bluuebunny/crossref_metadata_2025_split huggingface dataset:
Incidence and Long-term Follow-up of Pediatric Lateral Condyle Fractures: A Population-based Study
Authors: Wellings Elizabeth P. , Sullivan Mikaela H. , Thapa Prabin , Grigoriou Emmanouil , Stans Anthony A. , Shaughnessy William J. , Larson A. Noelle , Milbrandt Todd A. 
Published: November 2024

Objective:
Lateral condyle fractures are the second most common pediatric elbow fracture after supracondylar humeral fractures. Early complications are frequent which can lead to development of long-term problems. Current literature has evaluated short-term outcomes, but few studies have investigated long-term outcomes into adulthood. Our hypothesis is that the majority of pediatric patients with a lateral condyle fracture will have minimal complications and few surgeries as they age.

Methods:
A population-based database was used to identify patients who sustained a lateral condyle fracture before the age of 18 between 1966 and 2012. Electronic medical records from all treatment centers in the county were reviewed for clinical and radiographic data. Analysis was performed to determine incidence and long term outcomes based on fracture type and treatment.

Results:
From 1966 to 2012, 227 pediatric lateral condyle fractures were identified. One hundred seventy-seven fractures (78%) had at least 10 year clinical follow up. Incidence was found to be 13.97 per 100,000. We identified 80 (45%) Weiss type 1, 61 (34%) type 2, and 37 (21%) type 3 fractures. The overall complication rate was 17%, of which 47% were identified >10 years from injury. There was no significant difference in complication rates based on fracture type (P = 0.18) or treatment type (P = 0.55). The most common complication was malunion (n = 15), followed by fishtail deformity (n = 4), stiffness (n = 3), lateral epicondylitis (n = 3), nonunion (n = 2), osteoarthritis (n = 2), and tardy ulnar nerve palsy (n = 1). Five patients underwent revision surgery for nonunion, cubitus valgus, malunion with loose bodies, capitellar osteochondral dessicans with malalignment, and ulnar nerve palsy.

Conclusions:
This population-based study estimated the overall incidence of pediatric lateral condyle fractures to be 14 per 100,000. Displaced fractures had a higher incidence than undisplaced fractures. Complications beyond 10 years are rare, but the need for future revision surgery is possible, therefore, proper patient and family education is necessary at the time of injury. This is the largest study with the longest follow-up for pediatric lateral condyle fractures. Complications were rare but resulted in a 17% complication rate and a 3% reoperation rate at a minimum.

Level of Evidence:
Level III.
Changes in Segmental and Lumbar Lordosis Following Lumbar Interbody Fusion
Authors: Lechtholz-Zey Elizabeth A. , Ayad Mina , Gettleman Brandon S. , Mills Emily S. , Shelby Hannah , Ton Andy , Karakash William J. , Shah Ishan , Wang Jeffrey C. , Alluri Ram K. , Hah Raymond J. 
Published: November 2024

Study Design:
Systematic review and meta-analysis.

Objective:
To compare radiographic outcomes across lumbar interbody fusion (LIF) techniques, assessing segmental and global lumbar lordosis restoration.

Summary of Background Data:
LIF is a commonly utilized procedure to treat various spinal conditions, including degenerative pathology and adult spinal deformity. Common approaches include posterior LIF (PLIF), transforaminal LIF (TLIF), anterior LIF (ALIF), oblique LIF (OLIF), and lateral LIF (LLIF).

Methods:
A systematic review and meta-analysis were carried out using PRISMA guidelines with appropriate MeSH terms. Papers were included based on relevance, number of patients, and a minimum of 1-year radiographic follow-up. Radiographic outcomes included segmental lordosis (SL) and lumbar lordosis (LL). Only papers directly comparing SL restoration between two or more LIF techniques were utilized in the systematic review, while all articles meeting the aforementioned criteria were used in the meta-analysis.

