bluuebunny/crossref_metadata_2025 huggingface dataset:
A Case Report on the Short-Term Recurrence of Low-Grade Fibromyxoid Sarcoma in the Maxillary Sinus
Authors: Zhao Dan , Dai Jian , Hu Yu , Wang Tao
Published: October 2024

Low-grade fibromyxoid sarcoma (LGFMS) represents an exceptionally rare soft-tissue tumor, challenging to diagnose, and notorious for relentless recurrence and proliferation postsurgical resection. Primary symptoms of LGFMS include nasal congestion and rhinorrhea, accompanied by cheek numbness and distension. In this article, we report the diagnosis and treatment of a case of low-grade LGFMS originating in the maxillary sinus (MS). A 64-year-old male diagnosed with LGFMS of the left MS, undergoing 3 surgeries over a 1-year period with subsequent local recurrence. Following inconclusive postoperative pathology after the initial surgery, the patient experienced recurrence 2 months postsurgery, necessitating a second operation, which confirmed the LGFMS diagnosis pathologically. Radiation therapy commenced 1 month after the second surgery; however, recurrence transpired 6 months later, leading to a third operation. Subsequently, recurrence occurred again 8 months post third surgery, with the patient currently undergoing targeted therapy. This case underscores the distinct characteristics and therapeutic challenges inherent in LGFMS through the narrative of diagnosis and progression of LGFMS originating in the MS.
Peripheral intravenous therapy infiltration and extravasation (PIVIE) risks in 11 006 paediatric surgery inpatients in China: a retrospective observational study
Authors: Huang WenJiao , Liu Zheng , Feng Liwei , Zhu Hong
Published: October 2024

Objective

To determine the risk factors associated with peripheral intravenous therapy infiltration and extravasation (PIVIE) in paediatric surgery inpatients.

Methods

This retrospective observational study was conducted at a tertiary general hospital in Sichuan, China. Logistic regression was employed to identify independent risk factors predictive of PIVIE. Kaplan–Meier survival analysis was undertaken to determine the relationship between the occurrence of PIVIE and the duration of that event (survival time).

Results

This study included 11 006 paediatric surgery inpatients and 19 771 peripheral intravenous catheters (PIVCs). The incidence of PIVIE was 16.93% (3347 of 19 771). The following were significant predictors of PIVIE: sex (odds ratio [OR] 0.834; 95% confidence interval [CI] 0.772, 0.900); age (OR 0.945; 95% CI, 0.934, 0.956); disease classification (OR 0.962, 95% CI 0.950, 0.976); puncture site (OR 1.061; 95% CI 1.044, 1.078); and indwelling time (OR 1.257; 95% CI 1.215, 1.300).

Conclusions

Sex, age, type of disease, puncture site and indwelling time were risk factors for PIVIE. The puncture site should be effectively assessed and accurately selected. Informed judgements should be based on the child’s sex, age and medical condition, so that the appropriate preventive measures to minimize the risk of PIVIE can be implemented.
A Technology-Based Intervention Impacts Quality of Life for Low-Income Older Adults by Reducing Loneliness and Improving Healthcare Self-Efficacy and Self-Rated Health
Authors: Richards T. Anne , Oman Doug , DiMartino Angela , Kotwal Ashwin A.
Published: October 2024

This paper describes a technology program aimed at developing technical skills and confidence, reducing social isolation and loneliness, and increasing healthcare self-management and self-efficacy among older adults. We conducted a mixed-methods study using surveys collected at baseline and 12 months from 90 older adults. Focus group data ( n = 7) collected at 12 months were examined for convergence with key quantitative outcomes, emergent value-related themes, and evaluation of program structure and staff. Outcome data showed improvements in loneliness (Cohen’s d = −0.24, p = .004) (validated by qualitative data), self-rated health (d = 0.23, p = .011), and healthcare self-efficacy (d = 0.31, p = .004). Participants with higher healthcare self-efficacy (β = 0.24, p = .03) and higher negative emotions (β = 0.28, p = .01) had greater frequency of internet use to search for health information. Qualitative findings described program mechanisms supporting increases in self-efficacy, including increased technology use and confidence, and values statements demonstrating the meaningfulness of learning technology and its impact on multiple domains of quality of life.
Sustainable development: A fourth paradigm for twenty-first century careers
Authors: Hartung Paul J , Di Fabio Annamaria
Published: October 2024

This contribution proposes a fourth paradigm for twenty-first century careers adopting a sustainable development framework. First the evolution of the career development field through three paradigms (individual differences, individual development, life design) of career science and practice is offered. Then sustainable development as a fourth paradigm is introduced considering two pillars, Sustainability Science including contributions from the psychology of sustainability and sustainable development, and Human Security Psychology. Enhancing the well-being of individuals and environments, the fourth paradigm asks for redefining sustainable careers, career intervention, and skills for career counselors. Decent work, decent lives and healthy lives issues are included.
Metabolic profiling of blood plasma in depression in pregnant women during early pregnancy
Authors: Yang Hui , Jia Shuqin , Guo Xunyi , Chen Jin , Zou Tao
Published: October 2024

Objective

The study aimed to perform metabolic profiling of serum samples using liquid chromatography with mass spectroscopy (LC-MS) and to explore potential biomarkers of early trimester depression.

