bluuebunny/crossref_metadata_2025_split huggingface dataset:
In PD, Non-Invasive Trans-Spinal Magnetic Stimulation Enhances the Effect of Transcranial Magnetic Stimulation on Axial Motor Symptoms: A Double-Blind Randomized Clinical Trial
Authors: Khedr Eman M. , Haridy Nourelhoda A. , Korayem Mohammad A. , Tawfik Ahmed Mamdouh , Hamed Ahmed A. 
Published: December 2024

Background Axial symptoms in Parkinson’s disease (PD) often respond poorly to pharmacological treatment. We evaluated whether combining repetitive transcranial magnetic stimulation (rTMS) and repetitive spinal magnetic stimulation (rSMS) is more effective than rTMS alone in improving axial and other motor disabilities in PD. Methods A total of 42 PD patients with axial symptoms were randomly allocated to 2 experimental intervention groups: Group I received active rTMS + active rSMS (2000 pulses; 20 Hz; 80% resting motor threshold for each motor area “M1” + 1500 pulses rSMS 10 Hz, at 50% of maximal stimulator output). Group II received active rTMS + sham rSMS with the same number of pulses. Both groups received 10 sessions (5 consecutive days/week for 2 weeks). Assessments using Freezing of Gait Questionnaire, walking speed, Movement Disorder Society-Sponsored Revision of the Unified Parkinson’s Disease Rating Scale (MDS-UPDRS) parts II and III, and Parkinson’s Disease Questionaire-39 (PDQ-39) were performed at baseline (T0), end of sessions (T1), and 1 month later (T2). Results At T0, Group II showed higher walking speed. At T1 and T2, Group I demonstrated significantly greater improvements in MDS-UPDRS parts II, III, and sub-items of part III. Group I showed stronger improvement in TUG-T and average fast velocity immediately post-intervention, but this effect diminished after 1 month. PDQ-39 scores for leisure activity and walking problems were significantly higher in group I. Conclusions These findings indicate that combining rTMS and rSMS for 10 sessions is more effective than rTMS alone in managing PD’s motor and axial symptoms. The effect size of the outcome is large enough to be of significance in clinical practice. Trial Registration: The study was registered prospectively on 26/12/2021 at the clinicaltrial.gov website with the registration ID: NCT05271513, https://clinicaltrials.gov/study/NCT05271513 .
Acute management of a ruptured mycotic iliac artery pseudoaneurysm in a young transplant patient
Authors: Reinert Nathan J , Cass Bryan D , Ambani Ravi N 
Published: December 2024

Objectives Ruptured mycotic pseudoaneurysms are rare, yet devastating complications that can prove challenging to manage. In immunocompromised populations, highly virulent organisms such as Gemella morbillorum can be especially difficult to combat. Here, we outline our approach to temporizing maneuvers in an emergent setting and definitive revascularization in a 27-year-old with a ruptured mycotic iliac artery pseudoaneurysm from necrosis of her kidney and pancreas allografts. Methods The initial staged repair involved covered stenting of the right iliac artery for hemorrhagic control of a ruptured pancreatic allograft arterial anastomosis, explant of ipsilaterally placed renal and pancreas allografts from the right pelvis, and iliac artery reconstruction using left femoral vein. Subsequent abscess formation leading to anastomotic blowout required repeat covered stenting followed by a femoral-femoral arterial bypass with right femoral vein. Results The patient was discharged home with no further vascular events and preserved lower extremity perfusion. They returned to the clinic 1 month following discharge in stable condition with no wound healing or ischemic complications. Conclusions The choice of femoral vein as conduit for in-line arterial repair can provide both better long-term patency and resistance to infection than prosthetic bypass material.
Patient flow analysis with fast-track MRI for suspected stroke in the emergency department and associated non-comprehensive stroke center
Authors: Sagar Malini Vendela , Gandrup Karen Lind , Jensen Diane , Krag Christian Hedeager , Boesen Mikael Ploug , Raaschou Henriette , Christensen Helle Collatz , Kruuse Christina 
Published: December 2024

