bluuebunny/crossref_metadata_2025_split huggingface dataset:
Individuals Dispensed Buprenorphine in the United States Before and After Federal Policy Changes Aimed at Increasing Access
Authors: Guy Gery P. , Jones Christopher M. , Rikard Michaela , Strahan Andrea E. , Zhang Kun , Olsen Yngvild 
Published: February 2025

Objectives:
Buprenorphine can decrease opioid use disorder and mortality risk but remains underutilized. This study evaluates changes in monthly buprenorphine dispensing associated with federal policy changes in the United States from 2018 to 2023.

Methods:
This study used interrupted time series analysis comparing the monthly rate of patients dispensed buprenorphine after the implementation of telehealth flexibilities in March 2020, relaxation of training requirements in April 2021, and removal of waiver requirements in December 2022. Buprenorphine formulated for opioid use disorder was included from the IQVIA Total Patient Tracker.

Results:
Before March 2020, the monthly rate of individuals dispensed buprenorphine was increasing. The rate of increase slowed after each policy change: −0.69 (95% CI=−1.00 to −0.39) after telehealth flexibilities were initiated, −0.60 (95% CI=−0.92 to −0.27) after relaxing training requirements, and −0.49 (95% CI=−0.73 to −0.24) after waiver elimination. After the elimination of the waiver, declines were observed across several specialty groups, including pain medicine, emergency medicine, and primary care, while the rate increased among addiction medicine specialists.

Conclusions:
After each policy change, the rate of individuals dispensed buprenorphine increased at a slower rate than before each policy change. These findings suggest that the removal of the waiver, while important, may not be sufficient on its own to meaningfully expand buprenorphine prescribing. Individual and systems-level strategies may be needed to fully optimize the impact of these policy changes focusing on reducing patient, clinician, and institutional stigma, addressing clinician barriers, implementing systems-level improvements, and strengthening payment policies that incentivize prescribing.
Impact of Child Opportunity Index 2.0 and Insurance Type on Timely Access to Anterior Cruciate Ligament Reconstruction Among Children and Adolescents in a Socially Disadvantaged Community
Authors: Samuel Zachariah , Duvvi Anisha , Mehraban ﻿Alvandi Leila , Gjonbalaj Edina , Schulz Jacob F. , Drummond Mauricio , Fornari Eric D. 
Published: February 2025

Background:
This study aimed to evaluate the influence of socioeconomic status (SES), assessed by child opportunity index (COI) and insurance type, on access to orthopaedic care after pediatric ACL rupture. The secondary aim was to determine whether delays to care were associated with additional procedures at the time of ACL reconstruction (ACLR).

Methods:
This IRB-approved retrospective study reviewed 238 patients aged 10 to 21 who underwent primary ACLR between 2013 and 2021 at a tertiary care center. Demographic and clinical data were obtained via chart review. The time intervals analyzed included the date of injury to the initial orthopaedic visit, the date of the initial visit to the MRI examination, and the date of the MRI examination to surgery. Patients were grouped by time intervals of ≤30 days versus >30 days. COI scores (total and 3 domains: education, SES, and health) were determined by ZIP code and assigned quintile-ranking scores (very low/low and moderate/high/very high). χ2 and Fisher exact tests were used to compare patients with prompt versus delayed orthopaedic care.

Results:
A total of 238 patients (mean age 16.51±1.73, 66.0% male, 63.1% public insurance, and 87.4% with very low or low total COI scores) were included in this study. There were no significant differences in insurance type or demographics between those with prompt or delayed care. No significant differences were found in total COI, education COI, socioeconomic COI, or health COI between patients with care within or after 30 days. Patients with delayed initial orthopaedic visits had a significantly higher prevalence of meniscus tears requiring repair (56.7% vs. 38.9%, P=0.004) or meniscectomy (24.7% vs. 22.9%, P=0.004).

Conclusions:
Lower SES, as measured by COI and public insurance, did not impact time to orthopaedic care after pediatric ACL injury. Within a predominantly minority population with low COI, the effect of COI on access to care may be less pronounced than in white-majority settings. Community-based interventions may help recognize telltale signs of ACL injury, ensuring an orthopaedic visit within a month of injury and decreasing the incidence of meniscus tears.

