bluuebunny/crossref_metadata_2025_split huggingface dataset:
Beyond the hernia in groin ultrasound
Authors: Vasudeva Karthik M , Thaker Siddharth , Gupta Harun 
Published: December 2024

Introduction: Groin discomfort is one of the most common presenting complaints in health care and often requires ultrasound to detect hernias. However, such singular emphasis leads to over diagnosing hernia and other significant aetiologies in and around the groin are overlooked. Topic description: The article elaborates on the key areas a sonographer needs to focus on and presents a range of conditions responsible for groin pain other than hernia. Discussion: In addition to evaluating for hernia, a groin ultrasound should evaluate structures in the inguinal canal, the adductor muscles and symphyseal region, the superficial inguinal lymph nodes, the femoral neurovascular bundle, the hip joint with periarticular regions and the structures in the right iliac fossa. Conclusion: Sonographers must have a methodical approach, a good knowledge of normal anatomy and pathologies and a comprehensive understanding of the various types of groin abnormalities for a thorough examination.
Does long-term surveillance of primary linked total elbow arthroplasty identify failing implants requiring revision?
Authors: Morris Daniel Leslie James , Minhas Avneet , Walstow Katherine , Pitt Lisa , Morgan Marie , Cresswell Tim , Espag Marius P , Clark David I , Tambe Amol A 
Published: December 2024

Background Scoping review has identified a lack of evidence guiding long-term follow-up of elbow arthroplasty. We report the effectiveness of primary linked total elbow arthroplasty surveillance in identifying failing implants requiring revision. Methods A prospective database recording consecutive primary linked total elbow arthroplasty and subsequent surveillance in an elbow unit was analysed. Arthroplasties performed between 01.10.2013 and 31.07.2022 were included, with a minimum 1-year follow-up. Surveillance involves specialist physiotherapist review 1, 2, 3, 5, 8 and 10 years postoperatively. Patient-initiated review could occur between time points. Outcome measures include a number of surveillance reviews offered and attended; and the proportion that identified a failing implant requiring revision. Results Ninety-seven primary linked total elbow arthroplasties with minimum 1-year follow-up were performed (76 Discovery, 14 Nexel, 7 Coonrad/Morrey). Sixteen patients died prior to 31.07.2023, and three implants required revision <1 year postoperatively. 290 of 328 offered surveillance appointments were attended (88.4%). Five implants required revision ≥1 year post-operatively, with revision requirements identified by surveillance in all cases. Three failures occurred at 5 years postoperatively, and two failures occurred at 8 years postoperatively. Overall, 1.7% attended surveillance appointments identified a failing implant requiring revision. Discussion This is the first series reporting the effectiveness of primary linked total elbow arthroplasty surveillance in identifying implants requiring revision.
Management of the supposed elbow dislocation in newborns
Authors: Kruse Florian , Dizin Frederique , Ilharreborde Brice , Jehanno Pascal , Simon Anne-Laure , Mas Virginie 
Published: December 2024

Background: The newborn transphyseal fracture of the distal humerus is frequently misdiagnosed with an elbow dislocation due to the absence of the lateral condyle ossification node. No consensus has been reported either for the diagnosis or the management of these rare fractures. This study aimed to analyze a series of newborns with transphyseal distal humerus fractures. Methods: All consecutive infants treated between 2005 and 2020 for a transphyseal fracture of the distal humerus before the age of 6 months were retrospectively included. All radiological examinations were analyzed (X-ray, ultrasound, and magnetic resonance imaging (MRI)) as well as the therapeutic management (orthopedic or surgical treatment). The patients were seen at outpatient clinic visits with a minimum of 2-year follow-up. Results: Nine newborns were treated. The main cause was an obstetrical traumatism ( n = 8). The diagnosis was made on physical examination and addressed by obstetric departments with standard biplanar radiographs in four cases. The fracture was suspected on physical examination in the remaining five cases and confirmed by complementary imaging (ultrasound (2), MRI (1), and both (3)). A total of six patients were treated conservatively and three surgically with an open reduction. At a mean follow-up of 79 months, two complications occurred: one axillary abscess due to the cast and one cubitus varus deformity. All children had a full functional recovery. Conclusions: The transphyseal fracture of the distal humerus in newborns is a rare entity that should be managed conservatively. Additional imaging examinations are recommended to clarify the diagnosis. Level of evidence: Level IV, cohort study.
Lack of evidence for kynurenine pathway dysfunction in Huntington's disease: Cerebrospinal fluid and plasma analyses from the HDClarity study
Authors: Khetarpal Vinod , Herbst Todd , Dominguez Celia , Munoz-Sanjuan Ignacio , Sampaio Cristina , Marks Bryan , Miller Dennis L , Farnham James , Ledvina Aaron , Anglehart Hannah , Rehmani Imran , LaFayette Amber , Spridco Natasha , Langbehn Douglas , Wild Edward J , Pacifici Robert 
Published: December 2024

