bluuebunny/crossref_metadata_2025_split huggingface dataset:
Differences in Injury Patterns and Delays in Care-Seeking Behaviors in the Anabaptist Population
Authors: Salzwedel Marsha , Rhodes-Lyons Heather Xenia , Kracht Elizabeth 
Published: September 2024

BACKGROUND:
The lifestyle differences of Anabaptists and their views on health care may yield different injury patterns than standard populations and require a customized approach to injury prevention and health care delivery.

OBJECTIVE:
To identify differences in injury patterns and delays in care-seeking behaviors among the Anabaptists in Wisconsin.

METHODS:
This single-center retrospective cohort study was conducted from (23 years) January 1, 2000, to December 31, 2023. Local Trauma Registry data collected patient demographics, injury details, morbidity outcomes, in-hospital mortality, and preexisting comorbidity. Anabaptist trauma patients were isolated by confirmed identification in the Trauma Registry. The analysis utilized both descriptive statistics and a logistic regression model with the outcome of Anabaptist.

RESULTS:
A total of 14,431 patients were included in the analysis; 81 (0.4%) were confirmed as Anabaptist. The Anabaptist population showed a higher likelihood of helicopter transportation (odds ratio [OR] 4.64, p < .01) and an activation of Pediatric Level I (OR 4.07, p < .01). As the emergency department shock index increased by one unit, the odds of being Anabaptist increased by 9.87 (p < .01). The injury mechanisms that were associated with the Anabaptist population included buggy collisions (OR 312.58, p < .01), caught or crushed (OR 5.21, p = .01), machinery (OR 5.38, p < .01), near drowning (OR 14.09, p < .01), scooter (OR 13.93, p = .04), and woodworking (OR 12.81, p = .01).

CONCLUSIONS:
This study identified differences in injury patterns and delays in care-seeking behaviors in the Anabaptist population.
Stressing the System: Pediatric Trauma Centers May Be Unready to Implement Comprehensive Acute Stress Screening Programs for Pediatric Trauma Patients
Authors: Renaud Elizabeth Jay , Bromberg Julie R. , McRoberts Christina , Almonte Geraldine , Lin Timmy R. , Hensler Emily , Mello Michael J. 
Published: September 2024

BACKGROUND:
Children experiencing trauma are at risk of developing acute and chronic stress disorders. In 2022, the American College of Surgeons Committee on Trauma required verified pediatric trauma centers to screen at-risk patients and provide mental health provider referrals as needed.

OBJECTIVE:
The study objective is to assess the current readiness of pediatric trauma centers to meet the new American College of Surgeons requirements.

METHODS:
This study used an exploratory, electronic, cross-sectional survey design. The Pediatric Trauma Society distributed a survey on mental health screening practices to its members in February 2023. Results were summarized with descriptive statistics. Chi-square test was used to compare responses of Levels I and II pediatric trauma centers.

RESULTS:
There were 91 survey responses from the PTS membership of 1247 (response rate of 7.3%). Fifty-nine participants were from Level I and 27 from Level II pediatric trauma centers. 63.8% of Level I and 51.9% of Level II center respondents currently screened for acute stress (χ2(1) = 1.09, p = .30). Of these, 75.7% of Level I and 57.1% of Level II center respondents routinely screened all admitted trauma patients (χ2(1) = 1.68, p = .19). However, only 32.4% of Level I and 21.4% of Level II respondents reported having outpatient acute stress referral protocols. For pediatric trauma centers currently without screening, 65% of Level I and 46.2% of Level II pediatric trauma center respondents felt they needed more than six months to establish a program (χ2(1) = 1.15, p = .28). Most respondents (68.9%) reported staff shortages as a barrier to the delivery of acute stress services.

CONCLUSIONS:
Pediatric trauma center compliance with acute stress screening requirements for verification is variable. Pediatric trauma centers may benefit from technical assistance with acute stress screening.
Long-term maternal outcomes of pregnancy after orthotopic liver transplantation in the Netherlands: A retrospective multicenter cohort study
Authors: Meinderts Jildau R. , Metselaar Herold J. , van Hoek Bart , den Hoed Caroline M. , Rijntjes Douwe , Groenewout Mariette , van Vilsteren Frederike G.I. , Groen Henk , Berger Stefan P. , Prins Jelmer R. , de Jong Margriet F.C. 
Published: September 2024