Background: Good outcomes in stroke care require swift diagnostics, for which magnetic resonance imaging (MRI) as first-line brain imaging is superior to computed tomography scans. Reduced length of stay (LOS) in hospital and emergency departments (ED) may optimize resource use. Fast-track stroke MRI was implemented as the primary imaging technique for suspected stroke, in the ED at Copenhagen University Hospital—Herlev and Gentofte in 2020. Objectives: We aimed to describe and compare LOS, MRI utilization, and the rate of strokes versus stroke-mimicking conditions on the stroke ward, before and after the implementation of fast-track MRI. Design and method: In this cross-sectional study, we used data from admissions to the neurologic ED and associated non-comprehensive stroke unit. We compared two time periods, that is, January 1–December 31, 2019, and January 1–December 31, 2020, before and after the implementation of fast-track stroke MRI. Results: There were 6650 admissions before and 7201 after implementation of fast-track stroke MRI. After implementation, we observed reductions in average LOS in hospitals from 56.0 to 38.6 h ( p < 0.001), and LOS in ED from 9.17 to 8.63 h ( p < 0.001). The use of inpatient MRI increased significantly, and the rate of acute ischemic stroke patients on the ward increased yet the rate of non-strokes remained unchanged. The association between shorter admissions and access to MRI remained (odds ratio 1.81, p < 0.001), after adjusting for sex, age, weekend admissions, and lockdown periods. Conclusion: Fast-track stroke MRI in ED associated with reduced LOS in hospital.
Incidence and predictors of hyperglycemic emergencies among adult diabetic patients at public hospitals of Sidama Region and Gedeo Zone, Southern Ethiopia: a survival analysis
Authors: Tiruneh Kasie Gebeyehu , Mekonnen Migbar Sibhat , Getnet Zemeskel Addisu , Ayehu Akele Mequanint , Meno Abose Abinet , Zewde Wendimu Ashenafi 
Published: December 2024

Background: Hyperglycemic emergencies (HGEs) are the major deadliest acute complications of diabetes. HGEs have reached an alarming stage and increased year-to-year leading to increased morbidity, hospitalization, and mortality. Despite HGEs causing this increased healthcare, psychological, social, and economic burden, studies conducted to address this burden and its predictive factors remain limited. Thus, this study aimed to investigate the incidence and predictors of HGEs among adult diabetic patients. Methods: An institution-based retrospective follow-up study was employed on 538 systematically selected adult diabetic patients who had diabetic follow-up in Sidama region and Gedeo zone public hospitals from September 1, 2018, to September 1, 2022. The sample size was determined using STATA V-14. Data were collected using an extraction checklist, entered into EPI data version 4.4.2.2, and analyzed using STATA version 14. The Kaplan–Meier curve and log-rank test were used to determine the survival probabilities and to compare the survival status. The Cox proportional hazard regression model was used to determine the association and identify the predictor variables. A statistical significance was declared at a p-value of <0.05 in line with a 95% confidence interval (CI) and hazard ratios. Results: The study was conducted on 538 diabetic adult patients with a response rate of 100%. The mean age of study participants was 44.5 years, and more than 66.7% were males. The incidence rate of HGEs was found to be 29 (95% CI: 25.3–33.2) per 1000 person-months with a total of 7176.5 person-month observations. Being farmer (adjusted hazard ratio (AHR) = 6.47; 95% CI: 2.61–16.04), poor glycemic control (AHR = 6.84; 95% CI: 3.47–13.49), less frequent diabetic follow-up (AHR = 4.00; 95% CI: 1.02–15.57), and having hypertension (HTN) (AHR = 2.94; 95% CI: 1.62–5.34) were significantly associated with increased hazard of acquiring HGEs among adult diabetic patients. Conversely, the hazard of experiencing HGE was 63% lower among patients who had diabetic nephropathy relative to those without diabetic nephropathy (AHR = 0.35; 95% CI: 0.15–0.83). Hence, setting and strengthening specific diabetic management strategies focused on the identified predictors could be paramount to reducing HGEs and their unwanted effects. Moreover, it’s better to consider more frequent diabetic follow-up visits for all patients regardless of other complications.
Incidence and Risk Factors of Recurrent Proximal Junctional Failure in Adult Spinal Deformity Surgery
Authors: Park Se-Jun , Park Jin-Sung , Kang Dong-Ho , Lee Chong-Suh , Kim Hyun-Jun 
Published: December 2024

