bluuebunny/crossref_metadata_2025_split huggingface dataset:
Aromatase Inhibitor–Induced Carpal Tunnel Syndrome and Stenosing Tenosynovitis: A Systematic Review
Authors: Chung Karen Y. , Ho George , Novak Christine B. , Baltzer Heather L. 
Published: February 2022

Background:
Although aromatase inhibitors are the first-line treatment in postmenopausal women with hormone receptor–positive breast cancer, there is increasing evidence that they can induce carpal tunnel syndrome and stenosing tenosynovitis. This systematic review summarizes the risk factors, incidence, and management for patients with aromatase inhibitor–induced carpal tunnel syndrome and stenosing tenosynovitis compared to tamoxifen or placebo.

Methods:
A Preferred Reporting Items for Systematic Reviews and Meta-Analyses–guided systematic review of PubMed/MEDLINE, Ovid Embase, and the Cochrane Central Register of Controlled Trials was conducted (to March 19, 2020), supplemented with Google Scholar, Plastic and Reconstructive Surgery, and The Journal of Hand Surgery. Two reviewers independently completed the primary and secondary screens and the quality appraisal.

Results:
This study reviewed 577 abstracts and included 19 studies. Risk factors for aromatase inhibitor–induced carpal tunnel syndrome or stenosing tenosynovitis included hormone replacement therapy before trial entry, history of musculoskeletal symptoms, age younger than 60 years, prior chemotherapy, and body mass index greater than 25 kg/m2. The incidence can be increased up to 10 times compared to tamoxifen. Patient discontinuation of aromatase inhibitor treatment because of carpal tunnel syndrome and stenosing tenosynovitis was reported. Nonsurgical management led to complete resolution of carpal tunnel syndrome symptoms in up to 67 percent of cases. Although most aromatase inhibitor–induced stenosing tenosynovitis original studies were low quality, all recommended surgical release for symptom resolution.

Conclusions:
This study provides current knowledge of the associated risk factors, management options, and quality of literature for aromatase inhibitor–induced carpal tunnel syndrome and stenosing tenosynovitis. Early recognition can prevent self-discontinuation of an aromatase inhibitor and long-term sequelae of poorly treated carpal tunnel syndrome and stenosing tenosynovitis.
Surgical and Nonsurgical Factors Associated with Salvaging Exposed Vertical Expandable Prosthetic Titanium Rib Hardware
Authors: Kalmar Christopher L. , Zapatero Zachary D. , Lott Carina , Kosyk Mychajlo S. , Cahill Patrick J. , Swanson Jordan W. , Anari Jason B. , Taylor Jesse A. 
Published: February 2022

Background:
Vertical expandable prosthetic titanium rib (VEPTR) devices were designed to treat childhood scoliosis and thoracic insufficiency syndrome. Although they have drastically reduced patient mortality, they present a profound subcutaneous hardware burden. The authors examined the surgical and nonsurgical factors associated with salvage of VEPTR hardware exposures.

Methods:
Between 2014 and 2020, a prospective institutional database was queried for patients with VEPTR hardware complications who required soft-tissue reconstruction. Hardware salvage was considered successful if reconstruction allowed the hardware to be retained until the next VEPTR expansion.

Results:
Fifty-eight patients required VEPTR hardware salvage. Hardware complications were successfully salvaged in 62.1 percent of patients at 60.0 percent of operative sites. Neuromuscular scoliosis (p = 0.041) and nonambulatory status (p = 0.018) were factors associated with VEPTR hardware salvage failure, whereas congenital scoliosis was associated with successful hardware salvage (p = 0.012) and preventing need for immediate hardware removal (p = 0.049). Exposed hardware, as compared to threatened exposure, was more likely to require immediate removal (p = 0.045) and result in unsuccessful hardware salvage (p = 0.015).

