bluuebunny/crossref_metadata_2025_split huggingface dataset:
Stimulation of Lactation Using Acupuncture: A Case Study
Authors: Pierdant Guillermo , Westphal Kristin , Lange Anja , Usichenko Taras I. 
Published: February 2022

Introduction: Breastfeeding is a recognized preferred method of infant feeding; however, for many women, difficulties in breastfeeding result in termination before the recommended period of time. Acupuncture is suggested to be a promising option to treat lactation insufficiency and enhance the production of maternal milk. Main Issue: We have reported the case of a woman with lactation insufficiency due to Caesarean section and congenital unilateral invaginated nipple. Milk production started on the 3rd day following delivery. The newborn was not provided with any food or fluids other than mother’s milk. At 5 days of life, the newborn required long feeding periods and lost 4% of his birth weight, with the participant reporting lactation insufficiency described by the perception of inadequate milk production. Management: Despite the implementation of conventional measures to improve lactation, the difficulties in breastfeeding persisted. Acupuncture was tried on Day 6 of life, and enhanced milk production was observed, which could be measured as the volume of residual milk extracted using the breast pump each time after the newborn achieved satiety. After acupuncture treatment there was an augmentation of maternal milk production from both breasts and successful lactation. Conclusion: This case study provides information that might be useful for prospective investigation of acupuncture’s efficacy in women with lactation insufficiency.
Nurses’ Working Experiences of Their Provision of Cross-Cultural Services to Tibetan Patients With Kashin–Beck Disease: A Qualitative Study
Authors: Tan Rong , Zhou Wenjuan , Ye Shunan , Teng Fen , Zhang Jingshuo 
Published: February 2022

Introduction: Limited qualitative studies exist on nurses’ experience in terms of communicating with and caring for patients with endemic diseases. The purpose of this study was to describe the working experiences of nurses caring for Tibetan patients with Kashin–Beck disease in China. Method: A qualitative design was used in this study. Sixteen nurses who worked in the orthopedics department of a large tertiary general hospital in Wuhan, China, constituting a purposive sample, were interviewed face-to-face using semi-structured guided questions. Results: Three major themes and nine subthemes were identified. Major themes included the challenge in cross-cultural nursing, stress adjustment in cross-cultural nursing, and reshaping competencies in cross-cultural nursing. Discussion: This study revealed that nurses encountered multifaceted challenges when caring for Tibetan patients with Kashin–Beck disease. In a multiethnic society, communication and language skills, cultural competency and cultural sensitivity, and diverse training methods to improve cross-cultural knowledge could increase ethnic minority patient satisfaction with cross-cultural care.
Choriocapillaris alteration in patients with paracentral acute middle maculopathy
Authors: Maltsev Dmitrii S. , Kulikov Alexei N. , Burnasheva Maria A. 
Published: February 2022

PurposeTo evaluate with optical coherence tomography angiography the status of the choriocapillaris in the eyes of patients with resolved paracentral acute middle maculopathy (PAMM).MethodsNine patients with unilateral resolved PAMM, 14 age-matched healthy individuals, and 16 age-matched patients with unilateral retinal vein occlusion (RVO) were included. The choriocapillaris flow area, and the number of choriocapillaris flow voids was compared between the eyes of healthy individuals, both eyes of the PAMM patients, and the fellow eyes of unilateral RVO patients.ResultsThe number of choriocapillaris flow voids in the unaffected eyes of PAMM patients was statistically significantly higher than in the eyes of healthy individuals (p < 0.001) and in the fellow eyes of unilateral RVO patients (p = 0.022). The choriocapillaris flow area in the unaffected eyes of PAMM patients was statistically significantly lower than in the eyes of healthy individuals (p < 0.001) and in the fellow eyes of unilateral RVO patients (p = 0.019). There was no difference in the status of the choriocapillaris between two eyes of PAMM patients.ConclusionEyes of patients with resolved PAMM have a substantial decrease of choriocapillaris perfusion.
Comparison of Fluorescein Angiography Findings in Stage 3 Retinopathy of Prematurity in Zone II Treated With or Without Anti-VEGF
Authors: Vural Aslı , Demirayak Bengi , Ozbas Mehmet , Onur I. Umut , Celik Gökhan 
Published: February 2022

