bluuebunny/crossref_metadata_2025_split huggingface dataset:
Suggested guide to using lactate gap as a surrogate marker in the diagnosis of ethylene glycol overdose
Authors: Dimeski Goce , Holford Amanda , Isoardi Katherine 
Published: October 2024

Background Ethylene glycol (EG) poisoning, if not diagnosed rapidly, can lead to poor patient outcomes. Gas chromatography (GC) is primarily used for EG quantitation which is rarely available, and the turn-around time may be prolonged. Most lactate results from point-of-care (POCT) methods are falsely elevated in EG poisoning compared with automated chemistry analyser results. In combination, the lactate gap (POCT-Automated chemistry) can be used as surrogate marker in just about all laboratories to indicate likely EG toxicity and guide treatment. Case Report A man presented by ambulance to hospital with severe agitation requiring mechanical ventilation to facilitate ongoing management. Venous blood gas analysis confirmed a high anion gap metabolic acidosis (HAGMA) with an elevated lactate. The lactate and osmolarity measured in the laboratory showed a normal lactate and high osmolarity, giving a large osmolar gap. The patient was immediately commenced on renal replacement therapy for presumed EG poisoning to minimize kidney injury, and the treatment continued for 19 hours. A very high EG concentration was confirmed by GC the next day. Conclusion An elevated lactate gap along with a HAGMA and osmolar gap can provide rapid surrogate laboratory data indicating EG poisoning enabling timely treatment and better patient outcomes.
Working towards consensus on the assessment of mood after severe acquired brain injury: Focus groups with UK-based professionals
Authors: Rose Alexandra E , Cullen Breda , Crawford Sarah , Evans Jonathan J 
Published: October 2024

Objective The assessment of mood after brain injury is more challenging when people have ongoing severe cognitive and receptive communication impairments. There is no gold standard on how these assessments should be undertaken. This study aimed to reach a consensus on this among specialists working with this population. Design Focus groups were completed using a structured nominal group technique. Groups were compared for overlapping themes and agreed processes. Participants Five focus groups with a total of 14 participants who work with the population of interest were completed. Participants included 12 clinical psychologists, one psychiatrist and one consultant in rehabilitation medicine. Results Each of the five groups reached a consensus on a process for assessing mood in this population. Results overlapped and were combined into a proposed circular and iterative model of assessment that includes: (pre) information gathering, (peri) assessment processes, and (post) treatment; with formulation being seen as a vital part of the process. Standardised measures were not recommended for use with this population. Beyond the consensus processes, three implicit themes were identified: (1) depression is different after severe brain injury, (2) overlapping tasks and roles, and (3) looking at the bigger picture. Conclusions A good level of consensus was achieved across the five groups on processes to follow when assessing mood when people have ongoing cognitive and receptive communication impairments after severe brain injury. We recommend that this formulation-based model be followed when assessing people in this clinical population.
Effect of hydroxylated boron nitride and boron nitride nanosheets on the properties of doped organosilicone rubber composites
Authors: Zhao Han , Rong Jianxin , Li Dengke , Jia Dianqiu , Yu Xiaoyan , Zhang Qingxin 
Published: October 2024

As the electronic industry develops rapidly, the miniaturisation, integration and multifunctionality of electronic devices have resulted in a dramatic increase in power density, and the heat dispersal of electronic devices has attracted much attention. In this work, hydroxylated hexagonal boron nitride (BN-H) was obtained by hot alkali treatment, and boron nitride nanosheets (BNNS) with a thickness of about 4 nm were obtained by boric acid-assisted ball milling stripping. The effects of different types of fillers as well as filler contents on the thermally conductive and mechanical performance of organosilicon composites were also compared. Notably, when BN-H and BNNS thermally conductive fillers were added at 12 wt%, the thermally conductive coefficients of the composites were 0.4831 W·m−1·K−1 and 0.7131 W·m−1 K−1, respectively, which were 183% and 318% of higher than that for the pure silicone rubber (SR, with a thermally conductive coefficient of 0.1706 W·m−1·K−1). In addition, in respect of mechanical performance, the tensile strengths of SR/BN-H and SR/BNNS composites with a filling level of 12 wt% were 3.59 MPa and 3.89 MPa, respectively, and the storage moduli were 4501 MPa and 4583 MPa, respectively, which were improved to a certain extent compared with pure SR. The present work provides an effective way to develop organosilicone rubber composites with good thermal conductivity and mechanical properties by boric acid assisted ball milling to strip boron nitride in the field of electronics packages.
Rhabdomyosarcoma Presenting as an Infective Midline Nodule on the Chin in an Eight-year-old Child
Authors: Garge Saurabh , Sharma Ashutosh , Kumar Rajesh , Sharma Manish 
Published: October 2024

