bluuebunny/crossref_metadata_2025_split huggingface dataset:
Circumferential Dissection with Intimal Intussusception: An Unusual Case of Acute Aortic Type A Dissection
Authors: Orrit J. , Kalangos A. , Trindade P. T. , Christenson J. T. 
Published: September 2022

An unusual case of a type-A aortic dissection with complete circumferential dissection just above the aortic valve with intimointimal intussuseption just distal to the left subclavian artery partially obstructing the descending aorta is described. CT-scan and transesophageal echocardiography together with clinical suspicion led to the correct diagnosis. Intimointimal intussusception is an unusual type of aortic dissection in which a proximal circumferential tear causes dissection with intussusception of the torn intima downstream, which could cause confusion about the appropriate diagnosis [1]. It is a very infrequent complication of aortic dissection with only a few cases reported in the literature [2–6]. CT scan and transesophageal echocardiography are the most accurate diagnostic tools [7–9]. We describe a patient with intimointimal intussusception, diagnosed by CT scan and transesophageal echocardiography.
Aorto-Enteric Fistula is a Serious Complication to Aortic Surgery. Modern Trends in Diagnosis and Therapy
Authors: Sierra J. , Kalangos A. , Faidutti B. , Christenson J. T. 
Published: September 2022

Secondary aorto-enteric fistula (AEF) is a serious, but rare, complication following surgery of the abdominal aorta. AEF occurs in 0.3–2%, but is associated with a hospital mortality between 25–90%. It is also associated with an important morbidity with a lower limb amputation rate of 9%, and a 15% risk for renewed graft infection. Nine secondary AEF were surgically treated. The hospital mortality was high, 44% (4/9). Recurrent AEF was observed in 1 patient 2 years after the first operation. During follow-up 2 patients had mild infections which were resolved by antibiotic treatment. Diagnostic modalities, and recent advancements in surgical treatment as well as preventive measures are discussed.
A Short-Term Experience with the Tirone David I Valve Sparing Operation for the Treatment of Aneurysms of the Ascending Aorta and Aortic Root
Authors: Gelsomino Sandro , Frassani Romeo , Morocutti Giorgio , Masullo Gianluca , Da Col Paolo , Spedicato Leonardo , Porreca Lorenzo , Livi Ugolino 
Published: September 2022

Aim The aim of this report is to summarize our experience with the Tirone David I technique over a 4-year period. Methods Since 1997 15 patients were operated on using this surgical procedure. Of the patients, nine were male (60%) and six (40%) female. Ages ranged from 23 to 75 years (mean 62.1 ± 17.2 years). The underlying disease was chronic aneurysm of the ascending aorta or root in 13 (86.6%) and chronic dissection in two (13.4%). Four patients (26.6%) had skeletal manifestations of Marfan's syndrome. Additional cardiac procedures were performed in two patients (13.4%). Mean follow-up time was 26.6 ± 11.2 months (range 7–50 months). Results There were no early deaths. Postoperative non-fatal complications occurred in two (13.3%) patients. There was no valve-related late death occurring 6 months after operation. Actuarial survival was 0.94 ± 0.07 at 4 years; 4-year freedom from reoperation was 0.91 ± 0.07. The probability of needing reoperation was 8 ± 0.9%. There were no instances of infective endocarditis or thromboembolic complications. At the end of the follow-up period, trivial or no aortic regurgitation was demonstrated in 57.1%, mild in 42.9% and no patient had an insufficiency graded ≥moderate. Echocardiography showed early postoperative reduction in left ventricular end-systolic and end-diastolic dimensions, which was maintained at follow-up controls. Conclusions The Tirone David I procedure showed good early results, which encourage further use of this type of repair. However, further larger studies and long-term results are necessary for a definite judgment on this operative method.
Multidisciplinary Intervention for Control of Diabetes in Patients Undergoing Coronary Artery Bypass Graft (CABG)
Authors: Cohen Ohad , Dankner Rachel , Chetrit Angela , Luxenburg Osnat , Langenauer Claude , Shinfeld Amihay , Smolinsky Aram K. 
Published: September 2022

