bluuebunny/crossref_metadata_2025_split huggingface dataset:
Evaluating Chat Generative Pre-trained Transformer Responses to Common Pediatric In-toeing Questions
Authors: Amaral Jason Zarahi , Schultz Rebecca J. , Martin Benjamin M. , Taylor Tristen , Touban Basel , McGraw-Heinrich Jessica , McKay Scott D. , Rosenfeld Scott B. , Smith Brian G. 
Published: April 2024

Objective:
Chat generative pre-trained transformer (ChatGPT) has garnered attention in health care for its potential to reshape patient interactions. As patients increasingly rely on artificial intelligence platforms, concerns about information accuracy arise. In-toeing, a common lower extremity variation, often leads to pediatric orthopaedic referrals despite observation being the primary treatment. Our study aims to assess ChatGPT’s responses to pediatric in-toeing questions, contributing to discussions on health care innovation and technology in patient education.

Methods:
We compiled a list of 34 common in-toeing questions from the “Frequently Asked Questions” sections of 9 health care–affiliated websites, identifying 25 as the most encountered. On January 17, 2024, we queried ChatGPT 3.5 in separate sessions and recorded the responses. These 25 questions were posed again on January 21, 2024, to assess its reproducibility. Two pediatric orthopaedic surgeons evaluated responses using a scale of “excellent (no clarification)” to “unsatisfactory (substantial clarification).” Average ratings were used when evaluators’ grades were within one level of each other. In discordant cases, the senior author provided a decisive rating.

Results:
We found 46% of ChatGPT responses were “excellent” and 44% “satisfactory (minimal clarification).” In addition, 8% of cases were “satisfactory (moderate clarification)” and 2% were “unsatisfactory.” Questions had appropriate readability, with an average Flesch-Kincaid Grade Level of 4.9 (±2.1). However, ChatGPT’s responses were at a collegiate level, averaging 12.7 (±1.4). No significant differences in ratings were observed between question topics. Furthermore, ChatGPT exhibited moderate consistency after repeated queries, evidenced by a Spearman rho coefficient of 0.55 (P = 0.005). The chatbot appropriately described in-toeing as normal or spontaneously resolving in 62% of responses and consistently recommended evaluation by a health care provider in 100%.

Conclusion:
The chatbot presented a serviceable, though not perfect, representation of the diagnosis and management of pediatric in-toeing while demonstrating a moderate level of reproducibility in its responses. ChatGPT’s utility could be enhanced by improving readability and consistency and incorporating evidence-based guidelines.

Level of Evidence:
Level IV—diagnostic.
The Top 100 Cited Articles on Cervical Disc Arthroplasty
Authors: Patel Shrey , Schupper Alexander J. , Ezzat Bahie , Asfaw Zerubabbel , Yuk Frank J. , Stein Alan , Choudhri Tanvir F. 
Published: April 2024

Study Design:
Bibliometric analysis.

Objective:
Cervical disc arthroplasty (CDA) has emerged as an effective surgical intervention for degenerative cervical disc disease with potential advantages over traditional cervical fusion. This bibliometric analysis aimed to assess the current state of research on CDA by analyzing the relevant literature using bibliometric indicators.

Summary of Background Data:
Web of Science Core Collection.

Methods:
A comprehensive search was conducted using the Web of Science database, for articles related to CDA published in the last 19 years. The top 100 articles were reviewed using bibliometric analysis. Publication trends, citation patterns, authorship, and collaboration networks were analyzed using VOSviewer and the Bibliometrix package in RStudio.

Results:
The results revealed a significant increase in the number of publications related to CDA over the past 2 decades, with most of the articles being published in orthopedic and spine surgery journals. The most frequently cited articles were related to clinical outcomes, complications, and biomechanical studies of CDA. Co-authorship analysis identified influential authors and collaborative networks, highlighting the multidisciplinary nature of CDA research involving neurosurgeons, orthopedic surgeons, and engineers. Overall, this bibliometric analysis provides a comprehensive overview of the current state of research on CDA, highlighting the key research themes, influential authors, and collaborative networks in the field.

