bluuebunny/crossref_metadata_2025_split huggingface dataset:
When to Radiate and When to Stop? Timing Radiographic Surveillance During Nonoperative Treatment of Pediatric Diaphyseal Clavicle Fractures
Authors: Gomez Robert W. , Jessen David , Storino Morgan , Lamb Zachary J. , Wang Nigel K. , Jain Neil , Greenhill Dustin A. 
Published: September 2024

Introduction:
Conservative management of most pediatric clavicle fractures is standard. Despite a predictable nonoperative course, evidence about the timeliness of healing is lacking. The goal of this study was to identify when radiographic signs of healing should be expected during routine conservative management of closed pediatric diaphyseal clavicle fractures.

Methods:
Patients 18 years or younger with an acute diaphyseal clavicle fracture treated at a large academic multispecialty orthopaedic practice over 5 years were retrospectively reviewed. Patients who completed nonoperative management until radiographic and clinical evidence of union were included and categorized into 3 age groups: infants and toddlers (0 to 2 y old), school-aged children (3 to 9 y old), and adolescents (10 to 18 y old). Radiographic healing was analyzed within each 2- to 4-week interval.

Results:
Among 390 patients, 303 met inclusion criteria. Overall shortening and displacement averaged 0.3±0.6 centimeters and 42.6%±43.0%, respectively. Follow-up averaged 50±24 days with an orthopaedic physician and 16.3±14.8 months for a well-child check. No clinically relevant or statistically significant improvements in the number of cortices bridged were observed in infants/toddlers after 4 weeks (average 20.4±4.3 d from injury), in school-aged children after 8 weeks (average 39.7±7.9 d from injury), or in adolescents after 12 weeks (average 66.4±8.1 d from injury).

Conclusions:
This study provides an age-dependent timeline during which adequate radiographic healing should be expected in nonoperatively managed pediatric diaphyseal clavicle fractures. Radiographic protocols can be purposefully timed to visualize sufficient healing in infants and toddlers by 4 weeks, school-aged children by 8 weeks, and adolescents by 12 weeks.

Level of Evidence:
Level III.
Optimal Timing for Advanced Imaging in Childhood Bone and Joint Infection
Authors: Hunter Sarah , Brown Elsie , Crawford Haemish , Grant Cameron 
Published: September 2024

Objective:
Advanced imaging in the management of childhood bone and joint infection (BJI) has the potential to improve disease outcomes. Knowledge about the optimal timing for magnetic resonance imaging (MRI) in relation to both surgically and nonsurgically managed BJI is limited. This study examines the impact of MRI timing on number of surgeries, length of stay (LOS), hospitalization cost, and disease recurrence in childhood BJI.

Methods:
This is a retrospective review of patients younger than 16 years with acute hematogenous osteomyelitis (AHO) or septic arthritis (SA) treated in the Auckland region from 2018 to 2023. Cases undergoing MRI as part of diagnostic workup were included. Treatment, hours between admission and MRI, LOS, hospitalization cost, and infection recurrence were assessed.

Results:
There were 563 cases of BJI, of which 390 met the inclusion criteria. Cases were primarily AHO (85%). The percentage of cases having MRI increased over time from 54% (2018) to 80% (2023). Locally disseminated infections such as subperiosteal abscess or adjacent septic arthritis occurred in 48%. Children with preoperative (n = 145) versus postoperative MRI (n = 60) had a lower reoperation rate (33% vs 77%, P = 0.001) and shorter LOS (14.1 vs 22.4 d, P = 0.002). Hospitalization costs appeared lower but did not differ statistically ($59,419 vs $159,353, P = 0.12). In nonoperative cases, LOS was shorter if an MRI occurred within 48 hours of admission (7.3 vs 10 d, P = 0.03). Disease recurrence was not associated with MRI timing.

Conclusion:
Overall, children with BJI who underwent MRI scans before surgery had lower reoperation rates. Children receiving MRIs within 48 hours of admission had shorter LOS.
EVALUATING LARGE LANGUAGE MODELS ON THEIR ACCURACY AND COMPLETENESS
Authors: Edalat Camellia , Kirupaharan Nila , Dalvin Lauren A. , Mishra Kapil , Marshall Rayna , Xu Hannah , Francis Jasmine H. , Berkenstock Meghan 
Published: September 2024

Purpose:
To analyze the accuracy and thoroughness of three large language models (LLMs) to produce information for providers about immune checkpoint inhibitor ocular toxicities.