Results:
Nineteen studies were included in the final systematic review, and 88 papers were included in the meta-analysis. Seven studies in the systematic review showed a significantly higher increase in SL with ALIF versus TLIF, and two showed significantly higher SL gain with ALIF compared with LLIF. When comparing ALIF versus OLIF, one study favored ALIF, while another favored OLIF for SL restoration. OLIF likewise demonstrated superior restoration of SL compared with TLIF. LLIF demonstrated improved SL restoration compared with TLIF in 2 of the 3 studies comparing the 2 procedures. Furthermore, both ALIF and OLIF demonstrated superior LL restoration compared with TLIF in 4 and 3 studies, respectively. The meta-analysis results demonstrated that ALIF provided significantly better restoration of SL than TLIF, LLIF, and OLIF, while TLIF conferred significantly lower SL restoration than ALIF and OLIF. Similarly, LL restoration was significantly reduced with TLIF relative to OLIF and LLIF (all P<0.05).

Conclusions:
The included studies demonstrated superior SL and LL restoration with ALIF, OLIF, and LLIF compared with TLIF. ALIF improved SL to a greater extent when directly compared with all other interbody techniques.
Induction Agents for Tracheal Intubation in Critically Ill Patients
Authors: Kotani Yuki , Russotto Vincenzo 
Published: November 2024

OBJECTIVES:
Concise definitive review of the use of induction agents in critically ill patients undergoing tracheal intubation and their association with outcomes.

DATA SOURCES:
Original publications were retrieved through a PubMed search with search terms related to induction agents for tracheal intubation in critically ill patients.

STUDY SELECTION:
We included randomized controlled trials and observational studies that reported patient outcomes.

DATA EXTRACTION:
Data from included studies, including choice of induction agents and clinically relevant outcomes, were extracted.

DATA SYNTHESIS:
Etomidate and ketamine have been the most studied induction agents in critical care during last years. Recent studies on etomidate investigated the clinical impact of its recognized adrenal suppression in terms of morbidity and mortality. Etomidate may carry a non-negligible mortality risk without definitive hemodynamic benefits compared with ketamine. Available data then support the use of ketamine over etomidate, since the difference in the hemodynamic profile seems to be of minor clinical relevance. No multicenter randomized studies are available comparing propofol to other induction agents but evidence from a large observational study identified an association of propofol with post-intubation cardiovascular instability in critically ill patients. Despite the observational nature of these findings cannot exclude the role of confounders, the association of propofol with post-induction cardiovascular instability is pharmacologically plausible, justifying its avoidance in favor of drugs with a better safety profile in critical care such as ketamine.

CONCLUSIONS:
Although no definitive conclusions can be drawn based on the available evidence, recent evidence pointed out the potential negative effect of etomidate on survival and the association of propofol with cardiovascular instability. Ketamine may be considered the drug with a safer profile, widespread availability and low cost but future research should provide definitive data on optimal drug selection, its dosage in the context of critical illness and concomitant interventions to minimize the risk of peri-intubation complications.
Advancing Delirium Treatment Trials in Older Adults: Recommendations for Future Trials From the Network for Investigation of Delirium: Unifying Scientists (NIDUS)
Authors: Devlin John W. , Sieber Frederick , Akeju Oluwaseun , Khan Babar A. , MacLullich Alasdair M. J. , Marcantonio Edward R. , Oh Esther S. , Agar Meera R. , Avelino-Silva Thiago J. , Berger Miles , Burry Lisa , Colantuoni Elizabeth A. , Evered Lis A. , Girard Timothy D. , Han Jin H. , Hosie Annmarie , Hughes Christopher , Jones Richard N. , Pandharipande Pratik P. , Subramanian Balachundhar , Travison Thomas G. , van den Boogaard Mark , Inouye Sharon K. ,   on behalf of the Network for Investigation of Delirium: Unifying Scientists (NIDUS) Writing Group
Published: November 2024

OBJECTIVES:
To summarize the delirium treatment trial literature, identify the unique challenges in delirium treatment trials, and formulate recommendations to address each in older adults.

DESIGN:
A 39-member interprofessional and international expert working group of clinicians (physicians, nurses, and pharmacists) and nonclinicians (biostatisticians, epidemiologists, and trial methodologists) was convened. Four expert panels were assembled to explore key subtopics (pharmacological/nonpharmacologic treatment, methodological challenges, and novel research designs).