Conclusion:
These findings can serve as a guide for researchers, clinicians, and policymakers to identify knowledge gaps, research trends, and future directions in the field of CDA.
Macrophage hitchhiking for systematic suppression in postablative multifocal HCC
Authors: Li Xuehan , Zhang Yan , Li Shun , Shi Jiaqi , Liu Caiqi , Li Xianjun , Li Yingjing , Luo Shengnan , Wang Yuan , Lai Shihui , Li Mingwei , Zhang Meng , Sun Linlin , Du Xiaoxue , Zhou Meng , Xing Fan , Zhang Qian , Wu Zhiguang , Zheng Tongsen 
Published: April 2024

Background and Aims:
HCC, particularly the multifocal HCC, features aggressive invasion and dismal prognosis. Locoregional treatments were often refractory to eliminate tumor tissue, resulting in residual tumor cells persisting and subsequent progression. Owing to problematic delivery to the tumor tissue, systemic therapies, such as lenvatinib (LEN) therapy, show limited clinical benefit in preventing residual tumor progression. Therefore, more advanced strategies for postablative multifocal HCC are urgently needed.

Approach and Results:
Motivated by the chemotaxis in tumor penetration of macrophages, we report a strategy named microinvasive ablation–guided macrophage hitchhiking for the targeted therapy toward HCC. In this study, the strategy leverages the natural inflammatory gradient induced by ablation to guide LEN-loaded macrophages toward tumor targeting, which increased by ~10-fold the delivery efficiency of LEN in postablative HCC in vivo. Microinvasive ablation–guided macrophage hitchhiking has demonstrated significant antitumor activity in various HCC models, including the hydrodynamic tail vein injection multifocal HCC mouse model and the orthotopic xenograft HCC rabbit model, systematically inhibiting residual tumor progression after ablation and prolonging the median survival of tumor-bearing mice. The potential antitumor mechanism was explored using techniques such as flow cytometry, ELISA, and immunohistochemistry. We found that the strategy significantly suppressed tumor cell proliferation and neovascularization, and such enhanced delivery of LEN stimulated systemic immune responses and induced durable immune memory.

Conclusions:
The macrophage hitchhiking strategy demonstrates exceptional therapeutic efficacy and biosafety across various species, offering promising prospects for clinical translation in controlling residual tumor progression and improving outcomes following HCC ablation.
OPTICAL COHERENCE TOMOGRAPHY FINDINGS IN PRESUMED VETERINARY ANTHELMINTIC DRUG-INDUCED RETINAL TOXICITY
Authors: Guan Wen-Xue , Zhao Xu-Feng , Yu Wei-Hong , Peng Xiao-Yan 
Published: April 2024

Purpose:
To report optical coherence tomography findings of presumed veterinary anthelmintic drugs (VADs)-induced retinal toxicity that may aid in understanding potential pathogenic mechanisms.

Methods:
This is a retrospective observational case series analysis of patients with vision abnormalities following the accidental or intentional consumption of veterinary anthelmintic drugs. All cases underwent a thorough ophthalmological examination. Moreover, medical records, as well as the initial and follow-up optical coherence tomography images, were thoroughly scrutinized.

Results:
Four patients were identified (3 men; mean [range] age, 36.5 [22–52] years). Each patient overdosed on one or two of the following VADs: closantel, triclabendazole, praziquantel, pyrantel pamoate, and niclofolan. The most characteristic optical coherence tomography finding was diffuse, granular, hyperreflective lesions throughout the outer retina, which were initially identified in the ellipsoid zone in two cases. At follow-up, optical coherence tomography exhibited regression of hyperreflective lesions and extensive loss of the outer retinal elements in two patients. In addition, the subfoveal outer retinal layers may be partially preserved.

Conclusion:
Some veterinary anthelmintic drugs could be detrimental to the human retina if overdosed, resulting in visual disturbances. Optical coherence tomography revealed the mitochondria-enriched ellipsoid zone where outer retinal damage first appeared on, implying that these medications may harm the retina by inhibiting mitochondrial energy metabolism, as they do to eliminate parasites.
CHANGES IN SCLERAL THICKNESS IN THE ACUTE PHASE OF VOGT–KOYANAGI–HARADA DISEASE
Authors: Oshiro Ayano , Imanaga Naoya , Terao Nobuhiro , Koizumi Hideki 
Published: April 2024

Purpose:
To evaluate changes in scleral thickness in Vogt-Koyanagi-Harada (VKH) disease.

