bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Lack of Reporting Social Determinants of Health in Pediatric Orthopaedic Randomized Controlled Trials
Authors: Megafu Michael , Guerrero Omar , Yendluri Avanish , Uwefoh Michelle , Li Xinning , Kocher Mininder S. , Ganley Theodore J. , Parisien Robert L. ,   Investigation Performed By The Scientific Collaborative For Orthopaedic Research And Education (SCORE) Group
Published: August 2024

Background:
Social determinants of health (SDOHs) affect health outcomes outside the hospital, and understanding them can enhance postoperative outcomes in orthopaedic surgery patients. This study aimed to describe the prevalence of randomized controlled trials (RCTs) in pediatric orthopaedic journals reporting on the SDOHs of their patient cohorts. We hypothesize that many SDOHs will be underreported in RCTs investigating pediatric orthopaedic surgery.

Methods:
Utilizing the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines, the authors queried the PubMed database to examine SDOHs from 2 pediatric orthopaedic journals: Journal of Pediatric Orthopaedics and Journal of Pediatric Orthopaedics: Part B. The inclusion criteria incorporated RCTs published between 2005 and April 2024. The exclusion criteria included any articles that were not RCTs published in this period.

Results:
One hundred thirteen articles met the search criteria, with 31 excluded because they did not fall from 2005 to 2024. Eighty-two were published from 2005 to 2024, but 6 RCTs were excluded, as 3 were non-RCTs, and 3 examined cadavers. Seventy-six RCTs were included for analysis, with 65 articles from the Journal of Pediatric Orthopaedics and 11 articles from the Journal of Pediatric Orthopaedics: Part B. Articles originated from 17 countries, with the United States producing 61.8% (47) of the included studies. Of all 76 included studies, 96.1% (73) reported age, 88.2% (67) reported sex/gender, 30.3% (23) reported BMI, 21.1% (16) reported race/ethnicity, 5.3% (4) reported educational level, 2.6% (2) reported stress, and 2.6% (2) reported insurance. Smoking status, socioeconomic status, income levels, and employment status were each reported by only 1 study.

Conclusions:
The RCTs examining pediatric orthopaedic surgery tend to scarcely report SDOHs. Future RCTs should expand beyond demographic characteristics such as age, race/ethnicity, sex/gender, and BMI and incorporate other relevant SDOHs. This will allow us to develop a more comprehensive understanding of health outcomes in the pediatric orthopaedic population.

Level of Evidence:
I; Therapeutic Studies.
Exploring the Experiences and Expectations of Adolescent Females Undergoing Periacetabular Osteotomy
Authors: Luck Connor L. , Disantis Ashley E. , Spaid Victoria C. , Kazmerski Traci M. , McClincy Michael P. 
Published: August 2024

Background:
Adolescents presenting with symptomatic acetabular dysplasia (AD) complain of pain and reduced participation in activities of daily living (ADLs). Periacetabular osteotomy (PAO) is widely accepted as the preferred treatment for AD. Understanding the patient experience can lead to improvements in psychosocial and physical burden in adolescents. We sought to explore the experiences and expectations of adolescent females with AD who underwent a PAO.

Methods:
We conducted semistructured interviews with adolescent females who underwent a PAO >6 months ago. Questions focused on exploring their experiences with AD and their PAO expectations and decision-making. Participants also completed a 7-item Likert-scale questionnaire related to factors they considered in their decision-making, which was followed by a ranking of those considerations. We utilized an inductive and deductive coding approach to identify key themes from interviews and descriptively analyzed questionnaire responses.

Results:
Eighteen adolescent females between 13 and 19 years (17.2±1.9 y) at the time of PAO participated in the study. Time from surgery to interview ranged from 203 to 1534 days (927.7±320.8 d). Key themes included (1) prolonged time from symptom onset to PAO, with many seeing several providers; (2) major preoperative apprehensions of surgical outcome and setbacks in school and recreational activities; (3) discussion with the physician and people who underwent PAO were the most beneficial sources of information; (4) Postoperative worries include surgical outcome and return to daily living. Eighty-nine percent of participants reported that return to daily activities and sustaining long-term hip health were very important factors in their PAO decision-making, and 61% ranked their return to daily activities as their top priority.

Conclusions:
Adolescent females with AD report frustrating delays in diagnosis and appropriate intervention and value their return to daily living in their decision to undergo PAO. The development of future patient-centered interventions may improve the PAO decision-making process and should include information related to surgical recovery and anecdotes of others who underwent this procedure.

