bluuebunny/crossref_metadata_2025_split huggingface dataset:
Experimental investigation and parametric optimization of FSW of mineral-reinforced AA6061 matrix composite
Authors: Prabhu B Subramanya R , Herbert Mervin A 
Published: December 2024

Abstract
In this work, rutile reinforced AA 6061 matrix composites were joined using friction stir welding and the process variables were optimized using Taguchi L27 orthogonal design of experiments. The rotational speed, axial force and tool tilt angle were the parameters taken into consideration. The optimum process variables were determined with reference to tensile strength, impact strength and hardness of the joint. The predicted optimal value of output responses was confirmed by conducting the confirmation run using optimum parameters. The optimal process variables combination values that resulted in improved mechanical properties were observed at a tool rotational speed of 1400 rpm, a tool tilt angle of 2 degree, and an axial force of 3KN. Scanning electron microscopy (SEM) analysis were used to probe the microstructures.
Sexual History-Taking in a Surgery Clerkship Assessment: A Stubborn Clinical Skills Gap With Reproductive Health Care Implications
Authors: Coleman Taylen , Adamson Dylan T. , Marshall Hannah , Smith Jensen , Wright Tiffany , Bohnert Carrie A. , Shaw M. Ann , Weingartner Laura A. 
Published: December 2024

Abstract

Purpose
Patients present with sexual and reproductive health needs in a variety of clinical settings, so knowing when and how to elicit a relevant sexual history is critical in any specialty. This work examined whether reinforcing the surgical relevance of sexual health with an integrated training improved third-year medical students’ sexual history-taking.

Method
Third-year surgery clerkship standardized patient assessments were video coded from a 2021-2022 comparison and 2022-2023 intervention cohort (University of Louisville School of Medicine). The case used for both cohorts involved a 38-year-old patient assigned female at birth presenting with acute right lower abdominal pain. Before the assessment, the intervention cohort received an additional clerkship didactic session focused on evaluation and assessment of the acute abdomen emphasizing the importance of sexual history-taking for surgical patients. The frequency of sexual histories attempted, number of questions, topics discussed, and differential diagnoses were compared.

Results
There was not a significant difference between cohorts’ sexual history-taking frequency: 61% (72/119) of students in the comparison cohort, compared to 65% (86/132) in the intervention cohort. On average, students in the intervention group asked 6 questions related to sexual health, compared to 3 questions by students in the comparison group (P < .001). Across cohorts, 66% (104/158) of students who took a sexual history considered sexual diagnoses on their differential, compared to only 23% (21/93) of students who did not take a sexual history (P < .001).

Conclusions
Reinforcing the clinical relevance of sexual history-taking for surgical patients was associated with higher-quality histories and broader differentials but not higher rates of sexual history-taking. Because there is now variability in how reproductive health care can be delivered across the United States, medical educators must refocus on sexual history-taking skills in a variety of settings and work to address barriers preventing students from collecting this information.
Efforts in Undergraduate Medical Education to Improve Socioeconomic Status Diversity
Authors: Velasquez David E. , Shrestha Anmol , Matias Wilfredo R. 
Published: December 2024

Abstract

Purpose
Despite the importance of socioeconomic status (SES) diversity within the health care workforce, little progress has been made toward this elusive goal. Although centuries of structural disadvantage underlie this stagnation, medical schools are well positioned to increase enrollment and retention of students from low-SES backgrounds. In this research report, the authors investigate existing efforts in undergraduate medical education to improve SES diversity.

Method
The authors analyzed the Association of American Medical Colleges Medical School Admissions Requirements database, the American Association of Colleges of Osteopathic Medicine Choose DO Explorer tool, and official medical school websites from December 2022 to May 2023 to examine undergraduate medical education initiatives across 156 allopathic and 56 osteopathic medical schools. They searched for SES diversity efforts in 4 domains: publication of student body demographics (including low-SES or first-generation status), need-based financial aid, low-SES support or affinity groups, and faculty or alumni mentorship programs for low-SES students.

