bluuebunny/crossref_metadata_2025_split huggingface dataset:
Dual insulin resistance causes: how frequently type 2 diabetes mellitus and COVID-19 infection caused diabetic ketoacidosis? a case report
Authors: Bereda Gudisa 
Published: March 2023

Background and importance:
Infection with coronavirus disease 2019 (COVID-19) worsens insulin resistance and causes diabetic ketoacidosis (DKA). Patients with COVID-19 infection who develop DKA run the risk of worse outcomes. In both diabetic and nondiabetic patients, the COVID-19 infection may hasten the development of ketoacidosis, which could have negative effects on the fetus.

Case presentation:
A 61-year-old retired Black African female was taken into the emergency room on 22 April 2022, with significant complaints of frequent midnight urination, shortness of breath, blurry vision, and tingling in her hands and feet. On a chest radiography, bilateral diffuse, patchy airspace opacities that might be due to multifocal pneumonia or viral pneumonia were seen. The severe acute respiratory syndrome infection was confirmed by real-time reverse transcription-PCR testing from nasopharyngeal swabs. She received intravenous fluids and an intravenous insulin infusion and monitored her blood electrolyte levels as part of her treatment. She received subcutaneous enoxaparin 80 mg every 12 h a day for prophylaxis of deep venous thrombosis due to her confirmed COVID-19.

Clinical discussion:
In a large number of patients, COVID-19 has the ability to trigger DKA, and type 2 diabetes mellitus amplifies the underlying COVID-19 infection. Diabetes mellitus and COVID-19 are noted to have a reciprocal relationship in this regard.

Conclusions:
By making the body resistant to insulin and raising blood sugar levels, a COVID-19 infection can cause DKA. It is probable that her severe acute respiratory syndrome coronavirus 2 infection has a detrimental effect on the pancreatic beta cells, which are responsible for her body producing insufficient levels of insulin.
Xanthogranulomatous cholecystitis mimicking gallbladder carcinoma: a case report
Authors: Rijal Sabina , Basukala Sunil , Shah Kunda B. , Thapa Anup , Bohara Sujan , Shah Aashish 
Published: March 2023

Introduction:
Xanthogranulomatous cholecystitis (XGC) is an uncommon type of chronic cholecystitis. Clinical presentation, laboratory findings, and radiological analysis mimic gallbladder carcinoma. A definitive diagnosis is made by histological study. Cholecystectomy, along with adjuncts as required, is performed for management.

Case Presentation:
We present a case of a 67-year-old female who was planned for interval cholecystectomy for gallstone pancreatitis. Her clinical, laboratory and radiological findings were suggestive of cholelithiasis and was planned for laparoscopic cholecystectomy. Her intraoperative findings mimicked gallbladder carcinoma. The surgery was aborted, and a biopsy was sent for histopathological analysis. XGC was diagnosed, and the patient underwent laparoscopic cholecystectomy with no postoperative complications during the 6-month follow-up period.

Discussion:
XGC is a rare disorder resulting from chronic inflammation of the gallbladder. There is the presence of xanthogranuloma with predominant lipid-laden macrophages in the gallbladder wall along with fibrosis. Clinical presentation, laboratory findings, and radiological analysis mimic gallbladder carcinoma. Ultrasonography usually shows diffuse wall thickening of the gallbladder, intramural hypoechoic nodules, unclear liver and gallbladder interface, and the presence of gallstones. The final diagnosis is made by histopathological analysis. Laparoscopic or open cholecystectomy, along with adjuncts as required, is performed for management with a low postoperative complication rate.

Conclusion:
XGC is a rare, benign disease that is often confused with gallbladder cancer before histological analysis. XGC can be managed with laparoscopic cholecystectomy with minimal postoperative complications.
Post-traumatic chronic-encapsulated and calcified intracerebral hematoma mimicking a supratentorial hemangioblastoma: a case report and literature review
Authors: Borni Mehdi , Abdelmouleh Souhir , Abdelhedi Anis , Affes Ameur , Boudawara Mohamed Z. 
Published: March 2023

Introduction and importance:
Chronic-encapsulated intracerebral hematomas are a rare type of hematoma. They tend to be mistaken for abscesses or tumors. The etiology of these hematomas is not yet clear, although they have mainly been linked to arteriovenous malformations, cavernomas, and head trauma. Surgical evacuation is effective in improving neurological symptoms with a good prognosis. However, the lesion may be difficult to diagnose.

