bluuebunny/crossref_metadata_2025_split huggingface dataset:
Management of Pediatric and Adolescent Sublime Tubercle Injuries: Isolated and Complex Patterns Demonstrate Distinct Etiologies and Radiographic Outcomes
Authors: Mitchell Brendon C. , Fogleman Sarah A. , Carroll Alyssa N. , Leek Bryan T. , Edmonds Eric W. , Fronek Jan , Pennock Andrew T. 
Published: September 2023

Background:
The aim of this study was to assess the patient demographics, epidemiology, mechanism of injury, and natural history of sublime tubercle avulsion injuries.

Methods:
A multicenter retrospective study was performed in which sublime tubercle avulsion injuries were identified by surgeon records and database query of radiology reports. Demographic data and imaging were reviewed for each case, and injuries were classified as type 1 (isolated injuries with a simple bony avulsion or periosteal stripping) or type 2 (complex injuries with an associated elbow fracture or dislocation). Treatment modality and evidence of radiographic healing at a minimum of 3 months were collected.

Results:
Forty patients (78% male) with a median age of 15 years (range, 8 to 19 years) were identified with sublime tubercle avulsion injuries. Sixty-eight percent of cases (n=27) were determined to be type 1 injuries, and 32% (n=13) were classified as type 2 injuries. The majority of type 1 injuries (59%) occurred via a noncontact mechanism in overhead-throwing athletes, whereas 100% of the type 2 injuries were sustained via a contact mechanism. Type 1 injuries presented in a delayed manner in 19% of cases, whereas no type 2 injuries (0%) were delayed in presentation. Type 1 injuries infrequently underwent surgical intervention (19%), whereas 54% of type 2 injuries required surgery. Of those that did not undergo initial surgical management at a minimum of 3-month radiographic follow-up, 9/11 (82%) of type 1 injuries and 0/4 (0%) of type 2 injuries demonstrated evidence of healing. Only 1 case required reoperation (type 2 injury).

Conclusions:
This series of adolescents with sublime tubercle avulsion injuries expands our understanding of the epidemiology of this rare injury, which was previously only described as a noncontact injury in baseball players. Type 1 injuries are more likely to occur via a noncontact mechanism and generally demonstrate radiographic evidence of healing after a period of rigid immobilization. Conversely, type 2 injuries are more likely to undergo initial surgical intervention, and those managed nonoperatively are less likely to achieve radiographic healing. Further studies are needed to elucidate treatment protocols and long-term functional outcomes.

Level of Evidence:
Level IV—case series.
Chilblain-Like Eruption Unveiling Cutaneous Aleukemic Relapse of Acute Myeloid Leukemia
Authors: Brazão Cláudia , Mancha Dora , Antunes-Duarte Sofia , Kempf Werner , Soares-de-Almeida Luís 
Published: September 2023

Abstract:
Leukemia cutis corresponds to skin infiltration by malignant hematopoietic cells. It is most commonly reported in acute myeloid leukemia, particularly in subtypes with a monocytic component. Its clinical manifestations are extremely variable, and histopathologic diagnosis of cutaneous leukemic infiltrates may be challenging. We report the first case of cutaneous, that is, extramedullary, aleukemic relapse of acute myeloid leukemia within an unusual chilblain-like eruption that imposed a challenging clinical and histopathologic diagnosis. Primary chilblains are uncommon in the elderly, and a systemic underlying cause should be thoroughly investigated. In patients presenting with atypical chilblains (ie, persistent chilblains developing even without exposure to cold temperatures and/or refractory to therapy) and with a history of hematologic disorders such as leukemias, histopathologic examination is crucial to identify leukemic or aleukemic phases of relapse of underlying leukemia and initiate timely treatment.
Successful Shoulder Disarticulation under Local Anesthesia in the COVID-19 Era
Authors: Mbabazi Pitman , Mwaniki Mercy , Wambua Gloria , Kagua Samuel , Kamau Rosemary Wangari , Daggett Justin , Nthumba Peter M. 
Published: September 2023

