bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Biomechanical and Histological Processes of Rerouting Biceps to Treat Chronic Irreparable Rotator Cuff Tears in a Rabbit Model
Authors: Xu Junjie , Li Yufeng , Zhang Xueying , Han Kang , Ye Zipeng , Wu Chenliang , Jiang Jia , Yan Xiaoyu , Su Wei , Zhao Jinzhong 
Published: January 2022

Background: Recently, the biceps was rerouted into a newly fabricated bicipital groove for in situ superior capsular reconstruction (SCR), resulting in promising time-zero cadaveric and clinical outcomes. However, no studies have determined the in vivo biomechanical and histological processes after the biceps is transposed to a nonanatomic position. Purpose: To explore the in vivo biomechanical and histological processes of the rerouting biceps tendon to treat chronic irreparable rotator cuff tears (IRCTs) in a rabbit model. Study Design: Controlled laboratory study. Methods: A total of 94 skeletally mature male rabbits were used to create a chronic IRCT model in the supraspinatus tendon. Then, the biceps rerouting procedures were performed in rabbits with chronic IRCT. Eighteen rabbits were sacrificed at 1, 3, 6, 9, and 12 weeks postoperatively for biomechanical testing, micro—computed tomography scanning, and histological analysis. The biomechanical and histological changes of intra- and extra-articular portions of the rerouting biceps were evaluated at each time point, with the contralateral native superior capsule (NSC) and the native biceps (NB) as controls, respectively. The morphology and bone formation of the fabricated bicipital grooves were evaluated, with native grooves as controls. Results: The intra-articular rerouting biceps tendon was progressively remodeled over time, displaying denser fibers and more mature collagen than those of the NSC, with gradual improvements in the tendon-to-bone healing interface from 6 to 12 weeks. Consequently, the failure load and stiffness of the intra-articular rerouting biceps portion increased with time and were significantly higher than those of the NSC from 9 weeks. Similarly, the extra-articular portion of the rerouting biceps progressively healed into a new bicipital groove, as demonstrated by a smaller tendon-to-bone interface from 6 to 12 weeks, resulting in greater failure load and stiffness at 9 and 12 weeks than those of the NB attachment. The newly fabricated bicipital groove showed similar morphology to that of the native groove with sufficient trabecular bone formed underneath. Conclusion: The rerouting biceps could progressively remodel and heal into the newly fabricated bicipital groove over time, resulting in greater biomechanical performances in intra- and extra-articular portions than the NSC and the NB attachment. Clinical Relevance: The biceps rerouting technique may be a feasible procedure to perform in situ SCR to treat IRCT in the future clinical practice; however, more clinical evidence is required.
Outcomes of Arthroscopic Latarjet Procedure for Anterior Glenohumeral Instability in Patients With Epilepsy: A Case-Control Study
Authors: Dzidzishvili Lika , Calvo Claudio , Valencia María , Calvo Emilio 
Published: January 2022

Background: Unacceptably high rates of redislocation, reoperation, osteoarthritis, and coracoid nonunion have been reported in patients with a seizure disorder after surgery for shoulder instabilitiy. Purpose: To evaluate the objective and subjective functional and radiologic results of the arthroscopic Latarjet procedure for anterior shoulder instability in patients with epilepsy and compare them with the results of patients without epilepsy. Study design: Cohort study; Level of evidence, 3. Methods: A retrospective and comparative case-control analysis of patients operated for shoulder instability with arthroscopic Latarjet was conducted. Nineteen patients (21 unstable shoulders) with a seizure disorder (epilepsy group) were matched with 21 patients without a history of seizure (control group). Demographics, surgical indications, and imaging data were collected. Clinical outcomes at a minimum 2 years of follow-up (range, 2-9 years) postoperatively included Rowe score, Western Ontario Shoulder Instability Index (WOSI), Constant-Murley Shoulder Outcome (CMSO) score, and Single Assessment Numeric Evaluation (SANE). The incidence of complications, recurrent instability, redislocation, revision surgery, repeated seizure(s), and presence of osteoarthritis, coracoid nonunion, and osteolysis were also examined. Results: After a mean follow-up of 4.5 years, no significant differences in functional results were found between patients with and without epilepsy on the average Rowe ( P = .917), WOSI ( P = .621), CMSO ( P = .600), and SANE ( P = .859) scores. A total of 5 patients (7 shoulders) continued to have seizures postoperatively, but no seizure-related glenohumeral instability was documented. One dislocation and 1 subluxation were documented while participating in sports in each study group, comprising a recurrence rate of 9.5%, but no significant differences were found at comparison ( P = .605). A bone defect did not influence the results, as no significant difference was found between the 2 groups. Osteoarthritic changes of the glenohumeral joint were observed in 5 shoulders (23.8%) in the epilepsy group and in 3 (14.3%) in the control group ( P = .451). No case of coracoid nonunion or osteolysis was recorded. There was no statistically significant difference in postoperative athletic activity ( P = .660). However, patients with epilepsy had significantly lower pre- and postoperative sports participation ( P < .001). Conclusion: Arthroscopic Latarjet stabilization can lead to improved functional and subjective outcomes and should be considered in patients with epilepsy with recurrent anterior glenohumeral instability. These results can be achieved regardless of the presence of bone defect and the postoperative control of seizures and are similar to those in patients without epilepsy.
Toxicity assessment of gelsenicine and the search for effective antidotes
Authors: Li Yu-Juan , Yang Kun , Long Xue-Ming , Xiao Gang , Huang Si-Juan , Zeng Zi-Yue , Liu Zhao-Ying , Sun Zhi-Liang 
Published: January 2022