Level of Evidence:
Level IV, therapeutic study.
Medial Patellofemoral Ligament Reconstruction in Adolescents: What Parents Care About
Authors: Culpepper Sylvia , Rajendra Ravi , Suwak Patrik , Clement R. Carter 
Published: August 2024

Introduction:
Numerous techniques exist for pediatric medial patellofemoral ligament (MPFL) reconstruction (MPFL-R). Pediatric orthopaedic surgeons and patient families must navigate choices between allograft and autograft, incision type, and surgery cost. While previous research has found similar surgical outcomes among different MPFL-R techniques, minimal data exists on what patients and their families prefer. To engage in shared decision-making (SDM), pediatric orthopaedic surgeons must understand family preferences, including between incision type and cost. We conducted a study utilizing choice-based conjoint (CBC) analysis to explore these preferences.

Methods:
A survey was developed using Sawtooth Software (Lighthouse Studio version 9.2.0) to gather demographic information and preferences on surgical scenarios via CBC analysis. Anonymous participants, recruited via the Prolific crowdsourcing platform, qualified if they were US residents over 18 years of age with children aged 13 to 17. Data analysis involved the Hierarchical Bayes (HB) method to generate utility scores to determine the desirability of attributes.

Results:
The study included 496 participants who prioritized surgical success (average importance 48.8%) followed by co-pay amount (21.5%), incision size (17.4%), and return to sport (12.3%). Participants earning over $200,000 annually prioritized incision size over cost (25.8% vs. 12.1%, P<0.0053). Those with incomes below $50,000 valued recovery time at a lesser extent than other income groups (10.4% than 12.3% overall importance P<0.0003). The sex of the child significantly influenced preferences: incision size was more important to parents of girls (21.1%) than boys (14.0%, P<.0001). The importance of surgery success and recovery time also differed by sex, being higher for boys (50.4%, 13.1%) than girls (47.0%, 11.7%; P=0.025, 0.026, respectively).

Conclusions:
This CBC analysis suggests parents of adolescent patients undergoing MPFL-R most value surgical success (avoiding revision surgery), followed by copay, incision size, and time to return to sport. Of note, parent income level and sex of the child significantly influenced parental preferences. We hope this information will assist orthopaedic surgeons in SDM in MPFL-R surgery.

Level of Evidence:
Level III.
Socioeconomic Status Impacts Length of Stay and Nonhome Discharge Disposition After Posterior Cervical Decompression and Fusion
Authors: Opara Olivia A. , Narayanan Rajkishen , Issa Tariq , Tarawneh Omar H. , Lee Yunsoo , Patrizio Harrison A. , Glover Abbey , Brown Bergin , McCormick Christian , Kurd Mark F. , Kaye Ian D. , Canseco Jose A. , Hilibrand Alan S. , Vaccaro Alexander R. , Kepler Christopher K. , Schroeder Gregory D. 
Published: August 2024

Study Design.
Retrospective cohort study

Objective.
To examine how community-level economic disadvantage impacts short-term outcomes following posterior cervical decompression and fusion (PCDF) for cervical spondylotic myelopathy.

Summary of Background Data.
The effects of socioeconomic factors, measured by the Distress Community Index (DCI), on postoperative outcomes after PCDF are underexplored. By understanding the impact of socioeconomic status (SES) on PCDF outcomes, disparities in care can be addressed.

Materials and Methods.
Retrospective review of 554 patients who underwent PCDF for cervical spondylotic myelopathy between 2017 and 2022. SES was assessed using DCI obtained from patient zip codes. Patients were stratified into quintiles from Prosperous to Distressed based on DCI. Bivariate analyses and multivariate regressions were performed to evaluate the associations between social determinants of health and surgical outcomes, including length of stay, home discharge, complications, and readmissions.

Results.
Patients living in at-risk/distressed communities were more likely to be Black (53.3%). Patients living in at-risk/distressed communities had the longest hospitalization (6.24 d vs. prosperous: 3.92, P=0.006). Significantly less at-risk/distressed patients were discharged home without additional services (37.3% vs. mid-tier: 52.5% vs. comfortable: 53.4% vs. prosperous: 56.4%, P<0.001). On multivariate analysis, residing in an at-risk/distressed community was independently associated with nonhome discharge [odds ratio (OR): 2.28, P=0.007] and longer length of stay (E:1.54, P=0.017).

