bluuebunny/crossref_metadata_2025 huggingface dataset:
Alternative Life Cycle Impact Assessment Methods for Biodiversity Footprinting Could Motivate Different Strategic Priorities: A Case Study for a Dutch Dairy Multinational
Authors: Martínez‐Ramón Valentina , Bromwich Talitha , Modernel Pablo , Poore Joseph , Bull Joe W.
Published: December 2024

The private sector is increasingly engaged in formulating biodiversity strategies that aim to achieve net‐positive outcomes. Life cycle impact assessment (LCIA) methodologies are a leading approach for quantifying ‘biodiversity footprints’, providing baselines for biodiversity mitigation strategies. However, differences between existing LCIA methods remain understudied in this context. Using a large agricultural organisation case study, we compared biodiversity footprints from two LCIA methodologies: LC‐IMPACT and ReCiPe2016. Results varied considerably, with LC‐IMPACT attributing the largest impacts to international land use change from imported livestock feeds and ReCiPe2016 highlighting the impacts from imported feeds related to other pathways, such as water use, alongside on‐farm GHG emissions. These differences suggest that using different methodologies could lead to substantially different corporate biodiversity strategies and sub‐optimal prioritisation. To design effective biodiversity strategies, corporations must address uncertainties in biodiversity footprinting methods, and further research is needed to ensure these methodologies drive effective action to combat global biodiversity loss.
Assessment of publication time in Campbell Systematic Reviews: A cross‐sectional survey
Authors: Pan Bei , Ge Long , Wang Xiaoman , Ma Ning , Wei Zhipeng , Honghao Lai , Hou Liangying , Yang Kehu
Published: December 2024

Delayed publication of systematic reviews increases the risk of presenting outdated data. To date, no studies have examined the time and review process from title registration and protocol publication to the final publication of Campbell systematic reviews. This study aims to examine the publication time from protocol to full review publication and the time gap between database searches and full review publication for Campbell systematic reviews. All Campbell systematic reviews in their first published version were included. We searched the Campbell systematic review journals on the Wiley Online Library website to identify all completed studies to date. We manually searched the table of contents of all Campbell systematic reviews to obtain the date of title registration from the journal's website. We used SPSS software to perform the statistical analysis. We used descriptive statistics to report publication times which were calculated stratified by characteristics, including year of review publication, type of reviews, number of authors, difference in authors between protocol and review, and Campbell Review Groups. Non‐normal distributed data were reported as medians, interquartile range, and range, and normal distributed data will be reported as mean ± standard deviation. And we also visualized the overall publication time and the distribution of data. Approximately 18% of reviews were published within one to 2 years, faster than the aims set by Campbell systematic review policies and guidelines, which was 2 years. However, more than 40% of the reviews were published more than 2 years after protocol publication. Furthermore, over 50% of included reviews were published with a time gap of more than 2 years after database searches. There was no significant difference between Campbell coordinating groups' median publication times and time gap from searches of databases to full review publication existed. However, the methods group only published one full review with almost a 3‐year time gap from searches of databases to review publication. And there was a major difference between specific types of review. Systematic reviews had the longest median publication time of 2.4 years, whereas evidence and gap maps had the lowest median publication time of 13 months. Half of Campbell reviews were published more than 2 years after protocol publication. Furthermore, the median time from protocol publication to review publication varied widely depending on the specific type of review.
Enhancing Implant Position Accuracy in Guided Implantology: The Role of Drill Play Under Lateral Forces
Authors: Alevizakos Vasilios , Stryga Yannick , von See Constantin
Published: December 2024

Objectives

This study investigates the impact of drill play on the precision of implant positioning under lateral forces in guided implantology.

Materials and Methods

An in vitro experiment was conducted using artificial bone blocks and the SIC Invent‐guided surgery implant system. Custom drill guides were designed, and 3D‐printed, using three sleeve types: sleeveless, a big sleeve, and a small sleeve. Drillings were performed with varying lateral forces, and deviations in angle, depth, and position were measured.

Results

Sleeveless guides showed the highest variability in deviations, with a maximum deviation of 3.92 mm under extreme lateral forces. Big sleeve guides provided the most consistent precision, with deviations ranging from 0.42 to 1.33 mm. Small sleeve guides showed moderate precision, with deviations from 0.14 to 2.17 mm. Higher lateral forces generally increased deviations across all guide types.

Conclusions

Drill play significantly affects the precision of guided implant drilling, with lateral forces causing deviations from the planned implant position. Big sleeve guides offer better precision under lateral loads compared to sleeveless and small sleeve guides. Strict adherence to the drilling protocol is essential to minimize errors and ensure optimal implant positioning.
Modulation of Ti3C2Tx interlayer spacing and functional groups by Lewis‐basic halides and their effects on Li+ storage properties
Authors: Li Xuke , Guan Keke , Ding Lixiang , Wang Xinyue , Zhang Haijun , Deng Yaping , Lei Wen
Published: December 2024

