bluuebunny/crossref_metadata_2025_split huggingface dataset:
The care of the concussed pediatric patient prior to presentation to primary care pediatrician versus concussion specialists: Implications for management
Authors: Taubman Bruce , Michael Luciani A , Gealt David B , Drake Thomas P , Cochetti Philip , Farrar John T 
Published: March 2021

Objective Absent adequate randomized control trials to inform appropriate treatment for concussion in pediatric patients, guidelines have been developed based on expert opinion and observational data that may not apply to all groups. This study examines differences in the previous clinical care between concussed patients who present in pediatric practice and specialty clinics. Differences found might influence treatment recommendations for each setting. Study design Prospective data collected from a pediatric practice in 2011 to 2013 were compared to chart review data from two specialty clinics between 2015 and 2017. In all three groups patients 11–19 years of age with an ICD9 billing code for concussion were included if they met the 4th International Consensus definition of concussion. Patients were excluded if hospitalized or had abnormal CNS imaging. Results The time between injury and presentation was substantially longer in specialty clinic patients versus those seen in the primary pediatric care office. (median 10 vs. 2 days-p < 0.001) Primary care patients presenting had higher rates of immediate rest after injury, 61.4% vs 27.9% (p < 0.001). More specialty clinic patients had been seen in the emergency departments prior to presentation (47.5% vs. 18.8% p < 0.001) regardless of rest status at presentation to the office. Conclusion Several differences in previous clinical care between the groups were found. These included the time of presentation from injury, rates of cognitive rest both immediate and non-immediate, and emergency department visits. These differences may have implications for management recommendations. Accordingly, the appropriate treatment for patients seen by the primary pediatric care physicians may be different from those referred to specialty care. Given these findings randomized controlled trails should be conducted independently in both groups of patients.
Risk Factors Related to the Presence of Meniscal Injury and Irreparable Meniscal Tear at Primary Anterior Cruciate Ligament Reconstruction
Authors: Tomihara Tomohiro , Hashimoto Yusuke , Takahashi Shinji , Taniuchi Masatoshi , Takigami Junsei , Okazaki Shiro , Shimada Nagakazu 
Published: March 2021

Background: Few studies have attempted to identify risk factors associated with irreparable meniscal tears at anterior cruciate ligament reconstruction (ACLR) and to describe follow-up data, such as the failure rate, after meniscal repair. Purpose: To investigate the associations of age, sex, body mass index (BMI), time to surgery (TTS), and preinjury Tegner score with the presence of meniscal injuries and irreparable meniscal tears at primary ACLR. Study Design: Cross-sectional study; Level of evidence, 3. Methods: A retrospective review was performed on 784 patients who underwent primary ACLR by a single surgeon between 2005 and 2017 (406 men and 378 women; mean age, 25.8 years; mean BMI, 23.1; median TTS, 3 months; median preinjury Tegner score, 7). All patients had a minimum follow-up of 12 months (mean postoperative follow-up, 33.0 months). Multivariate logistic regression analysis was conducted to determine the association of patient variables with the presence of meniscal injuries and irreparable meniscal tears during primary ACLR. Results: The risk factor for medial meniscal injuries was TTS ≥3 months (odds ratio [OR], 4.213; 95% CI, 3.104-5.719; P < .001). The presence of irreparable medial meniscal tears increased with older age (OR, 1.053; 95% CI, 1.024-1.084; P < .001), higher BMI (OR, 1.077; 95% CI, 1.003-1.156; P = .042), and TTS ≥3 months (OR, 1.794; 95% CI, 1.046-3.078; P = .034). On multivariate analysis, none of the variables were significantly associated with lateral meniscal injuries and irreparable meniscal tears. The failure rate, defined as patients who needed additional medial meniscal surgery after medial meniscal repair, was 4.6%. Conclusion: Time from ACL injury to reconstruction of ≥3 months was strongly associated with medial meniscal injuries and irreparable medial meniscal tears at primary ACLR. Older age and increased BMI were also risk factors for the presence of irreparable medial meniscal tears at ACLR.
Arthroscopic Correction of Sports-Related Femoroacetabular Impingement in Competitive Athletes: 2-Year Clinical Outcome and Predictors for Achieving Minimal Clinically Important Difference
Authors: Mullins Karen , Filan David , Carton Patrick 
Published: March 2021

