bluuebunny/crossref_metadata_2025_split huggingface dataset:
Cervical Chondrocutaneous Branchial Remnant: A Case Report and Review of the Literature
Authors: Saliba Elie , Brem Candice 
Published: September 2023

Abstract:
Cervical chondrocutaneous branchial remnant is a rare congenital developmental anomaly typically located on the lateral neck. Histologically, it has the appearance of an accessory tragus demonstrating a central cartilaginous core with surrounding fibrosis located in the subcutaneous tissue. The condition has been associated with a variety of congenital anomalies, particularly involving the auditory, cardiovascular, and visual systems. Given that research-based evidence related to cervical chondrocutaneous branchial remnant in dermatology literature is sparse, we present this case to raise more awareness about this entity among dermatopathologists and review the different histopathologic presentations and possible associated anomalies.
Phenytoin Intoxication in a Patient Receiving a Therapeutic Dose for Postoperative Seizure Prophylaxis: A Case Study
Authors: Prasertsup Warisa , Chomchai Summon , Mekavuthikul Pattaraporn , Phuditshinnapatra Jariya 
Published: September 2023

Objective:
Phenytoin is commonly prescribed to prevent postoperative seizures. Despite the rarity of the CYP2C9 genetic polymorphism, which may result in poor phenytoin metabolism, in the Thai population, the authors report a case of phenytoin toxicity in a patient with poor metabolism administered with a standard dose of phenytoin.

Case Report:
A 58-year-old Thai woman presented to the outpatient clinic with a 2-day history of nausea, vomiting, and dizziness. She underwent craniotomy for tumor removal 2 weeks after being diagnosed with tuberculum sellae meningioma. After the surgery, she was prescribed 300 mg of phenytoin daily to prevent seizures. During the physical examination, ataxia, horizontal nystagmus, and cerebellar abnormalities were observed, with an initial serum phenytoin concentration of 58.85 mg/L. The brain imaging results were unremarkable. Omeprazole was the only recognized drug interaction; however, it is highly unlikely to account for this condition. Pharmacogenetic investigation of CYP2C9 revealed a homozygous CYP2C9*3/*3 mutation, which is indicative of suboptimal drug metabolism and can reduce phenytoin metabolism by 50%. This patient was administered repeated dosages of activated charcoal over the course of 2 days. Her symptoms eventually subsided, with the phenytoin levels dropping to 29.51 mg/L.

Conclusions:
In the absence of an overdose history or drug–drug interaction, CYP2C9 polymorphism should be suspected in patients with phenytoin toxicity. In such situations, the phenytoin dosage must be decreased and monitored closely.
Use and outcome of TIPS in hospitalized patients in Germany: A Nationwide study (2007–2018)
Authors: Gu Wenyi , Zeleke Yasmin , Hortlik Hannah , Schaaf Louisa , Uschner Frank E. , Schulz Martin , Tischendorf Michael , Peiffer Kai-Henrik , Brol Maximilian Joseph , Kimmann Markus , Vogl Thomas , Köhler Michael , Meyer Carsten , Gerbes Alexander , Rössle Martin , Laleman Wim , Zipprich Alexander , Steib Christian , Praktiknjo Michael , Trebicka Jonel ,   German TIPS Working Group
Published: September 2023

Background:
The number of complications in patients admitted for cirrhosis has increased over time. Portal hypertension is the driver of many complications of cirrhosis. TIPS placement is the most effective treatment of portal hypertension. The aim of this study was to analyze the use and impact of TIPS placement in the last decade in a nationwide study in Germany.

Methods:
We analyzed 14,598 admissions of patients for TIPS insertions in Germany from 2007 to 2018 using the DRG system, 12,877 out of 2,000,765 total admissions of patients with cirrhosis. All diagnoses and procedures were coded according to ICD-10-CM and OPS codes. The data were analyzed, focusing on the number of admissions and in-hospital mortality.

Results:
The number of TIPS placements increased over the last decade. In-hospital mortality of cirrhotic patients with TIPS decreased when it was placed for severe bleeding (15.2% [TIPS] vs. 19.5% [endoscopy treatment]), ascites (8.7% [TIPS] vs. 14.4% [paracentesis]), and hepatorenal syndrome (HRS) (17.1% [TIPS] vs. 43.3% [no-TIPS]). In the case of bleeding, TIPS significantly decreased in-hospital mortality and also in ascites and HRS. During hospitalization, 22.6% admissions of patients with TIPS insertion showed HE. However, in-hospital mortality in patients admitted with HE grades 1 or 2 and TIPS was lower than in patients without TIPS. In the logistic regression, a higher HE grade(3 and 4), infection, and circulatory disease were found to be independently associated with in-hospital mortality in patients with TIPS insertion.

