bluuebunny/crossref_metadata_2025_split huggingface dataset:
Comparing clinical and patient-reported outcomes between robot-assisted and conventional unicompartmental knee arthroplasty
Authors: Strait Alexander V. , Lee Ji Won , Supra Rajesh , Jeong Suin , Tefera Eshetu A , Desale Sameer , McCormick Brian , Boucher Henry R. 
Published: September 2024

Background:
Robot-assisted (RA) unicompartmental knee arthroplasty (UKA) has been associated with improved implant alignment and accuracy compared to conventional UKA; however, it is unclear if this translates to improved outcomes. The aim of this study was to compare short-term clinical and functional outcomes between RA and conventional UKA.

Methods:
A retrospective review of primary UKAs performed by a single surgeon from 2002 to 2021 was conducted using the institution’s electronic health records and outcomes database. Outcomes included 90-day complications, cumulative revisions, implant survivorship, and patient-reported outcome measures (PROMs). Oxford Knee Scores (OKS) and SF-12 physical and mental were compared using a mixed-effect regression model. A Kaplan-Meier curve was plotted to illustrate survivorship using revision as the endpoint.

Results:
A total of 397 cases were included (RA: n=85; conventional: n=312). The RA group had significantly more men (P<0.01) and a lower median BMI (P=0.02). Age and comorbidities were similar between groups (P>0.05). There was no difference in the rates of 90-day complications (RA: n=0, 0% vs. conventional: n=1, 0.9%, P=1). Significantly fewer cumulative revisions occurred in the RA group (RA: n=0, 0% vs. conventional: n=18, 5.8%; P=0.02). The median lengths of follow-up for RA and conventional UKA were 772 and 5,393 days, respectively. Both techniques showed within-group improvement in OKS and SF-12 physical through 2 yr (P<0.01). No between-group differences in PROMs occurred at any time point.

Conclusions:
Medial, fixed-bearing RA UKA shows no compromise in patient safety or outcomes when compared to conventional UKA through early-term follow-up.
Is Opioid Consumption Impacted by Study Participation? Maintenance of Fewer Opioid Refills With Reduced Prescription Quantity After Posterior Spinal Fusion in Adolescents With Idiopathic Scoliosis
Authors: Gong Davin , Yang Daniel Z. , Caird Michelle S. , Stepanovich Matthew , Whyte Noelle , Li Ying 
Published: September 2024

Background:
Opioid overprescribing can lead to nonmedical opioid use. In a previous prospective study (STUDY), we showed that a standardized protocol involving preoperative education and reduced opioid prescription quantity decreased opioid use in idiopathic scoliosis patients following posterior spinal fusion (PSF). A potential limitation was the Hawthorne effect, where participant behavior changes due to observation. At STUDY conclusion, we continued the reduced opioid prescriptions but discontinued the formal preoperative education. This retrospective study (post-STUDY) assessed if opioid refill requests increased outside of a study setting.

Methods:
Post-STUDY included patients aged 10 to 17 years who underwent PSF for idiopathic scoliosis between January 2022 and December 2023 and were discharged with a prescription of ≤30 oxycodone doses. Patients were excluded if they had previous spine surgery or were discharged with an opioid other than oxycodone. Demographics, perioperative variables, and opioid refill requests were compared with the data from STUDY, in which patients were aware their opioid use would be tracked. Patient-reported outcomes were collected via Scoliosis Research Society-22r (SRS-22r) surveys.

Results:
The post-STUDY cohort included 67 patients (69% female). The average age at the time of PSF was 13.9 years (range, 11 to 17 y). The mean number of levels fused was slightly higher (10.9 vs. 10.0, P=0.04), and intraoperative estimated blood loss was lower (211 vs. 303 mL, P<0.01) compared with the STUDY cohort. Demographics, preoperative major curve magnitude, surgery duration, and length of hospital stay were similar. The percentage of patients who requested and received opioid refills between the post-STUDY and STUDY cohorts was also similar [6/67 (9%) vs. 3/49 (6%), P=0.30]. SRS-22r showed improvements in self-image, satisfaction, and mean total score from preoperative to postoperative.