Level of Evidence:
Level III—retrospective cohort study.
A Double-blinded, Randomized Controlled Trial Assessing Outcomes in Standard De Quervain Surgery Versus Surgery With Intraoperative Corticosteroid Injection Adjunct
Authors: Jaroenporn Woraphon , Sritiengtrong Nuttapong , Vechasilp Jaruwat , Nitiwarangkul Lertkong , Pituckanotai Kwanchai , Harnboonseth Wisaroot 
Published: February 2025

Background:
De Quervain tenosynovitis is a condition affecting the first dorsal compartment of the wrist. While corticosteroid injections offer fast but short-term pain relief, surgery remains the gold standard, yielding excellent long-term clinical outcomes. However, postoperative pain, identified in multiple studies, has been implicated in prolonged recovery.

Methods:
This study aimed to assess the effectiveness of standard open surgery versus surgery with adjunct intraoperative local corticosteroid injection in De Quervain tenosynovitis through a double-blinded, randomized controlled trial conducted from 2019 to 2022. The trial included 108 patients, with 54 in the standard open surgery group and 54 in the adjunct intraoperative local corticosteroid injection group. The evaluation comprised preoperative and postoperative assessments using the Visual Analog Scale (VAS) and quick disabilities of the arm, shoulder, and hand (QuickDASH) scores.

Results:
The mean postoperative VAS score in the adjunct intraoperative local corticosteroid injection group significantly improved from the first day to the 14th day postoperation (P < 0.05). The mean QuickDASH score demonstrated significant improvement at 7th and 14th days of follow-up (P < 0.05). However, after the 28th day of follow-up, no significant differences in mean VAS and QuickDASH scores were observed. Notably, 2 patients in the adjunct local corticosteroid group experienced postoperative skin hypopigmentation.

Conclusions:
Surgical release stands as the gold standard treatment for De Quervain disease, ensuring complete symptom relief. The adjunct treatment with local corticosteroid injection showed promise in providing earlier symptom relief and expediting recovery, particularly in the initial 2 weeks postsurgery.

Levels of Evidence:
Level IV—therapeutic study.
Associations of physical activity, sedentary behavior, and sleep with risk of incident Parkinson’s disease: A prospective cohort study of 401,697 participants
Authors: Jiao Haishan , Huang Shuyi , Cheng Wei , Feng Jianfeng , Yu Jintai 
Published: February 2025

Abstract

Background:
Physical activity, sedentary behavior (SB), and sleep duration are associated with brain health. Effects of those on developing Parkinson’s disease (PD) are poorly investigated. This study aimed to examine the independent and joint associations of physical activity, SB, sleep with PD risk.

Methods:
We analyzed data on 401,697 participants from the UK Biobank cohort, which was enrolled in 2006–2010. Physical activities were measured based on a questionnaire. Sleep and SB time were defined through self-reported total number of hours. Models fitted with restricted cubic spline were conducted to test for linear and non-linear shapes of each association. Cox proportional hazards regression models were used to estimate the association of three modifiable behaviors.

Results:
Our analytic sample included 401,697 participants with 3030 identified cases of PD (mean age, 63 years; 62.9% male). PD risk was 18% lower in the high total physical activity group (95% CI, 0.75–0.90), 22% lower in the high leisure-time physical activity (LTPA) group (95% CI, 0.71–0.86) compared with the low level and 14% higher in the high sleep duration group (95% CI, 1.05–1.24) compared to moderate group. Total SB time was irrelevant with PD risk, while high TV viewing showed a 12% increase of PD risk compared to the low group (95% CI, 1.02–1.22). Low computer use (0 h/day) was associated with a 14% higher risk compared to 1 h/day use (95% CI, 1.04–1.26). Those associations were independent. A combination of 7 h/day sleep, moderate-to-high computer use, and moderate-to-vigorous intensity of LTPA showed lowest PD risk (HR, 0.70; 95% CI, 0.57–0.85).

Conclusions:
Physical activity, SB, and sleep were associated with PD risks separately. Our findings emphasize the possibility for changing these three daily activities concurrently to lower the risk of PD. These findings may promote an active lifestyle for PD prevention.
Subclinical hypothyroidism in pregnancy: an evolving and controversial landscape
Authors: Aberle Laurel , Nguyen Caroline T. 
Published: February 2025

Purpose of review
This review aims to elucidate the developments in subclinical hypothyroidism (SCH) in pregnancy effects, management, and treatment. While mostly focusing on recent research, landmark studies are briefly reviewed to highlight major developments since their publication.

