bluuebunny/crossref_metadata_2025_split huggingface dataset:
Quality of Labor Analgesia with Dural Puncture Epidural versus Standard Epidural Technique in Obese Parturients: A Double-blind Randomized Controlled Study
Authors: Tan Hon Sen , Reed Sydney E. , Mehdiratta Jennifer E. , Diomede Olga I. , Landreth Riley , Gatta Luke A. , Weikel Daniel , Habib Ashraf S. 
Published: February 2022

Background
The dural puncture epidural technique may improve analgesia quality by confirming midline placement and increasing intrathecal translocation of epidural medications. This would be advantageous in obese parturients with increased risk of block failure. This study hypothesizes that quality of labor analgesia will be improved with dural puncture epidural compared to standard epidural technique in obese parturients.

Methods
Term parturients with body mass index greater than or equal to 35 kg · m–2, cervical dilation of 2 to 7 cm, and pain score of greater than 4 (where 0 indicates no pain and 10 indicates the worst pain imaginable) were randomized to dural puncture epidural (using 25-gauge Whitacre needle) or standard epidural techniques. Analgesia was initiated with 15 ml of 0.1% ropivacaine with 2 µg · ml–1 fentanyl, followed by programed intermittent boluses (6 ml every 45 min), with patient-controlled epidural analgesia. Parturients were blinded to group allocation. The data were collected by blinded investigators every 3 min for 30 min and then every 2 h until delivery. The primary outcome was a composite of (1) asymmetrical block, (2) epidural top-ups, (3) catheter adjustments, (4) catheter replacement, and (5) failed conversion to regional anesthesia for cesarean delivery. Secondary outcomes included time to a pain score of 1 or less, sensory levels at 30 min, motor block, maximum pain score, patient-controlled epidural analgesia use, epidural medication consumption, duration of second stage of labor, delivery mode, fetal heart tones changes, Apgar scores, maternal adverse events, and satisfaction with analgesia.

Results
Of 141 parturients randomized, 66 per group were included in the analysis. There were no statistically or clinically significant differences between the dural puncture epidural and standard epidural groups in the primary composite outcome (34 of 66, 52% vs. 32 of 66, 49%; odds ratio, 1.1 [0.5 to 2.4]; P = 0.766), its individual components, or any of the secondary outcomes.

Conclusions
A lack of differences in quality of labor analgesia between the two techniques in this study does not support routine use of the dural puncture epidural technique in obese parturients.

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Outcomes of Pediatric Scaphoid Nonunions Treated With Distal Radius Cancellous Autograft
Authors: Lin James S. , Grenier Gregory , Balch Samora Julie 
Published: February 2022

Background:
The optimal management of pediatric scaphoid fracture nonunions is controversial. We hypothesize that pediatric patients with scaphoid fracture nonunions will have favorable functional outcomes with the utilization of nonvascularized distal radius cancellous autograft with open reduction and internal fixation (ORIF).

Methods:
A review was performed from 2012 to 2017 identifying skeletally immature patients with scaphoid fracture nonunions treated with ORIF and nonvascularized distal radius cancellous autograft, including demographic data, mechanism of injury, length of time from injury to treatment, operative procedure, length of immobilization, time to union, and complications.

Results:
Ten patients (9 males, 1 female) met inclusion criteria. Mean age was 14.3 SD 1.5 years. The majority of fractures were sustained during sports or secondary to a fall. Mean time between injury and orthopaedic evaluation was 33 weeks (SD 20 wk). Eight fractures occurred at the waist, and 2 occurred at the proximal pole. Four patients had a humpback deformity, and three presented with a dorsal intercalated segmental instability deformity. Nine patients were treated with a single cannulated compression screw with distal radius autograft. One patient also received a single Kirschner wire fixation in addition to a single cannulated screw and graft. Patients underwent a mean postoperative immobilization period of 14 SD 5 weeks. Two patients received a bone stimulator postoperatively. Radiographic union was documented after initial surgery in nine patients, with mean time to union of 17 SD 5 weeks. The 1 patient with persistent radiographic nonunion underwent revision fixation and repeat nonvascularized distal radius autograft, achieving union and resolution of symptoms. All patients ultimately reported full return to activity.