Methods:
This study included 34 eyes of 17 treatment-naïve patients with acute-phase VKH disease. Scleral thickness and the presence of ciliochoroidal effusion were examined using anterior segment optical coherence tomography at baseline and 1 week, 2 weeks, and 12 weeks after the start of corticosteroid treatment. Scleral thickness was measured 6 mm posterior to the scleral spur in four directions.

Results:
Twenty-eight eyes (82.4%) initially had ciliochoroidal effusion, but this rapidly decreased to nine eyes (26.5%) after 1 week. The sclera with ciliochoroidal effusion became thinner from baseline to 1 week at the superior (400.2 ± 46.9–353.5 ± 47.9 µm), temporal (428.4 ± 53.6–387.8 ± 56.1 µm), inferior (451.5 ± 71.0–400.5 ± 50.5 µm), and nasal (452.4 ± 78.0–407.6 ± 62.9 µm) points (P < 0.01 for all), and no further changes were observed. The sclera without ciliochoroidal effusion remained unchanged.

Conclusion:
In VKH disease, eyes with ciliochoroidal effusion exhibited the maximum scleral thickness during the acute phase. This thickening responded rapidly to treatment and became thinner within 1 week. Inflammation in VKH disease may affect not only the choroid but also the sclera.
Building Interprofessional Competency Through A Virtual Cardiopulmonary Case Collaboration
Authors: Pathare Neeti , Loder Rayne , Washington Rosanne 
Published: April 2024

Introduction
Interprofessional education (IPE) experiences are prioritized as a key component of physician assistant (PA) and Doctor of Physical Therapy (DPT) education programs’ curricula to reflect contemporary practice. Virtual IPE is reported to facilitate clinical decision making and teamwork in students. However, limited studies exist on its effectiveness to promote the IPE Collaborative's (IPEC) core competencies. As we aim to increase IPE in our curriculum, virtual IPE offers several advantages. The purpose of this study was to evaluate whether a case-based, virtual IPE improved students' knowledge and attitudes of collaborative team skills using the Interprofessional Collaborative Competencies Attainment Scale (ICCAS).

Methods
This study used a retrospective pretest-posttest design. Students in first-year PA and DPT programs (n = 130, PA = 48, DPT = 82) completed the ICCAS survey before and after attendance of a mandatory virtual IPE event. The virtual IPE session centered on designing a collaborative plan of care for an individual with congestive heart failure in an outpatient setting. To assess skill attainment, students completed the ICCAS survey. t Tests with Bonferroni's correction (P < .01) were conducted for analyses.

Results
One hundred twenty-two students (PA = 46, DPT = 76) provided complete survey data. Statistically significant improvement was noted for all 20 questions (P < .001). Large pre/post-IPE event effect sizes were observed for all 20 statements in the ICCAS. No statistically significant differences between the 2 disciplines were noted.

Discussion
Our findings suggest that a virtual case-based IPE experience may offer benefits to improve the student's attitude and knowledge related to IPEC during the initial year of PA and DPT programs. These data are encouraging as integration of virtual IPE experiences may affect teamwork competencies in healthcare programs.
Exploring Patient–Clinician Trust During Pregnancy Care
Authors: Molina Rose L. , Bazan Maria , Rivera Casul Giuliana , Pazos Herencia Yessamin , Alegría Margarita , Fernandez Leonor , Edelen Maria , Kaimal Anjali J. , Hacker Michele R. , Guise Jeanne-Marie 
Published: April 2024

OBJECTIVE:
To explore patient experiences and perspectives regarding trust in clinicians during pregnancy care among Latine patients, focusing on those with Spanish as their preferred language.

METHODS:
We conducted a qualitative focus group study to explore trust in pregnancy care clinicians. Eligible participants self-identified as Hispanic/Latine, reported Spanish or English as their preferred language, were pregnant or had given birth in the previous year, and were at least 18 years old. Participants completed a brief demographic survey. We report descriptive statistics for survey responses. A semistructured discussion guide was developed from a literature review and feedback from a patient advisory panel. We report emerging themes using a modified grounded theory approach with an analysis of focus group transcripts. We mapped themes to the five dimensions of trust according to the Building Trust Initiative—communication, caring, comfort, cost, and competency—and barriers to trust.

