bluuebunny/crossref_metadata_2025_split huggingface dataset:
Epidural Versus Local Anesthesia for Percutaneous Endoscopic Lumbar Discectomy
Authors: Mooney James , Erickson Nicholas , Laskay Nicholas , Salehani Arsalaan , Mahavadi Anil , Ilyas Adeel , Mainali Bipul , Godzik Jake 
Published: June 2023

Study Designs:
Systematic Review.

Objective:
To examine the impact of anesthesia type on patient-reported outcomes (PROs) and complications after percutaneous endoscopic lumbar discectomy (PELD).

Summary of Background Data:
A significant advantage of PELD involves the option to use alternative sedation to general anesthesia (GA). Two options include local anesthesia (LA) and epidural anesthesia (EA). While EA is more involved, it may yield improved pain control and surgical results compared with LA. However, few studies have directly examined outcomes for PELD after LA versus EA, and it remains unknown which technique results in superior outcomes.

Materials and Methods:
A systematic review and meta-analysis of the PubMed, EMBASE, and SCOPUS databases examining PELD performed with LA or EA from inception to August 16, 2021 were conducted. All studies reported greater than 6 months of follow-up in addition to PRO data. PROs, including visual analog scale (VAS)-leg/back, and Oswestry Disability Index (ODI) scores were collected. Complications, recurrent disk herniation, durotomy, and reoperation rates, as well as surgical data, were recorded. All outcomes were compared between pooled studies examining LA or EA.

Results:
Fifty-six studies consisting of 4465 patients (366 EA, 4099 LA) were included. Overall complication rate, durotomy rate, length of stay, recurrent disk herniation, and reoperation rates were similar between groups. VAS back/leg and ODI scores were all significantly improved at the first and last follow-up appointments in the LA group. VAS leg and ODI scores were significantly improved at the first and last follow-up appointments in the EA group, but VAS back was not.

Conclusions:
EA can be a safe and feasible alternative to LA, potentially minimizing patient discomfort during PELD. Conclusions are limited by a high level of study bias and heterogeneity. Further investigation is necessary to determine if PELD under EA may have greater short-term PRO benefits compared with LA.
Achilles Tendon Ruptures: From Treatment to the Playing Field
Authors: Hoenshel Robby , Polzer Hans , Vosseller J. Turner 
Published: June 2023

Abstract:
Achilles tendon ruptures are significant injuries that require intensive treatment and rehabilitation to return to full function. This statement is especially true for high-level athletes that seek to return to the highest levels of physical function. Outcomes after Achilles tendon ruptures have historically been good, although perhaps more guarded in those that require high levels of physical function. Essentially, the primary issue from a rehabilitation standpoint relates to strength and its relationship with the appropriate tension on the Achilles tendon. For reasons that remain somewhat elusive, patients with Achilles ruptures get profoundly weak after injury and well into recovery. Indeed, recovery is often protracted due to the length of time required to achieve full strength. In this review, we will focus on optimal rehabilitation of these injuries, how we can perhaps best prevent these injuries, and finally look at outcomes with a special focus on high-level athletes.

Level of Evidence:
Level V—Review.
Characterization of Thermoluminescent Dosimetry Systems According to the IEC 62387:2020 Standard
Authors: Kržanović Nikola , Stanković Petrović Jelena , Živanović Miloš , Krajinović Marko , Božović Predrag , Kojić Andrea , Topalović Dušan 
Published: June 2023

Abstract
A need for detailed testing of individual monitoring systems used in accredited service at the Vinca Institute of Nuclear Sciences was recognized following changes in individual, workplace, and environmental monitoring passive dosimetry systems acceptability criteria stated in IEC 62387:2020 and changes related to reference fields used in radiation protection defined in ISO 4037:2019. Reliability and accuracy of dosimetry data acquired by passive dosimetry systems used for individual monitoring is assured by carrying out type tests. In this manner, the effects of different radiation influence quantities are examined. Passive dosimetry systems comprised of an LiF:Mg,Ti (TLD-100) detector card placed in two different holder models (8814 and 8850) and the Harshaw TLD Model 6600 Plus Automated Reader were tested. Type tests were done in an extended range of photon energies from 40 keV up to 1.25 MeV, angle of incidence values of ±45° and ± 60° for both vertical and horizontal dosimeter orientation, and in the dose range from 0.05 mSv to 1 Sv. Both dosimetry system configurations perform in line with IEC 62387:2020 within mandatory range for tested influence quantities. Dosimeters that use the 8850 holder type showed less pronounced energy and angular dependence of the response in the low-energy range.
Evaluation of new approach to enhance visualization performance in cataract surgery: 3D visualization system with coaxial illumination
Authors: Wang Yan , Hu Yingfeng , Zhang Rong , Wang Zheng , Zhang Guangbin , Chen Wei , Ma Jack X. , Wang Daoguang , Ye Xiangyu 
Published: June 2023

