bluuebunny/crossref_metadata_2025_split huggingface dataset:
Contemporary management of epilepsy in pregnancy
Authors: Darmawan Kelly F. , Panelli Danielle M. 
Published: March 2023

Purpose of review
The number of reproductive aged people with epilepsy in the United States is increasing, making epilepsy during pregnancy more prevalent. Simultaneously, more people are using newer generations of antiseizure medications before, during and after pregnancy. Here, we review current evidence on contemporary management and outcomes of pregnancies among people with epilepsy.

Recent findings
This review evaluates recent literature to summarize current practices in preconception counselling, contraception, antiseizure medications before, during and after pregnancy, and peri-partum and postpartum risks in people with epilepsy.

Summary
With the introduction of newer generation antiseizure medications being used during pregnancy, current literature shows that there may be decreased risk in adverse foetal and maternal outcomes. In the peri-partum and postpartum period, recent literature shows that people with epilepsy have an increased risk of severe maternal morbidity and hospital readmission. Given this, as well as considerations for dosing of antiseizure medications, close surveillance of people with epilepsy during pregnancy is warranted.
Management of blood pressure in pregnancy: new perspectives from the CHAP trial
Authors: Holliman Kerry D. , Lowe Virginia , Nonni Gabriella 
Published: March 2023

Purpose of review
Chronic hypertension affects up to 10% of pregnancies in the United States and the incidence of hypertensive diseases of pregnancy has more than doubled in the past decade, affecting minority women at disproportionate rates. Recent data show potential benefit by lowering the threshold of blood pressure treatment for pregnant women to >140/90 mmHg.

Recent findings
In April 2022, the results of the Chronic Hypertension and Pregnancy (CHAP) trial was published and demonstrated that lower thresholds (>140/90 vs. >160/110 mmHg) for the initiation of antihypertensive therapy during pregnancy resulted in better pregnancy outcomes without negative impacts to foetal growth. In addition, professional societies, such as the American College of Obstetrics and Gynecology (ACOG) and the Society of Maternal Fetal Medicine (SMFM), have released statements supporting the initiation of antihypertensive therapy at elevations above 140/90 mmHg for pregnant women with chronic hypertension based upon these recent reports.

Summary
Treatment of hypertension in pregnant women is controversial, but recent data are emerging that treatment at lower blood pressure thresholds may be associated with improved perinatal outcomes without an increased risk of poor foetal growth. Although these recommendations may be applied to women with chronic hypertension, more research is needed to determine how these guidelines should be applied to other hypertensive diseases of pregnancy.
The pregnancy at risk for delivery at the threshold of viability
Authors: Boddy Mark G. , Davis Alexis S. , Perlman Nicola 
Published: March 2023

Purpose of review
To examine updated recommendations for obstetrical interventions that may improve neonatal outcomes in extremely preterm births.

Recent findings
Several recent studies of antenatal steroids at the threshold of viability have demonstrated benefits in both survival and survival without major morbidity. This has led to revised recommendations from the American College of Obstetricians and Gynecologist regarding the timing of antenatal steroids in these extremely preterm fetuses.

Summary
These recent developments have important implications for clinical care in patients at risk for extremely preterm birth based on a model of best practices and shared decision-making.
Successful Management of a High-output Lymphorrhea via Lymphaticovenous Anastomosis after Cannulation for Cardiopulmonary Bypass
Authors: Sloan Chad S. , Hon Heidi H. , Figy Sean C. 
Published: March 2023