Study Design Retrospective cohort study. Objectives This study aimed to examine the incidence and risk factors for recurrent proximal junctional failure (R-PJF) in adult spinal deformity (ASD) surgery. Methods Among 482 patients receiving ≥ five-level fusion to the pelvis for ASD, 60 patients who underwent fusion extension surgery for PJF were included in the study cohort. R-PJF was defined as the performance of re-revision surgery after revision surgery for PJF. Various clinical and radiographic variables were compared between no R-PJF and R-PJF groups. Stepwise multivariate logistic analysis was performed to identify the risk factors for R-PJF. Results Of the 60 patients, there were 51 women (85.0%) and 9 men (15.0%) with a mean age of 72.4 ± 6.7 years. The mean fusion length at the index surgery was 7.3 ± 1.6 levels and an average of 4.1 ± 1.3 levels was extended during the revision surgery. Among them, R-PJF developed in 17 patients (28.3%). Multivariate analysis revealed that overcorrection relative to age-adjusted pelvic incidence (PI) – lumbar lordosis (LL) at the index surgery and high total sum of proximal junctional kyphosis severity scale (PJKSS) at the revision surgery were significant risk factors for R-PJF development. The cutoff value for the PJKSS sum was calculated as 8.5 points. Conclusions R-PJF was developed in 17 patients (28.3%). PI–LL overcorrection should be avoided during the index surgery to mitigate the R-PJF. In addition, timely surgical intervention is required in patients with PJF, considering that the PJF severity tends to increase over time.
Referral patterns for the interdisciplinary care of chronic pelvic pain
Authors: Roversi Gustavo A , Strasburg Jessica , Genco Lauren , Ferrando Cecile A 
Published: December 2024

Objective: The primary objective of this study was to describe referral patterns to an interdisciplinary CPP clinic at a tertiary care center. Study design: This was a retrospective cohort study of female patients assigned an ICD-10 code diagnosis related to chronic pelvic pain at a tertiary care referral center between January 2017 and December 2019. Electronic medical records were queried for patient and clinician characteristics. The rate of referral to this clinic was determined based on the data collected, and patient and provider factors associated with referral were assessed using logistic regression analyses. Results: Of the 732 patients identified, 25.9% ( n = 190, 95% CI = [22.9%,29.3%]) received a referral to an interdisciplinary CPP clinic. Logistic regression analyses significantly revealed multiple factors associated with referral: number of previous treatment modalities used (adjusted OR [aOR] = 1.76 per treatment 95% CI = [1.48, 2.10], p < 0.001), distance to the treatment center (aOR = 0.48 [0–25 miles vs 25–60 miles] 95% CI = [0.31, 0.74], p < 0.001), IBS diagnosis (aOR = 1.67 95% CI = [1.02, 2.74], p = 0.044), endometriosis diagnosis (aOR = 1.63 95% CI = [1.06, 2.52], p = 0.026), as well as a psychiatric diagnosis (aOR = 1.46 95% CI = [1.00, 2.12], p = 0.048). Physicians were less likely to make a referral compared to Advanced Practice Providers (aOR = 0.38 95% CI = [0.22, 0.65], p < 0.001). Conclusion: Approximately one in four patients with a diagnosis of CPP were referred to our interdisciplinary clinic. Several patient factors were associated with referral. These data show a need for education about the existence of this type of center.
Multidisciplinary management of primary umbilical endometriosis (Villar’s nodule) with coexistent uterine leiomyomata: A case report
Authors: Gang’ombe Rukia Swaleh , Mutiso Stephen , Damtew Eyosias , Walong Edwin , Kiriga Maroa Fred , Wabwire Benjamin , Mecha Ezekiel 
Published: December 2024

Introduction: Primary umbilical endometriosis, also known as Villar’s nodule, is a rare manifestation of endometriosis within the umbilicus. Case description: A 41-year-old female who presented with a 4-year history of umbilical swelling associated with cyclic umbilical bleeding, dysmenorrhoea and heavy menstrual bleeding is herewith reported. Imaging procedures revealed an umbilical mass and uterine leiomyomas. The patient underwent combined surgery by the gynaecology and plastic surgery teams where an open myomectomy followed by omphalectomy, mesh repair of the rectus sheath and panniculectomy was done. Histopathological examination confirmed the presence of estrogen and progesterone receptor-positive endometrial glands and stroma in the umbilicus consistent with primary umbilical endometriosis and coexistent uterine leiomyomas. Clinical improvement was demonstrated 3 months following the surgery. Conclusion: Umbilical swelling associated with catamenial symptoms should raise suspicion for primary umbilical endometriosis. Inter-specialty approach is key in the management of primary umbilical endometriosis.
Comparison of Revision and Redislocation Rates After First-Time Anterior Shoulder Instability Between Subluxators and Dislocators: A Midterm Outcome Study
Authors: Nazzal Ehab M. , Herman Zachary J. , Engler Ian D. , Kaarre Janina , Tisherman Robert T. , Gibbs Christopher M. , Greiner Justin J. , Rai Ajinkya , Hughes Jonathan D. , Lesniak Bryson P. , Lin Albert 
Published: December 2024