Conclusions:
Reduced opioid prescriptions did not result in increased opioid refill requests in adolescents undergoing PSF for idiopathic scoliosis outside of a study setting. While formal preoperative discussions about postoperative pain control are important, other factors likely influence opioid use. Further research should explore characteristics that predispose patients to require higher amounts of postoperative opioids.

Level of Evidence:
Level III—therapeutic.
The Relationship Between Obesity and Lateral Condyle Fracture Healing: A Pilot Study
Authors: Smithey Jake , Debevec Cole , Jha Aaradhana , Gillon William , Dillon Tyler , Forrest Akeelein , Middleton Adam , Bhanat Eldrin , Nehete Priyanka , Melancon Drew P. , Spears Isaac J. , Leitch K. Kellie 
Published: September 2024

Objective:
Childhood obesity is a growing public health concern in the United States. Obesity has been shown to lead to increased complications with regards to orthopaedic injuries, such as more severe fracture patterns, notably observed in injuries like lateral condyle fractures of the humerus. However, there is currently a gap in the literature regarding the relationship between obesity and the healing potential of these fractures. This study aims to determine whether obesity is associated with increased surgical time, wound/pin site infections, delayed union/nonunion, and time to union in pediatric patients with lateral condyle fractures of the humerus.

Methods:
A retrospective chart review was conducted at a level 1 trauma center on all patients 18 years or younger who sustained a lateral condyle fracture of the humerus. Patients were stratified into groups based on their body mass index-for-age percentile as defined by the Centers for Disease Control and Prevention; normal weight (<85%), overweight (85 to <95%), and obese (≥95%). Demographic data, Weiss classification, postoperative complications (infection, delayed union or nonunion, malunion, and need for repeat surgery), length of surgery, and time to union were recorded. Comparisons of categorical data were analyzed using χ2 tests. Analysis of variance was used to compare the means between weight cohorts for continuous data.

Results:
A total of 123 patients were analyzed. Sixty-six were categorized as normal weight, 20 were overweight, and 37 were obese. There were no significant differences between weight classes for any complications, including infection, delayed/nonunion, malunion, or repeat surgery. There was no correlation with fracture severity as defined by the Weiss classification of lateral condyle fractures in regards to weight cohort (P = 0.098). There was no significant difference in length of surgery (P = 0.393) or average time to union (P = 0.236) between the weight cohorts.

Conclusion:
In this study, population with higher pediatric obesity rates than the population average, there was no significant correlation between body mass index-for-age and each of the surgical complications reviewed, length of surgery, or time to union, indicating the healing potential of lateral condyle fractures in obese pediatric patients is no more compromised than that of their normal weight peers.

Level of Evidence:
Level III—a retrospective study.
Psoas Muscle Morphology
Authors: Emami Arash , Abdelmalek George , Davila Iciar , Changoor Stuart , Patel Neil , Coban Daniel , Sahai Nikhil , Sinha Kumar , Hwang Ki 
Published: September 2024

Study Design.
Cross-sectional radioanatomic study.

Objective.
To introduce a classification system using magnetic resonance imaging to describe psoas morphology and examine the position of nearby neurovascular structures.

Background.
Oblique lumbar interbody fusion and lateral lumbar interbody fusion (LLIF) offer sagittal malignment correction and reduced morbidity. LLIF has a higher incidence of nerve injuries, whereas oblique lumbar interbody fusion has a higher incidence of vascular injuries.

Materials and Methods.
Measurements were completed on the left psoas at the inferior L4 endplate. Class A was designated if the ventral border of the psoas muscle was >2 mm anterior, class B if it was ≤ 2 mm anterior or posterior to the vertebral body, and class C if >2 mm posterior to the vertebral body ventral border. Modified oblique corridor, measured as the distance between two lines, one at the medial border of the psoas muscle and the other at the lateral border of the nearest vascular structure, and a preferred LLIF trajectory was projected onto an axial image of the left psoas. If the trajectory violated the posterior third of the psoas, it was considered a dangerous approach due to potential iatrogenic nerve injury.