Surface and interfacial chemistry play a vital role in shaping the properties of two‐dimensional transition metal carbides and nitrides (MXenes). This study focuses on utilizing Lewis‐basic halides (LiCl/KCl) for thermal treatment of multilayered Ti3C2Tx, leading to the simultaneous modulation of interlayer spacing and surface functional groups. Compared to the pristine Ti3C2Tx, the LiCl/KCl treated sample (heating temperature: 450°C, denoted as LK‐Ti3C2Tx‐450) showcases a remarkable increase in the interlayer spacing and synergistic optimization of the functional groups. These modifications endow LK‐Ti3C2Tx‐450 with enhanced electrochemical properties, rendering it as a promising anode candidate for lithium‐ion batteries. The increased interlayer spacing is particularly advantageous, as it facilitates efficient and rapid Li+ diffusion, a vital factor in enhancing the performance of energy storage devices.
Density, Climate, and Stochasticity Shape Four Centuries of Population Dynamics for Two Long‐Lived Tree Species
Authors: Waddle Ellen , Lesser Mark R. , Steenbock Christopher , Doak Daniel F.
Published: December 2024

The dynamics of colonizing populations may be strongly influenced by both extrinsic (e.g., climate and competition) and intrinsic (e.g., density) forces as well as demographic and environmental stochasticity. Understanding the impacts of these effects is crucial for predicting range expansions, trailing edge dynamics, and the viability of rare species, but the general importance of each of these forces remains unclear. Here, we assemble establishment time and spatial locations of most individuals that have reached maturity in six isolated, establishing populations of two pine species. These data allow us to quantify the relative importance of multiple factors in controlling growth of these populations. We found that climate, density, site, and demographic stochasticity were of varying importance both within and across species, but that no driver appeared to dominate dynamics across all populations and time periods. Indeed, exclusion of any one of these effects greatly reduced predictive power of our population growth models. Given the similarity in the abiotic characteristics of these sites, the varying importance of these classes of effects was surprising but speaks to the need to consider multiple effects when predicting the dynamics of small and colonizing populations.
Potential for Lowering Greenhouse Gas Emissions With the Addition of Hydrogen or Ammonia to Different Natural Gas Compositions—Application in Internal Combustion Engines
Authors: Ingo Christina , Tuuf Jessica , Björklund‐Sänkiaho Margareta
Published: December 2024

Internal combustion engines (ICEs) can be used in power plants to ensure flexibility in electricity generation. The use of carbon‐free fuels, such as hydrogen and ammonia, in ICEs is a way to decrease greenhouse gas emissions gradually until new carbon‐neutral technology has been fully implemented. By mixing small amounts of these compounds into natural gas (NG), the gas quality requirements can still be achieved and the modification work on the engine can be minimized. In this study, the CO2eq emission intensity was calculated for different NG compositions blended with hydrogen or ammonia while the mixture was within the gas quality specifications. The results showed that the addition of ammonia reduces the CO2eq emission intensity more than hydrogen and that the reduction depends on the NG quality. By utilizing H2‐NG and NH3‐NG mixtures as fuels in ICEs, the emissions can be reduced by 37%–44% and 3%–8%, respectively, compared to engines running on diesel oil or natural gas. The novelty of this study is to demonstrate the potential of cutting GHG emissions in power production using ICEs, new fuel blends, and fulfilling existing fuel requirements agreed on for engines.
Effect of Indenter Angle on Bearing Performance of Coal and Accompanying Rocks Under Point Load and Characterization of Mechanical Parameters
Authors: Wang Qian , Zhang Yujiang , Cui Delong , Feng Guorui , Du Yunlou , Zhang Shuai , Cheng Haojie , Zhang Zhengjun
Published: December 2024

Coal, mudstone, sandstone, and limestone, which are common in coal mines, were selected as research objects, and 60°, 90°, and 120° indenters were used to conduct point load tests to study the deformation and failure laws of rocks under point loads. This study identified a process for generating and crushing compacted bodies. As the indenter angle increased, the number of compacted bodies formed decreased significantly, and the stress drop decreased. The ultimate invasion depth upon reaching the failure load decreased as a quadratic function as the indenter angle increased. Under the load of indenter points at different angles, all samples underwent splitting failure along the loading axis. As the indenter angle increased, the indentation diameter increased quadratically. The angle of the indenter had a greater influence on the indentation diameter of low‐strength rocks, and the failure of coal and accompanying rocks was more stable under the action of large‐angle indenters. The point load test data were statistically analyzed. The load intensity of the indenter point at different angles exhibited a linear relationship with the uniaxial compressive strength, tensile strength, and elastic modulus, and the fitting degree was the best when the indenter angle was 120°
Nutritional and Anti‐Nutritional Properties of Extruded Puffed Snack Produced From Pearl Millet and Bambara Groundnut Flour Blends
Authors: Ajala Oladapo , Adelusi Oluwasola Abayomi , Kajihausa Olatundun Esther , Onabanjo Oluseye Olusegun , Bandele Oyewole Olusola , Obadina Adewale Olusegun
Published: December 2024

