bluuebunny/crossref_metadata_2025_split huggingface dataset:
Epidemiology of Pediatric Fractures and Effect of Socioeconomic Status on Fracture Incidence in Türkiye: A Nationwide Analysis of 2 Million Fractures
Authors: Kamaci Saygin , Yilmaz Engin Turkay , Goker Barlas , Dumlupinar Ebru , Ata Naim , Ulgu Mehmet Mahir , Birinci Suayip , Bingol Izzet , Yazici Muharrem , Kalenderer Onder 
Published: December 2024

Background:
Childhood fractures are an important public health issue worldwide as they potentially lead to long-term complications. This is the first study reporting a nationwide data pool of 2 million children. We aimed to investigate the epidemiology of pediatric fractures by sex, age, geographical region, and socioeconomic status (SES).

Methods:
Medical records of children diagnosed with fractures between 2016 and 2022 were collected from Türkiye’s e-health database. Fractures were divided into 16 anatomic locations. Age was evaluated in four categories: <5, 5–9, 9–14, and 15–19 years. Regional rankings were stratified based on SES.

Results:
A total of 1,989,212 pediatric fractures were analyzed (1,371,398 boys, 617,814 girls). The overall fracture incidence was 1117/100,000 person-years, being higher for boys (n=1501) compared with girls (n=713) (P<0.001). The mean fracture incidence between 0 and 19 years of age was 21.2% (boys: 28.5%; girls: 13.5%). The overall fracture incidence increased with age, peaking at 10 to 14 years for all children and decreasing thereafter. The 4 most common fracture locations were in the upper extremities. Wrist fractures accounted for 28.9% (575,192) of all pediatric fractures. Provinces with higher SES had significantly increased fracture risks.

Conclusions:
This study provides the most accurate epidemiological analysis of childhood fractures in the Turkish population with landmark nationwide analysis for the pediatric literature. One fifth of children experienced fractures before maturity. The results highlight the influence of SES on fracture rates, as children in more urbanized and developed areas had an elevated risk of fractures.

Level of Evidence:
Level III—diagnostic.
Effectiveness of Organ Preservation for Locally Advanced Rectal Cancer With Complete Clinical Response After Neoadjuvant Chemoradiotherapy: Bayesian Network Meta-analysis
Authors: Ouyang Kaibo , Yang Zifeng , Yang Yuesheng , Lyu Zejian , Wang Junjiang , Li Yong 
Published: December 2024

BACKGROUND:
Neoadjuvant chemoradiotherapy followed by radical surgery is the common treatment for patients with locally advanced rectal cancer. Presently, for patients with complete clinical response after neoadjuvant chemoradiotherapy, organ preservation (“watch-and-wait” and local excision strategies) has been increasingly favored. However, the optimal treatment for patients with complete clinical response remains unclear.

OBJECTIVE:
This study aimed to use Bayesian meta-analysis to determine the best treatment for patients with locally advanced rectal cancer with complete clinical response among radical surgery, local excision, and watch-and-wait strategies.

DATA SOURCES:
PubMed, Web of Science, Cochrane Library, and Embase (Ovid) databases were searched for literature published through December 31, 2023.

STUDY SELECTION:
Studies that compared 2 or more treatments for patients with complete clinical response were included.

INTERVENTION:
The analysis was completed via Bayesian meta-analysis using a random-effects model.

MAIN OUTCOME MEASURES:
Surgery-related complications, local recurrence, distant metastasis, and 5-year overall and disease-free survival rates.

RESULTS:
Eleven articles met the inclusion criteria. The watch-and-wait group and local excision group exhibited a higher rate of tumor recurrence compared to the radical surgery group (watch-and-wait vs radical surgery: OR, 9.10 [95% CI, 3.30–32.3]; local excision vs radical surgery: OR, 2.93 [95% CI, 1.05–9.95]). The distant metastasis, overall survival, and disease-free survival rates of the 3 treatments were not statistically different. The radical surgery group had the most number of stomas and had the greatest risk of morbidity than the watch-and-wait group (watch-and-wait vs radical surgery: OR, 0.00 [95% CI, 0.00–0.12]).

