bluuebunny/crossref_metadata_2025_split huggingface dataset:
Osteoporosis Drug Increases Hypocalcemia Risk in Dialysis Patients
Authors: Aschenbrenner Diane S. 
Published: February 2023

The Food and Drug Administration has issued a Drug Safety Communication regarding the osteoporosis drug denosumab (Prolia). The communication warns of an increased risk of significant hypocalcemia with denosumab use in patients with advanced kidney disease, especially if they also receive dialysis.Nurses and NPs need to assess for hypocalcemia in patients with advanced kidney disease who receive denosumab. Patient education concerning the need for calcium and vitamin D supplements and repeated laboratory monitoring is crucial.
Low-Dose Low-Molecular-Weight Heparin for Thromboprophylaxis During Pregnancy
Authors: Rosenberg Karen 
Published: February 2023

According to this study:

In women who have a history of venous thromboembolism, weight-adjusted intermediate-dose low-molecular-weight heparin during the combined antepartum and postpartum periods didn't reduce the risk of recurrence compared with fixed low-dose low-molecular-weight heparin.Further study is needed to determine whether intermediate-dose low-molecular-weight heparin may be more effective than low-dose low-molecular-weight heparin during the postpartum period.
ABCDEFGHI Systematic Approach to wound assessment and management
Authors: Hunt Sarah C. , Azad Sanjay 
Published: February 2023

Abstract:
The ABCDEFGHI approach introduces a systematic approach to wound care. It instructs the clinician to
A
sk pertinent questions, including those that may identify local and systemic
B
arriers to wound healing. After obtaining a thorough history, the clinician may proceed to
C
lean the wound and
D
o a physical examination, specifically looking for
E
xposed structures and
F
actors that will complicate the healing process.
G
ood
H
ealing strategies involving various dressings can then be implemented to promote healing. If necessary, a referral can be made to
I
nvolve specialists using various referral pathways. Information used to synthesize this approach was obtained through a review of national and international guidelines and Google Scholar, MEDLINE, and PubMed databases. The ABCDEFGHI approach to wound assessment and management is a simple and easy-to-follow guide that can be easily implemented into practice, thereby improving clinician confidence and competence in wound care.
Retrograde Nailing for Extremely Proximal Fractures of the Femoral Shaft
Authors: Nino Samantha , Courington Reese , Brooks Patrick , Langford Joshua , Haidukewych George 
Published: February 2023

Objectives:
To report the results of retrograde intramedullary nailing (RIMN) for the treatment of extremely proximal femur fractures.

Design:
Retrospective cohort study.

Setting:
Level I trauma center.

Patients/Participants:
63 patients with femoral shaft fractures involving the anatomic region within 10 centimeters of the inferior border of the lesser trochanter, which were treated with retrograde intramedullary nailing.

Intervention:
Retrograde intramedullary femoral nail.

Main Outcome Measurements:
Time to union, nonunion, malunion, and unplanned reoperation.

Results:
Between 2009 and 2020, 63 fractures were followed up to fracture union, reoperation, or a minimum of 1 year clinically. The mean follow-up was 32 months, and 48 (76%) of the patients were followed up beyond 1 year clinically. The mean patient age was 34 years (range 18–84 years), and the mean BMI was 27 (range 14–45) kg/m2. Forty (64%) patients were polytraumatized. Clinical and radiographic union was achieved in 59 (94%) fractures after index operation at a mean time to union of 22 weeks (range 9–51 weeks). Delayed union requiring nail dynamization occurred in 1 (2%) instance. Malreduction was noted in 1 (2%) patient with a 12-degree flexion deformity that resulted in nonunion. In total, there were 3 (5%) nonunions requiring revision surgery, 1 treated with retrograde exchange nailing and 2 revised to cephalomedullary nails; all were united after revision.

Conclusions:
Retrograde intramedullary nailing can be an effective treatment strategy for extremely proximal femur fractures when necessary. Our series demonstrated a high rate of union and a low rate of malalignment and complications.