Background and Aims: Rhabdomyosarcoma (RMS) is the most common subtype of soft tissue sarcoma (STS) in children. Early diagnosis is the most favourable prognostic factor and thus physicians need to include RMS in the differential diagnosis of more common diseases developing within the head and neck region. This report highlights the same while describing a case of an eight-year-old child who presented with a chin swelling which turned out to be an RMS. Methods: We present a rare case of an eight-year-old child with a midline painless mass. Results: This child had a transoral resection of the mass. He undertook further chemotherapy and was completely cured with no tumour recurrence. Conclusion: In a painless rapidly increasing mass in the head and neck area, despite rare, but RMS should be included as a differential diagnosis. This is important as early diagnosis and proper resection and treatment are paramount in the prognosis of the disease.
Timing of Fracture Fixation in Ankle Fracture-Dislocations
Authors: Penning Diederick , Tausendfreund Jasper , Naryapragi M. Azad , Reisinger Kostan W. , Joosse Pieter , Tanis Erik , Schepers Tim 
Published: October 2024

Ankle fracture-dislocations may require delayed internal fixation. Our aim was to compare acute open reduction and internal fixation (ORIF) with delayed ORIF, using external fixation or cast splint in ankle fracture-dislocations. Factors that affect the rates of re-operation and Surgical site infection (SSI) were identified. In this retrospective cohort study, patients were included with open and closed ankle fracture-dislocations treated with ORIF from two large peripheral hospitals and one academic center in the Netherlands. This study included 447 patients with an ankle fracture-dislocation. In the multivariate analysis, the difference between surgery <48 hours compared to bridging with cast or external fixation had no significant influence on unscheduled re-operation or SSI. Higher body mass index (BMI) and open fractures had a significant positive correlation with re-operation while diabetes mellitus (DM) and open fractures correlated with SSI. In patients with open fractures, there was also no significant difference in outcome between acute or delayed internal fixation. We suggest that it is safe to perform primary ORIF on all dislocated ankle fractures if the soft tissue injury allows surgery within 48 hours. When significant swelling is present, patients with well-reduced fractures and with no soft tissue injury could be treated safely with a cast until delayed ORIF is possible. Level of Evidence: Therapeutic level 2B (retrospective cohort study)
Poster 156: Intraobserver and Interobserver Reliability in Glenoid Track Measurement
Authors: Magee Anthony , Mccadden Austin , Min Kyong , Daner William , Zhou Liang , Bottoni Craig , Wake Jeffrey , Bermudez Alexys , Horng Jonathan , Bickley Ryan , Ahn Hyeong 
Published: October 2024

Objectives: The purpose of our study was to determine the accuracy and reliability of measuring on- and off-track lesions within our institution using the circle line method. Methods: Electronic medical records between 2009 and 2019 were reviewed for active-duty military personnel who underwent a Latarjet or had recurrent dislocations of the shoulder joint. Advanced imaging (CT and/or MRI) was reviewed for glenoid and humeral head bone loss; patients with both glenoid and humeral head bone loss were included in the study. Measurement of the Hill-Sachs lesion (HSL) was standardized prior to the start of the study and measured as described by Di Giacomo. Results: All surgeons completed the review of all 38 images for 2 measurements. Intraobserver reliability was shown to have moderate reliability amongst all reviewers (intraclass correlation coefficient [ICC] = 0.459; p < 0.001). The kappa (κ) value for interobserver reliability amongst all reviewers was moderate for glenoid diameter (ICC = 0.567; 95% CI, 0.474-0.663), moderate for glenoid defect (ICC = 0.61; 95% CI, 0.517-0.702), poor for HSL (ICC = 0.328; 95% CI, 0.232-0.441), moderate for glenoid track (ICC = 0.668; 95% CI, 0.584-0.75) and fair for HSL on- and off-track assessment (κ = 0.267, p < 0.001). Conclusions: The intraobserver reliability of measuring advanced imaging for shoulder instability using the circle line method is overall good; however, the interobserver reliability is moderate to poor.
Poster 160: Preoperative MRI Underestimates Shoulder Labral Injuries Compared with Diagnostic Arthroscopy
Authors: Herman Zachary , Fox Michael , Reddy Rajiv , Carlos Noel Bien , Kowdley Devan , Chang Audrey , Lin Albert 
Published: October 2024