Background: A growing body of literature supports surgical intervention for femoroacetabular impingement (FAI) in young, active athletes. However, factors likely to influence results in this cohort are less clearly defined. Purpose: To quantify changes in validated patient-reported outcome measures (PROMs) and determine whether differences in baseline athlete demographic characteristics, intraoperative findings, and surgical techniques are associated with achieving improved outcomes and minimal clinically important difference (MCID) after arthroscopic management of sports-related FAI. Study Design: Case series; Level of evidence, 4. Methods: Data were prospectively collected from competitive athletes who underwent hip arthroscopy between January 2009 and February 2017. Athletes who underwent primary arthroscopic correction of sports-related FAI with labral repair were included providing they had a Tönnis grade ≤1 and a lateral center-edge angle ≥20°, excluding significant articular cartilage injury and lateral rim dysplasia. The modified Harris Hip Score, Western Ontario and McMaster Universities Osteoarthritis Index, University of California Los Angeles activity scale, and 36-Item Short Form Health Survey were used to measure outcomes at the 2-year follow-up. MCID was measured using 3 methods: a mean change method, a distribution-based method, and the percentage of possible improvement (POPI) method. Multivariate regression models were used to assess a number of diagnostic and surgical variables associated with good outcome and achieving MCID at follow-up. Results: At 2-year follow-up, statistically significant improvements were observed for all PROMs ( P < .001 for all), and 84% of athletes continued to play sport. Higher preoperative PROM scores reduced the likelihood of achieving MCID; however, returning to play was the strongest predictor of reaching MCID in this athletic cohort. Using absolute score change (mean change or distribution method) to calculate MCID was less accurate owing to ceiling effects and dependence on preoperative PROM scores. Conclusion: Athletes undergoing arthroscopy for sports-related FAI can expect a successful outcome and continued sports participation at 2 years postoperatively. The majority of athletes will achieve MCID. The POPI method of MCID calculation was more applicable to higher functioning athletic cohorts. Reduced preoperative PROM scores and the ability to return to sport increased the likelihood of achieving MCID in this population.
Comparison of 2 Oblique Fifth Metatarsal Osteotomies for the Management of a Bunionette
Authors: Paterson Richard , Saragas Nikiforos Pandelis , Ferrao Paulo Norberto Faria 
Published: March 2021

Background: A bunionette is a painful prominence of the fifth metatarsal head. This study aimed to compare the clinical outcome of 2 corrective osteotomies, namely, the Mau-type and Ludloff-type osteotomies. We report results with regard to correction, healing, complications, and patient-reported outcomes. Methods: Thirty-two patients who underwent bunionette corrective surgery from March 2011 to May 2017 were included in the study. All patients had pre- and postoperative radiographs. The pre- and postoperative fourth-fifth intermetatarsal angles (IMAs) and postoperative fifth metatarsal bowing angle were measured. Radiographic union was assessed at 12 weeks. All patients completed the Self-Reported Foot and Ankle Score (SEFAS) questionnaire to assess clinical outcome. Thirty-two patients (43 feet) were available for follow-up and completed the SEFAS score. Twenty-two Mau-type and 21 Ludloff-type osteotomies were performed. Results: The mean pre- and postoperative IMA for Mau was 10.5 and 4.3 degrees, respectively, and for the Ludloff was 10.2 and 4 degrees, respectively, with no statistically significant difference between the 2 groups. The Mau caused more bowing with a mean of 9.8 degrees as compared to a mean of 3.5 degrees with the Ludloff. No patients in the Mau group reported clinical problems related to the increased bowing. All osteotomies united. The Mau cohort had a mean SEFAS score of 45 and the Ludloff cohort a mean of 46. No feet had fair or poor outcome scores. Conclusion: Patient satisfaction after bunionette correction with an oblique shaft rotational osteotomy was good. Orientation of the osteotomy did not affect outcomes. Postoperative bowing of the fifth metatarsal was greater with the Mau-type osteotomy. Postoperative fifth metatarsal bowing had no negative clinical effects. The trend in our unit has been a preference toward the Mau-type osteotomy as it is perceived to be more stable. Level of Evidence: Level III, retrospective comparative series.
Cybersecurity in health is an urgent patient safety concern: We can learn from existing patient safety improvement strategies to address it
Authors: O’Brien Niki , Ghafur Saira , Durkin Mike 
Published: March 2021