Conclusions:
Local and regional muscle flaps were able to prevent VEPTR hardware removal in the majority of patients, even in the setting of infection, immobility, incontinence, and multiple systemic comorbidities. Patients with neuromuscular scoliosis and nonambulatory status were at increased risk for failure, whereas those with incontinence and low body mass index trended toward increased risk of failure. Threatened exposure was associated with higher rates of salvage than exposed hardware, and thus earlier referral to plastic surgeons for soft-tissue salvage may be advised.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Risk, III.
Hybrid Prepectoral Direct-to-Implant and Autologous Fat Graft Simultaneously in Immediate Breast Reconstruction: A Single Surgeon’s Experience with 25 Breasts in 15 Consecutive Cases
Authors: Gronovich Yoav , Winder Gilad , Maisel-Lotan Adi , Lysy Ido , Sela Elad , Spiegel Gilad , Carmon Moshe , Hadar Tal , Elami Anat , Eizenman Nirit , Binenboym Rami 
Published: February 2022

Background:
The direct-to-implant method depends on the quality of the mastectomy flaps and can be used only when the flaps are adequately perfused. Even though the method was designed to be a definitive reconstruction procedure, it has been associated with an increased likelihood that additional operative revision will be required in order to achieve the expected final cosmetic outcome. The authors describe a hybrid prepectoral direct-to-implant method that combines autologous fat grafting in the superior medial pole with immediate reconstruction.

Methods:
In this prospective study, 15 patients (25 reconstructed breasts) underwent simultaneous hybrid prepectoral direct-to-implant reconstruction together with autologous fat grafting performed by a single senior plastic surgeon (Y.G).

Results:
The mean quantity of autologous fat grafted in the superior medial aspect of the breast was 59.4 ± 12.8 cc. The mean total volume of the hybrid reconstructed breast, including implant and autologous fat graft, was 497.2 ± 89.1 cc. Satisfying final outcomes were achieved in all cases. There were no major complications, although minor complications were observed.

Conclusions:
The authors’ hybrid approach allows the surgeon to achieve a more satisfying outcome with regard to the cleavage area. It results in a better natural appearance, an improved contour, and reduced upper pole rippling and deflation, with a lower likelihood that an additional operative revision will be required to achieve the desired final aesthetic outcome. The authors believe that their hybrid approach should be implemented as an integral part of the direct-to-implant prepectoral reconstruction procedure.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, IV.
The Business of Employed Plastic Surgery: Creating Your Seat at the Table
Authors: Ellsworth Warren A. , Gratzon Andrew C. , Friedman Jeffrey D. 
Published: February 2022

Background:
While the landscape of medicine changes, hospital employment continues to gain popularity in surgical specialties. The number of plastic surgeons entering an employed relationship has also grown, offering new opportunities and challenges alike. The authors studied the profitability of plastic surgery to the hospital and the necessity of the specialty to hospital administration through financial net revenue, contribution margin, and payer mix, to help plastic surgeons realize and capitalize on their importance and contribution to the hospital system.

Methods:
Facility net revenue and contribution margin from Houston Methodist West Hospital were evaluated. Average net revenue and contribution margin for inpatient and outpatient cases for plastic surgery, orthopedic surgery, and all combined surgical specialties were studied for the 2018 and 2019 fiscal years.

Results:
The authors demonstrated net increase per year for both outpatient and inpatient revenue in favor of plastic surgery versus orthopedics and combined surgical specialties. Plastic surgery contributed higher facility net revenue when compared to orthopedics, contributing 20 percent more per outpatient case and 86 percent more per inpatient case. A higher contribution margin for each year was realized for inpatient cases versus orthopedics and combined surgical specialties, increasing by 8 percent and 53 percent and 61 percent and 86 percent, respectively.

Conclusions:
A surgeon’s ability to present objective financial data and develop leadership roles within the hospital system can lead to a favorable outcome for both physician and hospital. An objective dialogue with hospital administration is critical and offers an avenue to negotiate the development of your practice.
Relationship between anti-Xa level achieved with prophylactic low-molecular weight heparin and venous thromboembolism in trauma patients: A systematic review and meta-analysis
Authors: Verhoeff Kevin , Raffael Kendra , Connell Matthew , Kung Janice Y. , Strickland Matt , Parker Arabesque , Anantha Ram V. 
Published: February 2022

BACKGROUND
Trauma patients have simultaneously high venous thromboembolism (VTE) and bleeding risk. Optimal chemoprophylaxis regimens remain unclear. This study aims to answer three questions for trauma patients. Is there any association between anti-Xa and VTE? Does dose adjustment improve prophylactic anti-Xa rates? Does dose adjustment improve anti-Xa adequacy and VTE compared with standard dosing?