Results
The authors found that 18 medical schools (8.5%) publicly report SES demographic information, 33 (15.6%) report having mentorship programs for low-SES students, 52 (24.5%) report having support or affinity groups for these students, and 154 (72.6%) report offering some level of need-based financial assistance. A greater proportion of MD and public medical schools (128 [82.1%] and 84 [80.0%], respectively) had any kind of SES initiative when compared with DO schools and private medical schools (40 [71.4%] and 84 [78.5%], respectively).

Conclusions
Medical schools can support students from lower-SES backgrounds by publicly reporting classwide SES demographics, dedicating staff and faculty to diversity, equity, and inclusion efforts, measuring and reporting debt burden by stratified student demographics, and introducing innovative financing solutions.
The Use of Oral Phenobarbital Loading for the Management of Alcohol Withdrawal Syndrome in an Outpatient Setting: A Case Report
Authors: Hamilton Erin , Bouchard Braden 
Published: December 2024

Abstract
Alcohol withdrawal syndrome is most frequently treated with benzodiazepines, but due to their short half-life, tapering prescriptions are frequently required for outpatients, which presents challenges to both clinicians and patients. Our local health system has had significant success treating alcohol withdrawal in the emergency department with phenobarbital loading doses. As patients also present in alcohol withdrawal to our outpatient addictions clinic, we have adapted our emergency department intravenous protocol to a staggered, oral loading protocol for the treatment of mild and moderate alcohol withdrawal syndrome in the community setting. In this case report, we successfully treat a 36-year-old man with mild alcohol withdrawal symptoms using this approach and without requiring a tapering sedative prescription.
Morphologic Development of the Posterior Sloping Angle of the Proximal Femoral Epiphysis in Children: What Is the Peak Risk Age for Slipping?
Authors: Wu Jingyu , Federico Canavese , Li Lianyong 
Published: December 2024

Objective:
The purpose of this study was to describe the developmental patterns of the posterior sloping angle (PSA) of the proximal femoral epiphyseal growth plate (PFEP) in a cohort of healthy Chinese children aged 5 to 14 years.

Methods:
Pelvic frog-leg lateral radiographs of 400 healthy children (n=800 hips) were retrospectively analyzed. The cohort included 215 males and 185 females with a mean age of 9.5 years (5 to 14). PSA measurements of the PFEP were obtained bilaterally from frog leg lateral radiographs. Subjects were equally divided into 10 subgroups of 40 patients each (80 hips per group) based on age, starting at 5 years of age; in addition, sex and lateral differences, as well as age-related developmental patterns were analyzed.

Results:
The PSA was −2.6±3.1 degrees at 5 years of age, indicating mild anterior inclination of the femoral epiphysis. It increased to 6.2±4.6 degrees at 11 years of age, decreased to 3.9±4.3 degrees at 12 years of age, and then stabilized until 14 years of age. Before 11 years of age, there was no significant sex difference in PSA values, whereas, after 11 years of age, males had a PSA of 5.8±4.3 degrees compared with 3.7±5.0 degrees in females (P<0.001), with the former showing an average increase of ~2 to 3 degrees more. In addition, the left PSA was ~2 degrees greater than the right PSA in both men and women (P<0.001).

Conclusions:
Before puberty, PSA gradually increased with age, peaking at 11 years of age, followed by a slight decline and then stabilization. After the age of 11 years, males had higher PSA levels than females, with the PSA of the left side being significantly higher than that of the right side. Understanding these developmental patterns may aid in the assessment and monitoring of adolescent PFEP disorders.

Level of Evidence:
Level III—diagnostic studies.
Accuracy and Value of Time-resolved MRA for Spinal Vascular Malformations
Authors: Wei Xiao-Er , Zhu Jin-Yu , Li Ming-Hua , Wei Jianyong , Wei Liming , Zhu Yueqi , Li Yuehua 
Published: December 2024

Study design.
Retrospective.

Objective.
To explore the value of time-resolved CE-MRA in evaluating and locating the SVM prior to digital subtraction angiography (DSA).

