bluuebunny/crossref_metadata_2025_split huggingface dataset:
Flag sign: a case report of an unusual magnetic resonance imaging finding of a free lateral meniscal fragment
Authors: Zhang Liang , Zhang Li , Ren Bo , Kang Xin , Zhang Xian , Zhao Zandong , Zheng Jiang 
Published: September 2024

Background Meniscal injury is a common sports medicine condition. Magnetic resonance imaging (MRI) is widely used to effectively diagnose meniscal injury. A flag sign on MRI is usually typical of a meniscal root tear. We report the case of a “flag sign” caused by a free lateral meniscal fragment that mimicked the anterior cruciate ligament (ACL) signal on MRI. Case presentation This was a 21-year-old male patient who suffered a knee injury (swelling and pain) playing football. A physical examination revealed positive Lachman and lateral McMurray tests. MRI images showed an ACL injury and the flag sign, and a diagnosis of ACL tear and lateral meniscal injury was made. Arthroscopic lateral meniscal repair and ACL reconstruction were performed. Six months postoperatively, MRI showed that the injuries were well healed. In this particular case, the flag sign introduced interference to the MRI assessment of ACL injury. Conclusions This case illustrates that clinicians should carefully identify the morphological changes in the meniscus and the relationship of the meniscus with the femoral condyle before reaching a final diagnosis.
Pelvic Stress Fractures Following Resection and Reconstruction of Pelvis Tumours—An Observational Study
Authors: Saad Ahmed , Iyengar Karthikeyan P. , Kurisunkal Vineet , Parry Michael , Botchu Rajesh 
Published: October 2024

Background and Aims: Pelvic bone tumours are rare, with a guarded prognosis despite advances in radiological imaging and surgical techniques. Despite this, limb salvage surgery has become the mainstay treatment for patients presenting with primary bone sarcomas, especially those with low histological grade variants. However, the rate of peri-operative-associated complications remains high in the form of local recurrence and surgical site infections (SSI). Objective: We highlight our experience from a tertiary referral oncology centre of incidence and clinical and radiological features, as well as discuss the risk factors for developing pelvic stress fractures (PSFs) in patients treated with hemipelvis resection. Materials and Methods: We performed a retrospective search from our radiology and oncology database at our tertiary orthopaedic oncology referral centre for patients referred, diagnosed and managed for stress fractures following an internal hemipelvectomy for pelvic tumours/Sarcoma through the service between 2007 and 2019. Patient demographics, clinical characteristics, complementary imaging, clinical management outcome and peri-operative complications were documented. A focussed evaluation of patients diagnosed and managed for PSFs in patients treated with hemipelvis resection. Results: We identified a total of six patients with stress fractures following internal hemipelvectomy. The sacrum was the most common anatomical region ( n = 3). Other areas identified with insufficiency stress fractures included the ischium and femoral neck. Conclusion: Stress fractures post pelvis resection and reconstruction is a rare complication. Radiologists and orthopaedic oncology surgeons need to be aware of this complication to aid with an early diagnosis and initiate appropriate management.
Detectable Concentrations With Inhaled Tobramycin in Critically Ill Infants and Children Following Implementation of Standardized Protocol
Authors: Johnson Peter N. , Chang Eugenie , Cormack Emily , Hornaday Kaley , Neely Stephen B. , Ranallo Courtney , Chaaban Hala , Garcia-Contreras Lucila , Miller Jamie L. 
Published: September 2024