Conclusion:
Our nationwide study demonstrates that TIPS insertion is increasingly used in Germany. TIPS improves outcomes, especially in patients with ascites and HRS, regardless of lower HE grades, while higher HE grades, infection, and circulatory diseases seem to be associated with risk of in-hospital mortality.
Transversal psoas muscle thickness measurement is associated with response and survival in patients with HCC undergoing immunotherapy
Authors: Scheiner Bernhard , Lampichler Katharina , Pomej Katharina , Beer Lucian , Balcar Lorenz , Sartoris Riccardo , Bouattour Mohamed , Sidali Sabrina , Trauner Michael , Mandorfer Mattias , Reiberger Thomas , Scharitzer Martina , Tamandl Dietmar , Pinato David J. , Ronot Maxime , Pinter Matthias 
Published: September 2023

Background:
Sarcopenia is a common problem in patients with HCC. We aimed to evaluate the prognostic and predictive value of baseline transversal psoas muscle thickness (TPMT) measurement in patients with HCC undergoing immunotherapy.

Methods:
HCC patients treated with programmed death ligand 1–based therapies between June 2016 and October 2022 at the Vienna General Hospital (n = 80) and the Hôpital Beaujon Clichy (n = 96) were included and followed until April 2023. TPMT at the level of the third lumbar vertebra was measured independently by 2 radiologists to evaluate interreader reliability. TPMT <12 mm/m in men and <8 mm/m in women indicated sarcopenia.

Results:
Overall, 176 patients (age: 66.3±11.7 y; male: n=143, 81%, Barcelona-Clinic Liver Cancer C: n=121, 69%) were included, of which 131 (74%) exhibited cirrhosis. Interreader agreement for the diagnosis of sarcopenia based on TPMT was 92.6%, and Cohen κ showed a “strong agreement” [κ = 0.84 (95% CI: 0.75–0.92)]. Sarcopenia, present in 58 patients (33%), was associated with shorter median overall survival [7.2 (95% CI: 5.0–9.5) vs. 22.6 (95% CI: 16.4–28.8 months); p < 0.001] and median progression-free survival [3.4 (95% CI: 0.2–6.8) vs. 7.9 (95% CI: 5.8–9.9 months), p = 0.001], and an independent predictor of overall [adjusted HR: 1.63 (95% CI: 1.07–2.48)] and progression-free mortality [adjusted HR: 1.54 (95% CI: 1.06–2.23)] in multivariable analyses. The objective response rate [evaluable in 162 subjects (92.0%)] per modified Response Evaluation Criteria In Solid Tumors (mRECIST) in patients with and without sarcopenia was 22% and 39%, respectively (p = 0.029). Survival and radiological responses were worse in patients with sarcopenia and systemic inflammation [median overall survival: 6.1 (95% CI: 3.6–8.6) mo; median progression-free survival: 2.8 (95% CI: 2.1–3.4) mo; objective response rate=16%; disease control rate=39%].

Conclusions:
Evaluation of sarcopenia using TPMT measurement is reliable and identifies HCC patients with a dismal prognosis and response to immunotherapy.
Evaluation of the Performance of Different Types of Radiation Protection Gloves: A Cross-sectional Study
Authors: Yasuda Mitsuyoshi , Manabu Syoji , Fuji Tomoki , Seino Noritaka , Watanabe Hiroyuki , Sato Hisaya , Kato Kyoichi 
Published: September 2023

Abstract
Radiation exposure of a practitioner’s fingers is a problem in interventional radiology, and radiation protection gloves (protective gloves) can help reduce such exposure. Several types of protective gloves are commercially available from various manufacturers. In the present study, we compared the protective effects and usability of four types of protective gloves. To investigate the radiation protection effect, we placed normal surgical gloves and the four types of protective gloves on phantom hands with thermoluminescent dosimeters (TLD) attached to the fingertips and the dorsum and palms of the hands. Next, they were irradiated with x rays, and the radiation dose was measured and compared using the TLDs. In terms of usability, 42 medical staff members completed a questionnaire that included seven items, such as finger movability, tactile sensation, grip, and overall satisfaction, which were scored on a 5-point scale. Consequently, the protective effects differed between the gloves, and radiation exposure was lower by 30% to 60% with these gloves compared with surgical gloves. In terms of usability, a difference of 2 to 4 points was noted between the gloves for each questionnaire item. These results suggest that radiation protective gloves can protect the surgeon's fingers from radiation exposure without reducing work efficiency by selecting gloves according to the surgical procedure.
Psychosocial Factors Associated With Time to Recovery After Concussion in Adolescent Ice Hockey Players
Authors: Luszawski Caroline A. , Plourde Vickie , Sick Stacy R. , Galarneau Jean-Michel , Eliason Paul H. , Brooks Brian L. , Mrazik Martin , Debert Chantel T. , Lebrun Constance , Babul Shelina , Hagel Brent E. , Dukelow Sean P. , Schneider Kathryn J. , Emery Carolyn A. , Yeates Keith Owen 
Published: September 2023

Objective:
To investigate the association between psychosocial factors and physician clearance to return to play (RTP) in youth ice hockey players after sport-related concussion.