Level of Evidence:
Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Intraoperative Interpectoral and Subserratus Nerve Blocks in Breast Augmentation Surgery
Authors: Lee Mark A. , McCartney Conor B. 
Published: February 2023

Background:
An essential component in ambulatory breast augmentation surgery is good analgesia. The demographic undergoing this operation is usually fit, low risk with few comorbidities. These patients do not require long-term hospitalization and do not want to spend excessive time in the hospital for financial reasons. Opiate analgesia can have significant side effects such as nausea, vomiting, and sedation. Reducing volumes of postoperative opiates allows faster ambulation and discharge from day surgery. We have developed two targeted nerve blocks that the operating surgeon can apply in minutes under direct vision, not requiring imaging. Anecdotally, we found that these targeted nerve blocks reduced opiate requirements and allowed accelerated discharge and faster return to normal activities. We conducted a prospective randomized, double-blind trial to test this theory.

Methods:
Twenty patients were randomized into saline (n = 10) or ropivacaine adrenaline solution (n = 10). The operating surgeons and anesthetists were blinded to the solution. All patients were closely followed up, and morphine equivalents were accurately recorded. Follow-up pain scores were recorded using the Overall Benefit of Analgesia pain questionnaire.

Results:
The ropivacaine nerve blocks significantly reduced opiate requirements postoperatively (P < 0.05). Pain scores were significantly decreased in the study group (P < 0.05). There were no side effects attributable to the nerve blocks.

Conclusion:
Intraoperative targeted nerve blocks significantly reduce postoperative opiate requirements in breast augmentation surgery resulting in faster recovery and higher patient satisfaction.
Mega Nerves: Factors Associated with Large Median Nerves on Ultrasound of the Carpal Tunnel
Authors: Kohls Morgan R. , Wasil Karen F. , Fowler John R. 
Published: February 2023

Background:
Although increased cross-sectional area of the median nerve on ultrasound has been associated with carpal tunnel syndrome, there has been little research examining outlier cases with exceedingly large nerves. The purpose of this study was to identify factors associated with these “mega” nerves, and to determine whether these nerves carry with them increased severity of disease.

Methods:
Patients who presented to clinic with upper extremity paresthesias over a 4-year period were included in this study. Two groups were created: mega nerves (cross-sectional area >2 SD above average), and nonmega nerves. Statistical analysis was performed to compare demographics, symptom scores, and nerve conduction studies (NCS). Significant variables were then compared between patients with mega nerves and those with ultrasound positive nerves (≥10 mm2), which did not reach mega size (normal nerves were excluded).

Results:
The cohort included 425 median nerves with 25 mega nerves. The groups differed significantly in diabetes status, body mass index (BMI), Boston Carpal Tunnel Questionnaire (BCTQ) Symptom Severity Scale scores, and NCS results. When compared only with ultrasound positive but nonmega nerves, mega nerves were still associated with diabetes, higher BMI, and worse NCS results.

Conclusions:
Diabetes, BMI, NCS results, and BCTQ Symptom Severity Scale scores are associated with mega nerves. However, BCTQ scores do not differ between mega nerves and other ultrasound positive nerves. In patients with obesity or diabetes, outlier ultrasound measurements may not correlate with worsened clinical symptoms, even in the setting of more significantly altered NCS results.
Practical Review of the Current Management of Frostbite Injuries
Authors: Zaramo Taborah Z. , Green Japjit K. , Janis Jeffrey E. 
Published: February 2023

Summary:
Frostbite is an injury that occurs when the skin and tissues are exposed to temperatures below their freezing point. This type of injury can lead to various complications such as functional loss, chronic pain, and psychological trauma. As such, understanding frostbite management is crucial for optimal patient care. A scoping review was conducted in February 2022 using PubMed, EMBASE, referenced articles and snowballing to identify relevant published articled using the terms “frostbite” and “management” and “surgery. Articles related to pathophysiology, classifications, radiography, complications, and medical and surgical management were included to formulate recommendations for practical management. Two hundred fifty-one articles were identified and 54 met inclusion criteria. Rapid rewarming in warm water (40-42 °C) remains the standard of care. Thrombolytic therapy has been shown in numerous studies to improve tissue salvage. Radiographic imaging has become crucial in the evaluation and management in frostbite injury. Current literature recommends delayed surgery with soft tissue debridement and bone scan-guided amputations. Surgical intervention including debridement, selective blister drainage, fasciotomies, surgical salvage, skin grafts‚ and flaps are often necessary in these patients towards optimizing form and function. The true prevalence and incidence of frostbite injury is unknown. A centralized national database will improve our understanding of the diagnostic and management modalities used in frostbite care. Plastic surgeons have a critical role in the management of frostbite care and must work with an interdisciplinary team to identify the best treatment route for optimal patient care.
Perception of Shame in the Plastic Surgery Field
Authors: AlQhtani Abdullh Z. , Alfaqeeh Faisal A. , Alabdulkarim Abdulaziz , AlSahabi Abdulrahman M. 
Published: February 2023