Background: A protocol was established for ventilator-associated tracheitis or pneumonia using inhaled tobramycin 300 mg every 12 hours in mechanically ventilated children via a vibrating mesh nebulizer, 30 cm from the endotracheal tube in the inspiratory loop of the mechanical ventilator. Objectives: The primary objective was to determine the incidence of detectable tobramycin trough concentrations >0.5 µg/mL. Secondary objectives included a comparison of clinical characteristics between those with and without detectable concentrations and identification of patients with acute kidney injury (AKI) as defined by the Kidney Diseases Improving Global Outcomes (KDIGO) criteria. Methods: This was a single-center retrospective study of critically ill children <18 years without cystic fibrosis receiving inhaled tobramycin between July 1, 2016, and August 31, 2021. Data collection included demographics, tobramycin regimen, and renal function. Analysis was performed using SAS 9.4, with a P-value <0.05, and a multivariable regression model was performed to identify factors for detectable concentrations and AKI. Results: Forty-four patients (66 courses) were included, with an overall age of 0.83 years. Thirty (68%) patients had detectable concentrations and 9 (20.5%) developed AKI. No significant differences in demographics, diagnosis, mechanical ventilation settings, and number of nephrotoxins were noted between those with and without detectable concentrations or AKI. Multivariable regressions did not identify factors associated with detectable concentrations or AKI. Conclusion and Relevance: Detectable concentrations occurred with the majority of courses, with AKI associated with approximately one-fourth of courses. Clinicians should consider utilizing trough monitoring for all mechanically ventilated critically ill children receiving inhaled tobramycin.
Characterization of Ganciclovir Dosing for the Management of Cytomegalovirus in Solid Organ Transplant Recipients Receiving Sustained Low-Efficiency Dialysis
Authors: Zhang Jinfan Aaron , Brown Paula , Harrison Jennifer , Battistella Marisa 
Published: September 2024

Background: The optimal dosing of intravenous ganciclovir in patients receiving sustained low-efficiency dialysis (SLED) remains unclear. Objective: The primary objective is to characterize the dosing of ganciclovir for treating and preventing cytomegalovirus (CMV) in Solid Organ Transplant Recipients receiving SLED. The secondary objective is to evaluate the safety and efficacy of the dosing practices described in this study. Methods: Retrospective review of electronic medical records from solid organ transplant recipients (SOTRs) admitted to the Medical Surgical Intensive Care Unit at the Toronto General Hospital (TGH) between November 28, 2016, and September 1, 2021, was conducted. Patients concurrently receiving ganciclovir and SLED were included. Results: Among the 27 encounters for CMV prevention, 18 patients underwent 8-hour SLED, 6 underwent 24-hour SLED, and 3 received other SLED durations. Most patients (80%) on 8-hour SLED began ganciclovir at 2.5 mg/kg/d, whereas 80% of those on 24-hour SLED started at 5 mg/kg/d. No breakthrough viremia occurred at 5 mg/kg/d, with 1 instance at 2.5 mg/kg/d. Cytopenia rates were higher at 5 mg/kg/d (33% vs 20%). For treatment (n = 20), 16 patients underwent 8-hour SLED, 2 underwent 24-hour SLED, and 2 underwent 12-hour SLED. Most (75%) on 8-hour SLED started at 2.5 mg/kg/d, whereas all on 24-hour SLED began at 5 mg/kg/d. Viral eradication rates were 75% and 60% at 2.5 and 5 mg/kg/d, respectively, with higher cytopenia rates at 5 mg/kg/d (37.5% vs 0%). Dose adjustments were primarily in response to refractory disease or cytopenia. Conclusion and Relevance: At our institution, ganciclovir dosing patterns suggest that for patients requiring 8-hour SLED, there is clinician comfort in using 2.5 mg/kg/d for prevention and 5 mg/kg/d for treatment. In 24-hour SLED, 5 mg/kg/d may be considered for prevention. Higher doses may be considered for CMV treatment; however, we found greater variability in the dosing practices for these patients. Further research with larger sample sizes and ganciclovir drug-level assessments is needed to optimize dosing strategies for CMV treatment.
Perceptions of Academic Performance, Impairment, and Mental Health in University Students With and Without ADHD
Authors: Stewart Christian M. , Master Allison , Mire Sarah S. , Hassett Kristen S. , Smith Bradley H. 
Published: September 2024

