bluuebunny/crossref_metadata_2025_split huggingface dataset:
The role of PET/CT in disease activity assessment in patients with large vessel vasculitis
Authors: Galli Elena , Pipitone Nicolò , Salvarani Carlo 
Published: March 2023

Purpose of review
The aim of this article was to review the recent contributions on the role of PET in assessing disease activity in patients with large-vessel vasculitis (giant cell arteritis and Takayasu arteritis).

Recent findings

18FDG (fluorodeoxyglucose) vascular uptake in large-vessel vasculitis at PET shows moderate correlation with clinical indices, laboratory markers and signs of arterial involvement at morphological imaging. Limited data may suggest that 18FDG (fluorodeoxyglucose) vascular uptake could predict relapses and (in Takayasu arteritis) the development of new angiographic vascular lesions. PET appears to be in general sensitive to change after treatment.

Summary
While the role of PET in diagnosis large-vessel vasculitis is established, its role in evaluating disease activity is less clear-cut. PET may be used as an ancillary technique, but a comprehensive assessment, including clinical, laboratory and morphological imaging is still required to monitor patients with large-vessel vasculitis over time.
Magnetic Resonance Imaging in the Management of Significantly Displaced Adolescent Posterior Sternoclavicular Joint Injuries
Authors: Tytherleigh-Strong Graham , Cuthbert Rory , Poutoglidou Freideriki , Tang Quen 
Published: March 2023

Background:
Computed tomography (CT) scans are the standard imaging modality for the diagnosis and treatment guide for adolescent posterior sternoclavicular joint (SCJ) injuries. However, the medial clavicular physis is not visualized and it is not possible to differentiate between a true SCJ dislocation and a physeal injury (PI). An magnetic resonance imaging (MRI) scan can visualize the bone and the physis.

Methods:
We treated a series of patients with adolescent posterior SCJ injuries diagnosed on CT scan. Patients underwent an MRI scan to differentiate between a true SCJ dislocation and a PI and to further differentiate between a PI with or without residual medial end clavicular bone contact. Patients with a true SCJ dislocation and a PI with no contact underwent an open reduction and fixation. Patients with a PI with contact were treated nonoperatively with repeat CT scans at 1 and 3 months. At final follow-up SCJ clinical function was assessed using Quick-DASH, Rockwood, modified Constant, and single assessment numeric evaluation (SANE) scores.

Results:
Thirteen patients (2 female and 11 male) with an average age of 14.9 years (12 to 17) were included in the study. Twelve patients were available at final follow-up (mean 50 mo, 26 to 84). One patient had a true SCJ dislocation and 3 had an off-ended PI and were treated with an open reduction and fixation. Eight patients had a PI with residual bone contact and were treated nonoperatively. For these patients serial CT scans showed that the position was maintained, with a serial increase in callus formation and bone remodeling. The average follow-up was 42.9 months (24 to 62). At final follow-up the mean Quick-disabilities of the arm, shoulder and hand (DASH) was 0.4 (0 to 2.3), Rockwood was 15, modified Constant was 98.8 (89 to 100) and SANE was 99.5% (95 to 100).

Conclusion:
In this case series of significantly displaced adolescent posterior SCJ injuries MRI scans allowed identification of true SCJ dislocations and off-ended PIs, which were successfully treated by open reduction, and PIs with residual physeal contact which were successfully treated nonoperatively.

Level of Evidence:
Level IV—case series.
An Exploration of Critical Care Professionals’ Strategies to Enhance Daily Implementation of the Assess, Prevent, and Manage Pain; Both Spontaneous Awakening and Breathing Trials; Choice of Analgesia and Sedation; Delirium Assess, Prevent, and Manage; Early Mobility and Exercise; and Family Engagement and Empowerment: A Group Concept Mapping Study
Authors: Mion Lorraine C. , Tan Alai , Brockman Audrey , Tate Judith A. , Vasilevskis Eduard E. , Pun Brenda T. , Rosas Scott R. , Balas Michele C. 
Published: March 2023

OBJECTIVES:
The goals of this exploratory study were to engage professionals from the Society for Critical Care Medicine ICU Liberation Collaborative ICUs to: 1) conceptualize strategies to enhance daily implementation of the Assess, prevent, and manage pain; Both spontaneous awakening and breathing trials; Choice of analgesia and sedation; Delirium assess, prevent, and manage; Early mobility and exercise; and Family engagement and empowerment (ABCDEF) bundle from different perspectives and 2) identify strategies to prioritize for implementation.

