bluuebunny/crossref_metadata_2025_split huggingface dataset:
Associations Between Body Mass Index, Gait Biomechanics, and In Vivo Cartilage Function After Exercise in Those With Anterior Cruciate Ligament Reconstruction
Authors: Garcia Steven A. , White McKenzie S. , Gallegos Jovanna , Balza Isabella , Kahan Seth , Palmieri-Smith Riann M. 
Published: November 2024

Background: Both high body mass index (BMI) and anterior cruciate ligament reconstruction (ACLR) independently influence knee osteoarthritis risk. Preliminary evidence shows the combination of these risk factors leads to poorer recovery and altered biomechanical outcomes after ACLR, but few studies have directly evaluated early changes in cartilage health between normal-BMI and high-BMI groups in this population. Purpose: To evaluate ultrasound-based measures of cartilage strain and compositional changes (via echo-intensity [EI]) in response to an incline walking stress test between normal-BMI and high-BMI individuals with ACLR. A secondary evaluation was conducted of associations between habitual walking biomechanics (ie, ground-reaction forces, sagittal knee kinetics and kinematics) and cartilage strain and EI outcomes. Study Design: Controlled laboratory study. Methods: Gait biomechanics and femoral trochlear ultrasound analyses were evaluated in 64 participants with ACLR who had normal BMI (BMI < 27.0; n = 40) and high BMI (BMI ≥ 27.0; n = 24). Ultrasound images were collected bilaterally before and after an incline treadmill walk, and medial and lateral trochlear strain and EI changes pre-post exercise were used to compare BMI groups and limbs. Gait outcomes included ground-reaction forces, peak sagittal plane knee moments, angles, and excursions and were used to determine associations with cartilage outcomes in the entire cohort. Results: High-BMI individuals with ACLR exhibited greater medial trochlear cartilage strain in the ACLR limb compared with normal-BMI individuals (approximately 6%; P < .01). In those with high BMI, the ACLR limb exhibited greater medial trochlear strain relative to non-ACLR limbs (approximately 4%; P < .05), but between-limb differences were not observed in the normal-BMI group ( P > .05). Medial trochlear EI changes were greater bilaterally in those with high BMI compared with normal-BMI ACLR counterparts (approximately 10%; P < .01). Last, individuals who walked with greater peak knee flexion angles exhibited less medial cartilage strain (Δ R2 = 0.06; P = .025). Conclusion: The data suggested that high BMI affects cartilage functional properties after ACLR, whereas smaller knee flexion angles were associated with larger medial cartilage strain. Clinical Relevance: High-BMI individuals with ACLR may represent a subset of patients exhibiting earlier declines in cartilage functional integrity in response to loading, necessitating additional or more targeted interventions to mitigate disease development.
Long-Term Impact of the Bloor Viaduct Suicide Barrier on Suicides in Toronto: A Time-Series Analysis: Effet à long terme de la barrière anti-suicide du viaduc Bloor sur les suicides à Toronto : une analyse chronologique
Authors: Sinyor Mark , Men Vera Yu , Chan Prudence Po Ming , Sanchez Morales Daniel , Levitt Anthony J , Schaffer Ayal 
Published: November 2024

Background A suicide prevention barrier was installed at Toronto's Bloor Viaduct bridge in 2003. It was associated with short-term location substitution, possibly mediated by media effects that did not persist over 1 decade. The long-term impact of the barrier is unknown. Methods We examined rates of suicides by jumping from the Bloor Viaduct, other bridges and by other methods using coroner's records in Toronto (1998–2020). We used interrupted time-series Poisson regression analyses to model changes in quarterly bridge-related suicides after barrier installation. A secondary analysis explored the potential substitution effects of suicide by other methods. Results Of 5219 suicides from 1998 to 2020, 303 were by jumping from bridges. After controlling for covariates, installation of the Bloor Viaduct suicide barrier was associated with a 49% step decrease in bridge-related suicide in the next quarter in Toronto (incidence rate ratio [IRR] = 0.51, 95% CI, 0.30 to 0.86) with no rebound increase in bridge-related suicide during the subsequent 17 years after the original drop (IRR = 0.99, 95% CI, 0.96 to 1.03). There was also no associated change in suicides by other methods after the barrier (IRR = 1.04, 95% CI, 0.90 to 1.20). Conclusions Contrary to initial findings, these results indicate an enduring suicide prevention effect of the Bloor Viaduct suicide barrier. They support the long-term utility of structural interventions at high-frequency sites for suicide.
Soft, precision engineered porous, hydrogel scaffolds mechanically tailored toward applications in the central nervous system
Authors: Zhen Le , Darrow Rebecca , Chen Ningjing , Anant Manjari , Tang Chaoyang , Gorantla Lahari , Crawford Lars , Dryg Ian , Ratner Buddy 
Published: November 2024

