bluuebunny/crossref_metadata_2025_split huggingface dataset:
Glucocorticoid withdrawal syndrome: what to expect and how to manage
Authors: Theiler-Schwetz Verena , Prete Alessandro 
Published: March 2023

Purpose of review
Glucocorticoid withdrawal syndrome (GWS) can develop after withdrawing exposure to supraphysiological levels of endogenous or exogenous glucocorticoids due to an established physical dependence. It is characterised by symptoms similar to adrenal insufficiency but needs to be regarded as a separate entity. GWS is often under-recognised in clinical practice and affected patients can experience significant impairment in their quality of life.

Recent Findings
A cornerstone in GWS management is adequate patient education and reassurance that symptoms are expected and typically temporary. Patients with endogenous Cushing's syndrome need to be aware that psychopathology may persist into the postoperative period. GWS is more likely to develop in severe Cushing's syndrome and in patients with very low levels of cortisol after surgery. Postoperatively, glucocorticoid replacement should be initiated and tapered in an individualised approach but there is currently no consensus on the best tapering strategy. If symptoms of GWS develop, glucocorticoid replacement ought to be temporarily increased to the previous, well tolerated dose. No randomised studies have thus far compared regimens for withdrawing glucocorticoids after treatment for anti-inflammatory or immunosuppressive causes to determine the best and safest tapering strategy. One open-label, single-arm trial in patients with asthma has recently proposed a personalised glucocorticoid tapering regimen which included the systematic assessment of adrenal function.

Summary
Awareness of GWS by treating physicians and patient education are essential. Evidence on optimal GWS management after Cushing's syndrome treatment is scarce, but new data are emerging for tapering after long-term glucocorticoid treatment.
Update on nonpolio enterovirus and parechovirus infections in neonates and young infants
Authors: Tomatis Souverbielle Cristina , Erdem Guliz , Sánchez Pablo J. 
Published: March 2023

Purpose of review
To review the epidemiology, clinical manifestations, and treatment strategies of nonpolio enterovirus and parechovirus (PeV) infections, and identify research gaps.

Recent findings
There is currently no approved antiviral agent for enterovirus or PeV infections, although pocapavir may be provided on a compassionate basis. Elucidation of the structure and functional features of enterovirus and PeV may lead to novel therapeutic strategies, including vaccine development.

Summary
Nonpolio human enterovirus and PeV are common childhood infections that are most severe among neonates and young infants. Although most infections are asymptomatic, severe disease resulting in substantial morbidity and mortality occurs worldwide and has been associated with local outbreaks. Long-term sequelae are not well understood but have been reported following neonatal infection of the central nervous system. The lack of antiviral treatment and effective vaccines highlight important knowledge gaps. Active surveillance ultimately may inform preventive strategies.
Choosing a Nursing Career During a Global Health Event
Authors: Avraham Rinat , Wacht Oren , Yaffe Eli , Grinstein-Cohen Orli 
Published: March 2023

Background:
Although in the past, the decision to enter the nursing profession was mainly due to intrinsic motives, more recent generations present additional extrinsic career choice motives. The motivation of choosing a nursing career may be affected by global health events, such as COVID-19.

Purpose:
To examine the motivation for choosing a nursing career during COVID-19.

Methods:
A repeated cross-sectional study was conducted among 211 first-year nursing students at a university in Israel. A questionnaire was distributed during 2020 and 2021. Linear regression evaluated the motives that predict choosing a nursing career during COVID-19.

Results:
Intrinsic motives were the leading motives for choosing a nursing career in a univariate analysis. A multivariate linear model revealed that choosing a nursing career during the pandemic was associated with extrinsic motives (β= .265, P < .001). Intrinsic motives did not predict choosing a nursing career during COVID-19.

Conclusion:
Reassessment of motives among candidates may help the efforts of faculty and nursing to recruit and retain nurses in the profession.
Ten Years of Disseminated Gonococcal Infections in North Carolina: A Review of Cases From a Large Tertiary Care Hospital
Authors: Sciaudone Michael , Cope Anna , Mobley Victoria , Samoff Erika , Seña Arlene C. 
Published: March 2023

Background
The detection and reporting of disseminated gonococcal infection (DGI) has been increasing across the United States.

Methods
We conducted a retrospective chart review of DGI case-patients diagnosed between 2010 and 2019 at a large tertiary care hospital in North Carolina.