RESULTS:
We conducted eight focus groups (five in Spanish, three in English) through Zoom between July and September 2023. Cost was not discussed in any of the focus groups. Rather, there was an emerging theme around acompañamiento (accompaniment is a distinct form of companionship in which there is shared power during a shared journey), particularly in the Spanish focus groups. Barriers to building trust exist at the interpersonal and health system levels, including miscommunication, lack of continuity, and brevity of appointments.

CONCLUSION:
This study explores how trust is conceptualized in pregnancy care according to the perspectives of Latine patients. We found that acompañamiento is a unique and crucial dimension of trust among Spanish-speaking patients.
What Gets Measured Gets Managed
Authors: Lalji Rahim , Muñoz Laguna Javier , Kauth Jael , Hofstetter Léonie , Kurmann Astrid , Adams Jon , Kongsted Alice , von Wyl Viktor , Puhan Milo A. , Hincapié Cesar A. 
Published: April 2024

Abstract
Musculoskeletal conditions are often managed in primary care settings. To facilitate research and healthcare quality, practice-based research networks offer sustained collaborations between clinicians and researchers. A scoping review was conducted to describe characteristics of practice-based research networks used for musculoskeletal research and musculoskeletal research conducted through practice-based research networks. Practice-based research networks were identified from 1) musculoskeletal-studies identified in OVID Medline, CINAHL, and Embase databases from inception to 5 February 2023 and in ClinicalTrials.gov and 2) from practice-based research network registries and websites. Among active musculoskeletal-focused practice-based research networks (i.e., currently recruiting and conducting research), an assessment of practice-based research network research good practices was performed. After screening 3025 records, 85 studies from 46 unique practice-based research networks met our eligibility criteria. Common conditions studied were low back pain (28%), musculoskeletal conditions not otherwise specified (25%), and osteoarthritis (19%). Thirty-two practice-based research networks (70%) were deemed to be active. Among active musculoskeletal-focused practice-based research networks, best practice data management information was retrievable for most (53%). Because of the scarcity of publicly available information, a large proportion of practice-based research network research good practice items was not assessable. Practice-based research networks have provided an avenue to assess clinical practice and patient outcomes related to musculoskeletal conditions. Further work to increase the transparency of musculoskeletal practice-based research network research practices is warranted.
Pittsburgh Impairment Testing Tool for Spina Bifida Can Predict Ambulation and Transfer Ability in Adults With Spina Bifida
Authors: Dicianno Brad E. , Pearson Elise M. , Mesoros Matthew , Houtrow Amy J. , McKernan Gina 
Published: April 2024

Objective
The aim of this study was to evaluate the predictive accuracy of the Pittsburgh Impairment Testing Tool. It was hypothesized that the Pittsburgh Impairment Testing Tool would have a good overall accuracy (≥80%) for predicting both ambulation and transfer ability and that overall accuracy of the Pittsburgh Impairment Testing Tool would be higher than that of other scales.

Design
A retrospective chart review was used to classify 409 adults with spina bifida according to seven neurological scales. A Naïve Bayes classifier was used to obtain accuracy estimates for predicting both ambulation and transfer ability as a function of each scale.

Results
The Pittsburgh Impairment Testing Tool was the only scale demonstrating >80% overall accuracy for predicting both ambulation and transfer ability. While several scales demonstrated ≥80% overall accuracy in predicting transfer ability, none were useful in predicting inability to transfer. Inability to transfer was difficult for all tools to predict.

Conclusions
The Pittsburgh Impairment Testing Tool demonstrated good overall accuracy for predicting both ambulation and transfer ability. Sensory and anatomic levels were less useful than motor level in predicting functional ability.
Relationship Between 2 Years of Muscle Strength Decrease and Volume Loss of Menisci and Cartilage According to Knee Pain in Mild and Moderate Knee Osteoarthritis
Authors: Zhang Hui , Shuai Tao , Wang Junqing , Li Kang , Nie Yong 
Published: April 2024

Objective
The aim of the study is to explore the relationship between 2-yr changes in muscle strength and cartilage according to knee pain in mild and moderate knee osteoarthritis.