Diseases and traumatic injuries to the central nervous system (CNS) demand the development of new biomaterials to improve healing and treatment options. Matching material mechanical properties to specific tissues and optimizing material porous structures are central goals for improving biomaterials. However, biomaterials with both precision-controlled porous structures and brain-matched mechanical properties (low modulus) are still lacking. In this study, we developed soft hydrogel scaffolds with mechanical properties similar to that of CNS tissues, and a uniform 40 µm porous structure—40 µm pores have been shown to be optimal for healing in many tissues. The two characteristics were achieved by a new fabrication process combining phase separation and sphere templating. The resulting scaffolds are non-cytotoxic according to the ISO 10993-5 standard. In addition, the three-dimensional culture of microglial cells within the scaffolds demonstrates cell attachment and maintenance of a rounded, quiescent morphology, potentially due to spatial confinement. These results justify further in vivo studies and suggest broad potential in CNS applications, such as brain-computer interfaces, neural regeneration, and basic neurobiology. Subject classification codes: Neural Interfaces, soft hydrogel, synthetic biomaterials
Hybrid managers in an evolving healthcare: Does gender matter?
Authors: Sartirana Marco , Montanelli Roberta 
Published: November 2024

Introduction Hybrid managers have the potential to respond to the need for more integrated, responsive and accountable healthcare. Scholars have studied the antecedents of hybridization, but the role of gender has been neglected. Therefore, we study whether and how gender impacts on the way in which medical professionals exercise their managerial role. Methods We adopted a qualitative approach in order to gain an in-depth understanding of the specificities of women hybrids. Data was collected through semi-structured interviews, focusing on hybrids in Italy in the field of neurology. Results We found that women hybrids show specific abilities and motivations, but they also encounter a specific lack of opportunities. Women hybrid managers appear well positioned to foster the evolution of professionalism, but healthcare organizations should implement policies and practices to effectively support them. Conclusion While existing research has treated hybrid managers as a homogenous group, we underline the specificities of women hybrids. They can support the evolution of healthcare organizations towards logics of service integration, user centricity, and staff engagement. Therefore, our findings have important theoretical and practical implications for health policy and management.
Improving sustainability in sexual health: A pilot project reintroducing reusable stainless steel vaginal specula at a sexual health clinic
Authors: Hall Isobel , Dean Gillian , Clarke Amanda 
Published: November 2024

Introduction In line with the NHS net zero initiative, University Hospitals Sussex (UHS) committed to a Green Plan which included the introduction of reusable instruments. Following positive responses from a staff and patient survey in 2021, the sexual health and contraception (SHAC) department began a pilot scheme of 100 medium size reusable stainless steel vaginal specula (RMS) as an alternative to disposable acrylic models. The aim was to determine outcomes regarding sustainability goals and clinician experiences. Methods Estimated carbon footprint and cost was calculated for actual use during study period, and expected use if RMS were to be exclusively used in the future. A staff questionnaire was distributed to ascertain attitudes towards RMS, including obstacles to their use and how these might be overcome. Results Monthly medium size plastic specula use decreased during the pilot, resulting in a 22.4% reduction in carbon footprint. Exclusively using RMS for all examinations could reduce carbon emissions by 85.6%. Clinicians had an overall positive attitude towards RMS. Key obstacles to use were poorly stocked rooms and insufficient variety of size. Discussion The success of this pilot scheme is being built upon by investing in a greater variety of sizes of RMS for use in SHAC aiming for a 100% reusable system.
Effects of combined exposure of manganese and iron on serum inflammatory factor levels among workers
Authors: Liang Dian-yin , Peng Jian-chao , Xie Bing-yan , Qin Wen-xia , Aschner Michael , Ou Shi-yan , Jiang Yue-ming 
Published: November 2024

