bluuebunny/crossref_metadata_2025_split huggingface dataset:
Pelvic Ring Injury Mortality: Are We Getting Better?
Authors: Marchand Lucas S. , Sepehri Aresh , Hannan Zachary D. , Zaidi Syed M.R. , Bangura Abdulai T. , Morrison Jonathan J. , Manson Theodore T. , Slobogean Gerard P. , O'Hara Nathan N. , O'Toole Robert V. 
Published: June 2021

Objectives:
To determine if changes in pelvic trauma care and treatment protocols have affected overall mortality rates after pelvic ring injury.

Design:
Retrospective cohort study.

Setting:
Level I trauma center.

Patients/Participants:
A total of 3314 patients with pelvic ring injuries who presented to a single referral center from 1999 to 2018 were included in the study.

Intervention:
Pelvic ring management, years 1999-2006 versus years 2007-2018.

Main Outcome Measurements:
In hospital mortality. Other examined variables included change in patient demographics, fracture characteristics, date of injury, associated injuries, length of hospital stay, Abbreviated Injury Severity Score.

Results:
The composite mortality rate was 6.5% (214/3314). The earliest cohort presented a mortality rate of 9.1% [111/1224; 95% confidence interval (CI), 7.6%–10.8%] compared with the more recent cohort mortality rate of 4.9% (103/2090; 95% CI, 4.1%–5.9%). Overall mortality was significantly lower in the more recent period, a risk difference of 4.1% (95% CI, 2.3%–6.1%; P < 0.01). After adjusting for age and Abbreviated Injury Severity Score of the brain, chest, and abdomen, the mortality reduction was more pronounced with an adjusted risk difference of 6.4% (95% CI, 4.7%–8.1%; P < 0.01).

Conclusion:
Significant improvement in the mortality rate of pelvic ring injuries has been demonstrated in recent years (4.9% vs. 9.1%) and the difference is even large when accounting for known confounders. Improvement appears to coincide chronologically with changes in trauma resuscitation and implementation of adjuvant treatments for managing patients with severe hemorrhagic shock. Although the exact benefit of each treatment awaits further research, these data might indicate improved care over time for these difficult patients.

Level of Evidence:
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
Operative Versus Nonoperative Treatment of Acute Displaced Distal Clavicle Fractures: A Multicenter Randomized Controlled Trial
Authors: Hall Jeremy A. , Schemitsch Christine E. , Vicente Milena R. , Dehghan Niloofar , Nauth Aaron , Nowak Lauren L. , Schemitsch Emil H. , McKee Michael D. ,   on behalf of the Canadian Orthopaedic Trauma Society (COTS)
Published: June 2021

Objectives:
To evaluate the differences in patient outcomes after operative or nonoperative treatment of displaced, type II distal clavicle fractures.

Design:
Multicenter, prospective, randomized controlled trial.

Setting:
Level I trauma centers.

Patients/Participants:
Patients with completely displaced type II distal clavicle fractures were included. Fifty-seven patients were randomized: 27 to the operative group and 30 to the nonoperative group.

Intervention:
Patients randomized to nonoperative care received a standard shoulder sling, followed by pendulum or gentle range of motion shoulder exercises at any time as directed by the attending surgeon. Patients randomized to the operative group received plate fixation with a precontoured distal clavicular plate or a “hook” plate within 28 days from injury.

Main Outcome Measure:
Disabilities of the Arm, Shoulder and Hand scores at 1 year.

Results:
There were no between-group differences in Disabilities of the Arm, Shoulder and Hand or Constant scores at 1 year. More patients in the operative group went on to union (95% vs. 64%, P = 0.02) within 1 year. Twelve patients in the operative group underwent a second operation for implant removal (12/27, 44%). In the nonoperative group, 6 patients (6/30, 20%) subsequently underwent 8 operative procedures.

Conclusion:
Although this study failed to demonstrate a difference in functional outcomes between operative and nonoperative treatment of Neer type II distal clavicle fractures, nonoperative management led to more complications including a moderate rate of nonunion, which often required secondary surgery to correct, a higher rate of early dissatisfaction with shoulder appearance, and a delayed return to activities in the first 6 months. Operative management provided a safe and reliable treatment option with few complications, but often required secondary implant removal, especially with hook plate fixation.

