bluuebunny/crossref_metadata_2025_split huggingface dataset:
Reliability of Radiologic Classifications of Sequelae of Septic Arthritis of the Hip in Children
Authors: Kumar Singh Amerendra , Gupta Parmanand , Kamath Siddarth , Moturu Devendra , Reddy Jonathan , Moka Siddardha , Jethwa Ravi , Shail Sumukh , Ganjwala Dhiren , Shah Hitesh 
Published: June 2024

Objective:
To the best of our knowledge, there is no study comparing the inter and intraobserver reliability of current classifications for postseptic hip sequelae in children. The current study aims to assess the interobserver and intraobserver reliability of four current classifications and identify hips that could not be classified in each classification system.

Methods:
The hip radiographs of 148 consecutive children with sequelae of sepsis of the hip from 2 centers were assessed after a minimum of 2 years of follow-up after sepsis. All hips (affected and normal sides) were classified according to the 4 original descriptions of the authors of the respective classifications. If a hip did not fall into any subtype of the classification, the rater was asked to mark it as nonclassifiable and state the reason for being unable to classify the hip in the respective classification. The intraclass correlation coefficient was computed to assess the reproducibility of each classification.

Results:
Interrater reliability and intrarater reliability were moderate (0.57 to 0.72) while including all hips. The reliability was poor (0.35 to 0.49) in all 4 classifications, with an evaluation of only affected 180 hips. A few sequelae of infection, including caput valgus (n = 7), acetabular dysplasia (4), joint space narrowing (2), and bony ankylosis (1), were not included in any of the 4 current existing classification systems.

Conclusion:
The reliability of all current classifications of sequelae of septic arthritis of the hip is moderate. A proportion of sequelae do not find a place in all current classifications.

Level of Evidence:
Level III.
MANAGEMENT OF LARGE FULL-THICKNESS MACULAR HOLES
Authors: Richards Kaitlyn , Kadakia Ankit , Wykoff Charles C. , Major James C. , Wong Tien P. , Chen Eric , Schefler Amy C. , Patel Sagar B. , Kim Rosa Y. , Henry Christopher R. , Fish Richard H. , Brown David M. , Benz Matthew S. , Pearce William , Shah Ankoor R. 
Published: June 2024

Background/Purpose:
To determine and compare the efficacy of a surgical internal limiting membrane (ILM) flap technique with the traditional ILM peel on long-term visual and anatomical outcomes for large (>400 µm) full-thickness macular holes.

Methods:
From October 2016 to July 2022, patients undergoing initial full-thickness macular hole repair with the ILM flap or ILM peel technique were reviewed. Final outcomes were recorded and based on size in microns: 401 to 800, 801 to 1,200, and >1,200.

Results:
Patients treated with ILM flap (n = 52, 94.2% closure rate) or ILM peel (n = 407, 93.6% closure rate) were followed with a mean follow-up time of 15.0 ± 10.2 and 20.0 ± 13.4 months, respectively. Success rates for ILM flaps and ILM peels were compared for full-thickness macular holes of 401 to 800 (100%, 95.8%, P = 0.39), 801 to 1,200 (95%, 93%, P = 0.74), and >1,200 (86.7%, 86.7%, P = 1.0) µm. Mean best-recorded logarithm of the minimal angle of resolution visual acuity for ILM flaps and ILM peels, respectively, was 1.02 ± 0.46 and 0.87 ± 0.47 preoperatively, with follow-up acuity of 0.48 ± 0.32 (P < 0.03) and 0.39 ± 0.42 (P < 0.01) at Year 3.

Conclusion:
Both techniques provide a similar anatomical closure rate and functional improvement in vision. Comparisons should be cautiously made based on difference in preoperative hole size.
MICROVASCULAR CHANGES IN TREATMENT-NAÏVE NONEXUDATIVE MACULAR NEOVASCULARIZATION COMPLICATED BY EXUDATION
Authors: Crincoli Emanuele , Catania Fiammetta , Labbate Gaia , Sacconi Riccardo , Ferrara Silvia , Parravano Mariacristina , Costanzo Eliana , Querques Giuseppe 
Published: June 2024

Purpose:
To assess differences in choriocapillaris (CC) and macular neovascularization (MNV) optical coherence tomography angiography quantitative parameters between long-term persistently nonexudative MNVs (NE-MNVs) and long-term activated NE-MNVs in age-related macular degeneration.

