bluuebunny/crossref_metadata_2025_split huggingface dataset:
“Finding My Piece in That Puzzle”: A Qualitative Study Exploring How Medical Students at Four U.S. Schools Envision Their Future Professional Identity in Relation to Health Systems
Authors: Leep Hunderfund Andrea N. , Kumbamu Ashok , O’Brien Bridget C. , Starr Stephanie R. , Dekhtyar Michael , Gonzalo Jed D. , Rennke Stephanie , Ridinger Heather , Chang Anna 
Published: July 2022

Purpose
Health systems science (HSS) curricula equip future physicians to improve patient, population, and health systems outcomes (i.e., to become “systems citizens”), but the degree to which medical students internalize this conception of the physician role remains unclear. This study aimed to explore how students envision their future professional identity in relation to the system and identify experiences relevant to this aspect of identity formation.

Method
Between December 2018 and September 2019, authors interviewed 48 students at 4 U.S. medical schools with HSS curricula. Semistructured interviews were audiorecorded, transcribed, and analyzed iteratively using inductive thematic analysis. Interview questions explored how students understood the health system, systems-related activities they envisioned as future physicians, and experiences and considerations shaping their perspectives.

Results
Most students anticipated enacting one or more systems-related roles as a future physician, categorized as “bottom-up” efforts enacted at a patient or community level (humanist, connector, steward) or “top-down” efforts enacted at a system or policy level (system improver, system scholar, policy advocate). Corresponding activities included attending to social determinants of health or serving medically underserved populations, connecting patients with team members to address systems-related barriers, stewarding health care resources, conducting quality improvement projects, researching/teaching systems topics, and advocating for policy change. Students attributed systems-related aspirations to experiences beyond HSS curricula (e.g., low-income background; work or volunteer experience; undergraduate studies; exposure to systems challenges affecting patients; supportive classmates, faculty, and institutional culture). Students also described future-oriented considerations promoting or undermining identification with systems-related roles (responsibility, affinity, ability, efficacy, priority, reality, consequences).

Conclusions
This study illuminates systems-related roles medical students at 4 schools with HSS curricula envisioned as part of their future physician identity and highlights past/present experiences and future-oriented considerations shaping identification with such roles. These findings inform practical strategies to support professional identity formation inclusive of systems engagement.
Nonoperative Management of Closed Displaced Tibia Shaft Fractures in Patients Under 18 Years of Age: Low Failure Rate
Authors: Cummings Jason L. , Rivera Asdrubal E. , Pereira Daniel E. , Oladeji Afolayan K. , Landau Andrew J. , Hosseinzadeh Pooya 
Published: July 2022

Background:
Tibial shaft fractures are the third most common pediatric long bone fracture pattern. Historically, these fractures have been initially treated with closed reduction and casting (CRC). Recently, there has been an increasing trend toward surgical intervention as an initial treatment for these injuries. In an effort to better understand whether this trend is warranted, this study seeks to characterize the clinical and radiographic outcomes of a large number of children who underwent nonoperative treatment with CRC as their initial treatment for pediatric tibial shaft fractures at a single tertiary care center.

Methods:
Outcomes measured included final alignment, other procedures performed, length of time to full radiographic healing, and length of time in each method of immobilization before progressing to full weight-bearing status. Patients were separated by ages into the following cohorts during statistical analysis: 4 to 8 years, 9 to 12 years, and 13+ years. Differences between continuous variables were analyzed with independent-samples t tests. χ2 tests were used to analyze differences in categorical variables. An α<0.05 was considered statistically significant.

Results:
A total of 137 patients met our inclusion criteria. The median age was 10.19 years (4.03 to 17.43). The average initial displacement among all age groups was 27.42% (±15.05%). After the initial intervention with CRC, all age groups demonstrated an average of <5 degrees of residual angulation and <20% of residual displacement. Complete radiographic healing was seen in 127 (92.7%) patients by 3 months. Loss of reduction requiring additional clinical intervention was seen in 30 (21.9%) patients with only 5% requiring surgical intervention, whereas malunion was seen in a total of 16 (11.7%) patients at the final visit. There were no cases of compartment syndrome or deep wound infection. Male and initial angulation were the only factors predictive of loss of reduction.