Purpose:
To evaluate the visualization performance of different approaches, including the 3D visualization system with coaxial illumination and the 3D system or microscope with standard illumination.

Setting:
Fuzhou Eye Hospital, Fuzhou City, China.

Design:
Cross-sectional study.

Methods:
This 2-part performance assessment for visualization composed of an objective analysis using surgical video images and a subjective survey collecting feedback from surgeons. Data of each eye were obtained with 3 approaches: standard operating microscope with standard illumination (SOM-S), 3D visualization system with standard illumination (3D-S), and 3D visualization system with coaxial illumination (3D-C).

Results:
112 eyes (107 cases) and 6 cataract surgeons were involved. The red reflex value was markedly greater in the 3D-C approach compared with other 2 approaches (P < .001). Compared with the SOM-S approach, the red reflex increased by 55%, 57%, and 53% in the 3D-C approach, corresponding to nuclear grades of II, III, and IV, respectively. In the questionnaire survey, red reflex scores were consistently significantly higher in the 3D-C approach than those in the others (P < .001). Depth of field was enhanced in both 3D approaches compared with the SOM-S approach (P < .05). The only minor advantage of the SOM system over the 3D-C approach was in the surrounding field clarity score, and the difference was not statistically significant (P = 1.000).

Conclusions:
The 3D-C approach significantly increased the red reflex in both objective and subjective assessments. Surgeon responses also showed a superior performance for the 3D-C approach.
Clinicopathological characteristics and prognostic factors of small bowel lymphomas: a retrospective single-center study
Authors: Dias Emanuel , Medas Renato , Marques Margarida , Andrade Patrícia , Cardoso Hélder , Macedo Guilherme 
Published: June 2023

Abstract

Background:
There is little information on diagnosis and management of small bowel lymphomas, and optimal management strategies are still undefined. This study aims to describe their main clinical and pathological characteristics and identify poor prognostic factors.

Methods:
A retrospective observational study of all patients with histological diagnosis of small bowel lymphoma between January 2010 and December 2020 was performed.

Results:
We included 40 patients, with male predominance (60%) and mean age of 60.7 years. The ileum was the most common location, and the most common histological subtypes were follicular lymphoma and diffuse large B-cell lymphoma. Clinical presentation was variable from asymptomatic patients (30%) to acute surgical complications (35%) including perforation, intestinal obstruction, ileal intussusception, or severe bleeding. Diagnosis was established by endoscopy in 22 patients (55%), and the most common findings included polyps, single mass, diffuse infiltration, or ulceration, whereas 18 (45%) required surgery because of acute presentations or tumor resection, and lymphoma was diagnosed postoperatively. Surgery was curative in one-third of those patients. Median survival was 52 months. Acute presentation (P = 0.001), symptomatic disease (P = 0.003), advanced stage (P = 0.008), diffuse large B-cell lymphoma (P = 0.007), anemia (P = 0.006), hypoalbuminemia (P < 0.001), elevated lactate dehydrogenase (P = 0.02), elevated C-reactive protein (P < 0.001), and absence of treatment response (P < 0.001) were significant predictors of mortality.