Objectives: To compare the overall agreement in the magnitude of shoulder labral injuries between preoperative MRI and assessment at the time of diagnostic arthroscopy. Methods: A retrospective chart review was performed of patients undergoing primary arthroscopic labral repair procedures between February 2018 and February 2023. Exclusion criteria included prior ipsilateral shoulder surgery, MRI study performed at outside health system, and incomplete documentation of labral tear location. Age, gender, and dates of injury, imaging, and surgery were recorded. Radiology and operative reports were reviewed to record the location and extent of the labral tear using conventional clock-face coordinates. Tear locations were further classified as either anterior (2-6 o’clock), posterior (6-10 o’clock), or superior (10-2 o’clock). MRI studies were performed by 1.5-Tesla scanner and all radiology reports were performed by fellowship-trained musculoskeletal radiologists at a single health system. Subgroup analysis of labral tear size on radiology interpretation was performed between MRI arthrogram (MRA) and conventional MRI studies. Results: A total of 138 subjects (mean age 25.8 years, 73% male) met criteria for inclusion in this study. Of the included subjects, 105 underwent MRI arthrogram and 33 underwent conventional MRI studies. The average time from initial injury to MRI was 153.4 days and the average time from MRI to surgical intervention was 66.8 days. The average total recorded labral tear size in clock-face coordinates was significantly greater on diagnostic arthroscopy compared with the radiologist MRI interpretation (4.4 vs 3.6, p<0.01). The average labral tear size in the posterior region was also significantly greater on diagnostic arthroscopy (2.4 vs 1.6, p<0.01). The average labral tear size in the anterior (2.5 vs 2.2, p=0.08) and superior (1.6 vs 1.5, p=0.29) regions was greater on diagnostic arthroscopy but did not reach statistical significance. The difference in total and posterior tear size remained significant in both the arthrogram and conventional MRI subgroups. Subjects undergoing MRI arthrogram had a significantly greater reported size of anterior labral tears in clock-face coordinates compared with conventional MRI (2.7 vs 2.0, p=0.03), but did not reach significance for the posterior (p=0.40), superior (p=0.31), and the overall global labrum (p=0.29). Conclusions: MRI significantly underestimate the overall size of labral tears in setting of shoulder instability, particularly in the posterior labrum. Surgeons should account for potential underestimation of true labral injury during preoperative planning for surgical management of shoulder instability.
Poster 202: Preoperative Abduction Weakness Predicts Delayed Achievement of Clinically Significant Outcomes Following Gluteus Medius and/or Minimus Repair
Authors: Wright-Chisem Joshua , Vogel Michael , Alvero Alexander , Nho Shane 
Published: October 2024