Background Evidence from animal studies and post-mortem studies of brains from people with Huntington's disease (PwHD) has suggested that the kynurenine pathway (KP) may be dysregulated in Huntington's disease (HD). Objective To determine whether there are differences in KP metabolites in the cerebrospinal fluid (CSF) and plasma of PwHD vs. healthy controls enrolled in the HDClarity study. Methods CSF and plasma samples from 141 PwHD with mild and moderate manifest disease and 75 healthy controls were analyzed for 3-hydroxykynurenine (3-OH-KYN), quinolinic acid, kynurenine, anthranilic acid, kynurenic acid, and tryptophan concentrations using validated high-performance liquid chromatography with tandem mass spectrometry methods. The primary and secondary endpoints compared metabolite concentrations between groups, and an exploratory analysis (PwHD only) evaluated the association between the metabolite levels and severity of disease. Results No significant differences in CSF or plasma concentrations of any of the six KP metabolites were observed between PwHD and controls, and there were no strong associations between the concentration of any KP metabolite and disease severity. A principal component analysis of the combined CSF and plasma measures showed a substantial positive correlation among all metabolites except for tryptophan in plasma. Conclusions We found no evidence to support the hypothesis of dysregulation of KP metabolites in HD based on CSF and plasma metabolite levels. The monitoring of KP metabolites in CSF or plasma is unlikely to serve as a pharmacodynamic biomarker for disease progression or therapeutic intervention in HD.
The Application of Augmented Reality in Simulation-Based Design Evaluations of Trauma Rooms
Authors: Estejab Hamid , Bayramzadeh Sara 
Published: December 2024

Purpose This study examined the augmented reality (AR) application in design evaluations through an immersive experience of medical task simulations in combination with a full-scale physical mock-up of a trauma room. Background Augmented reality technology is emerging in various fields including architectural design. Traditionally, building physical mock-ups has been the most effective tool to involve end-users in design evaluations. However, AR can eliminate cost- and labor-intensive components of a physical mock-up by replacing them with holograms. Methods Two simulation sessions with emergency department clinicians were conducted using AR. The research team collected user feedback through simulations and interviews. Clinicians’ feedback was systematically categorized and summarized according to various design elements. Result The integration of mock-up and AR simulations enabled the evaluation of design elements that were previously unattainable. Examples include simulating color-coded floor boundaries and adjusting door widths, which enhanced clinicians’ immersion and involvement in design changes. Interviews and analyses of video recordings captured from the clinicians’ perspectives supported the design evaluations during simulations. Conclusions Augmented reality has great potential to be used widely in the evaluation of healthcare environment design. Augmented reality is an innovative approach that can benefit end-users in interacting with a mix of real spaces and virtual components. It also introduces new ways of data collection and analysis to architectural design evaluation methods.
Overview of perianeurysmal edema following the endovascular management of cerebral aneurysms: A pooled analysis of 48 cases
Authors: Azab Mohammed A , Mostafa Hamid Abdelma’aboud , Attalah Oday 
Published: December 2024