Method

Using the Edinburgh Postnatal Depression Scale (EPDS), participants were randomly divided into study and control groups. Serum metabolic profiles of the two groups were analysed by using LC-MS. Differential metabolite and pathway analysis were identified by using orthogonal projections to latent structure-discriminant analysis (OPLS-DA) and Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analysis. Additionally, least absolute shrinkage and selection operator (LASSO) logistic and receiver operating characteristic (ROC) curve analyses were also conducted to explore potential biomarkers of antenatal depression (AD).

Results

The study included 41 participants, consisting of 16 subjects with AD and 25 controls. A total of 22 different metabolites were identified ( p < .005), mainly affecting glycerophospholipid metabolism, linoleic acid metabolism, synthesis and degradation of ketone bodies, phenylalanine metabolism, and butanoate metabolism. The area under the ROC curve (AUC) for the LysoPC (24:0) was 0.858. This suggests that LysoPC (24:0) may be a potentially effective predictor of risk factors for AD.

Conclusions

The study suggests that LysoPC (24:0) may be an effective and specific lipid biomarker for early trimester depression.
A Novel Self-Retentive Obturator to Facilitate Feeding in an Infant with Cleft Palate: A Case Report and Literature Review
Authors: Singh Deepak , GV Veena , Tripathi Tulika , Fatima Kaleem , Rai Priyank
Published: October 2024

Cleft lip and palate are common congenital defects with multifactorial complex etiology characterized by complete or incomplete cleft of lip, alveolus, and hard and soft palate. In infants, the main problem lies in the difficulty of suckling with frequent nasal regurgitation leading to respiratory and middle ear infections. This article presents a case report of an 8-day-old female with complete cleft of hard and soft palate who was given a novel self-retentive type feeding obturator. This obturator eliminated the need for supplementary aids to help in retention and has a simple design, is cost-effective, and easy to use.
Sarcomatoid Urothelial Carcinoma Arising in Autosomal Dominant Polycystic Kidney Disease: A Case Report and Literature Review
Authors: Bolous Yousef , Trpkov Kiril , Siadat Farshid , El Hallani Soufiane , Merrimen Jennifer , Wang Cheng
Published: October 2024

Autosomal dominant polycystic kidney disease (ADPKD) may be associated with various epithelial malignancies. The most reported ones are papillary renal cell carcinoma (RCC) and clear cell RCC. Only one noninvasive urothelial carcinoma arising in the renal pelvis has been previously reported in the setting of ADPKD in the English literature. A 52-year-old patient with ADPKD and a history of renal transplant presented with a poorly differentiated sarcomatoid neoplasm in his native left polycystic kidney. A recognizable urothelial or renal cell carcinoma differentiation was not identified in the resected neoplasm microscopically. The initial diagnosis for this specimen was challenging on morphology and immunohistochemistry, but targeted next-generation sequencing provided molecular evidence in support of urothelial origin, indicating a hotspot mutation −124 C > T in the TERT promoter (C228 T) and loss of heterozygosity on chromosomes 9p and 8p. This tumor is unique because, to our knowledge, this is the first report of upper tract sarcomatoid urothelial carcinoma in a patient with ADPKD.
The Role of Intrasexual Competition and the Big 5 in the Perpetration of Digital Dating Abuse
Authors: Bhogal Manpal Singh , Taylor Morgan
Published: October 2024

Recent research has examined digital dating abuse through an evolutionary lens, finding people who report intrasexual competitiveness engage in digital dating abuse. Here, we replicated this finding and extended the literature by examining the role of the Big Five personality traits in the perpetration of digital dating abuse, which, to our knowledge, has not been examined in relation to digital dating abuse ( n=280). This paper reports findings showing intrasexual competitiveness positively predicts the perpetration of digitaldating abuse; whereby high intrasexual competition is related to high levels of digital dating abuse. Agreeableness was a negative predictor of digital dating abuse; whereby high agreeableness was related to low perpetration of digital dating abuse. Our findings extend the literature exploring digital dating abuse through an evolutionary lens.
Circulating Levels of Vitamins A, C, and E-Alpha in Organ Donors After the Neurologic Determination of Death
Authors: Ream Robert S. , Li Yi , Marklin Gary F.
Published: October 2024

Introduction

The antioxidant effects of vitamins may attenuate the oxidative stress on organs imposed by ischemia–reperfusion injury during the process of organ transplantation from brain-dead donors. Circulating levels of vitamins A, C, and E-α in donors after brain death and their relationships to donor demographics, management, organ utilization, and recipient outcomes are largely unknown.

Methods

An observational, prospective, cohort study of 84 consecutive brain-dead organ donors managed at a single organ procurement recovery center was conducted. Vitamin levels were drawn immediately prior to procurement.

Results

Levels of serum vitamins A and E-α and plasma vitamin C were below normal in 80%, 85%, and 92% of donors and deficient in 40%, 62%, and 63%, respectively. Vitamin C deficiency was associated with a longer time between death and specimen collection ( P = .004). Death from head trauma and stroke were associated with lower levels of vitamin A than from anoxic causes ( P = .003) and smokers had greater vitamin C deficiency ( P = .03). During donor management, vitamin C deficiency was associated with longer vasopressor support ( P = .03) and normal levels of vitamin E-α were associated with reaching a lower alanine transferase compared to those with subnormal levels ( P < .05). Donors deficient in vitamin E-α were less likely to have a liver recovered for transplantation ( P = .005). Vitamin levels were not associated with the recipient outcomes examined.