This study investigates the nutritional and anti‐nutrient profiles of extrudates produced from seven formulations of pearl millet and Bambara groundnut flour in seven different ratios: 20:80, 30:70, 40:60, 50:50, 60:40, 70:30, and 80:20, with 100% pearl millet and 100% Bambara groundnut extrudates used as controls. The extrudates were processed using a twin screw extruder and analyzed for their nutritional and anti‐nutritional properties. The findings revealed a rising pattern in the content of fiber, moisture, protein, ash and fat as the substitution of Bambara groundnut increased in the extrudate. Conversely, the level of carbohydrates decreased with increased inclusion of Bambara groundnut. Our results also indicated a significant difference in the mineral composition of the pearl Millet‐Bambara groundnut extrudates, except for manganese. The values for calcium, iron, magnesium, phosphorus, sodium, copper, manganese, and potassium ranged from 38.43–67.97, 3.60–5.10, 39.64–64.65, 290.84–413.15, 10.60–21.76, 0.10–0.24, ND—0.08, and 21.51–70.45 mg/100 g, respectively. Notably, the calcium, sodium, and potassium levels in the snacks rose with higher proportions of Bambara groundnut in the extrudates. Conversely, the concentrations of iron, magnesium, phosphorus, and copper in the samples decreased as the percentage of Bambara groundnut in the formulation increased. However, the mineral levels recorded did not exceed the recommended daily intake, assuring no negative health effects upon consumption. Furthermore, the anti‐nutrient content, including trypsin inhibitor, phytate, and tannin, increased with the addition of Bambara groundnut flour, while the phenolic content decreased with increasing Bambara groundnut substitution. Overall, this study provides valuable insights for the development of nutritious snacks using locally available grains.
Comprehensive multi‐tissue epigenome atlas in sheep: A resource for complex traits, domestication, and breeding
Authors: Zhang Deyin , Cheng Jiangbo , Li Xiaolong , Huang Kai , Yuan Lvfeng , Zhao Yuan , Xu Dan , Zhang Yukun , Zhao Liming , Yang Xiaobin , Ma Zongwu , Xu Quanzhong , Li Chong , Wang Xiaojuan , Zheng Chen , Tang Defu , Nian Fang , Yue Xiangpeng , Li Wanhong , Tian Huibin , Weng Xiuxiu , Hu Peng , Feng Yuanqing , Kalds Peter , Jiang Zhihua , Zhao Yunxia , Zhang Xiaoxue , Li Fadi , Wang Weimin
Published: December 2024

Comprehensive functional genome annotation is crucial to elucidate the molecular mechanisms of agronomic traits in livestock, yet systematic functional annotation of the sheep genome is lacking. Here, we generated 92 transcriptomic and epigenomic data sets from nine major tissues, along with whole‐genome data from 2357 individuals across 29 breeds worldwide, and 4006 phenotypic data related to tail fat weight. We constructed the first multi‐tissue epigenome atlas in terms of functional elements, chromatin states, and their functions and explored the utility of the functional elements in interpreting phenotypic variation during sheep domestication and improvement. Particularly, we identified a total of 753,723 nonredundant functional elements, with over 60% being novel. We found tissue‐specific promoters and enhancers related to sensory abilities and immune response that were highly enriched in genomic regions influenced by domestication, while longissimus dorsi tissue‐specific active enhancers and tail fat tissue‐specific active promoters were highly enriched in genomic regions influenced by breeding and improvement. Notably, a variant, Chr13:51760995A>C, located in an enhancer region, was identified as a causal variant for tail fat deposition based on multi‐layered data sets. Overall, this research provides foundational resources and a successful case for future investigations of complex traits in sheep through the integration of multi‐omics data sets.
Digital Imaging of Peripheral Blood Smear With MC‐80 as a Screening Tool for Thalassemia
Authors: Chokchaipermpoonphol Peempol , Lamtanthong Satana , Nokkaew Sathaporn
Published: December 2024

Background

Thalassemia, a genetic blood disorder, poses significant global health challenges, emphasizing the importance of accurate screening methods. Traditional diagnostic tools, such as osmotic fragility and dichlorophenolindophenol tests, along with blood indices, such as mean corpuscular volume and mean corpuscular hemoglobin, have limitations. Digital microscopy of peripheral blood smears is a promising alternative for objective quantification and standardization.

Methods

Blood samples from 81 thalassemia screening‐negative and 41 screening‐positive individuals were analyzed using Mindray MC‐80 Digital Morphology.

Results

Pre‐classification of red blood cell (RBC) morphology using Mindray MC‐80 revealed significant differences between the screening‐positive and screening‐negative groups. Various RBC morphologies demonstrated statistically significant variance, including hypochromic cells, schistocytes, elliptocytes, target cells, teardrop cells (p < 0.001), and ovalocytes (p = 0.002). However, the area under the receiver operating characteristic curve of these parameters was < 0.8, indicating a limited discriminatory power.

Conclusion

RBC morphology showed promise in detecting subtle changes associated with thalassemia. However, it may not be sufficient for accurate screening alone, highlighting the need for complementary diagnostic approaches.
A novel minimally invasive nonanatomical single‐bundle medial collateral ligament reconstruction technique with a short isometric construct Achilles tendon allograft: A surgical description with clinical and radiological outcomes in multiligament knee injury patients
Authors: Minator Sajjadi Mohammadreza , Mirahmadi Alireza , Alizad Vahid , Dabis Mohammedhasan , Saeidi Ali , Movahedinia Mohammad
Published: December 2024

Purpose

Multiligament knee injuries (MLKIs) involve various ligaments in the knee. Current double‐bundle anatomical reconstructions of the medial collateral ligament (MCL) increase the level of technical complexity, often resulting in the establishment of numerous bone tunnels and different fixation points with additional hardware. To overcome these limitations, we proposed a novel minimally invasive nonanatomical MCL reconstruction with one tibial tunnel in the metaphysis using Achilles allograft in the MLKI setting.