Methods:
Eight questions were created about the general definition of checkpoint inhibitors, their mechanism of action, ocular toxicities, and toxicity management. All were inputted into ChatGPT 4.0, Bard, and LLaMA programs. Using the six-point Likert scale for accuracy and completeness, four ophthalmologists who routinely treat ocular toxicities of immunotherapy agents rated the LLMs answers. Analysis of variance testing was used to assess significant differences among the three LLMs and a post hoc pairwise t-test. Fleiss kappa values were calculated to account for interrater variability.

Results:
ChatGPT responses were rated with an average of 4.59 for accuracy and 4.09 for completeness; Bard answers were rated 4.59 and 4.19; LLaMA results were rated 4.38 and 4.03. The three LLMs did not significantly differ in accuracy (P = 0.47) nor completeness (P = 0.86). Fleiss kappa values were found to be poor for both accuracy (−0.03) and completeness (0.01).

Conclusion:
All three LLMs provided highly accurate and complete responses to questions centered on immune checkpoint inhibitor ocular toxicities and management. Further studies are needed to assess specific immune checkpoint inhibitor agents and the accuracy and completeness of updated versions of LLMs.
Exploring Potential Challenges in Implementing a Standardized Curriculum for the Physician Associate Program in India: Insights From Stakeholder Discussions
Authors: Muraleedharan Manesh , Sundar Gomathy , Smalley Scott , Begg Philip A. , Philip Deepa C. 
Published: September 2024

Introduction
This article explores the potential challenges in implementing a national-level standardized curriculum for physician associate (PA) programs in India, an initiative under the directions of the National Commission for Allied and Healthcare Professionals Act of 2021.

Methods
Initiated in August 2023, a multistage process began with emailing a draft curriculum for review to key stakeholders, followed by a virtual meeting on September 3. Key stakeholders, including faculty from various universities, participated in focus group discussions (FGDs) at the International Association of Physician Associate Educators and the Indian Association of Physician Assistants annual conference on September 21, 2023, in Gandhinagar.

Results
Four major themes emerged: (1) faculty development, (2) faculty recruitment, (3) alignment with the National Educational Policy, and (4) the necessity of master's degree programs for PAs. Challenges identified included shortage of qualified faculty, uncompetitive salaries for academic roles, and low enrollment in master's programs. Recommendations included increasing financial compensation for teaching PAs, developing more PA educators through additional master's programs, encouraging hospitals to mandate clinical and teaching roles for recruits, and introducing pedagogical training for PAs interested in teaching.

Discussion
Implementing a standardized curriculum for PAs faces significant challenges, especially in faculty recruitment and retention. Engaging a broader range of stakeholders is essential for the successful rollout of the curriculum and for meeting India's evolving health care needs.
National introduction of one-anastomosis gastric bypass in the UK National Bariatric Surgery Registry: a cohort study
Authors: Currie Andrew C. , Askari Alan , Parmar Chetan , Byrne James , Ahmed Ahmed R. , Pring Chris M. , Khan Omar A. , Small Peter K. , Mahawar Kamal 
Published: September 2024

Aim:
There is a paucity of evidence regarding the national introduction of newer bariatric metabolic surgery procedures. This study assessed the impact of introducing one-anastomosis gastric bypass (OAGB) in bariatric surgical practice in the UK on 30-day postoperative morbidity and early postoperative weight loss.

Methods:
Patients who underwent primary BMS in the UK National Bariatric Surgical Registry (2010–2019) were identified. Patient characteristics, 30-day postoperative morbidity, and 12-month total body weight loss (TBWL) were also assessed. Multivariate regression was performed for associations between 30-day postoperative morbidity and 12-month TBWL, with SG as a reference. Learning effects were assessed by factoring in the institutional OAGB caseload (0–24/25–49/50+ cases).

Results:
A total of 59 226 patients underwent primary BMS during the study period (RYGB, 38 434; SG, 24 702; AGB, 12 627; OAGB, 3408; and others, 276). The 30-day postoperative morbidity was lower for OAGB 1.8% (51/2802) compared to RYGB 4.2% (1391/32 853) and SG 3.4% (725/21 333) but higher than AGB 1.2% (123/9915), while on multivariate regression, OAGB was associated with reduced morbidity once the institution caseload exceeded 50 operations (OR 0.35 (95% CI: 0.22–0.56; P<0.001) and no statistical difference to SG at lesser caseloads. Overall, 12-month greater than 25% TBWL was seen in 69.4% (27 736/39 971) (RYGB: 82.9% (17 617/21 246)), SG: 65.4% (7383/11 283)), AGB: 23.9% (1382/5572)) and OAGB: 82.9% (1328/1601)). On multivariate regression, OAGB was associated with the highest 12-month TBWL once the institution caseload exceeded 50 operations (OR 3.47 (95% CI 2.75–4.39; P<0.001).