Summary:
Lymphatic leaks are a rare phenomenon, but can be a troublesome and persistent problem, especially in an already debilitated patient. Historically, management of lymphorrhea has involved non- and minimally-invasive techniques of elevation, compression, aspiration, or drain placement, among others. Ligation and sclerotherapy are additional utilized techniques, directly targeting the lymphatic vessel. Microsurgical management of lymphatic leaks via lymphaticolymphatic and lymphaticovenous anastomosis has gained popularity amongst surgeons as an alternative solution to the problem. We present a patient who developed a high-output lymphocutaneous fistula after a femoral cannulation procedure for cardiopulmonary bypass for an orthotopic heart transplantation. After multiple unsuccessful attempts at traditional management options, the patient had a successful resolution of the high-output lymphorrhea via a lymphaticovenous anastomosis utilizing end-to-end coaptation with an interpositional vein graft. This case uniquely describes a lymphaticovenous anastomosis and bypass of a lymph node in the setting of significant lymphorrhea (>1.0 L per day) and associated lymphocutaneous fistula, that was effectively managed in the acute postoperative setting. Management of lymphorrhea by microsurgical techniques and lymphatic vessel manipulation in the postoperative period provides surgeons with an enhanced option for direct operative management of lymphatic vessels and their associated sequelae.
PATHOLOGIC STUDY OF UNTREATED INTRARETINAL GLIOSIS SURGICALLY EXCISED VIA PARS PLANA VITRECTOMY
Authors: Wu Mengai , Ren Xinyu , Chen Yan , Chen Lifeng , Lian Hengli , Li Haidong , Li Qiuming , Zheng Bin 
Published: March 2023

Purpose:
To evaluate the pathologic process of intraretinal glioses by investigating mass tissues resected from untreated eyes with intraretinal glioses.

Methods:
Five patients with intraretinal gliosis without previous conservative treatment were included. All patients underwent pars plana vitrectomy. The mass tissues were excised and processed for the pathologic study.

Results:
During surgery, it was observed that the intraretinal gliosis mainly affected the neuroretina and the retinal pigment epithelium was not affected. Pathologic examination revealed that all intraretinal glioses consisted of different proportions of hyaline vessels and hyperplastic spindle-shaped glial cells. In one case, the intraretinal gliosis was mainly composed of hyaline vascular components. In another case, the intraretinal gliosis showed a predominance of glial cells. The intraretinal glioses in the other three cases had vascular and glial components. The proliferated vessels showed different amounts of collagen deposits against different backgrounds. Vascularized epiretinal membrane was found in some intraretinal glioses.

Conclusion:
Intraretinal glioses affected the inner retinal layer. Hyaline vessels were the most characteristic pathologic changes; the proportion of proliferative glial cells varied in different intraretinal glioses. The natural course of intraretinal gliosis may involve the proliferation of abnormal vessels in the early stage, which then gradually become scarred and are replaced by glial cells.
BULBOSITIES AND INTERVORTEX VENOUS ANASTOMOSIS IN VENOUS OVERLOAD CHOROIDOPATHY MASQUERADING AS POLYPOIDAL CHOROIDAL VASCULOPATHY
Authors: Ngo Wei Kiong , Keshet Yariv , Spaide Richard F. 
Published: March 2023

Purpose:
To describe a patient with venous overload choroidopathy in whom venous bulbosities masqueraded as polyps and intervortex venous anastomosis mimicked a branching vascular network, giving the appearance of polypoidal choroidal vasculopathy.

Methods:
The patient had complete ophthalmic examination including indocyanine green angiography and optical coherence tomography. Venous bulbosities were defined on indocyanine green angiography as focal dilations in which the diameter of the dilation is two times that of the host vessel.

Results:
A 75-year-old woman presented with combined subretinal and subretinal pigment epithelium hemorrhages in the right eye. During indocyanine green angiography, focal nodular hyperfluorescent lesions connected to a network of vessels were observed, which looked like polyps and branching vascular network in polypoidal choroidal vasculopathy. In both eyes, the midphase angiogram had multifocal choroidal vascular hyperpermeability. There was late-phase placoid staining nasal to the nerve in the right eye. During enhanced depth imaging–optical coherence tomography evaluation, there were no retinal pigment epithelium elevations that would be expected with polyps or branching vascular network in the right eye. A double-layer sign was seen corresponding to the placoid area of staining. Diagnosis of venous overload choroidopathy and choroidal neovascularization membrane was made. She was treated with intravitreal antivascular endothelial growth factor injections for the choroidal neovascularization membrane.