Methods:
Age-related macular degeneration patients with treatment-naïve NE-MNVs with >2 years of follow-up and no evidence of exudation within the first 6 months from diagnosis were retrospectively recruited. Two groups were considered according to the occurrence (EX group) or not (NE group) of exudation within the first 2 years of follow-up. Segmentation of the MNV and of the perilesional CC were obtained from enface optical coherence tomography angiography acquisitions at diagnosis and at 6-month follow-up. OCT B-scan images of the MNV were also collected. Fractal ratio was defined as the ratio between MNV fractal dimension (FrD) and CC FrD.

Results:
Fifty (50) eyes were included (20 EX group and 30 NE group). EX group showed higher flow deficit density and flow deficit number at the 6-month follow-up. It also showed higher MNV FrD, lower CC FrD, and higher fractal ratio at the 6-month follow-up. The fractal ratio significantly increased at 6-month acquisitions in the EX group, showing an area under the ROC curves of 0.887 (95% CI 0.869–0.922).

Conclusion:
Fractal ratio at 6 months can predict exudation risk of MNV within 2 years from diagnosis. This suggests increased structural complexity of the NE-MNV accompanied by progressive capillary rarefaction of the perilesional CC as a key driving factor for the development of exudation in NE-MNV.
Assessing the Burden of Respiratory Syncytial Virus-related Bronchiolitis in Primary Care and at 15-Day and 6-Month Follow-up Before Prophylaxis in France: A Test-negative Study
Authors: Rybak Alexis , Cohen Robert , Bangert Mathieu , Kramer Rolf , Delobbe Jean-François , Deberdt Patrice , Cahn-Sellem Fabienne , Béchet Stéphane , Levy Corinne 
Published: June 2024

Objective:
To assess the burden of respiratory syncytial virus (RSV)-related bronchiolitis in primary care and at 15 days and 6 months after a primary care visit.

Study Design:
In this test-negative study, children <2 years old with a first episode of bronchiolitis were prospectively enrolled by 45 ambulatory pediatricians in France from February 2021 to April 2023. RSV was assessed with a rapid antigen detection test. The burden of the disease was assessed with a questionnaire, including quality of life (PedsQL 1.0 Infant Scales), at 15-day and 6-month follow-up. Children with a positive RSV test result (RSV+) were compared to those with a negative test result (RSV−).

Results:
Among the 1591 children enrolled, 750 (47.1%) were RSV+. At 15 days follow-up (data availability: 69%), as compared with RSV− children, RSV+ children more frequently had fever (20.5% vs. 13.7%, P = 0.004) and decreased food intake (27.0% vs. 17.4%, P < 0.001) during the last 3 days. They had higher rates of hospitalization (11.8% vs. 5.8%, P < 0.001), childcare absenteeism (83.5% vs. 66.1%, P < 0.001) and parents who had to stop working to care for them (59.1% vs. 41.0%, P < 0.001) as well as lower quality of life (median PedsQL score 76.2 vs. 78.4, P = 0.03). At 6 months (data availability: 48.5%), the 2 groups did not differ in proportion of medical attendance, hospitalization, antibiotic treatment or quality of life.

Conclusion:
RSV+ children experienced much more severe disease and follow-up family and societal burden than RSV− children. These data may be used as baseline data as RSV prophylaxis is about to be implemented.
Subsequent Complications of Pediatric Patients With Osteomyelitis and Accompanying Subperiosteal Abscess
Authors: Hosokawa Takahiro , Deguchi Kuntaro , Takei Haruka , Sato Yumiko , Tanami Yutaka , Oguma Eiji 
Published: June 2024

Background:
Subperiosteal abscesses (SAs) are a complication of osteomyelitis that requires surgical intervention. This study aimed to characterize the occurrence of subsequent complications in pediatric patients with osteomyelitis and accompanying SA.

Methods:
Fourteen pediatric patients with SAs were included. We recorded clinical information, including age at diagnosis, interval (days) between the onset of symptoms and diagnosis, location of SAs (long/flat bone), pathogens [methicillin-resistant Staphylococcus aureus (MRSA)/non-MRSA], treatment period (days) and any subsequent complications. Patients were classified based on SAs with or without complications. Mann-Whitney U and Fisher exact tests were used for statistical analyses, and data are expressed as median and interquartile range.