LIMITATIONS:
The study included only 1 randomized controlled trial compared to 10 observational studies, which could affect overall quality. Funnel plots of disease-free survival rates and stoma suggest significant publication bias among studies that compared radical surgery with the watch-and-wait strategy.

CONCLUSIONS:
The watch-and-wait strategy could be optimal for patients with locally advanced rectal cancer with complete clinical response after neoadjuvant chemoradiotherapy.
Association of ADH1B and ALDH2 genotypes with the risk of lung adenocarcinoma
Authors: Pan Tzu-Yu , Lee Jui-Ying , Chen Jia-Jen , Liu Yu-Wei , Abishaw A. Nishawlini , Su Ming-Wei , Lin Chien-Wei , Hsieh Tusty-Jiuan , Peng Chiung-Yu , Turesky Robert J. , Bellamri Medjda , Kwan Aij-Lie , Wu Chia-Fang , Wu Ming-Tsang 
Published: December 2024

Objective
The incidence of lung adenocarcinoma (LAD) is increasing worldwide. Single-nucleotide polymorphisms in aldehyde dehydrogenase 2 family member gene (ALDH2) rs671 and alcohol dehydrogenase 1B (ADH1B) rs1229984 are common and functionally important genetic variants to metabolize endogenous and exogenous aldehyde chemicals, related to cancer.

Methods
This is a case–control study. A total of 150 newly diagnosed LAD patients were from Kaohsiung Medical University Hospital, Taiwan, between 2019 and 2022. Two control groups, TWB-1 (n = 600) and TWB-2 (n = 29 683), were selected from Taiwan Biobank (TWB), and the case patients were frequency-matched with TWB-1 based on age category (30–60 or >60 years old), sex, and education levels. Logistic regression models were employed to analyze the association between two genetic variants and LAD risk.

Results
A significant association was noted between ALDH2 and LAD risk. Those with ALDH2 rs671 *2/*2 in TWB-1 and TWB-2 controls had a 2.68-fold (95% CI = 1.43–4.99) and a 1.83-fold (95% CI = 1.07–3.11) increased risk of LAD, respectively, compared with those with ALDH2 rs671 *1/*1 or *1/*2, after adjusting for covariates. This association was particularly pronounced in females. No overall significant association between ADH1B rs1229984 and LAD risk was observed.

Conclusion
The findings indicate a strong and robust risk association between ALDH2 rs671*2/*2 and LAD in the Taiwan population, particularly in Taiwanese female adults.
Comparison of the Quality of Lymphatic Vessel Images Obtained Using Two Photoacoustic Imaging Systems
Authors: Suzuki Yushi , Kajita Hiroki , Otaki Marika , Watanabe Shiho , Okabe Keisuke , Sakuma Hisashi , Takatsume Yoshifumi , Asano Yuta , Soga Shigeyoshi , Imanishi Nobuaki , Sato Imari , Jinzaki Masahiro , Kishi Kazuo 
Published: December 2024