Results
We identified 12 DGI case-patients (7 men and 5 women, aged 20 to 44 years), of whom 5 had Neisseria gonorrheae isolated from a sterile site (confirmed), 2 had N. gonorrheae detected at a nonsterile mucosal site and had clinical manifestations consistent with DGI (probable), and 5 did not have N. gonorrheae isolated from any site, but DGI was the most likely diagnosis (suspect). Among the 12 DGI case-patients, the most common manifestation was arthritis or tenosynovitis (n = 11); 1 patient had endocarditis. Half of the patients had significant underlying comorbidities or predisposing factors, including complement deficiency. Eleven of the 12 case-patients were hospitalized, and 4 required surgical intervention.

Conclusions
This case series highlights the difficulty of making a definitive diagnosis of DGI, which could negatively affect reporting to public health authorities and hinder surveillance efforts to determine the true prevalence of DGI. A high index of suspicion is required, and a full diagnostic workup should be pursued in all cases of suspected DGI.
Derivation and Internal Validation of a Risk Score for Predicting Chlamydia trachomatis Infection in Kenyan Women Planning Conception
Authors: Pulei Anne N. , Lokken Erica M. , Kinuthia John , Richardson Barbra A. , Mandaliya Kishorchandra , Jaoko Walter , McClelland R. Scott 
Published: March 2023

AbstractBackgroundAvailability of laboratory confirmation of sexually transmitted infections (STIs) is increasing in low- and middle-income countries, but costs continue to limit their access.Chlamydia trachomatis(CT) is an STI of significant clinical importance, particularly among women. This study aimed to develop a risk score to identify women with a higher likelihood of CT infection, who could then be prioritized for laboratory testing, in a population of Kenyan women planning pregnancies.MethodsWomen with fertility intentions were included in this cross-sectional analysis. Logistic regression was used to estimate odds ratios for the association between demographic, medical, reproductive, and behavioral characteristics and the prevalence of CT infection. A risk score was developed and validated internally based on the regression coefficients in the final multivariable model.ResultsThe prevalence of CT was 7.4% (51/691). A risk score for predicting CT infection, with scores 0-6, was derived from participants' age, alcohol use, and presence of bacterial vaginosis. The prediction model yielded an area under the receiver operating curve (AUROC) of 0.78 (95%Cl: 0.72-0.84). A cutoff of ≤2 versus >2, identified 31.8% of women as higher risk with moderate sensitivity (70.6%, 95%Cl: 56.2-71.3) and specificity (71.3%, 95%Cl: 67.7-74.5). The bootstrap corrected AUROC was 0.77 (95%Cl: 0.72-0.83).ConclusionIn similar populations of women planning pregnancies, this type of risk score could be useful for prioritizing women for laboratory testing, and would capture most women with CT infections while performing more costly testing in less than half of the population.
Patient-Reported Barriers to Treatment Initiation and Completion for Latent Tuberculosis Infection Among Patients Within a Large Integrated Health Care System in Southern California
Authors: Spence Brigitte C. , Bruxvoort Katia , Munoz-Plaza Corrine , Shaw Sally , Navarro Maria , Chen Henry , Skarbinski Jacek , Tartof Sara 
Published: March 2023

Objective:
More than 80% of active tuberculosis in the United States is due to reactivation of latent tuberculosis infection (LTBI), which can be prevented via screening and treatment. Treatment initiation and completion rates are low for patients with LTBI in the United States, and the barriers to successful treatment are poorly understood.

Design:
We conducted semistructured qualitative interviews with 38 patients who were prescribed LTBI treatment (9 months isoniazid, 6 months rifampin, or 3 months rifamycin-isoniazid short-course combinations). We used purposeful sampling employing a maximum variation approach to obtain diverse perspectives of patients who did not initiate treatment, who did not complete treatment, and who completed treatment (n = 14, n = 16, and n = 8, respectively). Patients were asked about LTBI knowledge, experience regarding treatment, interactions with providers, and barriers they faced. Using a team coding model (2 coders/analysts), we developed deductively derived (a priori) codes based on our central research questions and inductively derived codes that emerged directly from the data. Analysis of our coding categories and relationships generated a hierarchy of key themes and subthemes.

Setting:
Kaiser Permanente Southern California.

Participants:
Individuals 18 years or older who received a diagnosis of LTBI and prescribed treatment.

