bluuebunny/crossref_metadata_2025_split huggingface dataset:
Fixation of Displaced Medial Epicondylar Fractures in Adolescents
Authors: Zlotolow Dan A. , Tueting Jonathan L. , Kozin Scott H. 
Published: July 2021

Background:
Fractures of the medial epicondyle are often a marker of injury of the medial collateral ligament complex of the elbow, regardless of displacement. The medial epicondyle serves as the origin for the flexor/pronator mass superficially and the medial collateral ligament near the base. These fractures occur most commonly through the apophysis at the base of the epicondyle, making differentiation of muscular versus ligamentous avulsion difficult. Fractures associated with elbow dislocation and fractures with an intra-articular incarcerated medial epicondyle are ligamentous injuries, requiring at least intraoperative examination and most likely fixation of the fracture. Degree of displacement has traditionally been considered the deciding factor for fracture fixation, but this concept has been proven unreliable both in the literature and in our experience. Regardless of the degree of displacement, we recommend examination under anesthesia for all displaced fractures, with fixation of any fractures that render the elbow unstable to valgus stress.

Description:
The patient is placed in the supine position, and an examination under anesthesia is performed. If the elbow is stable to valgus load, the patient is placed into a long arm cast and awakened from anesthesia. If the elbow is unstable, the patient is placed in the lateral decubitus position, and the arm is prepared and draped. The fingers and wrist are wrapped with a self-adhesive bandage in flexion to relax the flexor/pronator mass. Under tourniquet control, a curvilinear medial incision is made just dorsal to the medial epicondyle. The ulnar nerve is identified and transposed if necessary. A guidewire is placed through the fracture fragment and used as a joystick. The hand is then positioned on the posterior aspect of the hip to provide varus load to the elbow and assist with reduction. The medial epicondyle is reduced, and the guidewire is advanced unicortically. A 3.0-mm, partially threaded cannulated screw is then advanced over the guidewire. A long arm cast is applied after closure of the wound with buried absorbable sutures.

Alternatives:
Nonoperative treatment in a cast has been suggested. Surgical variations include supine positioning, bicortical screws, and use of washers.

Rationale:
Lateral decubitus positioning and wrapping of the hand and wrist in flexion facilitate reduction by both applying a varus load and relaxing the flexor/pronator mass. Unicortical fixation is sufficient and does not risk injury to anterolateral structures. Washers have a higher complication rate than screws alone and may not be necessary in most cases
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Rezső Milleker and political geography
Authors: Dövényi Zoltán , Perényi Bálint 
Published: July 2021

This paper aims to examinate and to present the political geographical work of Rezső Milleker. Although political geography was not his main specialty, time to time he tried to create something of scientifical value in this field of science, but the attention of professional circles and the success avoided him. By evaluating these works we try to answer the question, where his place was in Hungarian political geography between the two world wars.
Keywords: Milleker, political geography, Zeitschrift für Geopolitik, ethnic maps
Characterization of Sand Production for Clayey-Silt Sediments Conditioned to Openhole Gravel-Packing: Experimental Observations
Authors: Jin Yurong , Li Yanlong , Wu Nengyou , Yang Daoyong 
Published: July 2021

SummaryAs one of the geotechnical risks, sanding has been one of the main constraints for safely and sustainably developing marine natural gas hydrate. In this study, a cylindrical vessel that is packed with the clayey-silt sediment collected from the Shenhu area of the northern South China Sea is used to microscopically observe sand detachment, migration within matrix, invasion to gravel packing, and production for openhole gravel packing. More specifically, by injecting water from the vessel boundary, the seepage and stress-strain field for sediment near the wellbore after hydrate dissociation is simulated, and the sand failure characteristics [i.e., the produced sand volume and particle size distributions (PSDs)] are quantified. The sand failure pattern is found to largely differ from that of a sandstone reservoir, whereas fractures, wormholes, and fluidized channels are successively developed along with a large scale of sand production and inlet pressure variation. Followed is a steady flow state with a stable inlet pressure without noticeable sand failure. Correspondingly, the fracture is induced and propagated by the combinational effort of shear and tensile failure, whereas wormholes and fluidized channels are associated with the liquid dragging force. At the end of each test, foraminifera are found to accumulate near the external side of the gravel-packing region, which is beneficial to sand control. In the meantime, a compact mudcake, as an infiltration medium, is observed outside the gravel-packing layer. The 30/50 mesh gravel packing is able to control grain size up to 30.0 µm in diameter with a median of 5.0 µm, whereas the produced grains account for less than 1.0 vol% of the total sediment. By performing sensitivity analysis on sand production, depressurization shall be conducted at a small rate to not only control sand production, but also to induce flow paths at the early stage. Moreover, the sand production rate associated with fracture development is larger than those of wormholes and fluidized channels. This study focuses on the experimental observations on sand failure patterns, and the theoretical formulations and modeling will be presented and explained in a future work.3
Early crack detection using modified spectral clustering method assisted with FE analysis for distress anticipation in cement-based composites
Authors: Vedrtnam Ajitanshu , Kumar Santosh , Barluenga Gonzalo , Chaturvedi Shashikant 
Published: July 2021