Conclusion

Circulating vitamins A, C, and E-α is profoundly low in brain-dead organ donors, associated with relevant demographic features of the donor, and may influence donor management and organ utilization.
Tyrosine kinase inhibitors in patients with neuroendocrine neoplasms: a systematic literature review
Authors: Taboada Rodrigo G. , Cavalher Felicia P. , Rego Juliana F. , Riechelmann Rachel P.
Published: October 2024

Background:

Several tyrosine kinase receptors inhibitors (TKIs) have demonstrated antiproliferative effects in well-differentiated neuroendocrine tumors (NETs). We aimed to summarize and appraise the current evidence of the efficacy of TKIs in patients with different types of NETs.

Methods:

We performed a systematic review of clinical trials of TKIs in patients with advanced gastroenteropancreatic or lung NETs (PROSPERO registration number: CRD42024507379). Population characteristics, efficacy, and safety results were summarized by type of NET.

Results:

Twenty-eight studies were eligible, totaling 2284 patients. While sunitinib remains the only Food and Drug Administration-approved TKI in patients with NETs (for patients with pancreatic well-differentiated NETs), recent placebo-controlled randomized trials have demonstrated improved response rates and progression-free survival for patients with progressive and pre-treated well-differentiated pancreatic (cabozantinib or surufatinib) or gastrointestinal (GI) NETs (pazopanib, cabozantinib, or surufatinib). There is limited evidence to support the use of a TKI in patients with lung or grade 3 NETs. The toxicity associated with TKIs follows a class effect, with a significant proportion of patients experiencing fatigue, hypertension, and hand–foot skin reactions.

Conclusion:

TKIs are effective therapies in patients with pancreatic or GI well-differentiated NETs and should be part of the therapeutical sequencing of these patients.
Uptake of Dual Antiplatelet Therapy After High-Risk Transient Ischemic Attack at a University Hospital
Authors: Beyeler Morin , Bücke Philipp , Castigliego Pasquale , Baumann Joel , Ziegler Victor , Navi Babak B. , Jung Simon , Arnold Marcel , Liberman Ava L.
Published: October 2024

Multiple randomized controlled trials have demonstrated that dual antiplatelet therapy (DAPT) significantly reduces the risk of subsequent stroke as compared to aspirin monotherapy after high-risk transient ischemic attack (TIA) or minor ischemic stroke. We sought to evaluate the uptake of DAPT after high-risk TIA at a single center. We conducted a retrospective cohort study of consecutive TIA patients admitted via the Emergency Department (ED) of Bern University Hospital (1/1/2018-12/31/2019). We use descriptive statistics to detail cohort characteristics and compared patients treated with DAPT to those not treated. Statistical significance was set at α = 0.05 and all tests of comparison were two-sided. A total of 383 TIA patients were seen during the study period, 247 were eligible for DAPT. Among those eligible for DAPT, mean age was 72 years and 51% were female. A total of 49 (19.8%) eligible TIA patients were treated with DAPT; use of DAPT significantly increased from 2018 to 2019. Patients admitted to the stroke unit or intensive care unit (n = 33) had a significantly higher proportion of DAPT treatment as compared to those admitted to the general neurology ward or discharged to home from the ED. DAPT use was also significantly higher in patients with large artery atherosclerotic disease (n = 23) as compared to other etiological subtypes and significantly higher among patients who arrived to the ED within 24 h of symptom onset (n = 178). In conclusion, we found that only 2 out of every 10 high-risk TIA patients received DAPT in the years following its introduction in the clinical practice. Our results suggest that strategies to improve the uptake of new, evidence-based secondary stroke prevention treatment after high-risk TIA are needed.
Paper 38: Comparison of Clinical Outcomes and Return to Sport Rates Between Osteochondral Allograft Transplantation and Autologous Chondrocyte Implantation for Articular Cartilage Lesions in the Patellofemoral Joint
Authors: Triana Jairo , Hughes Andrew , Rao Naina , Li Zachary , Moore Michael , Garra Sharif , Strauss Eric , Campbell Kirk , Gonzalez-Lomas Guillem
Published: October 2024

Objectives:

The purpose of this study is to compare clinical outcomes and return to sport (RTS) rates between patients that undergo osteochondral allograft (OCA) transplantation and autologous chondrocyte implantation (ACI), or matrix-induced autologous chondrocyte implantation (MACI), for patellofemoral articular cartilage defects.

Methods:

A retrospective review of patients who underwent an OCA, ACI, and MACI from 2010 to 2020 with a minimum two-year follow-up was conducted. Patient-reported outcomes (PROs) collected included: Visual Analog Scale for pain and satisfaction, Knee Injury and Osteoarthritis Outcome Score (KOOS), and return to sport (RTS) status. Logistic regression controlling for age, sex, BMI, bone marrow edema, mechanism of injury, lesions size and location was used to identify predictors of worse outcomes.

