bluuebunny/crossref_metadata_2025_split huggingface dataset:
Ethylene glycol poisoning requiring veno-arterial ECMO: A case report
Authors: Orlando Anita , Sciutti Fabio , Colombo Costanza NJ , Fiocco Ermanno , Ambrosini Emanuele , Coccolo Matteo , Pellegrini Carlo , Degani Antonella , Biglia Alessio , Mojoli Francesco 
Published: November 2022

Supportive care is the cornerstone of the poisoned patient’s treatment, waiting for eventual antidotes to act. We recently treated a case of a severe Ethylene Glycol intoxication with early-onset veno-arterial ECMO. The patient was taken to our Emergency Department with the suspicion of acute cerebrovascular accident, since he was found unconscious at home. The arterial blood gas and blood tests showed a severe metabolic acidosis with high serum lactates and creatinine levels. The cerebral Computed Tomography was negative. The rapid increase in serum lactates suggested Ethylene Glycol intoxication. Although the patient was not in shock yet, arterial and venous introducers were placed in to the femoral vessels so that when the patient showed the first signs of cardiogenic shock, veno-arterial ECMO could be initiated in a very short time. The hemodynamic state progressively improved and V-A ECMO was removed after 16 h of support with complete recovery.
Transforming Nurse Self-Care Through Integration of Spirituality: Lessons From an International Collaboration in Palliative Care
Authors: Davis Andra , Repar Patricia , Wilson Marian , De Luca Enrico , Doutrich Dawn , Thanasilp Sureeporn 
Published: November 2022

Introduction: With growing evidence of compassion fatigue and burnout in health care, it is time for a deeper look at the vital practice of self-care among professionals providing palliative care. The purpose of this study was to provide insights into ways empowerment, caring for self, environment, and building relationships impact well-being among palliative care professionals. Methods: Interpretative descriptive methods framed focus group interviews, conducted during a conference on palliative care integrative health practices held in Thailand. An interprofessional research team used inductive reasoning processes to analyze the interviews. Results: Three themes emerged from the four focus groups ( N = 22): Buddhist Beliefs and Practices, Community-mindedness, and Empowerment. Aspects of spirituality were consistently woven into self-care practices. Discussion: Findings suggest that self-care can be reimagined to include highly personal and unique expressions of spirituality. Health care communities are called to integrate ritual in culturally congruent ways, thus supporting health care professionals to find new sources of meaning, enrichment, and empowerment.
Study on parameter optimization of noise-vibration-force-metal removal rate in TC4 titanium alloy milling
Authors: Shao Minghui , Li Shuncai , Hu Yuting , Li Yuqing , Popov Eugene 
Published: November 2022

Aiming at the influence of noise, vibration, and force on machining efficiency and machining quality in the process of milling, this paper proposed an improved particle swarm optimization algorithm. The algorithm could optimize the multi-objective and multi-parameter integration model and obtain the optimal milling parameters under the specified milling conditions, so as to reduce milling noise, vibration, and force and improve machining efficiency. First, based on the theory of all factor experiment, the milling experiment of TC4 titanium alloy was carried out, and the relevant milling noise, vibration, and force signals were obtained. Then, based on the response surface analysis method, the influence of milling parameters on noise, vibration, and force was studied. Finally, a multi-objective optimization model based on maximum metal removal rate, minimum noise, minimum vibration, and minimum force was established, and the improved particle swarm optimization algorithm was used to solve the optimal milling parameters. The result shows that when the milling speed is 24.9588 m/min, the feed speed is 9.9324 mm/min, and the milling depth is 1 mm, the optimal milling state within the constraint conditions can be achieved.
A Retrospective Study of the Role of Perioperative Serum Albumin and the Albumin–Bilirubin Grade in Predicting Post-Liver Transplant Length of Stay
Authors: Wang Ryan , Katz Daniel , Lin Hung-Mo , Ouyang Yuxia , Gal Jonathan , Suresh Sumanth , Labgaa Ismail , Tabrizian Parissa , Demaria Samuel , Zerillo Jeron , Smith Natalie K. 
Published: November 2022