Abstract
The present work reports an efficient way of capturing real-time crack propagation in concrete structures. The modified spectral analysis based algorithm and finite element modeling (FEM) were utilised for crack detection and quantitative analysis of crack propagation. Crack propagation was captured in cement-based composite (CBC) containing saw dust and M20 grade concrete under compressive loading using a simple and inexpensive 8-megapixel mobile phone camera. The randomly selected images showing crack initiation and propagation in CBCs demonstrated the crack capturing capability of developed algorithm. A measure of oriented energy was provided at crack edges to develop a similarity spatial relationship among the pairwise pixels. FE modelling was used for distress anticipation, by analysing stresses during the compressive test in constituents of CBCs. FE modeling jointly with the developed algorithm, can provide real-time inputs from the crack-prone areas and useful in early crack detection of concrete structures for preventive support and management.
A Rare Pathogen Comamonas Testosteroni: A Case Report And Review of The Literature
Authors: Buyukberber S. Gayenur , Mumcuoglu Ipek , Ozbay B.Orkun , Aypak Adalet , Dinc Bedia 
Published: July 2021

Abstract
Comamonas testosteroni is a Gram- negative, aerobic, motile, non-spore-forming bacillus. It has not been recognized as a component of the endogenous human microflora. Due to its ability to survive in liquid environments, it can survive for a long time in a hospital environment and cause opportunistic infections. Although rare, C. testosteroni has been reported as a cause of cellulitis, peritonitis, endocarditis, meningitis, endophthalmitis, tenosynovitis, pneumonia and bacteremia. Here, we present a case of a 4-year-old girl who was operated on for persistent cloaca with C. testosteroni isolated in her urine culture. Identification studies were performed by MALDI-TOF MS (bioMerieux, France) mass spectrophotometer method. Antibiotic susceptibility tests were performed with the automatic device VITEK-2 Compact (bioMérieux, France). Microorganism was found susceptible to ceftazidime and ciprofloxacin; intermediate susceptible to meropenem and piperacillin / tazobactam and resistant to gentamicin, amikacin, imipenem and trimethoprim-sulfamethoxazole. With this case report, C. testosteroni was reported as the first cause of urinary tract infection in our country and the third in the world.
Intrapartum ultrasound use in clinical practice as a predictor of delivery mode during prolonged second stage of labor
Authors: katzir tamar , Brezinov Yoav , Kharish Ella , Hadad Shira , Vaisbuch Edi , Levy Roni 
Published: July 2021

Abstract
Purpose

To determine the validity of Intrapartum ultrasound (IPUS), and particularly the angle of progression (AOP), in predicting delivery mode when measured in real-life clinical practice among women with protracted second stages of labor.
Methods

Using electronic medical records, nulliparous women with a second stage of labor of ≥ 3hours ("prolonged") and a documented AOP measurement during the second stage were identified. The ability of a single AOP measurement in "prolonged" second stage to predict a vaginal delivery (VD) was assessed. Fetal head descend, measured by AOP change/hour (calculated from serial measurements) was compared between women who delivered vaginally and those who had a cesarean delivery (CD) for arrest of descent.
Results

Of the 191 women who met the inclusion criteria, 62 (32.5%) delivered spontaneously, 96 (50.2%) had a vacuum extraction (VE) and 33 (17.3%) had a CD. The mean AOP was wider among women who had VD (spontaneous or VE) compared to those who had CD (153º±19 vs. 133º±17, p < 0.001). Wider AOPs were associated with higher rates of VD and an AOP ≥ 127º was associated with a VD rate of 88.6% (148/167). Among the 87 women who had more than one AOP measurement, the mean AOP change per hour was higher in the VD group than in the CD group (15.1º±11.4º vs. 6.2º±6.3º, p < 0.001).
Conclusion