Results:
Six patients (42.9%) had subsequent complications. There were significant differences in location of SAs between these two groups (long/flat bone, with versus without complication = 6/0 versus 3/5; P = 0.031). No significant differences were observed between the groups in terms of age [with versus without complication = 13.8 (9.7–24.5) versus 556.3 (5.0–107.8) months; P = 0.491], the interval (days) between symptoms onset and diagnosis [with versus without complications = 5 (1–10) versus 5 (3–6.5) days; P = 0.950], pathogenesis (MRSA/non-MRSA, with versus without complication = 4/2 versus 2/6; P = 0.277) and treatment period [with versus without complication = 50.5 (31–57) versus 29 (24.5–41.5) days; P = 0.108].

Conclusions:
Pediatric patients with SAs in the long bones have a higher likelihood of experiencing subsequent complications than those with SAs in flat bones. Physicians should carefully manage this vulnerable patient group.
Pneumococcal Colonization in Children With Persistent Asthma: A Retrospective Cohort
Authors: Olarte Liset , Banerjee Dithi , Swanson Douglas , Tabakh Jennifer , Lee Brian , Harrison Christopher J. , Selvarangan Rangaraj 
Published: June 2024

Background:
Asthma is the most common chronic medical condition among children ≥5 years of age with invasive pneumococcal disease. How asthma or its management affects pneumococcal colonization is not fully understood. Our objective was to compare pneumococcal colonization rates between children with persistent asthma and children without asthma, and to characterize the pneumococcal serotype distribution.

Methods:
We used nasal mid-turbinate samples obtained per routine care from 5- to 18-year-old children with upper respiratory symptoms from November to April (respiratory seasons) of 2017 to 2018 and 2018 to 2019 in Kansas City, United States. Pneumococcal immunization status, prior antibiotic use and other clinical data were collected. Samples were tested for pneumococcal colonization by real-time polymerase chain reaction targeting lytA gene. Positive samples underwent multiplex serotype-specific polymerase chain reaction assays to determine the serotype.

Results:
Of 363 children (120 with persistent asthma and 243 without asthma), 87.6% were 5 to 10 years old, 50.1% were female and 74.1% received ≥3 doses of a pneumococcal conjugate vaccine. The pneumococcal colonization rate was lower in children with persistent asthma than in children without asthma (10% versus 18.9%, P = 0.03). The odds of colonization were lower in children with persistent asthma [OR 0.4 (95% confidence interval: 0.2–0.9)] after adjusting for demographic and clinical data. Pneumococcal serotype was confirmed in 77.6% of positive samples; 35.6% of those samples corresponded to PCV13 serotypes and 64.4% to non-PCV13 serotypes. The most common serotypes were 19F (15%), 3 (13%) and 6C/6D (11%).

Conclusions:
Children with persistent asthma had lower rates of pneumococcal colonization than children without asthma when seeking care for respiratory symptoms.
Incidence, Risk Factors, Short-term Outcomes, and Microbiome of Ventilator-associated Pneumonia in Very-low-birth-weight Infants: Experience at a Single Level III Neonatal Intensive Care Unit
Authors: Huang Jane , Cayabyab Rowena , Cielo Mikhaela , Ramanathan Rangasamy 
Published: June 2024

Background:
Ventilator-associated pneumonia (VAP) is a common hospital-acquired infection in neonates on invasive mechanical ventilation, resulting in high morbidity and mortality. The objective of this study is to determine the incidence, risk factors, short-term outcomes and microbiome associated with VAP in very-low-birth-weight (VLBW) infants born at <32 weeks of gestational age (GA).

Methods:
Retrospective study of intubated VLBW infants born at <32 weeks of GA admitted to the Los Angeles General Medical Center neonatal intensive care unit from July 2015 to July 2021 who had routine tracheal aspirate cultures obtained. Neonates were retrospectively classified into 3 groups, confirmed VAP, suspected VAP and no VAP, for comparison of risk factors, outcomes and airway microbial colonization.

Results:
Eighty-seven infants met inclusion criteria with a mean GA of 26.1 ± 1 weeks and mean birth weight of 812 ± 281 g. The incidence of VAP was 7.8 per 1000 ventilator days, and the most common causative organisms were Gram-positive organisms (39%), predominantly coagulase-negative Staphylococcus. Duration of postnatal dexamethasone exposure predicted VAP compared to no VAP (coefficient, 0.31; 95% CI 0.03–0.59; P = 0.03) after adjusting for duration of intubation, surfactant use and antenatal steroid exposure. Infants with VAP had higher rate of grade 2/3 bronchopulmonary dysplasia (P = 0.03) and longer hospital stay (P = 0.04).