Conclusion:
Indocyanine green angiography findings in venous overload choroidopathy may mimic polypoidal choroidal vasculopathy, but differentiation is essential because it has implications for treatment. Similar findings may have been misinterpreted in the past and may have previously contributed to conflicting clinical and histopathologic descriptions of polypoidal choroidal vasculopathy.
Relative efficacy of prophylactic strategies for postthyroidectomy hypocalcemia: a systematic review and network meta-analysis
Authors: Ren Shuling , Zhu Yiyuan , Dong Yanbo , Cui Jianxin , Wang Yunyun , Li Guo , Zhang Aobo , Liu Liangfa 
Published: March 2023

Background:
Routine prophylaxis for at-risk patients may reduce the occurrence of postoperative hypocalcemia but is not widely adopted due to a lack of evidence on the efficacy of available prophylactic strategies. In this study, we compared the relative efficacy of prophylactic strategies for postthyroidectomy hypocalcemia with a systematic review and network meta-analysis.

Methods:
PubMed, Embase, and Cochrane Library were searched, covering the period from 1980 to May 2022, for randomized controlled trials (RCTs) comparing calcium, vitamin D3, activated vitamin D3, teriparatide, steroids, and magnesium with placebo or each other in patients receiving total or completion thyroidectomy. Involved RCTs reporting symptomatic or biochemical hypocalcemia. The primary outcome was symptomatic hypocalcemia, defined as circumoral tingling, and Chvostek and Trousseau signs. The secondary outcome was biochemical hypocalcemia. Risk of bias was assessed using the Cochrane risk of bias assessment tool for randomized trials. Pooled estimates were calculated using a random-effects inverse-variance weighting model. The network meta-analysis was performed under the frequentist framework. This meta-analysis was registered on the PROSPERO (International prospective register of systematic reviews) (CRD42022299982).

Results:
Twenty-seven RCTs comprising 3382 patients are included. Prophylactic strategies of teriparatide, oral calcium plus vitamin D3, and oral calcium plus activated vitamin D3 are superior to placebo in reducing symptomatic hypocalcemia. Teriparatide emerged as the most effective strategy for symptomatic hypocalcemia [relative risk (RR): 0.18; 95% CI: 0.03–0.98], followed by oral calcium plus activated vitamin D3 (RR: 0.42; 95% CI: 0.25–0.73) and oral calcium plus vitamin D3 (RR: 0.43; 95% CI: 0.26–0.71). Evidence on monotherapy with either oral calcium or vitamin D3 in reducing symptomatic hypocalcemia is insufficient. Intravenous calcium and oral calcium are effective in reducing biochemical hypocalcemia.

Conclusions:
This network meta-analysis provides information on the relative efficacy of current prophylactic strategies for postthyroidectomy hypocalcemia. Teriparatide performed better than other interventions and would seem appropriate for deployment among high-risk populations.
Biomechanics of surgical knot security: a systematic review
Authors: Wong Yoke-Rung , McGrouther Duncan A. 
Published: March 2023

Background:
This review aims to identify publications on quantitative biomechanical testing of surgical knot security and the physical factors that determine knot security and failure.

Materials and Methods:
An electronic literature search was performed in accordance with PRISMA guidelines in January 2022 utilizing the PubMed and Google Scholar databases to look for objective biomechanical studies on knot security in surgery using the primary terms ‘knot security’ and ‘biomechanical testing’.

Results:
Thirty-six articles were included. Twenty-four configurations of surface, laparoscopic, and arthroscopic knots were studied. Biomechanical tensile testing was used to evaluate knot security in vitro. Load to failure (N) and elongation at knot failure (mm) were quantified by static and cyclic testing to evaluate the knot holding capacity and failure mechanism of slippage or rupture.

Conclusion:
This review reassures that the knot configuration, suture materials, suture sizes, and number of throws are key factors in determining the knot’s security. Knot configuration has to be simple for laparoscopic and arthroscopic knots due to the confined space of the operating site. With the advent of stronger suture materials for high-tension surgical reconstructive procedures, there is an unmet need to understand the physical behavior of the knot and the factors that determine its resistance to slippage or rupture.

Level of Evidence: Level IV.
Hereditary head and neck paraganglioma: from basics to practical consequences
Authors: Trache Mihnea Cristian , Böttcher Arne , Betz Christian Stephan 
Published: March 2023

Purpose of review
This review summarizes practical recommendations for screening, work-up, and management of hereditary head and neck paragangliomas based on the growing molecular and empirical understanding of this disease.