Recent findings
Research has continued to show an increased risk of adverse outcomes in pregnant women with SCH, with recent research showing an increased risk of both impaired glucose tolerance and hypertensive disorders of pregnancy. Research has continued to show unclear effects of SCH on neonatal outcomes, specifically in offsprings’ intellectual development and ability. The benefit of treatment of SCH continues to be unclear; however, data suggest that treatment for thyroid stimulating hormone (TSH) 2.5–4 mU/l regardless of thyroid peroxidase antibodies status and TSH 4–10 mU/l in later pregnancy has not shown maternal or neonatal benefit.

Summary
With varying guidelines and inconsistent research outcomes, it is not surprising that SCH practices differ widely. Further research, with uniform definitions and criteria of SCH, is needed to elucidate the optimal management and treatment of this common pregnancy condition. Additionally, further research specifically aimed at optimizing TSH in preconception and early pregnancy is needed.
Normative BREAST-Q Scores in Sub-Saharan African Women: Interpreting the Impact of Mastectomy and Reconstruction
Authors: Baglien Brigit D. , Ganesh Kumar Nishant , Kennedy Sarah H. , Bekele Mahteme , Hoyte-Williams Paa Ekow , Ezeome Emmanuel E.R. , Momoh Adeyiza O. 
Published: February 2025

Background:
Breast cancer is a leading cause of mortality among women in sub-Saharan Africa (SSA). As such, optimizing outcomes for treatment and reconstruction is a global health priority. Currently, normative data for interpreting BREAST-Q results are limited to high-income countries. This study seeks to evaluate baseline breast-related quality of life in SSA women without breast cancer and compare it with previously published normative values.

Methods:
Women in Ghana, Nigeria, and Ethiopia 18 years of age and older with no history of breast cancer or breast surgery were recruited to complete the BREAST-Q preoperative mastectomy module. Multivariable regression was performed to identify correlations between sociodemographic variables and BREAST-Q scores. Comparisons were made between normative data previously published in high-income countries and within individual SSA populations.

Results:
Normative BREAST-Q scores were obtained from a total of 453 women (169 Ghanaian, 210 Nigerian, and 74 Ethiopian) with a mean age of 26 ± 7 years and body mass index of 26 ± 6 kg/m2. Scores were as follows: satisfaction with breasts, 64 ± 26; psychosocial well-being, 63 ± 23; sexual well-being, 57 ± 26; and physical well-being, 68 ± 16. Compared with scores published in the United States, SSA women scored higher in breast satisfaction and lower in psychosocial and physical well-being. Significant differences in scores were also found among countries in SSA.

Conclusions:
This study establishes normative values for the BREAST-Q mastectomy module in a group of women in SSA without breast cancer and found significant variability globally and among countries within the same region.
Silencing FAF2 mitigates alcohol-induced hepatic steatosis by modulating lipolysis and PCSK9 pathway
Authors: Huda Nazmul , Kusumanchi Praveen , Jiang Yanchao , Gao Hui , Thoudam Themis , Zeng Ge , Skill Nicholas J. , Sun Zhaoli , Liangpunsakul Suthat , Ma Jing , Yang Zhihong 
Published: February 2025

Background:
Chronic alcohol consumption leads to lipid accumulation, oxidative stress, cellular damage, and inflammation in the liver, collectively referred to as alcohol-associated liver disease (ALD). FAF2/UBXD8/ETEA (Fas-associated factor 2) is a ubiquitin ligase adaptor protein that plays a crucial role in the ubiquitin-mediated degradation of misfolded proteins in the endoplasmic reticulum. A recent genome-wide association study indicated an association between FAF2 and ALD; however, the exact contribution of FAF2 to ALD pathogenesis remains unclear.

Methods:
FAF2 was knocked down using AAV-delivered shRNA in C57/BL6 mice. Mice were subjected to a chronic-plus-single binge ethanol feeding (NIAAA) model. Nine hours after gavage, liver, blood, and other organs of interest were collected for gene expression and biochemical analyses.

Results:
We first observed a significant elevation in hepatic FAF2 protein expression in individuals with ALD and in mice subjected to an ethanol-binge model. Interestingly, knocking down FAF2 in the liver using adeno-associated virus serotype 8–delivered short hairpin RNA conferred a protective effect against alcohol-induced liver steatosis in ethanol-binged mice. Transcriptomic analysis revealed that differentially expressed genes were enriched in multiple lipid metabolism regulation pathways. Further analysis of transcription factors regulating these differentially expressed genes suggested potential regulation by SREBP1. Several SREBP1 target genes, including Fasn, Scd1, Lpin1, and Pcsk9 (proprotein convertase subtilisin/kexin type 9), were dysregulated in the livers of ethanol-fed FAF2 knockdown mice. Additionally, Pcsk9 could be regulated through the FOXO3-SIRT6 pathway in the livers of ethanol-fed FAF2 knockdown mice, leading to increased liver low-density lipoprotein receptor expression and reduced plasma LDL cholesterol levels. Furthermore, FAF2 knockdown in mouse liver enhanced adipose triglyceride lipase lipolytic activity by upregulating the adipose triglyceride lipase activator, comparative gene identification-58, and downregulating the adipose triglyceridelipase transport inhibitor, Elmod2, contributing to the alleviation of liver steatosis.