Results.
One hundred patients' magnetic resonance imaging (class A: 44; class B: 27; class C: 29) were analyzed. The average modified oblique corridor was 7.49 mm. Modified oblique corridor varied among the 3 types of psoas morphologies (A: 8.99 mm vs. B: 8.10 mm vs. C: 4.66 mm, P = 0.040). LLIF trajectory intersected the “danger zone” in 34.1%, 3.7%, and 0.0% of patients, (P < 0.001), respectively.

Conclusion.
Class A psoas had the largest modified oblique corridor but the highest proportion of those with a dangerous LLIF trajectory. Class C psoas had the narrowest modified oblique corridor, but no dangerous LLIF trajectories were identified.
Perceived Stress and Health Outcomes Among Latinx and Non-Latinx White Adult People With HIV in East Harlem, New York: A Cross-Sectional Study
Authors: Slaughter Alexander W. , Stiver Jordan , Savin Micah , Oleas Denise S. , Lee Hyunjung , Summers Angela , Zhu Danqi , Cham Heining , Robinson-Papp Jessica , Mindt Monica Rivera 
Published: September 2024

Abstract
Stress and HIV disproportionately affect Latinx adults in the United States, contributing to numerous health inequities. Among people living with HIV (PLWH), increased stress is associated with decreased medication adherence, effectiveness, and higher rates of immunosuppression and comorbidities. Our study (N = 126) examined the relationship between perceived stress and HIV-related health among Latinx (n = 83) and non-Latinx White (n = 43) PLWH. Latinx PLWH reported better HIV-related health outcomes than non-Latinx White PLWH, despite higher viral load (all p's < .05). An interaction effect showed that higher perceived distress was associated with worse health outcomes and lower CD4+ T cell count only in Latinx PLWH (p's < .05). Our findings highlight the consequences of stress on HIV-related health. Notably, higher stress may be especially detrimental among Latinx PLWH, underscoring the need for more culturally tailored interventions in HIV-related care. Future research should include additional sociocultural factors and longitudinal assessment in a larger sample.
Eosinophilic gastrointestinal disorders and the role for the epithelium in pathogenesis and treatment
Authors: Rodríguez-López Eric M. , Hill David A. 
Published: September 2024

Purpose of review
This review aims to provide an overview of the current understanding of eosinophilic gastrointestinal disorders (EGIDs) and the role of the epithelium in influencing disease pathogenesis to inform and devise future therapeutic strategies.

Recent findings
Changes in epithelial cell structure, functions, and integrity are observed in EGIDs. In eosinophilic esophagitis (EoE), the esophageal epithelium has been shown to play key roles in perpetuating the inflammatory response in EoE through the expression of pro-inflammatory cytokines and immunological cell-surface proteins. Similar mechanisms appear to exist in the other EGIDs, including eosinophilic gastritis (EoG), eosinophilic enteritis (EoN), and eosinophilic colitis (EoC). Because of the increasing rarity of each non-EoE EGID, research focusing on how the epithelium is modulating disease in each lower gastrointestinal compartment is still in its rudimentary stages.

Summary
While there has been significant progress in understanding the role of the epithelium in EoE, further research is needed to obtain a better understanding of the mechanisms mediating epithelial-immune crosstalk in non-EoE EGIDs. Using EoE-epithelial cell research to inform future EGID investigations could lead to the development of new therapeutic interventions, such as targeted therapies to restore epithelial barrier function and reduce inflammation, to improve rare disease-patient quality of life.
Barriers to the Uptake of Tickborne Disease Prevention Measures: Connecticut, Maryland 2016-2017
Authors: Hansen AmberJean P. , Wilkinson Melanie M. , Niesobecki Sara , Rutz Heather , Meek James I. , Niccolai Linda , Hinckley Alison F. , Hook Sarah 
Published: September 2024

Context
Public health programs promote numerous tickborne disease (TBD) prevention measures. However, measures are not frequently or consistently performed.

Objective
Describe barriers to consistent use of 4 commonly promoted TBD prevention measures.