Main Outcome Measures:
LTBI knowledge, attitudes toward LTBI, attitudes toward LTBI treatment, attitudes toward providers, and explanation of barriers.

Results:
Most patients reported having limited knowledge of LTBI. In addition to the duration of treatment, barriers to initiation and completion included perceived lack of support, uncomfortable side effects, and pervasive minimization of the positive impact of treatment on their health. Many patients felt there was little incentive to overcome barriers.

Conclusions:
Overall, patient experience with LTBI treatment initiation and completion could be improved with patient-centered treatment and more frequent follow-ups.
Aesthetic Genioplasty Based on Strategic Categorization
Authors: Hwang Chang Heon , Na Young Su , Lee Myung Chul 
Published: March 2023

Background:
Genioplasty is a popular procedure used for lower facial contour correction. Various osteotomy techniques enable us to perform advancement, setback, reduction, or narrowing procedures. Computed tomography (CT) images facilitate preoperative planning in detail. The authors used a novel planning method based on strategic categorization. The analytic results are described.

Methods:
This retrospective study reviewed 208 patients who underwent genioplasty procedures for facial contouring from October 2015 to April 2020. During preoperative evaluation of the mandible, the operative procedure selected was among one of three types: 1) horizontal segment osteotomy, 2) vertical and horizontal segment osteotomy, and 3) bone graft after repositioning. Adequate osteotomies were followed by rigid fixation using a titanium plate and screws. The follow-up period ranged from 8 to 24 months (average, 17 months). The results were assessed based on medical records, photographs, and facial bone CT images.

Results:
Overall, the patients were satisfied with the outcomes and had responder-based improvement in lower facial contour and balance. Chin point deviations were noted in 176 cases; left side deviation (n=135) was more frequent than right side deviation (n=41). Strategic osteotomies based on precise measurements led to correction of asymmetries. Temporary partial sensory losses reported in twelve cases resolved within an average of 6 months after surgery.

Conclusion:
Each patient’s chief complaint and bony structures should be carefully evaluated before genioplasty procedures are performed. During the operation, meticulous osteotomy, precise movement, and rigid fixation are necessary. The strategic process used for genioplasty resulted in aesthetic balance and predictable outcomes.
Systematic Review of Capsular Contracture Management Following Breast Augmentation: An Update
Authors: Boyd Carter J. , Chiodo Michael V. , Lisiecki Jeffrey L. , Wagner Ryan D. , Rohrich Rod J. 
Published: March 2023

Background:
Capsular contracture is one of the most frequent indications for revision following breast augmentation. Management goals focus on restoring breast aesthetics while minimizing subsequent recurrence of capsular contracture. As new data emerges, close review of the data is merited to build evidence-based clinical guidelines to inform surgical practice and management of capsular contracture.

Methods:
A systematic review of the MEDLINE, EMBASE, and Cochrane Database of Systematic Reviews was conducted to characterize the surgical management of capsular contracture in revision breast augmentations. The primary endpoint was capsular contracture recurrence rate.

Results:
The review was conducted in November 2021. Primary search revealed 14,163 results. Initial screening by title left 1,223 manuscripts. Abstract review left 90 articles for full-text review, of which 34 were ultimately included which were all observational in nature.

Conclusions:
Capsular contracture management remains an important topic with limited high-level evidence for establishing clear evidence-based treatment guidelines. While more evidence is required to assess the effects of capsulectomy, implant exchange and plane change, these appear to be useful mechanisms for reducing recurrent capsular contracture. There is more evidence regarding the use of ADM, though this still requires long-term follow-up studies. New developments regarding textured implants limit the revision breast augmentation surgeon to smooth devices.
Safety of Outpatient Plastic Surgery: A Comparative Analysis of Patient, Procedure, and Facility Characteristics Using the TOPS Registry with 286,826 Procedures.
Authors: Chopan Mustafa , Lee Jimmy , Nichols D. Spencer , Mast Bruce A. , Neal Dan , Covey Sarah , Satteson Ellen 
Published: March 2023

