bluuebunny/crossref_metadata_2025_split huggingface dataset:
The 13.5-mg, 19.5-mg, and 52-mg Levonorgestrel-Releasing Intrauterine Systems and Risk of Ectopic Pregnancy
Authors: Elgemark Karin , Graner Sofie , McTaggart Julia , Ramirez Löfström Jennie , Sörensen Daniela , Envall Niklas , Kopp Kallner Helena 
Published: July 2022

OBJECTIVE:
To assess the Pearl Index for risk of ectopic pregnancy in women using levonorgestrel-releasing intrauterine systems (LNG-IUS) with hormonal reservoirs of 13.5 mg, 19.5 mg, or 52 mg.

METHODS:
This was a retrospective cohort study. Women diagnosed with an ectopic pregnancy in Stockholm County, Sweden, between January 1, 2014, and December 31, 2019, were identified through the electronic medical record system. The final analysis included 2,252 cases of ectopic pregnancy. Information on age, reproductive and medical history, as well as current use of contraception was retrieved. The time of intrauterine device (IUD) insertion before ectopic pregnancy and the numbers of sold LNG-IUS during the study period were used to calculate the incidence rate for ectopic pregnancy during use per 100 woman-years (Pearl Index).

RESULTS:
Among women with an ectopic pregnancy diagnosis, 105 presented with a known type of hormonal IUD in situ, of whom 94 were included in the calculations of the Pearl Index. The estimated Pearl Index for ectopic pregnancy was 0.136 (95% CI 0.106–0.176) for the LNG-IUS 13.5-mg, 0.037 (95% CI 0.021–0.067) for the LNG-IUS 19.5-mg, and 0.009 (95% CI 0.006–0.014) for the LNG-IUS 52-mg. With the 52-mg LNG-IUS as referent, the relative risk (RR) for ectopic pregnancy was higher during the first year for LNG 13.5-mg (RR 20.59, 95% CI 12.04–35.21), and for both 13.5-mg (RR 14.49, 95% CI 9.01–23.3) and 19.5-mg (RR 4.44, 95% CI 1.64–12.00) during the total study period.

CONCLUSION:
The absolute risk of ectopic pregnancy during the use of LNG-IUS at any doses was low. The results show that the lower the dose of the IUD, the higher the risk of an ectopic pregnancy. Higher-dose LNG-IUS should be considered when providing contraceptive counseling to a woman with known risk factors for ectopic pregnancy who are considering a hormonal IUD.
Imiquimod-Associated Localized Skin Ulceration in a Patient With Uncontrolled Diabetes
Authors: McKinzie Alexandra H. , Christman Megan A. 
Published: July 2022

BACKGROUND:
Human papillomavirus, one of the most common viral infections worldwide, frequently manifests as condyloma acuminata, or anogenital warts. First-line treatment of this condition includes the use of imiquimod, a topical immunomodulator.

CASE:
We describe a case of a localized skin ulceration necessitating surgical debridement after the use of topical imiquimod for 24 hours in a patient with uncontrolled type 2 diabetes mellitus. After debridement, the patient's wound healed appropriately, with regular wound clinic visits and diabetes education.

CONCLUSION:
Health care professionals should use caution when prescribing imiquimod in patients with uncontrolled type 2 diabetes mellitus.
Commercially Available Home Pelvic Training Devices for the Treatment of Pelvic Floor Disorders
Authors: Pennycuff Jon F. , Borazjani Ali , Wang Haijun , Iglesia Cheryl 
Published: July 2022

OBJECTIVE:
To assess the clinical efficacy of commercially available pelvic muscle training devices on the treatment of pelvic floor disorders.

DATA SOURCES:
We searched MEDLINE, Web of Science, and ClinicalTrials.gov through April 2020. We included observational cohort studies and randomized trials. Case reports, case series, and conference poster presentations were excluded. Studies using vaginal weights or cones and those conducted in the peripartum periods were also excluded.

TABULATION, INTEGRATION, AND RESULTS:
A total of 294 studies were screened. Twenty-six studies were included in the qualitative analysis, and 15 studies were eligible for meta-analyses. Study characteristics and quality were recorded for each study. Meta-analysis showed a large positive effect of commercially available pelvic floor training devices on pelvic floor muscle strength by both objective and subjective measures. Meta-analysis of objective measures showed a reduction of 1.2 pads per day (P<.01), 1.3 incontinence episodes per day, (P<.01) and 11 g on 24-hour pad test (P<.01). Meta-analysis of subjective measures showed a reduction in UDI-6 (Urogenital Distress Inventory, Short Form) scores by 25.1 points (P<.01) and in IIQ-7 scores (Incontinence Impact Questionnaire, Short Form) by 14.1 points (P=.01). There was an increase in I-QOL (Incontinence Quality of Life) scores by 16.8 points (P<.01). The minimal important difference was met for the UDI-6 and I-QOL but not for the IIQ-7. We were unable to perform meta-analysis to evaluate whether pelvic floor training devices are as effective as traditional supervised pelvic floor physical therapy.

