bluuebunny/crossref_metadata_2025_split huggingface dataset:
Review of Statutory Obligations for Reporting Ballistic Injuries
Authors: Gemayel Kristina T. , Hiro Matthew E. , Sullivan Rachel R. , Payne Wyatt G. 
Published: March 2023

Background:
Traumatic ballistic injury is an unfortunate and commonly encountered problem seen by surgeons. An estimated 85,694 nonfatal ballistic injuries occur annually, and in 2020 there were 45,222 firearm-related deaths in the United States. Surgeons of all subspecialties may provide necessary care. Acute care injuries are generally reported to authorities immediately; however, delayed presentation of ballistic injuries may go unreported despite regulations to do so. We present a case of a delayed ballistic injury and a comparative review of individual states’ reporting requirements to highlight statutory obligations and penalties as an educational reference for surgeons treating ballistic injuries.

Methods:
Google and PubMed searches were performed utilizing keywords “ballistic,” “gunshot,” “physician,” and “reporting” as terms. Inclusion criteria included the English language, official state statute sites, legal and scientific articles, and websites. Exclusion criteria included nongovernmental sites and information sources. Data collected were analyzed to include statute numbers, time to report, infraction consequences, and monetary fines. The resultant data are reported by state and region.

Results:
All but two state jurisdictions mandate healthcare providers to report knowledge and/or treatment of ballistic injuries, regardless of the timeline of injury. Violations of mandatory reporting may lead to fines or imprisonment, depending on the specific state. The timeline for reporting, fines, and subsequent legal action varies by state and region.

Conclusions:
Requirements for reporting injuries exist in 48 of 50 states. The treating physician/surgeon should thoughtfully question patients with a chronic ballistic injury history and provide reports to local law enforcement.
Algorithmic Approach to Management of Complications of Permanent Facial Filler: A Saudi Experience
Authors: Alarfaj Seham , Zino Alarki Subhi M.K. , Habib Ovais , Wani Shabeer Ahmad , AlSalmi Loai Abdullah 
Published: March 2023

Background:
Facial filler is the most common type of cosmetic surgery next to Botox. Permanent filler is preferred nowadays due to low cost brought about by nonrecurring injection appointments. However, such fillers pose a higher risk for complications, with even greater adverse effects when the procedure is done using unknown dermal filler injections. This study aimed to establish an algorithm to categorize and manage patients that receive permanent fillers.

Methods:
Twelve participants were presented to the service through emergency or as outpatient from November 2015 to May 2021. Demographic characteristics such as age, sex, date of injection, time of onset, and types of complications were collected. After examination, all cases were managed based on an algorithm established. FACE-Q was used to measure overall satisfaction and psychological well-being.

Results:
An algorithm to diagnose and manage these patients effectively with high satisfaction rate was established in this study. All participants were non-smoking women, with no known medical comorbidities. The algorithm determined the treatment plan when faced with complications. Results revealed high appearance-related psychosocial distress before surgery, which significantly dropped after surgery. FACE-Q was able to establish evidence of satisfactory rating among patients before and after surgery.

Conclusion:
This treatment algorithm can guide the surgeon in formulating a suitable plan with less complications and high satisfaction rate.
Reconstruction of Noma Sequelae: A Surgical Treatment Algorithm Developed from Lessons from 210 Cases in Ethiopia
Authors: Rakhorst Hinne A. , Gresnigt Tom M. , van Kooten Oscar , Nishikawa Hiroshi , Fourie Leroux , Mizen Kelvin D. 
Published: March 2023

Background:
Noma is an infectious disease affecting mostly children aged 0–10. Although it has almost completely disappeared from the Western world, it is still prevalent in many developing regions, mainly Africa’s Sahel region. The infection behaves like a necrotizing fasciitis of the face, originating from the gums and progressively expanding into the cheek, nose, or eye regions. In an estimated 90% of cases, the disease is lethal as a result of systemic sepsis. For survivors, typical results are extensive defects of the cheek, nose, and periorbital and perioral regions. Due to the defects, extensive scarring is common, which leads to secondary problems such as growth alterations in an infant’s skeleton due to inhibition and restraint of growth resulting typically in cicatricial skeletal hypoplasia. Other sequelae include trismus, partially caused by scarring or complete fusion between maxilla/zygomatic arch and mandible. The resulting overall disfiguring facial appearance results in patients being disabled and socially isolated.