Case presentation:
Here, the authors report a case of a chronic-encapsulated and calcified intracerebral hematoma following recurrent mild head injuries mimicking a supratentorial hemangioblastoma in a healthy 26-year-old female patient presented with progressive raised intracranial pressure and left body heaviness with good outcomes after en bloc surgical resection.

Clinical discussion:
The chronic-encapsulated intracerebral hematoma was first described by Hirsh et al. in 1981. Their etiology is not yet clear, although they have mainly been linked to arteriovenous malformations, cavernomas, and head trauma. Pathologically, they are characterized by the presence of a fibrous capsule composed of an outer collagen layer and an inner granulated layer. Radiologically, they appear as cystic lesions with a homogeneous high signal on T1-weighted and T2-weighted images associated with a lower signal ring sign and ring enhancement after gadolinium administration that may suggest hemangioblastoma.

Conclusion:
Although chronic parenchymal hematomas remain a rare phenomenon, it has become increasingly logical to consider this entity in differential diagnoses with other lesions. In cases with recurrent head trauma, a detailed investigation will aid in making the diagnosis of such a rare pathology.
Compound heterozygosity for Hb C/Hb S (HBB: c.19G>A/HBB: c.20A>T) diseases observed in a Syrian family: a case report
Authors: Moassas Faten , Daboul Amir , Assád Manar , Murad Hossam 
Published: March 2023

Introduction:
Hemoglobin S and Hemoglobin C disease is a type of sickle cell disease caused by two mutations at codon 6 of β-globin gene. These mutations cause changes in the shape of the red blood cells. Little is known about its presence in our region.

Case Presentation:
The authors describe a case of a Syrian family consisting of father, mother, two daughters, and son. The mother presented with anemia, episodes of fatigue, and extreme pain (vaso-occlusive crisis). Beta and alpha-globin gene mutations have been analyzed using molecular detection methods. The results revealed that, the mother, second daughter, and son were all double heterozygous for hemoglobin C and S associated with the –α3.7 deletion mutation. The husband and the first daughter were found to have the hemoglobin C trait.

Discussion:
Hemoglobin (Hb) SC has been known to have a higher frequency in black populations and is restricted to persons of West African descent. In our case, all family members had dark brown skin color, and they were all diagnosed with Hb C or Hb SC. The mother, second daughter, and son had the clinical manifestations associated with Hb SC disease, and their values of mean cell volume and mean cell hemoglobin were low due to the presence of the –α3.7 deletion mutation. The husband and the first daughter do not have any serious health problems.

Conclusions:
To the best of the knowledge, this is the first case of compound heterozygous for hemoglobin C and S to be reported from a Syrian family.
Unusual location of gouty arthritis with shoulder joint involvement in an elderly male patient: a rare case report
Authors: Shrateh Oadi N. , Jobran Afnan W.M. , Zaid Momen A. , Hamed Heba K. , Asees Mohammad Y. , Soboh Omar , Dallashi Ahmad A. 
Published: March 2023

Introduction:
Gout is a metabolic disease characterized by recurrent episodes of acute arthritis. Gout has been reported in many locations but is rarely localized in the shoulder joint.

Case presentation:
A 73-year-old man who visited an outpatient clinic with the main complaint of a right shoulder ache lasting 2 weeks came to our attention. The patient reports his discomfort as being of an unbearable character, happening largely at night and preventing him from falling asleep. In the previous 6 months, he had two episodes of the same ailment that lasted around 3–5 days each and spontaneously resolved. Due to the pain’s continuance without improvement, the patient now seeks medical assistance. Gout with right shoulder involvement was identified as the cause. Prednisolone 40 mg/day for 10 days, allopurinol 300 mg/day, and colchicine 0.5 mg/day were all prescribed for the patient. After 6 months of follow-up, the patient had significantly improved.

Discussion and conclusions:
The condition of gout affecting the shoulder joint is quite rare. According to past medical history and clinical manifestations, doctors and orthopedic surgeons should take gouty shoulder arthritis into consideration when there is serious erosion.
Lipidomics, Acute Ischemic Stroke, Symptoms, and Outcomes
Authors: Martha Sarah R. , Pen Alice Y. , McGuire Laura Stone , Alaraj Ali , Maienschein-Cline Mark , Basu Sanjib , Loeb Jeffrey A. , Thompson Hilaire J. 
Published: March 2023

Background
Acute ischemic stroke is one of the leading causes of death and disability globally. Recent advances in omics methodology enable lipidomic profiling, which may provide knowledge of the underlying pathology of acute ischemic stroke and its associated outcomes.