Background:
Doctors and postgraduate students, especially those in the surgical field, face a highly stressful environment and are exposed to various emotions that have been studied, but the concept of shame-based learning (SBL) is still undergoing investigation, especially in the field of plastic surgery. SBL is a teaching method in which an instructor instills a sense of shame in the student, which may cause depression, anxiety, aggression, and poor job performance, leading to burnout, mental health illness, substance abuse, and suicide.

Methods:
From March to May 2022, two cross-sectional electronic surveys were conducted for residents and consultants in Saudi Arabia, respectively, which used a validated questionnaire to assess SBL.

Results:
Among the 70 responses received (29 residents and 41 consultants), 75.9% of the residents and 80.5% of the consultants were shamed. For residents, a wrong answer was the most common trigger for shame (44.8%), and the operating room was the most common place for it (51.7%). Losing self-confidence was the most common result of shaming (37.9%) and (41.4%) dealt with it by keeping it to themselves. Although 27.6% of residents stated that they had no negative effect, 20.7% stated that they were motivated. There are consultants who practice shaming directly or indirectly (65.9%), while some agreed that it is not necessary (80.5%).

Conclusions:
Although both groups agreed that SBL is unnecessary for the field and will not be practiced in the future, most residents and consultants experienced shame. The negative impact of SBL has several effects on the trainer, the teaching environment, and patient care.
Targeting YAP-mediated HSC death susceptibility and senescence for treatment of liver fibrosis
Authors: Du Kuo , Maeso-Díaz Raquel , Oh Seh Hoon , Wang Ergang , Chen Tianyi , Pan Christopher , Xiang Kun , Dutta Rajesh Kumar , Wang Xiao-Fan , Chi Jen-Tsan , Diehl Anna Mae 
Published: February 2023

Background and Aims:
Liver fibrosis results from the accumulation of myofibroblasts (MFs) derived from quiescent HSCs, and yes-associated protein (YAP) controls this state transition. Although fibrosis is also influenced by HSC death and senescence, whether YAP regulates these processes and whether this could be leveraged to treat liver fibrosis are unknown.

Approach and Results:
YAP activity was manipulated in MF-HSCs to determine how YAP impacts susceptibility to pro-apoptotic senolytic agents or ferroptosis. Effects of senescence on YAP activity and susceptibility to apoptosis versus ferroptosis were also examined. CCl4-treated mice were treated with a ferroptosis inducer or pro-apoptotic senolytic to determine the effects on liver fibrosis. YAP was conditionally disrupted in MFs to determine how YAP activity in MF-HSC affects liver fibrosis in mouse models. Silencing YAP in cultured MF-HSCs induced HSC senescence and vulnerability to senolytics, and promoted ferroptosis resistance. Conversely, inducing HSC senescence suppressed YAP activity, increased sensitivity to senolytics, and decreased sensitivity to ferroptosis. Single-cell analysis of HSCs from fibrotic livers revealed heterogeneous sensitivity to ferroptosis, apoptosis, and senescence. In mice with chronic liver injury, neither the ferroptosis inducer nor senolytic improved fibrosis. However, selectively depleting YAP in MF-HSCs induced senescence and decreased liver injury and fibrosis.

Conclusion:
YAP determines whether MF-HSCs remain activated or become senescent. By regulating this state transition, Yap controls both HSC fibrogenic activity and susceptibility to distinct mechanisms for cell death. MF-HSC-specific YAP depletion induces senescence and protects injured livers from fibrosis. Clarifying determinants of HSC YAP activity may facilitate the development of novel anti-fibrotic therapies.
Mucosal Atrophy Predicts Poorer Outcomes in Pediatric Ulcerative Colitis—A National Inception Cohort Study
Authors: Stenke Emily , Stallard Lorraine , Cooper Sarah , Dominik Anna , Pilkington Abigail , Sugrue Sheila , O’Sullivan Maureen , McDermott Michael , Quinn Shoana , Broderick Annemarie , Bourke Billy , Hussey Séamus 
Published: February 2023

Background:
Outcomes in pediatric ulcerative colitis (UC) are heterogeneous and predictors of disease course eagerly sought. Mucosal atrophy (MA) is characterized by histological abnormalities of colonic intestinal glands.