Methods:
Facing Africa is a UK-based non-governmental organization that treats the secondary problems of Ethiopian noma survivors. Operations are performed in Addis Ababa by a visiting expert team. Postoperatively, patients are seen annually for years after the surgery.

Results:
This article discusses basic principles, goals, and a practical surgical algorithm for operating on lip, cheek, and oral defects, based on 210 noma patients who were operated on in Ethiopia over a period of 11 years.

Conclusions:
The suggested algorithm has proven to work for the Facing Africa team members and is considered shareware for all surgeons to use and benefit from.
Antibiotic Prophylaxis for Distal Interphalangeal Joint Arthrodesis
Authors: Vohra Sahil F. , Beck Jadon H. , Barrett Patrick C. , Bravo Cesar J. , Apel Peter J. 
Published: March 2023

Background:
Prior evidence is clear that in clean, elective soft-tissue hand procedures less than 2 hours, antibiotic prophylaxis is not indicated. However, there is a lack of consensus regarding the boney procedures of the hand involving implanted hardware. Previous studies reviewing complications after distal interphalangeal (DIP) joint arthrodesis did not analyze whether patients receiving antibiotics before surgery had a significant difference in the infection rate.

Methods:
A retrospective review of clean, elective DIP arthrodesis was conducted between September 2018 and September 2021. The subjects were aged 18 years and older and underwent elective DIP arthrodesis for the treatment of osteoarthritis or deformity of the DIP joint. All the procedures were performed using an intramedullary headless compression screw. The rates of postoperative infections and treatments required for infections were recorded and analyzed.

Results:
Overall, 37 unique patients had at least one case of DIP arthrodesis that met the criteria for inclusion in our analysis. Twenty of the 37 patients did not receive antibiotic prophylaxis, and 17 of the 37 patients received antibiotic prophylaxis. Five of the 20 patients who did not receive antibiotics prophylactically developed infections, and none of the 17 patients who received antibiotics prophylactically developed an infection. Fisher exact test revealed a significant difference in the infection rates between the two groups (P < 0.05). There was no significant difference in infections with respect to smoking or diabetes status.

Conclusion:
Antibiotic prophylaxis should be administered for clean, elective DIP arthrodesis, using an intramedullary screw.
Ant Waist Surgery: Aesthetic Removal of Floating Ribs to Decrease the Waist-hip Ratio
Authors: Chiu Yen-Hao , Chiu Yu-Jen , Lee Chia-Chun , Wang Tien-Hsiang , Lee Jin-Liang 
Published: March 2023

Summary:
Decreasing waist circumference has become an essential feature in modern body contouring surgery owing to the attractiveness of hourglass body shapes. Traditionally, this can be achieved through lipomodeling and abdominal musculature strengthening techniques. An adjunctive procedure for ideal shaping of the waistline is resection of the 11th and 12th ribs, referred to as floating ribs. This study aimed to report and analyze clinical outcomes and self-reported patient satisfaction after “ant waist” surgery (floating rib removal) for aesthetic reasons. We retrospectively reviewed the medical records of five patients who had undergone bilateral 11th and 12th rib resections at a single institute in Taiwan in an outpatient setting. The mean lengths of the resected left and right 11th ribs were 9.1 and 9.5 cm, respectively. The mean lengths of the resected left and right 12th ribs were 6.3 and 6.4 cm, respectively. The mean waist-to-hip ratio decreased from 0.78 preoperatively to 0.72 postoperatively, with a mean decrease of 7.7%. No adverse events were reported. Generally, all patients reported being satisfied with the operation. Floating rib resection proved useful and effective in decreasing the waist-to-hip ratio using a safe, simple, and reproducible technique without significant complications. Although preliminarily, the authors’ comprehensive demonstration of this ant waist surgery supports further studies focusing on waistline contouring.
Influence of Mild Traumatic Brain Injury History and Mental Health Status on Alcohol and Cannabis Use in University Athletes
Authors: Wilson Alyssia , Gicas Kristina , Wojtowicz Magdalena 
Published: March 2023

Objective:
This study examined the relationship between mild traumatic brain injury (mTBI) history, mental health, and sex with single and polysubstance use in university athletes.

Design:
Observational study.

Setting:
University in Ontario, Canada.