Objective: This study aims to investigate the impact of positive illusory bias (PIB) on the relationship between ADHD symptoms and functioning in college students, with a focus on gender differences. Method: The sample consisted of 195 college students, including 148 with ADHD and 47 without ADHD. Measures of ADHD symptomatology, life satisfaction, affect, gender identity, and impairment were collected, along with cumulative grade point average. Results: ADHD symptomatology was inversely linked to subjective well-being, with PIB acting as a significant moderator. Functional impairment was predicted by ADHD symptoms and subjective well-being, while social impairment and academic functioning were predicted by PIB and well-being. Significant gender differences were found, particularly in the interaction between PIB and ADHD symptoms for non-binary individuals. Conclusion: This study suggests that PIB is relevant for emerging adults with ADHD enrolled in higher education. Subjective well-being and PIB act as buffers against the detrimental functional and social effects of ADHD symptoms in emerging adult college students. The study highlights the importance of considering gender-specific approaches in understanding and supporting the mental health of this population.
One-Year Prognosis Difference of Myocardial Infarction With or Without Coronary Obstruction in Developing Countries: Insights From the Moroccan Experience
Authors: Bouchlarhem Amine , Merimi Ihssane , Bazid Zakaria , ismaili Nabila , El ouafi Noha 
Published: September 2024

Introduction: The debate remains open as to the difference in prevalence of mortality and occurrence of acute events in patients with Myocardial infarction with non-obstructive coronary arteries (MINOCA) and others with Myocardial infarction with coronary arteries disease (MI-CAD). Methods: We conducted a 2-year retrospective study for patients admitted for Acute coronary syndrome (ACS) to analyze the clinical and prognostic characteristics of patients with MINOCA versus MI-CAD. We defined 1-year all-cause mortality as the primary outcome, and the secondary outcome as a composite of 1-year readmission for myocardial infarction or acute heart failure (AHF). Results: Our study included 1077 patients, 95.3% with MI-CAD and 4.7% with MINOCA. At admission, 71.1% patient were diagnosed STEMI and 28.9% with NSTEMI. The difference between the 2 groups was found on age ( P < .001), hypertension, diabetes with consecutive P-values of .007 and .001, as well as Ejection fraction ( P < .001). For the outcomes studied, the difference was significant between the 2 groups for all events, and MINOCA patients had a better prognosis than MI-CAD patients, with adjusted hazard ratios (HR) for 1-year mortality (HR = 0.601 P = .004), for readmission for ACS (HR = 0.662; P = .002) and for readmission for AHF (HR = 0.539; P = .019). Conclusion: Despite the ambiguity in the genesis of MINOCA, the short- and long-term prognosis of these patients remains generally favorable.
Compensating for Angiographic Underestimation With Oversized Balloon Angioplasty in Patients With Chronic Limb-Threatening Ischemia and Occluded Below-the-Knee Vessels
Authors: Teymen Burak , Emin Öner Mehmet , Erdağ Yiğit 
Published: September 2024

Purpose:Our study aims to determine optimal sizing of below-the-knee (BTK) artery angioplasty without intravascular ultrasound (IVUS), compensating for conventional angiography underestimation by selecting a balloon size one size larger than the 1-to-1 angiographic sizing.Materials and Methods:Our study is a retrospective, single-center study. Patients were separated into 2 groups as over and angiographic reference group which the over group is larger balloon diameter selection (0.5-mm larger balloon diameter selection), and angiographic reference group is 1-to-1 balloon diameter selection by angiographic images. Primary end point was the target vessel reocclusion, whereas major and minor amputation was the secondary end point.Results:Eighty-four patients with occluded BTK lesions treated with balloon angioplasty (Opt=43, Over=41). Primary patency was 62.8% at 12 months in angiographic reference group and 82.9% in over group (p=0.039). Amputation rate at 1-year follow-up was 9.8% in angiographic reference group and 16.3% in over group (p=0.382). TLR rate is 4.9% in over group versus 20.9% in angiographic reference group (20.9%) at 1-year follow-up (p=0.029).Conclusion:Our study demonstrates that oversizing the balloon diameter by one size larger in BTK artery angioplasty, guided by conventional angiography, results in a higher patency rate and a lower target lesion revascularization (TLR) rate, while amputation rate remains statistically similar between the 2 groups.Clinical ImpactOur study highlights the importance of compensating for conventional angiography’s underestimation in BTK artery angioplasty by using a balloon size one size larger than the 1-to-1 angiographic sizing. Our findings demonstrate that oversizing the balloon leads to significantly higher patency rates and lower TLR rates, with no increase in amputation risk. This approach provides a practical, cost-effective solution for clinicians performing angioplasty without IVUS, allowing for better vessel treatment and outcomes in patients with chronic limb-threatening ischemia. Clinicians can implement this strategy to optimize long-term results in BTK interventions.
Predicting Long-Term Outcome of Prolonged Disorder of Consciousness in Children Through Machine Learning Based on Conventional Structural Magnetic Resonance Imaging
Authors: Zheng Helin , Ding Shuang , Chen Ningning , Huang Zhongxin , Tian Lu , Li Hao , Wang Longlun , Li Tingsong , Cai Jinhua 
Published: September 2024