Summary:
Photoacoustic imaging (PAI) can evaluate lymphatic vessels with a high resolution (0.2 mm) compared with other methods. LUB0, a new PAI device that is smaller than the PAI-05 used since 2020 (both from Luxonus, Inc.), has been introduced. We aimed to determine the imaging capability of LUB0 by comparing it with that of PAI-05. Two healthy individuals and 4 patients with lymphedema underwent PAI using PAI-05 and LUB0. Each participant was subcutaneously injected with indocyanine green to visualize the lymphatic vessels. PAI was performed after confirming that the lymphatic flow had moved to the central part of the body using a near-infrared camera. Four physicians selected a device with superior image clarity based on a 5-point scale. LUB0 produced sharper images of lymphatic vessels and veins than PAI-05. The physicians scored 3.0 ± 1.2 with PAI-05 and 3.9 ± 0.9 with LUB0 (P < 0.05), implying that LUB0 provided significantly clearer images. Additionally, the dermal backflow image obtained using LUB0 from a patient with lymphedema depicted the precollector lymphatic vessels more clearly. LUB0 occupies approximately one-seventh of the footprint of PAI-05 and requires a shorter imaging time (5 minutes) than PAI-05 (10 minutes). The PAI model LUB0 improved the visualization of lymphatic vessels and veins, allowing better detection and evaluation of lymphatic vessels.
Modulatory effects of CNNM4 on protein-l-isoaspartyl-O-methyltransferase repair function during alcohol-induced hepatic damage
Authors: González-Recio Irene , Goikoetxea-Usandizaga Naroa , Rejano-Gordillo Claudia M. , Conter Carolina , Rodríguez Agudo Rubén , Serrano-Maciá Marina , Zapata-Pavas Leidy Estefanía , Peña-Sanfélix Patricia , Azkargorta Mikel , Elortza Félix , Herranz José María , Guillamon Thiery Álex , Guerra-Ruiz Armando Raúl , Jover Ramiro , Galicia-Garcia Unai , Martín César , Schaeper Ute , Delgado Teresa C. , Díaz-Moreno Irene , Díaz Quintana Antonio , Buccella Daniela , Nogueiras Rubén , Argemi JosepMaria , Ávila Matías A. , Gratacós-Ginès Jordi , Iruzubieta Paula , Pose Elisa , Bataller Ramón , Crespo Javier , Martínez-Cruz Luis Alfonso , Martínez-Chantar María Luz 
Published: December 2024

Background and Aims:
Alcohol-associated liver disease (ALD) is a leading cause of liver-related mortality worldwide, with limited treatment options beyond abstinence and liver transplantation. Chronic alcohol consumption has been linked to magnesium (Mg2+) deficiency, which can influence liver disease progression. The mechanisms underlying Mg2+ homeostasis dysregulation in ALD remain elusive. This study aimed to investigate the role of the Mg2+ transporter Cyclin M4 (CNNM4) in ALD by analyzing its expression patterns in patients with ALD and preclinical animal models.

Approach and Results:
In this study, CNNM4 is upregulated in the liver of both patients with ALD and animal models. CNNM4 overexpression triggers Mg2+ homeostasis dysregulation, linked to ALD progression. We propose a novel therapeutic approach for ALD treatment using N-acetylgalactosamine silencing RNA technology to specifically modulate Cnnm4 expression in the liver, improving mitochondrial function and alleviating endoplasmic reticulum stress. Notably, silencing Cnnm4 restores protein isoaspartyl methyltransferase (PCMT1) activity, essential for repairing ethanol-induced protein damage. Enhancing mitochondrial activity through Cnnm4-dependent mechanisms increases S-adenosylmethionine levels, crucial for PCMT1 function, highlighting the interconnected roles of mitochondrial health and protein homeostasis in ALD treatment.

Conclusions:
These findings shed light on the dysregulation of Mg2+ homeostasis in ALD, providing a promising therapeutic approach targeting CNNM4. N-acetylgalactosamine siCnnm4 therapy boosts the repair processes of ethanol-damaged proteins through the upregulation of PCMT1 activity.
Occupational exposure to inhalable agents is associated with reduced work ability: A prospective cohort study in Norway
Authors: Klepaker Geir , Torén Kjell , Henneberger Paul Keefer , Kongerud Johny , Fell Anne Kristin Møller 
Published: December 2024

Abstract

Background
This study aimed to assess work ability score (WAS) in 2018 based on self-reported data regarding inhalable occupational exposure and data from a northern European job-exposure matrix (N-JEM) recorded in 2013.