Objectives: To (1) define the time to achievement of clinically significant outcomes (CSOs) following primary gluteus medius and/or minimus repair and (2) identify predictors of delayed CSO achievement. Methods: Patients who underwent primary gluteus medius and/or minimus repair between January 2012 and January 2020 with complete preoperative, 6-month, 1-year, and 2-year Hip Outcome Score – Activities of Daily Living (HOS-ADL) were retrospectively identified. Cohort-specific minimal clinically important difference (MCID) and Patient Acceptable Symptom State (PASS) were calculated. The time to achievement of MCID and PASS were analyzed using Kaplan-Meier survival analysis. Multivariate stepwise cox proportional hazards regressions were used to identify predictors of delayed MCID and PASS achievement. Results: Fifty primary gluteus medius and/or minimus repairs were identified (age 59.4 ± 9.7 years old, BMI 27.9 ± 6.2 kg/m2, 94% female patients). Tears were partial thickness (78%) and involved both the gluteus medius and minimus tendons (60%) in most cases. Endoscopic and open repair were performed in 70% and 30% of cases, respectively. Labral repair was performed in 30% of cases. Most patients achieved MCID by 5.66 months and PASS by 11.03 months. The 2-year cumulative probability of MCID and PASS achievement was 92.7% and 66.7%, respectively. Preoperative abduction weakness on physical exam predicted delayed achievement of MCID (HR = 2.27, CI 1.04 – 4.96) and PASS (HR = 3.89, CI 1.34 – 11.28). Conclusions: Findings from this study demonstrate that most patients undergoing primary gluteus medius and/or minimus repair achieved MCID by 6 months and PASS by 12 months. Preoperative abduction weakness on physical exam predicted delayed achievement of MCID and PASS.
Poster 212: Ischial Tuberosity Avulsion Fractures: Treatment and Return to Sport in Athletes with Displaced Fragments
Authors: Heyworth Benton , Saleet Jayon , Heyworth Benton , Novais Eduardo , Yen Yi-Meng , Kocher Mininder , Micheli Lyle 
Published: October 2024

Objectives: Ischial tuberosity avulsion fractures are relatively rare injuries that typically occur in young athletes during activity. Some of these patients may experience significant morbidity, often through chronic pain and changes in sports participation. The influence of fragment displacement on optimal treatment and proper return to sport protocol has not been well investigated. This study sought to evaluate the relationship between displacement and both choice of treatment and time to return to sport. Methods: Retrospective analysis of ischial tuberosity avulsion fractures in pediatric patients between 2010-2021 at Boston Children’s Hospital was completed. Information regarding demographics, treatment, and recovery were extracted from individual patient charts. Plain radiographs and magnetic resonance imaging (MRI) were analyzed in order to measure fragment displacement at the ischial apophysis. Treatment protocol, return to sport (RTS) time, and complications were analyzed. Results: Eighty-eight patients with a diagnosis of an ischial tuberosity avulsion fracture were identified. Of these, 64 (73%) were treated non-operatively, 8 (9%) were treated acute operatively (within 6 weeks), and 16 (18%) were treated chronic operatively (>6 weeks). Imaging for measurement of fragment displacement was available for 86 (98%) of patients. The median displacement was 0.2cm for the non-operative group, 2.2cm for the acute operative group, and 1.5 for the chronic operative group. Of the 86 patients with available imaging, 67 (78%) had a RTS time. The median RTS was 3.6 months in the non-operative group, 5.5 months in the acute operative group, and 13.3 months in the chronic operative group. Conclusions: In this retrospective cohort study, nearly all fractures with displacement >= 1.0cm were surgically treated, either acutely or at a delayed time point. All patients that underwent acute operation had displacement > 1.0cm, while 87% of those undergoing delayed operation had displacements > 1.0cm. Those treated non-operatively returned to sport about 1 month earlier than those undergoing acute operation, and several months prior to those who underwent delayed surgical intervention. This data suggests that patients with displacement less than 1.0cm may be successfully treated through non-operative treatment and those with displacement greater than this should undergo operative treatment in the acute period to optimize outcome and return to sport.
Poster 218: Localized Acetabular Bone Density Distributions Are Altered in Unilateral Femoral Acetabular Impingement
Authors: Telfer Scott , Kanani Mohammed , Begur Anjana , Hagen Mia S. 
Published: October 2024