CONCLUSION:
Commercially available home pelvic floor training devices are effective in increasing strength of pelvic floor muscles and in the treatment of pelvic floor disorders.
Suture Compared With Staples for Skin Closure After Cesarean Delivery
Authors: Mackeen A. Dhanya , Sullivan Maranda V. , Schuster Meike , Berghella Vincenzo 
Published: July 2022

OBJECTIVE:
Absorbable suture is the preferred method of cesarean skin closure compared with metal staples, because it decreases wound complications. Two recently published trials in patients with obesity contradict this evidence. The goal of this meta-analysis was to assess whether suture remains the recommended method of cesarean skin closure, regardless of obesity status.

DATA SOURCES:
MEDLINE through OVID, PubMed, Cochrane Database, and ClinicalTrials.gov were searched from inception until September 24, 2021.

METHOD OF STUDY SELECTION:
Published randomized controlled trials (RCTs) comparing subcuticular absorbable suture with nonabsorbable metal staples for cesarean skin closure were included. Non-RCTs, RCTs that did not compare staples with suture, and ongoing trials were excluded. Fourteen studies met inclusion criteria.

TABULATION, INTEGRATION AND RESULTS:
Data were individually abstracted and entered into RevMan. Fixed and random effects models were used. The Cochrane risk-of-bias tool was used to assess each study. The primary outcome, a sensitivity analysis of wound complications (excluding studies at high risk of bias), showed a significant decrease in wound complications when the cesarean skin incision was closed with suture compared with staples (10 studies; 71/1,497 vs 194/1,465; risk ratio [RR] 0.47, 95% CI 0.25–0.87). When all studies were analyzed, there remained a significant decrease in wound complications when the skin was closed with suture (14 studies; 121/1,780 vs 242/1,750; RR 0.59, 95% CI 0.36–0.97). Of the individual wound complications, wound separation was significantly decreased with suture closure compared with staples (11 studies; 55/1,319 vs 129/1,273; RR 0.43, 95% CI 0.32–0.58). In patients with obesity, there remained a significant decrease in wound complications with suture closure of the skin incision compared with staples (five studies; 34/507 vs 67/522; RR 0.51, 95% CI 0.34–0.75).

CONCLUSION:
Closure of the cesarean skin incision with suture decreased composite wound complications by 50% as compared with closure with staples; a significant decrease persisted regardless of obesity status.

SYSTEMATIC REVIEW REGISTRATION:
PROSPERO, CRD42021270378.
Hip Fracture With Elevated Troponin: Harbinger of Mortality or Need for Accelerated Surgery?
Authors: O'Hara Nathan N. , Wu Jocelyn , Rolle Nicholas , Sprague Sheila , Devereaux P. J. , Borges Flavia K. , Slobogean Gerard P. 
Published: July 2022

Objective:
To determine the association of elevated troponin levels with time to surgery and the risk of mortality and other key clinical outcomes among elderly patients with hip fracture who had measured troponin levels at hospital admission.

Design:
Retrospective cohort study.

Setting:
Single academic trauma center.

Patients:
We included 299 consecutive patients 60 years of age or older with a hip fracture and cardiac troponin levels measured at the time of hospital admission.

Intervention:
Patients with elevated cardiac troponin levels at hospital admission (n = 43) compared with patients with normal troponin levels at admission (n = 256).

Main Outcome Measures:
Time to surgery, 90-day mortality, and major complications within 90 days of injury.

Results:
The median age of the cohort was 80 years (interquartile range, 70–87 years), 59% were female, and 86% were living independently before their injury. Elevated troponin levels were associated with a 21-hour [95% confidence interval (CI), 12 to 32, P < 0.001] increase in the median time from admission to surgery (43 vs. 22 hours). Elevated troponin levels were also associated with a 14% (95% CI, 0% to 29%, P = 0.01) absolute increase in 90-day mortality (28% vs. 14%). Patients with elevated troponins were 15% (95% CI, −1% to 30%, P = 0.06) more likely to have a major complication (37% vs. 23%); however, the difference did not reach statistical significance.