Conclusions:
VAP occurs at a high rate in VLBW infants who are exposed to prolonged dexamethasone use. It is predominantly caused by Gram-positive organisms.
Endoscopic therapies for bariatric surgery complications
Authors: Yakout Abdelrahman , Elli Enrique F. , Kumbhari Vivek , Bakheet Nader 
Published: June 2024

Purpose of review
The aim of this review is to present the current state of the field, highlight recent developments, and describe the clinical outcomes of endoscopic therapies for bariatric surgery complications.

Recent findings
The field of interventional endoscopy now presents a range of minimally invasive procedures for addressing postbariatric complications. Lumen-opposing metal stents have emerged as a reliable solution for managing gastrojejunal strictures following Roux-en-Y gastric bypass, whether with or without associated leaks. Additionally, they serve as a conduit for performing endoscopic retrograde cholangiopancreatography (ERCP) post-RYGB via EUS-directed ERCP (EDGE). Gastric peroral endoscopic myotomy, originally designed for gastroparesis, has demonstrated effectiveness in treating postgastric sleeve stenosis, particularly the challenging helical stenosis cases. Furthermore, innovative endoscopic antireflux techniques are showing encouraging outcomes in addressing gastroesophageal reflux disease (GERD) following sleeve gastrectomy. Additionally, several modifications have been proposed to enhance the efficacy of transoral outlet reduction (TORe), originally developed to treat weight regain due to gastrojejunal anastomotic issues post-RYGB.

Summary
Endoscopic management of bariatric surgery complications is continuously evolving. The development of new techniques and devices allows endoscopists to provide novel, minimally invasive alternatives that were not possible in the near past. Many techniques, however, are limited to expert centers because they are technically demanding, and specialized training in bariatric endoscopy is still required.
The environmental impacts of anesthesia
Authors: Grunert Matthew , Hunt Megan F. , Decker Mary 
Published: June 2024

Purpose of review
The healthcare sector has a substantial environmental footprint, and the delivery of anesthesia contributes significantly. Inhaled anesthetics themselves are potent greenhouse gases, unused intravenous medication exert toxic effects on the environment, and the increasing reliance on single-use devices has led to an ever-growing amount of solid waste produced in operating rooms. This review discusses many of these environmental impacts and suggests practices to mitigate the environmental footprint of anesthetic practice.

Recent findings
The choice of anesthesia maintenance has significant environmental implications, with nitrous oxide and desflurane having the highest carbon footprint of all anesthetic agents. Using low fresh gas flows and supplementing or replacing inhalational agents with propofol leads to a significant reduction in emissions. Many intravenous anesthetic agents pose a risk of environmental toxicity, and efforts should be made to decrease medication waste and ensure appropriate disposal of unused medications to minimize their environmental impacts. Additionally, consideration should be given to replacing single-use devices in the operating rooms with reusable alternatives that are often both environmentally and economically superior. And solid waste generated in the operating room should be segregated thoughtfully, as processing regulated medical waste is a highly energy-intensive process.

Summary
Significant opportunities exist to improve the environmental footprint of anesthesia practice, and with the rapidly worsening climate crisis, the importance of implementing changes is greater than ever.
Phantom sensation in genital gender-affirming surgery: a narrative review
Authors: Ferrin Peter C. , Burghardt Elliot , Peters Blair R. 
Published: June 2024

Purpose of review
To review findings related to phantom genital sensation, emphasizing phantom sensation in the transgender and gender diverse (TGD) population. We discuss prevalence, presentation and potential implications for sensory outcomes in genital gender-affirming surgery.

Recent findings
There is a high prevalence of phantom genital sensations in the TGD population. The prevalence varies by body part, approaching 50% in the most frequently reported transgender phantom – the phantom penis. Unlike genital phantoms that occur after trauma or surgery which are often painful, transgender phantoms are typically neutral and often erogenous in experience. Phantom sensation in the TGD population can be an affirming experience and important part of sexual well being and embodiment.