Pregnancy after orthotopic liver transplantation (OLT) puts the mother, child, and transplanted organ at risk. Little is known about long-term outcomes. We performed a nationwide retrospective cohort study to evaluate short-term and long-term outcomes of post-OLT pregnancies. The secondary aim was to assess predictors for adverse pregnancy outcomes. A composite outcome of preeclampsia, preterm birth, low birth weight, and neonatal intensive care unit admission was made. Survival of women who received a transplant at <50 years of age with and without pregnancy after OLT were compared (Dutch Organ Transplantation Registry data). Descriptive statistics, regression analysis, Kaplan-Meier and log-rank analysis, and generalized estimating equation analysis were used. Among the included 70 women with 113 pregnancies >20 weeks of gestation, hypertension occurred in 20% and preeclampsia in 12%. The live birth rate was 87%; 33% were preterm, and 23% had low birth weight. Long-term follow-up (median 10 y [IQR: = 4–14]) showed small changes in serum creatinine and bilirubin (p < 0.001). Sixteen mothers (23%) died during follow-up (median 8 y [IQR: = 4–12]), with all their children aged <18 years. No difference in survival was found when comparing women with and without pregnancy after OLT. The composite outcome occurred in 43/98 of pregnancies. Higher body mass index (BMI) and maternal age at conception increased the composite outcome risk (OR: 1.24, p < 0.01, and OR: 1.25, p = 0.01, respectively). To conclude, pregnancy after OLT does not seem to influence long-term outcomes of graft, kidney function, or patient survival in most cases. However, although pregnancy does not seem to impact survival after OLT, we do show that a substantial number of children will lose their mothers early in life. We believe this is important for pregnancy couseling of patients with an OLT and their partners.
Is tranexamic acid appropriate for all patients undergoing high-risk surgery?
Authors: Abad-Motos Ane , García-Erce Jose A. , Gresele Paolo , Páramo Jose A. 
Published: September 2024

Purpose of review
Tranexamic acid (TXA), an antifibrinolytic agent, reduces surgical bleeding in a variety of procedures, such as cardiac, orthopedic, abdominal, and urologic surgery, cesarean section, and neurosurgery. However, there are surgical interventions for which its use is not yet widespread, and some caution persists because of concerns regarding thrombotic risk. The purpose of this review is to analyze the most recent evidence in various subgroups of surgical specialties and the association of TXA with thrombotic events and other side effects (e.g. seizures).

Recent findings
Recent clinical trials and meta-analyses have shown that the efficacy and safety vary according to the clinical context, timing of administration, and dose. Some reports found that TXA reduces major bleeding by 25% without a significant increase in thrombotic events.

Summary
Wider use of TXA has the potential to improve surgical safety, avoid unnecessary blood use, and save healthcare funds.
Implementing Patient-Centered Outcomes Research Institute Stakeholder Engagement Principles in Models of Palliative Care Delivery and Advance Care Planning Research
Authors: Walling Anne M. , Verma Manisha , Grudzen Corita R. , Enguidanos Susan , Barrett Nadine J. , Johnson Kimberly S. , Combe Angela K. , Johnston Fabian M. , Greer Joseph A. 
Published: September 2024

Background:
Given the many challenges of conducting research that addresses the palliative and end-of-life care needs of patients with serious illnesses, stakeholder engagement starting from the moment of study conceptualization and design is critical to ensure successful participant recruitment, data collection, intervention delivery, data analysis, and dissemination.

Methods:
Guided by a conceptual model published by the Patient-Centered Outcomes Research Institute (PCORI) entitled, “Measuring What Matters for Advancing the Science and Practice of Engagement”14 and with the support of a PCORI Engagement Officer, representatives from 9 PCORI-funded study teams formed a working group to survey team members and review, outline, and describe key lessons learned and best practices for promoting stakeholder engagement in palliative care research.

Results:
Almost all study teams engaged with patients/caregivers, clinicians, researchers, and health care system experts as stakeholder partners. About half the teams also included payers and training institutions as part of their stakeholder advisors as well as a range of content experts. Study teams relied on a variety of support structures and resources, and they employed 10 distinct methods for maintaining engagement. All engagement methods were generally considered to be effective by teams who used the method, though there was some variability in team-rated engagement quality of each method. Nine barriers to stakeholder engagement were identified across the 9 studies as well as 9 strategies (or facilitators) to overcome these barriers. We share examples of how stakeholder engagement impacted studies in all phases, including the preparatory phase, study initiation phase, execution phase, and data analysis/dissemination phase.