Conclusion:
OAGB has been safely implemented in UK national bariatric surgery practice. It has lower reported postoperative morbidity and comparable weight loss to RYGB or SG, despite being offered to patients with more severe and complex obesity.
Clinical outcomes of preservation versus resection of portal/superior mesenteric vein during pancreaticoduodenectomy in pancreatic cancer patients who respond to neoadjuvant treatment: a retrospective cohort study
Authors: Chae Yoon Soo , Jung Hye-Sol , Yun Won-Gun , Han Youngmin , Cho Young Jae , Lee Mirang , Kwon Wooil , Park Joon Seong , Jang Jin-Young 
Published: September 2024

Background:
R0 rates have increased as neoadjuvant treatment (NAT) has become the primary treatment for pancreatic ductal adenocarcinoma (PDAC) with venous involvement, suggesting a decrease in venous tumor infiltration. The aim of this study was to investigate the clinical outcomes of preserving the portal/superior mesenteric vein (PV/SMV) during pancreaticoduodenectomy (PD) in PDAC patients who underwent NAT.

Material and methods:
The 113 patients with resectable and borderline resectable PDAC with venous involvement who responded to NAT and underwent curative PD between 2012 and 2022 were retrospectively reviewed.

Results:
Among the 113 patients, PV/SMV preservation (PVP) was performed in 68 patients (60.2%), and PV/SMV resection (PVR) was performed in 45 patients (39.8%). There was no significant difference in the R0 rate, 5-year overall survival (OS) and recurrence-free survival between the two groups. PV/SMV stenosis within 3 months after surgery was more common in the PVR group than in the PVP group (1.5% versus 22.2%; P<0.001), and 5-year PV/SMV stenosis-free survival was significantly higher in the PVP group than in the PVR group (76.5% versus 53.4%; P=0.014). Multivariate analysis showed that gemcitabine-based neoadjuvant chemotherapy was associated with poor OS. PVR, clinically relevant postoperative pancreatic fistula, and locoregional recurrence were independent risk factors for PV/SMV stenosis.

Conclusion:
The PVP group had similar oncologic outcomes and better vessel-functional outcomes than the PVR group. Therefore, if dissection is possible and there is a high likelihood of achieving R0 resection after NAT, routine PVR may be unnecessary in PDAC patients with venous involvement.
Radiation-emitting metallic stent for unresectable Bismuth type III or IV perihilar cholangiocarcinoma: a multicenter randomized trial
Authors: Chen Qi , Ge Nai-Jian , Li Yu-Liang , Huang Ming , Li Wen-Hui , Lu Dong , Wei Ning , Lv Peng-Hua , Tu Jian-Fei , He Cheng-Jian , Wang Wu-Jie , Ding Rong , Peng Bo , Wang Xue-Jun , Wang Fu-An , Zhu Guang-Yu , Wang Yong , Chen Li , Min Jie , Guo Jin-He , Teng Gao-Jun , Lu Jian 
Published: September 2024

Background and Aims:
Self-expandable metallic stents (SEMSs) have been recommended for patients with unresectable malignant biliary obstruction, while radiation-emitting metallic stents (REMSs) loaded with 125I seeds have recently been approved to provide longer patency and overall survival in malignant biliary tract obstruction. This trial is to evaluate the efficacy and safety of REMS plus hepatic arterial infusion chemotherapy (REMS-HAIC) versus SEMS plus HAIC (SEMS-HAIC) for unresectable perihilar cholangiocarcinoma (pCCA).

Materials and Methods:
This multicenter randomized controlled trial recruited patients with unresectable Bismuth type III or IV pCCA between March 2021 and January 2023. Patients were randomly assigned (1:1 ratio) to receive either REMS-HAIC or SEMS-HAIC using permuted block randomization, with a block size of six. The primary endpoint was overall survival (OS). The secondary endpoints were time to symptomatic progression (TTSP), stent patency, relief of jaundice, quality of life, and safety.

Results:
A total of 126 patients were included in the intent-to-treat population, with 63 in each group. The median OS was 10.2 months versus 6.7 months (P=0.002). The median TTSP was 8.6 months versus 5.4 months (P=0.003). The median stent patency was longer in the REMS-HAIC group than in the SEMS-HAIC group (P=0.001). The REMS-HAIC group showed better improvement in physical functioning scale (P<0.05) and fatigue symptoms (P<0.05) when compared to the SEMS-HAIC group. No significant differences were observed in relief of jaundice (85.7% vs. 84.1%; P=0.803) or the incidence of grade 3 or 4 adverse events (9.8% vs. 11.9%; P=0.721).