Conclusion:
Initial intervention with CRC is a safe and effective treatment for the majority of children in all age groups presenting with tibial shaft fractures demonstrating minimal angulation and displacement with surgical intervention being required in only 5% of patients. Further studies are warranted to elucidate the characteristics of patients who may benefit most from initial surgical intervention.

Level of Evidence:
Level III—retrospective study.
Ultrasound-guided Cervical Retro-laminar Block for Cervical Radicular Pain: A Comparative Analysis
Authors: Khashan Morsi , de Santiago Jesus , Pardo Itai , Regev Gilad , Ophir Dror , Salame Khalil , Lidar Zvi , Brill Silviu , Hochberg Uri 
Published: July 2022

Study Design and Objective.
Cervical radiculopathy is a common clinical condition, often treated with cervical epidural steroid injections (ESI). Retro-laminar cervical blocks (RLCB) may be considered safer than ESI as they do not require entering the neuroaxis.
In this study, we evaluated the outcome of RLCB in patients with cervical radiculopathy who had failed conservative treatment and were candidates for cervical spine decompression surgery.

Background Data.
Recently, we reported a clinical pilot study investigating the treatment of cervical radiculopathy with an ultrasound-guided RLCB.

Materials and Methods.
A retrospective, comparative analysis of prospectively collected data was carried out on the medical records of all patients who underwent RLCB for cervical radicular pain, between August 2019 and March 2021.

Results.
Ninety-eight patients were included in the analysis, with a total of 139 procedures.
A significant pain reduction was achieved for most patients immediately after the procedure and at the final follow up (16.9±13.4 wk). The mean numerical rating scale for the whole cohort changed from 7.21±2.51 to 4.04±2.51 (P-value <0.01) at the time of discharge, with similar patterns at the subgroup level. A functional evaluation was carried out by a questionnaire (Neck Disability Index—NDI). Overall, 83% of patients had a lower postprocedural NDI than preprocedural NDI. For 80% of patients, the improvement of NDI surpassed the minimal clinically important change at the final assessment. Most patients (61%) were discharged after just one RLCB. Eight patients (8%) eventually underwent surgery. The most frequent complaint was injection site soreness; however, there were no major adverse events reported.

Conclusions.
These findings suggest that RLCB can be performed as an alternative to cervical ESI and decompressive surgery in patients with cervical radicular pain that’s refractory to noninvasive treatment. More comparative and prospective studies are needed to confirm our results.
Reoperation for Misplaced Pedicle Screws: A Multicenter Retrospective Study
Authors: Odate Seiichi , Fujibayashi Shunsuke , Otsuki Bungo , Shikata Jitsuhiko , Tsubouchi Naoya , Tsutsumi Ryosuke , Ota Masato , Yusuke Kanba , Kimura Hiroaki , Onishi Eijiro , Tanida Shimei , Ito Hideo , Ishibe Tatsuya , Matsuda Shuichi 
Published: July 2022

Study Design.
A multicenter retrospective analysis

Objective.
To investigate reoperation of misplaced pedicle screws (MPSs) after posterior spinal fusion (PSF), focusing on neurological complications.

Summary of Background Data.
The management strategy for MPSs and the clinical results after reoperation are poorly defined.

Methods.
Subjects were 10,754 patients (73,777 pedicle screws) who underwent PSF at 11 hospitals over 15 years. The total number of reoperations for MPS and patient clinical data were obtained from medical records at each hospital.

Results.
The rate of reoperation for screw misplacement per screw was 0.17%. A total of 69 patients (mean age, 67.4±16.5 y) underwent reoperation because of 82 MPS. Reasons for reoperation were neurological symptoms (58 patients), contact with vessels (5), suboptimal bone purchase (4), and misplacement recognized during operation (2). Neurological symptoms were the major reason for reoperation in cervical (5/5 screws, 100%) and lumbo-sacral (60/67 screws, 89.6%) regions. Contact with vessels was the major reason for reoperation in the thoracic spine (6/10 screws, 60.0%). We further evaluated 60 MPSs in the lumbo-sacrum necessitating reoperation because of neurological symptoms. The majority of MPSs necessitating reoperation were placed in the lower lumbar spine (43/60 screws, 71.7%). The mean pedicle breach tended to be larger in the incomplete recovery group than in the complete recovery group (6.8±2.4 mm vs. 5.9±2.2 mm, P=0.146), and the cutoff value resulting in incomplete resolution was 5.0 mm. Multivariate analysis revealed that medial-caudal breaches (vs. medial breach, OR 25.8, 95%CI 2.58-258, P=0.0057) and sensory and motor disturbances (vs. sensory only, OR 8.57, 95%CI 1.30-56.6, P=0.026) were significant factors for incomplete resolution of neurological symptoms.