Design
We conducted an online survey (n = 1883) evaluating behaviors regarding TBD prevention measures including conducting tick checks, applying insect repellents, showering/bathing, and applying chemical or natural pesticides to residential yards. Respondents could select reasons for never, rarely, or sometimes performing these measures. Descriptive analysis and logistic regression modeling evaluated associations between the 3 most cited barriers for each measure and select demographic variables.

Setting
The survey was administered to residents in high Lyme disease incidence counties of Connecticut and Maryland, 2016-2017.

Results
For tick checks (n = 800), the most cited barriers were forgetting (63%), not spending time in tick habitat (28%), and too much trouble (11%). For applying insect repellents (n = 1303), the most cited barriers were forgetting (38%), personal safety concerns (24%), and too much trouble (19%). For showering/bathing 2 hours after outdoor activity in tick habitat (n = 1080), the most cited barriers were being unaware of the prevention measure (51%), too much trouble (18%), and forgetting (18%). For applying chemical pesticides to yards (n = 1320), the most cited barriers were having environmental (45%), pet safety (31%), and personal safety concerns (28%). Lastly, for applying natural pesticides to yards (n = 1357), the most cited barriers were being unaware of natural pesticides (31%), having cost concerns (23%), and not being concerned about ticks on property (16%).

Conclusions
Forgetting, too much trouble, unawareness, and safety concerns were primary barriers to using several TBD prevention measures. Education regarding effectiveness, safety, and timing may increase uptake of certain measures. These challenges can be difficult to address, highlighting the need for passive TBD prevention measures, such as a Lyme disease vaccine.
Review of Local Homeless Mortality Efforts: A Call for Standardized Data and Reporting
Authors: Meehan Ashley A. , King Ben T. , Biggs Rachel , Boyer Alaina P. , Berner-Davis Lauryn , DiPietro Barbara 
Published: September 2024

Context:
There are currently no national estimates of how many people die while unhoused in the US. Local jurisdictions have developed their own approaches for estimating homeless mortality.

Objective:
We aimed to examine these local approaches, document what is known about homeless mortality, and summarize local methodologies.

Design:
We reviewed 17 publicly available homeless mortality reports (ie, gray literature).

Setting:
Reports were sought from government, Health Care for the Homeless, coalition to end homelessness, and other advocacy and social service websites.

Main Outcome:
From each report, we extracted the number of homeless deaths, dates of observation, data source(s) used, determination of homeless status, manners and causes of death, and decedent demographics.

Results:
Data collection and reporting on homeless mortality varied greatly across reports. This variation limits aggregation across reports. Medical examiner data was the most used data source. Manner of death was the most consistently collected field, with accidental deaths reported as the most prevalent manner of homeless deaths. Not all reports listed specific causes of death, but those that did reported toxicity (eg, overdose) and cardiovascular causes as most prevalent. The most granular age category of most homeless decedents was 40 to 60 years. On average, 80% of decedents were of male sex. While over half of reports included race and ethnicity information, disparities could not be estimated without suitable denominators.

Conclusions:
Standardized data collection and reporting guidance is needed for homeless mortality. Health departments can work with local Health Care for the Homeless programs and Continuums of Care to establish data sharing processes. Matching vital statistics with homeless service utilization records may be one opportunity to improve these efforts. Until there is federal or national guidance on these standards, localities can consider adding housing or homelessness variables as optional or mandatory fields in electronic death reporting systems.
Limberg Flap for Lateral Midface Reconstruction
Authors: Gualtieri Matteo , Scivoletto Giulia , Pitino Francesca , D’Archivio Lanfranco , Valentini Valentino 
Published: September 2024