Methods

In a retrospective study, we enroled 24 patients with MLKIs who underwent a new single‐strand short isometric construct (SIC) nonanatomical MCL reconstruction during 2020 and 2021. We fixed an Achilles allograft in one tunnel in the distal femur on the medial epicondyle and one tunnel in the metaphyseal part of the tibia using interference screws at 2 cm below the joint line between the anatomical insertion of the superficial MCL and the posterior oblique ligament. The patients underwent clinical and radiological assessment at the last follow‐up, 1–2 years after the operation, including valgus stress radiographs, range of motion (ROM), Lysholm and International Knee Documentation Committee (IKDC) scores.

Results

The mean postoperative IKDC score was 77.8 (range, 50.1–86.6). The mean Lysholm score was 84.1 ± 11.9 (range, 96–59). The medial knee widening difference (i.e., mean side‐to‐side difference under valgus stress x‐ray) was measured to be 1.2 mm on average. Only two patients (8%) had ROM limitation of 20° in knee flexion, one of which had surgery failure. Results showed a significant statistical difference between the patients' outcomes according to the number of involved ligaments.

Conclusions

This novel SIC‐like technique with a single tibial metaphyseal tunnel demonstrated satisfactory patient‐reported outcome measures, valgus stress radiographs, ROM and a low rate of knee stiffness and graft failure. While the number of injured ligaments in MLKI patients significantly influenced the outcomes, the results remained acceptable across all patients.

Level of Evidence

Level IV.
Three‐dimensional computerized tomography reconstruction‐based morphologic assessment of the coracoid process in an Asian population: Clinical implications for shoulder surgery
Authors: Ji Tongyue , Yan Su , Lu Chao , Shu Hao , Sun Luning
Published: December 2024

Purpose

To assess coracoid process morphology in an Asian population using three‐dimensional (3D) computed tomography (CT) reconstruction and provide reference values for surgical treatment.

Methods

Data on demographic and shoulder CT characteristics were collected from 142 patients for 3D‐CT‐based scapular reconstruction. Ten coracoid morphological indicators and the glenoid width were measured. The morphology of the superior pillar and its undersurface were classified into common shapes. Statistical analyses included intraclass correlation coefficient (ICC) analysis, Cohen's κ value, independent samples t test, Welch's t test, Mann–Whitney U test, Kruskal–Wallis test, Spearman and Pearson correlations, receiver operating characteristic (ROC) curves and area under the curve (AUC) values. Relationships among the measured indicators, patient demographics (i.e., sex, age, height and weight) and superior pillar morphology were ascertained.

Results

The intraobserver and interobserver ICC values were 0.924–0.980 and 0.906–0.962, respectively. For intraobserver and interobserver agreement, Cohen's κ values were 0.927–0.950 and 0.901–0.937, respectively. Significant sex differences in coracoid measurements were noted. Correlations were observed between the coracoid indicators and glenoid width, sex, height and weight (p < 0.05). ROC curve analysis identified height as a significant predictor of safe distance, with cutoff values of 160.5 and 170.5 cm (AUC = 0.82 and 0.83) for women and men, respectively. The superior pillar morphologies included violin (24.65%), long rod (21.13%), short rod (33.80%), trapezoidal (11.97%) and wedge (8.45%) shapes, with the undersurfaces categorized as straight (16.20%), arched (76.76%) and hooked (7.04%), with significant differences in pillar widths among the different morphological types (p < 0.05).

Conclusion

Coracoid morphology is crucial in the preoperative planning of given shoulder surgeries, with height and sex serving as key predictors of coracoid graft length. Consideration of variations in the superior pillar shape and undersurface of the coracoid could minimize surgical complications associated with special shoulder surgery.

Level of Evidence

Level IV case series with no comparison.
Optimizing learners on direct care teaching services: A qualitative study of hospitalist clinicians at 26 sites
Authors: Callister Catherine , Astik Gopi , Atkins R. Matthew , Alday Angela , Dayton Khooshbu , Keniston Angela , Linker Anne , McBeth Lauren , Merriman John , Westergaard Sara , Yu Amy , Auerbach Andrew , Burden Marisha
Published: December 2024

Background

Academic medical centers are experiencing rapid clinical growth which has outpaced traditional teaching services. Learners such as medical students, advanced practice provider fellows, and residents may be placed onto direct care teaching services (i.e., inpatient services where attendings provide both direct care to patients and supervise learners) creating potential challenges for attending physicians due to clinical demands.

Objective

Characterize the hospitalist experience with direct care teaching services.

Methods

Embedded mixed methods study with a 16‐question survey and semistructured focus groups using rapid qualitative methods.

Setting and participants

Virtual focus groups in the Hospital Medicine Reengineering Network (HOMERuN). Main Outcome and measures: Qualitative themes.