METHODS
Systematic search of MEDLINE, Embase, Scopus, and Web of Science occurred in May 2021. Two author reviews included trauma studies that evaluated low molecular weight heparin chemoprophylaxis, reported anti-Xa level, and evaluated more than one outcome. Data were dually extracted and estimated effects were calculated using RevMan 5.4 applying the Mantel-Haenszel method. Analysis 1 compared patients with peak anti-Xa of 0.2 IU/mL or greater or trough 0.1 IU/mL or greater to those with lower anti-Xa using VTE as the primary outcome. Analysis 2 reported the effect of dose adjustment on anti-Xa. Analysis 3 compared standard dosing to dose adjustment with the primary outcome being anti-Xa adequacy; secondary outcomes were VTE, pulmonary embolism, and bleeding complications.

RESULTS
There were 3,401 studies evaluated with 24 being included (19 retrospective studies, 5 prospective studies). In analysis 1, achieving adequate anti-Xa was associated with reduced odds of VTE (4.0% to 3.1%; odds ratio [OR], 0.52; p = 0.03). Analysis 2 demonstrated that 768 (75.3%) patients achieved prophylactic anti-Xa with adjustment protocols. Analysis 3 suggested that dose-adjusted chemoprophylaxis achieves prophylactic anti-Xa more frequently (OR, 4.05; p = 0.007) but without VTE (OR, 0.72; p = 0.15) or pulmonary embolism (OR, 0.48; p = 0.10) differences. In subgroup analysis, anti-Xa dose adjustment also suggested no VTE reduction (OR, 0.68; p = 0.08).

CONCLUSION
Patients with higher anti-Xa levels are less likely to experience VTE, and anti-Xa guided chemoprophylaxis increases anti-Xa adequacy. However, dose adjustment, including anti-Xa guided dosing, may not reduce VTE.

LEVEL OF EVIDENCE
Systematic Review Meta-Analysis, Level IV.
Effectiveness of Atomoxetine (Strattera) for the Treatment of Poststroke Aphasia Combined With Cognitive Impairment
Authors: Park Jong Mi , Choi Soojin , Kim Yong Wook 
Published: February 2022

Objective
In this study, we aimed for the first time to evaluate the effectiveness of atomoxetine (Strattera) in the treatment of cognitive impairment and aphasia after stroke in a large sample.

Methods
We reviewed the data of 106 patients with poststroke aphasia and cognitive impairment (atomoxetine treatment group = 55 patients vs control group = 51 patients), including scores of the Korean version of the Mini-Mental State Examination (K-MMSE) and the Korean version of the Western Aphasia Battery. Wilcoxon signed-rank tests were used to compare the initial and follow-up K-MMSE and Korean version of the Western Aphasia Battery scores. Mann-Whitney U tests were used to compare the degree of improvement in K-MMSE and Aphasia Quotient (AQ) scores between the atomoxetine and control groups.

Results
Baseline characteristics including age, years of education, and scores of the initial Functional Independence Measure, Korean version of the Modified Barthel Index, Hamilton Depression Rating Scale, K-MMSE, and AQ did not differ significantly between the 2 groups. Follow-up K-MMSE and AQ scores were significantly better than the initial scores in both the treatment and control groups. However, improvements in K-MMSE scores were significantly greater in the treatment group than in the control group. In addition, the atomoxetine group had significantly higher AQ scores than the control group, especially for auditory verbal comprehension and naming.