Methods
During the 5-year follow-up period of this population-based study, 4423 participants completed a postal questionnaire comprising self-reported questions regarding occupational exposure, work history, and WAS.

Results
Ever, weekly, and daily exposure to vapors, gas, dust and fumes (VGDF) in the last 5 years in 2013 was associated with reduced WAS in 2018. The N-JEM data showed that exposure to irritants, wood and paper dust, and mixed agricultural agents were associated with reduced WAS.

Conclusions
Exposure to several occupational inhalable substances is associated with reduced work ability. We recommend reducing inhalable occupational exposure to prevent reduced work ability.
Gaps in Workplace Injury Reporting Among Physicians to the United States Bureau of Labor Statistics
Authors: Gabrielson Andrew T. , Chrouser Kristin , Hallbeck M. Susan , Cohen Tara , Corwin Claudia 
Published: December 2024

Abstract

Objective
To identify gaps in nonfatal injury and illness (NII) reporting between physicians and other occupations.

Methods
Bureau of Labor Statistics data (2011-2019) were analyzed, comparing annualized NII incidence rates using incidence rate ratios (IRR), with physicians as the reference.

Results
Between 2011-2019, physicians reported significantly lower NII rates compared to high-hazard non-medical occupations (IRR 17.2-70.8, all p < 0.01) and most low-hazard non-medical occupations (IRR 1.2-6.3, all p < 0.01), except lawyers. NII rates among physicians were also lower than those in non-physician medical occupations (IRR 1.4-27.6, all p < 0.01). In 2020, relative NII rates between physicians and non-physician medical occupations decreased but returned to pre-pandemic levels by 2021.

Conclusions
Physicians report significantly lower NII rates than other occupations, likely due to underreporting or undercounting, highlighting a potential gap in occupational injury data.
Proportional modes to hasten weaning
Authors: Bosma Karen J. 
Published: December 2024

Purpose of review
The purpose of this review is to examine the current state of the evidence, including several recent systematic reviews and meta-analyses, to determine if proportional modes of ventilation have the potential to hasten weaning from mechanical ventilation for adult critically ill patients, compared to pressure support ventilation (PSV), the current standard of care during the recovery and weaning phases of mechanical ventilation.

Recent findings
Proportional assist ventilation (PAV) and neurally adjusted ventilatory assist (NAVA) are two commercially available proportional modes that have been studied in randomized controlled trials (RCTs). Although several feasibility studies were not powered to detect differences in clinical outcomes, emerging evidence suggests that both PAV and NAVA may reduce duration of mechanical ventilation, intensive care unit (ICU) length of stay, and hospital mortality compared to PSV, as shown in some small, primarily single-centre studies. Recent meta-analyses suggest that PAV shortens duration of mechanical ventilation and improves weaning success rate, and NAVA may reduce ICU and hospital mortality.

Summary
The current state of the evidence suggests that proportional modes may hasten weaning from mechanical ventilation, but larger, multicentre RCTS are needed to confirm these preliminary findings.
Autosomal recessive renal tubular dysgenesis: antenatal ultrasound scanning and molecular investigations
Authors: Liu Yang , Luo Caiqun , Wu Xiaoxia , Chen Liyuan , Cao Xiushu , Wang Hui 
Published: December 2024

Objective
This study aimed to elucidate the fetal ultrasound characteristics, pathology, and molecular genetic etiology of autosomal recessive tubular dysplasia.

Methods
This retrospective study examined four fetuses with autosomal recessive tubular dysplasia (ARRTD) from two pregnancies, utilizing ultrasound evaluations and fetal renal pathology. Whole-exome sequencing-copy number variation analysis was employed to identify gene mutations.

Results
We present for the first time renal vascular resistance in fetuses with ARRTD, characterized by increased renal blood flow resistance and reversed diastolic blood flow, indicating fetal renal insufficiency. This is the first report of a nonsense mutation (C.571C>T) found in the angiotensinogen gene.