Results

Thirty‐eight hospitalist clinicians from 26 hospital systems across five geographic regions participated in the focus groups. Thirty‐four (89%) of participants responded to the survey and were predominantly physicians (97%). Most participants preferred traditional teaching services compared with direct care teaching services with 82% replying somewhat or to a great extent. Thematic analysis identified three themes: (1) Hospitalists prefer traditional teaching services in part due to a time and workload mismatch in direct care teaching services; (2) Adaptations can support attending physicians in direct care teaching services such as adjusting workloads based on the level of learners; and (3) Direct care teaching services were perceived to serve an important role by providing direct and personalized teaching, and offering teaching opportunities.

Conclusion

Direct care teaching services pose challenges given clinical workloads, time constraints for educational activities. Addressing these challenges may make these types of services more sustainable.
Association between ventricular arrhythmia (premature ventricular contractions burden and nonsustained ventricular tachycardia) and cardiovascular events in patients without structural heart disease
Authors: Ogiso Sho , Arita Takuto , Suzuki Shinya , Hirota Naomi , Yagi Naoharu , Otsuka Takayuki , Kishi Mikio , Kano Hiroto , Matsuno Shunsuke , Kato Yuko , Uejima Tokuhisa , Oikawa Yuji , Ako Junya , Yajima Junji , Yamashita Takeshi
Published: December 2024

Background

Premature ventricular contractions (PVCs) and nonsustained ventricular tachycardia (NSVT) are common arrhythmias in cardiovascular clinical settings. However, the clinical significance of PVCs and NSVT in the absence of structural heart disease has not yet been fully elucidated. This study aimed to evaluate the association between PVCs, NSVT, and clinical outcomes.

Methods

A study population of 26,117 patients was drawn from the Shinken Database established in June 2004. We enrolled 6332 patients without structural heart disease who underwent 24‐h Holter monitoring and were registered up to March 2019. We focused on ventricular arrhythmias and cardiovascular events in patients without structural heart diseases. The study population was divided by the number of baseline PVCs (PVCs: <1000 (n = 5507), 1000–9999 (n = 531), and 10 000 ≤(n = 294)). The study population was also divided according to the presence or absence of NSVT (n = 454 and n = 5878, respectively).

Result

During the follow‐up period up to 3 years, there were 16 deaths, 24 heart failure‐related hospitalizations, 14 acute coronary syndromes, and 37 embolism events. The frequency of PVCs was not associated with mortality or heart failure. On the other hand, the presence of NSVT was significantly associated with heart failure hospitalization in a multivariate model (hazard ratio: 3.02; 95% CI: 1.03–8.83; p = .044).

Conclusion

In patients without structural heart disease, NSVT was associated with a higher risk of heart failure hospitalization. Patients with NSVT but no structural heart diseases require careful follow‐up and management of heart failure risk factors.
The Role of Pulmonary Metastasectomy for Non‐Primary Lung Cancer: Umbrella Review of Meta‐Analyses
Authors: Woo Wongi , Park Brandon , Ahadi Awranoos , Chung Liam il‐young , Jung Chan Mi , Bharat Ankit , Chae Young Kwang
Published: December 2024

Background and Objectives

Due to heterogeneous characteristics of primary cancers, the efficacy of pulmonary metastasectomy (PM) in nonprimary lung cancers has not been investigated. This study aims to investigate the clinical outcomes of PM for non‐primary lung cancer.

Methods

A systematic search for meta‐analyses on PM for nonprimary lung cancers was conducted, encompassing publications up to January 3, 2024. This included seven primary cancers: renal cell, breast, adrenocortical, head and neck cancers, melanoma, germ cell tumors, and sarcoma. Overall survival and recurrence rates post‐PM were assessed using random‐effect models.

Results

This study included 16 systematic‐review articles and 101 individual studies, involving 10 277 patients who underwent PM for nonprimary lung cancer. About half of the patients (47.1%) presented with multiple metastasis, and complete resection achieved in 87.2% [95% CI: 83.0–90.8]. The pooled 5‐year overall survival rate post‐PM was 41.2% [95%CI: 37.1%–45.4%]. Patients with germ cell tumors demonstrated higher survival rate (p < 0.05), while melanoma exhibited the worst outcome (p < 0.05). During follow‐up, 57.6% [95% CI: 46.4–68.1] had recurrence; 48% of them had intrathoracic‐only recurrence.

Conclusion

This study underscores the survival benefits associated with PM. Overall survival rates following PM did not differ based on primary cancer types. These findings highlight the importance of recognizing and incorporating PM into clinical practice when appropriate.
De‐Escalating Surgery in Merkel Cell Carcinoma With Clinical Nodal Disease
Authors: Shafique Neha , Ertmann Emily , Tortorello Gabriella N. , Sharon Cimarron E. , Karakousis Giorgos C. , Miura John T.
Published: December 2024

Background

Merkel cell carcinoma (MCC) is a radiosensitive aggressive skin cancer that spreads via the lymphatics. There is uncertainty regarding the optimal management of the nodal basin for patients with MCC with clinically positive nodes. We study the efficacy of single node excision (SNE) as an alternative to a therapeutic lymph node dissection (TLND) in patients with limited nodal disease.

Methods

We performed a retrospective cohort study of patients with MCC with clinical nodal disease who underwent resection in the form of either SNE or TLND using the National Cancer Database. The association between type of surgery and overall survival (OS) was estimated using the Kaplan–Meier method and Cox proportional hazards modeling.