METHODS:
To provide background and context, a review of delirium treatment randomized controlled trials (RCTs) published between 2003 and 2023 was conducted and evidence gaps were identified. The four panels addressed the identified subtopics. For each subtopic, research challenges were identified and recommendations to address each were proposed through virtual discussion before a live, full-day, and in-person conference. General agreement was reached for each proposed recommendation across the entire working group via moderated conference discussion. Recommendations were synthesized across panels and iteratively discussed through rounds of virtual meetings and draft reviews.

RESULTS:
We identified key evidence gaps through a systematic literature review, yielding 43 RCTs of delirium treatments. From this review, eight unique challenges for delirium treatment trials were identified, and recommendations to address each were made based on panel input. The recommendations start with design of interventions that consider the multifactorial nature of delirium, include both pharmacological and nonpharmacologic approaches, and target pathophysiologic pathways where possible. Selecting appropriate at-risk patients with moderate vulnerability to delirium may maximize effectiveness. Targeting patients with at least moderate delirium severity and duration will include those most likely to experience adverse outcomes. Delirium severity should be the primary outcome of choice; measurement of short- and long-term clinical outcomes will maximize clinical relevance. Finally, plans for handling informative censoring and missing data are key.

CONCLUSIONS:
By addressing key delirium treatment challenges and research gaps, our recommendations may serve as a roadmap for advancing delirium treatment research in older adults.
Myoclonus After Cardiac Arrest: Need for Standardization—A Systematic Review and Research Proposal on Terminology
Authors: De Stefano Pia , Leitinger Markus , Misirocchi Francesco , Quintard Hervé , Degano Giulio , Trinka Eugen 
Published: November 2024

OBJECTIVES:
Although myoclonus less than or equal to 72 hours after cardiac arrest (CA) is often viewed as a single entity, there is considerable heterogeneity in its clinical and electrophysiology characteristics, and its strength of association with outcome. We reviewed definitions, electroencephalogram, and outcome of myoclonus post-CA to assess the need for consensus and the potential role of electroencephalogram for further research.

DATA SOURCES:
PubMed, Embase, and Cochrane databases.

STUDY SELECTION:
English-language adult (≥ 18 yr) studies from 1966 to May 31, 2024, reporting myoclonus, myoclonic status/status myoclonus (MyS/SM), myoclonic status epilepticus (MSE), and/or early Lance-Adams Syndrome (eLAS) less than or equal to 72 hours post-CA. All study designs were independently screened by two authors.

DATA EXTRACTION:
Data on patients presenting myoclonus, MyS/SM, MSE, and eLAS less than or equal to 72 hours post-CA, along with their definitions, electroencephalogram, and outcomes were extracted. The Newcastle-Ottawa Scale and Cochrane-Risk-of-Bias Assessment tool were used to evaluate study quality (PROSPERO n.CRD42023438107).

DATA SYNTHESIS:
Of 585 identified articles, 119 met the inclusion criteria, revealing substantial heterogeneity in definitions, electroencephalogram, and outcomes. Among 3881 patients, myoclonus was reported in 2659, MyS/SM in 883, MSE in 569, and eLAS in 40. Among patients with a defined outcome, a Cerebral Performance Category (CPC) scale of 1–2 was reported in 9.8% of patients with myoclonus, 5.8% with MyS/SM, 5.7% with MSE, and 82.0% with eLAS. Electroencephalogram was recorded in 2714 patients (69.9%). CPC of 1–2 was observed in 1.6% of patients with suppression/suppression burst (SB)/unreactive (U) electroencephalogram, 11.3% with non-SB/U electroencephalogram and status epilepticus (SE), and 22.3% with non-SB/U electroencephalogram without SE.

CONCLUSIONS:
Heterogeneity in definitions resulted in weak associations with outcomes. We propose to investigate myoclonus by including related electroencephalogram patterns: myoclonus associated with suppression/SB background electroencephalogram, myoclonus with nonsuppression/SB background but SE-electroencephalogram, and myoclonus with nonsuppression/SB background without SE-electroencephalogram. This pragmatic research approach should be validated in future studies.
Microneedling in Localized Acquired Hypomelanosis: A Randomized Controlled Trial
Authors: Elhoshy Khaled , Ibrahim Julbahar , Hafez Vanessa 
Published: November 2024

BACKGROUND
Several insults can cause acquired localized hypomelanosis which can be a therapeutic challenge. Microneedling is a minimally invasive procedure that stimulates melanogenesis with the benefit of short downtime and a low risk of scarring.