Conclusion
ARRTD disease should be strongly suspected when ultrasound examinations reveal increased renal blood flow resistance, oligohydramnios, and inadequate bladder filling, regardless of the presence of renal abnormalities.
Health System Expansion and Changes in Medicare Beneficiary Utilization of Safety Net Providers
Authors: Li Kun , Escarce José J. , Zhang Shiyuan , Agniel Denis , DeYoreo Maria , Timbie Justin W. 
Published: December 2024

Background:
Evidence is limited on insured patients’ use of safety net providers as vertically integrated health systems spread throughout the United States.

Objectives:
To examine whether market-level health system penetration is associated with: (1) switches in Medicare beneficiaries’ usual source of primary care from federally qualified health centers (FQHCs) to health systems; and (2) FQHCs’ overall Medicare patient and visit volume.

Research Design:
Beneficiary-level discrete-time survival analysis and market-level linear regression analysis using Medicare fee-for-service claims data from 2013 to 2018.

Subjects:
A total of 659,652 Medicare fee-for-service beneficiaries aged 65 and older lived in one of 27,386 empirically derived primary care markets whose usual source of care in 2013 was an FQHC or a non-FQHC–independent physician organization that predominantly served low-income patients.

Measures:
Beneficiary-year measure of the probability of switching to health system-affiliated physician organizations and market-year measures of the number of FQHC visits by Medicare beneficiaries, number of beneficiaries attributed to FQHCs, and FQHC Medicare market shares.

Results:
During 2013–2018, 16.5% of beneficiaries who sought care from FQHCs switched to health systems. When health system penetration increases from the 25th to 75th percentile, the probability of Medicare FQHC patient switching increases by 4.6 percentage points, with 22 fewer Medicare FQHC visits and 4 fewer beneficiaries attributed to FQHCs per market year. Complex patients and patients who sought care from non-FQHC, independent physician organizations exhibited higher rates of switching to health systems.

Conclusions:
Health system expansion was associated with the loss of Medicare patients by FQHCs, suggesting potential negative spillovers of vertical integration on independent safety net providers.
Overcoming resistance in HER2-positive gastric cancer: a case report on the synergistic effect of pembrolizumab and trastuzumab
Authors: Gong Ting , Ma Qing , Ren Yaoyao , Gu Liyan , Lv Hui , Zhong Diansheng 
Published: December 2024

Introduction:
The first-line standard therapy for advanced HER2-positive gastric cancer is chemotherapy combined with trastuzumab and pembrolizumab, while pembrolizumab alone does not benefit as a monotherapy in patients with mismatch repair proficiency (pMMR). This case explores the therapeutic potential of adding pembrolizumab to patients who were resistant to trastuzumab, focusing on the synergistic effect of an immune checkmate inhibitor, combined with HER2 antibody.

Case Presentation:
An 87-year-old metastatic gastric cancer patient, whose medical history was significant for intolerance to chemotherapy and had a poor status of performance. Immunohistochemical staining was presented as HER2 (3+), pMMR, and PD-L1 was 4. Initially treated with trastuzumab monotherapy, the patient showed no response and experienced progressive disease. Subsequently, a combined regimen of trastuzumab and a half-dose of pembrolizumab was administered every 3 weeks. Remarkably, it led to a significant reduction in tumor size, achieving partial remission (PR) after two cycles. This response was sustained over 21 months, as evidenced by the latest CT scans.

Clinical Discussion:
The concurrent administration of trastuzumab and pembrolizumab has demonstrated synergistic antitumor activity, achieving clinical efficacy in cases where each agent alone proved ineffective. Preclinical studies illustrated that tumor regression induced by HER2 antibodies requires T cell involvement, and the combination of immune checkpoint inhibitors with trastuzumab augments HER2-specific T cell responses, promotes immune cell recruitment, and induces the expansion of peripheral memory T cells, which showed synergistic rationales for a combination of pembrolizumab and trastuzumab.