Results:

A total of 95 patients with a mean age of 32.1 years (± 10.0) and mean BMI of 26.5 (± 5.9) were included. ACI or MACI was performed in 55 cases (57.9%) and OCA in 40 (42.1%). Satisfaction was not significantly different between groups. VAS pain scores were higher in the OCA group, but did not reach significance. Overall, KOOS pain was significantly poorer in the OCA group than the ACI/MACI group, while KOOS symptoms, KOOS sport, and KOOS QOL subscores were non-significantly different. Overall, RTS rate was 54.3.%, with no significant difference in return between OCA or ACI/MACI groups. Increasing age was associated with lower satisfaction in the OCA group and poorer outcomes in the ACI/MACI group, while larger lesion area was associated with lower satisfaction and poorer outcomes scores in the ACI/MACI group.

Conclusions:

Clinical outcomes and return to sport rates are similar in patients that undergo OCA or ACI/MACI for patellofemoral articular cartilage defects, except in measures of pain, where patients undergoing OCA may experience more symptoms, particularly in the setting of trochlear defects.
Poster 105: MRI Demonstrates Similar Diagnostic Value to MR Arthrogram for Determining Labral Tear Extent up to 2 Weeks Following Shoulder Dislocation
Authors: Cong Ting , Charles Shaquille , Greiner Justin , Cordle Andrew , Andrews Carol , Darwiche Sophie , Reddy Rajiv , Como Matthew , Drain Nicholas , Hughes Jonathan D , Lesniak Bryson , Lin Albert
Published: October 2024

Objectives:

The aim of this study was to determine the comparative accuracy and precision of routine Magnetic Resonance Imaging (MRI) versus magnetic resonance (MR) arthrogram in measuring labral tear size as function of time from shoulder dislocation, and to identify a time threshold after which MR arthrogram supersedes MRI in diagnostic utility.

Methods:

We retrospectively evaluated consecutive patients who underwent primary arthroscopic labral repair between 2012 and 2021 and completed a preoperative MRI or MR arthrogram of the shoulder within 60 days of injury, and subsequently underwent arthroscopic repair within 6 months of imaging. Arthroscopic labral tear size and location was used as standard comparison. Three musculoskeletal radiologists independently interpreted tear extent using clock-face convention. Accuracy and precision of MR labral tear measurements were defined by location and size of the tear, respectively. Accuracy and precision were compared between MRI and MR arthrogram, as a function of time from dislocation.

Results:

Thirty-two MRI and 65 MR arthrogram (total n=97) were independently assessed by radiologists. Multivariate analysis demonstrated that intraoperative tear size, early imaging, and arthrogram status were associated with increased MR accuracy and precision (p<0.05). Ordering surgeons preferred arthrogram for delayed imaging (p=0.018). For routine MRI, error in accuracy increased by 3.4° per day and error in precision increased by 2.3° per day (p<0.001) from time of injury. MR arthrogram, however, was not temporally influenced (Figure 1). Significant loss of accuracy and precision of routine MRI compared to MR arthrogram occurs at 2 weeks after acute shoulder dislocation.

Conclusions:

For determining shoulder labral tear size after acute dislocation, routine MRI has similar diagnostic value for measuring labral tear extent as MR arthrogram up to approximately 2 weeks postacute shoulder dislocation, after which it significantly loses accuracy and precision, possibly due to resolving posttraumatic effusion. MR arthrogram accuracy and precision were not temporally influenced.
Poster 314: Early Full Knee Extension Predicts Successful Return to Sport Following Anterior Cruciate Ligament Reconstruction
Authors: Drain Camila Grandberg Nicholas , Nazzal Ehab , Charles Shaquille , Steuer Fritz , Hughes Jonathan D , Musahl Volker , Lesniak Bryson
Published: October 2024

Objectives:

To identify predictive factors for successful return to sport (RTS) following anterior cruciate ligament reconstruction (ACL-R) with quadriceps tendon (QT) autograft.

Methods:

Data was retrospectively collected on consecutive patients who underwent ACL-R with QT autograft at a single institution between 2010-2020. Patient demographics, knee range of motion (ROM), injury characteristics, and intraoperative data were collected from the electronic medical record. Full RTS was defined as the patient returning to their prior level of sport and the presence of a clinical documentation of no further complications. Univariate and multivariate cox regression were utilized to conduct time-to-event analyses to identify predictors of early RTS clearance by surgeon. Additionally, both logistic regression analysis and generalized estimating equations were used to identify significant predictors of successful full RTS. STATA 16SE software was utilized for all analyses with statistical significance set to p < 0.05.

Results:

A total of 307 patients were included, consisting of 176 males (57.3%) and 131 females (42.7%), with an average of 20.7 ± 7.1 years of age and 14.5 ± 8.9 months follow-up. Ten patients (3.3%) were professional/semi-professional athletes, 38 (12.4%) were collegiate athletes, 144 (46.9%) were high school athletes (46.9%), and 115 (37.5%) were recreational athletes. Complete knee extension was achieved by 64.1% of patients at 6 weeks postoperatively, by 77.7% at 3 months, by 84.4% at 6 months, and by 84.7% at 1 year. Full knee extension at 3 (HR: 1.55, 95% CI: 1.13–2.12, p = 0.007) and 6 months (HR: 1.49, 95% CI: 1.05–2.12, p = 0.025) postoperatively were predictors of a higher rate of RTS clearance. Moreover, patients who achieved full knee extension at 3 months follow-up had a greater rate of RTS (1.02/person-years) compared to patients who did not achieve full knee extension at 3 months (0.83 per person-years). When considering RTS, only full knee extension at 4-6 weeks (OR:2.02, 95% CI:1.02–4.03, p = 0.045) and at 3 months (OR:2.36, 95% CI: 1.12–4.99, p = 0.024) postoperatively were predictive of successful RTS. No other significant predictors were identified.