OBJECTIVE
To determine the efficacy and safety of microneedling in localized acquired hypomelanosis.

MATERIALS AND METHODS
This is a randomized controlled trial. Twenty patients aged 18 years and older had their lesions randomized into either a single session of microneedling with 1.5-mm needles or no treatment. Three months later, peripheral tanning, patient satisfaction, surface tanning grade of improvement, Vitiligo Extent Score for a Target Area (VESTA), patient and physician global assessment of improvement (GAI) were evaluated.

RESULTS
Median peripheral tanning was observed in 80% of lesions in the microneedling arm versus 85% in the no-treatment arm. Median physician GAI was 37.5% versus 33.33%, respectively. Median VESTA was 37.5% versus 29%, respectively. Median Patient GAI was 50% in both arms. Surface tanning showed a median increase of +3 grades in both arms.

CONCLUSION
Medium-depth microneedling deserves a place in the armamentarium of therapeutic tools for localized acquired hypomelanosis in normal-texture and scarred skin. The authors suggest repetitive sessions at intervals of 1 to 2 months to offer better coverage. Interestingly, a possible systemic effect of microneedling deserves further investigation.
Low-level PM2.5 Exposure, Cardiovascular and Nonaccidental Mortality, and Related Health Disparities in 12 US States
Authors: Peralta Adjani A. , Castro Edgar , Danesh Yazdi Mahdieh , Kosheleva Anna , Wei Yaguang , Schwartz Joel 
Published: November 2024

Background
Investigations into long-term fine particulate matter (PM2.5) exposure’s impact on nonaccidental and cardiovascular (CVD) deaths primarily involve nonrepresentative adult populations at concentrations above the new Environmental Protection Agency annual PM2.5 standard.

Methods
Using generalized linear models, we studied PM2.5 exposure on rates of five mortality outcomes (all nonaccidental, CVD, myocardial infarction, stroke, and congestive heart failure) in 12 US states from 2000 to 2016. We aggregated predicted annual PM2.5 exposures from a validated ensemble exposure model, ambient temperature from Daymet predictions, and mortality rates to all census tract–years within the states. We obtained covariates from the decennial Census and the American Community Surveys and assessed effect measure modification by race and education with stratification.

Results
For each 1-µg/m3 increase in annual PM2.5, we found positive associations with all five mortality outcomes: all nonaccidental (1.08%; 95% confidence interval [CI]: 0.96%, 1.20%), all CVD (1.27%; 95% CI: 1.14%, 1.41%), myocardial infarction (1.89%; 95% CI: 1.67%, 2.11%), stroke (1.08%; 95% CI: 0.87%, 1.30%), and congestive heart failure (2.20%; 95% CI: 1.97%, 2.44%). Positive associations persisted at <8 µg/m3 PM2.5 levels and among populations with only under 65. In our study, race, but not education, modifies associations. High-educated Black had a 2.90% larger increased risk of CVD mortality (95% CI: 2.42%, 3.39%) compared with low-educated non-Black.

Conclusion
Long-term PM2.5 exposure is associated with nonaccidental and CVD mortality in 12 states, below the new Environmental Protection Agency standard, for both low PM2.5 regions and the general population. Vulnerability to CVD mortality persists among Black individuals regardless of education level.
Knowledge and awareness about inflammatory articular diseases: a cross sectional survey from a Syrian population
Authors: Ali Diaa H. , Debiat Moussab , Kudsi Maysoun 
Published: November 2024

Introduction:
Inflammatory articular diseases are autoimmune diseases that affect mainly joints, muscles, and systemic organs, leading to a public health challenge for the world. Patient participation in health care is essential, especially regarding chronic or life-threatening diseases. In inflammatory articular diseases, educating patients contributes positively to their psychological well-being, adherence to therapy, global assessment, rate of depression, and functional disability. The overall level of information about these diseases is low among patients living as demonstrated by studies. We aim in our research to assess the knowledge and awareness of these diseases in a sample of the Syrian population.