Objective:
To determine the prevalence of MA in a national inception cohort of pediatric UC and its impact on outcomes.

Methods:
Irish children < 16 years old with UC are diagnosed at a single referral center. At diagnosis, patients underwent phenotyping by Paris classification and activity assessment by Pediatric Ulcerative Colitis Activity Index. Biopsies from all colonic segments were evaluated for MA. Patients were followed prospectively. The primary outcome was corticosteroid-free remission at 1 year. Secondary outcomes included relapse, treatment escalation, and colectomy by 2 years.

Results:
Of 251 pediatric patients with UC (mean age 11.8 years, 55% male), 38 (15%) had MA on diagnostic biopsy. Baseline characteristics were similar between groups with/without MA and there was no difference in steroid-free remission or rates of moderate-severe UC at 1 year. Patients with MA had higher use of steroids (29% vs 15%, P = 0.04) and immunomodulators (40% vs 21%, P = 0.04) at 6 months, higher biologic use at 1 year (34% vs 16%, P = 0.03), earlier first relapse (mean ± SD 29.4 ± 26.1 vs 46.7 ± 43.4 weeks after diagnosis, P = 0.02), and higher colectomy rates by 2 years (21% vs 8%, P = 0.01).

Conclusions:
Children with MA at diagnosis had higher colectomy rates despite earlier treatment escalation and similar baseline severity scores. We identify MA as a promising new prognostic marker in children with newly diagnosed UC.
Venous Thromboembolism Prophylaxis in Pediatric Inflammatory Bowel Disease Patients Hospitalized With a Central Line
Authors: Hamant Laura G. , Gonzalez-llanos Lucia , Patel Ashish S. , McMahon Lisa , Knoll Christine , Swing Ted , Pasternak Brad 
Published: February 2023

Objectives:
Patients hospitalized with inflammatory bowel disease (IBD) have increased risk of venous thromboembolism (VTE). The aim of this study was to determine whether the adoption of a VTE protocol would change rates of medical VTE prophylaxis (low molecular weight heparin) in patients with IBD and a central venous catheter (CVC), while subsequently decreasing the incidence of VTE in this population.

Methods:
A protocol for VTE prophylaxis in IBD was established in March of 2018. Every patient hospitalized with an IBD flare and central venous access from March 2013 to March 2020 was identified. Study data, including patient demographics, rates of Doppler ultrasound (US), and rates of VTE were collected using International Classification of Diseases (ICD)-10 codes, CPT codes, and chart review retrospectively. Determination of an IBD flare was based on physician global assessment. Groups were compared with independent-sample t tests and chi-squared tests.

Results:
A total of 313 hospitalizations across 187 different patients were identified that met criteria including IBD and central venous access. VTE prophylaxis increased from 5.24% (n = 12) prior to the intervention to 63.10% (n = 53) after the intervention [chi-square (1, N = 313) = 125.0192, P < 0.001]. Rate of Doppler US increased from 9.17% (n = 21) prior to the intervention to 17.86% (n = 15) after the intervention [chi-square (1, N = 313) = 4.5562, P < 0.05]. Diagnosis of VTE increased from 0.87% (n = 2) prior to the intervention to 7.14% (n = 6) after the intervention [chi-square (1, N = 313) = 9.6992, P < 0.01]. There were no significant differences in the demographic characteristics pre- versus post-intervention.

Conclusions:
Rates of Doppler US and VTE prophylaxis use increased significantly after implementation of a VTE protocol. Rates of VTE diagnosis also increased, though we suspect this may be due to missed diagnoses prior to implementation of the protocol and increased risk awareness after the protocol was established.
Effects of Unit Census and Patient Acuity Levels on Discussions During Patient Rounds
Authors: Warren Carly , Chignell Mark , Pinkney Sonia J. , Armstrong Bonnie A. , Guerguerian Anne-Marie , Laussen Peter C. , Trbovich Patricia L. 
Published: February 2023

OBJECTIVES:
PICU teams adapt the duration of patient rounding discussions to accommodate varying contextual factors, such as unit census and patient acuity. Although studies establish that shorter discussions can lead to the omission of critical patient information, little is known about how teams adapt their rounding discussions about essential patient topics (i.e., introduction/history, acute clinical status, care plans) in response to changing contexts. To fill this gap, we examined how census and patient acuity impact time spent discussing essential topics during individual patient encounters.

