bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Role of Surveillance in Predicting Fracture in Pediatric Patients With Incidentally Discovered Nonossifying Fibromas and Fibrous Cortical Defects: Is It Worth It?
Authors: Patel Rohan R. , Damron Timothy A. 
Published: March 2024

Background:
Nonossifying fibroma (NOF) and fibrous cortical defect (FCDs), the most common benign pediatric bone lesions, are usually incidental x-ray findings. Surveillance of characteristic lesions has been recommended to monitor for enlargement and assess fracture risk. However, no accepted fracture risk prediction guidelines exist, so indications for prophylactic surgery are unclear. The study’s purposes were to (1) characterize the timing of NOF/FCD-associated fractures, (2) quantify the resources devoted to surveillance, and (3) evaluate the potential for surveillance to prevent pathologic fracture.

Methods:
A single institution retrospective review was conducted to identify pediatric patients (below 18 y old) with clinical-radiographic documentation of an NOF or FCD diagnosis from 2012 to 2020. Patients who presented with fracture were tallied but excluded from the surveillance analysis. Patients without at least one follow-up visit were also excluded. Lesional radiographic features were characterized on initial imaging. The number of visits and imaging studies devoted to surveillance were tabulated. The number of fractures and prophylactic surgeries were recorded to quantify the potential of surveillance to prevent pathologic fractures.

Results:
The study population presenting without fracture consisted of 301 patients with 364 lesions with a mean follow-up of 20 months. By contrast, over the same period, 38 patients presented with NOF/FCD associated pathologic fractures. Surveillance included 1037 additional imaging tests over 1311 follow-up visits, or on average, 3.4 imaging studies and 4.4 visits per patient. During surveillance, only 2 (0.55%) lesions fractured. Another 10/364 (2.8%) patients underwent curettage and grafting, suggesting that—at best—the potential for preventing pathologic fracture by surveillance, assuming all 10 patients who underwent surgery would have subsequently fractured along with the 2 documented fractures, is 3.3% of lesions (12/364).

Conclusions:
The small number of fractures and surgeries during the follow-up period probably does not justify additional resources for surveillance beyond the initial visit, except in symptomatic patients with large lesions. However, subsequent visits may play a role in educating patients and their families regarding the natural history of these lesions.

Level of Evidence:
Prognostic Level II—retrospective study.
Advances in testing for human papillomavirus-mediated head and neck cancer
Authors: Mehanna Hisham , Alemany Laia , von Buchwald Christian 
Published: March 2024

Purpose of review
New evidence has recently emerged regarding the utility and benefits of dual p16INKa (p16) and Human papillomavirus (HPV) status testing when determining the diagnosis and prognosis of patients with oropharyngeal cancer.

Recent findings
HPV RNA polymerase chain reaction (PCR) is the most accurate diagnostic test. The other assays (HPV DNA PCR, HPV DNA/RNA in-situ hybridization (ISH) and p16) applied to formalin fixed tumour tissue have varying but high sensitivities and specificities. Dual p16 and HPV testing identifies discordant (p16+/HPV− or p16−/HPV+) results in 9.2% of cases, who have significantly poorer prognoses than p16+/HPV+, particularly in smokers. The proportion of discordant cases varies by region, and appears to be highest in regions with lowest attributable (p16+/HPV+) fractions. Dual testing improves prognostication for oropharyngeal cancer cases by identifying discordant cases and improving the prognostic power of the Tumour Node Metastasis (TNM) classification, especially in regions with high discordant rates.

Summary
Dual testing is essential when considering patients for clinical trials of treatment de-escalation, and may be important when counselling patients on prognosis, especially in regions with high discordant rates and in smokers.
Preschooler Screen Time During the Pandemic Is Prospectively Associated With Lower Achievement of Developmental Milestones
Authors: Binet Marie-Andrée , Couture Mélanie , R Chevrier Jonathan , S Pagani Linda , Garon-Carrier Gabrielle , Fitzpatrick Caroline 
Published: March 2024

Abstract:

Objective:
The aim of this study was to assess the developmental risks associated with total screen time, and specifically newer mobile devices, in the context of the pandemic.

Methods:
This study uses parent-reported data from a prospective cohort of Canadian preschool-age children. The exposure variable is child daily screen time measured at the age of 3.5 years categorized as light (<1 hr/d), moderate (1–4 hr/d), or intensive (>4 hr/d) use (N = 315). Time spent on mobile devices was considered separately as a continuous variable. Our outcome is child global development scores, which combine assessments of communication, cognitive, personal-social, and motor skills measured at the age of 4.5 years using the Ages and Stages Questionnaire (ASQ) (N = 249, 79% retained). ASQ scores were dichotomized to distinguish children at risk of developmental delays (below the 15th percentile) from those not at risk. We estimate associations between child screen time and later global development using multiple regressions adjusted for child sex and temperament, and parent education. We also examine whether associations are moderated by child and parent characteristics.