Conclusions:

Restoration of full knee extension was strongly associated with higher rates of both surgeon clearance and successful RTS. The role of full knee extension in the ability to regain strength at 6 months, as measured by limb symmetry indices, after ACL-R has been previously described. While both ROM and strength play crucial roles in the rehabilitation process, achieving full ROM typically precedes restoration of full strength. Lack of full extension 3 months postoperatively may require further investigation and serves as a possible opportunity for a goal metric to maximize RTS rates and minimize complications after ACL-R.
Poster 349: Tobramycin-Soaked Grafts for the Prevention of Infection Following Anterior Cruciate Ligament Reconstruction: A Retrospective Review of Infection Rate
Authors: Flanigan David , Magnussen Robert , Kaeding Christopher , Stoodley Paul , Barker Tyler , Cavendish Parker , Milliron Eric , Burnett Zachary , Davis Madeleine
Published: October 2024

Objectives:

Infection can be a devastating complication of anterior cruciate ligament (ACL) reconstruction. Soaking or wrapping grafts in vancomycin solution has been adopted by many surgeons to prevent infection following ACL reconstruction. Recent meta-analysis demonstrated a significant reduction in the incidence of deep infection in vancomycin-soaked grafts to be 0.09% compared to 0.74% for nontreated grafts.1 Tobramycin may provide an alternative for patients with vancomycin allergies or if vancomycin is not available. The purpose of this study is to evaluate the incidence of deep and superficial infection following ACL reconstruction in young patients with tobramycin-soaked grafts as well as characterize potential risk factors for infection. We hypothesize that tobramycin-soaked grafts result in a low deep infection rate, comparable to that of vancomycin-soaked grafts published in the literature.

Methods:

A total of 812 consecutive patients under age 20 who underwent ACL reconstruction at an academic medical center between 2010 and 2020 with tobramycin-soaked grafts were identified. Retrospective chart review was performed to identify postsurgical superficial and deep wound infections, as well as other pertinent surgical characteristics. The incidence of infection in this tobramycin wrap cohort was compared to the incidence of infection of vancomycin wraps as published in the literature.

Results:

Superficial wound infections occurred in 24 patients (2.96%) and 0 deep joint infections were identified in the tobramycin wrap cohort. The incidence of infection was 3.16% in 728 patients who received prophylactic perioperative intravenous Cefazolin and 1.23% infection incidence in 81 patients who received prophylactic perioperative Clindamycin (p = 0.30). In addition, no significant difference in incidence of superficial infection was found with patient age, sex, body mass index, or graft type.

Conclusions:

 Tobramycin-soaked ACL grafts demonstrate a low infection risk comparable to that of vancomycin-soaked ACL grafts. The type of prophylactic IV antibiotic used in this young cohort did not impact the incidence of superficial wound infection. Further work with larger and older cohorts is needed to better characterize risk factors for postoperative infection following ACL reconstruction for all ages and comorbidities.
Poster 369: Medial and Lateral Posterior Tibial Slope in the Skeletally Immature: A Cadaveric Study
Authors: Okoro Sylvester , Taylor Vanessa , Troyer Stockton , Alayleh Amin , Ellis Henry , Yen Yi-Meng , Tompkins Marc , Ganley Ted , Shea Kevin
Published: October 2024

Objectives:

Increased knee posterior tibial slope (PTS) angle is risk factor for primary and secondary ACL injury. Adult biomechanical research indicates that decreasing the PTS may reduce ACL injuries, and osteotomy techniques have been developed to alter tibia slope to reduce risk of re-injury. Pediatric and adolescent athletes have the highest rates of primary and secondary ACL injury, and many in this age group may have abnormal PTS angle. The purpose of this study was to evaluate PTS in medial and lateral tibial plateaus in large database of CT scans, and to develop normative PTS data in this age group.

Methods:

IRB approval was waived, as the specimens were donated for research, no genetic information was collected, and there were no plans for family contact. 83 pediatric knee CT scans, ranging from ages 1 to 12, were analyzed using OsiriX imaging software. The PTS was evaluated at two distinct points on sagittal CT sections: (1) At the medial tibia plateau and 2) lateral tibial plateau, both aligned with the central part of on a coronal view of the medial femoral and lateral femoral condyles respectively condyle.

Results:

The average medial PTS angle was 6.56° ± 3.84° and 6.81° ± 3.62° for the lateral PTS. There was not a significant statistical difference between the medial and lateral PTS (P = 0.6632, determined using an independent-samples t-test and analysis of variance). When plotting the age versus PTS, we observed a positive correlation with the medial PTS (R2 = 0.0385) and a negative correlation with the lateral PTS (R2 = 0.0393).