Conclusions.
After reoperation, 70.1% of the patients acquired complete resolution of neurological symptoms. Features of possible residual neurological symptoms were sensory and motor disturbance, medial-caudal breach, and larger pedicle breach (>5 mm).
Complications, Readmissions, Revisions, and Patient-reported Outcomes in Patients With Parkinson Disease Undergoing Elective Spine Surgery: A Propensity-matched Analysis
Authors: Steinle Anthony M. , Nian Hui , Pennings Jacquelyn S. , Bydon Mohamad , Asher Anthony , Archer Kristin R. , Gardocki Raymond J. , Zuckerman Scott L. , Stephens Byron F. , Abtahi Amir M. 
Published: July 2022

Study Design.
Retrospective analysis on prospectively collected data.

Objective.
To determine the effectiveness of elective spine surgery in patients with Parkinson disease (PD).

Background Context.
PD has become increasingly prevalent in an aging population. While surgical treatment for degenerative spine pathology is often required in this population, previous literature has provided mixed results regarding its effectiveness.

Methods.
Data from the Quality Outcomes Database (QOD) was queried between April 2013 and January 2019. Three surgical groups were identified: (1) elective lumbar surgery, (2) elective cervical surgery for myelopathy, (3) elective cervical surgery for radiculopathy. Patients without PD were propensity matched against patients with PD in a 5:1 ratio without replacement based on American Society of Anesthesiology grade, arthrodesis, surgical approach, number of operated levels, age, and baseline Oswestry Disability Index, Numerical Rating Scale (NRS) extremity pain, NRS back pain, and EuroQol 5-Dimensions (EQ-5D). The mean difference was calculated for continuous outcomes (Oswestry Disability Index, NRS leg pain, NRS back pain, and EQ-5D at 3 and 12 mo after surgery) and the risk difference was calculated for binary outcomes (patient satisfaction, complications, readmission, reoperation, and mortality).

Results.
For the lumbar analysis, PD patients had a higher rate of reoperation at 12 months (risk difference=0.057, P=0.015) and lower mean EQ-5D score at 12 months (mean difference=−0.053, P=0.005) when compared with patients without PD. For the cervical myelopathy cohort, PD patients had lower NRS neck pain scores at 3 months (mean difference=−0.829, P=0.005) and lower patient satisfaction at 3 months (risk difference=−0.262, P=0.041) compared with patients without PD. For the cervical radiculopathy cohort, PD patients demonstrated a lower readmission rate at 3 months (risk difference=−0.045, P=0.014) compared with patients without PD.

Conclusion.
For the matched analysis, in general, patients with and without PD had similar patient-reported outcomes and complication, readmission, and reoperation rates. These results demonstrate that a diagnosis of PD alone should not represent a major contraindication to elective spine surgery.
Risk factors for CMV infection within 100 days posttransplantation in patients with acute leukemia
Authors: Chen Juan , Pang Aiming , Zhao Yuanqi , Liu Li , Ma Runzhi , Wei Jialin , Chen Xin , He Yi , Yang Donglin , Zhang Rongli , Zhai Weihua , Ma Qiaoling , Jiang Erlie , Han Mingzhe , Zhou Jiaxi , Feng Sizhou 
Published: July 2022

Objective:
To investigate the risk factors for cytomegalovirus (CMV) infection within 100 days and the relationship between early CMV infection and 1-year relapse for patients with acute leukemia following allogeneic hematopoietic stem cell transplantation (allo-HSCT).

Methods:
Three hundred fifty-nine patients with acute leukemia who received allo-HSCT at our center between January 2015 and January 2020 were retrospectively reviewed.

Results:
Of 359 patients, 48.19% (173) patients experienced CMV infection within 100 days posttransplantation. In univariate and multivariate logistic analysis, haploidentical-related donor (HRD) (P < 0.001; odds ratio [OR], 5.542; 95% confidence interval [CI], 3.186–9.639), and ratio of CD3+CD8+ cells in lymphocytes <14.825% (P < 0.001; OR, 3.005; 95% CI, 1.712–5.275) were identified as 2 independent risk factors. One-year relapse rate (RR) between the CMV infection group and the non-CMV infection group was not statistically significant (18.5% vs 19.9%, P = 0.688). When we divided the total cohort into AML, ALL, and MAL subgroups, there were no significant differences as well (P = 0.138; P = 0.588; P = 0.117; respectively).