Conclusions:
Our study uncovers a novel mechanism involving FAF2 in the pathogenesis of ALD.
Recent advancements in optic disc pit maculopathy management
Authors: Yokoi Tadashi , Ni Roselind L. , Sivalingam Meera D. , Yonekawa Yoshihiro 
Published: February 2025

Purpose of review
Optic disc pit maculopathy (ODPM) is a rare yet serious condition that can lead to visual impairment. While pars plana vitrectomy (PPV) remains the gold standard for ODPM that requires treatment, there is ongoing debate regarding adjunctive surgical techniques. This review explores the latest surgical advancements and innovations in the management of ODPM from the past few years.

Recent findings
Vitrectomy remains an effective procedure for ODPM management, achieving high success rates. Adjunctive techniques, including internal limiting membrane (ILM) peeling, gas tamponade, and juxtapapillary laser photocoagulation, have demonstrated efficacy, though their roles remain debated. Novel approaches using ILM plugging, amniotic membrane grafts, and autologous platelet concentrate offer promise, especially in refractory cases. High-level evidence remains scarce, and most recent publications are relatively small case series. Therefore, it remains unclear whether the additional techniques confer additional benefit beyond vitrectomy alone, although the novel approaches can be effective options for refractory cases. Larger comparative studies are required to provide better evidence.

Summary
Vitrectomy with or without additional maneuvers is an effective treatment for ODPM. Emerging adjunctive surgical techniques provide new possibilities, but further research is required to assess for comparative efficacy and optimize outcomes.
Evidence of Poor Utility of Current Sepsis Screening Tools in an At-Risk Population of Children With Community-Acquired Pneumonia
Authors: Roland Damian , Stohr Wolfgang , Gibb Diana , Sturgeon Kate , Bielicki Julia Anna , Lyttle Mark D. 
Published: February 2025

Background:
Children (6–24 kg) with lower respiratory tract infections were prospectively recruited in emergency departments to high or low doses of oral amoxicillin. We identified children who met the criteria for medium and high risks of sepsis, as per the UK’s National Institute for Health and Care Excellence (NICE). Of those able to be discharged with oral antibiotics; 54% (318/591) had high-risk sepsis criteria. NICE sepsis guidance is poorly specific, with implications for antimicrobial resistance and iatrogenic patient harm.

Methods:
Children (6–24 kg) with lower respiratory tract infections were prospectively recruited in emergency departments to high or low doses of oral amoxicillin.

Results:
Of those able to be discharged with oral antibiotics, 54% (318/591) had high-risk sepsis criteria as per the UK’s NICE.

Conclusions:
NICE sepsis guidance is poorly specific, with implications for antimicrobial resistance and iatrogenic patient harm.
Evaluation of Ceftazidime-avibactam and Ceftolozane-tazobactam Prescriptions in a Tertiary Hospital for Children in France: An Observational Study, 2017–2022
Authors: Labé Pauline , Husain Maya , Parize Perrine , Grimaud Marion , Roy Charlotte , Ratiney Robert , Cohen Jérémie F. , Lecuyer Hervé , Toubiana Julie 
Published: February 2025

Background:
Infections caused by drug-resistant Gram-negative bacteria, including carbapenem-resistant Enterobacterales and Pseudomonas aeruginosa, are emerging in pediatric hospitals. New ß-lactam/ ß-lactamase inhibitor combinations exhibit activity against these pathogens; however, there is limited data regarding their use in pediatric populations.

Objectives:
The study aimed to describe the characteristics of ceftazidime-avibactam (CAZ/AVI) and ceftolozane-tazobactam (C/T) prescriptions in children and assess their appropriateness.

Methods:
We retrospectively analyzed all CAZ/AVI or C/T prescriptions in children hospitalized in a French tertiary hospital between 2017 and 2022. All clinical, biological, and pharmacological data were collected prospectively as part of the antibiotic monitoring program set up by our antimicrobial stewardship (AMS) team.