Background:Outpatient plastic surgery at office-based surgery facilities (OBSFs) and ambulatory surgery centers (ASCs) has become increasingly prevalent over the past 30 years. Importantly, historical data are inconsistent regarding the safety outcomes of these venues, with advocates for both citing supporting studies. This investigation's purpose is to provide a more definitive comparative evaluation of outcomes and safety for outpatient surgery done in these facilities.Methods:The most common outpatient procedures were identified using the Tracking Operations and Outcomes for Plastic Surgeons (TOPS) Database between 2008 and 2016. Outcomes were analyzed for OBSFs and ASCs. Patient and perioperative information was also analyzed using regression analysis to identify risk factors for complications.Results:A total of 286,826 procedures were evaluated, of which 43.8% were performed at ASCs and 56.2% at OBSFs. Most patients were healthy, middle-aged women categorized as ASA class I. The incidence of adverse events was 5.7%, and most commonly included antibiotic requirement (1.4%), dehiscence (1.3%), or seroma requiring drainage (1.1%). Overall, there was no significant difference in adverse events between ASCs or OBSFs. Age, ASA class, BMI, diabetes, smoking history, general anesthesia, CRNA involvement, operative duration, non-cosmetic indications, and body region were associated with adverse events.Conclusions:This study provides an extensive analysis of common plastic surgery procedures performed in an outpatient setting in a representative population. With appropriate patient selection, procedures are safely performed by board-certified plastic surgeons in ambulatory surgery centers and office-based settings, as evidenced by the low incidence of complications in both environments.
Intra-arterial thrombolytic treatment for visual deficits caused by hyaluronic acid filler: efficacy, safety, and prognostic factors
Authors: Wang Yingliang , Li Qian , Ye Yongsheng , Zhang Jie , Shen Haiyang , Zhou Yu , Zhou Chen , Yu Youtao , Xiong Bin 
Published: March 2023

Background:
The benefits of intra-arterial thrombolytic treatment (IATT) in reversing hyaluronic acid (HA)-related visual deficits remain unclear. This study aimed to report a 5-year experience in the treatment of visual deficits resulting from HA embolization by IATT in a tertiary medical center.

Methods:
From December 2015 to June 2021, the medical records of consecutive patients with HA-related visual deficits who underwent IATT were retrospectively reviewed. The demographics, clinical features, imaging data, treatment details, and follow-up results of the patients were analyzed.

Results:
Totally 72 consecutive patients were analyzed, including 5 (5/72, 6.9%) men and 67 (67/72, 93.1%) women, aged 29.3 ± 7.6 years (range 24-73 years). Thirty-two patients (32/72, 44.4%) showed preserved visual acuity and forty (40/72, 55.6%) exhibited no light perception on admission. Ocular motility disorders were detected in 63 patients (63/72, 87.5%), ptosis in 61 patients (61/72, 84.7%), and facial skin changes in 54 patients (54/72, 75%). The technical success rate of IATT was 100% with successful recanalization of the occlusive artery. No procedure-related complications were detected, and all skin injuries, ptosis, and ocular motility disorders were healed. Improved visual acuity was detected in 26 cases (26/72, 36.1%). In the binary logistic regression model, only preoperative preserved visual acuity was independently associated with a good outcome.

Conclusion:
The IATT for selective patients with HA-related visual deficits is efficient and safe. Preoperative preserved visual acuity was independently associated with a good outcome after IATT.
The “Crossing Collection Sign”: A Diagnostic Tool on Spine Magnetic Resonance Imaging For Localizing Cerebrospinal Fluid Leak
Authors: Hill Daniel , Buchbinder Bradley , Pomerantz Stuart , Mehan William A. , Buch Karen 
Published: March 2023

Objective
The aim of the study is to determine whether the site of “cross” between ventral and dorsal spinal longitudinal extradural CSF collections (SLECs) seen on magnetic resonance imaging during initial workup of patients with suspected CSF leaks can predict the subsequently confirmed leakage site on computed tomography myelography or surgical repair.

Methods
This was an institutional review board–approved, retrospective study performed from 2006 to 2021. Patients with SLECs who underwent total spine magnetic resonance imaging at our institution, followed by myelography and/or surgical repair for CSF leak, were included. Patients with incomplete workup including lack of computed tomography myelography and/or surgical repair and patients severely motion degraded imaging were excluded from our study. The site of cross between ventral and dorsal SLECs was defined as the “crossing collection sign” and was compared with the anatomically confirmed site of leak on myelography and/or at surgical repair.