Summary of Background Data.
Spinal vascular malformations (SVM) can be detected with time-resolved contrast-enhanced MRA(CE-MRA).

Materials and Methods.
178 patients with suspected SVM who underwent time-resolved CE-MRA examination and DSA were included in this study. DSA served as the reference standard. The type of SVM, feeding arteries, fistula/nidus, and proximal segment of draining veins were evaluated on time-resolved CE-MRA. The diagnostic performance and classification performance of time-resolved CE-MRA in the diagnosis of SVM is summarized in terms of overall accuracy, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV). The difference of catheterized vessels during spinal vascular DSA between actual and estimated number was also analyzed.

Results.
147 patients were diagnosed with SVM (20 cervical, 118 thoracolumbar, and 9 deep lumbosacral) and 31 patients were diagnosed with non-SVM according to DSA findings. The diagnostic sensitivity, specificity, PPV, NPV, and accuracy of time-resolved CE-MRA for subtype of SVM were 0.961, 0.961, 0.993, 0.806 and 0.961, respectively. The overall accuracy of time-resolved CE-MRA for the diagnosis of SVM was 0.821, and was 0.783, 0.793, and 0.778 for cervical, thoracolumbar, and deep lumbosacral SVM, respectively. The actual number of catheterized vessels during spinal vascular DSA with time-resolved CE-MRA as the reference was lower than the estimated number of catheterized vessels in both SVM and non-SVM patients (P<0.001).

Conclusion.
Time-resolved CE-MRA could accurately evaluate SVM and reduce the number of catheterized vessels during spinal vascular DSA.
Perioperative Antidepressant Use is Associated with Symptomatic Pseudarthrosis after Lumbar Fusion
Authors: McCurdy Michael A. , Dalton Jonathan , Narayanan Rajkishen , Herczeg Chloe K. , Baidya Joydeep , Dawes Alexander , Melendez Manuel , Goldberg Marco , Wright Justin , Kaye Ian David , Woods Barrett , Cha Thomas , Canseco Jose A. , Hilibrand Alan S. , Vaccaro Alexander R. , Schroeder Gregory D. , Kepler Christopher K. 
Published: December 2024

Study Design.
Retrospective cohort.

Objective.
To explore the relationship between symptomatic pseudoarthrosis requiring revision after lumbar fusion and antidepressant use.

Summary of Background Data.
Approximately 25% of patients undergoing spine surgery are taking antidepressants. Pseudoarthrosis is a significant complication of spinal fusion surgery that can lead to debilitating pain and revision surgery. Animal models have identified selective serotonin reuptake inhibitors/serotonin and norepinephrine reuptake inhibitors (SSRIs/SNRIs) as detrimental to bone healing, and one database study identified antidepressants as associated with lumbar pseudoarthrosis. However, no single-institution study has replicated these findings.

Methods.
A structured query language search identified patients from 2017-2022 with pseudoarthrosis after lumbar fusion—this was verified by pseudoarthrosis listed as the indication for revision surgery in operative notes and by reviewing preoperative computed tomography imaging. Patients were counted as taking antidepressants if an antidepressant was an active medication at their preoperative and first postoperative appointments. Control patients who had no radiographic indication of pseudoarthrosis at their last clinical follow-up were matched 3:1 with pseudoarthrosis patients requiring revision based on smoking status, levels fused, levels decompressed, and procedure type. Statistical analysis was performed to compare the two groups.

Results.
36 patients were identified that had revision for symptomatic pseudoarthrosis after primary, elective lumbar fusion. These patients were compared to 108 patients who had lumbar fusion without pseudoarthrosis. Patients with pseudoarthrosis had higher rates of diagnosed depression (P=0.019), anxiety (P=0.007), and antidepressant use (P=0.001). Logistic regression identified SSRI/SNRI use as an independent predictor of requiring revision surgery for symptomatic lumbar pseudoarthrosis (OR 3.95, CI 1.66-9.45, P=0.002).

