bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effect of a Protocol to Reduce Radiographic Imaging in Pediatric Patients With Suspected Fractures
Authors: Schlacter Jamie A. , Roussos Demetrios , Masrouha Karim , Karamitopoulos Mara , Carter Cordelia , Price Andrew , Castañeda Pablo , Litrenta Jody 
Published: September 2022

Background:
Children with suspected fractures are typically evaluated with multiple x-rays. This approach can add time, discomfort, and radiation exposure without clinical benefit. The purpose of this study was to determine whether a focused radiographic protocol could reduce the number of x-rays performed without missing any fractures.

Methods:
Pediatric patients presenting at 2 sites within an academic medical center [urgent care (UC) and the emergency department(ED)] for a suspected fracture were identified. There were 495 patients (UC, 409; ED, 86) over a 3-month period. A retrospective chart review was performed to characterize the standard x-rays performed. Using this data, a simplified protocol was developed and distributed. Subsequently, 333 patients (UC, 259; ED, 74) were evaluated over the same period 1-year later. The main outcome measures included the final diagnosis, the total number of x–rays, the number of anatomic areas imaged, visit length, and the time for additional trips to radiology. Charts were reviewed to identify any missed injuries. Welch 2-sample t tests and Fisher exact tests were used for statistical analysis.

Results:
After implementing the radiographic protocol, there was a significant reduction in the number of x-ray views, 3.4 versus 5.1 (P<0.001). There was a decrease in imaging of multiple anatomic areas with the largest reduction occurring in patients presenting with elbow injuries (9% vs. 44%, P<0.001). No difference was found in the rate of patients sent back to radiology (6% vs. 7%, P=0.67). However, among patients presenting with outside imaging, significantly fewer were sent to radiology for additional x-rays (29% vs. 50%, P<0.01).

Conclusion:
A simple radiographic protocol for evaluating pediatric patients with suspected fractures safely led to a decrease in the overall number of x-rays without missing any injuries.

Level of Evidence:
Level III, retrospective comparative study.
Comparing Clinical and Radiographic Outcomes Between the Self-locking Stand-Alone Cage and Conventional Cage-Plate Construct: a 5-year Retrospective Cohort Study
Authors: Li Pan , Lei Runbo , Gan Lu , Shangguan Lei , Liang Zhuowen , Chang Le , Cao Xiongfei , Ye Zhengxu , Li Mo , Luo Zhuojing 
Published: September 2022

Study Design/Setting.
A retrospective cohort study.

Objective.
To evaluate the clinical efficacy of the self-locking stand-alone cage (SA) and conventional cage-plate construct (CPC) in treating degenerative cervical spondylosis with a 5-year follow-up.

Summary of Background Data.
The stand-alone approach was designed to reduce complications associated with traditional anterior cervical discectomy and fusion (ACDF). These techniques have been shown to have satisfactory short-term clinical outcomes. Literature describing the mid-term clinical outcomes of stand-alone cage is limited.

Methods.
We retrospectively analyzed patients with cervical spondylosis who had received an SA device or CPC between 2014 and 2016 at the Xijing Hospital. Participants were matched for sex, age, and operative level. Differences in clinical and radiographic outcomes and the occurrence of postoperative complications between the two groups were analyzed.

Results.
In total, 207 patients were included (101 with SA and 106 with CPC), the median follow-up for both groups were 60.2 months and 60.9 months. Both groups exhibited significant improvements in all measured values compared to the preoperative values. The SA group had a shorter operation time, less intraoperative blood loss, and a significantly lower incidence of dysphagia after surgery than the CPC group (P<0.05). At the last visit, cage subsidence was 6.9% and 3.8% in the SA and CPC groups, respectively (P=0.365). The radiographic ASD was significantly lower in the SA group than in the CPC group (6.9% vs. 27.4%, P<0.01). No symptomatic ASD was observed in the SA group, and 6 (5.7%) cases occurred in the CPC group (P=0.029).