Results

1835 patients met all inclusion criteria with 281 patients undergoing SNE and the remainder undergoing TLND. Patients receiving SNE and TLND were equally likely to receive radiation to the nodal basin (SNE 44.5% vs. TLND 48.5%, p = 0.22). There was no difference in 5‐year OS between patients who received SNE versus TLND (SNE 43.9% vs. TLND 44.7%, p = 0.36). This persisted in a multivariable Cox proportional hazards model in which receipt of SNE remained not significantly associated with survival after adjusting for clinical and treatment factors including receipt of radiation (Hazard Ratio [HR] 1.17, 95% CI 0.96–1.42, p = 0.11). In patients undergoing SNE with radiation, 5‐year OS was 54.4% (95% CI 44.1–63.6).

Conclusions

TLND is not associated with a survival advantage over SNE. Further prospective study into patterns of recurrence and safety of SNE is needed.
Validation of CLASS MRI for personalized ACL footprints identification
Authors: Thürig Grégoire , Usó Marc Barrera , Panadero‐Morales Raúl , Galley Julien , Schwab Joseph , Heimann Alexander , Tannast Moritz , Petek Daniel
Published: December 2024

Purpose

In modern anterior cruciate ligament (ACL) surgery, the focus is usually on anatomical reconstruction to restore the natural kinematics of the knee. The individual optimal positioning of the ACL footprints (FPs) in primary surgery is still controversial and, especially in revision surgery, difficult to realize surgically. In this regard, a new MRI‐based sequence, the Compressed Lateral and anteroposterior Anatomic Systematic Sequence (CLASS) with marked femoral and tibial FPs as a template, could help. The purpose of this study was to (1) validate the reliability and reproducibility of the localization of femoral and tibial FPs of ACL in the generation of CLASS and (2) compare the identification of ACL FPs by CLASS with previously described methods.

Methods

Magnetic resonance imaging (MRI) of uninjured knees from a predominantly young cohort is used to apply the CLASS algorithm. ACL FPs were subsequently identified by a board‐certified radiologist and an orthopaedic knee surgeon. Intraobserver reliability and interobserver reproducibility were assessed. Measurements of the ACL FPs according to established methods were performed and compared with the results from the literature.

Results

Identification of ACL FPs and generation of CLASS images resulted in ‘almost perfect’ reliability and reproducibility. Most measurements also showed ‘almost perfect’ consistency. Statistical analysis showed significant variations between the deep‐shallow and high‐low positions when compared to the published literature.

Conclusions

The CLASS MRI sequence is a reliable and reproducible method for identifying ACL FPs. The observed variability in the location of the ACL FP underlines the importance of a patient‐specific surgical approach.

Level of Evidence

Level II.
Fixation of Takeuchi Type II/III lateral hinge fractures provides favourable stability of a medial open wedge high tibial osteotomy—A biomechanical study
Authors: Peez Christian , Deichsel Adrian , Zderic Ivan , Richards R. Geoff , Drenchev Ludmil , Skulev Hristo K. , Gueorguiev Boyko , Raschke Michael J. , Kittl Christoph , Herbst Elmar
Published: December 2024

Purpose

To investigate the biomechanical consequences of osteosynthesis of lateral hinge fractures (LHFs) in medial open wedge high tibial osteotomy (MOWHTO).

Methods

Sixteen fresh‐frozen human cadaveric proximal tibiae underwent MOWHTO fixed with an ipsilateral locking compression plate. The specimens were assigned to two clusters simulating LHFs according to the Takeuchi classification: (1) Type II fracture; and (2) Type III fracture. The following conditions were serially tested: (1) intact hinge; (2) fractured hinge; (3) screw fixation of the LHF; (4) staple fixation of the LHF; and (5) locking T‐plate fixation of the LHF. Each specimen was subjected to 10 cycles of axial compression load (720 N; 36 N/s), and internal and external rotational loads (10 N m; 1 N m/s), while capturing the interfragmentary movements via motion tracking.

Results

In Takeuchi Type II fractures, osteosynthesis of the fractured hinge with staples or a plate significantly reduced fracture site displacement (p < 0.05) and significantly increased construct stiffness (p < 0.05) under axial and torsional loading, while only the plate restored intact torsional displacement (n.s.). For Takeuchi Type III fractures, both screw and plate fixation significantly reduced fracture site displacement (p < 0.05) and significantly increased construct stiffness (p < 0.05) under axial and torsional loading. Both techniques restored torsional stiffness in each rotational direction and torsional displacement in internal rotation (n.s.).

Conclusion

Additional plate fixation of Takeuchi Type II fractures was the construct with the highest stiffness, restoring the axial and torsional stability to a MOWHTO with an intact hinge. Screw and plate fixation of Takeuchi Type III fractures provided equivalent stability and restored the torsional and axial stability of the MOWHTO. In case of a Takeuchi Type II or III fracture, surgeons should consider additional plate or screw osteosynthesis of the fractured hinge to best restore the stability of the MOWHTO, which may potentially reduce the risk of loss of correction and impaired bone healing.