Purpose To define late-stage fluorescein angiography (FA) findings in patients who received anti-vascular endothelial growth factor (VEGF) agents (intravitreal bevacizumab or aflibercept) as a treatment for stage 3 retinopathy of prematurity (ROP) in zone II. We also compared the findings of untreated eyes. Method Infants with a history of ROP who underwent fluorescein angiography were evaluated retrospectively. The patients were divided into 2 groups: those who received anti-VEGF treatment and those who regressed spontaneously without treatment. Vascular abnormalities, such as vascular leakage, shunts at the vascular-avascular junction, periarteriolar areas with hypoperfusion, fine branching and blunt termination of the vessels and, were recorded. Results Angiography evaluations revealed leakage in the eyes of 27.69% of the infants in the anti-VEGF–treated group and in 21.7% of the untreated group ( p = .638). Among the abnormal vascular findings in the peripheral retina, the ratios of fine branching and blunt termination, numbers of shunts along the vascular-avascular junction, and sizes of periarteriolar areas of hypoperfusion were significantly larger in the untreated group than in the treated group ( p < .05; p < .01). The gestational ages and birth weights were significantly lower ( p ≤ .05) in infants with vascular findings in both groups. Conclusion Vascular abnormalities in the peripheral retina are likely due to the ROP itself. Although these abnormalities were detected by FA imaging in both treated and untreated infants with ROP, they were significantly less frequent in patients treated with anti-VEGF, indicating that anti-VEGF treatments have a partially positive effect on the retinal vascularization process.
Boston Carpal Tunnel Questionnaire Scores Alone Do Not Predict Surgical Intervention for Patients With Carpal Tunnel Syndrome
Authors: Chen Frank R. , Kerluku Jona , Manzi Joseph E. , Chen Aaron Z. , Nguyen Joseph T. , Wessel Lauren E. , Osei Daniel A. , Fufa Duretti T. 
Published: February 2022

Background: With the expanded indications for telemedicine, there is increased utility for screening methods to determine which patients are likely to progress to surgical intervention, requiring in-person visits. Patient-rated tools such as the Boston Carpal Tunnel Questionnaire (BCTQ) may be one such tool for screening patients with carpal tunnel syndrome (CTS). The aim of the study was to evaluate whether BCTQ scores were predictive of offering conservative treatment or surgical intervention for CTS. Methods: Patients diagnosed with CTS from January 2017 to February 2020 completed BCTQ questionnaires prior to in-person office visits. Demographics, comorbidities, and highest level of intervention recommended were recorded for each patient as conservative, injection, or surgery. Pearson χ2 and independent-samples t tests were conducted to determine whether BCTQ symptom severity and functional scores were associated with intervention type. Results: A total of 200 patients with CTS were included. Of these, 103 were recommended conservative or injection treatment and 97 were recommended surgery. There were no differences in comorbidities between groups, including other upper extremity pathology ( P = .57), previous upper extremity surgery ( P = .32), hypertension ( P = .17), hypothyroidism ( P = .15), rheumatoid arthritis ( P = .34), and diabetes ( P = .30). Between these groups, there were no differences in BCTQ symptom severity score (symptom severity scale [SSS]; P = .16) or BCTQ functional severity score (functional severity scale [FSS]; P = .96). Conclusions: There is no correlation between comorbidities and BCTQ SSS or FSS score, and offering surgery for CTS. In an era of minimizing non-essential health care visits, the BCTQ is insufficient in screening patients as potential surgical candidates.
Does Time to Imaging and Surgery for Distal Radius Fractures Vary based on Geographic Socioeconomic Disadvantage?
Authors: Rahman Rafa , Xu Amy L. , Dhanjani Suraj A. , Zhang Bo , Nayar Suresh K. , Humbyrd Casey J. , LaPorte Dawn 
Published: February 2022