Conclusion:
REMS plus HAIC showed better OS, TTSP, and stent patency compared with SEMS plus HAIC in patients with unresectable Bismuth type III or IV pCCA with an acceptable safety profile.
Single-chamber atrial pacing + Micra AV implantation: A case report
Authors: Cai Yongxiang , Liu Mingjiang , Tao Jianhong , Tang Yijia , Xiong Yan 
Published: September 2024

Rationale:
The use of transvenous pacing leads is associated with the risk of tricuspid valve dysfunction, mainly due to the continuous presence of the leads can have an impact on subsequent tricuspid function and possible operation injury of the tricuspid valve during implantation or operation.

Patient concerns:
A 69-year-old female with a history of syncope for 9 months was admitted to the hospital. The electrocardiogram showed sinus bradycardia, junctional escape rhythm, and a heart rate of 44 bpm. Echocardiography suggested a downward displacement and severe insufficiency of the tricuspid valve and atrial septal defect.

Diagnoses:
The cause of syncope was considered to be sick sinus syndrome. The patient was diagnosed with Ebstein anomaly and is considered a candidate for surgical intervention.

Interventions:
To avoid aggravating tricuspid insufficiency by pacing leads crossing the tricuspid valve and hindering subsequent tricuspid valve surgery, a single-chamber pacing mode with atrial pacing (AAI) lead and Micra AV was chosen for maintaining atrioventricular synchrony after multidisciplinary discussion.

Outcomes:
The patient had stable parameters and was in good general condition at 1- and 3-month outpatient follow-ups after discharge.

Lessons:
This is the first case of new implantation of single-chamber atrial pacing + leadless ventricular pacing with Micra AV, an alternative strategy to epicardial or coronary sinus system for tricuspid valve displacement and severe tricuspid regurgitation.
Mortality rate of pulmonary infection in senile dementia patients: A systematic review and meta-analysis
Authors: Yao Jianning , Liu Shunlin , Chen Qun 
Published: September 2024

Background:
Dementia is estimated that this kind of neurodegenerative disease directly affects 50 million patients worldwide. About 12% to 70% death of dementia disease can be attributed to pneumonia. We aimed to evaluate the pneumonia-related mortality of dementia patients and how the frequency of pneumonia-related death varies according to the data of death (autopsy or death certificate).

Methods:
English literatures published from PubMed and Embase databases were extracted. Stata/SE 16.0 software was used for statistical analysis.

Results:
In the end, a total of 7 studies were finally included in this meta-analysis. The results showed that: (1) The total mortality rate associated with pneumonia was 24.68% (95% confidence interval [CI]: 19.07%, 30.29%); (2) The pneumonia-related mortality rate of dementia patients confirmed by autopsy was 56.14% (95% CI: 32.36%, 79.92%); (3) The pneumonia-related mortality rate of dementia patients confirmed by death certificate was 16.12% (95% CI: 9.98%, 22.26%); (4) The pneumonia-related direct mortality rate of dementia patients was 50.07% (95% CI: 34.85%, 65.30%); (5) The pneumonia-related indirect mortality rate of dementia patients was 12.43% (95% CI: 5.85%, 19.00%); (6) The hospital-reported mortality rate of dementia patients related to pneumonia was 12.66% (95% CI: 6.60%, 18.72%); (7) The mortality rate of dementia patients related to pneumonia was 17.48% (95% CI: 10.60%, 24.38%).

Conclusion:
This meta-analysis shows that the pneumonia-related mortality of dementia patients is much higher than the expectation of clinicians. The results of the study greatly warned clinicians to pay close attention to pneumonia cases of senile dementia patients.
Integrated psychiatric and surgical care in managing self-inflicted abdominal trauma: a case report in a resource-limited setting
Authors: Adhikari Pratik 
Published: September 2024

Introduction and importance:
Self-inflicted abdominal stab wounds present rare yet critical challenges requiring urgent surgical intervention and comprehensive psychiatric evaluation. Such injuries often correlate with psychiatric disorders like schizophrenia and alcohol dependence, posing significant clinical and psychological management hurdles.

Case presentation:
A 36-year-old male with a history of chronic alcohol use and schizophrenia presented with a self-inflicted stab wound to the abdomen following auditory hallucinations. Upon admission, he was hemodynamically unstable, with eviscerated bowel loops and a lacerated greater omentum. Prompt surgical exploration revealed extensive abdominal trauma necessitating meticulous repair and intensive postoperative care.