Conclusions:

The data demonstrate variability in medial and lateral pediatric PTS and provides normative values for pediatric PTS values. For pediatric patients undergoing ACL surgeries, consideration of increased PTS values that are associated with higher rates of recurrent ACL injury may influence surgical treatment techniques. Correction of increased PTS to lower ACL injury risk is performed in adults with major corrective osteotomy surgery, but such procedures have not been performed in children due to osteotomy-induced damage to growth plates. Due to open growth plates, pediatric patients may be treated with minimally invasive guide growth procedures to lower PTS, with minimal complication risk. Guided growth procedures have a long history of successful alignment correction in the coronal plane. Future animal and clinic studies may also demonstrate the safety and effectiveness of guided growth sagittal plane correction as applied to increased PTS. PTS developmental anatomy and its relationship to ACL injury is crucial for surgical advancements, including the use of low risk guided growth interventions to reduce PTS and ACL injury in pediatric patients with high risk of recurrent injury.
Advancing Excellence in Transgender Health: An International Professional Development Conference on Affirming Care for Transgender and Gender Diverse People
Authors: Mitnick Sarah , Goldhammer Hilary , Thompson Julie , Bruno Jack , Dunn Mason , Reisner Sari L. , Keuroghlian Alex S.
Published: October 2024

OBJECTIVE

Increasing workforce capacity to provide knowledgeable, skilled, and affirming care for transgender and gender diverse people is critical to reduce health inequities; however, few clinicians receive sufficient training on this topic. This article describes Advancing Excellence in Transgender Health (AETH), an annual international conference that offers continuing professional development on evidence-based medical and behavioral healthcare for transgender and gender diverse people across the lifespan.

METHODS

Registration data and post-conference evaluation data were descriptively analyzed to assess conference reach, participant satisfaction, and participant intentions to change practice.

RESULTS

Between 2015 and 2022, AETH trained 2677 participants from all US states and 24 countries. Based on post-conference evaluations, 2017-2022, participant satisfaction was high (mean ≥4.4 on a 5-point scale) on all measures, including meeting learning objectives, quality of presentations, and relevance to practice. Participants reported intentions to: implement new information or skills (86.7%); create or revise protocols, policies, and/or procedures (63.2%); and seek additional information (64.2%). To increase equity, the conference waives fees for transgender and gender diverse participants and offers free online sessions. The conference also holds sessions specifically for transgender and gender diverse participants to promote opportunities for community-building, self-care, and professional networking.

CONCLUSION

The broad reach of AETH demonstrates a large demand for more continuing professional development on transgender and gender diverse healthcare. This conference has expanded the availability of training designed to increase and enhance clinical workforce capacity to meet the health needs of transgender and gender diverse communities in the US and across the world.
A systematic review examining outcomes of children following permanency placements
Authors: Longshaw Alexandra , Irvine Lynn Allardyce , Minnis Helen , Kainth Gary
Published: October 2024

Children in care have experienced adversities, including maltreatment prior to contact with the system, negatively impacting on their mental health outcomes. The type of placement and length of time in care are thought to be important and the child welfare system aim is to achieve a permanent decision for children that best supports their needs by establishing a stable familial network. Permanency decisions can include reunification, foster care, kinship care, adoption, and residential placements. This review aims to establish to what extent permanent placement type, maltreatment experienced, length of time in care and age at which permanency is achieved impacts child mental health outcomes. Following PRISMA guidelines, five databases (ASSIA, CINAHL, PsycINFO, Scopus and SocINDEX) and two registers (CENTRAL and TRoPHI) were systematically searched yielding six articles for inclusion in the study. Data were extracted and articles critically appraised utilising the Crowe Critical Appraisal Tool (CCAT). Papers reported mixed findings for permanent placement type and child mental health outcomes with little or no significant overall differences reported. Type of maltreatment experienced moderated the type of mental health symptomology reported. Difficulties in attachment and social relationships were reported for children placed older than two years, although confounding factors such as type of maltreatment likely reduce the strength of the association. Typically, children in permanent placements had better outcomes compared with peers in short-term or unstable placements. A lack of suitable validated and age-appropriate outcome measures and the existence of confounding factors impair our understanding of the interaction between pre-care adversities, the child welfare system itself and permanent placement outcomes.
Meta-analysis of genome-wide association studies of stable warfarin dose in patients of African ancestry
Authors: Asiimwe Innocent G. , Blockman Marc , Cavallari Larisa H. , Cohen Karen , Cupido Clint , Dandara Collet , Davis Brittney H. , Jacobson Barry , Johnson Julie A. , Lamorde Mohammed , Limdi Nita A. , Morgan Jennie , Mouton Johannes P. , Muyambo Sarudzai , Nakagaayi Doreen , Ndadza Arinao , Okello Emmy , Perera Minoli A. , Schapkaitz Elise , Sekaggya-Wiltshire Christine , Semakula Jerome R. , Tatz Gayle , Waitt Catriona , Yang Guang , Zhang Eunice J. , Jorgensen Andrea L. , Pirmohamed Munir
Published: October 2024