Background: While disparities in aspects of distal radius fracture (DRF) management and orthopedics at large have been studied, disparities in time to DRF evaluation and treatment are unknown. We sought to determine if geographic socioeconomic disadvantage is associated with time to imaging in the emergency department (ED) and time to surgery for DRFs. Methods: We performed a time-to-event analysis of 105 patients undergoing DRF surgery after ED triage within our hospital system between January 1, 2015, and January 1, 2020. Area Deprivation Index (ADI) national percentile was used as the metric of geographic socioeconomic disadvantage for each patient’s ZIP code of residence. We performed Cox regression analysis to determine hazard ratios to undergo DRF imaging and surgery for patients in each ADI group, adjusting for potential confounders, α = 0.05. Results: There was no association between geographic socioeconomic disadvantage and time to DRF imaging, after adjusting for confounders. However, compared to patients from the least disadvantaged areas, patients from the most disadvantaged areas (ADI Quartiles 3 and 4) had an adjusted hazard ratio for surgery of 0.55 [0.32, 0.94] ( P = .03), and were thus 45% [6%, 68%] less likely to undergo surgery for DRF at any time following ED triage. Conclusions: Operative patients from more socioeconomically disadvantaged neighborhoods see disparities in time to surgery for DRF. Equitable access to timely surgical care is needed and may be improved with increased access to orthopedic surgeons, patient education, support in navigating the health system, and improved continuity of fracture care. Level of Evidence: Level III
‘We can’t be perfect all the time’: Life with HIV before antiretrovirals: A narrative analysis of early published stories by women with HIV in the United Kingdom
Authors: Shepherd Jane 
Published: February 2022

Objectives: The experiences of women like me, diagnosed with HIV before the development of effective antiretrovirals, tend to be neglected and overlooked. Research, policy and services can better serve us if our lived experiences are known and understood within a contextual framework. This small study revisited published personal experience stories by women diagnosed with HIV before 1992 in order to examine what the women said and why. Methods: Due to limited data, a single published collection of 12 stories was chosen, Positively Women: Living with AIDS. Narrative analysis was used to make some overarching sense of identified themes, plots and genres within the women’s accounts. This method allows for a deep contextual reading. I adopted an inductive and reflexive approach using my lived experience to weave in contextual detail and analysis. Findings: In their search for sense-making, the women often expressed their life with HIV as transformative. Speaking out and peer support helped women construct a more positive identity and develop strategies for survival that were influenced by ideas contextually situated in an emerging public health crisis. However, women also felt defined and confined by their status, and others spoke of a conflict in living up to an emerging HIV subjecthood that was adherent to wellness regimes, self-improvement and positive thinking. Conclusion: The analysis brings to light some of the contradictions and conflicts within these early HIV narratives. Contextually examining women’s narratives from the perspective of lived experience offers new readings and fresh insights into wider cultural narratives that may resonate with today’s stories of living with HIV.
Evaluation of early scoring predictors for expedited care in patients with emphysematous pyelonephritis
Authors: Chawla Arun , Bhaskara Sunil Pillai , Taori Ravi , de la Rosette Jean J.M.C.H , Laguna Pilar , Pandey Akhilesh , Mummalaneni Sitaram , Hegde Padmaraj , Rao Shwetapriya , K Prakashini 
Published: February 2022

Introduction: Emphysematous pyelonephritis (EPN), an acute necrotizing infection of the kidney and surrounding tissues, is associated with considerable mortality. We evaluated how existing critical care scoring systems could predict the need for intensive care unit (ICU) management for these patients. We also analyzed if CT-imaging further enhances these predictive systems. Patients and Methods: A retrospective analysis of 90 consecutive patients diagnosed clinico-radiologically with EPN from January 2011 to September 2020. Five scoring systems were evaluated for their predictive ability for the need for ICU management and mortality risk: National Early Warning Score (NEWS), Modified Early Warning Score (MEWS), ‘quick’ Sequential Organ Failure Assessment score (qSOFA), Systemic Inflammatory Response Syndrome score (SIRS), and Sequential Organ Failure Assessment score (SOFA). CT images were classified as per Huang & Tseng and evaluated as stand-alone or added to the different predictive models. Receiver operating characteristic (ROC) curves were plotted for each critical care score and CT-Class using logistic regression, to obtain the area under curve (AUC) value for comparison of ICU admission predictability. Patients were analyzed up till discharge. Results: Ninety patients were diagnosed with EPN. Twenty-six patients required ICU management and nine patients died. The best scoring system to predict the need of early ICU management is NEWS (AUC 0.884). CT Class had no independent predictive power, nor did it add significantly to improvement in most of the early warning scoring systems, but rather guided us to the need for radiological, endourological or surgical intervention. Conclusion: In patients with EPN, the NEWS scoring system predicts best the requirement of ICU care. It aids in triage of patients with EPN to appropriate early management and reduce mortality risk.
Measuring Muscle Activity in the Trunk, Pelvis, and Lower Limb Which Are Used to Maintain Standing Posture in Patients With Adult Spinal Deformity, With Focus on Muscles that Contract in the Compensatory Status
Authors: Yamato Yu , Nojima Osamu , Banno Tomohiro , Hasegawa Tomohiko , Yoshida Go , Oe Shin , Arima Hideyuki , Mihara Yuki , Nagafusa Tetsuyuki , Yamauchi Katsuya , Matsuyama Yukihiro 
Published: February 2022