Introduction Serum albumin’s association with liver transplant outcomes has been investigated with mixed findings. This study aimed to evaluate perioperative albumin level, independently and as part of the albumin–bilirubin (ALBI) grade, as a predictor of post-liver transplant hospital and intensive care unit (ICU) length of stay (LOS). Methods Adult liver-only transplant recipients at our institution from September 2011 to May 2019 were included in this retrospective study. Repeat transplants were excluded. Demographic, laboratory, and hospital course data were extracted from an institutional data warehouse. Negative binomial regression was used to assess the association of LOS with ALBI grade, age, BMI, ASA score, Elixhauser comorbidity index, MELD-Na, warm ischemia time, units of platelets and cryoprecipitate transfused, and preoperative serum albumin. Results Six hundred and sixty-three liver transplant recipients met inclusion criteria. The median preoperative serum albumin was 3.1 [2.6–3.6] g/dL. The median postoperative ICU and hospital LOS were 3.8 [2.4–6.8] and 12 [8–20] days, respectively. Preoperative serum albumin predicted hospital but not ICU LOS (ratio .9 [95% confidence interval (CI) .84–.99], P = .03, hospital LOS vs ratio .92 [95% CI 0.84–1.02], P = .10, ICU LOS). For patients with MELD-Na ≤ 20, ALBI grade-3 predicted longer hospital and ICU LOS (ratio 1.40 [95% CI 1.18–1.66], P < .001, hospital LOS vs ratio 1.62 [95% CI 1.32–1.99], P < .001, ICU LOS). These associations were not significant for patients with MELD-Na > 20. Conclusions Serum albumin predicted post-liver transplant hospital LOS. ALBI grade-3 predicted increased hospital and ICU LOS in low MELD-Na recipients.
Impact of Chronic Kidney Disease on In-Hospital Outcomes of Hospitalizations With Acute Limb Ischemia Undergoing Endovascular Therapy
Authors: Patel Harsh P. , Decter Dean , Thakkar Samarthkumar , Anantha-Narayanan Mahesh , Kumar Ashish , Sheth Aakash R , Zahid Salman , Patel Bhavin A. , Patel Toralben , Devani Hiteshkumar , Shah Vrushali , Doshi Preet Mayank , Patel Smit , Shariff Mariam , Adalja Devina , Vallabhajosyula Saraschandra , Doshi Rajkumar 
Published: November 2022

Purpose: Studies on outcomes related to endovascular treatment (EVT) in advanced stages of chronic kidney disease (CKD) and end-stage renal disease (ESRD) among hospitalizations with acute limb ischemia (ALI) are limited. Methods: The Nationwide Inpatient Sample was quarried from October 2015 to December 2017 to identify the hospitalizations with ALI and undergoing EVT. The study population was subdivided into 3 groups based on their CKD stages: group 1 (No CKD, stage I, stage II), group 2 (CKD stage III, stage IV), and group 3 (CKD stage V and ESRD). The primary outcome was all-cause in-hospital mortality. Results: A total of 51 995 hospitalizations with ALI undergoing EVT were identified. The in-hospital mortality was significantly higher in group 2 (OR = 1.17; 95% CI 1.04 – 1.32, p=0.009) and group 3 (OR = 3.18; 95% CI 2.74–3.69, p<0.0001) compared with group 1. Odds of minor amputation, vascular complication, atherectomy, and blood transfusion were higher among groups 2 and 3 compared with group 1. Group 2 had higher odds of access site hemorrhage compared with groups 1 and 3, whereas group 3 had higher odds of major amputation, postprocedural infection, and postoperative hemorrhage compared with groups 1 and 2. Besides, groups 2 and 3 had lower odds of discharge to home compared with group 1. Finally, the length of hospital stay and cost of care was significantly higher with the advancing CKD stages. Conclusion: Advanced CKD stages and ESRD are associated with higher mortality, worse in-hospital outcomes and higher resource utilization among ALI hospitalizations undergoing EVT. Clinical Impact Current guidelines are not clear for the optimum first line treatment of acute limb ischemia, especially in patients with advanced kidney disease as compared to normal/mild kidney disease patients. We found that advanced kidney disease is a significant risk factor for worse in-hospital morbidity and mortality. Furthermore, patients with acute limb ischemia and advanced kidney disease is associated with significantly higher resource utilization as compared to patients with normal/mild kidney disease. This study suggests shared decision making between treating physician and patients when considering endovascular therapy for the treatment of acute limb ischemia in patients with advanced kidney disease.
Improved overall survival of metastatic renal cell carcinoma patients in the era of modern tyrosine kinase inhibitors and immune checkpoint inhibitors: results from a real-life, population-based Austrian study comprising three decades of follow-up
Authors: Fluhrer Hannah , Hutterer Georg C. , Golbeck Sylvia , Stidl Michael , Niedrist Tobias , Pichler Renate , Mischinger Johannes , Seles Maximilian , Mannweiler Sebastian , Spiegelberg Jasmin , Bauernhofer Thomas , Jost Philipp J. , Ahyai Sascha , Zigeuner Richard , Pichler Martin , Barth Dominik A. 
Published: November 2022