Conclusions.
Patients from socioeconomically disadvantaged communities experience longer hospitalizations and are more likely to be discharged to a rehabilitation or skilled nursing facility following PCDF. Social and economic barriers should be addressed as part of presurgical counseling and planning in elective spine surgery to mitigate these disparities and improve the quality and value of health care delivery, regardless of socioeconomic status.
Comparison of Titanium Mesh Cage, Nano-Hydroxyapatite/Polyamide Cage, and Three-Dimensional–Printed Vertebral Body for Anterior Cervical Corpectomy and Fusion
Authors: Li Jing , Zhang Junqi , Wang Beiyu , Huang Kangkang , Yang Xi , Song Yueming , Liu Hao , Rong Xin 
Published: August 2024

Study Design.
A prospective nonrandomized controlled study.

Objective.
To compare the clinical and radiographic outcomes of anterior cervical corpectomy and fusion (ACCF) using titanium mesh cages (TMCs), nano-hydroxyapatite/polyamide 66 (n-HA/PA66) cages, and three-dimensional–printed vertebral bodies (3d-VBs).

Background.
Postoperative subsidence of TMCs in ACCF has been widely reported. Newer implants such as n-HA/PA66 cages and 3d-VBs using biocompatible titanium alloy powder (Ti6Al4V) have been introduced to address this issue, but their outcomes remain controversial.

Patients and Methods.
We enrolled 60 patients undergoing ACCF using TMCs, n-HA/PA66 cages, or 3d-VBs from January 2020 to November 2021. For each group, there were 20 patients. Follow-up was conducted for a minimum of 2 years. Clinical outcomes, including Japanese Orthopedic Association (JOA) scores, Neck Disability Index, and Visual Analog Scale scores, and radiographic outcomes, including function of spinal unit (FSU) height, fusion rate, and cervical alignment, were collected preoperatively and at each follow-up. A loss of FSU height ≥3mm was deemed implant subsidence. One-way analysis of variance was used for comparisons of mean values at different time points within the same group, with pairwise comparisons performed using the least significance difference method. The Mann-Whitney test was used for comparisons between groups. Categorical data such as sex, smoking status, implant subsidence, and pathology level were analyzed using the χ2 test.

Results.
Postoperative FSU height loss at 2 years differed significantly among the TMC, n-HA/PA66, and 3d-VB groups, measuring 3.07 ± 1.25mm, 2.11 ± 0.73mm, and 1.46 ± 0.71mm, respectively (P < 0.001). The rates of implant subsidence were 45%, 20%, and 10%, respectively (P = 0.031). All patients obtained solid fusion at a 2-year follow-up. We observed statistically significant differences in Visual Analog Scale and JOA scores at 3 months postoperatively, and JOA scores at 2 years postoperatively among the 3 groups. At a 2-year follow-up, the n-HA/PA66 and the 3d-VBs groups exhibited less FSU height loss, lower subsidence rates, and demonstrated better cervical lordosis than the TMC group. No severe postoperative complications were observed in any of the patients, and no patient required reoperation.

Conclusion.
At a 2-year follow-up after ACCF, the n-HA/PA66 and the 3d-VBs groups exhibited less FSU height loss, lower subsidence rates, and demonstrated better cervical lordosis than the TMC group. Longer-term observation of implant subsidence in ACCF using TMC, n-HA/PA66, and 3d-VB is necessary.

Level of Evidence.
Level III—therapeutic.
Resistance mechanisms and potential therapeutic strategies in relapsed or refractory natural killer/T cell lymphoma
Authors: Wang Chengji , Wang Liang 
Published: August 2024

Abstract
Natural killer/T cell lymphoma (NKTCL) is a malignant tumor originating from NK or T cells, characterized by its highly aggressive and heterogeneous nature. NKTCL is predominantly associated with Epstein–Barr virus infection, disproportionately affecting Asian and Latin American populations. Owing to the application of asparaginase and immunotherapy, clinical outcomes have improved significantly. However, for patients in whom first-line treatment fails, the prognosis is exceedingly poor. Overexpression of multidrug resistance genes, abnormal signaling pathways, epigenetic modifications and active Epstein–Barr virus infection may be responsible for resistance. This review summarized the mechanisms of resistance for NKTCL and proposed potential therapeutic approaches.
Perdanakusuma Score in Pressure Injury Compared with Falanga Score: A New Qualitative Wound Assessment Tool
Authors: Sari Kartika Puspa , Saputro Iswinarno D. , Handriani Ira , Perdanakusuma David S. 
Published: August 2024

Background:
Effective wound assessment is crucial for managing pressure injuries, necessitating a valid and reliable wound bed scoring system that is practical for clinicians. The Falanga score was replaced with the Perdanakusuma score at the Dr. Soetomo General Hospital. However, the accuracy of the Perdanakusuma score remains unclear. This study aimed to assess the accuracy of the Perdanakusuma score compared with the Falanga score, the gold standard for pressure injury assessment.