Conclusion.
In this study of the Asian population, the stand-alone cage showed similar efficacy to that of the conventional cage-plate construct in treating cervical spondylosis with ACDF, with a significant reduction in the incidence of immediate postoperative dysphagia and mid-term ASD.
Percutaneous Transforaminal Endoscopic Discectomy Versus Microendoscopic Discectomy for Lumbar Disc Herniation: 5-year Long-term Results of a Randomized Controlled Trial
Authors: Chen Zihao , Zhang Liangming , Dong Jianwen , Xie Peigen , Liu Bin , Chen Ruiqiang , Li Shangfu , Liu Zhongyu , Yang Bu , Feng Feng , He Lei , Yang Yang , Pang Mao , Rong Limin 
Published: September 2022

Study Design.
Prospective randomized controlled study.

Objective.
To compare the efficacy and safety between percutaneous transforaminal endoscopic discectomy (PTED) and microendoscopic discectomy (MED).

Summary of Background Data.
Two kinds of minimally invasive discectomy, PTED and MED, are now widely used for treating lumbar disc herniation (LDH). The long-term comparative results of these two techniques still remained uncertain.

Methods.
In this single-center, open-label, randomized controlled trial, patients were included if they had persistent signs and symptoms of radiculopathy with corresponding imaging-confirmed LDH, and were randomly allocated to PTED or MED group. The primary outcome was the score of Oswestry Disability Index (ODI) and the secondary outcomes included the score of Medical Outcomes Study 36-Item Short-Form Health Survey bodily pain (SF36-BP) and physical function (SF36-PF), European Quality of Life-5 Dimensions (EQ-5D), Visual Analogue Scales for back pain (VAS-back) and leg pain (VAS-leg).

Results.
A total of 241 patients were accepted to enrolled in our RCT, of which 119 were randomly assigned to the PTED group, and the rest 122 were assigned to the MED group. 194 out of 241 patients (80.5%) completed the 5-year follow-up. PTED group was associated with shorter postoperative in-bed time and length of hospital stay. Both primary and secondary outcomes did not differ significantly between the two treatment groups at each follow-up time point. During the 5-year follow-up, 7 recurrent cases occurred in PTED group and MED group respectively.

Conclusion.
Over the 5-year follow-up period, PTED and MED were both efficacious in the treatment of LDH. The long-term clinical outcomes and recurrent rates were comparable between the treatment groups. PTED represents a more minimally invasive technique with the advantages of rapid recovery.
Circulating tumour DNA dynamics for assessment of molecular residual disease and for intercepting resistance in breast cancer
Authors: Valenza Carmine , Trapani Dario , Curigliano Giuseppe 
Published: September 2022

Purpose of review
Longitudinal evaluation of circulating tumour DNA (ctDNA) represents a promising tool for monitoring tumour evolution. In patients with breast cancer, ctDNA dynamics for the assessment of molecular residual disease (MRD) and resistances may, respectively, help clinicians in treatment modulation of adjuvant treatments, and in anticipating resistance to ongoing treatments and switch treatments before clinical progression, to improve disease control. Anyway, the introduction of this dynamic biomarker into clinical practice requires the demonstration of analytical validity, clinical validity and clinical utility.

Recent findings
In early breast cancer setting, several observational studies demonstrated the clinical validity of MRD monitoring through ctDNA in identifying patients at a higher risk of relapse, but many clinical trials evaluating the clinical utility are still ongoing, and few data resulted in inconclusive results.
Instead, ctDNA dynamics for intercepting resistance have not been fully evaluated in terms of clinical validity, because monitoring schedules of most observational studies are not intensive. The only trial assessing their clinical utility (PADA-1) demonstrated a benefit in terms of progression-free survival, portraying a new landscape for clinical trials in this space.

Summary
Rigorous clinical trials with adequate assays and patient-relevant endpoints are paramount to demonstrate the clinical utility of ctDNA dynamics and eventually increase clinical outcomes.
Breast surgery after neoadjuvant therapy
Authors: Gnant Michael 
Published: September 2022

Purpose of review
The standard of care in breast surgery has changed, from mastectomy to breast conserving surgery whenever possible, and from axillary dissection to sentinel node biopsy. Neoadjuvant systemic approaches have broadened the indications for organ-conserving and less mutilating surgery, but also raise important questions of balancing locoregional treatment de-escalation and protecting excellent long-term outcomes.