Recent findings
The proportion of hereditary cases among head and neck paragangliomas is significant (∼33 to 50%), and specific genetic alterations may increase the risk of malignancy. Genotyping should be performed for each case, and patients carrying a pathological mutation should be regularly screened for new tumors. Computed tomography (CT), magnetic resonance imaging (MRI), digital subtraction angiography (DSA), and functional positron emission tomography (PET) can provide a reliable preoperative diagnosis in the absence of histology. Comparative data on therapeutic outcome and morbidity now render radiation, stereotactic radiosurgery, and active surveillance preferable over surgery in highly advanced cases of jugulotympanic and vagal paragangliomas, whereas surgery remains the first choice for most carotid body paragangliomas.

Summary
Complete paraganglioma removal continues to be the primary therapeutic goal; however, this is sometimes impossible to accomplish with acceptable morbidity. In these cases, therapy selection should focus on preserving cranial nerve function and minimizing both tumor-associated and therapy-associated complications, particularly in genetically predisposed patients. An interdisciplinary approach to the management of hereditary head and neck paragangliomas is strongly recommended.
Head and neck squamous cell carcinoma in HIV patients
Authors: Rampinelli Vittorio , Gennarini Francesca , Borsetto Daniele , Piazza Cesare 
Published: March 2023

Purpose of review
The introduction of antiretroviral therapy has significantly impacted the incidence of head and neck squamous cell carcinoma (HNSCC) in people living with HIV (PLWH). This manuscript aims to give an overview of the evidence in the literature about this population.

Recent findings
PLWH have an increased incidence of HNSCC, with earlier age and more advanced stage at diagnosis. This epidemiologic trend may be explained by combining traditional and HIV-related risk factors. With the improvement of global health status, more patients are candidate for complex therapeutic strategies with curative intent. To date, it is still debated whether HIV-infected patients possess a profile of increased risk regarding treatment-related toxicity and survival outcomes, with the literature still lacking substantial evidence. Among the prognostic factors that can guide the clinician in selecting the most appropriate treatment strategy, age, site/subsite, stage, HIV viral load, and CD4+ T-cell count at diagnosis are the most relevant.

Summary
Pathogenesis, treatment characteristics, oncologic outcomes, and prognostic factors of HNSCC in PLWH are still debated. Given the increasing incidence of HNSCC in PLWH, the need for dedicated evidence-based studies represents a significant research gap to be addressed.
Vagal paragangliomas
Authors: Mottie Lena , Meulemans Jeroen , Vander Poorten Vincent 
Published: March 2023

Purpose of review
A vagal paraganglioma is a rare head and neck tumor arising from the paraganglionic tissue within the perineurium of the vagus nerve, anywhere along the course of the nerve. Due to its proximity to the internal carotid artery, the internal jugular vein and the lower cranial nerves, this disorder poses significant diagnostic and therapeutic challenges. The diagnostic workup and management keep on evolving.

Recent findings
This article gives a concise update of the clinical spectrum and the current state-of-the-art diagnostic workup and management of vagal paraganglioma.

Summary
Every patient with suspected vagal paraganglioma needs to be evaluated by a multidisciplinary team. The management strategy is selected depending on the growth rate of the tumor, the age and fitness of the patient, the number of affected cranial nerves, the metabolic activity of the paraganglioma, and the eventual multicentricity. An algorithm guiding the clinician through the different treatment options is presented.
The relationship between auditory behaviours and speech and language development in children with cleft lip and palate
Authors: van Eeden Stephanie 
Published: March 2023

Purpose of review
Children born with a cleft lip and palate (CLP) are at risk of speech problems. There is a high prevalence of conductive hearing loss due to otitis media with effusion and recent research has highlighted broader difficulties with language and educational attainment. There has been increased interest in the impact of auditory processing on a child's development, but little study into links between auditory skills and speech and language development.

Recent findings
Children with CLP consistently struggle with auditory tasks. Difficulties processing words in a noisy background, auditory attention and temporal processing are frequently reported. A recent study in the United Kingdom investigated the auditory behaviours of 95 children aged 5–8 years with nonsyndromic CLP and compared these with speech and language profiles. Auditory difficulties correlated with speech development and most auditory behaviours correlated with language outcomes. There was also a correlation of language with speech outcomes, suggesting a more complex and interdependent relationship.