Objective The aim of the study is to examine the association between long-term occupational exposure to Mn and Fe and their health effects in workers. Methods 108 Mn workers were selected for the Mn exposure groups; 92 non-Mn workers were in the control group. Inductively coupled plasma-mass spectrometry was used to determine the Mn and Fe concentration in the working environment. Graphite furnace-atomic absorption spectroscopy was used to determine the blood Mn concentration of workers. Serum inflammatory factors were measured by enzyme-linked immunosorbent assay. Results The blood Mn concentration, positive rate of clinical symptoms and serum inflammatory response in the Mn exposure group was higher than in the control group. Conclusions Low levels of Mn exposure may increase blood Mn concentrations, the rate of complaints of neurological symptoms and promote increased serum inflammatory response in workers.
Functional Outcome and Patient Satisfaction After Primary vs Secondary Arthrodesis for Lisfranc Injuries: Toward a Single-Surgery Approach
Authors: Wilhelmina Maria Engelmann Esmee , Halm Jens Anthony , Schepers Tim 
Published: November 2024

Background: The choice between primary arthrodesis (PA) and open reduction and internal fixation (ORIF) for acute Lisfranc injuries remains contentious. Apart from primary treatment, arthrodesis is often used for treating chronic Lisfranc injuries, including patients in whom initial ORIF or nonoperative treatment failed. The aim of this study was to compare PA and secondary arthrodesis (SA) in terms of complications and functional outcome. Methods: A retrospective cohort study was conducted on trauma patients with Lisfranc injuries treated at a level 1 trauma center between July 1, 2010, and July 1, 2020. Selected patients were evaluated at the outpatient clinic and received a survey. Demographics, injury characteristics, management, complications, and patient-reported outcomes (American Orthopaedic Foot & Ankle Society midfoot score, Foot Function Index) were analyzed. Results: Twenty-nine of 37 potential patients (78.4%; PA n = 11, SA n = 18) completed the survey with a median follow-up of 7.1 (PA) to 9.3 (SA) years ( P = .01). The majority were female (n = 18, 62.1%); the mean age of PA patients was 57.1 years (SD 14.2) compared with 43.5 years (SD 17.1) in SA patients ( P = .04). In the PA group, there was no infection, 100% union, and implants were removed in 5 of 11 patients. In the SA group, 11.1% (n = 2) developed infection, malunion rate was 11.1%, implants were removed in 33.3% (n = 6), and 22.2% required revision surgery. AOFAS was “good” in PA (77.7, SD 17.3) compared with rated “fair” in SA (67.1, SD 21.3, P = .19). FFI was better in PA (26.0, SD 26.2) than SA (37.6, SD 30.8, P = .32), which exceeded the minimally important clinical difference. Conclusion: Although this study was limited by sample size, the overall results suggest equivalent functional outcome, pain and treatment satisfaction in primary arthrodesis compared with secondary arthrodesis patients for treatment of Lisfranc injury.
Impact of symptomatic multiple sclerosis therapy on pregnancy outcome
Authors: Witt Laura , Haben Sabrina , Dost-Kovalsky Karen , Friedmann Natalia , Bast Nadine , Oganowski Theresa , Gold Ralf , Thiel Sandra , Hellwig Kerstin 
Published: November 2024

Background: Information on symptomatic therapy (ST) use in women of childbearing age with multiple sclerosis is sparse, and data on the impact of ST pregnancy exposure on pregnancy outcome are lacking. Objective: To investigate (1) ST use patterns pre-conception, during pregnancy and postpartum and (2) pregnancy outcomes. Methods: Pregnancy data from the German Multiple Sclerosis and Pregnancy Registry were analyzed for the ST use from pre-conception to postpartum. Pregnancy outcomes were compared between ST-exposed ( n = 282) and matched (disease modifying therapy and age) ST-naive (n = 536) pregnancies. Results: Of 2,449 pregnancies, 1,053 (43.0%) received ST anytime between pre-conception and postpartum, 282 (11.5%) at pre-conception and during pregnancy. The most commonly used drug classes were antidepressants (24.8%), analgetics (31.0%), and anticonvulsives (8.7%). Exposure to ST during pregnancy did not result in an increased incidence of adverse pregnancy outcomes, major congenital abnormalities, or pregnancy complications. Conclusion: Nearly 50% of women used ST between pre-conception and postpartum, but only 12% pre-conception and during pregnancy. ST use during pregnancy did not adversely affect pregnancy outcomes in our cohort. More data are needed to analyze the effect of ST on pregnancy and fetal outcomes stratified by drug to improve recommendations for ST use in family planning.
Clinical Application of DynaCT in the Study of Vascular Neointimal Hyperplasia Characteristics after Option Filter Placement
Authors: An Rui , Cai Yandong , Zhu Tianyi , Gao Ruijiao , Zhang Yanrong , Li Liang , Cao Pengkai , Liu Xiangdong , Li Yunsong 
Published: November 2024