Introduction Cybersecurity is a patient safety concern. Recent cyberattacks on healthcare institutions around the world have shown the risks to patients: from delayed treatment as hospitals and clinics are shutdown, to the threat of harm from the theft of personal data, to patient death. The recent Covid-19 pandemic has further increased cyber-attacks on health organisations. In low- and middle-income countries (LMICs) digital health, including the use of health informatics systems and electronic health records, is an increasing part of the health agenda as national governments move to scale up healthcare on the path to achieving Universal Health Coverage. Frontline healthcare workers are often warned of the dangers of data mismanagement and are advised to take precautions to ensure data is safe. However, as many workers are already overstretched with conflicting administrative priorities, cybersecurity risks are going unnoticed. Discussion In this commentary we argue that future education and training interventions for frontline healthcare workers on cybersecurity in LMICs can benefit from lessons learned from other areas of patient safety. Validated interventions, including education and awareness programmes and other simple tools, exist which can offer guidance on how cybersecurity awareness and education may be scaled up in frontline healthcare facilities, without adding an unacceptable burden to staff. Conclusions Efforts to develop frontline interventions on cybersecurity that can be easily implemented and sustained are essential to ensure patient safety is a top priority in a digitally reliant health system.
A thematic analysis of the prevention of future deaths reports in healthcare from HM coroners in England and Wales 2016–2019
Authors: Leary Alison , Bushe David , Oldman Crystal , Lawler Jessica , Punshon Geoffrey 
Published: March 2021

Background The Coroners and Justice Act allows coroners in England or Wales to issue reports after inquest, if they believe that action should be taken to prevent a future death. Coroners are under a statutory duty to issue a Prevention of Future Death (PFD) report to persons or organisations that they believe have the power to act. Cumulatively, these reports may contain useful intelligence for patient safety. The aim of this study was to examine the feasibility of extracting data from these reports and to evaluate if learning was possible from any common themes. Methods Reports were extracted from 2016 to 2019 for deaths in hospitals, care homes and the community in England and Wales. These were subjected to descriptive statistics and thematic analysis of coroner’s concerns. Application of data mining techniques was not possible due to data quality. Results 710 reports were examined, with 3469 concerns being raised (mean 4.88, range 1–33). 36 reports expressed concern about having to issue repeat PFDs to the same organisation for the same or similar concerns. Thematic analysis reliability was high ( κ 0.89 unweighted) with five emerging primary themes: deficit in skill or knowledge, missed, delayed or uncoordinated care, communication and cultural issues, systems issues and lack of resources. A codebook of 53 subthemes were identified. Conclusions PFD reports offer valuable insight. Aggregation and continued analysis of these reports could offer more informed patient safety, workforce development and organisational policy. Improved data quality would allow for possible automation of analysis and faster feedback into practice.
Easy Surgical Approach of the Posterolateral Corner of the Knee
Authors: Guy Sylvain , Rezende Fernando Cury , Ferreira Alexandre , Chadli Lamine , Carrozzo Alessandro , Vieira Thais Dutra , Sonnery-Cottet Bertrand 
Published: March 2021