Background: The treatment landscape of metastatic renal cell carcinoma (mRCC) has substantially advanced over the last three decades, whereby data from controlled clinical trials indicate significant improvements regarding patients’ overall survival (OS) in highly selected patient cohorts. The aim of this study is to evaluate the impact of potentially game changing drugs on patients’ outcomes by comparing three different historical mRCC treatment eras. Methods: In all, 914 mRCC patients who were diagnosed between July 1985 and September 2020 were included into this observational study and assigned to three different treatment eras [‘cytokine’, ‘first-generation tyrosine kinase inhibitors (TKIs)’, and ‘modern TKIs/immunotherapy’] based on the EMA approval dates of sunitinib (July 2006) and nivolumab (June 2015) in mRCC treatment. OS was considered the primary study endpoint. Kaplan–Meier analyses, log-rank tests, and uni- and multivariable Cox regression models were performed. Results: OS was significantly longer in patients of the modern TKIs/immunotherapy era (median OS not reached) as compared to the cytokine (2.4 years) and first-generation TKIs era (1.7 years, all p < 0.001). Moreover, patients of the modern TKIs/immunotherapy era demonstrated a significantly better prognosis [hazard ratio (HR): 0.41, 95% confidence interval (CI): 0.32–0.55, p < 0.001] compared to those of the cytokine era, while no statistically significant difference was observed between the cytokine and the first-generation TKIs era cohort (HR: 1.12, 95% CI: 0.89–1.41, p = 0.341). Subgroup analyses stratified by the International Metastatic RCC Database Consortium (IMDC) risk groups showed a significantly longer OS in the modern TKIs/immunotherapy era as compared to first-generation TKIs and cytokines across all IMDC risk groups. Conclusion: Significant advances in the systemic medical treatment of mRCC during the recent decade and the introduction of immunotherapy exerted a major impact on patient outcomes in terms of OS in a real-life population.
Reconceptualization of Trochlear Dysplasia in Patients With Recurrent Patellar Dislocation Using 3-Dimensional Models
Authors: Yu Kristin E. , Cooperman Daniel R. , Schneble Christopher A. , McLaughlin William , Beitler Brian , Kaliney Ryan , Wang Annie , Fulkerson John P. 
Published: November 2022

Background: Common classification schemes, measurements, and surgical planning for trochlear dysplasia are predicated on 2-dimensional imaging views. Purpose: To investigate patellofemoral joint osseous anatomy using 3-dimensional (3D) printed models to describe osseous anatomic trochlear variations in patients with recurrent patellar dislocation. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Computed tomography scans were obtained from 20 patients with recurrent patellar dislocation and 10 healthy control knees, and 3D prints generated from these computed tomography scans were studied with respect to mediolateral positioning of the proximal trochlear groove and groove obliquity as well as changes in the appearance, height, and orientation of the medial and lateral trochlear ridges. Each trochlea was centered with respect to a vertical line perpendicular to the distal femoral condyles and through the central intercondylar notch roof, with the 3D models resting on their posterior femoral condyles. A novel 3D measurement method was devised to assess groove obliquity, termed the entry point–transition point (EP-TP) angle. The EP was defined as the midpoint of the flattened region of the proximal trochlea where the lateral and medial ridges of the proximal trochlea meet, and the TP was the point along the trochlear groove at which the groove shape changes from an oblique orientation proximally to one more vertical distally. Measurements were obtained by 3 reviewers, and reliability analyses were performed. Results: With the dysplastic knees arranged according to flattening of the trochleas, increased obliquity of the trochlear grooves was observed, as reflected by increased EP-TP angles as well as more lateral patellar EPs into the proximal trochleas of these recurrent patellar dislocation knees when compared with the control knees. The degree of trochlear dysplasia (according to the Dejour classification and trochlear flatness in the frontal and axial planes) was associated with diminished prominence of the lateral trochlear convexity, increasingly lateralized proximal trochlear EPs, increased trochlear groove obliquity, lateral trochlear curvature, and progressive medial ridge deformity. Conclusion: The 3D reproductions enabled unique conceptualization of trochlear deformity associated with recurrent patellar dislocation.
Prolonged cardiac monitoring for stroke prevention: A systematic review and meta-analysis of randomized-controlled clinical trials
Authors: Tsivgoulis Georgios , Palaiodimou Lina , Triantafyllou Sokratis , Köhrmann Martin , Dilaveris Polychronis , Tsioufis Konstantinos , Magiorkinis Gkikas , Krogias Christos , Schellinger Peter D , Caso Valeria , Paciaroni Maurizio , Sharma Mukul , Lemmens Robin , Gladstone David J , Sanna Tommaso , Wachter Rolf , Filippatos Gerasimos , Katsanos Aristeidis H 
Published: November 2022