Level of Evidence

There is no level of evidence as this study was an experimental laboratory study.
PDGPT: A large language model for acquiring phase diagram information in magnesium alloys
Authors: Yan Zini , Liang Hongyu , Wang Jingya , Zhang Hongbin , da Silva Alisson Kwiatkowski , Liang Shiyu , Rao Ziyuan , Zeng Xiaoqin
Published: December 2024

Magnesium alloys, known for their lightweight advantages, are increasingly in demand across a range of applications, from aerospace to the automotive industry. With rising requirements for strength and corrosion resistance, the development of new magnesium alloy systems has become critical. Phase diagrams play a crucial role in guiding the magnesium alloy design by providing key insights into phase stability, composition, and temperature ranges, enabling the optimization of alloy properties and processing conditions. However, accessing and interpreting phase diagram data with thermodynamic calculation software can be complex and time‐consuming, often requiring intricate calculations and iterative refinement based on thermodynamic models. To address this challenge, we introduce PDGPT, a ChatGPT‐based large language model designed to streamline the acquisition of magnesium alloys Phase Diagram information with high efficiency and accuracy. Enhanced by prompt‐engineering, supervised fine‐tuning and retrieval‐augmented generation, PDGPT leverages the predictive and reasoning capabilities of large language models along with computational phase diagram data. By combining large language models with traditional phase diagram research tools, PDGPT not only improves the accessibility of critical phase diagram information but also sets the stage for future advancements in applying large language models to materials science.
Persistent Inequality in Access to Rheumatology Care for Females After the COVID‐19 Pandemic
Authors: Katz Steven J. , Ye Carrie
Published: December 2024

Objective

To examine the effect of biological sex on wait‐times to first rheumatology appointment in a central triage system before, during and after the COVID‐19 pandemic.

Methods

De‐identified data of patients referred to one centralised Rheumatology referral centre between November 2019 and December 2023 were extracted from the electronic medical record. Variables collected and analysed included time from referral to first appointment, biological sex, referral period, triage urgency, age, and geographic location.

Results

19,681 referrals were identified. In the pre‐COVID period, there was no significant difference in wait‐times by biological sex or age. After adjusting for triage level, age and geographic location, females waited significantly longer in the peri‐COVID period versus males (10.2 days, 95% CI 7.1, 13.3), which persisted in the post‐COVID period (7.5 days, 95% CI 4.0, 11.1). Similarly, younger patients waited longer than older patients in the peri‐COVID period (4.7 fewer days per decade increase in age (95% 3.9, 5.6)). This age discrepancy persisted through the post‐COVID period (2.3 days, 95% CI 1.6, 3.5). Geographic location was a significant predictor of wait‐times in the post‐COVID period, with those outside of Edmonton waiting longer than in Edmonton. Once the change in referral pattern from Northwest Territories was accounted for, this discrepancy ceased.

Conclusions

Female and younger patients have been disproportionately impacted by wait‐time increases during the COVID‐19 pandemic, with minimal improvements observed during the post‐COVID period. These findings should prompt further investigation into the underlying causes of these observed inequities in access to rheumatology care to identify solutions.
Voice Quality After Anterior Commissure Cordectomy Versus Marginal Cordectomy for cT1 Glottic Carcinoma: A Case‐Series
Authors: Lechien Jerome R. , Baudouin Robin , Remacle Marc J. , Crevier‐Buchman Lise , Hans Stephane
Published: December 2024

Objectives

To compare the presurgical to postsurgical voice quality (VQ) outcomes of types I, II, III, and VI transoral laser cordectomies (TLC).

Study design

Prospective uncontrolled study.

Setting

Multicenter study.

Methods

Patients treated with TLC for a cT1 glottic squamous cell carcinoma were recruited from 2 European hospitals. The pre‐ to 3‐, 6‐, and 12‐month post‐TLC VQ was investigated with the voice handicap index (VHI), GRBAS, speech rate, maximal phonation time (MPT), and acoustic parameters. VQ was compared between types of TLC (types I, II, III, VI).

Results

Ninety‐six patients completed the evaluations (16 females). The TLC consists of type I (N = 30), II (N = 27), III (N = 19), and VI (N = 20), respectively. The mean ages of groups ranged from 55.3 to 65.5 years. The VQ significantly improved from pre‐ to 3‐, and 12‐month post‐TLC in types I, II, and III TLC groups. Only grade of dysphonia was significantly improved in type VI TLC after 6‐ and 12‐month post‐TLC. Type VI TLC reported higher values of F0, breathiness, and percent jitter than types I to III TLC 6‐ and 12‐month after the surgery. Percent jitter, F0, and the breathiness were the voice outcomes that highlight the differences in VQ between TLC groups.

Conclusion

The pre‐ to 12‐month post‐TLC evolution of VQ is better in types I‐II TLC compared to types III and VI. Type VI TLC reported the worse VQ at baseline and throughout the follow‐up.
Evaluating HPV Vaccination‐Related Content on a Burgeoning Social Media Platform: Insufficient Quality of TikTok
Authors: Lin Matthew E. , Ayo‐Ajibola Oluwatobiloba , Castellanos Carlos X. , West Jonathan D. , Luu Neil , Kokot Niels C.
Published: December 2024

Objective

Assessing the quality of human papillomavirus (HPV) vaccination‐related content on TikTok is crucial due to its popularity among adolescents. We assessed these videos while comparing the content and quality of videos with and without physician involvement.

Study Design

Cross‐sectional cohort analysis.

Setting

HPV vaccination‐related TikTok videos.