Conclusion:
In conclusion, donor type (HRD) and the insufficient recovery of CD3+CD8+ cells were independent risk factors for CMV infection within 100 days posttransplantation in patients with acute leukemia. CMV infection within 100 days did not influence the incidence of relapse in 1 year for patients with acute leukemia.
Mucinous Syringometaplasia: Case Report and Review of the Literature
Authors: Macías-Alonso Begoña , Solís-Ledesma Guillermo , Sánchez-Tadeo María T. , Jarquin-Guillermo Norma E. , Velázquez-Espinosa Oscar A. , Sangüeza Omar P. 
Published: July 2022

Abstract:
Mucinous syringometaplasia is a rare and poorly recognized entity that usually presents as a warty tumor in acral regions. It is more frequent in men, and the age of presentation is variable. Typically, it has been reported as a solitary lesion with a warty appearance that occasionally can drain serous material. The affected sites include head, neck, breast, acral regions, and buttocks. The evolution over time is variable. The pathogenesis has not been elucidated. Diagnosis is established through histopathology, the characteristic feature is an epidermal invagination, which creates a structure similar to a “pore” at the dermal level. The clinical differential diagnosis is mainly with a viral wart, but it can also resemble basal cell carcinomas and other adnexal tumors. The treatment is surgical, and no recurrences have been reported to date. We describe the case of a 25-year-old woman who presented with a lesion on one of her eyelids. A shave removal of the lesion was performed, and the diagnosis was established by histopathologic examination.
Mechanic Hands/Hiker Feet in a Patient With Amyopathic Dermatomyositis and Interstitial Lung Disease
Authors: Regmi Aayushma , Saab-Chalhoub Mario W. , Speiser Jodi J. 
Published: July 2022

Abstract:
A 30-year-old African American woman with a history of interstitial lung disease presented with bilaterally symmetrical, nonpruritic, scaling and fissuring, hyperpigmented, lichenified plaques on her hands and feet. She reported occasional erythema of her face, intermittent erythema, and irritation of her eyes but denied any muscle weakness. A biopsy of the plantar first toe showed hyperkeratosis, striking alternating ortho- and parakeratosis with underlying apoptotic bodies. There was psoriasiform acanthosis without suprapapillary thinning, numerous apoptotic keratinocytes in all layers of the epidermis extending into the corneum that were out of proportion with the minimal interface inflammation. Colloidal iron and Alcian blue stains showed increased dermal mucin deposition. Given the clinical, histopathological, and supportive serological findings (positive anti-KU and anti-SSA), a diagnosis of clinically amyopathic dermatomyositis with mechanic hand/hiker feet (MH/HF) was rendered. The pseudocheckerboard pattern of MH/HF has been previously reported in only 4 patients. The most frequent associations with MH/HF are dermatomyositis and antisynthetase syndrome; however, our patient was negative for antiaminoacyl transfer RNA synthetase antibodies, a required criterion to diagnose antisynthetase syndrome. It is imperative to recognize MH/HF clinically and histopathologically because it may be an early indication of developing dermatomyositis or other connective tissue diseases, which would guide further workup and screening for systemic involvement of the disease, including interstitial lung disease.
Foamy Cell Histiocytosis Is a Diagnostic Pitfall: A Case Report of Xanthomatosis Secondary to Sitosterolemia Mimicking Progressive Nodular Histiocytosis
Authors: Garrido Maria C. , Torres María Penalba , Lorenzo Lucía Garzón , Gil Marco , Milla Carmen Palma , Rodriguez-Peralto Jose Luis , Palencia Pérez Sara I. 
Published: July 2022

Abstract:
We report a noteworthy case of a 10-year-old girl who presented with papular and nodular lesions on the skin that were clinically and histologically mistaken for progressive nodular histiocytosis. During the clinical management of the patient, the high lipid levels raised the suspicion of lipid metabolism disease and helped us to make the correct diagnosis of sitosterolemia. In sitosterolemia, proper management such as restriction of plant sterol intake and administration of cholesterol absorption inhibitor can improve prognosis.
The Appropriately Designed TDM Clinical Trial: Endpoints, Pitfalls, and Perspectives
Authors: van Gelder Teun 
Published: July 2022

Background:
Appropriately designed clinical trials can provide the evidence needed to broadly implement therapeutic drug monitoring (TDM). In the past 30 years, some stunning successes but also some fascinating failures in demonstrating the benefits of TDM have been observed. Future TDM studies can be designed based on this experience.