Conclusions:
Among patients with a hip fracture and measured troponin levels, elevated troponin levels were associated with significant delays in surgery and increased 90-day mortality.

Level of Evidence:
Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
A Prospective Randomized Controlled Trial Comparing Enoxaparin & Rivaroxaban for Venous Thromboembolism Prophylaxis in Orthopaedic Trauma
Authors: John Mitchell P. , Streufert Benjamin D. , Downes Katheryne , Chase Collin B. , Mir Hassan R. 
Published: July 2022

Objectives:
To determine whether there is a difference in orthopaedic trauma patient medication satisfaction and adherence using an oral versus subcutaneous injectable anticoagulant for venous thromboembolism chemoprophylaxis.

Design:
Randomized controlled trial.

Setting:
Single academic Level 1 trauma center.

Participants:
One hundred twenty adult orthopaedic trauma patients with operative pelvic or lower extremity fractures were randomized and completed the study.

Intervention:
Three weeks of either the service standard 40 mg once daily enoxaparin versus trial medication 10 mg once daily rivaroxaban postoperatively.

Main Outcome Measures:
Patient satisfaction as measured by the Treatment Satisfaction Questionnaire for Medication (TSQM-9). Medication adherence as measured by the Morisky Medication Adherence Scale (MMAS-8).

Results:
Medication adherence was similar in both groups. Medication satisfaction was significantly higher in the oral rivaroxaban group based on the TSQM-9 and patient-reported data. Secondary outcomes found no significant difference in the incidence of bleeding events or clinically relevant venous thromboembolism. The enoxaparin group experienced more adverse medication-related events. The rivaroxaban medication regimen costs 7.5–10× less out of pocket for uninsured patients.

Conclusion:
The results of this randomized controlled trial demonstrate that patients with surgical orthopaedic trauma prefer an oral anticoagulant for postoperative venous thromboembolism chemoprophylaxis and suggest that rivaroxaban may be a viable option. Furthermore, large-scale studies are needed to confirm safety and efficacy for rivaroxaban in this population as a potential alternative to enoxaparin and aspirin.

Level of Evidence:
Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.
Acupuncture and moxibustion treating lower urinary tract symptoms due to benign prostatic hyperplasia: a systematic review and network meta-analysis
Authors: Chen Zhe , Jiang Tao , Peng Yingying , Qiang Xiaoyu , Yang Fengwen , Hu Haiyin , Liu Chunxiang , Lee Myeong Soo 
Published: July 2022

Abstract

Objective:
Lower urinary tract symptoms (LUTS) caused by benign prostatic hyperplasia (BPH) affect the quality of life of elderly individuals. Acupuncture and moxibustion are used in the clinic in China for improving LUTS symptoms due to BPH. However, there is no evidence to suggest which is the best option. We compared the efficacy of acupuncture and moxibustion to provide evidence for clinical decision-making.

Methods:
PubMed, Embase, Cochrane Library, Web of Science, China National Knowledge Infrastructure, Wan Fang Data, and VIP databases were searched from inception to July 2020 to identify the randomized controlled trials (RCTs) of acupuncture and moxibustion for LUTS due to BPH. Two researchers filtered studies and extracted the information independently. This study conducted a network meta-analysis using the Bayesian random method. The interventions ranking was evaluated using the surface under the cumulative ranking curve (SUCRA).

Results:
We finally included 40 studies comprising 10 treating therapies and 3655 patients with LUTS caused by BPH. In terms of the International Prostate Symptom Score, maximum urinary flow rate, and quality of life, electroacupuncture (EA) (MD = −3.6, 95% credible interval [CrI] [−5.5, −1.8], very low certainty of evidence; MD = 2.2, 95% CrI [1.1, 3.3], low certainty of evidence; MD = −1.3, 95% CrI [−2.2, −0.43], very low certainty of evidence) may be consistently the optimal treatment compared with other interventions, with SUCRA values of 84%, 81%, and 89%, respectively.

Conclusions:
Of all treatments, EA may have the best efficacy with fewer adverse events for LUTS due to BPH. The quality of evidence supporting this result is low to very low certainty of the evidence due to limitations of primary studies; thus, more high-quality RCTs are needed for further evidence.
Chondrogenic differentiation of rat bone marrow mesenchymal stem cells induced by puerarin and tetrandrine
Authors: Dong Xin-Ran , Hu Meng-Jiao , Pan Hui-Xin , Li Ke-Feng , Cui Yuan-Lu 
Published: July 2022

Abstract

Objective:
This study aims to clarify the effect of the active components puerarin and tetrandrine on the chondrogenic differentiation of bone marrow mesenchymal stem cells (BMSCs).