Participants:
Participants were identified from a dataset of 416 university athletes ages 18 to 21. Participants were classified based on their substance use habits and, 153 met criteria for the nonsubstance group, 195 for the alcohol use (AU) only group, and 64 polysubstance use group [ie, a combined substance use (AU+) group].

Independent Variables:
Athletes received baseline assessments and completed self-reported questions regarding alcohol, cannabis, or other recreational substance use, the Patient Health Questionnaire-9, self-reported mTBI history, and self-reported anxiety, and/or panic disorder endorsement information.

Main Outcome Measures:
Comparison of mTBI history and mental health status between individuals in the alcohol only or polysubstance use group.

Results:
Mild traumatic brain injury history was a significant predictor of AU (P < 0.001) and AU+ (P < 0.001). Anxiety endorsement was also a significant predictor of polysubstance use (P < 0.001) and there was a small but nonsignificant association of polysubstance use in men (P = 0.057).

Conclusions:
University athletes who experience mTBI are more likely to engage in single or polysubstance use and athletes who experience anxiety are more likely to engage in polysubstance use. Consideration of mTBI history and mental health may inform clinical concussion management for identifying potential high-risk behavior such as polysubstance use in university athletes and tailoring intervention strategies (eg, incorporating education about substance use).
Artistic Swimming Injuries in Young Elite Athletes: An 11-year Follow-Up
Authors: Vignaud Emeline , Menu Pierre , Daley Pauline , Grondin Jérôme , Dauty Marc , Fouasson-Chailloux Alban 
Published: March 2023

Objective:
Artistic swimming is a highly challenging discipline, requiring physical skills and creativity. There are almost no published data on trauma. We aimed to assess the incidence and the nature of injuries in artistic swimmers.

Design:
An 11-year retrospective single-center cohort study.

Setting:
Department of Sport Medicine of a University Hospital.

Patients:
One hundred and twenty-four elite female artistic swimmers aged 12.9 ± 1.6 years.

Interventions:
The cohort was divided into 3 groups according to the competition categories (from 9 to 12 years old called “future”, 12-15 years old called “youth”, 15-19 years old called “junior”).

Main Outcome Measures:
Injury rate per season and per athlete was assessed.

Results:
The injury rate was 0.95 injuries/season/athlete and 1.05 injuries/1000 hours of practice. The most frequent injuries were rotator cuff tendinopathy (13.6%), acute low back pain (13.6%), and patellofemoral syndrome (11.9%). Swimmers in the youth and junior categories had significantly more injuries than those in the future category (P = 0.009), possibly because of more training hours (P < 0.001). Twelve major injuries occurred, all in the same group of youth swimmers.

Conclusion:
This is the first study investigating trauma during artistic swimming practice. A better knowledge of the main injuries is necessary for the physician to provide optimal care for athletes and to develop prevention. Attention should be particularly paid to the swimmers' shoulders and knees.
Myxopapillary Ependymoma in an 11-Year-Old Patient With Right-Sided Nocturnal Thigh Pain
Authors: Sim Don , Groswald Michael , Watters Aaron 
Published: March 2023

Abstract:
This case report highlights a rare type of primary spinal cord tumor, myxopapillary ependymoma, in a pediatric patient who presented to clinic with worsening chronic unilateral thigh pain and neurologic deficits. He was appropriately treated with total gross resection of the tumor and adjuvant radiotherapy and was cleared for competitive sports without any restriction within 1 year of his diagnosis and treatment. Although most musculoskeletal complaints among pediatric patients are of benign etiology, as evidenced by our case, clinicians should have a low threshold to further investigate with advanced imaging modalities should the clinical history and examination be consistent with a more concerning pathologic process.
PET in bladder cancer imaging
Authors: Muin Dina , Laukhtina Ekaterina , Hacker Marcus , Shariat Shahrokh F. 
Published: March 2023

Purpose of review
The aim of this study was to summarize the available evidence on different PET imaging modalities for the staging of patients diagnosed with bladder cancer (BCa). We further discuss the use of PET/computed tomography (CT) and PET/MRI with different radiopharmaceuticals to characterize tumour biology for treatment guidance.