Conclusions.
Patients requiring revision surgery for lumbar pseudoarthrosis had a higher rate of depression, anxiety, and antidepressant use. SSRI/SNRI use was identified as an independent predictor of requiring revision surgery for lumbar pseudoarthrosis. Future, prospective studies are needed to further evaluate this association.

Level of Evidence:
III
Serum protein risk stratification score for diagnostic evaluation of metabolic dysfunction–associated steatohepatitis
Authors: Lai Michelle , Dillon Simon T. , Gu Xuesong , Morhardt Tina L. , Xu Yuyan , Chan Noel Y. , Xiong Beibei , Can Handan , Ngo Long H. , Jin Lina , Zhang Xuehong , Moreira Claudia C. , Leite Nathalie C. , Villela-Nogueira Cristiane A. , Otu Hasan H. , Schattenberg Jörn M. , Schuppan Detlef , Afdhal Nezam H. , Libermann Towia A. 
Published: December 2024

Background:
Reliable, noninvasive tools to diagnose at-risk metabolic dysfunction–associated steatohepatitis (MASH) are urgently needed to improve management. We developed a risk stratification score incorporating proteomics-derived serum markers with clinical variables to identify high-risk patients with MASH (NAFLD activity score >4 and fibrosis score >2).

Methods:
In this 3-phase proteomic study of biopsy-proven metabolic dysfunction–associated steatotic fatty liver disease, we first developed a multi-protein predictor for discriminating NAFLD activity score >4 based on SOMAscan proteomics quantifying 1305 serum proteins from 57 US patients. Four key predictor proteins were verified by ELISA in the expanded US cohort (N = 168) and enhanced by adding clinical variables to create the 9-feature MASH Dx score, which predicted MASH and also high-risk MASH (F2+). The MASH Dx score was validated in 2 independent, external cohorts from Germany (N = 139) and Brazil (N = 177).

Results:
The discovery phase identified a 6-protein classifier that achieved an AUC of 0.93 for identifying MASH. Significant elevation of 4 proteins (THBS2, GDF15, SELE, and IGFBP7) was verified by ELISA in the expanded discovery and independently in the 2 external cohorts. MASH Dx score incorporated these proteins with established MASH risk factors (age, body mass index, ALT, diabetes, and hypertension) to achieve good discrimination between MASH and metabolic dysfunction–associated steatotic fatty liver disease without MASH (AUC: 0.87—discovery; 0.83—pooled external validation cohorts), with similar performance when evaluating high-risk MASH F2-4 (vs. MASH F0-1 and metabolic dysfunction–associated steatotic fatty liver disease without MASH).

Conclusions:
The MASH Dx score offers the first reliable noninvasive approach combining novel, biologically plausible ELISA-based fibrosis markers and clinical parameters to detect high-risk MASH in patient cohorts from the United States, Brazil, and Europe.
Missense variants in the TRPM7 α-kinase domain are associated with recurrent pediatric acute liver failure
Authors: Schlieben Lea D. , Achleitner Melanie T. , Bourke Billy , Diesner Max , Feichtinger René G. , Fichtner Alexander , Flechtenmacher Christa , Hadzic Nedim , Hegarty Robert , Heilos Andreas , Janecke Andreas , Konstantopoulou Vassiliki , Lenz Dominic , Mayr Johannes A. , Müller Thomas , Prokisch Holger , Vogel Georg F. 
Published: December 2024

Background:
Pediatric acute liver failure (PALF) is a rare and life-threatening condition. In up to 50% of PALF cases, the underlying etiology remains unknown during routine clinical testing. This lack of knowledge complicates clinical management and liver transplantation decisions. Recently, whole-exome sequencing has identified genetic disorders in a large number of cases without specific laboratory biomarkers or metabolic fingerprints.

Methods:
We describe how further analysis of whole-exome sequencing data combined with proteomic analyses in 5 previously unsolved PALF patients, where no pathogenic variants in genes previously associated with acute liver failure were identified, revealed rare biallelic variants in transient receptor potential cation channel subfamily M member 7 (TRPM7).