Conclusion:
Small bowel lymphoma is a rare malignancy with diverse clinical and endoscopic presentations that require a high index of suspicion. Primary factors associated with worse outcome included acute presentation, advanced stage, histological subtype, biochemical abnormalities, and absence of treatment response.
A new procedure for elimination of atrial fibrillation associated with mitral valve disease：a proof-of-concept study
Authors: Chen Liangwan , Li Qianzhen , Chen Junyi , Qiu Zhihuang , Xiao Jun , Tang Mirong , Wu Qingsong , Shen Yue , Dai Xiaofu , Fang Guanhua , Lu Heng 
Published: June 2023

Background:
Left atrial enlargement and fibrosis have been linked to the pathogenesis of atrial fibrillation (AF). We aimed to introduce a novel concept and develop a new procedure for AF treatment based on these characteristics.

Methods:
The study included three stages. The first stage was a descriptive study to clarify the characteristics of the left atrial enlargement and fibrosis’ distribution in patients with mitral valve disease and long-standing persistent AF. Based on these characteristics, we introduced a novel concept for AF treatment, and then translated it into a new procedure. The second stage was a proof-of-concept study with this new procedure. The third stage was a comparative effectiveness research to compare the clinical outcomes between patients with this new procedure and those who received Cox-Maze IV treatment.

Results:
Based on non-uniform fashion of left atrial enlargement and fibrosis’ distribution, we introduced a novel concept: reconstructing a left atrium with appropriate geometry and uniform fibrosis’ distribution for proper cardiac conduction, and translated it into a new procedure: left atrial geometric volume reduction combined with left appendage base closure. As compared to Cox-Maze IV procedure, the new procedure spent significantly shorter total surgery time, cardiopulmonary bypass time and aortic cross-clamp time (P<0.001). Besides, the new procedure was related to a shorter ICU stay period (OR=0.45, 95%CI=0.26-0.78), lower costs (OR=0.15, 95%CI=0.08-0.29) and a higher rate of A wave of transmitral and transtricuspid flow reappearance (OR=1.76, 95%CI=1.02-3.04).

Conclusions:
The new procedure is safe and effective for eliminating AF associated with mitral valve disease.
Predicting First-Time National Physical Therapy Examination Performance for Graduates of an Entry-Level Physical Therapist Education Program
Authors: Dombkowski Ryan , Sullivan Steven , Widenhoefer Tricia , Buckland Abigail , Almonroeder Thomas Gus 
Published: June 2023

Introduction.
The National Physical Therapy Examination (NPTE) is a standardized examination designed to assess competence after graduation from an entry-level physical therapist education program.

Review of Literature.
Previous studies have identified applicant and student variables that are related to NPTE performance, with applicant variables reflecting performance before admission and student variables reflecting performance after admission. However, there are very few articles describing how these variables can be combined to predict NPTE performance. The purpose of this study was to develop, evaluate, and describe models to predict first-time NPTE scores and NPTE outcomes (pass vs fail), based on various applicant and student variables related to academic performance.

Subjects.
Pre- and postadmission data and NPTE scores were recorded for 185 individuals who graduated from an entry-level physical therapist education program.

Methods.
Multiple linear regression was used to develop a model to predict NPTE scores, and binary logistic regression was used to develop a model to predict NPTE outcomes (pass vs fail).

Results.
A model including undergraduate prerequisite grade point average, grade point average in basic science courses taken during the program, and comprehensive examination scores combined to explain 30.9% of the variance in NPTE scores and accurately predicted NPTE outcomes (pass vs fail) 81.1% of the time.

Discussion.
In general, our findings support the notion that prediction of NPTE performance should be based on a combination of applicant and student variables. The models described in this article could be used to identify students who may be likely to struggle on the NPTE, making it possible to provide additional support to these students.

Conclusion.
Various applicant and student variables related to academic performance can be combined to predict NPTE performance. The results of this study provide a framework for programs interested in applying models to predict NPTE performance.
Comparison of dexmedetomidine with midazolam for third molar surgery: A meta-analysis of randomized controlled trials
Authors: Wang Ling , Yang Hongmei , Le Xi 
Published: June 2023

Introduction:
The analgesic sedation of dexmedetomidine compared with midazolam for third molar surgery remains controversial. We conduct a systematic review and meta-analysis to explore the influence of dexmedetomidine versus midazolam for third molar surgery.

Methods:
We have searched PubMed, EMbase, Web of science, EBSCO, and Cochrane library databases through December 2022 for randomized controlled trials assessing the effect of dexmedetomidine versus midazolam for third molar surgery. This meta-analysis was performed using the random-effect model.