Conclusions:
Teams utilized a variety of resources and support structures as well as capitalized on multiple engagement methods for fostering stakeholder engagement, resulting in a high level of collaboration and integration.
The impact of oral melatonin on pain and anxiety reduction during venipuncture in pediatric patients: a double-blind randomized clinical trial
Authors: Rahafard Sara , Akbari Jokar Zohre , Hosseini Seyed Ahmad , Alaee Ehsan 
Published: September 2024

Background:
Pain resulting from therapeutic procedures and injections is a prevalent source of stress for children. Immediate side effects of pain in infants include syncope, irritability, sleep disturbances, and nutritional issues. This study aimed to investigate the effects of oral melatonin on alleviating pain and anxiety in pediatric patients undergoing venipuncture.

Methods:
This double-blind, randomized controlled trial was conducted in the pediatric emergency ward. Patients were randomly assigned to one of two groups; the intervention group received 0.5 mg/kg of oral melatonin (maximum 5 mg) 30 min before venipuncture, while the placebo group received an equivalent amount of a placebo 30 min before the procedure. Using the Face, Legs, Activity, Cry, Consolability (FLACC) scale, postcanulation fear, pain severity, compliance, and potential side effects were evaluated.

Results:
In total, 202 patients (113 male and 89 female) in the intervention and control groups were included in the analysis. The mean pain score during venipuncture was 1.52±3.04 in the intervention group and 2.04±6.57 in the control group (P<0.001). In the intervention group, only 19 (18.8%) patients reported pain during venipuncture, whereas 79 (78.2%) patients in the control group reported pain (P<0.001). Less than half (44.6%) of the patients in the intervention group experienced anxiety during venipuncture, while the majority (94.1%) of the patients in the control group exhibited anxiety (P<0.001). The venipuncture success rate was 60.4% in the intervention group and 51.5% in the control group (P=0.257).

Conclusion:
Administering 0.5 mg/kg of oral Melatonin 30 min before venipuncture reduces procedure-related pain and anxiety in pediatric patients and may be associated with higher venipuncture success rates.
Malignant metastatic melanoma in brain with unknown primary origin: a case report
Authors: Khanal Kunjan , Rajbhandari Binod , Pandey Asim , Sherpa Pasang Lamu , Parajuli Samriddhi , Pandey Norina , Sedain Gopal , Bhattachan Maya 
Published: September 2024

Introduction:
Melanoma, a malignant tumor derived from neural crest melanocytes, predominantly affects the skin but can involve any organ with neural crest migration. Metastatic melanoma of unknown origin, particularly when it involves the brain, is associated with significant morbidity, mortality, and a typically poor prognosis.

Case presentation:
The authors present a 71-year-old man with a history of hypertension and seizure disorder who experienced a headache, transient loss of consciousness, and vomiting. Imaging revealed a mass with perilesional edema in the right temporal, right occipital, left frontal, and left periventricular regions. A craniotomy and excision of the right temporal lesion confirmed malignant metastatic melanoma through histological examination. Despite normal findings in skin, mucosal, anogenital, and ophthalmological examinations, and a comprehensive CT scan of the chest, abdomen, and pelvis that revealed no primary tumor, the diagnosis of metastatic melanoma of unknown origin was made. The patient did not receive treatment due to financial constraints.

Clinical discussion:
About 2–6% of melanoma patients present with tumors of unknown primary origin. Brain metastases occur in ~60% of advanced melanoma cases and carry a high risk of spontaneous bleeding. While traditional survival rates are low, surgical resection, stereotactic radiosurgery, immunotherapy, and BRAF/MEK inhibitors can improve outcomes.

Conclusion:
Headaches, lethargy, vomiting, and altered sensorium should prompt investigation for brain metastases from melanoma, even without a detectable primary tumor. Treatment strategies including immunotherapy and stereotactic surgery aim for a median survival of 8–10 months. Socio-economic factors, as highlighted in this case, significantly affect treatment access and patient outcomes.
Updated Risk Score Algorithms for Acute HIV Infection Detection at a Sexually Transmitted Infections Clinic in Lilongwe, Malawi
Authors: Bell Griffin J. , Chen Jane S. , Maierhofer Courtney N. , Matoga Mitch , Rutstein Sarah E. , Lancaster Kathryn E. , Chagomerana Maganizo B. , Jere Edward , Mmodzi Pearson , Bonongwe Naomi , Mathiya Esther , Ndalama Beatrice , Hosseinipour Mina C. , Emch Michael , Dennis Ann M. , Cohen Myron S. , Hoffman Irving F. , Miller William C. , Powers Kimberly A. 
Published: September 2024

Background:
Detection of acute (preseroconversion) HIV infection (AHI), the phase of highest transmission risk, requires resource-intensive RNA- or antigen-based detection methods that can be infeasible for routine use. Risk score algorithms can improve the efficiency of AHI detection by identifying persons at highest risk of AHI for prioritized RNA/antigen testing, but prior algorithms have not considered geospatial information, potential differences by sex, or current antibody testing paradigms.