Objective: The objective of this study was to analyze neointimal hyperplasia of the inferior vena cava (IVC) after Option filter implantation by DynaCT and to provide a reference for the safety of effective neointimal hyperplasia cutting after long retrieval window filter implantation in vivo. Methods: Clinical data on 22 patients with Option filters were retrospectively analyzed. DynaCT was used to analyze the characteristics of neointimal hyperplasia after filter implantation, including the distribution of neointimal hyperplasia and the maximum thickness of the neointimal hyperplasia. Correlation analysis was performed between the measurement results and the number of times the inner membrane of the filter was cut during filter retrieval, and correlation analysis also was performed between the measurement results and the time of filter placement. Results: As measured by DynaCT, the neointimal hyperplasia after filter placement was located around the barbs of the filter plug, and the maximum neointimal hyperplasia thickness was located in the 1 to 5 points of the IVC. There was a linear trend between neointimal hyperplasia thickness of the IVC and filter neointimal cutting times by the retrieval catheter after filter placement. Correlation analysis showed a correlation coefficient of r = 0.609 ( P = 0.003), indicating a significant correlation between the two. There also was a linear trend between neointimal hyperplasia thickness and implantation time. Correlation analysis showed that the correlation coefficient was r = 0.36 ( P = 0.102), and the correlation between the two was not significant. Conclusion: Based on DynaCT, the characteristics of IVC neointimal hyperplasia after Option filter implantation were analyzed, and the cutting force and direction of neointimal hyperplasia could be controlled effectively and safely by changing the filter retrieval catheter. Clinical Impact we can effectively and safely cut the hyperplastic intima by modifying the filter retrieval catheter to control the cutting force and direction and provide a reference for the safe and effective retrieval of the long-retrieval-time window filter after implantation in the body.
High mechanical thrombectomy procedural volume is not a reliable predictor of improved thrombectomy outcomes in patients with acute ischemic stroke in the United States
Authors: Qureshi Adnan I , Maqsood Hamza , Ford Daniel E , Gomez Camilo R , Hanley Daniel F , Hassan Ameer E , Nguyen Thanh N , Siddiq Farhan , Spiotta Alejandro M , Zaidi Syed F , Kwok Chun Shing 
Published: November 2024

Background The volume of mechanical thrombectomy (MT) performed at hospitals is used as one of the criteria for advanced-level designation for stroke care. Objective Our study sought to determine the relationship between annual MT procedural volume and in-hospital outcomes in acute ischemic stroke patients undergoing MT in the United States. Methods We analyzed the National Inpatient Sample from 2016 to 2020. The hospitals were grouped into quartiles based on the volume of MT procedures performed within the calendar year. We compared the rates of routine discharge/home health care; in-hospital mortality, and post-treatment intracranial hemorrhage (ICH) between the quartiles after adjusting for potential confounders. Results Patients undergoing MT ranged from 15,395 in quartile 1 to 78,510 MT in quartile 4. There were lower rates of discharge home/self-care of 22.5%, 20.8%, and 20.8% for quartiles 2, 3, and 4, respectively, compared with 34.9% in quartile 1. The odds of ICH increased to 1.81 ( p < 0.001), 1.84 ( p < 0.001), and 1.98 ( p < 0.001) among the quartiles from lowest to highest procedural volumes. The odds of home discharge/self-care decreased to 0.66 ( p < 0.001), 0.60 ( p < 0.001), and 0.63 ( p < 0.001) among the quartiles from lowest to highest procedural volumes. The odds of in-hospital mortality increased to 1.92 ( p < 0.001), 1.99 ( p < 0.001), and 1.84 ( p < 0.001) among the quartiles from lowest to highest procedural volumes. Conclusions We observed a paradoxical relationship between adverse outcomes and the annual procedural volume of MT at the hospital presumably due to the higher severity of acute ischemic stroke treated at high-volume hospitals.
SCALA: a randomized phase I trial comparing subcutaneous and intravenous alemtuzumab in patients with progressive multiple sclerosis
Authors: Montalban Xavier , Rodriguez-Acevedo Breogan , Nos Carlos , Resina Mireia , Forner Mireia , Wu Yanzhen , Chirieac Magdalena 
Published: November 2024