Ultrasound assessed fetal head station in nulliparous women with a protracted second stage of labor can be an accurate and objective additive tool in predicting mode and interval time to delivery in real-life clinical practice.
Study on the relationship between liver damage caused by anti-tuberculosis drug rifampicin and related metabolic enzyme gene polymorphisms
Authors: Su Qiang , Liu Qiao , Liu Juan , Fu Lingyun , Liu Tao , Liang Jing , Peng Hong , Pan Xue 
Published: July 2021

Abstract
Background

The occurrence of Anti-TB Drug-induced Liver Injury (ATLI) affects the progress of anti-tuberculosis treatment and the cure rate of tuberculosis. To understand the mechanism and risk factors of ATLI, it is helpful to reduce or avoid the occurrence of liver damage. It is of great significance for the smooth completion of anti-tuberculosis treatment.
Methods

In this study, 2255 pulmonary tuberculosis patients were included as the research object, and their medical records were reviewed, questionnaire surveys, liver function tests at the end of February (including patients with uncomfortable symptoms during the intensive treatment period) and blood samples were saved. Determine cases of liver damage based on the criteria for liver damage. The genotype was determined by the PCR-LDR method, and the single factor and unconditional Logistic regression methods were used to explore the relationship between genetic polymorphism and ATLI susceptibility.
Results

Through the screening of related factors affecting ATLI, this study found that ATLI may be related to gender, year and age is related to body weight; there is an association between the genetic polymorphism site CYP2C9 *2 and ATLI, and the best association model is a dominant inheritance model.
Conclusions

In-depth discussion of the genetic nature of ATLI is of great practical significance and practicality for preventing the occurrence of liver damage in patients with tuberculosis in our region, reducing the damage to the liver by anti-tuberculosis drugs, and formulating individualized chemotherapy regimens to avoid treatment failure due to liver damage.
Vitamin D Status And Parathyroid Hormone Levels In Girls With Central Precocious Puberty
Authors: Teodoro Durá-Travé , Fidel Gallinas-Victoriano , Lotfi Ahmed-Mohamed , Paula Moreno-González , María Urretavizcaya-Martinez , María Malumbres-Chacón 
Published: July 2021

Abstract
Background. The presence of vitamin D receptor in both the pituitary gland and female reproductive tissue suggests that vitamin D could be involved in female fertility mechanisms as well as in the activation of the hypothalamic-pituitary-gonadal axis. The objective of this study was to analyze the vitamin D status and PTH levels in 6- to 8-years-old girls with central precocious puberty. Methods. A cross-sectional clinical and blood testing (calcium, phosphorus, 25(OH)D and PTH) were carried out in 78 girls with central precocious puberty (CPP group), aged 6.1-7.9 years. A control group was recruited (157 prepubertal girls, aged 6.1-8.2 years). The criteria of the US Endocrine Society were used for the definition of hypovitaminosis D. Results. There were no significant differences in the vitamin D status between both groups. There were not significant differences in 25(OH)D levels between CPP (25.4±8.6 ng/mL) and control groups (28.2±7.4 ng/mL). In contrast, in CPP group PHT levels (44.8±16.3 pg/mL) were higher (p < 0.05) with respect to control group (31.0±11.9 ng/mL). In CPP group there was positive correlation (p < 0.05) between PTH levels and growth rate, bone age, basal estradiol, basal FSH, basal LH and LH peak. Conclusion: Vitamin D status in 6- to 8-years-old girls with CPP is similar to that in prepubertal girls. PTH levels were significantly higher in girls with CPP, and could be considered as a pubertal characteristic and, in this case, of pubertal precocity.
Estimated Impact of COVID-19 on Preventive Care Service Delivery: An Observational Cohort Study
Authors: Laing Scott , Johnston Sharon 
Published: July 2021