Background Perianeurysmal edema occurring after endovascular treatment for cerebral aneurysms is uncommon compared to surgical clipping. The clinical aspects and the exact explanation are poorly understood. Methods We searched PubMed, Google Scholar, and Web of Science. We used the following keywords: “endovascular management of cerebral aneurysms,” “perianeurysmal cerebral edema,” “perianeurysmal cerebral edema after endovascular treatment endovascular treatment,” “intracranial aneurysms with perianeurysmal edema,” and “vessel wall enhancement after endovascular therapy.” For each case, demographic, clinicopathological, therapeutic, and follow-up data were gathered and analyzed. Results Perianeurysmal edema after endovascular treatment has a clear female predilection, with a male: female ratio of 12:29 (25%; 60.41%). The average time from EVT to the onset of edema ranged from 1 day to about 8 years. The aneurysm dimension ranged from 6.8 to 25 mm as the largest size reported. Most patients were asymptomatic (18 [37.5 %]), and headache was the presenting symptom in 10 patients (20.8%). Aneurysmal wall enhancement was reported in 16 (33.3 %) patients with perianeurysmal edema. About 12 patients (25%) developed post-EVT hydrocephalus. The most common coil used was the platinum type (31 [64.58%]). Most of the patients were treated expectantly with follow-up (17 [35.41 %]), while steroids were used only in 14 (29.16%) patients. Most of the patients have their edema resolved (29 [60.41%]) or stable (9 [37.5%]). Conclusion There is growing evidence supporting the incidence of post-embolization inflammatory reactions involving the vessel wall and the surrounding parenchyma; however, the exact clinical perspectives and the predisposing factors are not fully uncovered. This analysis highlights the possible presentations and short-term outcome of patients presenting with perianeurysmal edema after endovascular management of cerebral aneurysms.
Medical software as a virtual service: A multifaceted approach to telemedicine through software-as-a-service and user-centric features
Authors: Mi Yanlin , O’Reilly Barry A , Tabirca Sabin 
Published: December 2024

Background This article presents medical software-as-a-virtual service platform, a comprehensive telemedicine solution integrating software-as-a-service principles with user-centric features to enhance healthcare service efficiency, accessibility, and patient–provider interaction. Methods Medical software-as-a-virtual service employs a multifaceted approach, incorporating a robust questionnaire system for data collection and an empathetic virtual agent module to facilitate nuanced patient–provider interactions. The platform prioritizes privacy and data security through advanced encryption standard encryption and data anonymization, aligning with Health Insurance Portability and Accountability Act standards. Results The initial deployment of medical software-as-a-virtual service demonstrates significant improvements in data collection efficiency, patient engagement, and healthcare service quality. The platform’s adaptability is evidenced by its successful application in specialized fields such as radiology and prolapse. User feedback underscores the system’s ease of use and potential for reducing healthcare providers’ workload. Discussion Despite its promising outcomes, medical software-as-a-virtual service faces challenges, including the need for in-person treatment and limited virtual agent customization. Short-term improvements aim to enhance appointment scheduling, speech recognition, and agent personalization. Long-term goals include integrating artificial intelligence for diagnostic assistance, Internet of Things for comprehensive remote care, and advanced virtual agents for improved patient interaction. Conclusion Medical software-as-a-virtual service emerges as a transformative telemedicine solution, effectively addressing contemporary healthcare challenges. Its continuous evolution, marked by the integration of advanced technologies and user-centered design, holds the potential to reshape the landscape of remote healthcare delivery. Future research will focus on refining platform features and examining the broader impact on healthcare systems and patient outcomes.
The impact of patient communication software app on facilitating communication with mechanically ventilated patients: A randomized clinical trial
Authors: Poursadeghi Zahra , Miri Kheizaran , Hajiabadi Fatemeh , Mazloum Seyyed Reza , Malekzadeh Javad , Niazi Fereshteh 
Published: December 2024