Methods:
Using network pharmacology, protein targets of puerarin and tetrandrine were predicted, and a database of cartilage formation targets was established. The protein target information related to disease was then collected, and the drug-targeting network was constructed by analyzing the protein–protein interactions. Genes related to chondrogenesis induced by puerarin and tetrandrine and chondroblast differentiation signaling pathways were searched. Finally, potential drug- and disease-related genes, as well as proteins, were screened and verified using real-time RT-PCR and western blotting.

Results:
Network pharmacological studies have shown that puerarin and tetrandrine are involved in BMSCs cartilage differentiation. The experimental results showed that puerarin and tetrandrine could regulate the expression of cartilage differentiation-related genes and proteins. Puerarin increased the protein expression of COL2A1, COL10A1, MMP13, and SOX-9, as well as the gene expression of Col2a1, Mmp13, Tgfb1, and Sox-9. Tetrandrine increased the protein expression of COL2A1, COL10A1, MMP13, and SOX-9, as well as the gene expression of Col10a1, Tgfb1, Sox-9, and Acan. The combination of puerarin and tetrandrine increased the protein expression of COL2A1, COL10A1, MMP13, and SOX-9 and the gene expression of Col2a1, Col10a1, Sox-9, and Acan.

Conclusions:
Puerarin, tetrandrine, and their combination can promote the proliferation of BMSCs and induce their differentiation into chondrocytes, and they are thus expected to be inducers of chondrogenic differentiation. These results suggest that puerarin and tetrandrine have potential therapeutic effects on osteoarthritis.
Dry Eye–Related Risk Factors for Digital Eye Strain
Authors: Talens-Estarelles Cristian , García-Marqués José Vicente , Cerviño Alejandro , García-Lázaro Santiago 
Published: July 2022

Objectives:
To evaluate dry eye–related lifestyle and demographic factors associated with digital eye strain (DES).

Methods:
An anonymous online survey was conducted in 851 university students. Participants were classified into DES (computer vision syndrome questionnaire [CVS-Q]≥6) or non-DES (CVS-Q<6). Respondents completed three dry eye questionnaires (Ocular Surface Disease Index [OSDI]; 5-item Dry Eye Questionnaire [DEQ-5]; 8-item Contact Lens Dry Eye Questionnaire) and were surveyed on dry eye risk factors contemplated by the Tear Film and Ocular Surface Society Dry Eye Workshop II.

Results:
Six hundred twenty-eight participants were classified into the group with DES and 222 into the group without DES. Participants with DES slept fewer hours, spent more hours indoors with air conditioning, drank more caffeinated beverages, used the computer for longer periods, reported poorer health quality, and obtained a higher score in all questionnaires (P<0.025). A higher proportion of the participants were female, had several health disorders, and took several medications associated with dry eye (P<0.029). Multivariate logistic regression analysis revealed that stress (P=0.035), contact lens wear (P=0.011), hours of computer use per day (P=0.010), migraine headaches (P=0.013), and a higher OSDI (P<0.001) and DEQ-5 score (P<0.001) were associated with DES.

Conclusions:
Several dry eye–related risk factors and health conditions are associated with suffering from DES. Clinicians should acknowledge the relevance of triaging questions and dry eye disease risk factors when dealing with patients who view screens for extended periods.
Addressing Compassion Fatigue in Trauma Emergency and Intensive Care Settings: A Pilot Study
Authors: Beres Katherine E. , Zajac Lisa M. , Mason Heidi , Krenke Karen , Costa Deena Kelly 
Published: July 2022

BACKGROUND:
Emergency and intensive care health care professionals are experiencing exhaustion and helplessness, which may cause compassion fatigue. Unaddressed compassion fatigue impacts staff morale and patient safety. Structured debriefing sessions may reduce compassion fatigue by providing social support and increasing job satisfaction.

OBJECTIVE:
To investigate the feasibility of a 12-week pilot of structured debriefing sessions and its impact on compassion fatigue experienced by emergency and intensive care health care professionals after patient death.

METHODS:
In this 12-week pilot study (March 2021 to May 2021), we used a preintervention/postintervention design to determine the feasibility of structured debriefing among trauma health care professionals experiencing patient death in an urban, academic, 300-bed, Midwest, Level II trauma center. Compassion fatigue was measured using the Professional Quality of Life Measure survey. Univariate descriptive statistics, independent unpaired t tests, and χ2 tests examined the intervention impact.