DESIGN:
Mixed-methods group concept mapping over 8 months using an online method. Participants provided strategies in response to a prompt about what was needed for successful daily ABCDEF bundle implementation. Responses were summarized into a set of unique statements and then rated on a 5-point scale on degree of necessity (essential) and degree to which currently used.

SETTING:
Sixty-eight academic, community, and federal ICUs.

PARTICIPANTS:
A total of 121 ICU professionals consisting of frontline and leadership professionals.

INTERVENTIONS:
None.

MEASUREMENTS AND MAIN RESULTS:
A final set of 76 strategies (reduced from 188 responses) were suggested: education (16 strategies), collaboration (15 strategies), processes and protocols (13 strategies), feedback (10 strategies), sedation/pain practices (nine strategies), education (eight strategies), and family (five strategies). Nine strategies were rated as very essential but infrequently used: adequate staffing, adequate mobility equipment, attention to (patient’s) sleep, open discussion and collaborative problem solving, nonsedation methods to address ventilator dyssynchrony, specific expectations for night and day shifts, education of whole team on interdependent nature of the bundle, and effective sleep protocol.

CONCLUSIONS:
In this concept mapping study, ICU professionals provided strategies that spanned a number of conceptual implementation clusters. Results can be used by ICU leaders for implementation planning to address context-specific interdisciplinary approaches to improve ABCDEF bundle implementation.
Intensive Care and Organ Support Related Mortality in Patients With COVID-19: A Systematic Review and Meta-Analysis
Authors: Chandel Abhimanyu , Leazer Sahar , Alcover Karl C. , Farley Josiah , Berk Joshua , Jayne Christopher , Mcnutt Ryan , Olsen Meredith , Allard Rhonda , Yang Jiahong , Johnson Caitlyn , Tripathi Ananya , Rechtin Maria , Leon Mathew , Williams Mathias , Sheth Phorum , Messer Kyle , Chung Kevin K. , Collen Jacob 
Published: March 2023

OBJECTIVES:To perform a systematic review and meta-analysis to generate estimates of mortality in patients with COVID-19 that required hospitalization, ICU admission, and organ support.DATA SOURCES:A systematic search of PubMed, Embase, and the Cochrane databases was conducted up to December 31, 2021.STUDY SELECTION:Previously peer-reviewed observational studies that reported ICU, mechanical ventilation (MV), renal replacement therapy (RRT) or extracorporeal membrane oxygenation (ECMO)-related mortality among greater than or equal to 100 individual patients.DATA EXTRACTION:Random-effects meta-analysis was used to generate pooled estimates of case fatality rates (CFRs) for in-hospital, ICU, MV, RRT, and ECMO-related mortality. ICU-related mortality was additionally analyzed by the study country of origin. Sensitivity analyses of CFR were assessed based on completeness of follow-up data, by year, and when only studies judged to be of high quality were included.DATA SYNTHESIS:One hundred fifty-seven studies evaluating 948,309 patients were included. The CFR for in-hospital mortality, ICU mortality, MV, RRT, and ECMO were 25.9% (95% CI: 24.0–27.8%), 37.3% (95% CI: 34.6–40.1%), 51.6% (95% CI: 46.1–57.0%), 66.1% (95% CI: 59.7–72.2%), and 58.0% (95% CI: 46.9–68.9%), respectively. MV (52.7%, 95% CI: 47.5–58.0% vs 31.3%, 95% CI: 16.1–48.9%;p= 0.023) and RRT-related mortality (66.7%, 95% CI: 60.1–73.0% vs 50.3%, 95% CI: 42.4–58.2%;p= 0.003) decreased from 2020 to 2021.CONCLUSIONS:We present updated estimates of CFR for patients hospitalized and requiring intensive care for the management of COVID-19. Although mortality remain high and varies considerably worldwide, we found the CFR in patients supported with MV significantly improved since 2020.
Utility of Multimodal Treatment Protocols in the Management of Scalp Cutaneous Angiosarcoma
Authors: Alharbi Adel , Kim Young-Chul , AlShomer Feras , Choi Jong-Woo 
Published: March 2023

Background:
Cutaneous angiosarcomas are rare, aggressive tumors with high recurrence and poor prognosis. We share our experiences with the challenging surgical management of these lesions, focusing on both ablative and reconstructive outcomes.