Conclusions:
Pediatric scaphoid fracture nonunions that undergo ORIF using nonvascularized distal radius cancellous autograft have favorable rates of consolidation and functional outcomes. Surgeons should consider this source of grafting in operative management of scaphoid nonunions in children and adolescents.

Level of Evidence:
Level IV, therapeutic.
Acute Intoxications and Fatalities Associated With Benzimidazole Opioid (Nitazene Analog) Use: A Systematic Review
Authors: Montanari Eva , Madeo Graziella , Pichini Simona , Busardò Francesco Paolo , Carlier Jeremy 
Published: February 2022

Background:
Synthetic benzimidazole opioids (BOs) are highly potent µ-opioid receptor agonists with heroin-like effects. Isotonitazene was first available in 2019 in the drug market, although new analogs have multiplied recently. The authors aimed to identify BO use trends and gather toxicological data from BO-related cases to assist in clinical and forensic investigations.

Methods:
A systematic literature search was conducted according to the PRISMA guidelines. PubMed and Scopus databases were accessed in October 2021 to identify scientific reports of BO-related intoxication and fatalities. Publication dates, case descriptions, symptoms, autopsy findings, and concentrations of BOs and metabolites in biological matrices were compiled.

Results:
Data from 8 case reports with 93 fatalities involving isotonitazene (n = 65), metonitazene (n = 20), etonitazepyne (N-pyrrolidino etonitazene) (n = 8), flunitazene (n = 4), and/or butonitazene (n = 1), and 1 acute intoxication involving etonitazepyne were collected. Autopsy findings included pulmonary congestion/high lung weight (66%), cardiomegaly/high cardiac weight (39%), cerebral edema (22%), gastric contents in the airways (22%), and organ congestion (22%). Median peripheral blood concentrations were 1.7 ng/mL for isotonitazene (0.4–9.5 ng/mL, n = 13), 5.4 ng/mL for metonitazene (0.52–33 ng/mL, n = 17), 5.4 ng/mL for etonitazepyne (2.4–8.3 ng/mL, n = 2), 1.3 ng/mL for flunitazene (0.58–2.1 ng/mL, n = 2), and 3.2 ng/mL for butonitazene (n = 1). Central nervous system depressants were almost always coadministered.

Conclusions:
Isotonitazene was predominant in cases from 2019 to mid-2020 and was replaced by metonitazene after scheduling in the United States. Typical findings on opioid overdoses have been reported. Peripheral blood concentrations were consistent with a potency similar to that of fentanyl. These results must be interpreted carefully, considering the scarcity of reports on BO-related cases and drug co-exposures.
Pediatric Forensic Analysis
Authors: Hornor Gail , Benzinger Elizabeth , Doughty Katherine , Hollar Jessica , Wolf Kathryn 
Published: February 2022

ABSTRACT

Background
Although the presence of forensic evidence aids in successful prosecution of sexual abuse, controversy remains regarding the timing and indications for collection of forensic evidence in child sexual abuse/assault.

Objective
The purpose of this study was to describe forensic evidence findings in acute child sexual abuse after implementing more inclusive indications for collection of evidence in a pediatric emergency department and to identify factors associated with yield of DNA.

Results
Of the 306 evidence kits collected and analyzed, 110 (35.9%) kits were positive for an interpretable DNA profile foreign to the patient, which may or may not have contributed to the investigation of the sexual abuse concern. Several factors were associated with increased forensic yield of identifiable foreign DNA: increased age of child victim, 48 hours or less between the latest incident of sexual abuse and the collection of forensic evidence, child disclosure of high-severity sexual abuse acts (anal–genital or genital–genital contact) in the pediatric emergency department forensic interview, and sexual abuse by a nonrelative perpetrator.