Background: Anterior shoulder instability is a common pathology seen especially in young men and highly active patient populations. Subluxation is a commonly encountered clinical issue, yet little is known about the effects of first-time subluxation compared with dislocation on shoulder stability and clinical outcomes after surgical stabilization. Purpose: To compare revision and redislocation rates as well as patient-reported outcomes (PROs) between subluxators and dislocators after a first-time anterior shoulder instability event. Study Design: Cohort study; Level of evidence, 3. Methods: Included were patients who underwent operative intervention for a first-time anterior instability event between 2013 and 2020 at a single institution. Exclusion criteria were posterior/multidirectional instability, revision surgery, and recurrent instability. The main outcomes of interest were the rates of redislocation and revision. Demographics and surgical details were retrospectively collected. Instability was categorized as subluxation (no documentation of formal shoulder reduction) or dislocation (documented formal shoulder reduction). Labral tear location and size were determined from preoperative magnetic resonance imaging scans. PROs and return-to-sport, redislocation, and revision rates were collected from prospective survey data. Results: A total of 256 patients (141 subluxators and 115 dislocators) were available for analysis. There were no significant differences in baseline demographics or preoperative physical examination findings. Rates of bony Bankart lesions were comparable, but Hill-Sachs lesions were more commonly present in dislocators compared with subluxators (88.7% vs 53.9%; P < .01). There were no group differences in labral tear size, incidence of concomitant posterior or superior labrum anterior-posterior tears, or number of anchors used. Rates of remplissage were comparable between groups. Prospectively collected survey data of 60 patients (35 subluxators, 25 dislocators) were collected at 6.4 and 7.1 years of follow-up, respectively. Rates of recurrent dislocation (11.8% vs 20.0%) and revision (8.8% vs 16.0%) were comparable between subluxators and dislocators, respectively. All PROs and return-to-sport rates were comparable between groups. Conclusion: Subluxators and dislocators may present with comparable rates of redislocation and revision surgery even at midterm follow-up. Both cohorts may further present with comparable injury characteristics and PROs. Given the findings, future prospective studies comparing outcomes of first-time instability events are needed.
Evaluating Performance Among National Basketball Association Players After Jones Fractures: A Retrospective Cohort Study
Authors: Kim Andrew H. , Cha Myung-Jin , Pan Alvina , Dafflisio Gianna , Cartagena-Reyes Miguel A. , Mun Frederick , Kaplan Jonathan R. , Aiyer Amiethab A. 
Published: December 2024

Background: In professional basketball, Jones fractures are among the most common cause of lower extremity stress injury. Despite its prevalence, there is a paucity of research on the impact of Jones fractures on athletic performance in the National Basketball Association (NBA). Purpose: To determine the impact of Jones fractures on return to play and performance among NBA players when compared with preinjury values and healthy matched controls. Study Design: Cohort study; Level of evidence, 3. Methods: NBA injury reports were analyzed to identify 18 players who sustained a Jones fracture between 2011 and 2022. Reports were verified through public press releases, social media accounts, and player profiles. A publicly available database was used to collect player data including position, age, and years of NBA experience. Performance and advanced statistics were collected for seasons pre- and postinjury. Players were 1:1 matched with healthy controls based on age, player position, and career performance. Univariate and multivariable regression analyses were performed to compare advanced and per-game performance statistics between injured and healthy control players. Results: NBA players who sustained a Jones fracture had a mean age of 23.9 ± 2.31 years at the time of injury. The mean NBA experience was 3.00 ± 2.35 years and mean preinjury minutes played per game was 19.64 ± 11.24. All players (18/18) were able to return to NBA-level competition the year following the injury. There was no change in player efficiency rating (PER), value added, and estimated wins added metrics when comparing pre- and postinjury performances among injured players. Injured players missed more games ( P < .001) postinjury compared with the matched controls. Multivariate analysis revealed that for players with a height of <2 m, every additional centimeter of height significantly decreased postinjury PER by 1.08 (95% CI, 0.35-1.80; P < .01). Conclusion: Despite its severity, most NBA players who sustain Jones fractures can return to preinjury performance and level of competition. There was no statistically significant decline in advanced statistics in the following season after injury, with a significant decrease in games played when comparing injured players with their healthy controls.
A New Clinical Test to Evaluate Intrinsic Foot Muscle Function
Authors: Panchbhavi Megna , Poliner Michael C. , Finegan Patrick M. , Jupiter Daniel C. 
Published: December 2024