Abstract
Background: COVID-19 has caused significant healthcare service disruptions. Surgical procedure backlogs have been calculated but not those for other healthcare services. This study aims to estimate the backlog of key primary preventive care services caused by COVID-19. Methods: This observational study assessed preventive care screening rates at three primary care clinics in Ottawa, Ontario from March to November 2020 using data from 22,685 electronic medical records. The change in cervical cancer, colorectal cancer, and type 2 diabetes screening rates were extrapolated using 2016 census data, estimating the volume of key services delayed by COVID-19 across Ontario and Canada.Results: The mean percentage of patients appropriately screened for cervical cancer decreased by 7.5% (-0.3% to -14.7%; 95% CI), colorectal cancer decreased by 8.1% (-0.3% to -15.8%; 95% CI), and type 2 diabetes decreased by 4.5% (-0.2% to -8.7%; 95% CI). Extrapolation estimated that Ontarians delayed 288,000 cervical cancer (11,000 to 565,000; 95% CI), 326,000 colorectal cancer (13,000 to 638,000; 95% CI), and 274,000 type 2 diabetes screenings (13,000 to 535,000; 95% CI). Extrapolation to the Canadian population nearly triples these numbers. Re-opening measures have not reversed these trends.Interpretation: COVID-19 decreased the delivery of preventive care services, which may cause delayed diagnoses, increased mortality, and increased health care costs. Virtual care and reopening measures have not restored the provision of preventive care services. Electronic medical record data could be leveraged to improve screening via panel management. Additional, system-wide primary care and laboratory capacity will be needed to restore pre-COVID-19 screening rates.
Weaning From Noninvasive Ventilatory Support in Infants With Severe Bronchiolitis: An Observational Study
Authors: Cassibba Julie , Freycon Claire , Doutau Julia , Pin Isabelle , Bellier Alexandre , Fauroux Brigitte , Mortamet Guillaume 
Published: July 2021

Abstract
Background: The aim of the study was to analyze the weaning success, the type of weaning procedures, and weaning duration in consecutive infants hospitalized over a winter season in a Pediatric Intensive Care Unit.Methods: A retrospective observational study in a pediatric intensive care unit in a tertiary center. Infants hospitalized for a severe bronchiolitis were included and the weaning procedure from continuous positive airway pressure (CPAP), noninvasive ventilation (NIV) or high flow nasal cannula (HFNC) was analyzed.Results: Data from 95 infants (median age 47 days) were analyzed. On admission, 26 (27%), 46 (49%) and 23 (24%) infants were supported by CPAP, NIV and HFNC, respectively. One (4%), nine (20%) and one (4%) infants failed weaning while supported by CPAP, NIV or HFNC, respectively (p=0.1). In infants supported by CPAP, CPAP was stopped directly in 5 patients (19%) while HFNC was used as an intermediate ventilatory support in 21 (81%). The duration of weaning was shorter for HFNC (17 hours, [IQR 0-26]) than for CPAP (24 hours, [14-40]) and NIV (28 hours, [19-49]) (p<0.01).Conclusions: The weaning phase represent a large proportion of noninvasive ventilatory support duration in infants with bronchiolitis. The weaning procedure following a “step down” strategy may lead to an increase in duration of weaning.
Impact of the COVID-19 Pandemic on Career Intention Among Undergraduate Medical Students: A Single-center Cross-Sectional Study in Hubei Province
Authors: Wang Xue-lin , Liu Ming-xiu , Peng Shuai , Yang Lei , Lu Chen , Shou Shi-cong , Wang Jian-ru , Sun Jun-yi , Wang Jia-qi , Hu Yan , Zhao Jun , Duan Peng 
Published: July 2021

Abstract
Background：Undergraduate medical (UM) students faced the realities of the difficulties inherent in medical careers due to the coronavirus 2019 (COVID-19) outbreak. Thus imperative containment measures could affect UM students’ career intentions. There is limited information regarding the factors potentially associated with these students’ career change intentions.Methods：we conducted a cross-sectional survey to investigate the impact of the COVID-19 pandemic on career intention and the associated factors in UM students in August 2020. Univariate analyses and logistic regression analysis were used to identify the factors that contributed to any change of career intention.Results: A total of 2,040 medical students were contained from Hubei University of Medicine. The change of career intention was related to grade, attitude towards being a health worker and the impact of the COVID-19 pandemic.Conclusions: Changes in career intentions were particularly influenced by grade, attitude towards being a health worker, and the degree of COVID-19’s impact on the participants’ lives. Treating large-scale public health emergencies in rational way, setting up correct views of occupation choice and building reasonable career planning may reduce the loss of medical talents.
The Influence of Sex on Navigating Acute Coronary Syndrome: A Hospital-Based Cohort Study in South Asia
Authors: Ralapanawa Udaya , Karunathilake Parackrama , Bandara Charith , Kumarihamy Prabhashini , Gunaratne Sujeewa , Ranasinghe Dhammika , Jayasinghe Ruwanthi , Kularathna Vishvara 
Published: July 2021