Methods:
Retrospective cross-sectional chart review was conducted of patients diagnosed with scalp cutaneous angiosarcoma between 2005 and 2021. Resectability, defect reconstruction, and survival outcomes were analyzed.

Results:
Thirty patients were included, 27 (90%) men and three (10%) women, with a mean age at diagnosis of 71.77 ± 7.3 years, and mean follow-up of 429.43 ± 305.6 days. Only 12 patients completed their regular follow-up, while the remaining patients died. There was a median survival of 443.50 days (range, 42–1283) and median time to recurrence of 21 days (range, 30–1690). Multimodal therapy compared with surgery alone had a significantly better overall median survival (468 days versus 71 days; P = 0.021). Defect coverage was obtained in 24 cases (75%) through an anterolateral thigh flap, two patients (6%) with a local transposition flap, and one patient (3%) with a transverse rectus abdominis myocutaneous flap. The remaining three patients received a skin graft. All of the flaps survived, with one requiring a vein graft for venous congestion.

Conclusions:
Timely multimodal therapy with a histologically safe margin, combined with adjuvant therapy, improves survival and delays recurrence and metastasis, in cutaneous angiosarcoma patients. An anterolateral thigh flap facilitates the coverage of wide defects. Further investigations of advanced treatment modalities such as immunotherapy and/or gene therapy are required to deal with this highly aggressive tumor.
Lymphaticovenular Anastomosis for Lymphorrhea after Expander-based Breast Reconstruction: A Case Report
Authors: Shikano Yusuke , Tomita Koichi , Otani Naoya , Kuroda Kazuya , Kubo Tateki 
Published: March 2023

Summary:
Refractory axillary lymphorrhea is a postoperative complication of breast cancer with no established standard treatment. Recently, lymphaticovenular anastomosis (LVA) was used to treat not only lymphedema but also lymphorrhea and lymphocele in the inguinal and pelvic regions. However, only a few reports have been published on the treatment of axillary lymphatic leakage with LVA. This report presents a case of successful treatment of refractory axillary lymphorrhea after breast cancer surgery with LVA. A 68-year-old woman underwent nipple-sparing mastectomy for right breast cancer, axillary lymph node dissection, and immediate subpectoral tissue expander placement. Postoperatively, the patient developed refractory lymphorrhea and subsequent seroma around the tissue expander, and underwent postmastectomy radiation therapy and frequent percutaneous aspiration of the seroma. However, lymphatic leakage persisted, and surgical treatment was planned. Preoperative lymphoscintigraphy showed lymphatic outflow from the right axilla to the space around the tissue expander. There was no dermal backflow in the upper extremities. To reduce lymphatic flow into the axilla, LVA was performed at two sites in the right upper arm. The lymphatic vessels used for anastomosis were 0.35 mm and 0.50 mm in diameter, and each was anastomosed to the vein in an end-to-end fashion. The axillary lymphatic leakage stopped shortly after the operation, and there were no postoperative complications. LVA may be a safe and simple option for the treatment of axillary lymphorrhea.
Combined Tripier and V-Y Advancement Flaps for Reconstruction of Large Lid-cheek Junction Defects
Authors: Mookerjee Vikram G. , Prassinos Alexandre J. , Alper David P. , Clune James E. 
Published: March 2023

Summary:
Reconstruction of lid-cheek junction defects has a known risk of ectropion. Cervicofacial flaps require significant dissection and can still be prone to ectropion. V-Y advancement flaps have been described as less morbid, but their use is limited to moderate-size defects that do not involve the lid margin. The authors present a technique of combined Tripier and V-Y advancement flaps for reconstruction of large defects of the lid-cheek junction involving the lower eyelid. A retrospective review of patients undergoing the authors’ technique was performed. A facial artery perforator flap was designed in a V-Y fashion and advanced into the cheek. An orbicularis oculi myocutaneous flap (Tripier flap) was elevated from the upper eyelid and rotated into the lower eyelid/upper cheek to meet the superior edge of the V-Y flap. A separate review of patients undergoing cervicofacial flap reconstruction was also performed. Demographics, operative details, and complications were recorded and compared. This technique was applied to five patients with large-size (19.9 ± 5.6 cm2) defects of the lid-cheek. In all cases, healing was achieved without ectropion, hematoma, infection, dehiscence, flap necrosis, or facial nerve injury. Twenty-four patients separately underwent cervicofacial flap reconstruction for defects of comparable size (15.8 ± 10.7 cm2). Two patients developed ectropion, one patient developed a hematoma, and two patients developed an infection. Combined Tripier and V-Y advancement flaps is a useful technique to reconstruct lid-cheek junction defects. This method allows for the reconstruction of large lid-cheek junction defects that involve the lid margin.
Rotational stability of plate-haptic toric intraocular lenses in Asian eyes: risk period for intraocular lens rotation and its influencing factors
Authors: Ma Dongmei , Shen Jiying , Qiu Tian , Zhang Limei , Hua Zhixiang , Cai Lei , Yang Jin 
Published: March 2023