Design:
Prospective cohort study, Safe to Play (2013-2018).

Setting:
Youth hockey leagues in Alberta and British Columbia, Canada.

Participants:
Three hundred fifty-three ice hockey players (aged 11-18 years) who sustained a total of 397 physician-diagnosed concussions.

Independent Variables:
Psychosocial variables.

Main Outcome Measures:
Players and parents completed psychosocial questionnaires preinjury. Players with a suspected concussion were referred for a study physician visit, during which they completed the Sport Concussion Assessment Tool (SCAT3/SCAT5) and single question ratings of distress and expectations of recovery. Time to recovery (TTR) was measured as days between concussion and physician clearance to RTP. Accelerated failure time models estimated the association of psychosocial factors with TTR, summarized with time ratios (TRs). Covariates included age, sex, body checking policy, days from concussion to the initial physician visit, and symptom severity at the initial physician visit.

Results:
Self-report of increased peer-related problems on the Strengths and Difficulties Questionnaire (TR, 1.10 [95% CI, 1.02-1.19]), higher ratings of distress about concussion outcomes by participants (TR, 1.06 [95% CI, 1.01-1.11]) and parents (TR, 1.05 [95% CI, 1.01-1.09]), and higher parent ratings of distress about their child's well-being at the time of injury (TR, 1.06 [95% CI, 1.02-1.09]) were associated with longer recovery.

Conclusions:
Greater pre-existing peer-related problems and acute distress about concussion outcomes and youth well-being predicted longer TTR. Treatment targeting these psychosocial factors after concussion may promote recovery.
Newborn screening for severe combined immunodeficiency and inborn errors of immunity
Authors: Lev Atar , Somech Raz , Somekh Ido 
Published: September 2023

Purpose of reviewSevere combined immune deficiency (SCID) is the most devastating genetic disease of the immune system with an unfavorable outcome unless diagnosed early in life. Newborn screening (NBS) programs play a crucial role in facilitating early diagnoses and timely interventions for affected infants.Recent findingsSCID marked the pioneering inborn error of immunity (IEI) to undergo NBS, a milestone achieved 15 years ago through the enumeration of T-cell receptor excision circles (TRECs) extracted from Guthrie cards. This breakthrough has revolutionized our approach to SCID, enabling not only presymptomatic identification and prompt treatments (including hematopoietic stem cell transplantation), but also enhancing our comprehension of the global epidemiology of SCID.SummaryNBS is continuing to evolve with the advent of novel diagnostic technologies and treatments. Following the successful implementation of SCID-NBS programs, a call for the early identification of additional IEIs is the next step, encompassing a broader spectrum of IEIs, facilitating early diagnoses, and preventing morbidity and mortality.
Prophylactic Antibiotics to Prevent Cholangitis in Children with Biliary Atresia After Kasai Portoenterostomy: A Meta-Analysis
Authors: Alatas Fatima Safira , Lazarus Glen , Junaidi Michelle Clarissa , Oswari Hanifah 
Published: September 2023

Objectives:
A connection between the bowel and bile ducts after the Kasai hepatoportoenterostomy (HPE) procedure poses a risk of ascending cholangitis. There were only a few evidence-based consensuses on the benefits of prophylactic antibiotics. This study aims to assess the value of prophylactic antibiotics in reducing the risk of cholangitis following the Kasai HPE procedure.

Methods:
Meta-analysis is performed using random-effects model from the search result of 5 online databases (PubMed, Google Scholar, EBSCO MEDLINE, ClinicalTrials.gov, and EuropePMC) from inception to October 27, 2021. The keywords used were “antibiotic,” “antimicrobial,” “Kasai,” “portoenterostomy,” “biliary atresia,” and “bile duct atresia.” Cochrane Risk of Bias tool and Newcastle-Ottawa Scale is used to assess the risk of bias. The outcomes are incidence of cholangitis and native liver survival.