Summary:
The use of the wide-awake local anesthesia no tourniquet, a tumescent local anesthetic technique in recent years, emerged as a powerful tool primarily in hand surgery. It has been adopted in many low- and middle-income countries where it was applied to an increasingly broad group of procedures. We report the case of an older patient with an arm liposarcoma for which surgery under general or regional anesthesia was deemed unsafe, but was successfully managed with a curative right shoulder disarticulation using tumescent local anesthesia.
Postoperative Hematoma-induced Vasospasm after Sarcoma Reconstruction Using a Pedicled Anterolateral Thigh Flap
Authors: Matsuoka Yuki , Karakawa Ryo , Yoshimatsu Hidehiko , Yano Tomoyuki 
Published: September 2023

Summary:
Hematoma-induced vasospasm is a significant factor that can compromise the success of flap reconstructive surgery. Despite advances in microsurgical techniques and knowledge, vasospasm remains a direct cause of flap loss. Hematoma-induced vasospasm occurs due to the presence of blood breakdown products, which can lead to arterial constriction and reduced blood flow to the transplanted tissue. A 77-year-old man with a history of coronary angina developed soft tissue sarcoma on the right groin. Postoperative hematoma-induced vasospasm occurred subsequent to the reconstruction using a pedicled anterolateral thigh flap for the defect after wide resection. The hematoma was evacuated, and blood flow to the flap was restored with topical application of warm saline and vasodilators. Postoperative administration of intravenous alprostadil was used to counteract the vasospasm, and the flap completely survived without any problems with blood flow. It is important to recognize the triggers of vasospasm, such as hematomas, which may occur intra- or postoperatively, and to take appropriate measures to prevent or treat them. Treatment of vasospasm includes the intraoperative topical application of warm saline or vasodilators and the administration of intravenous alprostadil or 4% lidocaine postoperatively. Nevertheless, in the case of hematoma-induced vasospasm, it is important to remove the hematoma.
Synchronous Melanoma: Definition, Prognosis, and Implications. A Comprehensive Review of Literature
Authors: Kang Ajaipal S. , Rajput Rahul , Kang Genelia 
Published: September 2023

Background:
Although multiple primary melanomas (MPMs) have been reported in the literature, the subgroup of synchronous melanomas (SMs) remains understudied.

Methods:
We conducted a comprehensive systematic review of the English literature from 1972 to 2023 to characterize SM. Our objective was to clarify the definition, determine incidence and prognosis, and present recommendations.

Results:
We found 18 case series articles and six case reports that met our criteria. Twelve of eighteen studies defined SM as a second primary melanoma identified within 1 month. The total number of SM patients reported was 1083. The cumulative percentage of MPM in total melanoma patients was 2.9 %, and the cumulative percentage of SM patients in MPM patients was 31.3%. SM patients trended toward higher body anatomical concordance, older age, and male sex. Despite limited data, SMs do not show a worse prognosis for patients compared with single melanomas.

Conclusions:
Despite a lack of consensus in the past, we recommend that SM be defined as a second primary melanoma detected within 1 month of the initial diagnosis. SMs comprise almost one-third of MPM cases and do not seem to carry any worse prognosis than the patients presenting with single melanoma. We believe older age and male sex may be more prone to SM. We recommend patient education, self-skin evaluations and TSE at initial and follow-up visits. Neither randomized controlled trials nor meta-analyses on SM exist. Ideally, further studies with a large cohort of patients are needed to accurately define SM.
Additional predictors of the lower limit of cerebral autoregulation during cardiac surgery
Authors: Gavish Benjamin , Gottschalk Allan , Hogue Charles W. , Steppan Jochen 
Published: September 2023

Objectives:
The lower limit of autoregulation (LLA) of cerebral blood flow was previously shown to vary directly with the Ambulatory Arterial Stiffness Index (AASI) redefined as 1-regression slope of DBP-versus-SBP readings invasively measured from the radial artery before the bypass. We aimed expanding the predictive capacity of the LLA with AASI by combining it with additional predictors and provide new indications whether mean arterial pressure (MAP) is above/below the LLA.