Recent findings
Available evidence supports the benefits of PET/CT in BCa staging due to its higher accuracy in the detection of nodal metastases compared with CT alone. The use of PET/MRI is of major future interest due to the higher soft tissue contrast of MRI, which might enable the early detection of the tumour in the bladder. For the time being, the sensitivity of PET/MRI is still too low, when it comes to the diagnosis of early-stage BCa. This is mainly due to the renal excretion of the commonly used [18F]FDG PET tracer, wherefore small lesions in the wall of the bladder can be missed. Novel studies using PET radiopharmaceuticals to target immune checkpoints or other immune cell targets (immunoPET) demonstrated high uptake in tumour lesions with high PD-L1 expression. The use of immunoPET could therefore help identify BCa patients who exhibit PD-L1 positive tumours for systemic immune-therapy.

Summary
PET/CT and PET/MRI seem to be promising imaging tools in BCa staging, especially for the detection of lymph node and distant metastases, as they are more accurate than conventional CT. Future clinical trials with novel radiopharmaceuticals and machine-learning driven PET-technologies bear the potential to help in the early detection, staging, monitoring and precision-medicine approach. Specifically, immunoPET is of high future interest, as it could help develop the concept of precision-medicine in the age of immunotherapy.
Thoracic Aortic Aneurysm and Dissection
Authors: Krywanczyk Alison , Rodriguez E. Rene , Tan Carmela D. , Gilson Thomas 
Published: March 2023

Abstract
Aortic dissection and rupture (collectively termed “sudden aortic death”) are commonly encountered by forensic pathologists, with an estimated incidence at autopsy between 0.6% and 7.7%. Despite this, there is no standard of practice for the evaluation of sudden aortic death at autopsy.
Recent studies have shown 20% of patients with thoracic aortic aneurysm or dissection (TAAD) have an identifiable genetic syndrome, and 19% will have an affected first-degree relative. The past 2 decades have seen identification of new culprit genes and syndromes, which can have subtle or nonexistent external phenotypes. A high index of suspicion is warranted to identify possible hereditary TAAD (H-TAAD), allowing family members to obtain screening to avoid catastrophic vascular events. Forensic pathologists need broad knowledge of the spectrum of H-TAAD and awareness of the relative significance of hypertension, pregnancy, substance use, and microscopic changes of aortic architecture.
This article reviews the common subtypes of H-TAAD, including Marfan syndrome, vascular Ehlers-Danlos, Loeys-Dietz, and familial thoracic aortic aneurysm and dissection. Recommendations for the evaluation of sudden aortic death at autopsy are presented, including (1) performance of a complete autopsy, (2) documentation of aortic circumference and valve morphology, (3) notifying family of the need for screening, and (4) preservation of a sample for potential genetic testing.
Improving Daily Patient Goal-Setting and Team Communication: The Liber8 Glass Door Project*
Authors: Jones Ian G. R. , Friedman Shayne , Vu Michael , Awladthani Saif , Watts Cathy , Simpson Andrea , Al-Farsi Ahmed A. , Gupta Ronish , Cupido Cynthia , Choong Karen 
Published: March 2023

OBJECTIVES:
To develop and implement a tool to improve daily patient goal setting, team collaboration and communication.

DESIGN:
Quality improvement implementation project.

SETTING:
Tertiary-level PICU.

PATIENTS:
Inpatient children less than 18 years old requiring ICU level care.

INTERVENTION:
A “Glass Door” daily goals communication tool located in the door front of each patient room.

MEASUREMENTS AND MAIN RESULTS:
We used Pronovost’s 4 E’s model to implement the Glass Door. Primary outcomes were uptake of goal setting, healthcare team discussion rate around goals, rounding efficiency, acceptability and sustainability of the Glass Door. The total implementation duration from engagement to evaluation of sustainability was 24 months. Goal setting increased significantly from 22.9% to 90.7% (p < 0.01) patient-days using the Glass Door compared to a paper-based daily goals checklist (DGC). One-year post implementation, the uptake was sustained at 93.1% (p = 0.04). Rounding time decreased from a median of 11.7 minutes (95% CI, 10.9–12.4 min) to 7.5 minutes (95% CI, 6.9–7.9 min) per patient post-implementation (p < 0.01). Goal discussions on ward rounds increased overall from 40.1% to 58.5% (p < 0.01). Ninety-one percent of team members perceive that the Glass Door improves communication for patient care, and 80% preferred the Glass Door to the DGC for communicating patient goals with other team members. Sixty-six percent of family members found the Glass Door helpful in understanding the daily plan and 83% found it helpful in ensuring thorough discussion among the PICU team.