Warfarin dose requirements are highly variable because of clinical and genetic factors. Although genetic variants influencing warfarin dose have been identified in European and East Asian populations, more work is needed to identify African-specific genetic variants to help optimize warfarin dosing. We performed genome-wide association studies (GWASs) in 4 African cohorts from Uganda, South Africa, and Zimbabwe, totaling 989 warfarin-treated participants who reached stable dose and had international normalized ratios within therapeutic ranges. We also included 2 African American cohorts recruited by the International Warfarin Pharmacogenetics Consortium (n = 316) and the University of Alabama at Birmingham (n = 199). After the GWAS, we performed standard error-weighted meta-analyses and then conducted stepwise conditional analyses to account for known loci in chromosomes 10 and 16. The genome-wide significance threshold was set at P < 5 × 10−8. The meta-analysis, comprising 1504 participants, identified 242 significant SNPs across 3 genomic loci, with 99.6% of these located within known loci on chromosomes 10 (top SNP: rs58800757, P = 4.27 × 10−13) and 16 (top SNP: rs9925964, P = 9.97 × 10−16). Adjustment for the VKORC1 SNP -1639G>A revealed an additional locus on chromosome 2 (top SNPs rs116057875/rs115254730/rs115240773, P = 3.64 × 10−8), implicating the MALL gene, that could indirectly influence warfarin response through interactions with caveolin-1. In conclusion, we reaffirmed the importance of CYP2C9 and VKORC1 in influencing warfarin dose requirements, and identified a new locus (MALL), that still requires direct evidence of biological plausibility.
Noninvasive diagnostic modalities and prediction models for detecting pulmonary hypertension associated with interstitial lung disease: a narrative review
Authors: Arvanitaki Alexandra , Diller Gerhard Paul , Gatzoulis Michael A. , McCabe Colm , Price Laura C. , Wort S. John
Published: October 2024

Pulmonary hypertension (PH) is highly prevalent in patients with interstitial lung disease (ILD) and is associated with increased morbidity and mortality. Widely available noninvasive screening tools are warranted to identify patients at risk for PH, especially severe PH, that could be managed at expert centres. This review summarises current evidence on noninvasive diagnostic modalities and prediction models for the timely detection of PH in patients with ILD. It critically evaluates these approaches and discusses future perspectives in the field. A comprehensive literature search was carried out in PubMed and Scopus, identifying 39 articles that fulfilled inclusion criteria. There is currently no single noninvasive test capable of accurately detecting and diagnosing PH in ILD patients. Estimated right ventricular pressure (RVSP) on Doppler echocardiography remains the single most predictive factor of PH, with other indirect echocardiographic markers increasing its diagnostic accuracy. However, RVSP can be difficult to estimate in patients due to suboptimal views from extensive lung disease. The majority of existing composite scores, including variables obtained from chest computed tomography, pulmonary function tests and cardiopulmonary exercise tests, were derived from retrospective studies, whilst lacking validation in external cohorts. Only two available scores, one based on a stepwise echocardiographic approach and the other on functional parameters, predicted the presence of PH with sufficient accuracy and used a validation cohort. Although several methodological limitations prohibit their generalisability, their use may help physicians to detect PH earlier. Further research on the potential of artificial intelligence may guide a more tailored approach, for timely PH diagnosis.
Antibody-mediated protection against respiratory syncytial virus in children
Authors: Coindy Emma L. , Efstathiou Claudia , Talwar Shubha , Moureau Annick , Vernhes Charlotte , Openshaw Peter J.M. , Thwaites Ryan S.
Published: October 2024

Respiratory syncytial virus (RSV) is a major global pathogen, causing lower respiratory tract disease in at-risk populations including young children. Antibodies form a crucial layer of protection from RSV disease, particularly in immunologically naïve infants. Such antibodies are derived from the motherviatransplacental transfer and breast milk, but may be particularly low in high-risk infants such as those born preterm. Maternally derived antibodies can now be supplemented by the administration of anti-RSV monoclonal antibodies, while a rising wave of maternal and paediatric vaccine strategies are approaching. The implementation of these prophylactics may profoundly decrease the healthcare burden of RSV. In this article, we review the role of antibody-mediated immunity in protecting children from RSV. We focus on maternally derived antibodies as the main source of protection against RSV and study factors that influence the scale of this transfer. The role of passive and active prophylactic approaches in protecting infants against RSV are discussed and knowledge gaps in our understanding of antibody-mediated protection against RSV are identified.
Impaired lung function and associated risk factors in children born prematurely: a systematic review and meta-analysis
Authors: van Boven Menne R. , Hutten Gerard J. , Richardson Rianne , Königs Marsh , Leemhuis Aleid G. , Onland Wes , Terheggen-Lagro Suzanne W.J. , Oosterlaan Jaap , van Kaam Anton H.
Published: October 2024

Background

Immature lung development and respiratory morbidity place preterm-born children at high risk of long-term pulmonary sequelae. This systematic review and meta-analysis aims to quantify lung function in preterm-born children and identify risk factors for a compromised lung function.

Methods

We searched MEDLINE, Embase, Cochrane Library, Web of Science and Scopus for relevant studies published on preterm cohorts born since 1990. Studies comparing forced expiratory volume in 1 s (FEV1) in preterm-born children aged ≥5 years to term-born controls or normative data were included. Study quality was assessed using the Newcastle–Ottawa Scale for cohort studies. Standardised mean differences in FEV1and secondary spirometry outcomes per study were pooled using meta-analysis. The impact of different demographic and neonatal variables on studies’ FEV1effect sizes was investigated by meta-regression analyses. Certainty of evidence was assessed using the Grading of Recommendations, Assessment, Development, and Evaluations framework.

Results

We identified 42 studies with unique cohorts including 4743 preterm children and 9843 controls. Median gestational age in the studies was 28.0 weeks and age at assessment ranged from 6.7 to 16.7 years. Preterm children had lower FEV1than controls (−0.58sd, 95% CI −0.69– −0.47sd, p<0.001) resulting in a relative risk of 2.9 (95% CI 2.4–3.4) for abnormal outcome, with high certainty of evidence. FEV1was significantly associated with gestational age, birthweight, bronchopulmonary dysplasia and invasive mechanical ventilation in univariate meta-regression analyses (R2=36–96%).