Results:
In total, 50 CAZ/AVI and 25 C/T prescriptions were recorded, which concerned 21 and 20 patients, respectively. All patients had an underlying chronic condition. Most prescriptions originated from Pediatric Intensive Care Units and the Department of Pediatric Pulmonology and were mainly initiated for respiratory tract infections (n = 41/50, 82% of the CAZ/AVI prescriptions and n = 14/25, 56% of the C/T prescriptions). P. aeruginosa was the primary pathogen in documented infections for both CAZ/AVI and C/T prescriptions (n = 26/48, 54% and n = 16/19, 84%, respectively). Almost all prescriptions of CAZ/AVI and C/T were considered appropriate (n = 47/50, 94% for CAZ/AVI and n = 23/25, 92% for C/T, respectively) by the AMS team. Both CAZ/AVI and C/T treatments were well tolerated and resulted in clinical success in 33 (66%) and 19 (76%) cases, respectively.

Conclusion:
Our study suggests that CAZ/AVI and C/T are reasonable treatment options for children infected with Gram-negative pathogens resistant to carbapenems.
Dysmenorrhea and the clinical encounter: testing a conceptual model of physician–patient interactions among emerging adults
Authors: Brilz Alexandra R. , Gagnon Michelle M. 
Published: February 2025

Abstract
Dysmenorrhea affects as much as 85% of female youth in Canada and the United States and can negatively impact academic performance, overall health, and mental well-being. The physician–patient relationship can play an important role in supporting patients with pain conditions, such as dysmenorrhea. Through effective communication, trust, and validation, physician–patient interactions can empower pain patients, potentially improving pain outcomes. To date, no studies have quantitatively examined the impact of physician–patient interactions on youth's experiences of dysmenorrhea. Therefore, our aim was to explore the relationships among perceived physician communication, pain invalidation, trust in the physician, treatment adherence, menstrual sensitivity, and dysmenorrhea symptom severity among emerging adults (EA) and test a conceptual model of potential interactions using partial least squares structural equation modeling (PLS-SEM). The online survey was administered to Canadian and American EA aged 18 to 21 (M
age = 19.4, SD = 1.1) years with dysmenorrhea. Two models were tested using PLS-SEM: model A only included participants who had received a treatment plan from their physician (n = 279) and model B included the full data set (N = 362). In both models, the perception of more effective physician communication and reduced pain invalidation were related to lower dysmenorrhea symptom severity through menstrual sensitivity. In model A, better physician communication and lower pain invalidation were also associated with higher reported treatment adherence by trust in the physician; however, neither treatment adherence nor trust in the physician were associated with dysmenorrhea symptom severity. Future research should include additional elements within the clinical encounter and further refine the model.
Cortical reorganization in neuropathic pain due to peripheral nerve degeneration: altered cortical surface morphometry and hierarchical topography
Authors: Lin Chien-Ho (Janice) , Hsueh Hsueh-Wen , Chiang Ming-Chang , Hsieh Sung-Tsang , Chao Chi-Chao 
Published: February 2025

Abstract
Degeneration of peripheral nerves causes neuropathic pain. Previous studies have documented structural and functional brain alterations in peripheral neuropathy, which may be attributed to maladaptive plasticity following chronic neuropathic pain. Nevertheless, the effects of peripheral neuropathic pain on the macroscale organization of the cerebral cortex have not been explored. This study investigated altered surface morphology and topographic hierarchy of the cerebral cortex in patients with neuropathic pain due to peripheral neuropathy. T1-weighted magnetic resonance imaging data were acquired from 52 patients with peripheral neuropathic pain and 50 age- and sex-matched healthy controls. Cortical morphometric features including thickness and gyrification index were obtained using surface-based morphometry. A topographic gradient encoding interregional similarity in cortical thickness was extracted using a machine-learning technique named diffusion map embedding. Compared with controls, patients with neuropathic pain exhibited cortical thinning in the frontal and sensorimotor cortices, with the severity increasing with greater neuropathic pain. The patients also showed decreased gyrification in the insula, with a greater reduction in gyrification linked to more severe skin nerve degeneration. Moreover, the patients exhibited altered topographic organization of the cerebral cortex, where the direction of the topographic gradient deviated from the occipital-to-frontal axis observed in the controls in this study and reported in the literature. Our findings provided a novel perspective for macroscale cortical structural reorganization after neuropathic pain, showing thinning and gyral flattening in pain-related areas and deviation from the normal topographic axis of the cerebral cortex.