Several local skin flaps and tissue rearrangement techniques have been described in the literature, including the rhomboid flap. The Limberg flap is one of the most versatile local flaps that can be used for reconstruction of a wide range of skin defects in different parts of the body. The purpose of this study is to demonstrate the safety and applicability of the Limberg flap for reconstruction of skin facial defects, particularly after cutaneous tumor resection.
The following article presents a retrospective case series of 8 patients in whom the Limberg flap was used to reconstruct skin defects resulting from malignant tumor resections in the lateral part of the face. No restrictions were collected regarding etiology, location, size, age, sex, or any other patient factors. The recruited patients were treated in the Maxillofacial Surgery Unit of Floraspe Renzetti Hospital of Lanciano and the study was conducted in collaboration with Sapienza University of Rome, from April 2023 to April 2024.
All the flaps settled with no complications and all the patients were FOD (free of disease) 6 months after surgery. So, in accordance with the literature, the Limberg flap turns out to be a rapid and reliable option that could be easily applied for small (size around 1–2 cm) and medium-sized (size around 2–4 cm) cutaneous defects of the face even for the oldest and/or emaciated patients.
Whole blood: Total blood product ratio impacts survival in injured children
Authors: Feeney Erin V. , Morgan Katrina M. , Spinella Philip C. , Gaines Barbara A. , Leeper Christine M. 
Published: September 2024

BACKGROUND
Some studies in both children and adults have shown a mortality benefit for the use of low titer group O whole blood (LTOWB) compared with component therapy for traumatic resuscitation. Although LTOWB is not widely available at pediatric trauma centers, its use is increasing. We hypothesized that in children who received whole blood after injury, the proportion of whole blood in relation to the total blood product resuscitation volume would impact survival.

METHODS
The trauma database from a single academic pediatric Level I trauma center was queried for pediatric (age <18 years) recipients of LTOWB after injury (years 2015–2022). Weight-based blood product (LTOWB, red blood cells, plasma, and platelet) transfusion volumes during the first 24 hours of admission were recorded. The ratio of LTOWB to total transfusion volume was calculated. The primary outcome was in-hospital mortality. Multivariable logistic regression model adjusted for the following variables: age, sex, mechanism of injury, Injury Severity Score, shock index, and Glasgow Coma Scale score. Adjusted odds ratio representing the change in the odds of mortality by a 10% increase in the LTOWB/total transfusion volume ratio was reported.

RESULTS
There were 95 pediatric LTOWB recipients included in the analysis, with median (interquartile range [IQR]) age of 10 years (5–14 years), 58% male, median (IQR) Injury Severity Score of 26 (17–35), 25% penetrating mechanism. The median (IQR) volume of LTOWB transfused was 17 mL/kg (15–35 mL/kg). Low titer group O whole blood comprised a median (IQR) of 59% (33–100%) of the total blood product resuscitation. Among patients who received LTOWB, there was a 38% decrease in in-hospital mortality for each 10% increase in the proportion of WB within total transfusion volume (p < 0.001) after adjusting for age, sex, mechanism of injury, Injury Severity Score, shock index, and Glasgow Coma Scale score.

CONCLUSION
Increased proportions of LTOWB within the total blood product resuscitation was independently associated with survival in injured children. Based on existing data that suggests safety and improved outcomes with whole blood, consideration may be given to increasing the use of LTOWB over CT resuscitation in pediatric trauma resuscitation.

LEVEL OF EVIDENCE
Therapeutic/Care Management; Level III.
Neural Maturation Provides the Stability of Representation and the Solution for Understanding Complex Concepts
Authors: Watanabe Hiroyasu 
Published: September 2024

summaryRecent advancements in realizing human-like brain functions through artificial intelligence have progressed significantly day by day. However, much of this astonishing progress in AI does not necessarily require an understanding of modern molecular biology. Here, I illustrate the significance of neural maturation in neural network-based information processing models. In both supervised and reinforcement learning paradigms, immature transmission can learn properties like normal high-fidelity conditions but lose these properties after reaching catastrophic points. I then investigated genes responsible for neuronal maturation and found that the candidate gene KCNH7 is expressed at higher levels during mouse brain development. In the simulated neural model with the KCNH7 channel property, the excitation threshold increased, resulting in a linear response property. These properties enhanced the stability of representation recall and enabled the comprehension of complex concepts in unsupervised learning models.These results highlight the importance of neural maturation in achieving higher recognition abilities in adults.