Methods

The TikTok library was queried using the search terms #HPVvaccine, #HPVvaccination, #Gardasil, #Gardasilvaccine, and #Gardasilvaccination. Video quality was evaluated using the DISCERN scale, assessing treatment‐related information quality. Descriptive statistics were used to characterize our cohort. t Test and Fischer's exact test were used to assess for differences in video content and quality based on physician involvement. Significance was set at P < .05.

Results

Our search yielded 131 videos, averaging 68,503.12 views, 2314.27 likes, and 89.28 comments per video. Videos frequently involved physicians (48.09%), focused on education (54.96%) or advocacy (22.90%), and were US‐made (68.90%). Otolaryngologists were rarely featured (3.17%). While most videos mentioned the HPV vaccine protected against cancer generally (86.26%), and cervical cancer specifically (67.94%), few discussed its protective effect against head and neck cancer (26.72%). Videos infrequently discussed updated eligibility among all adults ≤45 years of age (26.72%) or that men can also receive the vaccine (28.24%). Physician‐involved videos were more focused on education (P < .001) and focused less on patient experiences (P < .001) and advocacy (P = .036). Overall DISCERN scores were low among physician (mean = 2.46, SD = 1.13) and nonphysician (mean = 2.09, SD = 1.02) content.

Conclusion

TikTok HPV vaccination content is poor in quality, even with physician involvement. Enhancing content quality and increasing otolaryngologist participation can boost HPV awareness and vaccination rates.
Association of Neighborhood‐Level Area Deprivation with Demographics and Outcomes in Oropharyngeal Squamous Cell Carcinoma
Authors: Asthana Shravan , Park Asher C. , Talwar Abhinav , Burdett Kirsten B. , Puchi Christopher , Ibrahim Ahmed , Dunne Olivia , Patel Urjeet , Samant Sandeep , Stepan Katelyn O.
Published: December 2024

Objective

To characterize neighborhood‐level area deprivation's association with oropharyngeal carcinoma clinicodemographics, tumor staging, recurrence, and overall survival.

Study Design

Retrospective study.

Setting

Single institution academic medical center.

Methods

Patients diagnosed with oropharyngeal squamous cell carcinoma (OPSCC) between 2007 and 2022 at our institution were included in this study. The Area Deprivation Index (ADI) was used to quantify neighborhood‐level disadvantage based on patients’ primary residence at the time of their diagnosis. Continuous variables were compared between groups using the Wilcoxon rank sum test. For categorical variables, proportions were compared using Fisher's exact test. Overall survival (OS) and recurrence‐free survival (RFS) distributions were estimated using the Kaplan‐Meier method and log‐rank test. OS and RFS were further assessed by univariable and multivariable analyses performed using the Cox proportional hazards model.

Results

The higher ADI (more disadvantaged) group consisted of a significantly greater proportion of Black race (P < .001), 10+ pack‐year smoking history (P = .003), and Medicare patients (P = .018). On logistic regression analysis, neither ADI nor other social factors were significantly associated with increased likelihood of advanced clinical staging in the p16 positive OPSCC population. Furthermore, while ADI did not correspond with significant differences in survival, multivariate cox regression model demonstrated that “Other” insurance type (Medicaid and uninsured) (hazard ratio [HR] = 10.1, P = .008), age at diagnosis (1.10, P < .001), and advanced clinical staging (HR = 3.25, P = .004) were all significantly associated with increased HR of death.

Conclusion

While ADI may not be significantly associated with outcomes in HPV‐related OPSCC patients, this study revealed significant sociodemographic and risk factor differences across ADIs, as well as individual factors influencing prognosis. These findings emphasize the need for a comprehensive approach to understanding factors influencing HPV‐related OPSCC incidence and prognosis.
The Role of Prenatal Ultrasound and Added Value of Post‐Mortem Radiographic Imaging With X‐Ray and CT in Suspected Fetal Skeletal Dysplasia
Authors: Rajala Katri , Toiviainen‐Salo Sanna , Mäkitie Outi , Stefanovic Vedran , Tanner Laura
Published: December 2024

Objective

This study aims to assess the diagnostic value of post‐mortem radiographic imaging compared with prenatal ultrasound in suspected fetal skeletal dysplasias in a large Finnish cohort.

Method

Prenatal ultrasound findings and their association with post‐mortem radiographic imaging were evaluated in a cohort of 36 fetuses with prenatally suspected skeletal dysplasia.

Results

Prenatal ultrasound performed well in detecting skeletal dysplasias and severe forms of the disease. Additional radiographic imaging was performed post‐mortem in 16/27 terminated pregnancies. Post‐mortem X‐ray and 3D‐CT detected several features not seen with US. They were superior to US in identifying spinal and thoracic anomalies and performed better in discovering fractures and deformities of long bones. In addition, disease‐specific findings became more accurate with X‐ray/CT, especially in the group of true skeletal dysplasias (14/18, 77.8%). Post‐mortem X‐ray and CT increased phenotypic data and facilitated interpretation of genetic findings.

Conclusion

Post‐mortem X‐ray and CT offer additional information supporting the diagnostic process. Detailed phenotypic data are important in interpreting the results of genetic analyses and in assessing the recurrence risk in future pregnancies. Complementary imaging methods including post‐mortem radiography are therefore recommended.