% in pharmacy expenditures for adults and 2%–4% for children. Moreover, there was a 3%–4% decrease in primary care expenditures for adults and a 4%–6% decrease for children. Acute care utilization did not significantly change during a SNAP churn period.

Conclusion:
Our findings of decreases in pharmacy and primary care spending suggest that preventing SNAP churn may help reduce instances where adult and child participants forgo necessary care.
Course Review: Yorkshire Microsurgery Course 2023
Authors: Bollen Edward , Paul Ganesh 
Published: July 2023

Abstract
Microsurgery is an advanced set of techniques that require a high level of skill to be performed safely. Surgical skills courses offer safe environments for practice in such skills and form a fundamental part of surgical training. The Yorkshire Microsurgery Course is a 3-day course at Bradford Royal Infirmary, United Kingdom. Delivered via short lectures followed by supervised practical sessions, the course aims to provide delegates with the essential knowledge and skills required for microsurgery.
We detail an outline and critical evaluation of the February 2023 iteration of the course, with recommendations for improvement.
Overall, we found the course excellent. It provided delegates with a solid grounding in the fundamentals of microsurgery and the opportunity for personalized practice supervised by experts. We would recommend this course to colleagues interested in a career in plastic surgery.
Regional Anesthesia in Upper-Limb Surgery
Authors: McLennan Lachlan , Haines Morgan , Graham David , Sullivan Timothy , Lawson Richard , Sivakumar Brahman 
Published: July 2023

BackgroundLocal and regional anesthesia is associated with numerous clinical and institutional advantages relative to general anesthesia. As anesthesiologists and surgeons increasingly integrate local and regional anesthesia into their clinical practice, an understanding of the principles, evolution, and trends underpinning modern anesthetic techniques continues to be relevant.MethodsA review of the literature in databases Medline, PubMed, and EMBASE identified recent developments, ongoing trends, and historical milestones in upper-limb regional anesthesia.ResultsAdvances in regional anesthetic techniques in the last century have led to reduced postoperative pain, improved safety, and improved outcomes in upper-limb surgery. The development of ultrasound-guided techniques, as well as pharmacological advances in local anesthetic drugs and adjuncts, has further advanced the role of regional anesthesia. Wide-awake local anesthesia with no tourniquet has allowed certain procedures to be performed on select patients in outpatient and low-resource settings.ConclusionsThis review provides an overview of local and regional anesthesia in the upper-limb from its historical origins to its contemporary applications in upper-limb surgery, particularly during the COVID-19 pandemic.
Surgical Treatment of Symptomatic End-Neuroma With a New Bioresorbable Copolyester Nerve Capping Device
Authors: Power Dominic , Curtin Catherine , Bellemère Philippe , Nyman Erika , Pajardi Giorgio , Isaacs Jonathan , Levin Lawrence Scott 
Published: July 2023

Background
Neuroma-induced neuropathic pain is associated with loss of function and reduced quality of life. No consistently effective standard-of-care treatment has been defined. Neurocap, a bioresorbable nerve capping device, has been designed to isolate the nerve stump from surrounding tissues to reduce development of symptomatic end-neuromas.

Methods
Patients with peripheral symptomatic end-neuromas were included in a prospective, multicenter, single-arm design. Data were collected presurgery up till 24 months postsurgery. Eligible patients with neuromas were identified based on blocks using anesthetic. Intervention included surgical excision and capping of the transected proximal nerve end with the Neurocap. Main outcome measures were pain, function, recurrence of symptomatic neuroma, use of analgesics, and adverse events.

Results
In total, 73 patients with 50 upper-extremity and 23 lower-extremity end-neuromas were enrolled. End-neuromas were predominately located in the digits and lower leg. Statistical power of the study outcomes was preserved by 46 of 73 patients completing 24-month follow-up. The mean VAS-Pain score at baseline was 70.2 ± 17.8 (scale 0–100) and decreased significantly to 31 ± 32.5 (P < 0.001). Function significantly improved over time. The recurrence rate of confirmed symptomatic neuroma was low (2 of 98 capped nerves). Adverse event rate was low and included pain and infection; there were no unexpected device-related adverse events. Most patients reported lower use of nonsteroidal anti-inflammatory drugs, opioids, and antineuropathic medications at last follow-up compared with baseline.