Background Gelsenicine, one of the most toxic alkaloids of Gelsemium elegans Benth ( G. elegans), causes severe respiratory depression. However, its toxicity mechanisms are yet to be elucidated and no effective antidotes are available. Objective This study aimed to analyse the toxicity characteristics of gelsenicine. Methods Both acute and sub-acute toxicities were evaluated. Gelsenicine distribution and elimination in the central nervous system (CNS) and blood were observed. Effective antidotes for gelsenicine poisoning were screened. Results In the acute toxicity study, gelsenicine was highly toxic, and female rats exhibited greater sensitivity to gelsenicine than male rats (LD50 0.520 mg/kg vs 0.996 mg/kg, respectively). Death was primarily caused by respiratory failure. However, in the sub-acute toxicity study, no significant organ damage was observed. Gelsenicine was easily absorbed from the gastrointestinal tract and penetrated the blood–brain barrier, reaching peak concentrations in the CNS within 15 min and rapidly decreasing thereafter. Flumazenil or diazepam combined with epinephrine reversed gelsenicine toxicity and significantly improved survival rate in mice. Conclusions Gelsenicine is a highly toxic substance that affects nerve conduction without causing damage; the potential toxic mechanism is possibly associated with GABAA receptors. Our findings provide insights into the clinical treatment of gelsenicine -related poisoning and its toxicity mechanisms.
Hydroxyurea- a cost effective treatment in developing countries for Atypical Chronic Myeloid Leukemia (aCML): Case Report of Two Patients
Authors: Hassan Zair , Iqbal Ayesha , Zahoor Saiqa , Ali Iftikhar , Iqbal Muhammad Mamoon , Bibi Rashida 
Published: January 2022

Introduction Atypical chronic myeloid leukaemia (aCML) is a rare chronic myeloproliferative disorder with a poor prognosis. Case report This case report presents two cases of male geriatric patients, both referred from primary care in rural areas and received at an urban clinic in a tertiary care hospital on separate instances. The first patient complained of low-grade fever (on/off), generalized body aches, rapid weight loss and shortness of breath for the last 2 months. The second patient arrived pale looking with symptoms of generalized body aches, dizziness and anorexia. Both patients were diagnosed to have aCML according to the World Health organization criteria. Management & outcome Both the patients were from a low economic bracket and were treated with Hydroxyurea a relatively economic medicine successfully. The follow-up lasted for 12 months in both cases. No progression to acute myeloid leukaemia (AML) or relapse was observed. Discussion This case report shows the promising results of Hydroxyurea in treating aCML and can be a cost effective alternate to other expensive treatments (allogeneic hematopoietic stem cell transplantation) and expensive medicines in lower and middle-income countries especially for resource-limited patients. These two cases show promising evidence for further studies to evaluate and conduct pharmaco-economic evaluations as well as clinical trials to compare hydroxyurea with other available alternative treatments for an affordable therapeutic option towards prevention of relapse and disease free survival after aCML.
Skin ulcers caused by ruxolitinib in a patient with chronic cutaneous graft-versus-host disease
Authors: Aslan Candır Burcu , Yiğenoğlu Tuğçe Nur , Kızıl Çakar Merih , Dal Mehmet Sinan , Altuntaş Fevzi 
Published: January 2022