Methods:
We used elastic net models to develop sex-stratified risk score algorithms in a case–control study of persons (136 with AHI, 250 without HIV) attending a sexually transmitted infections (STI) clinic in Lilongwe, Malawi, from 2015 to 2019. We designed algorithms for varying clinical contexts according to 3 levels of data availability: (1) routine demographic and clinical information, (2) behavioral and occupational data obtainable through patient interview, and (3) geospatial variables requiring external datasets or field data collection. We calculated sensitivity, specificity, and area under the receiver operating characteristic curve (AUC) to assess model performance and developed a web application to support implementation.

Results:
The highest performing AHI risk score algorithm for men (AUC = 0.74) contained 5 variables (condom use, body aches, fever, rash, genital sores/ulcers) from the first 2 levels of data availability. The highest performing algorithm for women (AUC = 0.81) contained 15 variables from all 3 levels of data availability. A risk score cut point of 0.26 had an AHI detection sensitivity of 93% and specificity of 27% for men, and a cut point of 0.15 had 97% sensitivity and 44% specificity for women. Additional models are available in the web application.

Conclusions:
Risk score algorithms can facilitate efficient AHI detection in STI clinic settings, creating opportunities for HIV transmission prevention interventions during this critical period of elevated transmission risk.
Disentangling the Effects of Comorbidity and Polypharmacy on Cognitive Function and Physical Frailty in Individuals With HIV
Authors: Michael Henry Ukachukwu , Brouillette Marie-Josée , Tamblyn Robyn , Fellows Lesley K. , Mayo Nancy E. 
Published: September 2024

Objective:
To estimate the extent to which comorbidity, polypharmacy, and anticholinergic/sedative burden interrelate to influence cognitive ability, perceived cognitive deficits (PCD), and physical frailty in people living with HIV.

Design:
Cross-sectional Structural Equation Modeling of data from 824 older people living with HIV in Canada, participating in the Positive Brain Health Now study.

Method:
Structural Equation Modeling was used to link observed variables, including comorbidity, polypharmacy, anticholinergic, and sedative burden, to cognitive ability and 2 latent constructs—physical frailty and PCD. The model was adjusted for age, sex, education, nadir CD4, duration of HIV, and symptoms of anxiety/depression. Maximum Likelihood with Robust standard errors and bootstrapping were used to test the robustness and significance of the model's indirect effects.

Results:
Anticholinergic burden had a direct significant negative relationship with cognitive ability (βstd = −0.21, P < 0.05) and indirect effect on PCD (βstd = 0.16, P < 0.01) and frailty (βstd = 0.06, P < 0.01) through sedative burden. Sedative burden was directly associated with PCD (βstd = 0.18, P < 0.01) and indirectly with frailty through PCD (βstd = 0.07, P < 0.01). Comorbidity and polypharmacy exerted indirect effects on PCD and physical frailty through anticholinergic and sedative burden. The model fits the data well (CFI: 0.97, TLI: 0.94, RMSEA: 0.05, SRMR: 0.04).

Conclusions:
Anticholinergic and sedative burden function as a pathway through which polypharmacy and comorbidities influence physical frailty and PCD. Reducing the use of anticholinergic and sedative medications could help prevent and manage cognitive impairment and frailty in older people living with HIV.
Efficacy and Safety of 2 Fixed Doses of Ibalizumab Plus Optimized Background Regimen in Treatment-Experienced HIV-Positive Individuals
Authors: DeJesus Edwin , Towner William J. , Gathe Joseph C , Cash R. Brandon , Anstett Kaitlin 
Published: September 2024

Background:
Sustained viral suppression in patients with multidrug-resistant (MDR) HIV infection remains difficult; accordingly, agents targeting different steps in the HIV life cycle are needed. Ibalizumab, a humanized immunoglobulin G4 monoclonal antibody, is a cluster of differentiation (CD4)-directed postattachment inhibitor.

Methods:
In this phase 2b study, 113 patients with MDR HIV-1 and limited treatment options were assigned an optimized background regimen (OBR) and randomized to either 800 mg ibalizumab every 2 weeks (q2wk; n = 59) or 2000 mg ibalizumab every 4 weeks (q4wk; n = 54) up to week 24.