Results:
Six studies consisting of 4 cohorts and 2 cross-sectional studies were extracted. A total of 714 patients reported different cholangitis incidence after prophylactic antibiotics administration post-Kasai HPE. The incidence of cholangitis following Kasai HPE was not statistically significant among participants. There is conflicting evidence on the efficacy of antibiotics in prolonging native liver survival.

Conclusions:
The existing evidence does not support the administration of prophylactic antibiotics in preventing cholangitis after Kasai HPE among biliary atresia patients. Additionally, their roles in native liver survival are still inconclusive. The fact that there were heterogeneous method and antibiotic usage between existing studies must also be highlighted for better design in future studies.
Validation of a Reduced Set of High-Performance Triggers for Identifying Patient Safety Incidents with Harm in Primary Care: TriggerPrim Project
Authors: Garzón González Gerardo , Alonso Safont Tamara , Conejos Míquel Dolores , Castelo Jurado Marta , Aguado Arroyo Oscar , Jurado Balbuena Juan José , Villanueva Sanz Cristina , Zamarrón Fraile Ester , Luaces Gayán Arancha , Cañada Dorado Asunción , Martínez Patiño Dolores , Magán Tapia Purificación , Barberá Martín Aurora , Toribio Vicente María José , Drake Canela Mercedes , Mediavilla Herrera Inmaculada 
Published: September 2023

Objective
The aim of the study was to construct and validate a reduced set of high-performance triggers for identifying adverse events (AEs) via electronic medical records (EMRs) review in primary care (PC).

Methods
This was a cross-sectional descriptive study for validating a diagnostic test. The study included all 262 PC centers of Madrid region (Spain). Patients were older than 18 years who attended their PC center over the last quarter of 2018. The randomized sample was n = 1797. Main measurements were as follows: (a) presence of each of 19 specific computer-identified triggers in the EMR and (b) occurrence of an AE. To collect data, EMR review was conducted by 3 doctor-nurse teams. Triggers with statistically significant odds ratios for identifying AEs were selected for the final set after adjusting for age and sex using logistic regression.

Results
The sensitivity (SS) and specificity (SP) for the selected triggers were: ≥3 appointments in a week at the PC center (SS = 32.3% [95% confidence interval {CI}, 22.8%–41.8%]; SP = 92.8% [95% CI, 91.6%–94.0%]); hospital admission (SS = 19.4% [95% CI, 11.4%–27.4%]; SP = 97.2% [95% CI, 96.4%–98.0%]); hospital emergency department visit (SS = 31.2% [95% CI, 21.8%–40.6%]; SP = 90.8% [95% CI, 89.4%–92.2%]); major opioids prescription (SS = 2.2% [95% CI, 0.0%–5.2%]; SP = 99.8% [95% CI, 99.6%–100%]); and chronic benzodiazepine treatment in patients 75 years or older (SS = 14.0% [95% CI, 6.9%–21.1%]; SP = 95.5% [95% CI, 94.5%–96.5%]).
The following values were obtained in the validation of this trigger set (the occurrence of at least one of these triggers in the EMR): SS = 60.2% (95% CI, 50.2%–70.1%), SP = 80.8% (95% CI, 78.8%–82.6%), positive predictive value = 14.6% (95% CI, 11.0%–18.1%), negative predictive value = 97.4% (95% CI, 96.5%–98.2%), positive likelihood ratio = 3.13 (95% CI, 2.3–4.2), and negative likelihood ratio = 0.49 (95% CI, 0.3–0.7).

Conclusions
The set containing the 5 selected triggers almost triples the efficiency of EMR review in detecting AEs. This suggests that this set is easily implementable and of great utility in risk-management practice.
Energy expenditure during typical household and community activities of daily living in persons with lower limb amputation: A pilot study
Authors: Mellema Mirjam , Gjøvaag Terje 
Published: September 2023

Introduction:
Knowledge about the energy expenditure of typical activities of daily living (ADL) in persons with lower limb amputation (LLA) is lacking. This study investigated the following: (1) oxygen consumption per unit distance (V̇O2; mL·kg−1·min−1), (2) proportion utilization of peak oxygen consumption (%V̇O2peak), (3) oxygen cost (energy cost; mL·kg−1·m−1), and (4) perceived exertion (rating of perceived exertion) of ADL in persons with LLA and able-bodied controls.

Methods:
Participants (21 with LLA/12 controls) performed 2 household ADL experiments: in-house walking and vacuuming and 3 community ADL experiments: marked shopping, fast walking, and stair negotiation. V̇O2peak was assessed with arm crank ergometry, and ambulatory activity was monitored for 7 days with a StepWatch.