Conclusions
Atomoxetine has been shown to significantly improve cognitive function and language in patients with poststroke aphasia. It is also the first study to report improvement in auditory comprehension and naming by administration of atomoxetine.
Metronidazole-Induced Toxic Neuropathy With the “Boomerang” Sign
Authors: Ghosh Ritwik , Chatterjee Subhankar , Dubey Mahua Jana , Dubey Souvik , Benito-León Julián 
Published: February 2022

Background
Metronidazole has been used to treat a broad range of infections over the decades, and its safety profile has been presumably well studied. However, neurological severe adverse events after prescription and nonprescription use of metronidazole is well recognized but underdiagnosed.

Case Presentation
We report the case of a 48-year-old Indian man who presented with unremitting symptoms of peripheral neuropathy along with a silent callosal lesion in the splenium (“boomerang” sign). Because he had visited 3 neurologists previously, there were many targeted and nontargeted investigations, which failed to reach an etiological diagnosis and hence to provide relief. The patient was questioned about a potential neurotoxin exposure, and at this point, he said that he was taking metronidazole for a long time, without any supervision, as an over-the-counter remedy for self-diagnosed “chronic amebiasis.” On stopping metronidazole, he recovered gradually. In the sixth month of follow-up, brain magnetic resonance imaging showed disappearance of the callosal lesion and significant improvement in the nerve conduction studies.

Conclusions
Clinicians should keep metronidazole toxicity in mind while dealing with a case of cytotoxic lesion of the corpus callosum with splenium involvement and peripheral neuropathy.
Mechanisms of Entry Into the Central Nervous System by Neuroinvasive Pathogens
Authors: Valizadeh Navid , Rudmann Emily A. , Solomon Isaac H. , Mukerji Shibani S. 
Published: February 2022

Background:
The literature on neurological manifestations, cerebrospinal fluid analyses, and autopsies in patients with COVID-19 continues to grow. The proposed mechanisms for neurological disease in patients with COVID-19 include indirect processes such as inflammation, microvascular injury, and hypoxic-ischemic damage. An alternate hypothesis suggests direct viral entry of SARS-CoV-2 into the brain and cerebrospinal fluid, given varying reports regarding isolation of viral components from these anatomical sites.

Evidence Acquisition:
PubMed, Google Scholar databases, and neuroanatomical textbooks were manually searched and reviewed.

Results:
We provide clinical concepts regarding the mechanisms of viral pathogen invasion in the central nervous system (CNS); advances in our mechanistic understanding of CNS invasion in well-known neurotropic pathogens can aid in understanding how viruses evolve strategies to enter brain parenchyma. We also present the structural components of CNS compartments that influence viral entry, focusing on hematogenous and transneuronal spread, and discuss this evidence as it relates to our understanding of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2).

Conclusions:
Although there is a paucity of data supporting direct viral entry of SARS-CoV-2 in humans, increasing our knowledge of the structural components of CNS compartments that block viral entry and pathways exploited by pathogens is fundamental to preparing clinicians and researchers for what to expect when a novel emerging virus with neurological symptoms establishes infection in the CNS, and how to design therapeutics to mitigate such an infection.
An Analysis Between Trump’s Presidency and Health-Seeking Behaviors of African Americans in the United States
Authors: Animasahun Adeola A. , Nunez Ashley M. , Jean Rachelle F. 
Published: February 2022