Conclusions
Finally, although certain factors were associated with increased yield of identifiable foreign DNA within each factor, there were multiple outliers where failure to collect forensic evidence would have resulted in a loss of recoverable foreign DNA.
The Effects of Relaxation Techniques on Pain, Fatigue, and Kinesiophobia in Multiple Sclerosis Patients: A 3-Arm Randomized Trial
Authors: Kesik Gülşah , Ozdemir Leyla , Mungan Ozturk Semra 
Published: February 2022

ABSTRACT

BACKGROUND: In addition to the available medical treatment options, multiple sclerosis (MS) patients may tend toward complementary and integrative therapies. Relaxation techniques are a nonpharmacological and side-effect–free therapy option currently available to alleviate the symptoms of many different chronic diseases. The aim of this study was to examine and compare the effects of relaxation techniques on the pain, fatigue, and kinesiophobia in MS patients. METHODS: This 3-arm randomized controlled trial consisted of 80 MS patients. Relaxation techniques, progressive muscle relaxation and Benson relaxation technique were applied to 2 intervention groups, the third was the control group. The study lasted 12 weeks, and the patient information form, visual analog scale, Fatigue Severity Scale, and Tampa Scale for Kinesiophobia were used for data collection. RESULTS: There was a statistically significant decrease in pain, fatigue, and kinesiophobia levels in the intervention groups compared with the control group (P < .05). Progressive muscle relaxation was more effective than Benson relaxation technique (P < .05). CONCLUSION: Relaxation techniques are recommended for the management of symptoms of pain, fatigue, and kinesiophobia, which can often cause disability in MS patients, because they have no side effects and are practical administrations. These exercises are also promising in the rehabilitation process of MS patients.
Disease-specific gaps within fungal respiratory tract infections: clinical features, diagnosis, and management in critically ill patients
Authors: Martin-Loeches Ignacio , Nseir Saad , Rodriguez Alejandro , Azoulay Elie 
Published: February 2022

Purpose of review
We aim to examine the most recent findings in the area of invasive pulmonary fungal infections to determine the appropriate/and or lack of prevention measures and treatment of upper fungal respiratory tract infections in the critically ill.

Recent findings
This will be addressed by focusing on the pathogens and prognosis over different bedridden periods in ICU patients, the occurrence of invasive fungal respiratory superinfections in patients with severe coronavirus disease 2019 which has been recently noted following the SARS-CoV-2 pandemic. Relevant reports referenced within include randomized controlled trials, meta-analyses, observational studies, systematic reviews, and international guidelines, where applicable. Of note, it is clear there is a significant gap in our knowledge regarding whether bacterial and fungal infections in coronavirus disease 2019 are directly attributable to SARS-CoV-2 or a consequence of factors such as managing high numbers of critically unwell patients, and the prolonged duration of mechanical ventilation/ICU admission duration of stay.

Summary
An optimal diagnostic algorithm incorporating fungal biomarkers and molecular tools for early and accurate diagnosis of Pneumocystis pneumonia, invasive aspergillosis, candidemia, and endemic mycoses continues to be limited clinically. There is a lack of standardized molecular approach to identify fungal pathogens directly in formalin-fixed paraffin-embedded tissues and suboptimal diagnostic approaches for mould blood cultures, tissue culture processing for Mucorales, and fungal respiratory cultures (i.e., the routine use of bronchoscopic examination in ICU patients with influenza-associated pulmonary aspergillosis) for fungal point-of-care testing to detect and identify new, emerging or underrecognized, rare, or uncommon fungal pathogens.
Biomarkers for the diagnosis and monitoring of celiac disease: can you count on me?
Authors: Topa Matilde , Sanders David Surendran , Elli Luca 
Published: February 2022

Purpose of review
Different markers are available to diagnose and monitor celiac disease (CeD); however, the concordance among them and their efficacy are still controversial. We aim at defining the efficacy of CeD biomarkers, their advantages and limits.

Recent findings
CeD diagnostic criteria are widely accepted, being a positive serology and duodenal atrophy (according to the Marsh-Oberhuber score) the main hallmarks. Flow cytometry and other molecular biomarkers support the diagnosis of refractory CeD. On the other side, CeD monitoring is less defined, as the biomarkers are not always reliable. To date, the reference standard to detect mucosal healing is represented by duodenal histology, but its timing and significance are debated. Novel scores may better define the trend of mucosal damage and MicroRNAs are among the innovative noninvasive biomarkers. The assessment of a correct gluten-free diet (GFD) is another aspect of CeD monitoring, based upon questionnaires and recently developed tools such as dosage of urinary or faecal gluten immunogenic peptides.