Results:
We establishe TRPM7 as a novel disease gene for PALF. Yet, the cation channel kinase TRPM7 has not been associated with any Mendelian disorder. No homozygous loss-of-function variants were found in in-house exomes or publicly available databases. Rare biallelic TRPM7-variants were significantly enriched in the PALF cohort compared with a pediatric control cohort. Viral infections preceded the majority of PALF episodes. Recurrent PALF episodes characterized the disease course with rapid progression, leading to early death in 3 cases. Proteomic analyses of patient fibroblasts unveiled significantly reduced TRPM7 protein levels, indicative of functional impairment. Severely reduced Mg2+ levels in one individual with a mutation in the channel domain suggests a potential interaction between disturbed Mg2+ homeostasis and PALF. The consistent presence of mutations in the TRPM7 protein-kinase-domain across all patients suggests its specific relevance in PALF.

Conclusions:
Our data extend the genetic spectrum of recurrent PALF and prompt consideration of TRPM7 in children with unexplained liver failure.
Cardiovascular Health Disparities in Adults of Color Aged 18 to 50
Authors: Howard Quiana , Adeyinka Sharon , Martin Shemaine , Griggs Stephanie 
Published: December 2024

Background
Although cardiovascular disease is the leading cause of death among US adults of color, there is a limited understanding of cardiovascular health status, including health behaviors (sleep health, diet, physical activity, and nicotine exposure) and health factors (body mass index, blood lipids, blood glucose, and blood pressure).

Purpose/Methods
The objective of this systematic review was to synthesize original research on racial and ethnic disparities in CVH among US adults aged 18 to 50 years using Life's Simple 7 and Life's Essential 8 metrics. Multiple electronic databases (PubMed, PsycINFO, and CINAHL) were searched for relevant original studies published in English until March 28, 2023.

Results
Fifteen original descriptive studies were selected (N = 364 426, mean age = 39.2 ± 8.4 years, 64.6% female, 65.4% non-Hispanic White [NHW], 10.7% non-Hispanic Black [NHB], 11.7% Hispanic, 6.2% multiracial 0.6% non-Hispanic Asian, and <1% American). There were race-, sex-, and age-based differences in CVH scores. People of color had lower CVH scores when compared with NHW, and NHB had the lowest CVH of all racial groups. Males had lower CVH and higher rates of low CVH across most racial groups. However, NHB women had lower CVH scores than NHB men on average compared with these other groups.

Conclusions/Clinical Implications
The findings of this review contribute to understanding CVH disparities among US adults of color. Ideal CVH is associated with a lower cardiovascular disease risk; therefore, further research is needed to estimate CVH among a racially and ethnically representative sample of US adults.
Expansive Arterial Remodeling and Its Risk Factors in Cerebral Infarction
Authors: Gong Bingzheng , Pian Ying , Yang Qichao , Zhang Jingjun 
Published: December 2024

Objective:
Cerebral infarction (CI) is a prevalent and frequently occurring condition. However, the association between expansive remodeling in the carotid artery system and CI is still uncertain. This study aims to investigate the significance of the carotid artery system and aortic arch (AA) remodeling for the prevention and treatment of CI.

Methods:
We collected data from 821 patients who underwent computed tomography angiography at our hospital, performed statistical analysis, and compared it with various clinical data.

Results:
We found that the diameters and detection rates of the common carotid artery (CCA), internal carotid artery (ICA), carotid bifurcation, and AA were significantly greater in the CI group than in the without CI group (P<0.05). The number of carotid sinus plaque (CSP) and the length of aortic arch plaque (AAP) were considered to be 2 important factors in predicting CCA remodeling. Moreover, the thickness of AAP was considered to be an important factor in predicting AA remodeling.

Conclusions:
Patients with CI exhibited a significant increase in the diameter of the carotid system and AA, which correlated with certain features of arterial plaque. Hence, early detection of arterial plaques, along with interventions to delay or potentially reverse expansive arterial remodeling, may be effective in preventing and treating CI.