Abstract
BackgroundThe cardiovascular risk profile and adverse events following acute coronary syndrome (ACS) differ between the Sex, indicating the importance of studying the sex differences in factors associated with ACS.MethodsA cross-sectional descriptive study was performed among ACS patients presented to Teaching Hospital Peradeniya. An interviewer-administered prevalidated questionnaire was used to collect data, and analysis was done. ResultsA total of 789 patients were included, consisting of 40.4% females. The mean age of females (62.17±11.06) was higher than males (59.80±11.24) (p=0.004), and in females, the mean age for unstable angina (60.5±10.5) was lower than NSTEMI (63.8±12.5) (p=0.022) and STEMI (64.0±9.2) (p=0.026). The male-female composition for unstable angina (46.3% vs 53.7%) and STEMI (75.8% vs 24.2%) showed varied proportions. The mean BMI (24.95±4.40 kg m-3 vs 23.77±3.88 kg m-3) (p=0.008) and obesity (21.6% vs 13.8%) (p=0.048) was higher in females. Overweight (9.4% vs 8.8%) (p=0.048) and the waist-hip ratio (0.98±0.07 vs 0.94±0.10) (p=0.006) was higher in males. Family history of hypertension was higher in females (24.1% vs 17.0%) (p=0.014). Most of the females were co-morbid with diabetes (37.9%) (p=0.008), hypertension (59.8%) (p<0.001) and dyslipidaemia (40.3%) (p<0.001) than males. The prevalence of smoking and alcohol intake was significantly higher in males (p<0.001). The predominant symptom was chest pain (93.4%), regardless of Sex. Right chest pain was primarily present in females (8.0% vs 3.6%) (p=048), and radiation of pain to the right arm mainly occurred in males (18.2% vs 7.5%) (p=0.007). Vomiting and dyspnoea was higher in females (47.7% vs 38.4%, p=0.049 and 53.1% vs 43.2%, p=0.039). The delay in presentation to the hospital was more in females (6:04±6:02) than males (3:55±4:22) with STEMI. The commonest reason for the delay was not suspecting an ACS, and a three-wheeler was the primary mode of transport in both sexes without any sex difference. Only 7.0% was delayed due to the unavailability of a transport facility.ConclusionFemale and male patients with ACS show differences in the age of onset, the spectrum of ACS, comorbidities, anthropometric measurements, risk factors like smoking and alcohol intake, clinical presentation aspects and delay in presentation to the hospital.
Effect of Mechanical Stress on Rheumatoid Arthritis of the Temporomandibular Joint: a Morphological and Histological Evaluation
Authors: Nagai Kohei , Ishii Takenobu , Nishii Yasushi 
Published: July 2021

Abstract
Background

Rheumatoid arthritis of the temporomandibular joint (TMJ-RA) has been reported to have a larger incidence range than systemic rheumatoid arthritis (RA). The presence or absence of mechanical stress (MS) is considered a factor in this. In this study, we hypothesized that TMJ-RA develops or worsens when excessive MS is applied to the temporomandibular joint of RA mouse models. We aimed to clarify the relationship between TMJ-RA and MS through morphological and histological evaluation.
Methods

Collagen antibody-induced arthritis (CAIA) was induced in male DBA/1JNCrlj 9–12 weeks old mice by administering Type II collagen antibody and lipopolysaccharide to produce RA model mice. MS was applied to the mandibular condyle. The group was separated into non-RA (control group (N = 5) and MS group (N = 5)), and RA group (CAIA group (N = 5)and CAIA MS group (N = 5)). To confirm the morphological changes in the mandibular condyle, micro-CT imaging was performed. Histological evaluation of the TMJ was performed by hematoxylin and eosin staining for condylar cartilage cell layer thickness, Safranin O staining for proteoglycans, and tartrate-resistant acidic phosphatase staining for osteoclast count. Immunohistochemical evaluation was performed to assess the localization of cartilage destruction enzymes using ADAMTS-5 (a disintegrin and metalloproteinase with thrombospondin motifs) antibody. Additionally, CD3 (cluster of differentiation), CD45, and γδ TCR (T cell receptor) antibodies were used to localize and identify the type of lymphocytes.
Results

In the CAIA MS model, a three-dimensional analysis of the temporomandibular joint by microcomputer tomography showed a crude change in the surface of the mandibular condyle. Histological examination revealed a decrease in the chondrocyte layer width and an increase in the number of osteoclasts in the mandibular condyle. T cell accumulation was observed, and γδ T cell involvement was confirmed.
Conclusions

In the CAIA model, the TMJ was less sensitive to the initiation of RA. However, the results suggested that it was exacerbated by MS, and that γδ T cells may be involved in TMJ-RA.