Introduction Graft-versus-host disease (GVHD) is a common complication of allogeneic hematopoietic cell transplantation (HCT). In the treatment of chronic GVHD, skin directed therapy, systemic corticosteroids, calcineurin inhibitors (such as cyclosporine (CsA) and tacrolimus), rituximab, mycophenolate mofetil (MMF), extracorporeal photopheresis (ECP) and ruxolitinib are used. Case report We present an 18 year old male with Philadelphia chromosome positive acute B lymphoblastic leukemia, treated with allogeneic HCT from a full matched sibling donor. The patient had grade 2 chronic cutaneous GVHD resistant to corticosteroids, CsA, MMF, and ECP treatment. Three months after initiation of ruxolitinib therapy, the patient developed skin ulcers on his lower extremities. Management & outcome The biopsy revealed that the changes were caused by the drug reactions. We suspected ruxolitinib as the likely cause of these ulcerative lesions after evaluating the adverse drug reaction probability scale. The adverse drug score was 4, therefore, ruxolitinib treatment was discontinued. Ulcerative lesions fully recovered after 4 weeks of follow-up. Discussion Ruxolitinib is used in the treatment of chronic GVHD that has been resistant to steroids and other salvage therapies. In our case, ruxolitinib was used as a salvage therapy in a patient who had refractory chronic skin GVHD. Ruxolitinib-related skin lesions with ulcers of lower extremities and whole body erythematous skin lesions were reported previously in patients with myelofibrosis. The pathophysiology of ruxolitinib related skin ulcers is unknown. Skin changes of patients using ruxolitinib should be closely monitored, and newly developing lesions should be suspected of being drug-related and biopsied.
Health-related quality of life among cervical cancer patients at Kenyatta National Hospital
Authors: Shajahan Ahamed Mehreen , Degu Amsalu 
Published: January 2022

Background Previous study showed that health-related quality of life (HRQoL) was adversely affected during treatment of cervical cancer, with a worsening global score. Therefore, this study aimed to determine the HRQoL of cervical cancer patients at Kenyatta National Hospital. Methods A cross-sectional study design was employed among cervical cancer patients. All eligible consecutive samples of 103 cervical cancer patients were included in the study. Following consent, patients were interviewed using The European Organization for Research and Treatment of Cancer Quality-of-Life Questionnaire 30 (EORTC QLQ-30) and Cervical Cancer Module CX24 (EORTC QLQ-CX24). The data were entered and analyzed using the SPSS version 20.0 software. Univariate and multivariate binary logistic regression analysis was employed to investigate the predictors of HRQoL. A p-value of ≤ 0.05 was considered statistically significant. Results The majority (69%) of the patients had a poor overall quality of life while 31% of study participants had a good quality of life. Patients with early-stage disease were 7.3 times (AOR = 7.3, 95% CI = 2.4–21.7, p = 0.000) more likely to have a good HRQoL than patients with advanced-stage disease. Patients with no comorbidities were 3.1 times (COR = 3.1, 95% CI = 1.1–9.1, p = 0.037) more likely to have a good HRQoL than patients with comorbidities. Conclusion The overall HRQoL among cervical cancer patients was poor in the setting. Advanced stage of disease and presence of comorbidities were the significant predictors of poor quality of life.
Vincristine induced fever in a child with embryonal rhadbomyosarcoma
Authors: Janani Dr. Arul , Shruthilaya Dr. Anandkumar , Dhaarani Dr. Jayaraman , Julius Dr. Scott X 
Published: January 2022

Introduction Febrile episodes in oncology is common are mostly of infectious etiology requiring repeated investigations and escalation of antibiotics. But, drug induced fever occur more often than we think in oncological set-up. Case Report A 5 year old male child with rhabdomyosarcoma, developed high grade fever spikes following Vincristine monotherapy. Infective etiology work up was negative and the fever responded to corticosteroids. Management and Outcome He was treated with corticosteroids as premedication considering vincristine induced fever. The further courses of VCR- monotherapy were uneventful with steroids as premedication. Discussion We present the case of vincristine induced fever in a child with embryonal rhabdomyosarcoma. Clinician’s should consider drug induced fever at appropriate conditions, to avoid leading to antibiotic resistance.
Change in Abdominal Aortic Aneurysm Sac Diameter After Endovascular Repair: A Single-Center Experience From Taiwan
Authors: Tseng Hsien-Wei , Chang Po-Ya , Chang Chin-Hao , Wu I-Hui , Hsu Ron-Bin , Chan Chih-Yang 
Published: January 2022