Objective
This study aims to examine the longer-term relationships between symptoms and outcomes following acute ischemic stroke and the underlying lipidomic signatures over 6 months during recovery between acute ischemic stroke patients who received reperfusion therapies and those who did not.

Methods
This prospective cohort study will enroll 104 participants post-acute ischemic stroke in two groups based on their receipt of reperfusion therapy (Group 1) or not (Group 2; n = 52/group). Peripheral plasma samples will be collected from both groups for lipidomic analysis over 6 months. Arterial blood samples will be collected during the procedure for those receiving reperfusion. Self-reported symptoms and outcome data will be collected from both groups.

Discussion
We will compare and examine the associations among plasma lipidomic biomarkers and symptoms and cognitive, functional, and health-related quality of life outcomes over 6 months between acute ischemic stroke patients who did and did not receive reperfusion intervention.
Leukocytosis and C-Reactive Protein Levels as Indicators of Infection in Children With Diabetic Ketoacidosis
Authors: Hamtzany Omer , Weiser Giora , Heiman Eyal , Avnon-Ziv Carmit , Auerbauch Adi , Levy-Khademi Floris 
Published: March 2023

Background
Diabetic ketoacidosis (DKA) is one of the serious complications of type 1 diabetes mellitus and may be aggravated by infection. Diagnosing an infection in a patient with DKA is often complicated because of the overlap of symptoms and the presence of leukocytosis in both conditions. Reliable indicators for the diagnosis of bacterial infection in DKA may reduce unnecessary use of antibiotics and enable closer monitoring of patients at risk.

Methods
This is a retrospective study. The study cohort included 180 children and adolescents with type 1 diabetes mellitus who were admitted to the Pediatric Emergency Department at Shaare Zedek Medical Center and had blood test results. We compared white blood cell count, C-reactive protein (CRP) levels, blood glucose levels, pH, the degree of acidosis, and the incidence of infection in patients with and without DKA.

Results
The incidence of probable bacterial infection in the entire cohort was 13.9%: 15.7% in the DKA group and 7.5% in the non-DKA group (P = 0.65). The incidence of leukocytosis was significantly higher in patients with DKA (P = 0.0003), although this was not related to bacterial infection. The CRP levels were higher in the DKA group with infection than without infection, and this was statistically significant (P = 0.008).

Conclusions
Our findings suggest that leukocytosis in DKA is not a reliable indicator of concomitant bacterial infection. In contrast, CRP levels were not related to the DKA or degree of acidosis and were significantly higher in patients with infection within the DKA group, and are therefore a more reliable indicator of concomitant infection in these patients.
The Influence of the Weight of the Backpack on the Biomechanics of the Child and Adolescent: A Systematic Review and Meta-analysis With a Meta-Regression
Authors: Cuenca-Martínez Ferran , Varangot-Reille Clovis , Calatayud Joaquín , Suso-Martí Luis , Salar-Andreu Cristina , Gargallo Pedro , Blanco-Díaz María , Casaña José 
Published: March 2023

Purpose:
To evaluate and explore the influence of the weight of a backpack on standing posture and gait in children and adolescents.

Methods:
We conducted a search of MEDLINE (PubMed), Cochrane Library, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Web of Science, with the last search in July 2021. Standardized mean differences (SMD) and 95% confidence intervals were calculated for relevant outcomes and were pooled in a meta-analysis using the random-effects model. The participants were healthy children or adolescents. The outcomes were postural variables, spatiotemporal gait variables, gait kinematics, and muscle activity. We analyzed the influence of a loaded backpack on posture while standing and spatiotemporal and kinematic variables while walking. We used GRADE, Risk of Bias 2, ROBINS-I, MINORS, and PEDro scales to rate the quality, certainty, and applicability of the evidence.

Results:
Wearing a loaded backpack induces a significant increase of the craniohorizontal angle while standing and a decrease of walking speed and stride length while walking. Only the craniovertebral angle had a significant relationship with the weight of the backpack.

Conclusions:
Wearing a backpack induces postural changes while standing and affects gait in children and adolescents; however, almost all the changes are not related to the backpack weight.
Development and Initial Evaluation of a Soft Ankle Support for Children With Ankle Impairments
Authors: Civil Danielle A. , Orlando Julie M. , Cunha Andrea B. , Li Bai , Lobo Michele A. 
Published: March 2023

Purpose:
Develop and initially evaluate a soft ankle support (SAS) garment for children with ankle impairments.