Results
Thirthy-eight patients met inclusion criteria with 18 females and 11 males ranging in age from 27 to 60 years (median, 40 years; interquartile range, 14 years). The crossing collection sign was seen in 76% of patients (n = 29). The distributions of confirmed CSF leak were as follows: cervical (n = 9), thoracic (n = 17), and lumbar spine (n = 3). The crossing collection sign predicted the site of CSF leak in 14 of 29 patients (48%) and was within 3-vertebral segments in 26 of 29 cases (90%).

Conclusions
The crossing collection sign can help prospectively identify spinal regions with highest likelihood for CSF leak in patients with SLECs. This can potentially help optimize the more invasive subsequent steps in the workup for these patients, including dynamic myelography and surgical exploration for repair.
Can Sublingual Nitrate Improve Visualization of Lower Limb Arteries on Computed Tomography Angiography?
Authors: Gupta Sanchita , Dixit Rashmi , Prakash Anjali , Daga Mradul Kumar , Mishra Anurag 
Published: March 2023

Objective
The aim of the study is to evaluate the role of sublingual nitrate in improving vessel visualization on peripheral computed tomography angiography (CTA).

Methods
Fifty patients clinically diagnosed with peripheral arterial disease of the lower limb were prospectively included in this study: Twenty-five underwent CTA after sublingual nitrate administration (nitrate group) and 25 without (non-nitrate group). Two blinded observers qualitatively and quantitatively assessed the data thus generated. The mean luminal diameter, intraluminal attenuation, site, and percentage of stenosis were evaluated in all segments. Assessment of collateral visualization at sites of significant stenosis was also done.

Results
Patients in the nitrate and non-nitrate groups were similar in age and sex characteristics (P > 0.05).
On subjective evaluation, there was significantly improved visualization of the femoropopliteal and tibioperoneal vasculature of the lower limb in the nitrate group compared with the non-nitrate group (P < 0.05). Quantitative evaluation showed a statistically significant difference in the measured arterial diameters for all evaluated segments in the nitrate group versus the non-nitrate group (P < 0.05). Intra-arterial attenuation was significantly greater for all segments in the nitrate group resulting in better contrast opacification in these studies. Collateral visualization around segments with more than 50% stenosis/occlusion was also better in the nitrate group.

Conclusions
Our study suggests that nitrate administration before peripheral vascular CTA can improve visualization, especially in the distal segments by increasing the vessel diameter and intraluminal attenuation along with better delineation of the collateral circulation around stenotic areas. It may also improve the number of evaluable segments of vasculature in these angiographic studies.
Diffusion-Weighted Imaging as a Quantitative Imaging Biomarker for Predicting Proliferation Rate in Hepatocellular Carcinoma: Developing a Radiomics Nomogram
Authors: Yan Chuan , Han Zewen , Chen Xiaojie , Gao Lanmei , Ye Rongping , Li Yueming 
Published: March 2023

Purpose
This study aimed to explore the predictive performance of diffusion-weighted imaging with apparent diffusion coefficient map in predicting the proliferation rate of hepatocellular carcinoma and to develop a radiomics-based nomogram.

Methods
This was a single-center retrospective study. A total of 110 patients were enrolled. The sample included 38 patients with low Ki67 expression (Ki67 ≤10%) and 72 with high Ki67 expression (Ki67 >10%) as demonstrated by surgical pathology. Patients were randomly divided into either a training (n = 77) or validation (n = 33) cohort. Diffusion-weighted imaging with apparent diffusion coefficient maps was used to extract radiomic features and the signal intensity values of tumor (SItumor), normal liver (SIliver), and background noise (SIbackground) from all samples. Subsequently, the clinical model, radiomic model, and fusion model (with clinical data and radiomic signature) were developed and validated.

Results
The area under the curve (AUC) of the clinical model for predicting the Ki67 expression including serum α-fetoprotein level (P = 0.010), age (P = 0.015), and signal noise ratio (P = 0.026) was 0.799 and 0.715 in training and validation cohorts, respectively. The AUC of the radiomic model constructed by 9 selected radiomic features was 0.833 and 0.772 in training and validation cohorts, respectively. The AUC of the fusion model containing serum α-fetoprotein level (P = 0.011), age (P = 0.019), and rad score (P < 0.001) was 0.901 and 0.781 in training and validation cohorts, respectively.

Conclusions
Diffusion-weighted imaging as a quantitative imaging biomarker can predict Ki67 expression level in hepatocellular carcinoma across various models.