Purpose: The purpose of this study was to investigate the change in the diameter of infrarenal abdominal aortic aneurysm (AAA) sacs after endovascular aortic repair (EVAR) in Taiwanese patients and to depict its association with clinical outcomes. Materials and Methods: This retrospective cohort study was conducted on patients who underwent EVAR for infrarenal AAA between January 2011 and December 2016. All preoperative and follow-up computed tomography (CT) images were reviewed. Postoperative CT angiography was arranged after 1 month and annually thereafter. The maximal diameter on the axial plane and the maximal diameter perpendicular to the centerline on the coronal and sagittal planes were measured. The study examined post-EVAR sac diameter change over time and compared the differences in adverse events (AEs) among groups. Results: The survey included a total of 191 patients with a median follow-up duration of 2.5 (interquartile range: 1.1–2.9) years. Overall survival rates at 1, 2, and 5 years were 92%, 81%, and 76%, respectively. According to their last CT scans, the patients were categorized into 3 groups as follows: shrinkage, stationary, and enlargement, which comprised 58 (30.4%), 118 (61.8%), and 15 (7.9%) patients, respectively. Pre-EVAR characteristics and sac diameters were similar among the groups. Sac shrinkage was exclusively observed in the first 2 years, whereas sac enlargement developed at all follow-up periods. Patients with sac enlargement had higher incidence rates of endoleaks, complications, and reintervention than the other groups. Conclusion: Based on our observations, post-EVAR sac shrinkage only occurs in the first 2 years; however, post-EVAR sacs may enlarge at any point and even after 5 years. In our study, patients with sac enlargement had higher rates of adverse events and reintervention.
Reverse Cheese-Wire Septotomy to Create a Distal Landing Zone for Thoracic Endovascular Aortic Repair
Authors: Stern Jordan R. , Pham Xuan-Binh D. , Lee Jason T. 
Published: January 2022

Purpose: The objective of this study is to describe a novel method for creating a distal landing zone for thoracic endovascular aortic repair (TEVAR) in chronic aortic dissection. The technique is described in a patient with prior total arch and descending aortic replacement, with false lumen expansion. Technique: A cheese-wire endovascular septotomy was desired to create a single lumen above the celiac axis. To avoid dividing the septum caudally across the visceral segment, we performed a modified septotomy in a cephalad direction. Stiff wires were passed into the prior surgical graft, through true lumen on the right and false lumen on the left. An additional wire was passed across an existing fenestration at the level of the celiac axis, and snared and externalized. 7F Ansel sheaths were advanced and positioned tip-to-tip at the fenestration. Using the stiff wires as tracks, the through-wire was pushed cephalad to endovascularly cut the septum. Angiogram demonstrated successful septotomy, and TEVAR was performed to just above the celiac with successful aneurysm exclusion and no endoleak or retrograde false lumen perfusion. Follow-up computed tomography angiogram (CTA) showed continued exclusion without false lumen perfusion. Conclusions: This novel modification in a reverse direction provides an alternative method for endovascular septotomy, when traditional septotomy may threaten the visceral vessels.
Peroneal Stabilization Via Tightening of the Peroneal Tendon Sheath
Authors: Cates Nicole K. , Salerno Nicholas D. , Kavanagh Amber M. , Schuberth John M. , Rubin Laurence G. 
Published: January 2022

Peroneal subluxation is a rare but debilitating pathology that can be the result of a superior peroneal retinaculum tear or intrasheath laxity. On clinical examination of both cases, the pathology is observed when the ankle is circumducted in eversion and dorsiflexion. With a superior peroneal retinaculum tear, the tendons dislocate from the peroneal groove, whereas with intrasheath laxity the tendons remain in the groove. In the present case series, peroneal stabilization was performed for both superior peroneal retinaculum tear and intrasheath laxity. With our technique, the fibro-osseous connections of the peroneal tendon sheath are detached from the distal one third of the fibula. Drill holes are made through the fibula for suture to be passed through and the peroneal tendon sheath is reattached to the fibula through horizontal mattress sutures via pants over vest technique to restore tension to the sheath. A total of 5 patients underwent peroneal stabilization, 100% (5/5) of which had preoperative pain with palpation along the peroneal tendons and a palpable click with range of motion of the ankle joint. Postoperatively, 100% (5/5) of the patients were fully weight-bearing, compared to 60% (3/5) preoperatively. No patients had residual subluxation of the peroneal tendons postoperatively or a need for revisional surgery. Residual peroneal tendonitis was present in 20% (1/5) of patients and sural neuritis occurred in 20% (1/5) of patients. The peroneal tendons are physiologically tightened within the peroneal tendon sheath to mitigate the pathologic subluxation, without sacrificing tendons for transfer or using allograft material. Clinical Level of Evidence: Therapeutic, Case Series, Level 4
Evaluating discrepancy rates of radiology resident provisional reports for cross-sectional body imaging studies at a tertiary hospital
Authors: Kia-Sheng Phua Jonathan , Tim-Ee Cheng Lionel 
Published: January 2022