Level of Evidence:
Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.
Myocardial strain and left ventricular geometry: a meta-analysis of echocardiographic studies in systemic hypertension
Authors: Tadic Marijana , Sala Carla , Carugo Stefano , Mancia Giuseppe , Grassi Guido , Cuspidi Cesare 
Published: June 2021

Aim:
Evidence on systolic dysfunction, as assessed by left ventricular (LV) mechanics, in hypertensive heart disease phenotyped by abnormal LV geometric patterns is still limited. Thus, we performed a systematic meta-analysis of 2D/3D speckle-tracking studies in order to provide an updated comprehensive information on this topic.

Methods:
The PubMed, OVID-MEDLINE, and Cochrane library databases were analyzed to search for articles published from the inception up to 31 January 2021. Studies were identified by using MeSH terms and crossing the following search items: ‘myocardial strain’, ‘left ventricular mechanics’, ‘speckle tracking echocardiography’, ‘systolic dysfunction’, ‘hypertensive heart disease’, ‘left ventricular hypertrophy’, left ventricular remodeling”, ‘concentric hypertrophy’, ‘eccentric hypertrophy’.

Results:
Overall, data of 267 normotensive controls and 712 hypertensive patients (234 normal geometry, 97 LV concentric remodeling, 176 eccentric LVH, and 205 concentric LVH) from eight studies were considered. Pooled ejection fraction was similar in normotensives and in the whole group of hypertensive patients: (SMD 0.037 ± 0.05, confidence interval (CI): 0.14/0.07, P = 0.51) as well as in hypertensive subgroups. LVMI, and E/e’ gradually increased from hypertensive patients with normal geometry and concentric remodeling, to patients with eccentric and concentric LVH. LV global longitudinal strain (GLS) was lower in all hypertensive groups compared with normotensive controls, in particular, in the eccentric (SMD 1.14 ± 0.22, CI: 0.69/1.59, P < 0.0001) and concentric LVH group (SMD 1.37 ± 0.21, CI: 0.95/1.79, P < 0.0001). The meta-analysis restricted to hypertensive patients showed that GLS gradually deteriorated from hypertensive patients with normal LV geometry, across those with concentric remodeling, to participants with eccentric and concentric LVH (−19.5 ± 0.6 versus −18.8 ± 0.73 versus −17.6 ± 0.66 versus −16.5 ± 0.6%, P < 0.001 for trend). Statistical significance was reached when GLS of the concentric and eccentric LVH group but not the concentric remodeling was compared with the normal geometry one.

Conclusion:
The present meta-analysis confirms that GLS performs better than ejection fraction in identifying systolic dysfunction in the hypertension setting. More importantly, it suggests that this occurs in patients with altered LV structure and geometry, such as LVH.
Postpulmonary embolism syndrome
Authors: Fabyan Kimberly D. , Holley Aaron B. 
Published: June 2021

Purpose of review
It is now recognized that more than half of patients with acute pulmonary embolism (APE) will have persistent symptoms beyond 3 months after their initial event. Persistent symptoms are referred to as post-PE syndrome, an umbrella term that covers a spectrum of patient complaints and underlying pathologies. Data published over the last 5 years have added significantly to our understanding of this syndrome and its management.

Recent findings
Underlying pathologies linked to post-PE syndrome include chronic thromboembolic pulmonary hypertension (CTEPH), chronic thromboembolic disease (CTED), cardiac dysfunction, and deconditioning. Treatment for post-PE syndrome will depend on the underlying causative pathologies found. Evaluation and treatment for CTEPH is well defined, but less than 10% of patients with post-PE syndrome will qualify as having this diagnosis.

Summary
A large percentage of patients will experience post-PE syndrome following APE. Strategies for identification and treatment for some pathologies are well studied, but the majority of patients will have subtle abnormalities on imaging and functional testing for which diagnostic criteria and management are not well defined. A number of active studies are designed to help optimize the management of post-PE syndrome and should help us improve intermediate and long-term outcomes for patients following APE.
Bioactive glass in the treatment of chronic osteomyelitis—a valid option?
Authors: Ziegenhain Franziska , Neuhaus Valentin , Pape Hans-Christoph 
Published: June 2021