Results:
Participants with LLA performed in-house walking, marked shopping, vacuuming, and stair negotiation at a similar V̇O2 as controls, while their self-selected walking speed (WS) was significantly lower. Participants with LLA had significantly higher %V̇O2peak than controls during in-house walking and reported a significantly higher rating of perceived exertion for vacuuming and marked shopping. The highest possible WS of participants with LLA during fast walking was significantly lower than that of controls, but V̇O2 was also significantly lower, indicating a limited capacity to walk at higher WS. Participants with LLA had a significantly lower daily step count, significantly lower-proportion high-intensity ambulation, but significantly higher-proportion low-intensity ambulation than controls, indicating that persons with LLA also walked at lower WS in daily life.

Conclusions:
The results indicate that persons with LLA have increased physical and perceived effort during performance of ADL compared with persons without amputation, which has consequences for community participation, and hence independence and quality of life.
The Tennessee Center for AIDS Research HIV Research Training Program for Minority High School and Undergraduate Students: Development, Implementation, and Early Outcomes
Authors: Koethe John R. , Eeds Angela , Stewart LaMonica V. , Haas David W. , Hildreth James E. K. , Mallal Simon , Wanjalla Celestine , Perkins Jessica , Ahonkhai Aima , Dong Xinhong , Berhanu Rebecca , Dash Chandravanu 
Published: September 2023

Background:
The Southern region of the United States has the highest HIV incidence, and new infections disproportionately affect Black Americans. The Tennessee Center for AIDS Research (CFAR) Diversity, Equity, and Inclusion Pathway Initiative (CDEIPI) program supports the training of individuals from groups underrepresented in medicine and science in multiple areas of research to increase the pool of HIV-focused investigators at early educational and career stages.

Setting:
The Tennessee CFAR is a partnership between Vanderbilt University Medical Center, Meharry Medical College (one of the oldest historically Black medical colleges), Tennessee Department of Health, and Nashville Community AIDS Resources, Education and Services (a sophisticated community service organization, which emphasizes research training responsive to regional and national priorities).

Methods:
The Tennessee CFAR CDEIPI program leverages existing Vanderbilt University Medical Center and Meharry Medical College structured biomedical training programs for high school and undergraduate students to provide an intensive, mentored, HIV research experience augmented by CFAR resources situating this training within the broader history, scientific breadth, and societal and political aspects of the HIV epidemic.

Results:
The first year of the Tennessee CFAR CDEIPI program trained 3 high school and 3 undergraduate students from underrepresented in medicine and science backgrounds in basic, clinical/translational, and community-focused research projects with a diverse group of 9 mentors. All students completed the program, and evaluations yielded positive feedback regarding mentoring quality and effectiveness, and continued interest in HIV-related research.

Conclusions:
The Tennessee CFAR CDEIPI program will continue to build upon experience from the first year to further contribute to national efforts to increase diversity in HIV-related research.
Addressing Stigma by Increasing Empathy Toward Vulnerable Populations in Preprofessional Trainees: Impacts of the Generation Tomorrow Summer Health Disparities Scholars Program
Authors: Antoine Denis G. , Manogue Sean , Blue Jasmine , Irvin Risha , Irvin Nathan 
Published: September 2023

Background:
Creating empathetic health care professionals is critical to addressing the health equity challenges of today, particularly because it relates to vulnerable populations.

Methods:
To assess the impact of the Johns Hopkins Center for AIDS Research Generation Tomorrow Summer Health Disparities Scholars (GTSHDS) program on students' empathy toward individuals living with substance use disorder and differential impact on empathy related to the COVID-19 pandemic, the Attitudes towards Mental Illness Questionnaire (AMIQ), an assessment of stigmatizing attitudes, was administered. Preprogram and postprogram participation AMIQ survey data were compared using paired t tests to explore changes within the program year. Unpaired t tests were used to characterize differences between the mean scores across the 2 student cohorts.

Results:
Both GTSHDS cohorts displayed postprogram increase in empathy. Mean 2019 cohort AMIQ scores shifting from −1.4 (SD 2.01) to −0.8 (SD 2.35) (P = 0.54), and the 2022 cohort shifting from −3.67 (SD 2.01) to −3 (SD 1.61) (P = 0.79). On average, individual scores improved by 2.2 (SD 1.65) points in the 2019 cohort and 2.4 (SD 1.86) points in the 2022 cohort (P = 0.83). Although these were not statistically significant, they suggested a trend toward more empathy.

Conclusions:
Preliminary data suggest that programs such as GTSHDS that expose students to various aspects of health care principles can prepare future health care professionals in a manner that may reduce health care disparities. Future research with larger population sizes is needed to understand the impacts of the curriculum on empathy and related concepts to achieving health equity.