Design and method:
In 181 patients undergoing cardiac surgery, mean (SD) age 71 (8) years), we identified from the demographic, preoperative and intraoperative characteristics independent and statistically significant ‘single predictors’ of the LLA (including AASI). This was achieved using multivariate linear regression with a backward-elimination technique. The single predictors combined with 1-AASI generated new multiplicative and additive composite predictors of the LLA. Indicators for the MAP-to-LLA difference (DIF) were determined using DIF-versus-predictor plots. The odds ratio (OR) for the DIF sign (Outcome = 1 for DIF≤0) and predictor-minus-median sign (Exposure = 1 for Predictor  ≤ Median) were calculated using logistic regression.

Results:
BMI, 1-AASI and systolic coefficient of variation were identified single predictors that correlated similarly with the LLA (r = −0.26 to −0.27, P < 0.001). The multiplicative and additive composite predictors displayed higher correlation with LLA (r = −0.41 and r = −0.43, respectively, P < 0.001) and improved LLA estimation. The adjusted OR for the composite predictors was nearly twice that of the single predictors.

Conclusion:
The novel composite predictors may enhance the LLA estimation and the ability to maintain MAP in the cerebral autoregulatory range during cardiac surgery.
In Vitro Effect of Propofol on the Expression of Genes Involved in Inflammation and Apoptosis in Corneal Activated Keratocytes
Authors: Sanie-Jahromi Fatemeh , Sanie Jahromi Mohammad Sadegh 
Published: September 2023

Purpose:
We investigated the effect of propofol (0.5, 5, and 50 μM) on the gene expression of inflammatory cytokines [IL-1β, IL-6, transforming growth factor β (TGF-β), and LIF] and apoptosis process (BCL-2 and Bax) in corneal activated keratocytes (CAKs).

Methods:
CAKs (106 cells/10 cm2) were exposed to propofol at a concentration of 0.5, 5, and 50 μM for 24 hours at 37°C. The control group did not receive propofol at the same time or under the same condition. Ribonucleic acid (RNA) extraction, complementary DNA (cDNA) synthesis, and real-time polymerase chain reaction (PCR) were performed to quantify the relative expression of IL-1β, IL-6, TGF-β, LIF, BCL-2, and Bax expression in the treated versus control cells.

Result:
The results of this study showed that propofol treatment (0.5 and 5 μM) led to the downregulation of IL-1β and IL-6 gene expression in CAKs. TGF-β (with a role in fibrogenesis) was not changed in 0.5 and 5 μM propofol-treated CAKs, whereas CAKs treated with 50 μM propofol showed upregulation of the TGF-β gene. LIF (with a role in regeneration) was upregulated in 0.5 and 5 μM propofol-treated CAKs. The BCL-2/Bax ratio (as the antiapoptosis index) was increased in CAKs treated with 0.5 μM propofol and indicated the induction of an antiapoptotic effect.

Conclusions:
We showed that CAKs treatment with propofol, at concentrations of 0.5 and 5 μM, could decrease the expression of genes related to inflammation and enhance the genes associated with cell regeneration. While 50 μM propofol treatment might induce CAK fibrogenesis. This proof-of-concept study could preserve a groundwork for future drug design for the treatment of corneal stromal diseases and ocular regenerative medicine.
Reimagining the Past: A Future for Antibiotic Drug Discovery in Ophthalmology
Authors: Chen Eric R. , Wozniak Rachel A. F. 
Published: September 2023

Abstract:
Antibiotic resistance has emerged as a critical threat for the treatment of bacterial ocular infections. To address the critical need for novel therapeutics, antibiotic drug repurposing holds significant promise. As such, examples of existing FDA-approved drugs currently under development for new applications, novel combinations, and improved delivery systems are discussed.
Inequities in the Training Environment and Health of Female Golfers Participating in the 2022 International Golf Federation World Amateur Team Championships
Authors: Mountjoy Margo , Schamasch Patrick , Murray Andrew , Hawkes Roger , Hospel Tomas , Thomas Bruce , Samson Ethan , Junge Astrid 
Published: September 2023

Objective:
To assess health problems and training environment of female golfers participating in the 2022 World Amateur Team Championships (WATC) and to compare golfers (a) with and without health problems prior the WATC and (b) living and training in countries ranking in the upper versus lower 50% of the team results at the 2022 WATC.

Design:
Cross-sectional cohort study using an anonymous questionnaire.