Results:
Four randomized controlled trials were included in the meta-analysis. Overall, compared with midazolam for third molar surgery, dexmedetomidine administration leads to comparable oxygen saturation (standard mean difference [SMD] = 0.25; 95% confidence interval [CI] = −0.24 to 0.74; P = .31), heart rate (SMD = −0.37; 95% CI = −1.18 to 0.44; P = .37), SBP (SMD = −0.24; 95% CI = −0.57 to 0.09; P = .16), DBP (SMD = −0.26; 95% CI = −0.60 to 0.07; P = .12), as well as nausea and vomiting (OR = 0.58; 95% CI = 0.05–6.61; P = .66).

Conclusions:
Dexmedetomidine may obtain the comparable sedation efficacy with midazolam for third molar surgery.
Biofeedback physical regulation of hypertension based on acupoints: A clinical trial
Authors: Ma Ling-Hui , Zhang Zhou , Ma Liang-Xiao , Mu Jie-Dan , Qian Xu , Zhang Qin-Yong , Sun Tian-Yi 
Published: June 2023

Background:
Hypertension is a predominant risk factor for cardiovascular disease and has imposed a global disease burden. Poor medication compliance is the major obstacle to antihypertensive drug therapy, and negative mood status is also detrimental to blood pressure (BP) management. While transcutaneous electrical acupoint stimulation (TEAS), as an electrical stimulation modality for biofeedback physical regulation based on acupoints, offers a such nondrug alternative option that is noninvasive, safe, and effective with high adherence. However, the optimal stimulation parameters of TEAS for hypertension remain unclear, especially the frequency, which needs further exploration.

Objective:
The study aims to investigate the efficacy of TEAS for hypertension, and to screen the optimal electrical stimulation frequency.

Methods:
This is an 8-week, randomized, controlled pilot trial with 3 parallel groups. In a ratio of 1:1:1, 120 patients with stage 1 hypertension will be divided into the TEAS-2Hz group, TEAS-10Hz group, or usual care group. All patients will receive the usual care for hypertension including lifestyle education, etc. Additionally, the 2 TEAS groups will receive 12 sessions of TEAS interventions at 2 Hz or 10 Hz, 3 times weekly for 30 minutes each, with 4 weeks of follow-up. The main outcome will be the change from baseline to week 4 in systolic BP among the groups. Secondary outcomes consist of changes in diastolic BP, mean arterial pressure, heart rate, heart rate variability, medication adherence, and quality of life. The safety outcomes will be any adverse event during the treatment.

Discussion:
As a pre-study for the next large clinical trial of TEAS for hypertension, this study will offer references for optimized frequency of biofeedback electrical devices and promote more consciousness of the benefits of body-mind holistic regulation of BP, thereby achieving proactive and overall process management of BP.
Acupuncture is effective in the treatment of postprandial distress syndrome: A systematic review and meta-analysis
Authors: Xiao Ganchen , Zhao Yingtao , Chen Xingyu , Xiong Fangli 
Published: June 2023

Background:
Traditional Chinese medicine advocates the use of acupuncture for the treatment of postprandial distress syndrome (PDS) in people with Functional dyspepsia, but large clinical trials of acupuncture have produced controversial results. This study aims to confirm the clinical significance of acupuncture in the treatment of PDS .

Methods:
This study only randomized controlled trials were included from the following databases: CNKI, Medline, Cochrane Central, Web of Science, and Clinical Trial. The risk of bias in the included studies was assessed using Revman 5.4.1 (Revman 2020), and all 12 included studies were considered to have a low risk of bias. This study used Stata 16.1 for data analysis, including sensitivity analysis and publication bias test. The quality of each study was evaluated with the Cochrane tool. The main outcomes included the overall therapeutic rate, the SID score, the HADS Score, The NDI score, and Side effects.

Results:
This study identified a total of 1532 studies interested in the curative effect of acupuncture on Postprandial discomfort syndrome (PDS) and finally included a total of 12 studies with 1113 patients after identifying their abstracts, titles, and full text. The process of literature searches and identifying is shown in Figure 1 and data analysis showed that acupuncture is effective in the treatment of PDS and promotes the life quality of patients.