ABSTRACTBackgroundSlavery legally ended over 150 years ago, yet African Americans are still oppressed. The lingering effects of systemic and institutional racism are still present in all walks of life, especially in healthcare. As a result, Black patients have historically been less likely to seek preventative care and subsequently, reported lower health outcomes compared to their white counterparts. The election of Donald Trump in 2016 forced a shift in that narrative. This study aimed to investigate whether there was any correlation between changing racial preferences fueled by Trump’s racist rhetoric and the health-seeking behaviors of Black patients. Through this, we explored if the number of Black patients that reported not having a primary care physician has changed, and how online search history trends researching Black physicians have also changed.MethodsThis study utilized datasets from the Behavioral Risk Factor Surveillance System (BRFSS) and Google Trends. Pearson’s correlation testing was run to establish any correlation between the number of google searches and positive health-seeking behaviors.ResultsGoogleTrends data does support an increased popularity for the search term “black doctor near me” over the years of 2015-2018, supporting our hypothesis. Multiple logistic regression analysis was performed to determine if race, among other variables, was a significant predictor for our predetermined health indicators. The results showed race was significant in nine out of our eleven health indicators.DiscussionDespite decades of work to minimize healthcare disparities, this study has demonstrated how much more still needs to be done. It has shown how the intersection of seemingly unrelated issues, such as politics and health, as described in this study, can drastically impact health outcomes. This study highlights the importance of targeted and equitable programming to ensure quality care for all, that can withstand political and social pressures.
High-resolution lung adenocarcinoma expression subtypes identify tumors with dependencies on MET, CDK4, CDK6, and PD-L1
Authors: Roh Whijae , Geffen Yifat , Miller Mendy , Anand Shankara , Kim Jaegil , Heiman David , Gainor Justin F. , Laird Peter W. , Cherniack Andrew D. ,   National Cancer Institute Center for Cancer Genomics Tumor Molecular Pathology (TMP) Analysis Working Group, Getz Gad 
Published: February 2022

AbstractLung adenocarcinoma is one of the most common cancer types with various treatment modalities. However, better biomarkers to predict therapeutic response are still needed to improve precision medicine. We utilized a consensus hierarchical clustering approach on 509 LUAD cases from TCGA to identify five robust LUAD expression subtypes. We then integrated genomic (patient and cell line) and proteomic data to help define biomarkers of response to targeted therapies and immunotherapies. This approach defined subtypes with unique proteogenomic and dependency profiles. S4-associated cell lines exhibited specific vulnerability to CDK6 and CDK6-cyclin D3 complex gene, CCND3. S3 was characterized by dependency on CDK4, immune-related expression patterns, and altered MET signaling; experimental validation showed that S3-associated cell lines responded to MET inhibitors, leading to increased PD-L1 expression. We further identified genomic features in S3 and S4 as biomarkers for enabling clinical diagnosis of these subtypes. Overall, our consensus hierarchical clustering approach identified robust tumor expression subtypes, and our subsequent integrative analysis of genomics, proteomics, and CRISPR screening data revealed subtype-specific biology and vulnerabilities. Our lung adenocarcinoma expression subtypes and their biomarkers could help identify patients likely to respond to CDK4/6, MET, or PD-L1 inhibitors, potentially improving patient outcome.SignificanceThrough integrative analysis of genomic, proteomic, and drug dependency data, we identified robust lung adenocarcinoma expression subtypes and found subtype-specific biomarkers of response, including CDK4/6, MET, and PD-L1 inhibitors.
Cell-Mediated Immune Response after COVID 19 Vaccination in Patients with Inflammatory Bowel Disease
Authors: Caldera Freddy , Farraye Francis A. , Necela Brian M. , Cogen Davitte , Saha Sumona , Wald Arnold , Daoud Nader D. , Chun Kelly , Grimes Ian , Lutz Megan , Swift Melanie D. , Virk Abinash , Bharucha Adil E. , Patel Tushar C. , Gores Gregory J. , Chumsri Saranya , Hayney Mary S. , Knutson Keith L. 
Published: February 2022

AbstractIntroductionMost patients with IBD mount an antibody response to mRNA COVID-19 vaccines, but few studies have evaluated the cell mediated immune response (CMIR).MethodsWe performed a prospective study (HERCULES) to evaluate CMIR among patients with IBD and healthy controls (HC) after completion of the primary series of mRNA COVID-19 vaccines.ResultsOne hundred 158 patients with IBD and 20 HC were enrolled. The majority (89%) of IBD patients developed a CMIR which was not different than HC (94%, p=0.6667). There was no significant difference (p=0.5488) in CMIR response between those not immunosuppressed (median 255 Spike T cells/million PBMC, IQR 146, 958) and immunosuppressed (median 377, IQR 123, 1440). There was also no correlation between antibody responses and CMIR (p=0.5215)DiscussionMost patients with IBD achieved CMIR to a COVID-19 vaccine. Future studies are needed evaluating sustained CMIR and clinical outcomes.