Setting:
International Golf Federation WATC.

Participants:
One hundred sixty-two female golfers from 56 countries.

Interventions:
N/A.

Main Outcome Measures:
Golfers’ answers on the presence and characteristics of health problems, their training environment, and to the Oslo Sport Trauma Research Centre Questionnaire.

Results:
Almost all golfers (n = 162; 96%) answered the questionnaire. In the 4 weeks before the WATC, 101 golfers (63.1%) experienced 186 musculoskeletal complaints, mainly at the lumbar spine/lower back, wrist, or shoulder. Just half of the golfers (50.6%) performed injury prevention exercises always or often. More than a third (37.4%) of the golfers reported illness complaints and 32.5% mental health problems in the 4 weeks preceding the WATC. General anxiety, performance anxiety, and low mood/depression were the most frequent mental health problems. Golfers with injury complaints rated their daily training environment poorer. Golfers ranking in the lower 50% at the WATC had significantly less support staff, rated their training environment poorer, and had a higher prevalence of illness complaints and mental health problems.

Conclusions:
Effective illness and injury prevention programs should be implemented and better access to education and health support in the daily training environment provided.
Impact of Trauma-Informed Care Training on Attitudes Among Emergency Department Personnel, Staff Advocates, and Nursing Students
Authors: Wholeben Melissa , Castro Yessenia , Salazar Gloria , Field Craig 
Published: September 2023

BACKGROUND:
Health care providers may risk retraumatizing patients and intensifying patient distress unless they practice trauma-informed care. As the first line of defense in assisting trauma survivors' physical and emotional recovery, health care providers must use a strengths-based framework that promotes resilience and expands on the trauma survivor's existing resources.

OBJECTIVE:
This study aimed to compare the effect of trauma-informed care training on the attitudes of emergency department personnel, staff advocates, and nursing students toward trauma-informed care.

METHODS:
This study used a pretest–posttest design. Assessment of attitudes toward trauma-informed care was done before and after trauma-informed care training. Data collection occurred from February 2021 through August 2021. Participants included three cohorts of emergency department staff, advocates for trauma survivors, and nursing students. Attitudes toward trauma-informed care were measured using the Attitudes Related to Trauma-Informed Care (ARTIC) Scale.

RESULTS:
A total of 433 participants were studied, including 88 emergency department staff, 123 staff advocates, and 222 nursing students. All three cohorts significantly increased ARTIC Scale scores posttraining (p < .001). At preintervention, all three cohorts significantly differed from each other on ARTIC Scale scores (p < .01). In contrast, postintervention, ARTIC Scale scores did not significantly differ between nursing students and advocates (p = .99). Nursing students showed a significant increase in scores from pre- to postintervention compared with either advocates or emergency department staff.

CONCLUSION:
The results strongly suggest that health care providers can improve attitudes toward trauma-informed care after completing training on the principles and application of trauma-informed care.
Probiotics for Infection Prevention in Critically Ill and Trauma Patients: A Concise Review
Authors: Vitko Heather A. , Troxell Jordan J. , Sherwood Paula R. 
Published: September 2023

BACKGROUND:
Critically ill trauma patients are at an increased risk for infection, which can increase morbidity and mortality. The use of probiotic preparations for infection prevention is promising, yet the results of their effectiveness are mixed.

OBJECTIVES:
To synthesize current research regarding the use of probiotics to prevent and possibly treat infection in the critically ill adult trauma population.

METHODS:

DATA SOURCES:
The medicine and nursing databases PubMed, CINAHL, and ProQuest were searched for this review.

STUDY SELECTION:
Studies addressed the efficacy of probiotics in the critically ill in reducing health care–associated infection rates, with particular emphasis on patients who experienced severe trauma.

DATA EXTRACTION:
Studies were reviewed and included through the consensus of the authors. Each study's population, design, methodology, results, and conclusions were analyzed for relevance. Of 170 publications retrieved and reviewed, 21 articles were identified for use in this review, including original research, meta-analyses, and reviews.

RESULTS:

DATA SYNTHESIS:
There is a lack of homogeneity of studies concerning probiotic species/strain selection and frequency and timing of dosing in the current body of literature.

