bluuebunny/crossref_metadata_2025_split huggingface dataset:
Risk Reduction and Perioperative Complications in Diabetics with Multiple Medical Comorbidities Undergoing Charcot Foot Reconstruction
Authors: Lyons Madeline M. , Pinzur Michael S. , McGregor Patrick C. , Adams William , Wilkos-Prostran Lynette 
Published: January 2022

Category: Diabetes; Other Introduction/Purpose: Modern Patient Safety Programs focus on medical optimization prior to surgery, regional anesthesia and hospitalist-orthopaedic co-management during the perioperative period. Methods: Eighty-five consecutive diabetic patients with multiple medical co-morbidities underwent surgical reconstruction for acquired deformities secondary to Charcot foot arthropathy with circular ring fixation between 2016 and 2019. All patients participated in a standardized perioperative medical optimization program, which included medical optimization prior to surgery, regional anesthesia whenever possible and hospitalist-orthopaedic comanagement during hospitalization. Charts were retrospectively reviewed for medical comorbidities, complications, and length of stay. The National Surgical Quality Improvement Program (NSQIP) Risk Calculator was used to retrospectively calculate their predicted perioperative risk. Results: On multivariable analysis, longer lengths of stay were associated with low preoperative hemoglobin values (RR = 1.36; P =.01) and congestive heart failure (RR = 1.42; P =.02). There were 22 (27%) complications, though only 10 (12%) were serious. These included acute kidney injury (n = 6), sepsis (n = 2), one cardiac event, and one pulmonary embolism. Overall, the accuracy of predicting a complication using the NSQIP risk calculator was 74% (95% CI: 63% - 85%) which was comparable to the accuracy of predicting a complication using only patients' congestive heart failure and pin-tract infection statuses (c = 74%, 95% CI: 62% - 86%). Conclusion: Medical optimization of diabetic patients with multiple medical co-morbidities prior to elective complex reconstruction orthopaedic surgery leads to improved clinical outcomes. Preoperative anemia and congestive heart failure are associated with longer hospitalizations in this patient group. The American College of Surgeons NSQIP Risk Calculator is a reliable predictor of complications in the perioperative period. This study demonstrates that reconstructive surgery in this complex patient population can be accomplished with a reasonable exposure to risk for complication.
Calculation of Minimally Clinically Important Difference in VAS, SF-36, and LSA Scores for Hallux Rigidus Correction Via MTP Fusion
Authors: Manz Wesley J. , Lunati Matthew , Greenshields Joel , Zaldumbide Joel A. , Kadakia Rishin J. , Coleman Michelle M. , Bariteau Jason T. 
Published: January 2022

Category: Bunion; Midfoot/Forefoot; Other Introduction/Purpose: Hallux rigidus is a mobility limiting disease commonly seen in elderly patient populations. Correction via metatarsophalangeal (MTP) fusion has been shown to be a safe and effective means of treatment in these populations relative to younger cohorts. An increasingly important measure of surgical efficacy is the establishment of patient-reported outcomes for achieving meaningful change through a procedure. Calculation of a minimally clinically important difference (MCID) has been established to illuminate these thresholds. The objective of this study was to calculate MCID thresholds for visual analogue pain (VAS), Short Form 26 Health survey (SF-36), and LifeSpace Mobility Assessment (LSA) following first MTP fusion. Methods: A prospective study of all patients undergoing MTP fusion between August 1, 2015 and July 1, 2018 by a single surgeon was conducted following IRB approval. A total of 143 patients were included in the study. Demographics and surgical data were collected from review of the electronic medical record. Patient reported VAS, SF-36, and LSA scores were collected at routine 6- month and 12-month follow-up clinic appointments, as well as preoperatively. This study utilized a distribution-based approach for calculation of MCID for each of the patient reported outcomes. The MCID was defined as 0.5 times the standard deviation of the pre-operative score, 95% bootstrap confidence intervals were creating using the bias corrected and accelerated method. Results: The average age of patients undergoing first MTP fusion was 63.4 years (SD 10.6). Patient demographics were recorded, 25.9% of patients were current or former smokers, 60.8% had clinically managed hypertension, 9.8% had diabetes, and 31.5% carried a diagnosis of osteoarthritis. The average patient had 1.9 (SD 1.1) toes operated on during the procedure, including their MTP fusion. Mean tourniquet time was 65.6 (SD 24.8) minutes and mean operative time was 89.9 (SD 31.4) minutes. Mean (SD): VAS, 4.7 (2.8); LSA, 86.4 (35.1); SF-36 physical component score, 63.00 (19.9); SF-36 component score, 77.4 (19.8). MCID: VAS, 1.4 (95% CI 1.3 to 1.5); LSA, 17.6 (95% CI 14.4 to 21.4); SF-36 physical component score, 9.9 (95% CI 9.1 to 11.0); SF-36 mental component score, 9.8 (95% CI 8.7 to 11.4). Conclusion: This study identifies the MCID for VAS, SF-36, and LSA following first MTP fusion. The MCID of VAS reveals minimal improvements in pain (>1.5) are clinically significant. Both SF-36 physical and mental component scores reveal narrow 10- point differences have clinically significant changes. In contrast, LSA appears to have a relatively wide MCID value for patients undergoing first MTP fusion, highlighting the need for a large increase in mobility for significant improvement.
Efficacy of 3T MRI vs Diagnostic Arthroscopy for the Diagnosis of Osteochondral Lesions of the Talus in Patients Undergoing Brostrom Repair for Lateral Ankle Instability
Authors: Stauch Chris M. , Koroneos Zachary , Ptasinski Anna , Martinazzi Brandon , Bifano Shawn M. , Aynardi Michael C. 
Published: January 2022