Conclusions:
This study analyzed the effects of acupuncture on PDS from 5 aspects: overall therapeutic rate, SID, HADS, NDI, and side effects, overall therapeutic rate as primary outcome measure. Statistical analysis results showed that acupuncture has a significant effect on the treatment of PDS. In conclusion, it is an effective clinical treatment method. Also, the potential bias in the included studies, high-quality studies are needed to further confirm the possible side effects of acupuncture in treatment.
Multiple epithelioid angiosarcoma of stomach and small intestine with multiple lymph node metastases: A case report
Authors: Yu Jun-Hua , Cao Lu-Lu , Qian Jun 
Published: June 2023

Rationale:
Angiosarcoma is a mesenchymal soft tissue sarcoma with a tendency for vascular endothelial differentiation. It is highly malignant with a poor prognosis but has a low incidence. Epithelioid angiosarcoma of the gastrointestinal tract is rare, and simultaneous multiple lesions of the stomach and small intestine are even rarer. It is easy to be misdiagnosed clinically. We report on a case of preoperative misdiagnosis of gastric cancer and postoperative diagnosis of epithelioid angiosarcoma with multiple lymph node metastases.

Patient concerns:
A 75-year-old patient who was admitted to the hospital because of fatigue, melena and dysuria for >1 month.

Diagnosis, interventions and outcomes:
Gastroscopy revealed gastric fundus ulcer and the biopsy revealed poorly differentiated adenocarcinoma of the fundus. We performed a radical gastrectomy for gastric cancer during which multiple ulcers were found in the jejunum and resected. Postoperative pathology showed multiple epithelioid angiosarcoma in the stomach and small intestine with lymph node metastases. The patient did not receive further treatment and died 2 month after the surgery.

Lessons:
Gastrointestinal epithelioid angiosarcoma is one of the differential diagnoses of gastrointestinal adenocarcinoma and surgery is the main treatment. The lymph nodes are one of the main sites of metastasis.
Neurosarcomatous amelanotic transformation of malignant melanoma presenting as malignant periopheral nerve sheath tumor: Rare case report
Authors: Bofan Lu , Xiaofei Xiu , Jingwen Zhang , Zuzhuo Zhang , Tianxiao Ma , Feng Gao , Guochuan Zhang , Zhou Zhuang 
Published: June 2023

Rationale:
Malignant melanoma (MM) is notorious for its remarkable morphological variation and aberrant histopathological patterns. In addition, Malignant Periopheral Nerve Sheath Tumor (MPNST) is an uncommon but aggressive soft tissue sarcoma. Because of the common embryological origin of melanocytes and Schwann cells in the neural crest, discriminating between a particular type of MM and MPNST can be difficult, particularly when they are amelanotic. Our goal is to increase awareness among clinicians of the rare variations of MM and the importance of medical history in improving the accuracy of the final clinical diagnosis.

Patient concerns:
A 68-year-old man was admitted to the hospital due to pain in his right ankle, which had persisted for 8 months, along with swelling for 4 months. Medical history revealed delayed healing of right plantar for 5 years after a traumatic injury.

Diagnoses:
The ankle mass was initially diagnosed as MPNST through biopsy. After reviewing the patient’s medical history and receiving the final pathological report following amputation, we have revised the diagnosis to metastatic amelanotic desmoplastic melanoma in the ankle part and lentigo maligna melanoma in the plantar part. This is due to both lesions displaying positive markers or mutated genes in immunohistology and Gene Mutation Detection, indicating homology between the 2 tumors.

Interventions:
Due to the malignant characteristics of the tumor and the patient’s wishes, amputation of the right lower leg was carried out.

Outcomes:
Subsequently, the patient was treated with interferon-γ and immunosuppressant PD-1 inhibitor, and survived for 1 year after amputation.

Lessons:
Clinical data, immunohistochemisty biomarkers and genes detection results can serve as valuable evidence for pathologists and clinicians in identifying the disease process. Collaborative efforts between clinicians and scientists are crucial in order to identify specific markers that can effectively differentiate between the 2 tumors, thereby enhancing the conclusiveness of the diagnosis.