DESIGN:
Observational study.

SETTING:
PICU at a university-affiliated children’s hospital, Toronto, ON, Canada.

SUBJECTS:
Interprofessional morning rounding teams.

INTERVENTIONS:
None.

MEASUREMENTS AND MAIN RESULTS:
We observed 165 individual patient encounters during morning rounds over 10 weeks. Regardless of census or patient acuity, the duration of patient introductions/history did not change. When census was high versus low, acute clinical status discussions significantly decreased for both low acuity patients (00 min:50 s high census; 01 min:39 s low census; –49.5% change) and high acuity patients (01 min:10 s high census; 02 min:02 s low census; –42.6% change). Durations of care plan discussions significantly reduced as a function of census (01 min:19 s high census; 02 min:52 s low census; –54.7% change) for low but not high acuity patients.

CONCLUSIONS:
Under high census and patient acuity levels, rounding teams disproportionately shorten time spent discussing essential patient topics. Of note, while teams preserved time to plan the care for acute patients, they cut care plan discussions of low acuity patients. This study provides needed detail regarding how rounding teams adapt their discussions of essential topics and establishes a foundation for consideration of varying contextual factors in the design of rounding guidelines. As ICUs are challenged with increasing census and patient acuity levels, it is critical that we turn our attention to these contextual aspects and understand how these adaptations impact clinical outcomes to address them.
The CSF-1R inhibitor Pexidartinib impacts dendritic cell differentiation through inhibition of FLT3 signaling and may antagonize the effect of durvalumab in patients with advanced cancer – results from a phase 1 study
Authors: Voissière Aurélien , Gomez-Roca Carlos , Chabaud Sylvie , Rodriguez Céline , Nkodia Axelle , Berthet Justine , Montane Laure , Bidaux Anne-Sophie , Treilleux Isabelle , Eberst Lauriane , Terret Catherine , Korakis Iphigénie , Garin Gwenaelle , Pérol David , Delord Jean-Pierre , Caux Christophe , Dubois Bertrand , Ménétrier-Caux Christine , Bendriss-Vermare Nathalie , Cassier Philippe A. 
Published: February 2023

AbstractTumor-associated macrophages (TAM) are critical determinant of resistance to programmed death-1/programmed death-ligand 1 (PD-1/PD-L1) blockade. This phase I study (MEDIPLEX,NCT02777710) investigated the safety and efficacy of pexidartinib, a CSF-1R-directed tyrosine kinase inhibitor (TKI), and durvalumab (anti-PD-L1) in patients with advanced colorectal (CRC) and pancreatic (PDAC) carcinoma with the aim to enhance responses to PD-L1 blockade by eliminating CSF-1-dependent suppressive TAM. No unexpected toxicities were observed and 2% and 15% of patients achieved partial response and stable disease respectively. Increase of CSF-1 levels and decrease of CD14lowCD16highmonocytes in peripheral blood mononuclear cells (PBMC) confirmed CSF-1R engagement. Treatment significantly decreased blood dendritic cell (DC) subsets and impaired IFN-λ/IL-29 production by type-1 conventional DC inex vivoTLR3-stimulated PBMC. Pexidartinib also targets c-KIT and FLT3, both key growth factor receptors of DC development and maturation. In patients, FLT3-L levels increased with pexidartinib treatment.In vitro, pexidartinib impaired the FLT3-L but not GM-CSF-dependent generation of DC subsets from murine bone marrow progenitors. Our results demonstrate that pexidartinib, through the inhibition of FLT3 signaling, has deleterious effect on DC differentiation, which may explain the limited anti-tumor clinical activity observed in this study. This study suggests that inhibition of FLT3 should be taken into account when combining TKIs with immune checkpoint blockers.One-sentence summaryPexidartinib affects the development of dendritic cells