Background: Intrinsic foot muscle weakness has been implicated in a wide range of forefoot conditions and is typically measured by the paper grip test. The proposed “knuckle test” is intended to evaluate intrinsic foot muscle function, in which active flexion of toes makes the metatarsal heads (“knuckles”) prominent in the forefoot. This study seeks to compare prevalence of negative knuckle test results and intrinsic muscle weakness in patients, primarily by association with a positive paper grip test result and secondarily with presence of toe deformities. Methods: Ninety-eight patients, 55 with toe deformity and 43 without, were evaluated for ability to flex their toes to the extent of knuckle prominence (knuckle test) and grip paper on the ground with their toes (paper grip test). Variables were compared between those with positive and negative knuckle test results. Results: A negative knuckle test result is significantly associated with the inability to grip a paper strip ( P < .05). Conclusion: Given that the paper grip test outcomes are a well-established sign of intrinsic muscle weakness, the significant association between knuckle and paper grip test outcomes substantiates the use of the knuckle test to detect intrinsic muscle weakness. The knuckle test is a potentially quick, simple, and cost-effective clinical maneuver to indicate intrinsic foot muscle weakness in a patient. Level of Evidence: Level III, diagnostic test development.
Some Truths About Engagement
Authors: Chella Ganesh 
Published: December 2024

History tells us that some problems are admired so deeply that we forget to solve them. But then, there are also times when we move to solve them too quickly, without having admired them enough. So, what about employee engagement? For several decades motivational theorists admired the problem with great fascination and offered the world a whole host of theories that we continue to fall back on. Then in the last few decades, consulting companies have offered the world their own models of motivation under the umbrella of engagement. Given that the context has changed so enormously and so much water has flown under the bridge, I believe it is time to step back and admire the problem once again. That is the purpose of my article.
“People Need to Know; We’re Part of the Community. We’re Here.”: Examining Experiences of Sharing Demographic Information for a Community-Based Diabetes Prevention Program
Authors: Craven Sarah A. , Sim Jenna A. P. , Cranston Kaela D. , Jung Mary E. 
Published: December 2024

Background Collecting demographic data is critical for identifying inequities in healthcare services and delivery. Inaccurate collection of demographic data can make developing equitable health interventions and improving reach of existing interventions difficult. This study aimed to (a) examine experiences in completing a community-based type 2 diabetes prevention program Small Steps for Big Changes (SSBC) demographic questionnaire (SSBC-DQ) among adults from equity-owed groups, and (b) assess recommendations for improvement to the questionnaire. Methods Adults with no prior involvement in SSBC were recruited. Participants completed the SSBC-DQ online and then engaged in one-on-one structured interviews. Interview data was analyzed using interpretive description and coded using the APEASE criteria. Results Twelve participant interviews were included in analysis. Five principle themes were developed to capture the experiences of completing the SSBC-DQ: representation, comprehension, demographics are an emotional experience, the role that privilege plays, and beliefs about demographic data. Sixty suggested changes were coded using the APEASE criteria; six suggestions met the criteria for implementation, 20 did not meet the criteria, and 34 required further discussion with the research team. Conclusions Results from this study illustrate that people’s lived experiences can drive their reactions and interpretations to demographic questionnaires. Based on end-user suggestions, SSBC made changes to its demographic questionnaire to be more inclusive. Having a demographic questionnaire that is more inclusive can help SSBC better understand what populations it is and is not reaching in an acceptable and inclusive manner. This will help inform future directions regarding evaluating program reach and equity.