Conclusions
End-neuroma treatment with excision and capping resulted in long-term significant reduction in reported pain, disability, and analgesic medication use. Adverse event rate was low.
Perioperative Factors Aggravating Pharyngocutaneous Fistula After Total Laryngectomy
Authors: Haga Yoshitaka , Yasunaga Yoshichika , Araki Jun , Nakao Junichi , Mori Hiroaki , Nakagawa Masahiro , Mukaigawa Takashi 
Published: July 2023

Background
Pharyngocutaneous fistula formation represents a major postoperative complication following total laryngectomy. We aimed to investigate the risk factors for pharyngocutaneous fistula development after total laryngectomy and to identify factors that lead to severe cases of pharyngocutaneous fistula.

Methods
Patients who underwent total laryngectomy between January 2013 and February 2021 were included in the study and were divided into 2 groups: Those with and without pharyngocutaneous fistula. The severity of pharyngocutaneous fistula was graded using the Clavien-Dindo classification.

Results
Patients with pharyngocutaneous fistula experienced longer operative time, greater intraoperative blood loss, greater decrease in perioperative hemoglobin level, and longer postoperative hospitalization. Unlike in lower-severity cases, patients with grade IIIb pharyngocutaneous fistula underwent preoperative radiotherapy or chemoradiotherapy; preoperative treatment was thus a risk factor for higher severity of pharyngocutaneous fistula (odds ratio, 35; P = 0.004).

Conclusion
Salvage laryngectomy was found to be a predictor of severe pharyngocutaneous fistula development. Prolonged operative time, increased intraoperative blood loss, and decreased postoperative hemoglobin level were found to be predictors of postlaryngectomy pharyngocutaneous fistula formation.
Mitochondria Transplantation Mitigates Damage in an In Vitro Model of Renal Tubular Injury and in an Ex Vivo Model of DCD Renal Transplantation
Authors: Rossi Andrea , Asthana Amish , Riganti Chiara , Sedrakyan Sargis , Byers Lori Nicole , Robertson John , Senger Ryan S. , Montali Filippo , Grange Cristina , Dalmasso Alessia , Porporato Paolo E. , Palles Christina , Thornton Matthew E , Da Sacco Stefano , Perin Laura , Ahn Bumsoo , McCully James , Orlando Giuseppe , Bussolati Benedetta 
Published: July 2023

Objectives:
To test whether mitochondrial transplantation (MITO) mitigates damage in two models of acute kidney injury (AKI).

Summary Background Data:
MITO is a process where exogenous isolated mitochondria are taken up by cells. As virtually any morbid clinical condition is characterized by mitochondrial distress, MITO may find a role as a treatment modality in numerous clinical scenarios including AKI.

Methods:
For the in vitro experiments, human proximal tubular cells were damaged and then treated with mitochondria or placebo. For the ex vivo experiments, we developed a non-survival ex vivo porcine model mimicking the donation after cardiac death (DCD) renal transplantation scenario. One kidney was treated with mitochondria, while the mate organ received placebo, before being perfused at room temperature for 24 hours. Perfusate samples were collected at different time points and analyzed with Raman spectroscopy. Biopsies taken at baseline and 24 hours were analyzed with standard pathology, immunohistochemistry and RNA sequencing analysis.

Results:

In vitro, cells treated with MITO showed higher proliferative capacity and ATP production, preservation of physiological polarization of the organelles and lower toxicity and reactive oxygen species production. Ex vivo, kidneys treated with MITO shed fewer molecular species, indicating stability. In these kidneys, pathology showed less damage while RNAseq analysis showed modulation of genes and pathways most consistent with mitochondrial biogenesis and energy metabolism and downregulation of genes involved in neutrophil recruitment, including IL1A, CXCL8, and PIK3R1.

Conclusions:
MITO mitigates AKI both in vitro and ex vivo.