bluuebunny/crossref_metadata_2025_split huggingface dataset:
Elastic Intramedullary Nails in the Treatment of Pediatric Length Unstable Femur Fractures
Authors: Ouillette Ryan J. , Bastrom Tracey P. , Newton Peter O. , Pennock Andrew T. 
Published: January 2022

Background:
Elastic intramedullary nails (EINs) are the treatment of choice for school-age children (5 to 12) with diaphyseal femur fractures. Previous literature suggests that EINs are an effective treatment for stable fracture patterns, but may be inadequate for unstable fracture patterns. The purpose of this study was to evaluate whether patients with length unstable fractures had a higher complication rate than those with length stable fractures when treated with EINs.

Methods:
All patients with diaphyseal femur fractures treated with EINs over a 22-year period at a single institution were reviewed. Patients were excluded if they had a pathologic fracture, neuromuscular disorder, spinal cord injury with subsequent involvement of affected limb, metabolic bone disease, or if they did not have at least 6-month follow-up.

Results:
A total of 85 patients with 87 diaphyseal femur fractures treated with EINs were included in the study. In all, 57.5% of the fractures were categorized as length stable and 42.5% were length unstable. Fourteen percent of length stable patients had a residual angular deformity compared with 5.4% of the length unstable group (P=0.24). The length unstable group experienced more shortening at the fracture site than the patients in the length stable group (P=0.003), but no patient required further intervention for their shortening. Two patients in the length stable group experienced overgrowth >2 cm and required subsequent surgery. No relationship was observed between fracture pattern and frequency of complications (length stable 8% vs. length unstable 10.8%, P=0.69). Finally, the knee immobilizer group (10.7%) and the long leg cast group (18.2%) had significantly higher complication rates than the single leg spica cast group (0%, P<0.05).

Conclusions:
There was no significant difference in complication rate between length stable and unstable fractures treated with EINs. Adjunctive spica casting may be protective against postoperative complications. While fracture shortening was more likely in the length unstable group, it did not result in increased rate of limb length discrepancy at final follow-up.

Level of Evidence:
Level IV, Case Series.
Impact of bacterial infection and intestinal microbiome on colorectal cancer development
Authors: Sun Jun 
Published: January 2022

Abstract
Accumulating evidence suggests that intestinal bacteria play an important role in the pathogenesis of colorectal cancer (CRC). Due to the complexity of the intestinal microbiome, identification of the specific causative microbial agents in CRC remains challenging, and the search for the causative microbial agents is intense. However, whether bacteria or their products can induce inflammation that results in tumorigenesis or directly causes CRC in humans is still not clear. This review will mainly focus on the progress of bacterial infection and CRC, and introduce the microbial contribution to the hallmarks of cancer. This article uses Salmonella and its chronic infection as an example to investigate a single pathogen and its role in the development of CRC, based on laboratory and epidemiological evidence. The bacterial infection leads to an altered intestinal microbiome. The review also discusses the dysfunction of the microbiome and the mechanism of host–microbial interactions, for example, bacterial virulence factors, key signaling pathways in the host, and microbial post-translational modifications in the tumorigenesis. Colonic carcinogenesis involves a progressive accumulation of mutations in a genetically susceptible host leading to cellular autonomy. Moving forward, more human data are needed to confirm the direct roles of bacterial infection in CRC development. Insights into the inhibiting infection will help to prevent cancer and develop strategies to restore the balance between host and microorganisms.
Zoster Eye Disease Study: Rationale and Design
Authors: Cohen Elisabeth J. , Hochman Judith S. , Troxel Andrea B. , Colby Kathryn A. , Jeng Bennie H. ,   on behalf of The ZEDS Trial Research Group
Published: January 2022

Purpose:
The purpose of this study was to describe the rationale and design of the Zoster Eye Disease Study (ZEDS).

Methods:
ZEDS is a National Eye Institute–supported randomized clinical trial designed to determine whether 1 year of suppressive valacyclovir in patients with herpes zoster ophthalmicus (HZO) reduces complications because there is currently no high-quality evidence to support its use. Eligible patients are 18 years and older, immunocompetent, have a history of a typical rash at disease onset, and have had a record of active epithelial or stromal keratitis or iritis within 1 year before enrollment. Exclusion criteria include estimated glomerular filtration rate less than 45 or pregnancy. The primary endpoint is the time to first occurrence of new or worsening dendriform epithelial keratitis, stromal keratitis without or with ulceration, endothelial keratitis, or iritis due to HZO during 12 months of study treatment requiring prespecified treatment changes. The study has 80% power to detect a 30% difference between treatment groups, with a 30% rate of endpoints by 1 year assumed among controls. Secondary and exploratory questions include whether there is a persistent treatment benefit during the 6 months after treatment, whether development of postherpetic neuralgia varies by treatment group, and whether vaccinations against herpes zoster affect study outcomes and coronavirus disease 19 status.