Background The prognosis of prolonged disorders of consciousness (pDoC) in children has consistently posed a formidable challenge in clinical decision-making. Objective This study aimed to develop a machine learning (ML) model based on conventional structural magnetic resonance imaging (csMRI) to predict outcomes in children with pDoC. Methods A total of 196 children with pDoC were included in this study. Based on the consciousness states 1 year after brain injury, the children were categorized into either the favorable prognosis group or the poor prognosis group. They were then randomly assigned to the training set (n = 138) or the test set (n = 58). Semi-quantitative visual assessments of brain csMRI were conducted and Least Absolute Shrinkage and Selection Operator regression was used to identify significant features predicting outcomes. Based on the selected features, support vector machine (SVM), random forests (RF), and logistic regression (LR) were used to develop csMRI, clinical, and csMRI-clinical-merge models, respectively. Finally, the performances of all models were evaluated. Results Seven csMRI features and 4 clinical features were identified as important predictors of consciousness recovery. All models achieved satisfactory prognostic performances (all areas under the curve [AUCs] >0.70). Notably, the csMRI model developed using the SVM exhibited the best performance, with an AUC, accuracy, sensitivity, and specificity of 0.851, 0.845, 0.844, and 0.846, respectively. Conclusions: A csMRI-based prediction model for the prognosis of children with pDoC was developed, showing potential to predict recovery of consciousness 1 year after brain injury and is worth popularizing in clinical practice.
A public value-based model to understand patients’ adoption of eHealth: Theoretical underpinnings and empirical application
Authors: Alhur Mohammad , Caamaño-Alegre José , Reyes-Santias Francisco 
Published: October 2024

Objective The main objective of this study is to develop an eHealth adoption model based on patients’ perceptions of public value dimensions and empirically apply the model to understand the adoption of a governmental health app by Jordanian patients. The study attempts to contribute to overcoming the narrow focus of contemporary theories such as UTAUT and, ultimately, to designing more effective implementation strategies in order to address the current delays in global eHealth adoption. Methods We conducted a quantitative survey of 430 Jordanian patients, utilizing structural equation modeling (SEM) to process the empirical data. Specifically, we applied an SEM two-step approach that involved (a) evaluating the model-data fit through a review of the measurement model(s) and common method bias; and (b) analyzing the structural model. Results Our findings confirm that the proposed patients’ value scale is valid and reliable. Its five dimensions (hedonistic motivation, utilitarian motivation, social value, ethical public value, and public trust value) significantly correlate with patients’ public value, and the latter directly affects their use of eHealth apps, with habits mediating this relationship. Among the dimensions, hedonistic motivations tend to be prioritized over utilitarian ones. Ethical and trust values also play an essential role, particularly in how health technology handles patients’ data and upholds their dignity and self-esteem. Conclusions This study highlights the holistic nature of eHealth adoption by patients and the crucial role of public values in their use behavior. It provides useful insights for policymakers and developers.
High-dose IV ascorbic acid therapy for patients with CCUS with TET2 mutations
Authors: Xie Zhuoer , Fernandez Jenna , Lasho Terra , Finke Christy , Amundson Michelle , McCullough Kristen B. , LaPlant Betsy R. , Mangaonkar Abhishek A. , Gangat Naseema , Reichard Kaaren K. , Elliott Michelle , Witzig Thomas E. , Patnaik Mrinal M. 
Published: October 2024

Abstract
This phase 2 trial assessed high-dose IV ascorbic acid in TET2 mutant clonal cytopenia. Eight of 10 patients were eligible for response assessment, with no responses at week 20 by International Working Group Myelodysplasia Syndromes/Neoplasms criteria. This trial was registered at www.clinicaltrials.gov as #NCT03418038.
Collaborative Optimization of a Matrix Manufacturing System Based on Overall Equipment Effectiveness
Authors: Pei Fengque , Liu Jianhua , Zhuang Cunbo , Zheng Liang , Zhang Jiapeng 
Published: September 2024