Introduction: Prolonged cardiac monitoring (PCM) substantially improves the detection of subclinical atrial fibrillation (AF) among patients with history of ischemic stroke (IS), leading to prompt initiation of anticoagulants. However, whether PCM may lead to IS prevention remains equivocal. Patients and methods: In this systematic review and meta-analysis, randomized-controlled clinical trials (RCTs) reporting IS rates among patients with known cardiovascular risk factors, including but not limited to history of IS, who received PCM for more than 7 days versus more conservative cardiac rhythm monitoring methods were pooled. Results: Seven RCTs were included comprising a total of 9048 patients with at least one known cardiovascular risk factor that underwent cardiac rhythm monitoring. PCM was associated with reduction of IS occurrence compared to conventional monitoring (Risk Ratio: 0.76; 95% CI: 0.59–0.96; I2 = 0%). This association was also significant in the subgroup of RCTs investigating implantable cardiac monitoring (Risk Ratio: 0.75; 95% CI: 0.58–0.97; I2 = 0%). However, when RCTs assessing PCM in both primary and secondary prevention settings were excluded or when RCTs investigating PCM with a duration of 7 days or less were included, the association between PCM and reduction of IS did not retain its statistical significance. Regarding the secondary outcomes, PCM was related to higher likelihood for AF detection and anticoagulant initiation. No association was documented between PCM and IS/transient ischemic attack occurrence, all-cause mortality, intracranial hemorrhage, or major bleeding. Conclusion: PCM may represent an effective stroke prevention strategy in selected patients. Additional RCTs are warranted to validate the robustness of the reported associations.
Sesamoid View X-ray vs Weightbearing Computed Tomography in the Measurement of Metatarsal Pronation Angle
Authors: Steadman Jesse , Siebert Matthew , Saltzman Charles L. 
Published: November 2022

Category: Bunion; Midfoot/Forefoot Introduction/Purpose: First metatarsal (M1) axial rotation as measured by the metatarsal pronation angle (MPA) has increasingly become recognized as a clinically relevant component of hallux valgus deformity and methods to realign the M1 in 3 dimensions have been developed. Preoperative imaging with weightbearing computed tomography (WBCT) is considered the best way to image and measure the MPA, however WBCT is not available to many foot and ankle surgeons. The aim of this project is to investigate if the MPA measured on sesamoid view weight bearing radiographs is similar to that measured on WBCT. Methods: A retrospective analysis of patient imaging studies was performed. We identified 25 feet with both sesamoid WBR and WBCT images from a consecutive patient database. Included subjects had no trauma or foot and ankle operation between acquisition of the two scans. MPA of the WBCT for each patient was initially measured. After an appropriate washout period, the observer then measured MPA of the WBR for the cohort. Demographic statistics were calculated, a paired t-test was performed to evaluate for any significant difference in angular measurement between the two scans. Results: Patient characteristics: mean age 53 +- 16 years, mean BMI 32 +- 8 kg/m2, 13 right and 12 left feet, 19 females and 6 males. Average time between sesamoid view WBR and WBCT was 5.7 +- 9.5 months. Mean difference in MPA between WBR and WBCT = 0.6 +- 3.9 degrees (p= 0.444, t=0.777). Conclusion: Among the cohort assessed, we found no significant difference present in the measurement of the metatarsal pronation angle as evaluated on sesamoid view weightbearing radiography compared with weightbearing computed tomography (Figure 1). Routine acquisition of a sesamoid view weightbearing radiograph may be considered as an appropriate substitute for weightbearing computed tomography in the preoperative evaluation of M1 rotation in the coronal plane. These findings may benefit physicians who do not have access to weightbearing computed tomography in their clinics.
A Clinical and Economic Evaluation of ORIF Management for Calcaneal Fractures with and without Adjunctive Umbilical Cord
Authors: Stewart Chris 
Published: November 2022