CONCLUSIONS:
The Glass Door is a highly visible tool that can improve patient goal setting and collaborative team discussion with good uptake and acceptability among healthcare team members and patient families.
Early Changes in Arterial Partial Pressure of Carbon Dioxide and Blood Pressure After Starting Extracorporeal Membrane Oxygenation in Children: Extracorporeal Life Support Organization Database Study of Neurologic Complications*
Authors: Shah Neel , Li Xilong , Shanmugham Prashanth , Fan Eddy , Thiagarajan Ravi R. , Venkataraman Ramgopal , Raman Lakshmi 
Published: March 2023

Objective:
Neurologic complications in pediatric patients supported by extracorporeal membrane oxygenation (ECMO) are common and lead to morbidity and mortality; however, few modifiable factors are known.

Design:
Retrospective study of the Extracorporeal Life Support Organization registry (2010–2019).

Setting:
Multicenter international database

Patients:
Pediatric patients receiving ECMO (2010–2019) for all indications and any mode of support.

Interventions:
None.

Measurements and Main Results:
We investigated if early relative change in Paco
2 or mean arterial blood pressure (MAP) soon after starting ECMO was associated with neurologic complications. The primary outcome of neurologic complications was defined as a report of seizures, central nervous system infarction or hemorrhage, or brain death. All-cause mortality (including brain death) was used as a secondary outcome.
Out of 7,270 patients, 15.6% had neurologic complications. Neurologic complications increased when the relative Paco
2 decreased by greater than 50% (18.4%) or 30–50% (16.5%) versus those who had a minimal change (13.9%, p < 0.01 and p = 0.046). When the relative MAP increased greater than 50%, the rate of neurologic complications was 16.9% versus 13.1% those with minimal change (p = 0.007). In a multivariable model adjusting for confounders, a relative decrease in Paco
2 greater than 30% was independently associated with greater odds of neurologic complication (odds ratio [OR], 1.25; 95% CI, 1.07–1.46; p = 0.005). Within this group, with a relative decrease in Paco
2 greater than 30%, the effects of increased relative MAP increased neurologic complications (0.05% per BP Percentile; 95% CI, 0.001–0.11; p = 0.05).

Conclusions:
In pediatric patients, a large decrease in Paco
2 and increase in MAP following ECMO initiation are both associated with neurologic complications. Future research focusing on managing these issues carefully soon after ECMO deployment can potentially help to reduce neurologic complications.
Quantification of facial fat compartments variations according to gender, age and BMI: a 3-Dimensional morphometric analysis of the cheek
Authors: Estler Arne , Grözinger Gerd , Estler Eva , Hepp Tobias , Feng You-Shan , Daigeler Adrien , G. Jorge A. Cristina S. R. , Santos Stahl Adelana , Nikolaou Konstantin , Stahl Stéphane 
Published: March 2023

Objective:
The contour of the cheek is the main determinant of facial attractivity. The aim of this study is to evaluate the relationship between age, gender and BMI and cheek fat volume in a large cohort to better understand and treat facial aging.

Materials and methods:
This study was performed by a retrospective review of the archives of the Department of Diagnostic and Interventional Radiology, University Hospital of Tübingen. Epidemiological data and medical history were assessed. The patients´ cheek superficial and deep fat compartment volumes were measured on magnetic resonance (MR) images. Statistical analyses were performed using the SPSS (Statistical Package for Social Sciences, version 27) and SAS statistical software package (Version 9.1; SAS Institute, Inc, Cary, NC).

Results:
87 patients with a mean age of 46.0 years (range: 18–81 years) were included. The superficial and deep fat compartment volumes of the cheek increase with BMI (p< 0.001 and p=0.005), but there was no significant relationship between age and volume. The ratio of superficial versus deep fat does not change with age. No significant difference of the superficial or deep fat compartments was found between men and women in a regression analysis (p=0.931 and p=0.057).

Conclusion:
Cheek fat volume measurements on MRI scans using reconstruction software suggest that the fat volume of the cheek increases with BMI but does not significantly change with age. Further studies will have to elucidate the role of age-related changes of bone structures or sagging of the fat compartments.

Level of Evidence:
II (Exploratory cohort study developing diagnostic criteria (with “gold” standard as reference) in a series of consecutive patients).