Background: Alemtuzumab is administered intravenously (IV) for relapsing-remitting multiple sclerosis (RRMS), with limited studies of subcutaneous (SC) treatment. Objectives: We sought to evaluate the pharmacodynamics (PD), pharmacokinetics (PK), and safety profile of SC-administered alemtuzumab in people with progressive multiple sclerosis (PMS). Design: SCALA was a phase I, open-label, randomized, parallel-group study with two 12-month periods and a safety monitoring phase to 60 months. Methods: Of 29 screened participants, 24 were enrolled and randomized 2:1 to two 12 mg/day alemtuzumab treatments (60 and 36 mg total; SC:IV). Key inclusion criteria: ⩾18 years with a PMS diagnosis. Key exclusion criteria included RRMS diagnosis and prior treatment with anti-CD52 antibodies. Primary endpoint: CD3+ lymphocyte count. Secondary endpoints: PD and PK parameters. Results: Demographics were broadly similar for participants in the SC (16) and IV (8) arms; more participants with primary PMS received SC (44%) versus IV (25%) treatment. After the first course, the mean CD3+ cell count/µL was reduced at month 1 in both arms (SC: baseline (BL) 1326 to 48 vs IV: BL 1155 to 84). Lymphocyte counts partially repopulated by month 12, with mean CD3+ cell counts/µL of SC 599 versus IV 528. The mean lymphocyte counts/µL decreased again after the second course at month 13 in both arms (SC: 90 vs IV: 129), with partial repopulation by month 24. Alemtuzumab serum concentrations were lower following SC administration relative to IV, with 32% bioavailability. There were no adverse events leading to permanent treatment discontinuation or death. Conclusion: In SCALA, there were similar patterns of lymphocyte depletion and repopulation for participants receiving SC or IV alemtuzumab. In both arms, alemtuzumab had a manageable safety profile, with no emerging safety concerns. The general stabilization of neurological outcomes observed over 60 months underscores the potential long-term benefits of alemtuzumab treatment. Trial registration: Clinicaltrials.gov identifier: NCT02583594.
Subclinical malaria among pregnant women living in refugee settlements in Northern Uganda
Authors: Kibone Winnie , Bongomin Felix , Lebu Sarah , Ochaya Stephen , Nantale Ritah , Okot Jerom , Awekonimungu Byron , Beardsley Rachel , Muoghalu Chimdi , Manga Musa 
Published: November 2024

Background: Malaria during pregnancy contributes to significant perinatal morbidity and mortality, accounting for almost 25% of global maternal mortality. However, the epidemiology and risk factors for subclinical malaria among pregnant women living in refugee settlements is poorly understood. Objective: To determine the prevalence and predictors of subclinical malaria among pregnant women in refugee settlements in Northern Uganda. Design: We conducted a multi-center, cross-sectional study. Methods: The study was conducted between April and June 2023 and involved pregnant women aged 18–45 years attending routine antenatal care (ANC) at three health facilities serving refugee communities in Adjumani district, Uganda. We collected sociodemographic, environmental, maternal, and obstetric factors using a structured questionnaire. Both CareStart Malaria HRP-2/pLDH (Pf/Pan) combo rapid diagnostic test (RDT) and blood smear microscopy with 3% Giemsa staining were simultaneously performed on samples from each patient. Logistic regression analysis identified factors independently associated with subclinical malaria, reported as adjusted odds ratios (aORs) and 95% confidence intervals (CIs). Results: We enrolled 304 pregnant women, with a mean age of 25 years. In total, 68.8% ( n = 209) had lived in the settlement for over 12 months, 25.7% ( n = 78) were primigravida, and 1.0% ( n = 3) were living with HIV. Malaria prevalence was 5.3% ( n = 16) by RDT and 3.2% ( n = 10; seven Plasmodium falciparum and three P. malariae) by microscopy. Only 4 (25.0%) of the RDT-positive cases were also positive by microscopy (Cohen’s kappa: 0.278—Fair agreement). All participants were asymptomatic. Factors associated with higher odds of subclinical malaria included primiparity (aOR: 2.79, 95% CI: 1.25–6.25, p = 0.013), ⩾4 ANC visits (aOR: 2.41, 95% CI: 1.34–4.34, p = 0.003), and residence in the settlement for less than 12 months (aOR: 2.54, 95% CI: 2.0–3.22, p < 0.001). Living in the settlement for over 3 years, being primigravida, and being married were associated with 68%, 50%, and 68% lower odds of subclinical malaria, respectively (aOR: 0.32, 95% CI: 0.13–0.79, p = 0.014; aOR: 0.50, 95% CI: 1.22–5.52, p = 0.016; aOR: 0.32, 95% CI: 0.13–0.78, p = 0.012). Conclusion: Our study reveals the high prevalence of subclinical malaria among pregnant women in refugee settlements, particularly among primiparous women and recent arrivals. The poor agreement between RDT and microscopy suggests the need for dual screening in asymptomatic pregnant women.