Purpose:
To investigate the rotational stability of plate-haptic toric intraocular lenses (IOLs) during 3-month follow-up.

Setting:
Eye and ENT Hospital of Fudan University, Shanghai, China.

Design:
Prospective observational study.

Methods:
Patients with cataracts implanted with AT TORBI 709M toric IOLs were enrolled and followed at 1 hour, 1 day, 3 days, 1 week, 2 weeks, 1 month, and 3 months postoperatively. A linear mixed model of repeated measures was applied to investigate the time course of absolute IOL rotation change. The 2-week overall IOL rotation was analyzed in the age, sex, axial length (AL), lens thickness (LT), preexisting astigmatism, and white-to-white subgroups.

Results:
A total of 328 eyes of 258 patients were included. The rotation from the end of surgery to 1 hour and 1 day to 3 days was significantly smaller compared with the rotation from 1 hour to 1 day but more than that at other time intervals in the overall group. 2 weeks postoperatively, the mean uncorrected distance visual acuity and remaining positive cylinder were 0.19 ± 0.22 logMAR and 0.60 ± 0.44 diopters, respectively. Significant between-group differences in 2-week overall rotation were found in the age, AL, and LT subgroups.

Conclusions:
Maximum rotation occurred within 1 hour to 1 day postoperatively, and the first 3 days postoperatively was a high-risk period for the plate-haptic toric IOL rotation. Surgeons should make the patients aware of this.
Airborne transmission of respiratory viruses including severe acute respiratory syndrome coronavirus 2
Authors: Tang Julian W. , Marr Linsey C. , Tellier Raymond , Dancer Stephanie J. 
Published: March 2023

Purpose of review
The coronavirus disease 2019 pandemic has had a wide-ranging and profound impact on how we think about the transmission of respiratory viruses This review outlines the basis on which we should consider all respiratory viruses as aerosol-transmissible infections, in order to improve our control of these pathogens in both healthcare and community settings.

Recent findings
We present recent studies to support the aerosol transmission of severe acute respiratory syndrome coronavirus 2, and some older studies to demonstrate the aerosol transmissibility of other, more familiar seasonal respiratory viruses.

Summary
Current knowledge on how these respiratory viruses are transmitted, and the way we control their spread, is changing. We need to embrace these changes to improve the care of patients in hospitals and care homes including others who are vulnerable to severe disease in community settings.
A Comparison of Variable Versus Fixed Insulin Infusion Rate on Resolution of Diabetic Ketoacidosis
Authors: Bohach Nathan , Moorman John M. , Cunningham Brittany , Mullen Chanda , Fowler Melissa 
Published: March 2023

Background:
Diabetic ketoacidosis (DKA) is a well-known, potentially fatal complication of diabetes. The American Diabetes Association hyperglycemic crises guidelines suggest the use of intravenous insulin in patients presenting with DKA, along with a recommended rate of glucose reduction of 50–75 mg/dL/h. However, no specific guidance is provided regarding how to best achieve this rate of glucose decline.

Study Question:
Is there a difference in time to DKA resolution between a variable intravenous insulin infusion strategy and a fixed infusion strategy in the absence of an institutional protocol?

Study Design:
Single-center, retrospective cohort study of DKA patient encounters in 2018.

Measures and Outcomes:
Insulin infusion strategy was considered to be variable if the infusion rate changed within the first 8 hours of therapy or was considered fixed if the rate remained unchanged for the same period. The primary outcome was time to resolution of DKA. Secondary outcomes were hospital length of stay, intensive care unit length of stay, hypoglycemia, mortality, and DKA recurrence.

Results:
The median time to resolution of DKA was 9.3 hours in the variable infusion group compared with 7.8 hours in the fixed infusion group (HR, 0.82; 95% CI, 0.43–1.5, P = 0.5360). Severe hypoglycemia was observed in 13% of patients in the variable infusion group and in 50% of patients in the fixed infusion group (P = 0.006).