Category: Hindfoot Introduction/Purpose: The number of calcaneus fractures per year continues to increase in the United States, resulting in an increased number of open reduction and internal fixation (ORIF)procedures to repair these injuries. These surgeries are notorious for post-operative complications, including post-surgical wound healing problems that occur in 16 to 43% of patients. Umbilical cord (UC) allograft has anti-inflammatory and anti-scarring properties and has been shown to promote healing of cutaneous wounds. The objective of this study was to evaluate the clinical and economic outcomes related to wound complications after ORIF management of calcaneal fractures with and without adjunctive UC. Methods: A clinical and economic evaluation was performed based on information pertaining to ORIF management obtained from the published literature and our previous clinical data of ORIF for calcaneal fractures with (n=20) and without adjunctive UC (n=20). Results: After ORIF for calcaneal fractures, 10% of patients that received adjunctive UC required wound care compared to 35% of patients didn't receive the adjunctive treatment. Similarly, the readmission and reoperation rate were higher in the control group compared to the UC treatment group (30% vs 10%, respectively). Available cost-effectiveness data demonstrated that treatment with UC results in an average cost-savings of $2,775.50 per person over a five-year period (total cost of $330, 500 vs. $386,010 in the UC and control group, respectively). Using available data that includes costs incurred from time off work, adjunctive UC allograft treatment resulted in an average cost-savings of $14,377.50 per patient over a four-year period (total cost of $704,260 vs. $991,810 in the UC and control group, respectively). Conclusion: Wound complications remain a significant burden to patient recovery and an economic burden to payors and providers. Based on our observed complications rates, adjunctive use of UC during ORIF management of calcaneal fractures may not only decrease wound complications but also reduce socioeconomic costs.
Synovial fluid pH is as specific as synovial leukocyte count but less sensitive for the diagnosis of chronic prosthetic joint infection
Authors: Theil Christoph , Ackmann Thomas , Gosheger Georg , Puetzler Jan , Moellenbeck Burkhard , Schwarze Jan , Schulze Martin , Klingebiel Sebastian 
Published: November 2022

Abstract
Background
Synovial fluid markers (synovial leukocyte count and differential) have been shown to be most accurate in diagnosing prosthetic joint infection (PJI). An inverse correlation for synovial leukocyte count and synovial pH is known assuming that leukocyte metabolism causes synovial fluid acidosis. This study’s purpose is to analyze the use of synovial pH as a potential diagnostic marker for PJI.

Materials and methods
92 patients who presented with painful total joint arthroplasty (TJA) of the hip (THA; n = 25) or knee (TKA, n = 67) were prospectively investigated. In our cohort 33% (30/92) had PJI and 67% (62/92) were diagnosed non-infected based on the modified Musculoskeletal Infection Society (MSIS) criteria of 2018. Receiver operating curves and the Youden’s index were used to define an ideal cut-off value for synovial pH and the sensitivity and specificity were calculated using cross-tables. Additionally, the sensitivity and specificity were calculated for synovial white blood cell (WBC) count (cut-off > 3000 leukocytes) and percentage of neutrophils (PMN%, cut-off > 80%).

Results
The median synovial pH level was significantly lower in the group with chronic PJI compared to implants with aseptic failure (7.09 vs. 7.27; p < 0.001). The calculated optimal cut-off value was 7.11 (AUC 0.771) with a sensitivity of 53% and specificity of 89%. However, the sensitivity and specificity of synovial WBC count were 90% and 88% and for synovial PMN% 73% and 98%, respectively.

Conclusion
Synovial pH may be a useful adjunct parameter in the diagnosis of chronic PJI after hip or knee arthroplasty, but showed low sensitivity in this preliminary cohort. Future studies with larger numbers are needed.

Level of evidence
2a, diagnostic study.
Trial registration German Clinical Trials Register (Registration number: DRKS00021038).