Methods:
The survey was conducted in Damascus, Syria, between 1 December 2021 and 1 December 2022 on participants. The validity and reliability of the survey were confirmed in a pilot test with 30 participants. After confirmation, participants were directed to the survey to complete questions around socio-demographic data, and knowledge and awareness questions about inflammatory articular diseases. We ranked our participants into five levels: excellent, good, average, bad, and very bad. Fisher’s exact test, and the Chi-squared test for comparison between the groups. Tests are considered statistically significant when P < 0.05.

Results:
A total of 641 participants with a mean age of 28.5 were included. 54.45% of them were female. 50.39% of participants related to the medical field, 23.09% have a family history of inflammatory articular diseases, and 17.94% described themselves as having an inflammatory articular disease. Rheumatoid arthritis was the most frequently reported disease among our study sample participants. Finally, the respondents gave the right answer to a mean of 8.45 statements out of 20 statements.

Conclusion:
More educational programs by healthcare professionals are needed to increase the knowledge and awareness about these diseases in Syria.
Impact on Distance and Near Contrast Sensitivity of Multifocal Contact Lenses: A Systematic Review
Authors: Mena-Guevara Kevin J. , de Fez Dolores , Piñero David P. 
Published: November 2024

Purpose:
To investigate the impact on distance and near contrast sensitivity (CS) after fitting multifocal contact lenses (MFCLs) for presbyopia correction according to the scientific evidence already published.

Methods:
Three bibliographic search was conducted on PubMed, Web of Sciences, and Scopus. Inclusion criteria were articles written in English evaluating distance and/or near CS in presbyopic patients using MFCLs, controlled clinical trials, and articles published from 2000 to 2024. After reading and analyzing carefully the articles that were finally included, the Critical Appraisal Skills Programme (CASP) tool for clinical trials was used to evaluate the quality of the research.

Results:
A total of eight articles were considered. One study did not find significant changes in binocular contrast sensitivity function (CSF) after fitting center-distance MFCL (CD) in the dominant eye and a center-near (CN) in the nondominant eye. Another research did not detect significant differences comparing CN MFCLs with monovision. However, another study found significant differences when comparing CN MFCL with spectacles. Half of studies only reported the comparison in CSF among different MFCL designs, with two studies confirming worse visual performance with MFCLs compared to pinhole contact lenses. Concerning the CASP analysis, some level of variability in the quality scores was found, with 5/13 in three studies, 6/13 in three studies, 7/13 in one study, and 8/13 in one study.

Conclusions:
The limited evidence on the impact on CS of using MFCLs does not allow to extract consistent generalizable conclusions, with only three studies suggesting a variable impact and no evidence of the real clinical benefit of using this metric for the evaluation and optimization of MFCL fitting. More research is needed on this topic.
Pilot Study of Weighted Blankets on Agitation
Authors: Dimas Adrianne , Lober Angela , Reeves Renae 
Published: November 2024

ABSTRACT

BACKGROUND: Hospitalized patients who have had neurological trauma often require interventions to reduce agitation. Weighted blankets deliver deep pressure touch stimulation, which influences parasympathetic activity through increased vagal tone, to induce calmness and reduce sympathetic activation and reduction of the stress response. The purpose of this study was to investigate the effect of weighted blankets as an intervention on agitation scores in hospitalized adults who have experienced neurologic trauma. METHOD: This was a quasi-experimental design, pilot study with a convenience sample of patients who experienced neurological trauma. Participants who met the inclusion criteria received a weighted blanket that remained in place for 30 minutes. The Agitated Behavior Scale was used to measure the effect of the weighted blanket before and after the intervention with each participant serving as their own control. RESULTS: Twelve participants were included in the study. Related-samples Wilcoxon signed rank test indicated a significant difference for heart rate (P = .05) and Agitated Behavior Scale scores (P = .005). There were no significant differences with blood pressure or oxygen saturation levels. CONCLUSION: This pilot study demonstrated a reduction in agitation scores with the use of a weighted blanket. The deep pressure touch stimulation provided by a weighted blanket may provide a low-risk intervention to decrease agitation and prevent escalation. Future studies with larger sample sizes may demonstrate weighted blankets to decrease agitation and provide an adjunct therapy for patients.