Results:
Logistic regressions revealed that intensive users were more at risk of global developmental delays compared with light users (OR = 4.29, p = 0.020). Mobile device use was also associated with lower global scores (β = −3.064; p = 0.028), but not with risk of delays. We found no evidence that associations were moderated by child sex and temperament, or parent education.

Conclusion:
The findings suggest that intensive screen time may be associated with delays in child global development. Early childhood professionals should encourage families with preschoolers to prioritize screen-free activities to promote optimal cognitive, language, social, and motor development.
New Concept for Articulated Alar Rim Graft Positioning
Authors: Lyrio Tiago , Maricevich Pablo , Andrade Alexei A. , De Bacco Felipe Webber , Tamanqueira Paula 
Published: March 2024

Summary:
The articulated alar rim graft (AARG) proposed by Davis is a simple and effective method for avoiding and correcting most alar rim deformities in rhinoplasty. In addition to its benefit for the nasal ala, the position suggested herein allows for a precise definition of the facet polygon and infratip lobule. A retrospective series of 317 patients surgically treated with the modified AARG positioning were evaluated. The height of the septal extension graft was always a few millimeters above the new dome, without demanding excessive lateral crural tensioning (LCT), and the AARG itself was fixed more on the facet polygon and infratip than in the standard procedure. The results were favorable after 1 year of follow-up. The proposed AARG modification yielded good nasal tip projection and definition without excess LCT, enhanced the facet polygon and supra-alar sulcus, and stretched the skin downward. Functional gain was reported by most patients. Few minor and common complications were reported. The use of this modified AARG position can avoid and correct most alar deformities, with the added benefit of providing better control over tip definition without the need for excessive LCT or overprojection of the nose.
Clinical and Laboratory Biomarkers as Predictors of Severity in Pediatric Inflammatory Multisystem Syndrome-temporally Associated With SARS-CoV-2: Data From a Prospective Nationwide Surveillance Study in Switzerland
Authors: Wurm Juliane , Uka Anita , Buettcher Michael , Kottanattu Lisa , Schöbi Nina , Trück Johannes , Villiger Reto , Ritz Nicole , Zimmermann Petra ,   on behalf of the Swiss Paediatric Surveillance Unit
Published: March 2024

Background:
PIMS-TS (pediatric inflammatory multisystem syndrome-temporally associated with SARS-CoV-2) is a rare but serious condition in children following SARS-CoV-2 infection, characterized by a range of clinical symptoms with varying severity. Understanding risk factors for severe PIMS-TS is crucial for appropriate and timely intervention.

Objective:
To identify factors associated with increased PIMS-TS severity in children.

Methods:
In this nationwide prospective observational study, epidemiological and clinical data was collected from children <18 years of age with suspected or confirmed PIMS-TS from all 29 pediatric hospitals in Switzerland. Children were categorized into 3 groups according to admission to intensive care unit (ICU): non-ICU, ICU-moderate and ICU-severe, defined as requirement of invasive ventilation and/or inotropic support.

Results:
A total of 204 children were included; 99 (49%) were categorized as non-ICU, 50 (25%) as ICU-moderate and 55 (27%) as ICU-severe. In ICU-severe cases, respiratory and neurological symptoms were more frequent compared with non-ICU cases: 72% versus 47%, P < 0.001 and 66% versus 41%, P = 0.001, respectively. Compared with the non-ICU group, children in the ICU-severe group had lower lymphocyte counts, higher neutrophil-lymphocyte ratios, lower platelet counts, as well as higher C-reactive protein, N-terminal pro-B-type natriuretic peptide, troponin T and creatinine levels at admission. Lymphopenia and elevated troponin T levels at admission were associated with an increased risk of being in the ICU-severe group.

Conclusion:
The severity of PIMS-TS may be predicted using clinical symptoms and laboratory biomarkers, which help clinicians in decision-making and management of patients.
Urban Rural Differences on Accessing Patient Centered Medical Home Among Children With Mental/Developmental Health Conditions/Disorders
Authors: Huang Li , Onge Jarron Saint , Lai Sue-Min 
Published: March 2024

ABSTRACT

Introduction:
To address healthcare spending growth and coordinated primary care, most states in the United States have adopted patient-centered medical homes (PCMHs). To evaluate urban rural difference on accessing PCMH among US children, particularly for children with developmental disabilities (DDs) and mental health disorders (MHDs).