Category: Ankle; Arthroscopy Introduction/Purpose: Osteochondral lesions of the talus (OLT) are commonly seen in patients with lateral ankle instability. If left undiagnosed, OLTs can lead to significant ankle pain and progressive osteoarthritis. While arthroscopy has long been the gold standard for the diagnosis of OLTs, MRI is a useful imaging modality for pre-operative evaluation and surgical planning in patients undergoing surgery for lateral ankle instability. The purpose of this study was to evaluate the diagnostic accuracy of 3T MRI for the diagnoses of OLTs in patients undergoing a Broström Gould procedure for lateral ankle instability. Methods: Following institutional review board approval, a database was obtained for all patients from 2/11/2015 to 1/21/2019 who underwent a Broström Gould procedure for lateral ankle instability in addition to diagnostic arthroscopy of the tibiotalar joint. Additionally, patients required a pre-operative 3T MRI for inclusion in the study. Patients who underwent the Broström Gould procedure but did not have a diagnostic arthroscopy or did not have a pre-operative MRI were excluded from the study. The average time from MRI to surgery was 3.5 months. Patient charts were then reviewed to determine the proportion of MRIs that correctly identified the presence or absence of OLTs compared to diagnostic arthroscopy. Results: A total of 80 patients were included for analysis with an average age of 38.1 +- 14.3 years. 46 (57.5%) patients were female and 34 (42.5%) were male. A total of 39 patients (48.8%) were identified to have an OLT on arthroscopy. Of these 39 patients, 28 patients (71.8%) were correctly identified by the pre-operative 3T MRI as having an OLT and 11 patients (28.2%) had MRIs that failed to identify an OLT. 41 patients had an arthroscopy that was negative for OLTs. Of these 41 patients, MRI correctly diagnosed 40 patients (97.6%) as not having an OLT and misdiagnosed 1 patient as a false positive (2.4%). Conclusion: In patients undergoing Broström Gould procedures with diagnostic arthroscopy for osteochondral lesions of the talus, 3T MRI demonstrates a sensitivity of 71.8% and a specificity of 97.8%. Thus, pre-operative MRI can be a useful imaging modality to assess for OLTs prior to surgery and should prompt surgeons to perform an arthroscopy with subsequent treatment of the OLT. However, a negative MRI does not rule out the possibility of an OLT being present due to a relatively high false- negative rate.
Triadimefon in aquatic environments: occurrence, fate, toxicity, and ecological risk
Authors: Hou Lin , Jin Xiaowei , Liu Na , Luo Ying , Yan Zhenfei , Chen Miao , Liu Yang , Xie Huiyu , Giesy John P. , Wu Fengchang , Xu Jian 
Published: January 2022

Abstract
Background
As a triazole fungicide, triadimefon is widely used around the world. The ubiquitous occurrence of triadimefon in aquatic environments and potential adverse effects on aquatic organisms have resulted in global concerns. In this review, the current state of knowledge on occurrence, environmental behavior, and toxic effects are presented and used to conduct an assessment of risks posed by current concentrations of triadimefon in aquatic environments.