Conclusion:
The observed synergy between pembrolizumab and trastuzumab highlights a promising treatment avenue that warrants further investigation.
The Petri dish under the ice: permafrost pathogens and their impact on global healthcare and antibiotic resistance
Authors: Saleem Muhammad M. , Elahi Naz , Athar Roha , Gul Areeba , Adil Mariam , Ellahi Aayat , Kashif Haider , Hojeij Moussa 
Published: December 2024

Background:
A shallow active layer of soil above the permafrost thaws during the summer months which promotes microbial growth and releases previously confined pathogens which result in bacterial epidemics in circumpolar regions. Furthermore, these permafrost sources harbor several antibiotic resistance genes (ARGs) which may disseminate and pose a challenge for pharmacologists worldwide.

Aims:
The authors examined the potential association between climate change-induced permafrost thawing, and the resulting release of antibiotic-resistant pathogens, as well as the potential impact this can have on global healthcare systems in the long run.

Methodology:
A cursory abstract screening was done to rule out any articles that did not have to do with viral pathogens caused by melting permafrost. Articles that were not available in English or that our institutions library did not have full-text access were weeded out by a secondary screen.

Results:
A comprehensive analysis of 13 relevant studies successfully revealed a wide variety of bacterial genera, including Staphylococcus spp., Pseudomonas spp., Acinetobacter spp., and Achromobacter spp., along with a total of 1043 antibiotic resistance genes (ARGs), with most pertaining to aminoglycosides and beta-lactams, offering resistance via diverse mechanisms such as efflux pumps and enzymatic modifications, within the permafrost isolates. Additionally, mobile genetic elements (MGEs) housing antibiotic resistance genes (ARGs) and virulence factor genes (VFGs), including plasmids and transposons, were also discovered.

Conclusion:
Permafrost thawing is an underrated healthcare challenge warranting the need for further articles to highlight it alongside concerted efforts for effective mitigation.
External Validation of the Surgical Intervention for Traumatic Injuries Scale in Children
Authors: Jonsson Bergthor , Madhok Manu , Lammers Shea , Reimche Paige , McClure Meghan , Kiragu Andrew W. , Kebriaei Meysam A. , Bergmann Kelly R. 
Published: December 2024

Objectives:
The Surgical Intervention for Traumatic Injuries (SITI) scale is intended to predict the likelihood of needing surgical decompression among patients with traumatic brain injury (TBI). We sought to examine the performance of the SITI score to predict likelihood of acute neurosurgical intervention for children with TBI.

Methods:
We conducted a cross-sectional, retrospective, observational study of children diagnosed with TBI as determined by International Classification of Diseases codes, presenting to a single level 1 pediatric trauma center, between June 1, 2003, and May 31, 2018. The main outcome was decompressive craniotomy or craniectomy within 24 hours of arrival. Data for SITI scoring were abstracted by research assistants, and all cases were scored by a physician who was blinded to the outcome. The SITI scale performance was evaluated using receiver operating characteristic curve and by calculating the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV).

Results:
There were 656 encounters with TBI, of which 39 (5.9%) underwent surgical decompression. The mean SITI scores were 4.15 for the operative group and 0.40 for the nonoperative group (P < 0.001). A cutoff of 2 or greater for a positive score gave the best performance with a sensitivity of 0.79, specificity of 0.90, PPV of 0.34, and NPV of 0.99. The area under the receiver operating characteristic curve was 0.89 (95% confidence interval, 0.83–0.96). In sensitivity analysis excluding 75 cases with depressed skull fractures, a score of 2 or greater had a sensitivity of 0.96, specificity of 0.91, PPV of 0.31, and NPV of 1.00. The area under the receiver operating characteristic curve was 0.98 (95% confidence interval, 0.97–1.00).

Conclusions:
A SITI score of less than 2 is associated with nonoperative management. However, clinicians should not be falsely reassured by a low score in patients with depressed skull fractures.