AbstractWhen several traditional flow-shop lines operate in parallel, the operation mode with no communication between production lines will no longer be the optimal production paradigm. This paper describes matrix manufacturing systems (MMS) in a general manner from the perspective of related works, comparing different manufacturing organizational forms and their characteristics. Subsequently, MMS are extracted during the parallel production of multiple surface mount technology (SMT) lines. An overall equipment effectiveness (OEE) online calculation model and a collaborative optimization method are proposed based on the OEE of the MMS. The innovative idea of this study is to divide existing multiple parallel SMT lines into MMS. The efficiency of each matrix unit (MU) was calculated, and a collaborative optimization method was proposed based on an indicator (OEE). In this paper, an example of eight SMT lines is presented. The partitioning of MUs, OEE calculation of each MU, and the low OEE unit collaborative optimization method are described in detail. Through a case study, the architecture of the collaborative optimization model for the MMS was constructed and discussed. Finally, the improvement in the OEE proved the effectiveness and usability of the proposed architecture.
ScRNAbox: empowering single-cell RNA sequencing on high performance computing systems
Authors: Thomas Rhalena A. , Fiorini Michael R. , Amiri Saeid , Fon Edward A. , Farhan Sali M. K. 
Published: October 2024

Abstract
Background
Single-cell RNA sequencing (scRNAseq) offers powerful insights, but the surge in sample sizes demands more computational power than local workstations can provide. Consequently, high-performance computing (HPC) systems have become imperative. Existing web apps designed to analyze scRNAseq data lack scalability and integration capabilities, while analysis packages demand coding expertise, hindering accessibility.

Results
In response, we introduce scRNAbox, an innovative scRNAseq analysis pipeline meticulously crafted for HPC systems. This end-to-end solution, executed via the SLURM workload manager, efficiently processes raw data from standard and Hashtag samples. It incorporates quality control filtering, sample integration, clustering, cluster annotation tools, and facilitates cell type-specific differential gene expression analysis between two groups. We demonstrate the application of scRNAbox by analyzing two publicly available datasets.

Conclusion
ScRNAbox is a comprehensive end-to-end pipeline designed to streamline the processing and analysis of scRNAseq data. By responding to the pressing demand for a user-friendly, HPC solution, scRNAbox bridges the gap between the growing computational demands of scRNAseq analysis and the coding expertise required to meet them.
What are the mechanisms of effect of group antenatal care? A systematic realist review and synthesis of the literature
Authors: Mehay Anita , Motta Giordana Da , Hunter Louise , Rayment Juliet , Wiggins Meg , Haora Penny , McCourt Christine , Harden Angela 
Published: October 2024

Abstract
Background
There is growing interest in the benefits of group models of antenatal care. Although clinical reviews exist, there have been few reviews that focus on the mechanisms of effect of this model.

Methods
We conducted a realist review using a systematic approach incorporating all data types (including non-research and audiovisual media), with synthesis along Context-Intervention-Mechanism-Outcome (CIMO) configurations.

Results
A wide range of sources were identified, yielding 100 relevant sources in total (89 written and 11 audiovisual). Overall, there was no clear pattern of ‘what works for whom, in what circumstances’ although some studies have identified clinical benefits for those with more vulnerability or who are typically underserved by standard care. Findings revealed six interlinking mechanisms, including: social support, peer learning, active participation in health, health education and satisfaction or engagement with care. A further, relatively under-developed theory related to impact on professional practice. An overarching mechanism of empowerment featured across most studies but there was variation in how this was collectively or individually conceptualised and applied.

Conclusions
Mechanisms of effect are amplified in contexts where inequalities in access and delivery of care exist, but poor reporting of populations and contexts limited fuller exploration. We recommend future studies provide detailed descriptions of the population groups involved and that they give full consideration to theoretical underpinnings and contextual factors.

Registration
The protocol for this realist review was registered in the International Prospective Register of Systematic Reviews (PROSPERO CRD42016036768).