Results
The key findings from this review are that: (1) triadimefon occurred widely in surface waters, with high rates of detection; (2) abiotic degradation of triadimefon was affected by many factors. Stereoselectivity was found during biotic degradation and metabolism of triadimefon. Different enantiomers can cause various adverse effects, which complicates the assessment and requires enantiomers-specific considerations; (3) triadimefon exposure can affect organisms by causing multiple toxic effects on the thyroid, reproductive system, liver, nervous system as well as carcinogenicity and teratogenicity, and it can also act synergistically with other pesticides. Long-term, low-dose effects were considered to be the main characteristics of toxic effects of triadimefon; (4) results of the risk assessment based on probabilistic relationships represented by joint probability curves (JPCs) indicated that risk of triadimefon was classified as low risk.

Conclusion
Triadimefon occurred widely in surface waters, with high rates of detection, while the concentration data of triadimefon in surface water is insufficient. Researches about toxic effects and mechanisms of triadimefon on invertebrate are needed. Meanwhile, researches about toxic effects and environmental exposure of chiral monomers are also required. Due to its reproductive toxicity, triadimefon might result in adverse effects on the population level or even on the ecosystem level. Risk assessments for pesticides that cause long-term and low-dose effects on aquatic organisms such as triadimefon need to consider higher-level ecological risk.
Optimizing left ventricular-arterial coupling during the initial resuscitation in septic shock – a pilot prospective randomized study
Authors: Zhou Xiaoyang , Zhang Yiqin , Pan Jianneng , Wang Yang , Wang Hua , Xu Zhaojun , Chen Bixin , Hu Caibao 
Published: January 2022

Abstract
Background
Left ventricular-arterial coupling (VAC), defined as the ratio of effective arterial elastance (Ea) to left ventricular end-systolic elastance (Ees), has been extensively described as a key determinant of cardiovascular work efficacy. Previous studies indicated that left ventricular-arterial uncoupling was associated with worse tissue perfusion and increased mortality in shock patients. Therefore, this study aims to investigate whether a resuscitation algorithm based on optimizing left VAC during the initial resuscitation can improve prognosis in patients with septic shock.

Methods
This pilot study was conducted in an intensive care unit (ICU) of a tertiary teaching hospital in China. A total of 83 septic shock patients with left ventricular-arterial uncoupling (i.e., the Ea/Ees ratio ≥ 1.36) were randomly assigned to receive usual care (usual care group, n = 42) or an algorithm-based resuscitation that attempt to reduce the Ea/Ees ratio to 1 within the first 6 h after randomization (VAC-optimized group, n = 41). The left VAC was evaluated by transthoracic echocardiography every 2 h during the study period. The primary endpoint was 28-days mortality. The secondary endpoints included lactate clearance rate, length of ICU stay, and duration of invasive mechanical ventilation (IMV).

Results
Eighty-two patients (98.8%) completed the study and were included in the final analysis. The Ea/Ees ratio was reduced in both groups, and the decrease in Ea/Ees ratio in the VAC-optimized group was significantly greater than that in the usual care group [median (interquartile range), 0.39 (0.26, 0.45) vs. 0.1 (0.06, 0.22); P < 0.001]. Compared with the usual care group, the VAC-optimized group likely exhibited the potential to reduce the 28-days mortality (33% vs. 50%; log-rank hazard ratio = 0.526, 95% confidence interval: 0.268 to 1.033). Moreover, the VAC-optimized group had a higher lactate clearance rate than the usual care group [27.7 (11.9, 45.7) % vs. 18.3 (− 5.7, 32.1) %; P = 0.038]. No significant difference was observed in terms of the length of ICU stay or duration of IMV.

Conclusions
During the initial resuscitation of septic shock, optimizing left ventricular-arterial coupling was associated with improved lactate clearance, while likely having a beneficial effect on prognosis.