Summary
Children with CLP present with high levels of difficulties with auditory skills. The potential impact of this on broader development needs further research, but clinicians should ensure that auditory skills beyond the hearing test are monitored, and advice given to parents to minimize the impact.
Open tibial shaft fractures: treatment patterns in sub-Saharan Africa
Authors:   ORCA Study Group
Published: March 2023

Abstract

Objective:
Open tibial shaft fractures are a leading cause of disability worldwide, particularly in low and middle-income countries (LMICs). Guidelines for these injuries have been developed in many high-income countries, but treatment patterns across Africa are less well-documented.

Methods:
A survey was distributed to orthopaedic service providers across sub-Saharan Africa. Information gathered included surgeon and practice setting demographics and treatment preferences for open tibial shaft fractures across 3 domains: initial debridement, antibiotic administration, and fracture stabilization. Responses were grouped according to country income level and were compared between LMICs and upper middle-income countries (UMICs).

Results:
Responses from 261 survey participants from 31 countries were analyzed, with 80% of respondents practicing in LMICs. Most respondents were male practicing orthopaedic surgeons at a tertiary referral hospital. For all respondents, initial debridement occurred most frequently in the operating room (OR) within the first 24 hours, but LMIC surgeons more frequently reported delays due to equipment availability, treatment cost, and OR availability. Compared with their UMIC counterparts, LMIC surgeons less frequently confirmed tetanus vaccination status and more frequently used extended courses of postoperative antibiotics. LMIC surgeons reported lower rates of using internal fixation, particularly for high-grade and late-presenting fractures.

Conclusions:
This study describes management characteristics of open tibial shaft fractures in sub-Saharan Africa. Notably, there were reported differences in wound management, antibiotic administration, and fracture stabilization between LMICs and UMICs. These findings suggest opportunities for standardization where evidence is available and further research where it is lacking.

Level of Evidence:
VI—Cross-Sectional Study.
“Lipedema: The use of cultured adipocytes for identification of diagnostic markers”
Authors: Ernst Anna M. , Steiner Marianne , Kainz Verena , Tempfer Herbert , Spitzer Gabriel , Plank Tanja , Bauer Hans-Christian , Bresgen Nikolaus , Habenbacher Andreas , Bauer Hannelore , Lipp Anna-Theresa 
Published: March 2023

Background:
Lipedema is a progressive disease, diagnosed most often in women, which is characterized by the unproportionate and symmetrical distribution of adipose tissue primarily in the extremities. Despite numerous results from in vitro and in vivo studies, many questions regarding the pathology and genetic background of lipedema have remained unanswered.

Methods:
Adipose tissue-derived stromal/stem cells (ASCs) were isolated from lipoaspirates derived from non-obese and obese lipedema and non-lipedema donors. Growth/morphology, metabolic activity, differentiation potential and gene expression were evaluated using quantification of lipid accumulation, metabolic activity assay, live-cell imaging, RT-PCR, quantitative PCR and immunocytochemical staining.

Results:
The adipogenic potential of lipedema and non-lipedema ASCs did not rise in parallel with the donors' BMI and did not differ significantly between groups. However, in vitro differentiated adipocytes from non-obese lipedema donors showed significant upregulation of adipogenic gene expression compared to non-obese controls. All other genes tested were equally expressed in lipedema and non-lipedema adipocytes. The ADIPOQ/LEP ratio (ALR) was significantly reduced in adipocytes from obese lipedema donors compared to their non-obese lipedema counterparts. Increased stress fiber-integrated SMA was visible in lipedema adipocytes compared to non-lipedema controls and appeared enhanced in adipocytes from obese lipedema donors.

Conclusions:
Not only lipedema per se but also BMI of donors impact adipogenic gene expression substantially in vitro. The significantly reduced ALR and the increased occurrence of myofibroblast-like cells in “obese” lipedema adipocyte cultures underlines the importance of attention towards the co-occurrence of lipedema and obesity. These are important findings towards accurate diagnosis of lipedema.