Results:
Over approximately 4 years, over 400 study participants have been enrolled.

Conclusions:
ZEDS aims to provide scientific evidence on whether suppressive valacyclovir treatment improves outcomes in HZO and should become the standard of care.
The application of ambroxol hydrochloride combined with fiberoptic bronchoscopy in elderly patients with severe pneumonia
Authors: Tang Haowei , Yuan Zhi , Li JingJie , Wang Qun , Fan Weijie 
Published: January 2022

Abstract

Background:
The role of ambroxol hydrochloride combined with fiberoptic bronchoscopy in elderly patients with severe pneumonia remains unclear, we aimed to analyze this issue to provide evidences into the management of clinical pneumonia.

Methods:
We searched PubMed et al databases up to October 20, 2021 for the randomized controlled trials on the application of ambroxol hydrochloride combined with fiberoptic bronchoscopy in elderly patients with severe pneumonia. Related outcomes were extracted and analyzed. Review Manager 5.3 software was used for data analysis.

Results:
A total of 13 randomized controlled trials involving 1317 elderly patients (559 cases in the ambroxol hydrochloride + fiberoptic bronchoscopy group and 658 cases in the fiberoptic bronchoscopy group) with pneumonia were included. Meta-analyses indicated that the blood oxygen partial pressure [mean difference (MD) = 5.75, 95% confidence interval (CI) (3.80, 7.70)], blood oxygen saturation [MD = 6.43, 95% CI (4.39, 8.48)], oxygenation index [MD = 26.75, 95% CI (14.61, 38.89)] of experimental group was significantly higher than that of control group (all P < .001), the incidence of multiple organ failure [odds ratio = 0.42, 95% CI (0.31, 0.56), P < .001], mortality on day 28 [odds ratio = 0.44, 95% CI (0.33, 0.59)] of experimental group was significantly less than that of control group (all P < .001).

Conclusions:
The high-dose ambroxol hydrochloride combined with fiberoptic bronchoscopy is beneficial to improve the patient's blood gas indicators, and reduce mortality in elderly patients with severe pneumonia.
The features and clinical outcomes of inflammatory bowel disease associated with autoimmune pancreatitis
Authors: Conti Bellocchi Maria Cristina , Marconato Eugenio , Lamonaca Laura , Cattani Mottes Martina , Ciccocioppo Rachele , Carrara Silvia , de Pretis Nicolo’ , Gabbrielli Armando , Crinò Stefano Francesco , Frulloni Luca 
Published: January 2022

Abstract
The prevalence of inflammatory bowel disease (IBD) has been described in 5% to 40% of autoimmune pancreatitis (AIP) patients. The aim of our study was to evaluate the prevalence, endoscopic features, and outcome of IBD in association with AIP.
A retrospective analysis including all consecutive patients with AIP and a histological diagnosis of IBD from 2010 to 2020 was performed. Demographical data, AIP, and IBD features, as well as clinical course, were recorded.
Among 267 AIP patients, 45 were diagnosed with ulcerative colitis (UC) (27 men, mean age 31.6), all with a diagnosis of type 2 AIP. The most frequent presentation of AIP was acute pancreatitis (55.5%). Both diffuse (51.1%) and focal (48.9%) pancreatic involvement were observed. The AIP relapse rate was 11.1% over a mean follow-up of 55 months. In 69% of patients, the interval time between the diagnosis of AIP and UC was <1 year. When UC was present at AIP onset, UC was in clinical remission in 50% of patients. Fecal calprotectin levels, when available, were elevated in 86.6% of these patients. Mostly, mild–moderate pancolitis was initially diagnosed (55.5%). During follow-up, escalation therapy for UC was required in 40% of patients after a mean time of 45 months. Two patients (4.4%) underwent colectomy.
The prevalence of UC in AIP patients was 17%. Mild pancolitis with a low rate of colectomy was found. Greater awareness is needed to avoid a delayed diagnosis of UC, and the dosage of fecal calprotectin levels could have a role in this setting.
Association between liver stiffness measurement by transient elastography and chronic kidney disease
Authors: Chan Ya-Ju , Chang Shy-Shin , Wu Jenny L. , Wang Sen-Te , Yu Cheng-Sheng 
Published: January 2022