Recent findings
Recent studies have aimed at investigating the safety of de-escalating surgical approaches not only in the upfront breast surgery situation but also after neoadjuvant systemic therapy. This pertains to both the safety of breast conserving surgery – including more complex oncoplastic approaches – within the new (posttherapeutic) anatomical extent of the residual disease, but more controversially to de-escalating surgical treatment of the axilla. While sentinel node biopsy appears to be the standard of care for node-negative disease also after primary systemic therapy, the optimal procedure in situations of posttherapeutic node-positive disease remains highly controversial.

Summary
Both breast and axillary surgery after neoadjuvant systemic therapy for women with breast cancer has undergone multiple paradigm changes in recent years. For the primary tumor in the breast, breast-conserving surgery constitutes the standard of care, and unnecessary mastectomies should be strongly discouraged. For axillary surgery, sentinel-node biopsy should be aimed at, and completion axillary dissections minimized for situations of extensive disease and or poor neoadjuvant treatment response. Additional techniques such as targeted axillary dissection are currently under evaluation in clinical trials.
Long-term Locoregional Control With Unilateral Radiation for AJCC-7 T1-2N2b Tonsillar Cancer
Authors: Frankart Andrew J. , Abana Chike O. , Geier Natalie , Bahig Houda , Manzar Gohar Shahwar , Garden Adam S. , Phan Jack , Takiar Vinita 
Published: September 2022

Objectives:
Unilateral radiation to cervical nodes has been used as a de-escalation strategy in well-lateralized tonsil cancers. The efficacy of this approach with multiple ipsilateral nodes is not established. The study hypothesis was that unilateral radiation for American Joint Committee on Cancer (AJCC)-7 T1-2N2b tonsillar cancer results in a low rate of contralateral nodal failure.

Materials and Methods:
This study was a retrospective chart review of patients with AJCC-7 T1-2N2b tonsillar cancer from 2 academic institutions who were treated with unilateral radiation. The primary endpoint was the contralateral nodal failure rate. Locoregional control, overall survival, and the need for gastrostomy tube placement were additional endpoints.

Results:
The study cohort included 66 patients treated between 2005 and 2016. The median follow-up time was 80.9 months; contralateral nodal failure occurred in 2/66 (3.0%) patients at 4.1 and 20.9 months, respectively. Both patients underwent salvage treatment with long-term subsequent survival. Overall locoregional control at both 2 and 5 years was 93.9% and the median duration of control was not reached. Overall survival at 5 years was 92.4%.

Conclusions:
The use of unilateral radiation for AJCC-7 T1-2N2b tonsillar cancer resulted in low rates of contralateral nodal failure. This outcome demonstrates the safety of considering unilateral radiation treatment in patients with a relatively high ipsilateral nodal burden.
Clinical value of bacterial culture in sinus tract in the diagnosis of fracture-related infection
Authors: Ma Xianzhi , Huang Kunkun , Ma Sichao , Lv Ruiqiang , Qi Wanle , Wang Kai , Chao Shilan 
Published: September 2022

Objectives:
This study compared the results of bacterial culture from operation versus sinus tract samples in patients with fracture-related infection (FRI), and examined the ability of bacterial culture in sinus tract to identify pathogenic bacteria.

Methods:
A retrospective analysis of 53 patients with FRI from June 2016 to June 2021 was done. Common infection sites were femur, tibiofibular, hip joint, and ankle. Samples collected in sinus tract and during the operation were sent for bacterial culture. Results were summarized and compared, respectively, with pathogenic bacteria.

Results:
In sinus tract bacterial culture, bacteria were found in 75.6% of culture samples. The top 3 bacteria presented were: Staphylococcus aureus (32.26%), Staphylococcus epidermis (12.90%), and Pseudomonas aeruginosa (8.06%). Bacterial culture from the sinus tract matched the result of intraoperative samples 67.30% of the time, while 51.50% matched the pathogenic bacteria.

Conclusion:
Bacterial culture of sinus tract samples is not recommended as the basis for identifying pathogenic bacteria. Stopping antibiotic 2 weeks before operation, taking multiple samples at different sites, and sending multiple samples for bacterial culture are good ways to improve pathogen detection rate.
CONVENTIONAL INTERNAL LIMITING MEMBRANE PEELING VERSUS INVERTED FLAP FOR SMALL-TO-MEDIUM IDIOPATHIC MACULAR HOLE
Authors: Ventre Luca , Fallico Matteo , Longo Antonio , Parisi Guglielmo , Russo Andrea , Bonfiglio Vincenza , Marolo Paola , Caselgrandi Paolo , Avitabile Teresio , Borrelli Enrico , Reibaldi Michele 
Published: September 2022

Purpose:
To compare conventional internal limiting membrane (ILM) peeling versus inverted flap technique in small-to-medium idiopathic macular hole.