Abstract
Chronic osteomyelitis continues to represent a challenge both for patients and the treating physician, especially in the presence of multiple germs. We performed a literature review assessing the current role of the indications of bioactive glass. We included studies about patients with chronic osteomyelitis that were treated with S53P4. A literature review of Medline via PubMed was performed. After the exclusion of case reports, 7 studies were included in the narrative review. Recurrence of infection was defined as the main outcome parameter. Six of 7 studies were retrospective, or case studies with a relatively small sample size (total patient number N = 274). The overall recurrence rate was 10.6%. Studies that compared the outcome of the treatment with S53P4 versus antibiotic-loaded polymethyl methacrylate (PMMA) revealed no significant difference. The data reviewed indicate that in cases of multiple bacteria and resistance to antibiotic treatment, bioglass may be a valuable treatment alternative to other forms of spacers (e.g., PMMA). This statement is limited by the fact that the number of described cases is very low. Therefore, a definitive statement of its effectiveness cannot be made at this point.
Coated nails: is their use supported by the literature?
Authors: Liu Jane Z. , Crist Brett D. 
Published: June 2021

Abstract
Antibiotic-coated intramedullary nails have been popularized in recent decades for treating long-bone infections. They are especially useful in treating diaphyseal infections requiring stability, such as those involving fractures and nonunions. The nails are made by injecting antibiotic-impregnated polymethylmethacrylate or “cement” around a metal core using a silicone tube as a mold. There are a variety of techniques that can be used to customize the nail to the affected site. Antibiotic cement has long been demonstrated as an effective local antibiotic delivery system. It is able to elute high concentrations of antibiotics while having little systemic toxicity. Several case series have reported good outcomes using this technique, defined by bone union and infection control. Further research is needed to determine the amount of weight that can safely be transferred through the nail and to optimize antibiotic elution.
Collagen fleece in orthopaedic infections
Authors: Ge Susan M. , Harvey Edward J. 
Published: June 2021

Abstract
Collagen fleece is a relatively new development. It represents another option in the battle against infection. It is a cheap, biocompatible, and resorbable local antibiotic delivery mechanism with favorable drug release kinetics and low risk of adverse effects or toxicity. Benefit may be conferred when used in contaminated cases. Significantly more research is still needed before the adoption of collagen fleece as the standard of care. However, we can likely conclude that there are no major adverse effects and it can be safely used as an adjunct in addition to conventional therapies for the prophylaxis and treatment of infections.
Cervical Cancer Screening in South Florida Veteran Population 2014-2020: Cytology and High-Risk HPV Correlation and HPV Epidemiology
Authors: Syler Lee B. , Stobaugh Corinne L. , Foulis Philip R. , Carlton George T. , DeLand Lauren A. , Borkowski Andrew A. 
Published: June 2021

ABSTRACTObjectiveThis project aims to use our robust women’s health patient data to analyze the correlation between cytology and Hr-HPV testing, study performance of Hr-HPV testing for detecting cytology lesions, and examine epidemiologic measures of HPV infections in the women’s veteran population.MethodsWe collected patient data from 2014 to 2020 from our computerized patient record system. We performed HPV assays using the ROCHE 4800 system. The COBAS HPV assay detects HPV 16, HPV 18, and 12 other HPV types (31, 33, 35, 39, 45, 51, 56, 58, 59, 66, and 68). We organized cytology results and Hr-HPV assays with Microsoft Access and Microsoft Excel for analysis.ResultsA total of 9437 cervical specimens were co-tested. High-grade cytology lesions (HSIL or higher and ASC-H) were overwhelmingly positive for Hr-HPV (94.1% and 87.2%, respectively). Low-grade cytology lesions (LSIL and ASC-US) were positive for Hr-HPV in lower percentages (72.6% and 54.9%, respectively). Hr-HPV testing had a sensitivity of 91.3%, a specificity of 93.1%, a positive predictive value of 16.4%, and a negative predictive value of 99.8% for detecting high-grade cytology lesions. Hr-HPV testing had a lower performance for detecting low-grade cytology lesions. Ten (10) cases had high-grade cytology and negative Hr-HPV test. Nine out of ten (9/10) of these patients showed no dysplasia (6) or low-grade dysplasia (3) on subsequent biopsy. Overall, 14.4% of tests were positive for Hr-HPV. The highest positive Hr-HPV test rates were in the second and eighth decades of life, 25.1% and 22.0%, respectively. In women over age 30, HPV types 16 and 18 were present in 11.7% and 6.4% of tests, respectively. Other HPV types were present in 82.3% of tests.ConclusionsHr-HPV testing has high performance for detecting high-grade cytology lesions. We believe our findings are in accordance with recent studies and guidelines that recommend primary Hr-HPV testing as the preferred screening method. The percentage of positive Hr-HPV tests and rates for age and HPV types 16 and 18 in our women’s veteran population suggest similar HPV prevalence to that of the general US population.
Maternal cigarette smoking and cleft lip and palate: A systematic review and meta-analysis
Authors: Fell Matthew , Dack Kyle , Chummun Shaheel , Sandy Jonathan , Wren Yvonne , Lewis Sarah 
Published: June 2021