In Israel, as elsewhere, diabetes mellitus is highly prevalent among patients undergoing coronary artery bypass graft (CABG). The bulk of evidence, derived retrospectively, suggests that poor control of diabetes predisposes to complications of CABG and increases mortality; but the findings in a number of studies fail to support that impression. Anticipating a prospective investigation designed to resolve this issue, we have carried out a preliminary study of 147 consecutive patients with diabetes who were hospitalized for elective CABG during 1998. Our objective was to determine how well and how often diabetes could be controlled in accordance with selected metabolic goals in the brief interval between hospital admission and surgery and during the operation itself and in the postoperative period. The task was undertaken by a multidisciplinary team, in cooperation with the Department of Cardiac Surgery. The metabolic goals were: fasting blood glucose consistently between 65–140 mg/dl before and after surgery and 120–180 mg/dl at the time of surgery; and postprandial blood glucose consistently < 180 mg/dl. These goals were achieved in 18.1% of fasting blood glucose measurements before and after surgery, 22.1% of preprandial and 14.6% of postprandial blood glucose levels consistently < 180 mg/dl. There were no clinical episodes of hypoglycemia. Due to the low incidence of major infection related complications (deep sternal wound infection in only 3 patients (2.0%)) no significant statistical conclusions on the relations between glucose control and these complications could be drawn. The means of all values of FBG and of hemoglobin A1c were significantly higher among patients with complications ( n=49) than in those without ( P=0.01).
Stripping Operation with Preservation of the Calf Saphenous Veins for Primary Varicose Veins: Hemodynamic Evaluation
Authors: Nishibe Toshiya , Nishibe Masayasu , Kudo Fabio , Flores Jorge , Miyazaki Keiko , Yasuda Keishu 
Published: September 2022

Purpose. To study early changes in venous hemodynamics in stripping operation with preservation of the calf saphenous veins. Patients and methods. From October 1999 to December 2000, 110 extremities of 73 patients were treated for primary varicose veins. Based on preoperative ascending venography, 40 extremities underwent the groin-to-knee stripping of the GSV, 20 underwent the proximal division of the LSV, and 50 received combinations of both surgeries. To evaluate venous hemodynamic changes, air plethysmography was performed before operation and 7–14 days after operation. Results. The venous volume, venous filling index and residual volume fraction were improved after surgery, but the ejection fraction did not change. The overall incidence of nerve injury was 4.5% (five limbs). Conclusions. In stripping operations, the preservation of the calf saphenous veins, which is shown to be advantageous in reducing saphenous or sural nerve injuries, does not adversely affect early venous hemodynamic improvement.
Considering patient narrative-based and medico-scientific epistemologies in framing psychiatric care
Authors: Looi Jeffrey CL , Bastiampillai Tarun , Allison Stephen , Maguire Paul A 
Published: September 2022

Objective Personal narratives of lived experience with psychiatric illness and distress remain central in the epistemology of mental illness. We provide a commentary on this potential bridging of patient narrative-based epistemology, and medico-scientific epistemology used by psychiatrists used for diagnosis, formulation, prognosis and treatment. Conclusion Discussion and planning of psychiatric care can be framed by understanding the narrative-based epistemology of a patient’s illness as highlighted by five key questions to explore the patient’s illness explanatory models. We propose five key questions for the psychiatrist’s complementary consideration of medico-scientific epistemology that frame conceptual models of aetiology, pathophysiology, diagnosis, formulation, prognosis and treatment, which are embedded in the predominant socio-cultural environment. These questions assist in bridging patient narrative and medico-scientific explanatory models to facilitate more effective collaborative care planning.
Analysis of Bicarbonate-Based Purge Solution in Patients With Cardiogenic Shock Supported Via Impella Ventricular Assist Device
Authors: Bergen Kyle , Sridhara Shashank , Cavarocchi Nicholas , Silvestry Scott , Ventura Davide 
Published: September 2022