Summary
Recent studies have begun to characterize the prevalence and presentations of phantom genital sensations in TGD people, informing our evolving understanding of the sensory experiences of the transgender and gender diverse population. Targeting integration of these centrally-mediated phantom genital sensations with the peripherally generated sensation from genital stimulation may represent one potential avenue to improve sensation and embodiment following genital gender-affirming surgical procedures. Additionally, emerging techniques in modern peripheral nerve surgery targeting phantom pain may offer potential treatment options for painful phantom sensation seen after cases of genital surgery or trauma.
Physical Therapy and Aminopyridine for Downbeat Nystagmus Syndrome: A Case Report
Authors: Cornforth Elizabeth , Schmahmann Jeremy D. 
Published: June 2024

Background and purpose:
Individuals with downbeat nystagmus (DBN) syndrome present with DBN, dizziness, blurred vision, and unsteady gait. Pharmacological intervention with 4-aminopyridine (4-AP) may be effective in improving oculomotor function, but there is minimal evidence to date that it improves gait. This suggests the possible benefit of combining pharmacotherapy with physical therapy to maximize outcomes. This case report documents improvements in gait and balance after physical therapy and aminopyridine (AP) in an individual with DBN syndrome.

Case description:
The patient was a 70-year-old man with a 4-year history of worsening dizziness and imbalance, diagnosed with DBN syndrome. He demonstrated impaired oculomotor function, dizziness, and imbalance, which resulted in falls and limited community ambulation.

Intervention:
The patient completed a customized, tapered course of physical therapy over 6 months. Outcome measures included the 10-meter walk test, the Timed Up and Go (TUG), the Dynamic Gait Index (DGI), and the modified clinical test of sensory integration and balance.

Outcomes:
Improvements exceeding minimal detectable change were demonstrated on the TUG and the DGI. Gait speed on the 10-meter walk test did not change significantly, but the patient was able to use a cane to ambulate in the community and reported no further falls.

Discussion:
Controlled studies are needed to explore the potential for AP to augment physical therapy in people with DBN syndrome. Physical therapists are encouraged to communicate with referring medical providers about the use of AP as pharmacotherapy along with physical therapy for individuals with DBN syndrome.
Pelvic Floor Rehabilitation After Rectal Cancer Surgery
Authors: Bosch Noes Margaretha , Kalkdijk-Dijkstra Jenneke Aaltje , van Westreenen Hendrik Leendert , Broens Paul ma , Pierie Eugène Nicolas Jean , van der Heijden Joost Albertus Gerardus , Klarenbeek Bastiaan Rijk ,   On behalf of the FORCE trial group
Published: June 2024

Objective:
To evaluate the effects of pelvic floor rehabilitation (PFR) after low anterior resection (LAR) at 1-year follow-up.

Background:
After LAR, with restoration of bowel continuity, up to 90% of patients develop anorectal dysfunction, significantly impacting their quality of life (QoL). However, standardized treatment is currently unavailable. The FORCE trial demonstrated the beneficial effects of PFR after 3 months regarding specific domains of the Fecal Incontinence QoL (FIQL) questionnaire and urgency compared with usual care.

Methods:
The FORCE trial is a multicenter, two-arm, randomized clinical trial. All patients undergoing LAR were randomly assigned to receive either usual care or a standardized PFR program. The primary outcome measure is the Wexner incontinence score, and the secondary endpoints included the low anterior resection syndrome score, the European Organization for Research and Treatment of Cancer colorectal-specific QoL questionnaire, and health and FIQL. Assessments were conducted at baseline before randomization, at 3 months and 1-year follow-ups.

Results:
A total of 86 patients were included (PFR: n = 40, control: n = 46). After 1 year, PFR did not significantly improve Wexner incontinence scores (PFR: -3.33, 95% CI: -4.41 to -2.26, control: -2.54, 95% CI: -3.54 to -1.54, P = 0.30). Similar to the 3-month follow-up, patients without near-complete incontinence at baseline showed a sustained improvement in fecal incontinence (PFR: -2.82, 95% CI: -3.86 to -1.76, control: -1.43, 95% CI: -2.36 to -0.50, P = 0.06). Significant improvement was reported in the FIQL domains Lifestyle (PFR: 0.51, control: -0.13, P = 0.03) and Coping and Behavior (PFR: 0.40, control: -0.24, P = 0.01).

Trial registration:
Netherlands Trial Registration, NTR5469, registered on September 3, 2015.

Conclusions:
At 1-year follow-up, no significant differences were found in fecal incontinence scores; however, PFR was associated with improved FIQL compared with usual care.