ABSTRACTObjectivesA systematic review and meta-analysis to determine the association between active maternal smoking and cleft lip and palate etiology.Data SourcesMedline, Embase, Web of Science and the Cochrane database from inception to November 2020.Study selectionObservational studies of cigarette smoking habits in pregnant women. Outcomes included cleft lip and/or palate, cleft lip ± palate and cleft palate only.Data analysisPublication bias analyses were performed and the Newcastle Ottawa scales were used to assess study quality. Fixed or random effect models were used in the meta-analysis, dependent on risk of statistical heterogeneity.ResultsForty-five studies were eligible for inclusion of which 11 were cohort and 34 were case-control studies. Sixteen studies were of sufficient standard for inclusion in the meta-analysis. The summary odds ratio for the association between smoking and cleft lip and/or palate was 1.42 (95%CI 1.27 to 1.59) with a population attributable fraction of 4% (95%CI 3% - 5%). There was limited evidence to show a dose-response effect of smoking.ConclusionsThis review reports a moderate association between maternal smoking and orofacial cleft but the overall quality of the conventional observational studies included was poor. There is a need for high quality and novel research strategies to further define the role of smoking in the etiology of cleft lip and palate.
Quarantine and testing strategies to reduce transmission risk from imported SARS-CoV-2 infections: a global modelling study
Authors: Quilty Billy J , Russell Timothy W , Clifford Samuel , Flasche Stefan , Pickering Suzanne , Neil Stuart JD , Galão Rui Pedro , Edmunds W John ,   CMMID COVID-19 Working Group
Published: June 2021

AbstractBackgroundMany countries require incoming air travellers to quarantine on arrival and/or undergo testing to limit importation of SARS-CoV-2.MethodsWe developed mathematical models of SARS-CoV-2 viral load trajectories over the course of infection to assess the effectiveness of quarantine and testing strategies. We consider the utility of pre and post-flight Polymerase Chain Reaction (PCR) and lateral flow testing (LFT) to reduce transmission risk from infected arrivals and to reduce the duration of, or replace, quarantine. We also estimate the effect of each strategy relative to domestic incidence, and limits of achievable risk reduction, for 99 countries where flight data and case numbers are estimated.ResultsWe find that LFTs immediately pre-flight are more effective than PCR tests 3 days before departure in decreasing the number of departing infectious travellers. Pre-flight LFTs and post-flight quarantines, with tests to release, may prevent the majority of transmission from infectious arrivals while reducing the required duration of quarantine; a pre-flight LFT followed by 5 days in quarantine with a test to release would reduce the expected number of secondary cases generated by an infected traveller compared to symptomatic self-isolation alone, Rs, by 85% (95% UI: 74%, 96%) for PCR and 85% (95% UI: 70%, 96%) for LFT, even assuming imperfect adherence to quarantine (28% of individuals) and self-isolation following a positive test (86%). Under the same adherence assumptions, 5 days of daily LFT testing would reduce Rs by 91% (95% UI: 75%, 98%).ConclusionsStrategies aimed at reducing the risk of imported cases should be considered with respect to: domestic incidence, transmission, and susceptibility; measures in place to support quarantining travellers; and incidence of new variants of concern in travellers’ origin countries. Daily testing with LFTs for 5 days is comparable to 5 days of quarantine with a test on exit or 14 days with no test.
An integrative analysis to predict the Active Ingredients and explore Polypharmacological Mechanisms of Orthosiphon stamineus Benth. for human health
Authors: Wang Xingqiang , Zhao Weiqing , Zhang Xiaoyu , Wang Zongqing , Han Chang , Xu Jiapeng , Yang Guohui , Peng Jiangyun , Li Zhaofu 
Published: June 2021