Description of Cases:
Two participants were evaluated at baseline and interviews with their parent(s) to identify wants and needs for the SAS. The SAS was developed and evaluated via participant report and functional measures in barefoot, ankle-foot orthosis (AFO), and SAS conditions.

Outcomes:
Children and parents expressed dissatisfaction with AFOs' dimensions, weight, adjustability, comfort, and ease of use. Gait and gross motor function were similar for SAS and AFOs' conditions; however, participants rated the SAS better for weight and bulk, integration with shoes, adjustability, comfort, cost, and washability.

Discussion:
The SAS and AFOs performed similarly in this initial testing, yet the SAS also met participants' needs across key metrics not well addressed by AFOs. Ankle support devices that meet users' broad needs may support improved adherence and user satisfaction.
Aesthetic Considerations in Extremity Salvage and Reconstruction
Authors: Govshievich Alexander , Bauder Andrew , Kovach Stephen J. , Levin L. Scott 
Published: March 2023

Learning Objectives:
After studying this article, the participant should be able to: 1. Have an in-depth understanding of the functional and aesthetic requirements of lower extremity reconstruction. 2. Describe the considerations for achieving an optimal aesthetic outcome in the primary reconstruction settings. 3. Describe modalities of secondary flap revision for achieving an optimal aesthetic outcome.

Summary:
Significant advancements have been made in the management of lower extremity reconstruction since Dr. Taylor’s seminal case in 1973. Improvements in our understanding of vascular anatomy and evolution of microsurgical techniques have allowed for an ever-increasing array of free tissue transfer options for lower extremity reconstruction. The resulting expertise has engendered a paradigm shift toward the reconstructive elevator approach, with increased emphasis on cosmetic results. In the primary setting, aesthetic considerations play an important role in precoverage wound preparation, flap selection, and harvest technique, with the goal of achieving excellent like-with-like reconstruction at the time of initial surgery. Flap selection should be made to best match the three-dimensional architecture of the wound, and take into account the defect thickness, flap thickness, flap composition, and pedicle length. Primary flap thinning and harvest in the superficial fascial plane has been shown to be an effective modality to address excess adiposity and improve contour. Despite these efforts, secondary procedures are often required to optimize the limb’s final appearance and functional outcomes, particularly in the foot and ankle region. These include debulking, liposuction, and staged excisions. As the field of limb salvage keeps evolving, aesthetics will continue to play an important role in extremity reconstruction planning and execution.
Comprehensive analysis of local anesthetics affecting adipose stem cells, in vitro
Authors: Guillaume Vincent G. J. , Lippold Ella F. , Beier Justus P. , Ruhl Tim 
Published: March 2023

Background:
Fat grafting represe nts a common technique to treat volume deficits, e.g. for breast augmentation. Therein, adipose stem cells (ASCs) hold a great regenerative capacity, because of their differentiation capability and, more importantly, their secretory activity. Thus, the survival of ASCs is of great significance during perioperative harvesting. Various local anesthetics are commonly applied during fat grafting procedures. Historically, these substances are known to impair cellular viability, which would affect graft survival and its final outcome. However, the exact extent of local anesthetics’ impact on ASC biology is rather unknown.

Methods:
We analyzed the short- and long-term effects of four different local anesthetics, i.e., lidocaine, mepivacaine, ropivacaine, bupivacaine at increasing concentrations (0.1 nM - 10 mM) on primary human ASC proliferation and metabolic activity, evaluated by crystal violet staining and the PrestoBlue assay, respectively. Trilinear differentiation was assessed by OilRedO stain to measure adipogenesis, SafraninO and cresolphthalein labeling was used for chondrogenic and osteogenic differentiation. Supernatants were used to analyze cytokine (IL-6/ -8, VEGF, HGF) secretion by ELISA.

Results:
Bupivacaine at >100 µM demonstrated the strongest anti-proliferative short- and long-term effects, whereas lidocaine and ropivacaine did not affect cell numbers. Mepivacaine evoked reciprocal results regarding cell count at >1 mM. Each compound impaired differentiation into the adipogenic, chondrogenic and osteogenic lineage. Furthermore, secretion of HGF and IL-8 was significantly reduced by local anesthetic exposure, whereas the levels restored after substances were washed out.