Methods:
Eyes with ≤400 μm idiopathic macular holes were randomized into the conventional ILM peeling group (25 eyes) and inverted flap group (25 eyes). A 12-month follow-up was considered. Macular sensitivity (MS) change detected with MP-1 microperimetry was the primary outcome. Secondary outcomes included best-corrected visual acuity change, closure rate, anatomical findings on optical coherence tomography such as U-shape foveal contour, restoration of external limiting membrane, and ellipsoid zone.

Results:
In both groups, MS improved throughout the follow-up. Final MS was greater in the conventional ILM peeling group compared with the inverted flap group, being 16.6 ± 2.3 dB versus 14.9 ± 2.9 dB, respectively (P = 0.026). In both groups best-corrected visual acuity improved throughout the follow-up, with a final best-corrected visual acuity of 0.19 ± 0.14 logMar (20/31 Snellen) in the conventional ILM group and 0.22 ± 0.11 logMar (20/33 Snellen) in the inverted flap group (P = 0.398). Anatomical hole closure was achieved in all cases. No difference in optical coherence tomography findings was shown between the two groups.

Conclusion:
A better final MS was found in eyes undergoing conventional ILM peeling. Inverted flap technique has disadvantages compared with conventional peeling for the treatment of small-to-medium idiopathic macular holes.
The analgesic contribution of external oblique intercostal block: Case reports of 3 different surgeries and 3 spectacular effects
Authors: Coşarcan Sami Kaan , Erçelen Ömür 
Published: September 2022

Introduction:
Abdominal wall blocks are frequently used due to the use of effective blocks, such as the transversus abdominis plane (TAP) block and the widespread use of ultrasound (US) imaging. A good knowledge of abdominal innervation is required for the use of abdominal wall blocks. We describe the extraordinary performance of external oblique intercostal (EOI) blocks in 3 different surgeries.

Patient concerns, diagnosis and interventions:
Case 1: A man aged 30 to 35 was taken to the operating room for open liver surgery. After surgery, unilateral EOI block and bilateral TAP block were performed with the patient in the supine position, and a catheter was placed under the external oblique muscle. Postoperative analgesia was followed by patient-controlled analgesia (PCA) through the catheter. Case 2: A male patient aged 35 to 40 was taken to the operating room for laparoscopic liver surgery. After surgery, unilateral (EOI) block and bilateral TAP block were performed with the patient in the supine position. The patient received iv tramadol PCA (bolus dose 10 mg only, lockout 20 minutes). Case 3: A man aged 25 to 30 was taken to the operating room for laparoscopic bariatric surgery. After the surgery, bilateral EOI and bilateral rectal sheath blocks were performed with the patient in the supine position. The patient received iv tramadol PCA (bolus dose 10 mg only, lockout 20 minutes).

Outcomes:
All patients had low NRS scores in the recovery unit and very low opioid consumption in the first 72 hours postoperatively. All were satisfied with the quality of analgesia.

Conclusion:
We think that EOI block will come to occupy a significant place in upper abdominal analgesia, especially in obese patients, due to its wide innervation area and ease of application.
Better care for women with polycystic ovary syndrome – a proposal for an international evidence based best practice framework to improve care
Authors: Tay Chau Thien , Joham Anju E. , Moran Lisa J. , Teede Helena 
Published: September 2022

Purpose of review
Polycystic ovary syndrome (PCOS) is the most common endocrinopathy in reproductive-age women and has reproductive, pregnancy, metabolic, dermatologic, and psychologic complications. Here we summarize current challenges and gaps in PCOS care, and propose a pathway forward to implement high quality international guideline recommendations and resources, through development of a best practice framework and benchmarking for evidence-based, patient-centric models of care (MoC).