Design
Two hundred seventy-nine participants were retrospectively obtained from the Osteoarthritis Initiative. Western Ontario McMaster University and Knee Injury and Osteoarthritis Outcome Score were used to assess pain and function. Five muscles strength (maximum extensor and flexor, normalized maximum extensor and flexor, and extensor/flexor ratio) were measured from isometric strength test. Menisci and cartilage volumes were measured from magnetic resonance imaging to assess 2 yr of osteoarthritis progression.

Results
Mild and moderate knee osteoarthritis progression was characterized by patellofemoral cartilage loss and meniscal degeneration. For WOMAC pain >2 participants, decrease in extensor strength and normalized extensor strength were positively correlated with medial meniscus volume loss (r = 0.261, P = 0.021; r = 0.232, P = 0.041, respectively). The extensor/flexor ratio changes were positively associated with Western Ontario McMaster University function changes (r = 0.291, P = 0.013) over 2 yrs.

Conclusions
The study observed a positive correlation between quadriceps strength decrease and medial meniscus degeneration in mild and moderate knee osteoarthritis patients with Western Ontario McMaster University pain >2. These findings suggested quadriceps-hamstrings balance possibly plays a protective role in knee function for participants with weaker quadriceps and severe pain.

To Claim CME Credits
Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCME

CME Objectives
Upon completion of this article, the reader should be able to: 1): Determine the effect of knee extensor muscle strength changes on the medial and lateral meniscus, tibia, and medial and lateral femoral cartilage over 2 yrs in mild to moderate knee osteoarthritis patients; 2): Describe the correlation of knee extensor strength with the medial and lateral meniscus, tibia, and medial and lateral femoral cartilage at different WOMAC-pain levels; and 3): Discuss the relationship between changes in muscle strength and changes in meniscus and cartilage volume and WOMAC pain scores over 2 yrs in mild to moderate knee osteoarthritis patients.

Level
Advanced

Accreditation
The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.
The Association of Academic Physiatrists designates this Journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.
A Case Report of Becker Muscular Dystrophy and Stroke Who Successfully Regained Mobility With Robot-Assisted Gait Training
Authors: Tay San San , Zainul Abideen Abbas Bin , Neo Jin Rui Edmund , Ho Esther Kye Ning , Visperas Christine Alejandro 
Published: April 2024

Abstract
A 30-yr-old patient with Becker muscular dystrophy presented with stroke. Background issues of proximal weakness, dilated cardiomyopathy, and reduced endurance challenged the usual goal-setting and formulation of a stroke rehabilitation plan. We discuss the holistic rehabilitation program that this patient underwent, with a focus on the utilization of robot-assisted gait training that eventually led him to successfully regain mobility.
Core Training for Pain Management and Functional Improvement in Patients With Patellofemoral Pain Syndrome
Authors: Wang Yongshen , Li Hongpeng , Zhang Di , Zhao Tianyu , Liu Zhixiang , Chen Jia , Gong Meng , Pan Juanhong , Lu Li , Jin Song 
Published: April 2024

Objective
The aim of the study is to investigate the effects of core strengthening exercises on pain, mobility, and lower limb muscle strength in patients with patellofemoral pain syndrome.

Design
Six databases were searched from inception until August 11, 2023. Pain, function, and muscle strength-related outcomes were extracted and the quality of the studies was assessed using the PEDro scale and the level of evidence was assessed using the GRADE.

Results
Nineteen studies involving 1138 patients were included. Very low-grade evidence supported the short-term pain-relieving effect of core training (standardized mean difference = −0.60, 95% confidence interval [−0.95, −0.25]), high-grade evidence supported the short-term functional improvement effects of core training (weighted mean difference = 3.61, 95% confidence interval [1.44, 5.78]), which was similarly significant within 3–12 mos of follow-up. The results of the subgroup analyses suggested that hip-knee training was most advantageous in relieving pain and enhancing motor function.

Conclusions
Although training that includes trunk core is clearly superior to knee strengthening alone, the effectiveness of hip-knee training, which is also a core training program for pain and function, is more pronounced. The available evidence supports that hip-knee training is the most valuable treatment option for patients with patellofemoral pain syndrome.