AbstractBackgroundOrthosiphon stamineus Benth. was a dietary supplement or a traditional folk herb with widespread clinical application, but it was lack of comprehensive understanding of its active ingredients and polypharmacological mechanisms. The aim of this work was to systematically study its natural compounds and the molecular mechanisms of the O. stamineus via network pharmacology.MethodsCompounds from O. stamineus were collected by literature retrieval and evaluated by SwissADME with the physicochemical property (ADMET model) and the likelihood for a natural medicine. The connection of active ingredients and target genes was built and confirmed by Cytoscape and AutoDock vina. Then, Gene Ontology (GO) enrichment analysis and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analysis were separately performed to obtain a more in-depth understanding of O. stamineus. Finally, the relationship among active ingredients, targets, and diseases was built to clarify the polypharmacological mechanisms and found relevant active substances for further drug discovery.ResultsA total of 159 compounds of O. stamineus were collected, and 22 potentially active ingredients were screened out. The Ingredient-Target Interaction Network was built with 12 flavonoids, 3 diterpenes, 3 phenols, and 4 volatile oils, and 65 targets. The Docking analysis indicated that the ingredient-target interaction network was reliable; most ligand-receptor had a strong binding affinity (lowest binding energy: −6.9 kcal/mol). After pathway analysis, 185 significant biological processes and 36 signal pathways were found, and the ingredient-target-disease network of O. stamineus was constructed for polypharmacological mechanisms.ConclusionOur study clarified the polypharmacological mechanisms via the relationship among active ingredients, targets, and diseases and provided better guidance for subsequent experiments and potential active ingredients for drug discovery or health promotion.
A qualitative study exploring the experience of the Medical Intern Programme: Supportive transition for international doctors working in the NHS
Authors: Lavallée J. F. , Conen S. , Corfield D. R. , Howells J. , Pugh M. , Hart J. 
Published: June 2021

AbstractBackgroundThe UK is experiencing a shortage of doctors. Consequently, the Medical Intern Programme, a unique two year programme consisting of an observership, four clinical rotations at the level of a foundation doctor within an NHS Trust and a postgraduate diploma from a university in the north of England, was set up to enhance the NHS workforce by facilitating the entry of international medical graduates into UK medicine via a supported transitional programme. We aimed to explore the experiences of the doctors enrolled on the Medical Intern Programme.MethodsSemi-structured interviews were conducted via the telephone with seven doctors enrolled on the programme. The interview guide was informed by the research questions and data were analysed using a thematic analysis.ResultsWe identified four themes that were important in the experiences of the doctors: preparing to work in the UK, feeling supported, weighing up the pros and cons of the programme and comparisons between countries.ConclusionsThe Medical Intern Programme successfully facilitated international doctors’ transition to the UK and working in the NHS. Support needs to be provided at the organisational, team and individual level including a period of observing and shadowing to enable the doctors to understand the systems and multidisciplinary team working in the NHS.
Engineered small extracellular vesicles as a FGL1/PD-L1 dual-targeting delivery system for alleviating immune rejection
Authors: Tsai Hsiang-i , Wu Yingyi , Liu Xiaoyan , Xu Zhanxue , Liu Longshan , Wang Changxi , Zhang Huanxi , Huang Yisheng , Wang Linglu , Zhang Weixian , Su Dandan , Khan Fahim Ullah , Zhu Xiaofeng , Yang Rongya , Pang Yuxin , Eriksson John E. , Zhu Haitao , Wang Dongqing , Jia Bo , Cheng Fang , Chen Hongbo 
Published: June 2021

AbstractThere is an urgent need for developing new immunosuppressive agents due to the toxicity of long-term use of broad immunosuppressive agents post organ transplantation. Comprehensive sample analysis revealed dysregulation of FGL1/LAG-3 and PD-L1/PD-1 immune checkpoints in allogeneic heart transplantation mice and clinical kidney transplant patients. In order to enhance these two immunosuppressive signal axes, we developed a bioengineering strategy to simultaneously display FGL1/PD-L1 (FP) on the surface of small extracellular vesicles (sEVs). Among various cell sources, FP sEVs derived from mesenchymal stem cells (MSCs) not only enriched FGL1/PD-L1 expression but also maintained the immunomodulatory properties of unmodified MSC sEVs. Next, we confirmed that FGL1 and PD-L1 on sEVs were specifically bound to their receptors LAG-3 and PD-1 on target cells. Importantly, FP sEVs significantly inhibited T cell activation and proliferationin vitroand a heart allograft model. Furthermore, FP sEVs encapsulated with low-dose FK506 (FP sEVs@FK506) exerted stronger effects on inhibiting T cell proliferation, reducing CD8+T cell density and cytokine production in the spleens and heart grafts, inducing regulatory T cells in lymph nodes, and extending graft survival. Taken together, dual-targeting sEVs have the potential to boost the immune inhibitory signalings in synergy and slow down transplant rejection.