Abstract
Transient elastography or elastometry (TE) is widely used for clinically cirrhosis and liver steatosis examination. Liver fibrosis and fatty liver had been known to share some co-morbidities that may result in chronic impairment in renal function. We conducted a study to analyze the association between scores of 2 TE parameters, liver stiffness measurement (LSM) and controlled attenuation parameter (CAP), with chronic kidney disease among health checkup population.
This was a retrospective, cross-sectional study. Our study explored the data of the health checkup population between January 2009 and the end of June 2018 in a regional hospital. All patients were aged more than 18 year-old. Data from a total of 1940 persons were examined in the present study. The estimated glomerular filtration rate (eGFR) was calculated by the modification of diet in renal disease (MDRD-simplify-GFR) equation. Chronic kidney disease (CKD) was defined as eGFR < 60 mL/min/1.73 m2.
The median of CAP and LSM score was 242, 265.5, and 4.3, 4.95 in non-CKD (eGFR > 60) and CKD (eGFR < 60) group, respectively. In stepwise regression model, we adjust for LSM, CAP, inflammatory markers, serum biochemistry markers of liver function, and metabolic risks factors. The P value of LSM score, ALT, AST, respectively is .005, <.001, and <.001 in this model.
The LSM score is an independent factor that could be used to predict renal function impairment according to its correlation with eGFR. This result can further infer that hepatic fibrosis may be a risk factor for CKD.
MR imaging features of Lhermitte–Duclos disease
Authors: Zhang Han-wen , Zhang Yuan-qing , Liu Xiao-lei , Mo Yong-qian , Lei Yi , Lin Fan , Feng Yu-ning 
Published: January 2022

Abstract

Rationale:
Lhermitte–Duclos disease (LDD) is a rare tumor of the nervous system with a typical “tiger striped’” sign, but its features on functional magnetic resonance imaging (fMRI) are still inconclusive.

Patient concerns:
To explore the characteristics of LDDs using fMRI.

Diagnoses:
We report 3 cases of pathologically confirmed LDDs.

Interventions:
Three patients underwent brain tumor surgery.

Outcomes:
All the patients had a good prognosis.

Lessons:
Magnetic resonance spectroscopy and susceptibility-weighted imaging combined with conventional MRI can be used to better diagnose LDDs. Perfusion-weighted imaging is not specific for distinguishing cerebellar tumors. The combined application of fMRI and conventional MRI can improve the accuracy of LDD diagnoses.
Evaluation of the safety and efficacy of Zhenwu decoction as adjuvant therapy for the treatment of heart failure with reduced ejection fraction
Authors: Han Yue , Huang Lanlin , Zhong Guofu , Chang Xiao , Zhu Qinghua , Xu Mujuan , Mingtai Chen , Men Ling , Wang Ling 
Published: January 2022

Abstract

Introduction:
Heart failure with reduced ejection fraction (HFrEF) demonstrates a substanital threat to global public health. Several Chinese studies have been conducted to date evaluating the clinical efficacy of Zhenwu decoction (ZWD) as a treatment for HFrEF. The present systematic review will be conducted to more comprehensively evaluate the impact of ZWD on HFrEF outcomes.

Methods:
For this systematic review, all randomized controlled trials (RCTs) reporting on the effectiveness of ZWD as a treatment for HFrEF published as of December 30, 2021 in the Embase, PubMed, Springer, Web of Science, Cochrane Library, China Biomedical Literature Database, China National Knowledge Infrastructure, and the Wan-Fang databases will be identified without any language or publication restrictions. Two researchers will independently choose investigations, extract information, and gauge research quality. Primary outcomes of interest will include all-cause mortality and HF-associated mortality. Secondary outcomes will include the incidence of adverse events, ultrasonic cardiographic indices (including left ventricular ejection fraction and left ventricular mass index), New York Heart Association grade, N-terminal pro-b-type natriuretic peptide, B-type natriuretic peptide, and 6-minute walking distance. RevMan v 5.3 will be used to conduct meta-analyses where possible, with descriptive or subgroup analyses otherwise being conducted. Data will be given as risk ratios for categorical variables and mean difference for continuous variables.