Methods:
The manuscript is based on a combination of personal experience and published articles and discusses several aspects of the design and conduct of TDM studies.

Results:
Recommendations are provided to reduce the risk of protocol violations and to maximize the potential impact of a TDM study on clinical practice.

Conclusions:
There are lessons that can be learned from previous experience, and this article gives an overview of potential TDM study designs, endpoints, pitfalls, and perspectives.
Early menopause and a low body mass index are associated with an increased risk of coronary heart disease in Japanese women
Authors: Yamanouchi Keiko , Ohta Tsuyoshi , Konta Tsuneo , Nakamura Fumihiro , Horikawa Shouta , Nakai Nanako , Sakai Kazuyoshi , Fukase Mika , Seino Manabu , Yamatani Hizuru , Watanabe Masafumi , Ueno Yoshiyuki , Nagase Satoru 
Published: July 2022

Abstract

Objective
The primary objective was to investigate the association between early menopause and cardiovascular disease (CVD) prevalence in Japanese women. The secondary objective was to ascertain the association with CVD risk factors.

Methods
In this cross-sectional study, 7,239 naturally menopausal women from the Yamagata Cohort Study who completed an annual health visit and questionnaire between 2009 and 2015 were divided into three groups according to their age at menopause (women experiencing menopause at <45, 45-49 y, and ≥ 50 y). The diagnosis of coronary heart disease (CHD) and stroke were made by self-report, while hypertension, hyperlipidemia, and diabetes mellitus, were diagnosed by vital signs and laboratory parameters. Logistic regression analysis was used to estimate the associations between age at menopause and CVD prevalence and CVD risk factors.

Results
A total of 354 (4.9%) and 156 (2.2%) women reported a history of CHD and stroke, respectively. Women experiencing menopause at <45 years had a higher prevalence of CHD than those experiencing menopause at ≥50 years (OR 1.77, 95% CI 1.07-2.90; P = 0.023). Stroke, hypertension, diabetes mellitus, and hyperlipidemia were equally prevalent among the three groups. Significant interactions were observed between age at menopause and body mass index (BMI) (P = 0.025) and parity (P = 0.025). Among those with a BMI < 18.5 or parity ≥2, women experiencing menopause at <45 years had a significantly higher prevalence of CHD than those experiencing menopause at ≥50 years.

Conclusion
Early menopause and low BMI were associated with CHD in Japanese women.
EFFECTS OF INTRAVITREAL BEVACIZUMAB THERAPY ON GLOMERULAR FILTRATION RATES IN PATIENTS TREATED FOR PROLIFERATIVE DIABETIC RETINOPATHY
Authors: Camp David A. , Price David A. , Neiweem Ashley E. , Jusufbegovic Denis 
Published: July 2022

Purpose:
To assess whether the repeated use of intravitreal bevacizumab injections in treatment of proliferative diabetic retinopathy is associated with a long-term decline in the glomerular filtration rate (GFR).

Methods:
Three hundred charts were retrospectively reviewed, of which 60 patients met the criteria for inclusion. The criteria were as follows: reception of at least one bevacizumab injection, baseline GFR before initial bevacizumab injection, and end GFR 6 to 24 months after baseline. Analysis controlled for time between baseline and end GFR measurements, blood pressure, hemoglobin A1C, race, sex, age, and use of an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker. Significance testing was performed with step-wise multiple linear regression. The significance threshold was 5%, and all tests were two-sided.

Results:
Patients received a range of 1 to 17 injections (average 3.6). The average baseline GFR was 76 ± 38 mL/minute, and the end GFR was 63 ± 39 mL/min. The number of injections patients received was not associated with end GFR (P = 0.72), GFR reduction (P = 0.88), or percent GFR reduction (P = 0.49).

Conclusion:
Increased number of intravitreal bevacizumab injections at therapeutic dosage was not associated with reduced GFR in patients with proliferative diabetic retinopathy. This study supports that intravitreal antivascular endothelial growth factor agents are renally safe.