Recent findings
The majority of women with PCOS are unsatisfied with their healthcare experience due to delayed diagnosis, inadequate information provision and inconsistent advice from diverse healthcare providers. The 2018 International Evidence-based PCOS Guideline recommended co-development of evidence-based, patient centric MoC. High-quality guidelines and resources are now available to help women understand and manage PCOS and to assist healthcare professionals to partner in their care. Leveraging these and developing a best practice framework for patient centric PCOS MoC is now a vital to optimise care and outcomes in this common and neglected condition.

Summary
Collaborative interdisciplinary efforts from academic leads, healthcare professionals and consumers are now needed to co-develop a framework and benchmarking performance indicators to guide evidence-based, patient centric PCOS MOC to improve experience and outcomes.
What factors influence the R value in data-driven respiratory gating technique? A phantom study
Authors: Hayashi Naoya , Ogasawara Daisuke , Tokorodani Ryotaro , Kirizume Rikito , Kenda Shuji , Yabe Fumika , Itoh Kenji 
Published: September 2022

Objective
The R value is adopted as a metric for the effectiveness of the respiratory waveform in the Advanced Motion Free implemented in the PET scanner as the data-driven respiratory gating (DDG) algorithm. The effects of changes in various factors on R values were evaluated by phantom analysis.

Methods
We used a programmable respiratory motion phantom QUASAR with a sphere filled with an 18F solution. Respiratory motion simulation was performed by changing the sphere diameter, radioactivity concentration, amplitude, respiratory cycle, and respiratory waveform shape. Three evaluations were performed. (1) The power spectra calculated from the input waveforms were evaluated. (2) The effects of changes in the factors on the R value were evaluated. (3) DDG waveforms and inspiratory peak intervals were compared with the input waveform data set.

Results
The R values were increased and converged to a certain value as sphere diameter, radioactivity concentration, and amplitude gradually increased. The respiratory cycle showed the highest R value at 7.5 s, and the graph showed an upward convex pattern. The R value of the sinusoid waveform was higher than that of the typical waveform. There was a relationship between the power spectrum of the input waveform and R value. The visual score was also lower in the condition with a lower R value. In cases of no sphere, radioactivity, or motion, and a fast respiratory cycle, peak intervals were not accurately acquired.

Conclusions
Factors affecting the R value were sphere diameter, radioactivity concentration, amplitude, respiratory cycle, and respiratory waveform shape.
Correlation between MAMMI-PET findings and anatomopathological outcomes in breast cancer patients
Authors: de Andrés Gómez Alejandra , Villalba Ferrer Francisco , Ferrer Rebolleda Jose , Sánchez Jurado Raúl , García García Jose Ángel , García-Vilanova Comas Andrés , Fuster Diana Carlos A. 
Published: September 2022

Objective
Imaging tests are a key element in the preoperative diagnosis of patients with breast cancer. Whole-body PET-computed tomography (PET/CT) breast studies have a limited spatial resolution, although dedicated breast PET (dbPET) devices such as the Mammography with Molecular Imaging PET (MAMMI-PET), have an increased sensitivity to detect tumor foci, especially those smaller than 2 cm. The purpose of this study is to define the validity and reliability of this new device.

Methods
A prospective and analytical observational study was carried out in a sample of patients with histologically confirmed breast cancer who were treated at our hospital between January 2017 and November 2018. The anatomopathological study findings for the surgical pieces were used as gold standards and we calculated their concordance with the findings from the MAMMI-PET as well as the validity and reliability parameters for this test.

Results
Data from 32 patients and 44 lesions (36 malignant and 8 benign) were evaluated. The mean patient age was 51.50 ± 11.68 years. Twenty patients had received neoadjuvant chemotherapy (NACT). The technique concordance rate was weak (K = 0.349, P = 0.001) and was 84.3% for benign lesions and 62.6% for malignant ones. The MAMMI-PET sensitivity was 75%, whereas its specificity was 57.1%; the positive predictive value was 81.8% and the negative predictive value was 47.1%, with an overall precision of 70%. The MAMMI-PET sensitivity was higher in patients who had not undergone NACT and was significantly higher in patients with luminal B breast cancer compared to the luminal A subtype.

Conclusion
The MAMMI-PET device had acceptable sensitivity and a high positive predictive value for the preoperative evaluation of patients with breast cancer; it was especially useful for lesions whose diagnosis with other imaging tests had been doubtful.