Methods:
We reviewed the medical records of 142 patients with pressure injuries who consulted for wound management at the department of plastic, reconstructive, and aesthetic surgery at Dr. Soetomo General Hospital between 2015 and 2019. We compared the accuracy of the Perdanakusuma and Falanga scores using receiver operating characteristic curves and area under the curve.

Results:
Of the total 142 patients with pressure injuries, 76 were men and 66 were women. The mean age was 47.61 years. Of the pressure injuries, 55.6% were stage III pressure injuries. The area under the curve for the Perdanakusuma scores from D-0 to D-15 treatment were 0.702, 0.724, 0.644, and 0.697, whereas the Falanga scores were 0.769, 0.721, 0.631, and 0.576, respectively.

Conclusions:
The Perdanakusuma score is a more accurate diagnostic tool for assessing pressure injuries than the Falanga score. Implementing a reliable wound bed scoring system such as the Perdanakusuma score would permit appropriate and timely treatment and improve communication on wound progress, thereby improving the healing rate.
Airway Events and Critical Care Requirements in Patients with Robin Sequence after Palatoplasty
Authors: Cohen Stephanie M. , Kanack Melissa , Nussbaum Lisa , Nguyen Tyler T. , Resnick Cory M. , Park Raymond , Evans Faye , Rogers-Vizena Carolyn R. , Ganske Ingrid M. 
Published: August 2024

Background:
Patients with Robin sequence (RS) are often thought to be at high-risk for airway complications after cleft palate repair, and may be routinely admitted to the intensive care unit after surgery. This study compares frequency of postoperative airway events in patients with and without RS undergoing palatoplasty, and assesses potential risk factors for needing intensive care.

Methods:
A matched cohort study of patients with and without RS undergoing palatoplasty from February 2014 to February 2022 was conducted. Variables of interest included prior management of micrognathia, comorbidities, polysomnography, age and weight at the time of palatoplasty, operative techniques, intubation difficulty, anesthesia duration, and postoperative airway management. Airway events were defined as airway edema, secretions, stridor, laryngospasm, obstruction, and/or desaturation requiring intervention. Logistic regression was performed to identify factors predictive of airway events.

Results:
Thirty-three patients with RS and 33 controls were included. There were no statistically significant differences in airway events between groups (eight RS, four controls, P = 0.30). Anesthetic duration over 318 minutes was associated with increased risk of postoperative airway events [(OR) 1.02 (1.00–1.04) (P = 0.04)] for patients with RS, but not for patients in the control cohort.

Conclusions:
Postoperative intensive care unit admission is not universally necessary for patients with RS after palatoplasty if intubation was straightforward and there were no concomitant procedures being performed. Patients with longer anesthesia durations were more likely to have postoperative airway events and may need a higher level of care postoperatively.
Artificial Intelligence–Based Indocyanine Green Lymphography Pattern Classification for Management of Lymphatic Disease
Authors: Ozmen Berk B. , Pandey Sonia K. , Schwarz Graham S. 
Published: August 2024

Background:
Lymphedema diagnosis relies on effective imaging of the lymphatic system. Indocyanine green (ICG) lymphography has become an essential diagnostic tool, but globally accepted protocols and objective analysis methods are lacking. In this study, we aimed to investigate artificial intelligence (AI), specifically convolutional neural networks, to categorize ICG lymphography images patterns into linear, reticular, splash, stardust, and diffuse.

Methods:
A dataset composed of 68 ICG lymphography images was compiled and labeled according to five recognized pattern types: linear, reticular, splash, stardust, and diffuse. A convolutional neural network model, using MobileNetV2 and TensorFlow, was developed and coded in Python for pattern classification.

Results:
The AI model achieved 97.78% accuracy and 0.0678 loss in categorizing images into five ICG lymphography patterns, demonstrating high potential for enhancing ICG lymphography interpretation. The high level of accuracy with a low loss achieved by our model demonstrates its effectiveness in pattern recognition with a high degree of precision.