Objectives: Femoral acetabular impingement (FAI) can lead to bony and cartilage changes at the joint, and it has been suggested that changes in bone mineral density in the acetabulum may correlate with osteoarthritic degeneration of the hip. In this study, we aimed to use opportunistic quantitative computed tomography (QCT) to map density distributions across the acetabular region in patients with unilateral FAI and determine if there were differences between the affected and unaffected side. Furthermore, we assessed if these differences in density distributions were associated with radiographic measures of FAI. Methods: Twenty patients (age 31.9 (SD 9.2), 13 female) who underwent surgery for unilateral FAI and had an associated CT scan of both hips were included in this retrospective study. Both sides of the pelvis were segmented, and 3D models were created. Estimated bone density values were mapped across the bone models via QCT. A thin-spline semi-landmarking approach was used to allow density values at equivalent anatomical points to be compared within patients and across the group. With the contralateral side used as the control, differences in bone density between sides were calculated. A mixed effect linear regression model was used to determine if there were associations between the localized bone density and radiographic measures of Tonnis grade, alpha angle, lateral center edge angle (LCEA), and cross over sign, while controlling for age and sex. To visualize the data, density changes and statistical results were color-mapped to the bone models. Results: Overall, several regions of the acetabulum were found to have increased bone density in the affected side compared to the contralateral (Figure 1). Specifically, the anterior-superior parts of the acetabular rim appeared to be most affected, along with the posterosuperior region (Figure 2). Limited associations were found between localized density and the clinical variables, with the most notable finding being a region of the superior rim that was found to be associated with the alpha angle (Figure 3). Conclusions: FAI leads to distinct patterns of bone density changes around the acetabulum, although there is still variability at the level of the individual patient. It is unclear whether these changes in bone density may be related to the underlying condition, alterations in the patient’s mechanics due to pain, or a combination of these factors. Providing detailed density maps of the bony anatomy may also assist surgical providers in planning interventions. Further research may elucidate the relationship between bone density changes and long-term degeneration of the joint.
Poster 259: Effect of Current Osteochondral Allograft Harvesting Techniques on Regional Chondrocyte Viability
Authors: Elias Tristan J. , Haneberg Erik , Morgan Vince K. , Allahabadi Sachin , Walker Alexandra B. , Beals Corey T. , Cole Brian J. , Yanke Adam B. 
Published: October 2024

Objectives: Chondrocyte viability directly correlates with the clinical success of osteochondral allograft (OCA) transplantation. It is not known how OCA plug harvest with a powered reamer affects the chondrocyte viability in a human model, or how to best mitigate potential thermal damage. The purpose of this study was to investigate the effect of distal femoral OCA plug harvest and recipient site preparation on regional cell viability when using handheld saline irrigation versus saline submersion. Methods: Thirteen clinical-grade femoral hemicondyles (JRF Ortho) were used in this study. For each condyle, four samples were harvested: (1) 5 mm control piece of cartilage, (2) 15 mm OCA donor plug harvested with a powered coring reamer and concurrent handheld saline irrigation (“Traditional”), (3) 15 mm OCA donor plug harvested while submerged under normal saline (“Submerged”), and (4) 5 mm cartilage from the peripheral rim of a recipient socket created with a 15 mm cannulated counter bore reamer to a total depth of 7 mm (“Recipient”). Samples were stained using Calcein and Ethidium. Live-dead images were acquired using a confocal microscope. ImageJ was used to calculate live cell percentages for the whole plugs. Additionally, the 15 mm diameter plugs were divided into the central 5 mm and the peripheral 5 mm for comparison of regional cell viability. The live/dead cell percentages were compared between all groups using Friedman tests. Cell viability was determined to be significantly different if P < 0.05. Results: Compared to the Submerged group, Traditional plugs had significantly lower percentages of live cells across the whole plug (61.42% ± 4.98% vs. 71.54% ± 4.82%; P=0.003), in the plug center (62.38% ± 6.11% vs. 72.76% ± 5.86%; P=0.005), and the plug edges (60.91% ± 4.75% vs. 70.93% ± 4.51%; P=0.003). The Traditional plugs had significantly less live cells in all regions compared to Control (77.51% ± 9.23%; P<0.0001 for all regions). There were no significant differences in cell viability between Control and Submerged plugs (whole: P=0.590; center: P=0.713; edge: P=0.799).There were no intra-group regional differences between the central and peripheral 5 mm plug regions for Traditional ( P=0.108) or Submerged ( P=0.061). Recipient (61.10% ± 5.02%) had significantly lower cell viability compared to Control ( P<0.001) and Submerged ( P=0.009) but was equivalent to traditional ( P=0.990). Conclusions: There is a significant amount of chondrocyte death induced by donor OCA plug harvesting with traditional handheld irrigation that is mitigated by harvesting while submerged under saline. Similarly, there is a significant amount of cell death experienced at the periphery of the recipient OCA socket. Mitigating this damage may help improve edge integration of OCA transplants.