Background: The Impella device is a continuous axial flow pump which provides hemodynamic support by expelling blood into the aorta. The manufacturer recommends using dextrose-based heparin containing solutions as the default purge. As an alternative to anticoagulant solutions, a bicarbonate-based purge solution has been proposed with limited data substantiating adequate protection and durability. Objective: To assess the impact of a bicarbonate-based purge solution on Impella pump thrombosis and bleeding outcomes. Methods: Single-center, retrospective study of cardiogenic shock patients who received an Impella between December 2020 through September 2021. Patients were evaluated based on whether they received bicarbonate-based purge solutions or remained on heparin-based purge solutions. The primary outcome was the rate of Impella pump thrombosis, defined as multiple purge pressures greater than 800 mm Hg. Secondary outcomes included incidence of bleeding defined as a drop in Hgb of at least 2 g/dL along with use of blood products and supratherapeutic anticoagulation defined as an aPTT of greater than 70 seconds. Results: Forty-three patients received bicarbonate-based purge solutions and 49 controls received heparin. The incidence of purge thrombosis by purge pressure threshold was similar between the two groups (16.3% vs 12.2%, P = 0.58). The rate of bleeding was lower with bicarbonate-based purge (27.9% vs 65.3%, P < 0.05) driven by a drop in Hgb of more than 2 g/dL. The rate of supratherapeutic anticoagulation was higher in the heparin arm (65.3% vs 27.9%, P < 0.05) Conclusion and Relevance: Nonanticoagulant purge alternatives offer the potential to reduce bleeding complications and laboratory monitoring burden while maintaining durability.
Regression of bilateral orbital inflammation with anti-CD20 in a patient with relapsing granulomatosis with polyangiitis: A case report
Authors: Castellino Niccolò , Scuto Salvatore , Zanoli Luca , Toro Mario Damiano , Avitabile Teresio , Castellino Pietro , Russo Andrea 
Published: September 2022

Purpose To describe a case of bilateral orbital inflammation in a patient with relapsing granulomatosis with polyangiitis as only sign of disease recurrency treated with anti-CD20 antibodies. Methods A 62-year-old Caucasian man affected by Granulomatosis with polyangiitis (GPA) was admitted to our hospital showing bilateral orbital inflammation as the only signs of disease recurrency. In addition, eye visit detected severe visual loss in the left eye (light perception). Guidelines to manage severe orbital involvement in patients with GPA are lacking. The patient was treated with intravenous rituximab and glucocorticoids. Results Complete regression of inflammatory signs by imaging were observed at three-year of follow-up after the treatment with anti-CD20. However, ocular multimodal imaging showed severe optic nerve damages in the left eye with irreversible visual loss. Conclusion Patients affected by GPA with inflammatory orbital involvement may benefit from anti-CD20 antibodies.
Age-specific trends in intravenous thrombolysis and mechanical thrombectomy utilization in acute ischemic stroke in children under age 18
Authors: Kaur Navreet , Patel Smit , Ayanbadejo Michael Omoniyi , Hoffman Haydn , Akano Emmanuel , Anikpezie Nnabuchi , Aneni Ehimen , Lamikanra Oluwatomi , Wee Claribel , Albright Karen , Khandelwal Priyank , Latorre Julius Gene , Chaturvedi Seemant , Otite Fadar Oliver 
Published: September 2022