Trial registration
Chinese Clinical Trial Registry,
ChiCTR1900024031. Registered 23 June 2019 - Retrospectively registered.
Did you hear about HIV self-testing? HIV self-testing awareness after community-based HIVST distribution in rural Zimbabwe
Authors: Rotsaert Anke , Sibanda Euphemia , Hatzold Karin , Johnson Cheryl , Corbett Elizabeth , Neuman Melissa , Cowan Frances 
Published: January 2022

Abstract
Background
Several trials of community-based HIV self-testing (HIVST) provide evidence on the acceptability and feasibility of campaign-style distribution to reach first-time testers, men and adolescents. However, we do not know how many remain unaware of HIVST after distribution campaigns, and who these individuals are. Here we look at factors associated with never having heard of HIVST after community-based campaign-style HIVST distribution in rural Zimbabwe between September 2016 and July 2017.

Methods
Analysis of representative population-based trial survey data collected from 7146 individuals following community-based HIVST distribution to households was conducted. Factors associated with having never heard of HIVST were determined using multivariable mixed-effects logistic regression adjusted for clustered design.

Results
Among survey participants, 1308 (18.3%) self-reported having never heard of HIVST. Individuals who were between 20 and 60 years old {20–29 years: [aOR = 0.74, 95% CI (0.58–0.95)], 30–39 years: [aOR = 0.56, 95% CI (0.42–0.74)], 40–49 years: [aOR = 0.50, 95% CI (0.36–0.68)], 50–59 years [aOR = 0.58, 95% CI (0.42–0.82)]}, who had attained at least ordinary level education [aOR = 0.51, 95% CI (0.34–0.76)], and who had an HIV test before [aOR = 0.30, 95% CI (0.25–0.37)] were less likely to have never heard of HIVST compared with individuals who were between 16 and 19 years old, who had a lower educational level and who had never tested for HIV before, respectively. In addition, non-household heads or household head representatives [aOR = 1.21, 95% CI (1.01–1.45)] were more likely to report never having heard of HIVST compared to household head and representatives.

Conclusions
Around one fifth of survey participants remain unaware of HIVST even after an intensive community-based door-to-door HIVST distribution. Of note, those least likely to have heard of self-testing were younger, less educated and less likely to have tested previously. Household heads appear to play an important role in granting or denying access to self-testing to other household members during door-to-door distribution. Differentiated distribution models are needed to ensure access to all.
Trial registration PACTR, PACTR201607001701788. Registered 29 June 2016, https://pactr.samrc.ac.za/ PACTR201607001701788
Age-adjusted Charlson comorbidity index in recurrent glioblastoma: a new prognostic factor?
Authors: Barz Melanie , Bette Stefanie , Janssen Insa , Aftahy A. Kaywan , Huber Thomas , Liesche-Starnecker Friederike , Ryang Yu-Mi , Wiestler Benedikt , Combs Stephanie E. , Meyer Bernhard , Gempt Jens 
Published: January 2022

Abstract
Background
For recurrent glioblastoma (GB) patients, several therapy options have been established over the last years such as more aggressive surgery, re-irradiation or chemotherapy. Age and the Karnofsky Performance Status Scale (KPSS) are used to make decisions for these patients as these are established as prognostic factors in the initial diagnosis of GB. This study’s aim was to evaluate preoperative patient comorbidities by using the age-adjusted Charlson Comorbidity Index (ACCI) as a prognostic factor for recurrent GB patients.

Methods
In this retrospective analysis we could include 123 patients with surgery for primary recurrence of GB from January 2007 until December 2016 (43 females, 80 males, mean age 57 years (range 21–80 years)). Preoperative age, sex, ACCI, KPSS and adjuvant treatment regimes were recorded for each patient. Extent of resection (EOR) was recorded as a complete/incomplete resection of the contrast-enhancing tumor part.

Results
Median overall survival (OS) was 9.0 months (95% CI 7.1–10.9 months) after first re-resection. Preoperative KPSS > 80% (P < 0.001) and EOR (P = 0.013) were associated with significantly improved survival in univariate analysis. Including these factors in multivariate analysis, preoperative KPSS < 80 (HR 2.002 [95% CI: 1.246–3.216], P = 0.004) and EOR are the only significant prognostic factor (HR 1.611 [95% CI: 1.036–2.505], P = 0.034). ACCI was not shown as a prognostic factor in univariate and multivariate analyses.