Background: The anatomy of the posterolateral corner (PLC) of the knee is complex. The approach of the PLC can be a challenging and stressful surgical time. Indications: The indications are posterolateral meniscal repair, open lateral meniscus allograft transplantation, posterolateral tibial plateau fracture, and PLC reconstruction for grade III sprains. Technique Description: The skin incision is straight, realized with the knee positioned at 90° of flexion, passing slightly posterior to the lateral epicondyle, anterior to the fibular head (FH), and ending on Gerdy’s tubercle. The subcutaneous tissues are dissected posteriorly so as to expose the FH and the biceps femoris (BF) tendon. The aponeurosis of the peroneus muscles is incised vertically opposite to the anterior side of the FH. The common fibular nerve is exposed at the neck of the fibula. Metzenbaum scissors are then inserted subaponeurotically, posteriorly, and parallel to the BF tendon, superficially to the nerve. An incision is made opposite the scissor’s blades, freeing the common fibular nerve. The BF tendon is spread forward and the lateral gastrocnemius is pulled posteriorly. Metzenbaum scissors are inserted in a closed position between the lateral gastrocnemius and the posterolateral joint capsule, and then spread to create a triangular door with a proximal base. The base consists of the BF tendon, the posterior side of the lateral gastrocnemius, and the anterior side of the posterolateral joint capsule. A counter-angled Hohmann retractor can now be applied against the posterior tibial plateau to retract the lateral gastrocnemius posteriorly and medially, exposing the PLC of the knee. Results: Noble structures are easily exposed and protected. The common fibular nerve is dissected and reclined posteriorly, and the popliteus vessels are reclined posteriorly and medially, protected by the lateral gastrocnemius. Passing under the BF tendon allows a better vision of the PLC along with less constraint than passing above, as the working window is further away from the femoral insertion of the lateral gastrocnemius. Discussion/Conclusion: The present surgical approach allows a simple, safe, and reproducible exposure of the PLC of the knee.
Anti-inflammatory activity of CD44 antibodies in murine immune thrombocytopenia is mediated by Fcγ receptor inhibition
Authors: Norris Peter A. A. , Kaur Gurleen , Khan Ramsha , Zhu Guangheng , Ni Heyu , Lazarus Alan H. 
Published: March 2021

AbstractMonoclonal immunoglobulin G (IgG) antibodies to CD44 (anti-CD44) are anti-inflammatory in numerous murine autoimmune models, but the mechanisms are poorly understood. Anti-CD44 anti-inflammatory activity shows complete therapeutic concordance with IV immunoglobulin (IVIg) in treating autoimmune disease models, making anti-CD44 a potential IVIg alternative. In murine immune thrombocytopenia (ITP), there is no mechanistic explanation for anti-CD44 activity, although anti-CD44 ameliorates disease similarly to IVIg. Here, we demonstrate a novel anti-inflammatory mechanism of anti-CD44 that explains disease amelioration by anti-CD44 in murine ITP. Macrophages treated with anti-CD44 in vitro had dramatically suppressed phagocytosis through FcγRs in 2 separate systems of IgG-opsonized platelets and erythrocytes. Phagocytosis inhibition by anti-CD44 was mediated by blockade of the FcγR IgG binding site without changing surface FcγR expression. Anti-CD44 of different subclasses revealed that FcγR blockade was specific to receptors that could be engaged by the respective anti-CD44 subclass, and Fc-deactivated anti-CD44 variants lost all FcγR-inhibiting activity. In vivo, anti-CD44 functioned analogously in the murine passive ITP model and protected mice from ITP when thrombocytopenia was induced through an FcγR that could be engaged by the CD44 antibody’s subclass. Consistent with FcγR blockade, Fc-deactivated variants of anti-CD44 were completely unable to ameliorate ITP. Together, anti-CD44 inhibits macrophage FcγR function and ameliorates ITP consistent with an FcγR blockade mechanism. Anti-CD44 is a potential IVIg alternative and may be of particular benefit in ITP because of the significant role that FcγRs play in human ITP pathophysiology.
Research Progress of Thermosensitive Hydrogel in Tumor Therapeutic
Authors: Ma Nian , Yan Zhihui 
Published: March 2021