Introduction Urgent radiological studies obtained during on-call hours are often preliminarily read by on-call residents before consultant radiologists finalise the reports at a later time. Such provisional radiology reports provide important information to guide initial patient management. This study aims to determine discrepancy rates between provisional reports and final interpretations, and to assess the clinical significance of such discrepancies. Methods This retrospective quality assurance project reviewed a total of 1218 cross-sectional imaging studies of the body (thorax, abdomen and pelvis) done between July 2015 and May 2016 during on-call hours. The studies included 1201 Computed tomography (CT) scans and 17 Magnetic Resonance Imaging (MRI) scans. Studies with incomplete or unavailable reports were excluded. Conclusions of both the provisional and final reports of each study were reviewed for concordance, with reference to the full report if needed. Discrepancies were graded according to the ACR 2016 RADPEER scoring system. Results There were 1210 studies with complete reports. Discrepant reports were noted in 183 (15.1%) studies. Of these, 89 (7.3%) were assessed to be clinically significant and the majority of these (55) were due to interpretations which should be made most of the time. CT of the abdomen and pelvis were the most prone to discrepant reports, accounting for 148 cases (80.9%). Conclusion The majority of preliminary reports for on-call body scans were concordant with final interpretations. The discrepancy rates for provisional body scan reports provided by residents while on call were comparable to those previously reported in literature.
Does the Interval Slide Procedure Reduce Supraspinatus Tendon Repair Tension?: A Biomechanical Cadaveric Study
Authors: Porschke Felix , Nolte Philip Christian , Knye Christian , Weiss Christel , Studier-Fischer Stefan , Gruetzner Paul Alfred , Guehring Thorsten , Schnetzke Marc 
Published: January 2022

Background: The benefits of the interval slide (IS) procedure in retracted rotator cuff tears remain controversial. Purpose: The purpose was to evaluate the effect of the IS procedure on repair tension (RT). It was hypothesized that the IS procedure (anterior IS [AIS], posterior IS [PIS], and intra-articular capsular release [CR]) would reduce the RT of a supraspinatus tendon. Study Design: Controlled laboratory study. Methods: A total of 31 Thiel-embalmed human cadaveric shoulders (mean age, 74 years; range, 68-84 years) were tested. Full-thickness supraspinatus tendon tears were created, and 1 cm of tendon was resected to simulate a retracted defect. Shoulders were randomized into intervention (n = 16) and control (n = 15) groups. In all shoulders, the load during tendon reduction to footprint was measured, an endpoint was defined as maximum tendon lateralization before 50 N was reached, and the RT (load during lateralization to endpoint) of the native tendon (t1) was evaluated. In the intervention group, AIS (t2), PIS (t3), and CR (t4) were performed in order, with RT measurement after each step. In the control group, RT was assessed at the same time points without the intervention. Results: A complete reduction of the tendon was not achieved in any of the shoulders. Mean maximum lateralization was 6.7 ± 1.30 mm, with no significant differences between groups. In the intervention group, the overall IS procedure reduced RT about 47.0% (t1 vs t4: 38.7 ± 3.9 vs 20.5 ± 12.3 N; P < .001). AIS reduced RT significantly (t1 vs t2: 38.7 ± 3.9 vs 27.4 ± 10.5 N; P < .001), whereas subsequent PIS (t2 vs t3: 27.4 ± 10.5 vs 23.2 ± 12.4 N; P = .27) and CR (t3 vs t4: 23.2 ± 12.4 vs 20.5 ± 12.3 N; P = .655) did not additionally reduce tension. Comparison between groups at t4 revealed a reduction of RT of about 47.8% (control vs intervention: 39.3 ± 4.0 vs 20.5 ± 12.3 N; P < .001). Conclusion: The IS procedure reduces RT of the supraspinatus tendon in human cadaveric shoulders. However, performing PIS and CR subsequent to AIS does not reduce tension additionally. Clinical Relevance: These findings provide surgeons with a biomechanical rationale regarding the efficacy of the IS procedure.