Summary
Clinicians lack of a widely acknowledged tools to monitor CeD and GFD. Here, we present the efficacy of the most used markers.
Severe Hepatitis in Pediatric Coronavirus Disease 2019
Authors: Antala Swati , Diamond Tamir , Kociolek Larry K. , Shah Amit A. , Chapin Catherine A. 
Published: February 2022

ABSTRACTHepatic involvement in coronavirus disease 2019 (COVID‐19) is typically characterized as mild hepatitis with preserved synthetic function in children. Severe hepatitis is a rare complication of COVID‐19 infection that has not been extensively described in the pediatric population. We report a case series of four previously healthy children who presented with significant hepatitis as the primary manifestation of COVID‐19 infection. Two of these patients met criteria for acute liver failure. None of the patients had respiratory symptoms. One patient was found to have complement dysfunction resulting in microangiopathic features and was treated successfully with eculizumab. This case is in line with adult post‐mortem data showing that more severe cases of hepatic dysfunction secondary to COVID‐19 infection may be associated with complement activation and microangiopathic features. Liver function should be evaluated in cases of severe COVID‐19, and severe acute respiratory syndrome coronavirus 2 infection should be considered as a cause of acute severe hepatitis even in patients without significant respiratory or other systemic symptoms.
Esophageal Microbiome in Healthy Children and Esophageal Eosinophilia
Authors: Parashette Kalyan Ray , Sarsani Vishal Kumar , Toh Evelyn , Janga Sarath Chandra , Nelson David E. , Gupta Sandeep K. 
Published: February 2022

ABSTRACTObjectives:There is limited knowledge about the role of esophageal microbiome in pediatric esophageal eosinophilia (EE). We aimed to characterize the esophageal microbiome in pediatric patients with and without EE.Methods:In the present prospective study, esophageal mucosal biopsies were obtained from 41 children. Of these, 22 had normal esophageal mucosal biopsies (“healthy”), 6 children had reflux esophagitis (RE), 4 had proton pump inhibitor (PPi)‐responsive esophageal eosinophilia (PPi‐REE), and 9 had eosinophilic esophagitis (EoE). The microbiome composition was analyzed using 16S rRNA gene sequencing. The age median (range) in years for the healthy, RE, PPi‐REE, and EoE group were 10 (1.5–18), 6 (2–15), 6.5 (5–15), and 9 (1.5–17), respectively.Results:The bacterial phylum Actinobacteria, Bacteroidetes, Firmicutes, Fusobacteria, and Proteobacteria were the most predominant. The Epsilonproteobacteria, Betaproteobacteria, Flavobacteria, Fusobacteria, and Sphingobacteria class were underrepresented across groups. The Vibrionales was predominant in healthy and EoE group but lower in RE and PPi‐REE groups. The genus Streptococcus, Rahnella, and Leptotrichia explained 29.65% of the variation in the data with an additional 10.86% variation in the data was explained by Microbacterium, Prevotella, and Vibrio genus. The healthy group had a higher diversity and richness index compared to other groups, but this was not statistically different.Conclusions:The pediatric esophagus has an abundant and diverse microbiome, both in the healthy and diseased states. The healthy group had a higher, but not significantly different, diversity and richness index compared to other groups.
Case Report: Bilateral Corneal Ectasia Developed during Pregnancy after Small-incision Lenticule Extraction
Authors: Huang Tian-Ze , Jin Hong-Ying 
Published: February 2022

SIGNIFICANCE
This case highlights that hormonal changes during pregnancy could affect the biomechanical stability of the cornea and lead to corneal ectasia during pregnancy after corneal refractive surgery.

PURPOSE
We report an unusual case of bilateral corneal ectasia after small-incision lenticule extraction that developed during pregnancy.

CASE REPORT
A 27-year-old woman experienced post–small-incision lenticule extraction corneal ectasia. Her pre-operative corneal topography was normal, with a minimum central corneal thickness of 538 μm in the right eye and 530 μm in the left eye. The manifest refraction was −7.75 −0.25 × 180 and −7.50 −0.75 × 10, and the lenticule thickness was 140 and 139 μm in the right and left eyes, respectively. After 11 months, in her first trimester, the patient began to experience gradually deteriorating blurred vision. Two years post-operatively, corneal ectasia was diagnosed based on topographic data. The automatic optometer examination was −7.25 −2.50 × 42 in the right eye and −11.00 −5.00 × 140 in the left eye. Later, the patient underwent corneal collagen cross-linking to control further progression and was recommended to wear rigid gas-permeable contact lenses.