Objectives: To evaluate current trends in the utilization of intravenous thrombolysis (IV-tPA) and mechanical thrombectomy (MT) in acute ischemic stroke (AIS) in various age groups of children in the United States. Methods: We conducted a serial cross-sectional study using primary AIS admissions in children ⩽ 17 years (weighted n = 2807) contained in the 2009–2019 KIDS Inpatient Database. Age-specific utilization frequency of IV-tPA and MT were calculated. Multivariable-adjusted models were used to evaluate demographic predictors of treatment. Results: From 2009 to 2019, there were 2807 AIS admissions in children in the KID of which 55.9% were in boys and 29.9% were 15–17 years old.128 (4.6%) received IV-tPA. IV-tPA utilization differed by age (5–9 years: 3.1%, 15–17 years 8.1% p value < 0.001). Overall MT usage was 2.3% and this also varied by age (1–4 years: 0.9% and 15–17years 4.0%, p value = 0.006). IV-tPA utilization almost tripled across the study period (2.5% 2009 to 6.5% in 2019, p value =  0.001) while MT use more than doubled over time (1.2% in 2009 and 3.0% in 2019, p value = 0.048). Increased IV-tPA utilization was seen primarily in children 10–14 years (0.8% in 2009 to 7.2% 2019, p value = 0.005) and 15–17 years (5.4% in 2009 to 10.4% in 2019, p value = 0.045). Utilization in younger age groups remained unchanged over time. MT usage was very variable across various age groups over time. IV-tPA and MT utilization increased over time in nonchildren’s hospitals (both p values < 0.05) but usage in designated children’s hospitals did not change significantly over time. In multivariable models, there was no significant difference in odds of IV-tPA and MT use by sex, race or insurance status. Conclusion: IV-tPA and MT utilization in pediatric AIS increased in the United States over the past decade mainly in older children 10–17 years. Utilization increased mainly in patients hospitalized in nonchildren’s hospitals. Usage in children’s hospitals did not change significantly over time.
The influence of exercise therapy dosing on pain and functional outcomes in patients with subacromial pain syndrome: A systematic review
Authors: McConnell Ryan , Klopper Mareli , Rhon Daniel I. , Young Jodi L. 
Published: September 2022

Background The objective was to identify exercise therapy dosing parameters for subacromial pain syndrome (SAPS) associated with improved pain and function outcomes (via effect sizes) and determine the extent of exercise intervention reproducibility. Methods An electronic search of PubMed/MEDLINE, Cumulative Index to Nursing and Allied Health Literature, EMBASE, Cochrane Database of Systematic Reviews, and SportDiscus identified studies that used exercise therapy exclusively to treat SAPS. Exercise therapy dosing parameters were extracted and within-group effect sizes were calculated for all pain and functional outcomes. Template for Intervention Description and Replication and Consensus on Exercise Reporting were used to record intervention reporting. The risk of bias and Grading of Recommendations, Assessment, Development, and Evaluation were assessed by two reviewers. Results Twenty-one trials with 674 subjects were included. Effect sizes for pain and function were large in 18 studies, medium in six studies, and small or no effect in four studies, despite the type of supervision. With moderate certainty, effect sizes of pain and function were not influenced by exercise therapy dosing parameters. Intervention reporting was generally poor. Discussion Exercise therapy for SAPS was associated with large effect sizes for improvement in pain and function but optimal exercise therapy dosing parameters could not be identified. Strong recommendations conditionally suggest treating SAPS with a variety of exercise therapy dosing parameters.
Recurrence of the frozen shoulder after hydrodilatation, what is the true incidence?
Authors: Flintoft-Burt Matthew , Stanier Paul , Planner Andy , Thahal Hyeladzira , Woods David 
Published: September 2022

Purpose of the study To assess the outcome and recurrence rates of frozen shoulder treated by hydrodilatation in an independent hospital setting. Method Patients presenting to a shoulder clinic from August 2019 to July 2021 with a diagnosis of frozen shoulder were offered hydrodilatation. Data included primary or secondary frozen shoulder, length of symptoms, and diabetic status. An Oxford Shoulder Score was completed prior to hydrodilatation. Using ultrasound guidance, 40 mg Triamcinolone and local anaesthetic (10–25 mL depending on patient tolerance) were injected into the rotator interval. At a mean of 9 months, patients recorded their tolerance of the procedure, subsequent progress, the need for further treatment, and their current Oxford Shoulder Score. Results From 55 shoulders, six patients had a failure to improve and 10 patients had a transient improvement followed by recurrence (29%). 2/21 (9.5%) patients had 25 mL injected compared to 14/34 (41%) who had < = 20 mL ( p = 0.012). 14/43 (33%) of primary frozen shoulder patients had a recurrence, compared with 2/12 (16%) secondary frozen shoulder patients, p = 0.019. Conclusion Further treatment was indicated in 14/34 (41%) of patients who underwent hydrodilatation in the frozen stage of frozen shoulder and could not tolerate more than 20 mL of injection, and was more commonly required in primary (33%) versus secondary (16%) frozen shoulder.
Difference on Glucose Profile From Continuous Glucose Monitoring in People With Prediabetes vs. Normoglycemic Individuals: A Matched-Pair Analysis
Authors: Rizos Evangelos C. , Kanellopoulou Afroditi , Filis Panagiotis , Markozannes Georgios , Chaliasos Konstantinos , Ntzani Evangelia E. , Tzamouranou Athina , Tentolouris Nikolaos , Tsilidis Konstantinos K. 
Published: September 2022