Background & Aim The use of mechanical ventilation devices as a supportive respiratory system for hospitalized patients in intensive care units is often accompanied by the inability of alert patients to establish verbal communication. This study aims to determine the impact of patient communication software on facilitating communication for mechanically ventilated patients in the intensive care unit. Methodology This clinical trial was conducted with two groups, each comprising 60 alert, mechanically ventilated patients hospitalized in medical universities in Mashhad, from December 2022 to January 2023. Patients were randomly assigned to the intervention and control groups. In the intervention group, communication with the patient was established using specially designed software, while in the control group, conventional methods were used to identify patient needs. Data collection tools included a demographic questionnaire and the Ease of Communication Scale. SPSS software (version 20) was utilized for data analysis, employing chi-square, independent t-test, Mann–Whitney, Wilcoxon and paired t-tests. Cohen's d was also used to evaluate the magnitude of the effect size. Results The composition of the groups, including gender and marital status, was comparable, as was their baseline demographic and clinical characteristics (age, gender, education level, marital status, underlying diseases, airway type, hospital stay length, sedative medication, and mechanical ventilation duration), with no significant differences found ( p > 0.05). Before the intervention, there was no difference in communication ease scores between the groups. Post-intervention, the intervention group showed significantly improved communication ease scores compared to the control group ( P < 0.001) The Wilcoxon test results indicated a significant reduction in the average communication ease score after the intervention within both the intervention and control groups. Conclusion Software designed to assist communication for patients on mechanical ventilation with artificial airways could enhance their ability to communicate their needs more effectively, offering an alternative to methods such as lip-reading, writing, alphabet boards and communication boards.
Pre-Operative Direct Oral Anticoagulant Level Measurement Reduces Time to Surgery in Hip Fracture Patients
Authors: P’ng Stephanie Su-Yin , Teh Yue Wern , Reynolds Sophie , Boardman Glenn , Jones Christopher W. , Seymour Hannah 
Published: December 2024

Introduction The optimal management of patients taking DOAC medications in the perioperative trauma setting is based on limited evidence. Current guidelines recommend withholding DOAC medications 48-72 hours pre-operatively. The objective of this trial was to determine the utility of measuring DOAC levels prior to surgery, evaluate the safety of a cut-off level of <50 ng/mL and to compare the outcomes with time parameters. Materials and Methods We performed a cohort study of patients aged 50 years and older admitted with a hip fracture who underwent surgery between January 12 017 and December 31 2019. Primary outcome was time to surgery (TTS) in hours. Secondary outcomes include inpatient transfusion and thromboembolism rates and 30-day mortality. Results 1579 patients underwent operative management of their hip fracture. The mean TTS in the DOAC group was 33.0 hours. This was significantly longer when compared to patients not on anticoagulation whose mean TTS was 24.4hours (95% CI -13.78: −8.71, P value <.05). It was also significantly higher than patients on warfarin whose mean TTS was 26.4hours (95% CI -12.41: −4.18, P value <.05). There was no significant difference in the transfusion rate and 30-day mortality between the groups (X2 = 2.086, df = 2, P value = .352)]. There was no significant difference in transfusion rates and 30-day mortality between the patients with a DOAC level <50 ng/mL compared with the patients not on any anticoagulation. There was no significant difference in 30-day mortality or transfusion rates between those patients on a DOAC operated within 48 hours compared with those operated after 48 hours ( P value = .67). Discussion and Conclusion DOAC therapy delays surgery for patients with a hip fracture. Using a DOAC level <50 ng/mL is a safe level to proceed with surgery and reduces the TTS compared to following current guidelines. If DOAC levels are not available the data still supports operation at 48 hours.
Smooth muscle spheroids: Superior building blocks for bladder tissue engineering
Authors: Planta Dafni , Gerwinn Tim , Baumgartner Valentin , Salemi Souzan , Eberli Daniel , Horst Maya 
Published: December 2024

Background: Congenital bladder disorders in children necessitate innovative approaches for bladder tissue regeneration, aiming to minimize complications associated with conventional therapies. This study focused on generating a cell-seeded scaffold using superior smooth muscle cells (SMCs) by exploring the potential of smooth muscle cell spheroids (3D SMCs) compared to conventionally cultured SMCs (2D SMCs) for bladder tissue engineering. Additionally, adipose-derived stem cells (ADSCs) were investigated for their impact on SMC proliferation and maturation, and pre-differentiated smooth muscle-like ADSCs (pADSCs) for their potential as alternative cell source. Methods: 3D SMCs were seeded into a compressed collagen scaffold as monoculture and as co-culture with ADSCs or pADSCs and incubated for 2 weeks. Their contractile potential as well as proliferation and cell distribution within the scaffold were compared to conventionally cultured 2D SMCs by immunofluorescent staining and qRT-PCR. Results: 3D SMCs in collagen scaffolds exhibited significantly superior cell distribution, proliferation, and contractile marker expression compared to 2D SMCs. While ADSCs showed limited impact, co-culture with pADSCs enhanced contractile marker expression, though not surpassing 3D SMC monoculture. Conclusion: For the first time, a collagen scaffold seeded with 3D SMCs was generated and evaluated. This study recommends 3D SMCs as optimal building blocks for bladder tissue engineering, highlighting the potential of pADSCs as an alternative cell source. These findings offer crucial insights for refining cell sources as well as culture techniques in pediatric bladder regeneration and provide a superior cell-seeded scaffold for further bladder tissue engineering experiments.
The Republic of Kazakhstan’s multi-vector foreign policy
Authors: Nyshanbayev Nurbolat , Bekov Kairat , Baizakova Zhulduz , Amangeldy Alipbayev 
Published: December 2024