Conclusions:
This study demonstrates that AI models can accurately classify ICG lymphography patterns. AI can assist in standardizing and automating the interpretation of ICG lymphographic imaging.
Occurrence of Transient Myocardial Ischemic Events Among Non-ST Segment Elevation Acute Coronary Syndrome Patients Before or After Invasive Coronary Angiography
Authors: Suba Sukardi , Carey Mary G. , Pelter Michele M. 
Published: August 2024

Background:
The occurrence of transient myocardial ischemia (TMI) is an important pathology in patients with non-ST elevation acute coronary syndrome (NSTE-ACS), yet studies are scarce regarding when TMI occurs during hospitalization, particularly in relation to invasive coronary angiography (ICA). This study examined: (1) TMI before or after ICA; (2) patient characteristics and ischemic burden by TMI group (before or after ICA); and (3) major in-hospital complications (transfer to critical care, death) and length of stay by TMI group (before or after ICA).

Methods:
Secondary data analysis in hospitalized NSTE-ACS patients with TMI event(s) identified from 12-lead electrocardiographic Holter. Patient records were reviewed to assess ischemic burden [TMI time (min) ÷ hours recording duration], outcomes, and TMI timing, before or after ICA.

Results:
In 38 patients, 3 (8%) had TMI before and after ICA. Of the remaining 35 patients (92%), TMI occurred before ICA (16; 46%), and after ICA (9; 26%), and 10 (28%) did not have ICA. Patient characteristics, untoward outcomes, and TMI duration (minutes) did not differ by group. Ischemic burden was higher in patients with TMI after ICA (7.29 ± 8.82 min/h) compared to before ICA (2.54 ± 2.11 min/h), P = 0.039. Hospital length of stay by TMI group was 113 ± 113 (before), 226 ± 244 (after), and 85 ± 65 hours (no ICA); P = 0.172.

Conclusions:
Almost half of the sample had TMI before ICA; one-third had TMI but did not have ICA. Patients with TMI after an ICA had a higher ischemic burden. Future studies with larger sample sizes are needed to investigate further the short- and long-term clinical significance of TMI among NSTE-ACS patients.
Comparative Effectiveness of Alternate Antibiotic Therapies for Intrapartum Group B Streptococcus Colonization
Authors: Swayze Emma J. , Liske Emily J. , Henry Lydia M. , Dolvin Erin G. , Swailes Alexa L. 
Published: August 2024

Background
Intrapartum antibiotic therapy is imperative to minimize maternal-to-fetal transmission of group B Streptococcus (GBS). Penicillin is the gold standard for treatment, but there is a paucity of data on alternate antibiotic therapies for penicillin-allergic patients. This study evaluates the effectiveness of alternate antibiotic therapies in this population.

Methods
This was a retrospective cohort analysis of GBS-positive pregnant patients at a single safety-net hospital from 2019 through 2022. GBS-positive penicillin-allergic patients were matched 1:2 with nonallergic controls. The primary outcomes were as follows: GBS-positive neonates, neonatal length of stay, GBS septicemia, Apgar scores, fetal demise, and 30-day neonatal complications (sepsis, deafness, pneumonia, or meningitis). χ2 and Fisher exact analyses were performed on Stata version 16.1 (StataCorp, College Station, TX).

Results
Two hundred twenty-three GBS-positive pregnant patients were analyzed, including 78 penicillin-allergic (35.0%) and 145 nonallergic (65%). Patients were treated with vancomycin (n = 64, 28.7%), clindamycin (n = 7, 3.1%), cephalosporins (n = 6, 2.7%), or penicillin (n = 146, 65.5%). Rates of GBS-positive infants were low but varied by antibiotic treatment (P < 0.01): penicillin, 0/146 (0%); vancomycin, 0/64 (0%); clindamycin, 1/7 (14.3%); and cephalosporins, 1/6 (16.7%). There was also a significant difference in 30-day neonatal complications (P = 0.03): penicillin, 3/146 (2.1%); vancomycin, 0/64 (0%); clindamycin, 1/7 (14.3%); and cephalosporins, 1/6 (16.7%) but no difference in length of stay (P = 0.07), 5-minute Apgar scores (P = 0.32), or fetal demise (P = 1.00).

Conclusions
Antibiotic effectiveness for GBS-positive pregnant patients varied slightly by medication, but the risk was low in all cohorts. Vancomycin appears to be effective for penicillin-allergic patients, but alternative antibiotic therapies may also provide adequate coverage with a lower risk of promoting antibiotic resistance.