Conclusion

This systematic review shows robust evidence of impaired lung function in preterm-born children with a high certainty of evidence.
Migration of cervical spine screws to the sacral canal: a case report
Authors: Fang Miao , Zeng Yong , Song Yueming
Published: October 2024

Cervical open door laminoplasty is widely used in multilevel decompression, which is a motion-sparing decompression treatment option for multilevel cervical myelopathy. Implant distance migration in cervical laminoplasty has not been reported. A 61-year-old woman underwent cervical laminoplasty, three months postoperatively, she experienced left shoulder pain and left upper limb pain, and underwent cervical magnetic resonance imaging, which showed no abnormalities. She gradually developed dizziness, headache, unstable walking, incomplete urinary incontinence, and fluctuating neck lumps. The X-ray showed that the screws of the C7 lateral mass had disappeared and migrated to the sacral canal. The patient underwent cerebrospinal leakage repair and removal of the screws in the spinal canal. Displacement of fixators implanted into the spinal canal after cervical laminoplasty is a rare complication that can cause permanent neurological injury.
2q31 microdeletion syndrome with the velocardiofacial phenotype and review of the literature: a case report
Authors: Candelo Estephania , Giraldo-Ocampo Sebastian , Nevado Julian , Lapunzina Pablo , Pachajoa Harry
Published: October 2024

Background

The 2q31 deletion results in a distinct phenotype characterized by varying degrees of developmental delay, short stature, facial dysmorphism, and variable limb defects. Dysmorphic features include microcephaly, downslanting palpebral fissures, a long and flat philtrum, micrognathia, and dysplastic, low-set ears. To date, comparative genomic hybridization has identified this deletion in 38 patients. Consequently, additional patients with comprehensive clinical data are required to fully understand the spectrum of clinical manifestation associated with a deletion in the 2q31 cytoband.

Case presentation

We present the case of an 8-year-old female patient with clinical features of velocardiofacial syndrome, which include facial dysmorphism, congenital heart disease (persistent truncus arteriosus and ostium secundum-type atrial septal defect), and a seizure syndrome. Array comparative genomic hybridization revealed a non-continous deletion spanning cytobands 2q31.1-to 2q31.3, confirming a diagnosis of 2q31 microdeletion syndrome. The patient has undergone supportive therapies for swallowing and speech. Additionally, we provide a review of the literature on previous cases to give context.

Conclusion

In this report, we present the first documented case of a complex, discontinuous deletion spanning in the 2q31-2q32 regions. This case contributes to our understanding of the phenotypic and mutational spectrum observed in individuals with deletions in these cytobands. It underscores the significance of employing high-resolution techniques and comprenhensive analysis in diagnosing patients with complex phenotypes. Such approaches are crucial for differentiating this condition from more common microdeletion syndromes, such as the 22q11 deletion syndrome.
Donor age over 55 is associated with worse outcome in lung transplant recipients with idiopathic pulmonary fibrosis
Authors: Moneke Isabelle , Ogutur Ecem Deniz , Kornyeva Anastasiya , Fähndrich Sebastian , Schibilsky David , Bierbaum Sibylle , Czerny Martin , Stolz Daiana , Passlick Bernward , Jungraithmayr Wolfgang , Frye Bjoern Christian
Published: October 2024

Background

Lung transplantation (LTx) remains the only efficient treatment for selected patients with end-stage pulmonary disease. The age limit for the acceptance of donor organs in LTx is still a matter of debate. We here analyze the impact of donor organ age and the underlying pulmonary disease on short- and long-term outcome and survival after LTx.

Methods

Donor and recipient characteristics of LTx recipients at our institution between 03/2003 and 12/2021 were analyzed. Statistical analysis was performed using SPSS and GraphPad software.

Results

In 230 patients analyzed, donor age ≥ 55 years was associated with a higher incidence of severe primary graft dysfunction (PGD2/3) (46% vs. 31%, p = 0.03) and reduced long-term survival after LTx (1-, 5- and 10-year survival: 75%, 54%, 37% vs. 84%, 76%, 69%, p = 0.006). Notably, this was only significant in recipients with idiopathic pulmonary fibrosis (IPF) (PGD: 65%, vs. 37%, p = 0.016; 1-, 5-, and 10-year survival: 62%, 38%, 16% vs. 80%, 76%, 70%, p = 0.0002 respectively). In patients with chronic obstructive pulmonary disease (COPD), donor age had no impact on the incidence of PGD2/3 or survival (21% vs. 27%, p = 0.60 and 68% vs. 72%; p = 0.90 respectively). Moreover, we found higher Torque-teno virus (TTV)-DNA levels after LTx in patients with IPF compared to COPD (X2 = 4.57, p = 0.033). Donor age ≥ 55 is an independent risk factor for reduced survival in the whole cohort and patients with IPF specifically.

Conclusions

In recipients with IPF, donor organ age ≥ 55 years was associated with a higher incidence of PGD2/3 and reduced survival after LTx. The underlying pulmonary disease may thus be a relevant factor for postoperative graft function and survival.

Trial registration number DKRS

DRKS00033312.