Results:
This comprehensive protocol will aid in the systematic and objective evaluation of the efficacy and safety of ZWD as a treatment for HFrEF, providing a scientific basis for the clinical utilization of ZWD.
Radiologic assessment of rupture risk in small (<5 mm) posterior communicating artery aneurysms
Authors: Kim Jang Hun , Choi Jong-Il , Lim Dong-Jun 
Published: January 2022

Abstract
Although previous studies have investigated the predictors of posterior communicating artery (PCoA) aneurysm rupture with clinical and radiologic parameters, the accessibility of “small PCoA aneurysms (<5 mm)” has rarely been reported. Here, we designed a study to identify the factors which are thought to be risky and prone to rupture in small PCoA aneurysms (<5 mm).
A total of 114 patients diagnosed with PCoA aneurysm under 5 mm in size on digital subtraction angiography were retrospectively enrolled and divided into ruptured (n = 51) and unruptured (n = 63) groups. Clinical variables were reviewed, and 10 radiologic parameters were obtained, including maximum diameter, height, width, neck width, aspect ratio, dome-to-neck ratio, bleb formation, size ratio, presence of fetal-type PCoA, and inflow angle. Statistical analyses were conducted to compare the groups (ruptured vs unruptured) and identify the risk factors for rupture.
High rupture rate of small PCoA aneurysm is noted (51/114, 44.7%). In the comparison analysis, parameters of size ratio (P = .045), aspect ratio (P = .001), and bleb formation (P = .015) were significantly different between the 2 groups. In the regression model, the aspect ratio (P = .045) and bleb formation (P = .004) were significantly associated with the rupture of aneurysm.
In respect of small (<5 mm) PCoA aneurysms of our cohort, morphologic parameters of “bleb formation” and “a high aspect ratio” are present more often in ruptured aneurysms as compared to unruptured aneurysms.
Modified procedure of anterior orbital exenteration enables eye socket reconstruction
Authors: Ma Ruiqi , Li Xiaofeng , Gan Lu , Guo Jie , Qian Jiang 
Published: January 2022

Abstract
The conventional procedure of anterior orbital exenteration is unfavorable for eye socket reconstruction, whereas a modified procedure enables socket reconstruction and prosthesis fitting. Our study aims to compare the cosmetic outcomes between these 2 surgical techniques.
We retrospectively recruited patients treated with modified or conventional exenteration during January 2015 to May 2021 in our hospital. The conventional approach was performed along with dermis-fat graft transplantation. The modified approach was conducted followed by eye socket reconstruction and eyelid blepharoplasty. The clinical data were collected and analyzed, including demographics, tumor characteristics, postoperative complications, tumor-related events, and cosmetic outcomes.
Forty-nine patients were consecutively recruited in this study, including 22 cases of modified exenteration and 27 cases of conventional exenteration. Forty-four subjects (89.8%) were diagnosed with ocular surface malignancies (conjunctival melanoma and squamous cell carcinoma) and 5 subjects (10.2%) were diagnosed with extraocular stage of uveal melanoma. After follow-up for 31.8 ± 17.1 months, the 1-, 2-, 5-year overall survival rate was calculated as 100%, 79.2%, and 59.2% in the Modified group, and 94.2%, 73.8%, and 51.5% in the Conventional group. Comparison of the survival curves showed no significant differences. In the Modified group, all patients received orbital implant placement and eye socket reconstruction. The implant motility was satisfactory in 12 cases (54.5%) with movements in 3 to 4 directions. The eyelid function was acceptable in 17 cases (77.3%) with no entropion, ectropion or lower lid laxity. Ocular prosthesis was delivered in 17 cases (77.3%) with successful fitting in 11 cases (64.7%). The self-rated cosmetic score was statistically (t test, P < .0001) higher in the Modified group (6.7 ± 0.9) than the Conventional group (2.2 ± 0.4).
The modified approach to anterior orbital exenteration enables eye socket reconstruction and cosmetic rehabilitation while still preserves the curable chance for the treatment of advanced periocular/intraocular malignancies.
Successful treatment of angioinvasive aspergillosis causing diaphragmatic rupture with bowel perforation and cerebral aspergillosis in a patient with FLT3-mutated acute myeloid leukemia
Authors: Bae Nan Young , Byun Ja Min , Kang Chang Kyung , Choe Pyoeng Gyun , Kim Nam Joong , Kim Min-Sung , Park Kyu Joo , Yoon Sung-Soo 
Published: January 2022

Abstract

Rationale:
Throughout the clinical course of acute myeloid leukemia (AML), aspergillosis infection remains a significant determinant of treatment outcomes and survival. To emphasize the importance of early diagnosis and appropriate application of integrated therapeutic approaches, we present a case of AML patient who survived through angioinvasive aspergillosis infection causing diaphragmatic rupture with bowel perforation and cerebral aspergillosis during active AML treatment.