Conclusions:
In this analysis, insulin infusion strategy (variable vs. fixed) was not associated with a significant difference in the time to resolution of DKA in the absence of an institutional protocol. The fixed infusion strategy was associated with a higher incidence of severe hypoglycemia.
Gastrojejunocolic fistula after gastrojejunostomy in eastern Ethiopia: a case report
Authors: Umer Keno M. , Nureta Tilahun H. , Akalu Tiruwork F. , Shale Wongel T. 
Published: March 2023

Background:
Gastrojejunocolic fistula (GJF) is an infrequent condition that presents late as a complication of gastroenterostomy conducted for complications of peptic ulcer disease and is believed to be a result of continuous acid secretion due to insufficient stomach resection and incomplete vagotomy. Symptoms of the fistula present late, usually 20 years or more after gastroenterostomy. Patients with GJF usually present with chronic on-and-off diarrhea, weight loss, fecal-smelling belching or vomiting, and malnutrition.

Case Presentation:
The case is of a 45-year-old man with GJF who presented with diarrhea, weight loss, and foul-smelling vomiting. The diagnosis was made intraoperatively despite preoperative investigations with computerized tomography scan and endoscopy. The patient underwent a single-stage operation, and the postoperative course was uneventful.

Conclusion:
Knowledge of this uncommon illness can aid in prevention through improved operative strategy and medical treatment during the stomal ulcer phase with proton pump inhibitor and Helicobacter pylori eradication
Uncommon presentation of a giant psoas muscle lipoma: a case report and brief literature review
Authors: Rastrelli Marco , Hoxhaj Ilda , Di Maggio Antonio , Sbaraglia Marta , Chiusole Benedetta , Tropea Saveria , Mazza Marcodomenico , Del Fiore Paolo , Mocellin Simone 
Published: March 2023

Giant retroperitoneal lipomas, particularly within the psoas muscle, are a rare condition. We herein present one such case of a 45-year-old Italian man and a literature review. There are only two case reports published in the literature, thus posing challenges for the appropriate diagnosis and treatment. Our patient was admitted to the emergency department with colicky abdominal pain. Computerized tomography (CT) with contrast enhancement revealed kidney stones and a 19.5×13.6×18 cm mass of adipose tissue with septa located in the right retroperitoneum, in close continuity with the right psoas major muscle. Magnetic resonance imaging showed a voluminous neoformation with predominantly adipose content and a compressive effect on adjacent vascular structures. The CT-guided biopsy indicated spindle cell mesenchymal neoplasm, not otherwise specified. Surgical resection of the retroperitoneal mass with the capsule was performed, and a histopathology examination confirmed the diagnosis of spindle cell lipoma. Despite the fact that CT and MRI are the main diagnostic tools, this case report emphasizes the need for a CT-guided core needle biopsy prior to surgery for appropriate diagnosis.
Conservative surgical staging as a means to preserve fertility in patients with dysgerminoma: a case report
Authors: Maidarti Mila , Garinasih Prini D. , Anggraeni Tricia D. 
Published: March 2023

Introduction and importance:
Ovarian tumor is a rare condition in pediatrics. Due to the improvement in surgical techniques and chemotherapy in recent years, it is currently possible to preserve fertility in selected cases of patients who desire motherhood.

Case presentation:
We present a case of pregnancy following conservative surgery and complete chemotherapy for ovarian dysgerminoma stage IIA. A 16-year-old female presented with complaints of abdominal mass and discomfort. Histopathological examination displayed dysgerminoma arising from the right ovary. Conservative treatment with right salpingo-oophorectomy and six cycles of chemotherapy was performed. Within 2 years following the surgery, the patient conceived and did not indicate tumor recurrence.

Clinical discussion:
Dysgerminoma is the most common ovarian malignant germ cell tumor and usually affects women at a young age. Conservative surgery followed by chemotherapy is the treatment of choice, particularly in young patients with a strong desire to have a family. Conservative fertility-sparing surgery does not have inferior outcomes in terms of survival or recurrence. It is possible that in certain cases, patients previously treated for ovarian cancer may retain their fertility, thereby improving their quality of life.

Conclusion:
Most patients with dysgerminoma can be treated with the maintenance of normal reproductive function. Reassurance regarding the high probability of conceiving and having normal children after conservative surgery and chemotherapy should be informed to the patient and family.