Clinical discussion:
The case highlights the intricate interplay between severe psychiatric illness and self-harm, exacerbated by alcohol intoxication. Integrated psychiatric and surgical care proved pivotal in achieving stabilization and facilitating recovery. The challenges encountered in a resource-limited setting included a lack of advanced imaging modalities, limited access to specialized psychiatric care, and constraints in postoperative monitoring equipment, underscoring the importance of adaptive management strategies.

Conclusion:
This report emphasizes the critical need for a multidisciplinary approach in managing self-inflicted abdominal injuries. The successful outcome underscores the efficacy of timely surgical intervention and comprehensive psychiatric support. Integrated care models are essential for addressing the complex needs of patients with psychiatric comorbidities, ensuring holistic management, and reducing the risk of recurrence in similar cases.
Echogenic bowel on the second-trimester ultrasound as an indicator of jejunal atresia: a case report
Authors: Gholami Fatemeh , Mehrabi Sahar , Nazari Nooshin , Shateranni Fatemeh , Asemi Zatollah 
Published: September 2024

Introduction and importance:
Fetal echogenic bowel (FEB) is a finding on prenatal ultrasound characterized by increased echogenicity of the fetal intestine. In this study we present a case of FEB with severe bowel dilatation identified on second-trimester ultrasound that was subsequently diagnosed with jejunal atresia postnatally.

Case presentation:
A 28-year-old primigravida woman was referred to our perinatology clinic at 18 weeks/3 days gestational age for a fetal anomaly scan. The anomaly scan examination identified grade 3 fetal bowel hyperechogenicity. The results of the fetal echocardiogram and maternal serum screening for TORCH infections were normal, and the NIPT analysis showed low-risk results for chromosomal aneuploidies.

Clinical discussion:
In our case, the fetal bowel diameter measured 21 mm at 29 weeks/6 days gestational age, which significantly exceeded the established clinical cut-off value for fetal bowel dilatation. This timing is crucial because if a specific problem is detected in the ultrasound that indicates an abortion of the fetus, it can only be performed legally under the 19th week of pregnancy; otherwise, termination of pregnancy is considered illegal according to the policies of this country.

Conclusion:
Nowadays, ultrasonography is a non-invasive tool that facilitates the early detection of many prenatal problems. In this case, with the early detection of FEB and further investigations, we were able to safely manage the pregnancy until the 39th week of pregnancy and plan the delivery in a tertiary referral center to ensure the availability of intensive care for the baby at birth.
Seizure Induced by Single-Pulse TMS Delivered to Lesioned Hemisphere in Stroke
Authors: Franco Sara Barbosa , Marques Lucas M. , Battistella Linamara R. , Fregni Felipe , Simis Marcel 
Published: September 2024

Abstract
Transcranial magnetic stimulation (TMS) is used for therapeutic and research purposes, but it is still important to establish safety guidelines and recommendations mainly related to serious adverse effect (SAE). As part of this, safety reports need to be published. Our report highlights a case of a male patient who was a 30-year-old with a history of hemorrhagic stroke following an accidental seizure episode during a single-pulse TMS.
Disseminated hydatidosis an unusual presentation: a case report
Authors: Ziad Fatima , Zouaoui Imane , El Mamoune Mostaine , Aoufi Sarra 
Published: September 2024

Hydatidosis, also known as cystic echinococcosis, is a widespread zoonosis, caused by a tapeworm of the genus Echinococcus. It presents a significant public health concern, particularly in endemic areas. The occurrence of disseminated hydatid disease is uncommon, even in regions where it is endemic, with an incidence ranging from 1–8%. The definitive diagnosis relies on a parasitological method.
In this work, we present an unusual case of disseminated hydatid disease that was diagnosed in the central parasitology–mycology laboratory of ‘The Ibn Sina University Hospital’.
This is a 21-year-old patient residing in a rural area, who presented with heaviness-type pain in the right hypochondrium, accompanied with nausea and vomiting. During the examination, the patient mentioned the contact with dogs. Abdominal radiography (ultrasound and CT) revealed findings suggestive of multiple hydatid cysts located in the liver and peritoneum. This suspicion was confirmed by positive hydatid serology.
After 9 months of treatment with albendazole, the patient underwent surgery for excision of the cysts shown on the x-ray, as well as other cysts incidentally discovered intraoperatively at the pelvic and rectal levels. All of the extracted specimens were sent to the parasitology laboratory. The direct examination, along with the viability test, revealed the presence of hooks and scolex of non-viable Echinococcus granulosus.
Disseminated hydatidosis is a rare but serious presentation, and the positive diagnosis relies on several epidemiological, clinical, radiological and parasitological arguments. Medical and surgical treatments play a crucial role in determining the patient’s prognosis.