Conclusion:
Depending on our in vitro data, lidocaine, mepivacaine and ropivacaine could be applied at concentrations of 1 - 10 mM without affecting ASC survival. Contrariwise, bupivacaine at concentrations >100 µM should be administered with great caution. However, the differentiation of ASCs and the ASC’s secretome might already be decreased by each local anesthetic at 1 mM.
Betadine Soaking of Silicone Coupons Minimally Impacts Acellular Dermal Matrix Incorporation in a Preclinical Primate Model
Authors: Nahabedian Maurice Y. , Kabaria Nimesh , Lombardi Jared , Leung Braden K. , Sandor Maryellen 
Published: March 2023

Background:
Microbial pathogens local to prosthetic breast devices may promote infection, inflammation, and capsular contracture. While antimicrobial solutions have been utilized, their effects on human acellular dermal matrix (HADM) incorporation when used with prosthetic devices is unknown. Our objective was to histologically assess the effect of 10% povidone-iodine (PI)-saturated tissue expander (TE) exposure on HADM biological response in a primate model. It was hypothesized that PI exposure would not negatively impact the HADM biological response.

Methods:
Samples (1.5×1.5 cm) from smooth silicone TEs were saturated in saline or PI for 2 minutes and sutured to HADM to create HADM/TE constructs. Primates implanted subcutaneously with saline (n=9) and PI-treated HADM/TE (n=9) construct pairs were evaluated histologically for biologic response following 2 or 4 weeks via a host response scoring scale (1-9), including recellularization, neovascularization, and inflammation. Inflammatory cells (eosinophils, lymphocytes, neutrophils, histiocytes, foreign body giant cells) and evidence of HADM remodeling (fibroblasts, vessels) were further evaluated via a cell-specific scoring scale (0-4) and corroborated by immuno-staining (CD3, CD20, CD68, FSP-1, collagen type IV).

Results:
Mean histology scores were similar between saline and PI-exposed HADM at 2 (5.3±0.9 and 5.6±0.5, ±SD, P=0.52) and 4 weeks (4.6±1.0 and 4.2±0.9, P=0.44). There was no difference in inflammatory cell presence at 2 and 4 weeks between groups. Fibroblast infiltration differences were insignificant between groups but exhibited trends towards an increase between timepoints for saline (1.6±0.7 to 1.8±0.8) and PI (1.3±0.8 to 1.8±1.0) groups, suggesting HADM incorporation over time.

Conclusions:
Data suggests HADM exposure to PI-treated TEs does not negatively impact inflammation, vascularization, recellularization, incorporation, or host response to HADM in this model.

Clinical Relevance Statement:
Povidone-iodine is a surgical pocket irrigant used to address bacterial colonization, but impact on acellular dermal matrix (ADM) incorporation is unknown. This study demonstrates similar biologic response to ADMs adjacent to povidone-iodine or saline-saturated tissue expanders in a primate model.
CD248 Regulates Inflammation and Encapsulation in Silicone-related Capsule Formation
Authors: Chang Tzu-Yen , Hong Yi-Kai , Kuo Yao-Lung , Wu Hua-Lin , Shieh Shyh-Jou 
Published: March 2023

Background:
Capsular contracture is the most common reason for having a secondary breast implant surgery. The failure of the implanted device and discomfort are related to foreign body response, which involves a pathologic encapsulation. An upregulated expression of CD248 was previously demonstrated to modulate inflammation and fibrosis. We hypothesized that CD248 contributes to foreign body reaction and contracture during silicone-stimulated capsule formation.

Methods:
A murine capsular contracture model was established to correlate CD248 with capsular contracture. The timing and site of CD248 expression were characterized by protein analysis and histologic examination. The capsules between wild-type mice and CD248 knockout mice were compared in this model to verify the possible role of CD248 in silicone-related capsule formation.

Results:
CD248 was expressed in the peri-silicone implant capsule by stromal fibroblast and perivascular fibroblast. CD248 was overexpressed since day 4 and down to a constant level, but it was still upregulated through day 21 to day 56 after silicone implantation. The CD248 knockout mice showed a prolonged inflammation period, while the wild-type mice developed a thinner but more collagenous capsule.

Conclusions:
In conclusion, an effective murine capsular contracture model was established to study the relationship between CD248 and capsular contracture. CD248 may play a role in inflammation and encapsulation during silicone implantation. CD248 deletion in mice contributed to a loose and irregular collagen bundle in a capsule area, implying a decrease in contracture. Therefore, CD248 could be a potential therapeutic target in capsular contracture.