RESULTS:
Fifty-six health care professionals participated in 20 debriefing sessions during the 12-week intervention: 37 (80%) registered nurses, 10 (5.6%) respiratory therapists, and 5 (11.2%) nursing assistants or emergency medical technicians. The debriefings covered nearly half of all patient deaths (38%). No significant differences were seen in burnout (M = 25.5, SD = 5.4, p = .47), secondary traumatic stress (M = 23.9, SD = 5.6, p = .99), or compassion satisfaction (M = 36.8, SD = 6.4, p = .61).

CONCLUSIONS:
Structured debriefings to address compassion fatigue among trauma health care professionals are feasible, but further research on effectiveness is needed. Administration-provided emotional support strategies may assist health care professionals in processing work-related stress.
Tributary Medicine System of the Qing Dynasty: A Preliminary Study
Authors: Zhang Zi-Long , Xian Yi-Sha , Shi Xiao-Jie , Wang Xue-Qi , Sun Ling-Yi 
Published: July 2022

Abstract
Medicine was one of the articles of tribute paid by other countries and kingdoms to the imperial court of the Qing dynasty (1644–1912). The act of paying tributes and the rituals associated with it enhanced communication and helped establish relationships between ancient China and other nations or territories. The imperial court was generous in return, which attracted many countries to pay tributes. This paper analyzes how medicines as tributes played an important role in consolidating the dominant status of ancient China, and in promoting the exchange of knowledge between Chinese and Western medicine.
Use of Non-Verbal Representations to Define Concept of Pulse Conditions in Traditional Chinese Medicine Standards
Authors: Zhang Chun-Ke , Wang Yi-Qin , Guo Rui , Yan Hai-Xia , Yan Jian-Jun , Wu Wen-Jie , Li Jing 
Published: July 2022

Abstract
The standardization of terms and definitions is fundamental to all activities in the domain of traditional Chinese medicine (TCM). For decades, definitions of TCM terminology relied on conventional verbal representations to differentiate between related concepts. However, the ancient Chinese is obscure and comprises a massive volume of information, making it difficult to convey the definition accurately in other languages. This article proposes a potential solution that the definition for pulse terminology can be supplemented by modern means of non-verbal representation, i.e., using pulse waveform graphs and parameters to complete the definition of each pulse. A discussion of the challenges of obtaining reliable data is also included.
Art of Nourishing Life According to the Kidney Meridian in Zhenjiu Dacheng (The Great Compendium of Acupuncture and Moxibustion)
Authors: Bui Anita 
Published: July 2022

Abstract
“Daoyin Benjing” (Art of Nourishing Life) discusses the kidney meridian in depth. It is a dense and heterogeneous text that is heavily influenced by Daoism. The text proposes rules for the maintenance of life using language that is often cryptic and understandable only to the initiated. This language is closely interwoven with the classical terms of traditional Chinese medicine. The kidney is the home of vital energy, which is a type of sexual energy and the root of life. Engagement in moderate sexual activity nourishes life and leads to a long life. This is the goal of every Daoist follower and the goal of every doctor.
Role of pilocarpine use following laser peripheral iridotomy in eyes with refractory acute angle closure glaucoma: A case report and literature review
Authors: Yen Chu-Yu , Chen Chun-Chen , Tseng Po-Chen 
Published: July 2022

Rationale:
Angle closure glaucoma (ACG) is one of the most emergent types of glaucoma in clinical practice. Laser peripheral iridotomy (LPI) could minimize pupillary block and prevent ACG from an acute attack. However, recurrent increase in intraocular pressure (IOP) may still occur despite successful LPI. The aim of this study is to highlight the importance of postLPI pilocarpine use and larger LPI size as well as to share some experiences of cataract surgery in patients with ACG.

Patient concerns:
A 63-year-old female was referred to our hospital for headache, and poor control of IOP in the right eye for 3 hours.

Diagnoses:
The patient was diagnosed ACG in the right eye. Recurrence of ACG in the right eye and new-onset and recurrent ACG in the left eye were noted during follow-up, despite successful LPI. The diagnosis was confirmed through slit lamp and gonioscope examination.

Interventions:
The LPI size was enlarged and pilocarpine use was maintained at 2% (1 drop 4 times a day) in both the eyes. Finally, cataract surgery was performed in both the eyes.

Outcomes:
No recurrence of ACG was noted during postLPI pilocarpine use in both the eyes. The postoperative IOP was stable for >6 months after cataract surgery without any surgical intervention or antiglaucoma medication use. No discomfort or major complication was observed.

Conclusion:
This report highlights the importance of postLPI pilocarpine use and larger LPI size in patients with refractory ACG.