Study Design Prospective single-center study. Objective This study aimed to investigate the muscle activity of the trunk, pelvis, and lower limb, which are used to maintain a standing posture in elderly patients with spinal deformities. We also elucidated the mechanism of compensation against spinal deformity in terms of muscle activity. Methods Any patient scheduled to undergo surgery for adult spinal deformity was included. Surface electromyography and radiography were performed preoperatively. The following four representative alignments were defined as compensations: 1. pelvic retroversion, 2. reduction in thoracic kyphosis, 3. hyperextension of the lumbosacral junction, and 4. knee flexion. Individual muscle activity was compared with and without compensation. The patients were stratified into three groups according to the severity of spinal compensation, and differences in muscle activity were compared. Results This study included 76 patients (7 men and 69 women, average age 69.4 years). Our results revealed that pelvic retroversion and knee flexion were compensations that required trunk muscle activity. In contrast, reduction of thoracic kyphosis and hyperextension of the lumbosacral junction did not require much trunk muscle activity. There was a significant difference in the muscle activity of the pelvis and lower limbs according to the severity of the deformity. Conclusions In terms of muscle activity, compensation for regional alignment changes in the adjacent spine is economical. However, extra-spinal compensations, such as pelvic retroversion and knee flexion, are non-economical. According to compensation recruitment, the muscle activity of the pelvis and lower limbs increased with the severity of the spinal deformity.
Supine and Dynamic Extension Radiographs as the Strongest Predictors of Post-operative Alignment in Minimally Invasive Lumbar Spine Surgery
Authors: Barber Lauren A. , Lafage Renaud , Muzammil Hamna , Shinn Daniel J. , Kim Jeong H. , Lafage Virginie , Iyer Sravisht 
Published: February 2022

Study Design Institutional review board-approved retrospective cohort study. Objectives Failure to achieve alignment goals may result in accelerated adjacent segment degeneration and poorer outcomes. In “open” spine surgery, intraoperative tools can fine tune alignment; minimally invasive spine surgery techniques may not allow for this type of intraoperative adjustment. The aim of this study was to identify pre-operative radiographic parameters that accurately predict post-operative alignment after minimally invasive lumbar spine surgery. We hypothesized that pre-operative supine and extension sagittal alignment would predict post-operative standing alignment. Methods 50 consecutive patients underwent lateral or anterior lumbar interbody fusion with or without percutaneous posterior instrumentation by a single-surgeon. Sagittal alignment parameters were evaluated on pre-operative standing scoliosis radiographs, dynamic radiographs, supine CT scout, and 6-week post-operative standing radiographs. Demographic and perioperative data were analyzed. Results The mean age was 67.8 years. The mean BMI was 29.7. On average, 3 levels were instrumented (range, 2–6). Surgical time was 4.5 ± 1.8 hours. Following surgery, global lordosis increased from 44.7 ± 17° to 48.6 ± 16° ( P = .001). However, there was no significant difference between the pre-operative supine (48.5 ± 15°), pre-operative extension (49.2 ± 18°), or 6-week post-operative standing radiographs (48.6 ± 16°). There were strong correlations between post-operative alignment and pre-operative supine (r = .825) and extension (r = .851) alignment. Conclusions Our results suggest that pre-operative supine and extension radiographs could be a gold standard for minimally invasive lumbar spine surgery alignment correction as they predict post-operative alignment. The extension alignment was the strongest predictor of post-operative alignment.
ACL Tears in the National Football League From 2013 to 2020: Analysis of the 2020 Season After Delays and Schedule Changes From the Early COVID-19 Pandemic Relative to Prior Seasons
Authors: Allahabadi Sachin , Gatto Andrew P. , Pandya Nirav K. 
Published: February 2022