Conclusion
For patients with surgery for recurrent glioblastoma, the ACCI does not add further information about patient’s prognosis besides the well-established KPSS and extent of resection.
Effect of a pediatric fruit and vegetable prescription program on child dietary patterns, food security, and weight status: a study protocol
Authors: Saxe-Custack Amy , Todem David , Anthony James C. , Kerver Jean M. , LaChance Jenny , Hanna-Attisha Mona 
Published: January 2022

Abstract
Background
Although nutrients in fruits and vegetables are necessary for proper development and disease prevention, most US children consume fewer servings than recommended. Prescriptions for fruits and vegetables, written by physicians to exchange for fresh produce, address access and affordability challenges while emphasizing the vital role of diet in health promotion and disease prevention. Michigan’s first fruit and vegetable prescription program (FVPP) exclusively for children was introduced in 2016 at one large pediatric clinic in Flint and expanded to a second clinic in 2018. The program provides one $15 prescription for fresh produce to all pediatric patients at every office visit. Prescriptions are redeemable at a year-round farmers’ market or a local mobile market. The current study will assess the impact of this FVPP on diet, food security, and weight status of youth.

Methods
Demographically similar pediatric patient groups with varying levels of exposure to the FVPP at baseline will be compared: high exposure (> 24 months), moderate exposure (12–24 months), and no previous exposure. Data collection will focus on youth ages 8–16 years. A total of 700 caregiver-child dyads (one caregiver and one child per household) will be enrolled in the study, with approximately 200 dyads at clinic 1 (high exposure); 200 dyads at clinic 2 (moderate exposure), and 300 dyads at clinic 3 (no previous exposure). Children with no previous exposure will be introduced to the FVPP, and changes in diet, food security, and weight status will be tracked over two years. Specific aims are to (1) compare baseline diet, food security, and weight status between pediatric patients with varying levels of exposure to the FVPP; (2) measure changes in diet, food security, and weight status before and after never-before-exposed children are introduced to the FVPP; and (3) compare mean 12- and 24-month follow-up measures of diet, food security, and weight status in the initial no exposure group to baseline measures in the high exposure group.

Discussion
Completion of study aims will provide evidence for the effectiveness of pediatric FVPPs and insights regarding the duration and intensity of exposure necessary to influence change.

Trial registration
The study was registered through clinicaltrials.gov [ID: NCT04767282] on February 23, 2021.
Does an endocrinology subspecialty residency rotation enhance resident endocrine clinical knowledge?
Authors: Miller-Chang Yeng M. , Gauer Jacqueline L. , Butler Logan , Olson Andrew P.J. , Shrestha Rupendra T. , Redmon J. Bruce 
Published: January 2022

Abstract
Background
Internal Medicine (IM) programs offer elective subspecialty rotations in which residents may enroll to supplement the experience and knowledge obtained during general inpatient and outpatient rotations. Objective evidence that these rotations provide enhanced subspecialty specific knowledge is lacking. The purpose of this study was to determine whether exposure to an endocrinology subspecialty rotation enhanced a resident’s endocrinology-specific knowledge beyond that otherwise acquired during IM residency.

Methods
Data were collected on internal medicine resident scores on the American College of Physicians Internal Medicine In-Training Examinations (IM-ITE) for calendar years 2012 through 2018 along with enrollment data as to whether residents had completed an endocrinology subspecialty rotation prior to sitting for a given IM-ITE. Three hundred and six internal medicine residents in the University of Minnesota Internal Medicine residency program with 664 scores total on the IM-ITE for calendar years 2012 through 2018. Percentage of correct answers on the overall and endocrine subspecialty content areas on the IM-ITE for each exam were determined and the association between prior exposure to an endocrinology subspecialty rotation and percentage of correct answers in the endocrinology content area was analyzed using generalized linear mixed-effects models.

Results
Two hundred and thirty-three residents (76%) completed an endocrinology subspecialty rotation at some point during their residency; 121 (40%) residents had at least one IM-ITE both before and after exposure to an endocrine subspecialty rotation. Exposure to an endocrinology subspecialty rotation exhibited a positive association with the expected IM-ITE percent correct on the endocrinology content area (5.5% predicted absolute increase). Advancing year of residency was associated with a predicted increase in overall IM-ITE score but did not improve the predictive model for endocrine subspecialty score.

Conclusions
Completion of an endocrinology subspecialty elective was associated with an increase in resident endocrine specific knowledge as assessed by the IM-ITE. These findings support the value of subspecialty rotations in enhancing a resident’s subspecialty specific medical knowledge.