Patient concerns:
A 39-year old male with FLT3-mutated AML was transferred to our hospital due to persistent fever after induction therapy.

Diagnosis and interventions:
During voriconazole treatment for his invasive pulmonary aspergillosis, the patient was diagnosed with colon perforation at splenic flexure and suspected perforation of left diaphragm with communication with left pleural space. Although pancytopenic, emergency laparotomy was performed with granulocyte transfusion. Also, dual antifungal therapy with voriconazole and micafungin was applied. With supportive care, he was able to successfully complete 3 cycles of consolidation using tyrosine kinase inhibitor. However, 80 days after the last chemotherapy, the patient experienced seizure caused by a single 1.5 cm sized enhancing mass in the right occipital lobe. Diagnostic and therapeutic mass removal was carried out, and pathology-confirmed cerebral aspergillosis was diagnosed.

Outcomes:
The patient's neurologic symptoms are resolved and he is leukemia free, but remains on voriconazole for his cerebral aspergillosis till this day.

Conclusions:
Our case highlights the importance of timely integrated intervention and adequate underlying disease control in treatment of invasive aspergillosis in immunocompromised patients. Such rigorous efforts can save even the most seemingly dismal case.
Case report of a delayed iatrogenic Pipkin type III femoral head fracture-dislocation
Authors: Li Qin-Wen , Zhou Cai-Sheng , Li Yu-Peng 
Published: January 2022

Abstract

Rationale
Pipkin III femoral head fracture dislocation (FHFD) is rarely observed in clinical practice, and its outcome is alarming. A considerable proportion of Pipkin III fractures result from repeated or forceful closed reduction of an irreducible FHFD. Pipkin type III fractures pose a therapeutic challenge. Most patients underwent total hip arthroplasty.

Patient concerns
A 34-year-old man experienced high-energy trauma to the left hip from a terrible traffic accident. Radiography and computed tomography (CT) at the local hospital revealed a left posterior FHFD. Emergency close reduction of the hip was performed.48 hours later, the patient was transferred to our institution. New radiography and CT examinations demonstrated an iatrogenic femoral neck fracture (FNF) associated with FHFD. In addition, a right talar fracture was observed.

Diagnosis
Pipkin III fracture combined with contralateral talar fracture.

Interventions
Considering his Pipkin fracture classification (Pipkin Type-III) and the time to surgery after his injury (>48 hours), the patient underwent left total hip arthroplasty uneventfully, followed by below-ankle plaster cast immobilization for his right ankle.

Outcomes
At the 6-month follow-up, the patient was able to walk pain-free, and plain radiographs were satisfactory, with no evidence of heterotopic ossification or osteonecrosis of the talus.

Lessons
Before emergency closed reduction, early recognition of the unique characteristics of an irreducible FHFD is essential to avoid iatrogenic femoral neck fracture.
Thromboelastography and Its Use in Pediatric Trauma Patients
Authors: Tanner Thomas E. , Drapkin Zachary , Fino Nora , Russell Katie , Chaulk David , Hewes Hilary A. 
Published: January 2022

Background/Purpose
Thromboelastography's (TEG's) use in pediatric trauma patients is not widely studied. Identifying clotting cascade defects can direct decision making regarding blood product transfusion.

Methods
We performed a single-center retrospective review of all level 1 pediatric trauma patients. Data collected included demographics, diagnoses, Injury Severity Score, intensive care unit length of stay (ICU LOS), mortality, TEG values, and blood products received. We identified TEG values associated with mortality, ICU LOS, and need for blood product transfusion.

Results
A total of 237 trauma 1 patients were identified. After exclusions, 148 patients were included for analysis. Most patients were below TEG transfusion cut points. Patients with elevated reaction time, K value, and fibrinolysis at 30 minutes had increased odds of mortality with odds ratios of 1.71 (95% confidence interval [CI], 1.22–2.40), 1.94 (95% CI, 1.23–3.05), and 1.15 (95% CI, 1.03–1.28), respectively. For ICU LOS, elevated reaction time, K value, and fibrinolysis at 30 minutes, α angle, and maximum amplitude demonstrated hazard ratios of 0.76 (95% CI, 0.65–0.88), 0.82 (95% CI, 0.64–1.0), 0.95 (95% CI, 0.88–0.99), 1.05 (95% CI, 1.02–1.08), and 1.04 (95% CI, 1.01–1.06), respectively. There was no association between TEG and blood product transfusion.

Conclusions
Coagulopathic patients based on TEG had higher mortality. All TEG values, as they moved toward transfusion-trigger cut points, were associated with increased mortality.