Results:
Viral loads (VL) below the detection limit were achieved in 44% and 28% of patients in the 800 mg q2wk and 2000 mg q4wk groups, respectively, at week 24. Mean (SD) VL (log10 copies/mL) decreased from Baseline [4.6 (0.8), 800 mg q2wk; 4.7 (0.7), 2000 mg q4wk] to week 2, with the reduction maintained through week 24 [2.9 (1.5), 800 mg q2wk; 3.2 (1.4), 2000 mg q4wk]. Baseline CD4+ counts were 80.5 and 54.0 cells/μL in the 800 mg q2wk and 2000 mg q4wk groups, respectively. Mean CD4+ T-cell count was increased at week 24 in both groups. No serious adverse events were related to ibalizumab.

Conclusions:
In heavily treatment-experienced patients with HIV (PWH) at a more advanced baseline disease severity, clinically significant response rates at week 24 were achieved with ibalizumab plus OBR. Ibalizumab's unique mechanism of action and lack of cross-resistance to other antiretroviral agents make it an important component of combination treatment regimens for PWH with limited treatment options.
Microliposuction and Radiofrequency Combined With Fat Grating as a New Method for Hybrid-Type Nasolabial Folds
Authors: Jia Xinyu , Li Ming , Li Facheng , Yin Bo 
Published: September 2024

Backgrounds:
The hybrid-type nasolabial fold is a special, complex type of nasolabial fold with various causes, making it difficult to obtain an ideal effect with a single treatment.

Objectives:
This study aimed to investigate the effect and complications of a comprehensive therapy combining microliposuction, radiofrequency, and fat grafting on hybrid-type nasolabial folds.

Results:
Twenty-one patients aged 27 to 45 (mean: 34.71±5.41) years, who underwent the therapy for hybrid-type nasolabial folds were retrospectively analyzed. All patients were followed up for 12 months. Two independent observers conducted postoperative follow-ups at 1 week and 12 weeks. One week postoperatively, the hematoma, mass nodule, and skin scald ecchymosis scores were 1.24±0.43, 1.62±0.58, and 1.48±0.59, respectively. At 12 weeks, the scores of mass nodules and skin scald ecchymosis decreased (1.19±0.39 and 1.05±0.21, respectively) without obvious hematoma. The WSRS grade decreased from 4.33±0.47 to 2.19±0.39 (P<0.001), and the hybrid-type nasolabial folds significantly improved. The Face-Q scale score was 20.43±2.63 points (standard score: 85.12±10.95 points). 76.19% of the patients scored more than 80 points in the subjective Face-Q evaluation.

Conclusion:
Microliposuction and radiofrequency combined with fat grafting effectively treats hybrid-type nasolabial folds, resulting in high patient satisfaction. Most complications can be prevented, and optimal outcomes can be obtained by comprehensive surgical methods and correct procedures, which is thus worthy of clinical promotion.
Head and Neck Airbag Penetrating Injuries
Authors: Terenzi Valentina , Dell’Aquila Alberto , Pitino Francesca , Pagliuca Giulio , Gallipoli Camilla , Valentini Valentino 
Published: September 2024

Background:
Airbags have significantly decreased fatalities in frontal vehicle accidents, but their deployment can lead to more severe injuries and rarely death. The authors present a case of a penetrating injury causing tissue loss in the left cheek, an “explosion” of the zygomatic arch, and facial nerve damage, discussing the management in the contest of literature examining similar injuries in the head and neck region.

Materials and Methods:
Reviewing English literature from 1995 to 2023, 9 patients experienced severe airbag-related penetrating head and neck injuries, in 3 cases resulting in death. In addition, we describe the case of a young male reporting a deep cheek laceration with facial nerve damage, tissue loss, and comminuted maxilla-zygomatic fracture; 48 hours after trauma, he underwent surgical reconstruction using a bilobed flap, direct suture of the resected masseter muscle, closed reduction of the comminuted zygomatic arch fracture, and direct neurorrhaphy of the lacerated facial nerve.

Results:
Five months after surgery, facial nerve function recovery was observed. Mouth opening was restored, but a mixed low-medium hearing loss persisted for high frequencies. In another case marginal nerve damage was reported, but management is not described.

Conclusion:
The use of seat belts and airbags has led to a significant reduction in the incidence of facial fractures and fatalities after motor vehicle accidents, but at the same time, in some cases, complex facial trauma and/or penetrating injury can be observed. In case of suspected or certain facial nerve damage, it is mandatory to perform exploration and eventual reconstruction within 72 hours.