KEY THEMES:
There is also a lack of consensus on what constitutes a “health care–associated infection,” with few studies identifying specific types of infection and the role probiotics may play in preventing these infections.

CONCLUSION:
Upon reviewing the current body of evidence, one cannot definitively conclude that probiotic supplementation in the critically-ill trauma population decreases health care–associated infection rates and improves outcomes, but most published evidence supports their use.
Robotic-assisted Navigation Bronchoscopy
Authors: Pyarali Fahim F. , Hakami-Majd Niv , Sabbahi Wesam , Chaux George 
Published: September 2023

Background:Robotic-assisted navigation bronchoscopy (RANB) is a novel method to biopsy lung nodules, with initial reports demonstrating excellent accuracy. We aimed to evaluate pooled estimates of diagnostic yields and complication rates with RANB by performing a meta-analysis of the available literature.Methods:We searched 3 databases, including PubMed, EmBase, and Web of Science. The resulting abstracts were reviewed by 2 investigators. Analyses were performed using random effects models, and diagnostic yield and complication rates were estimated after the Freeman-Tukey transformation.Results:A total of 23 articles, comprising 1409 patients and 1541 nodules, were included in the final analysis. Mean ages ranged from 63.2 to 69.3 years. The average size of the nodules ranged between 5.9 and 25.0 mm. Most patients (54.0% to 92.0%) had a current or prior smoking history in studies that reported them (n=8). The pooled diagnostic yield was 81.9% (12 studies, 838 nodules, 95% CI: 83.4%-91.0%), and the pooled sensitivity for malignancy was 87.6% (8 studies, 699 nodules, 95% CI: 81.3%-89.5%). The pooled incidence of pneumothorax rates was 0.60% (95% CI: 0.11%-1.35%). The pooled incidence of major bleeding was <0.01%.Conclusion:Diagnostic yield for patients with pulmonary nodules undergoing RANB is high, though may be impacted by the prevalence of malignancy, participant selection, and publication bias. Complication rates, including pneumothoraces and bleeding rates, appear low across all studies. If RANB is available, clinicians should consider utilizing this platform to biopsy pulmonary nodules.
G-EYE Improves Polyp, Adenoma, and Serrated Polyp Detection Rates in Colonoscopy
Authors: Haghbin Hossein , Zakirkhodjaev Nurruddinkhodja , Beran Azizullah , Lee Smith Wade , Aziz Muhammad 
Published: September 2023

Background:
Colonoscopy is the gold-standard test to decrease mortality from colorectal cancer (CRC). G-EYE is an inflated balloon on the bending section of the scope with the ability to flatten the folds to improve the adenoma detection rate (ADR). We performed this meta-analysis to evaluate the efficacy of G-EYE in improving ADR and other quality indicators of colonoscopy.

Methods:
A literature search was performed through March 21, 2023, on databases including Embase, Medline, Cochrane Central Register of Controlled Trials, Web of Science Core Collection, KCI—Korean Journal Index, and Global Index Medicus. Core concepts of G-EYE, colonoscopy, ADR, polyp detection rate (PDR), serrated polyp detection rate (SPDR), and withdrawal time were searched. Statistical analysis was performed with OpenMeta[Analyst]. The odds ratio (OR) for the proportional variable and mean difference for the continuous variable along with 95% CI was used with a P-value <0.05 considered statistically significant. We used the DerSimonian-Laird method and random effects model for pooling data.

Results:
The search strategy yielded a total of 143 articles. Three studies with 3868 total colonoscopies were finalized. The pooled ADR, PDR, and SPDR showed statistical improvement with G-EYE (OR: 1.744, 95% CI: 1.534-1.984, P<0.001; OR: 1.766, 95% CI: 1.547-2.015, P<0.001; and OR: 1.603, 95% CI: 1.176-2.185, P=0.003). The withdrawal time was also noted to be higher in the G-EYE group (mean difference: 0.114, CI: 0.041-0.186, P=0.002).

Conclusions:
This meta-analysis suggests that G-EYE can improve ADR, PDR, and SPDR. Further studies are needed to evaluate the effect of G-EYE on interval CRC and mortality rate.