Introduction: Comprehensive characteristics of the glycemic profile for prediabetes derived by continuous glucose monitoring (CGM) are unknown. We evaluate the difference of CGM profiles between individuals with prediabetes and normoglycemic individuals, including the response to oral glucose tolerance test (OGTT). Methods: Individuals with prediabetes matched for age, sex, and BMI with normoglycemic individuals were instructed to use professional CGM for 1 week. OGTT was performed on the second day. The primary outcomes were percentages of glucose readings time below range (TBR): <54 or <70 mg/dL, time in range (TIR): 70 to 180 mg/dL, and time above range (TAR): >180 or >250 mg/dL. Area under the curve (AUC) was calculated following the OGTT. Glucose variability was depicted by coefficient of variation (CV), SD, and mean amplitude of glucose excursion (MAGE). Wilcoxon sign-ranked test, McNemar mid P-test and linear regression models were employed. Results: In all, 36 participants (median age 51 years; median body mass index [BMI] = 26.4 kg/m2) formed 18 matched pairs. Statistically significant differences were observed for 24-hour time in range (TIR; median 98.5% vs. 99.9%, P = .013), time above range (TAR) >180 mg/dl (0.4% vs. 0%, P = .0062), and 24-hour mean interstitial glucose (113.8 vs. 108.8 mg/dL, P = .0038) between people with prediabetes compared to normoglycemic participants. Statistically significant differences favoring the normoglycemic group were found for glycemic variability indexes (median CV 15.2% vs. 11.9%, P = .0156; median MAGE 44.3 vs. 33.3 mg/dL, P = 0.0043). Following OGTT, the AUC was significantly lower in normoglycemic compared to the prediabetes group (median 18615.3 vs. 16370.0, P = .0347 for total and 4666.5 vs. 2792.7, P = .0429 for incremental 2-hour post OGTT). Conclusion: Individuals with prediabetes have different glucose profiles compared to normoglycemic individuals. CGM might be helpful in individuals with borderline glucose values for a more accurate reclassification.
The Direct to Consumer Stem Cell Market and the Role of Primary Care Providers in Correcting Misinformation
Authors: Arthurs Jennifer R. , Martin Lillie Charlene M. , Master Zubin , Shapiro Shane A. 
Published: September 2022

Introduction: Direct to consumer stem cell and regenerative interventions (SCRIs) for various medical conditions have increased in popularity due to unmet medical needs and the promise of SCRIs to meet those needs. These interventions may have varying levels of safety and efficacy data and many lack sufficient scientific data to be marketed. The direct to consumer SCRI industry has received significant attention due to potential physical, economic, and emotional harms to patients. Patients may seek the counsel of their primary care providers when considering stem cell therapy for their condition. Methods: Here we describe strategies primary care providers can utilize when counseling patients. Results: Although we recommend constructing these discussions around individual patients’ needs, one can utilize a general approach consisting of 4 parts. First, providers should recognize what information the patient is seeking and what is their understanding of stem cell and regenerative medicine. Next, providers should convey evidence-based information at the level of patients understanding so that they are aware of the risks, benefits, and descriptions of possible procedures. Throughout the conversations, attempts should be made to guide patients to a trusted resource that can provide additional information. Finally, providers should make an effort to address misinformation in a way that is nonjudgmental and patient-centered to make the patient feel safe and comfortable. Conclusion: Effectively communicating risk information by primary care providers to patients is important given the harms reported from direct-to-consumer SCRIs. Correcting misinformation remains a priority when discussing SCRI’s. Providers should strive to offer patients with additional resources such as the opportunity for consultation with a specialist or a consultation service dedicated to informing patients about regenerative medicine.