Background: The impact of fatigue and preseason preparation on anterior cruciate ligament (ACL) tears in the National Football League (NFL) are not well described. The 2020 NFL season did not include the standard preseason in response to changes secondary to the coronavirus disease-2019 (COVID-19) pandemic. Purpose: To evaluate the association of game play on ACL tears in NFL athletes and to determine if differences in ACL tear epidemiology were present based on season of play from 2013 to 2020. Study Design: Descriptive epidemiology study. Methods: ACL tears in NFL athletes were identified using publicly available data. Games played and snap counts at the time of injury were recorded for each athlete sustaining game-related injuries. Tear rates were determined, and injuries were also calculated per 1000 athlete-exposures. Incidence rate ratios (IRRs) with 95% confidence intervals (CIs) were calculated. Results: Overall, 379 ACL tears were identified, including 256 (67.6%) during game play and 118 (31.1%) during practice. Practice-based injuries were significantly higher in the preseason versus the remainder of the season. Games and snaps at the time of injury did not differ by year. The incidence rate of preseason injuries was significantly greater relative to in-season injuries (IRR = 2.68; 95% CI, 2.18-3.29; P < .00001). There was an elevated incidence rate of in-season injuries in 2020 relative to 2014-2019 combined (IRR = 1.49; 95% CI, 0.98-2.19; P = .048). In 2013 to 2019, the most frequent month of injury was the first month of the preseason in August (119/334 tears; 35.6%), whereas in 2020, the most frequent month was September (13/41 tears, 31.7%). The proportion of tears in September 2020 was not different from the proportion of tears in August 2013 to 2019. Conclusion: There was an increased proportion of in-season ACL tears in the 2020 NFL season relative to 2014 to 2019; this is attributable to a frameshift in the consistent trend of injuries in the 1st month to return of competitive play, with 2020 being in the regular season in September as opposed to the preseason in August.
Impact of Anterior Cruciate Ligament Injury on European Professional Soccer Players
Authors: Mazza Daniele , Viglietta Edoardo , Monaco Edoardo , Iorio Raffaele , Marzilli Fabio , Princi Giorgio , Massafra Carlo , Ferretti Andrea 
Published: February 2022

Background: The impact of anterior cruciate ligament reconstruction (ACLR) on the performance and career of professional soccer players has not been extensively investigated. Purpose: To evaluate in professional European soccer players (1) the ACL injury incidence, (2) the return-to-play (RTP) rate and time after ACLR, (3) career survival and athlete performance in the first 3 postoperative seasons after RTP, (4) factors likely related to different outcomes after ACLR, and (5) any related differences between the top 8 European soccer leagues. Study Design: Descriptive epidemiology study. Methods: Included were professional soccer players in the top 8 European Soccer leagues (Serie A [Italy], Premier League [England], Ligue 1 [France], LaLiga [Spain], Bundesliga [Germany], Jupiler Pro League [Belgium], Liga NOS [Portugal], and Premier Liga [Russia]) who sustained an ACL injury during seasons 2014 to 2015, 2015 to 2016, and 2016 to 2017. Data were retrieved from publicly available online sources. Outcomes were evaluated based on player age (<25 years, 25-30 years, and >30 years), position (goalkeeper, defender, midfielder, and forward), affected side (dominant vs nondominant), and league. Results: Overall, 195 players sustained an ACL injury, for a mean annual ACL injury incidence of 1.42%. The RTP rate was 95%, with a mean RTP time of 248 ± 136 days. Within the third postoperative season, 66 players (36%) competed in a lower level national league, and 25 (13.6%) ended their careers; a significant reduction in the mean minutes played per season was found in all 3 postoperative seasons. Player age correlated significantly with reduction in performance or recovery from an ACL injury. No significant correlation was found between postoperative player performance and affected side, position, league, or time to RTP. Conclusion: A substantial ACL injury incidence was found in top European elite soccer players; however, a high RTP rate in a reasonable time was seen after ACLR. Nevertheless, professional soccer players experienced a short-term decline in their performance.