CONCLUSIONS
Surgeons should be alert for cornea ectasia after refractive surgery in pregnant patients, as hormonal changes during pregnancy may affect corneal biomechanical stability.
Building a Community-Centered Public Health Advocacy Training Program for Medical Students
Authors: Shankar Sruthi , Phinney Robin , Krapek Annie , Surapaneni Vishnu Laalitha 
Published: February 2022

Context:
Public health advocacy is increasingly acknowledged as an essential component of practice in medicine. Medical schools, residency programs, and professional organizations have begun developing curricula in an effort to teach advocacy. This article describes the structuring and evolution of the Dr Pete Dehnel Public Health Advocacy Fellowship, an innovative program prioritizing a community-centered approach to teaching physician advocacy to medical students.

Program:
Created by the Twin Cities Medical Society (TCMS), the fellowship's curriculum adopts a cohort-based learning model organized around skills training, personalized physician-mentor pairing in a shared field of interest, and hands-on advocacy activities. The curriculum also centers insights and practical knowledge from community members who are outside of the health care sphere alongside those of experienced physician-advocates.

Implementation:
TCMS partnered with an independent research organization to conduct an ongoing developmental evaluation (DE) of the fellowship. DE focuses on rapid-cycle feedback and utilization of findings to inform the development of program components. This enables TCMS to customize the fellowship's curricular components to the local context and in response to student and mentor feedback.

Evaluation:
Early findings have allowed TCMS to refine curricular components while providing evidence of significant gains in 3 areas of growth among fellows: perceived knowledge and advocacy skills proficiency; perceived self-efficacy; and motivation for lifelong advocacy practice.

Discussion:
Key fellowship components, including a flexible curricular structure with built-in adaptability and emphasis on long-term health advocacy engagement, are associated with student growth. These core elements along with a focus on community-centeredness can be integrated into curricula of other programs seeking to train medical learners and physicians to embrace a lifelong commitment to public health advocacy.
Extracorporeal Shock Wave Therapy on Spasticity After Upper Motor Neuron Injury
Authors: Zhang Hui-Ling , Jin Rong-Jiang , Guan Li , Zhong Dong-Ling , Li Yu-Xi , Liu Xiao-Bo , Xiao Qi-Wei , Xiao Xi-Li , Li Juan 
Published: February 2022

Objective
The aim of the study was to evaluate the effectiveness and safety of extracorporeal shock wave therapy on spasticity after upper motor neuron injury.

Design
Eight electronic databases were searched systematically from their inception to August 3, 2021, to provide robust evidence for the efficacy of extracorporeal shock wave therapy for spasticity and range of motion after upper motor neuron injury. Study screening, data extraction, risk of bias assessment, and evaluation of the certainty of evidence were performed independently by two independent reviewers. Data analysis was conducted using RevMan 5.3.5 and R 3.6.1 software.

Results
Forty-two studies with 1973 patients who met the eligibility criteria were selected from articles published from 2010 to 2021, of which 34 were included in the meta-analysis. A comparison intervention revealed that extracorporeal shock wave therapy significantly decreased the Modified Ashworth Scale score and increased the passive range of motion of a joint. Regarding the safety of extracorporeal shock wave therapy, slightly adverse effects, such as skin injury, bone distortion, muscle numbness, pain, petechiae, and weakness, were reported in five studies.

Conclusions
Extracorporeal shock wave therapy may be an effective and safe treatment for spasticity after upper motor neuron injury. However, because of poor methodological qualities of the included studies and high heterogeneity, this conclusion warrants further investigation.

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CME Objectives
Upon completion of this article, the reader should be able to: (1) Determine the impact of extracorporeal shock wave therapy on spasticity after upper motor neuron injury; (2) Describe the factors that affect the efficacy of extracorporeal shock wave therapy on spasticity; and (3) Discuss the mechanism of action of extracorporeal shock wave therapy on spasticity.

Level
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