The purpose of this scientific work is to assess the developing directions of Kazakhstan’s interaction with other states in various spheres. Different methods of scientific research were used in the study, namely analysis and synthesis, comparison, deduction, abstraction, formal legal method etc. Since independence, Kazakhstan’s multi-vector foreign policy has to some extent contributed to maintaining the balance of power in the region. Having chosen the professional diplomat Tokayev as his successor, Nazarbayev resigned on March 19, 2019, ushering in a new, unanalysed phase of the multi-vector foreign policy that has developed over the past 30 years. A theoretical analysis of the development of Kazakhstan’s foreign policy during the transition of power was carried out. It is concluded that during the transition of power, the multi-vector foreign policy develops in a new direction and in accordance with the priority of geo-economic values. The practical value of this research lies in the contribution to the literature of understanding the concept of multi-vector foreign policy or balance-based foreign policy during power transitions.
Real-world results of the Zeiss selective laser trabeculoplasty in adult South African primary open-angle glaucoma patients
Authors: Church Brian , Wassermann Pierre 
Published: December 2024

Background: Selective laser trabeculoplasty (SLT) is an effective long-term option for the treatment of open-angle glaucoma. Objectives: To investigate the real-world efficacy and safety of SLT with the Zeiss VISULAS green laser in medically treated primary open-angle glaucoma (POAG). Design: Retrospective, single-center study. Methods: POAG patients ⩾18 years of age on at least one antiglaucoma medication prior to the procedure, who underwent SLT with the Zeiss VISULAS green laser (Carl Zeiss Meditec, Jena, Germany). Medications were terminated or reinstated at subsequent follow-ups depending on the intraocular pressure (IOP) control. The primary efficacy outcome measures were mean reduction in glaucoma medications and mean reduction in IOP at 3, 6, and 12 months compared to baseline. Safety outcomes were intra- or post-procedural complications. Results: One hundred fifty-six eyes of 156 patients, aged 66.5 ± 13.2 years, were recruited. The mean number of medications was reduced from 2.3 ± 1.0 at baseline to 0.8 ± 1.1 and 0.8 ± 1.2 at 3- and 6 months, respectively ( p < 0.001). Despite the reduction of medications, the mean IOP (mmHg) was reduced from 16.6 ± 3.10 at baseline to 15.4 ± 3.82 at 3 months ( n = 156) and 15.1 ± 3.30 at 6 months ( n = 140) ( p < 0.001). IOP reduction ⩾20% was observed in 28.8% of patients at 3 months and 27.9% of patients at 6 months. In the 12-month follow-up group ( n = 22), mean medications and IOP (mmHg) at baseline were 2.3 ± 0.9 and 16.0 ± 2.80, respectively, which decreased to 0.9 ± 1.1 ( p < 0.001) and 14.5 ± 1.92 ( p = 0.103), respectively. At 3- and 6-month post-procedure, 59.6% of patients and 60% of patients, respectively, were medication-free compared to none at baseline. At 6 months, 69.3% of patients maintained IOP lower than or equal to pre-procedure IOP on fewer medications compared to baseline. No vision-threatening intra- or post-procedure complications were noted. Conclusion: SLT with the Zeiss VISULAS green laser resulted in a clinically and statistically significant reduction in number of medications needed for IOP control. The procedure had a good safety profile similar to that described in the literature for SLT, with no vision-threatening complications.