AbstractCompared with traditional tumor therapy strategies, hydrogel as a drug reservoir system can realize on-demand drug release and deep tissue penetration ability. It also exhibits great tumor-site retention to enhance the permeability and retention effect of tumor treatment. This can significantly overcome the drug's resistance and severe side effects. Inorganic/organic composite hydrogel has attracted wide attention due to its combined effects, enhancing therapeutic effects against various kinds of tumors. In situ injectable hydrogel can securely restrict the drugs in the lesion sites without leakage and guarantee better biosafety. Moreover, hydrogel possesses interconnected macropores which can provide enough space for nutrient transport, cellular activity, and cell–cell interactions. Thermal therapy is an effective strategy for tumor therapy due to its minimal invasiveness and high selectivity. Because the location temperature can be precisely controlled and helps avoid the risks of destroying the body's immune system and ablate normal cells, thermal therapy exhibits significant treatment outcomes. Nonetheless, when the cellular temperature reaches approximately 43 °C, it causes long-term cell inactivation. Based on these merits, thermosensitive hydrogel formulation with adaptive functions shows excellent efficacy, unlimited tissue penetration capacity, and few deleterious side effects. Furthermore, the thermosensitive hydrogel has unique physical properties under the external stimuli, which is the ideal drug delivery system for on-demand release in tumor treatment. This article will review the state of the thermosensitive hydrogel in clinic application for cancer therapy.
OmicLoupe: facilitating biological discovery by interactive exploration of multiple omic datasets and statistical comparisons
Authors: Willforss Jakob , Siino Valentina , Levander Fredrik 
Published: March 2021

AbstractBackgroundVisual exploration of gene product behavior across multiple omic datasets can pinpoint technical limitations in data and reveal biological trends. Still, such exploration is challenging as there is a need for visualizations that are tailored for the purpose.ResultsThe OmicLoupe software was developed to facilitate visual data exploration and provides more than 15 interactive cross-dataset visualizations for omics data. It expands visualizations to multiple datasets for quality control, statistical comparisons and overlap and correlation analyses, while allowing for rapid inspection and downloading of selected features. The usage of OmicLoupe is demonstrated in three different studies, where it allowed for detection of both technical data limitations and biological trends across different omic layers. An example is an analysis of SARS-CoV-2 infection based on two previously published studies, where OmicLoupe facilitated the identification of gene products with consistent expression changes across datasets at both the transcript and protein levels.ConclusionsOmicLoupe provides fast exploration of omics data with tailored visualizations for comparisons within and across data layers. The interactive visualizations are highly informative and are expected to be useful in various analyses of both newly generated and previously published data. OmicLoupe is available at quantitativeproteomics.org/omicloupe
DeltaNeTS+: elucidating the mechanism of drugs and diseases using gene expression and transcriptional regulatory networks
Authors: Noh Heeju , Hua Ziyi , Chrysinas Panagiotis , Shoemaker Jason E. , Gunawan Rudiyanto 
Published: March 2021

AbstractBackgroundKnowledge on the molecular targets of diseases and drugs is crucial for elucidating disease pathogenesis and mechanism of action of drugs, and for driving drug discovery and treatment formulation. In this regard, high-throughput gene transcriptional profiling has become a leading technology, generating whole-genome data on the transcriptional alterations caused by diseases or drug compounds. However, identifying direct gene targets, especially in the background of indirect (downstream) effects, based on differential gene expressions is difficult due to the complexity of gene regulatory network governing the gene transcriptional processes.ResultsIn this work, we developed a network analysis method, called DeltaNeTS+, for inferring direct gene targets of drugs and diseases from gene transcriptional profiles. DeltaNeTS+ uses a gene regulatory network model to identify direct perturbations to the transcription of genes using gene expression data. Importantly, DeltaNeTS+ is able to combine both steady-state and time-course expression profiles, as well as leverage information on the gene network structure. We demonstrated the power of DeltaNeTS+ in predicting gene targets using gene expression data in complex organisms, includingCaenorhabditis elegansand human cell lines (T-cell and Calu-3). More specifically, in an application to time-course gene expression profiles of influenza A H1N1 (swine flu) and H5N1 (avian flu) infection, DeltaNeTS+ shed light on the key differences of dynamic cellular perturbations caused by the two influenza strains.ConclusionDeltaNeTS+ is a powerful network analysis tool for inferring gene targets from gene expression profiles. As demonstrated in the case studies, by incorporating available information on gene network structure, DeltaNeTS+ produces accurate predictions of direct gene targets from a small sample size (~ 10 s). Integrating static and dynamic expression data with transcriptional network structure extracted from genomic information, as enabled by DeltaNeTS+, is crucial toward personalized medicine, where treatments can be tailored to individual patients. DeltaNeTS+ can be freely downloaded fromhttp://www.github.com/cabsel/deltanetsplus.