Methods:
This cross-sectional study used the 2016–2018 National Survey for Children's Health (NSCH). Multivariable adjusted logistic regression analyses were used to assess the association between accessing PCMHs and rurality and mental/developmental conditions/disorders.

Results:
Children with both DDs and MHDs were statistically significantly higher in rural areas (10.9% rural vs. 8.3% urban, p ≤ .001). Children in rural areas reported higher odds of accessing PCMHs (14%) among all U.S. children, but no differences by subgroups for children with MHDs and/or DDs. Compared with children without DDs/MHDs, the reduction in access to PCMHs varies by children's health status (41% reduction for children both DDs and MHDs, 25% reduction for children with MHDs without DDs) effects. Children with MHDs/DDs were less likely to receive family-centered care, care coordination, and referrals.

Conclusions:
Quality improvements through PCMHs could focus on family-centered care, care coordination, and referrals. Patient-centered medical home performance measurement could be improved to better measure mental health integration and geographical differences.
Single-Leg Heel Raise Capacity is Lower, and Perceived Ankle Instability is Greater, in Dancers and Athletes With Posterior Ankle Impingement Syndrome
Authors: Baillie Peta , Cook Jill , Ferrar Katia , Mayes Susan 
Published: March 2024

Objective:
To compare clinical assessment findings between elite athletic populations with and without a clinical diagnosis of posterior ankle impingement syndrome (PAIS).

Design:
Cross-sectional case–control study.

Setting:
Elite ballet and sport.

Participants:
Ten male and female professional ballet dancers and athletes with a clinical diagnosis of PAIS and were matched for age, sex, and activity to 10 professional ballet dancers and athletes without PAIS.

Independent Variables:
Posterior ankle pain on body chart and a positive ankle plantarflexion pain provocation test.

Main Outcome Measures:
Single-leg heel raise (SLHR) endurance test, range of motion testing for weight-bearing ankle dorsiflexion, passive ankle plantarflexion, and first metatarsophalangeal joint dorsiflexion, and Beighton score for generalized joint hypermobility. Participants also completed the Cumberland Ankle Instability Tool (CAIT) questionnaire.

Results:
The group with PAIS achieved significantly fewer repetitions on SLHR capacity testing (P = 0.02) and were more symptomatic for perceived ankle instability according to CAIT scores (P = 0.004).

Conclusions:
Single-leg heel raise endurance capacity was lower, and perceived ankle instability was greater in participants with PAIS. The management of this presentation in elite dancers and athletes should include the assessment and management of functional deficits.
The Kaleidoscope of Midface Management in Apert Syndrome: A 23-Year Single-Institution Experience
Authors: Wu Meagan , Massenburg Benjamin B , Ng Jinggang J , Romeo Dominic J , Swanson Jordan W , Bartlett Scott P , Taylor Jesse A 
Published: March 2024

Background:
This study assesses operative trends over time and outcomes of five osteotomy techniques used to treat the Apert midface. Using clinical and photogrammetric data, we present our institution’s selection rationale for correcting specific dysmorphologies of the Apert midface based on the individual phenotype.

Methods:
We retrospectively reviewed patients with Apert syndrome who underwent midface distraction from 2000 to 2023. Patients were temporally divided by the year 2012 to assess differences in surgical approach. Postoperative facial dimension changes, surgical and perioperative characteristics, and complications data were compared across techniques.

Results:
Thirty-nine patients with Apert syndrome underwent 41 midface distraction procedures: 23 (56%) in the early cohort and 18 (44%) in the late cohort. The use of segmental osteotomies for frontofacial advancement increased from 0% before 2012 to 61% from 2012 onwards (p<0.001). Monobloc with bipartition was the only technique that decreased intercanthal distance (p=0.016), and Le Fort II with zygomatic repositioning achieved the greatest median change in bilateral canthal tilt of 8.7° (IQR 1.3°, 8.7°; p=0.068). Monobloc with Le Fort II achieved the greatest median change in facial convexity of -34.9° (IQR -43.3°, -29.2°; p=0.031). Severity of complications, stratified by Clavien-Dindo grade, was greater in transcranial than subcranial procedures but similar between segmental and non-segmental osteotomies (p=0.365).

Conclusions:
In studying the Apert midface and attempting to resolve its varying functional and aesthetic issues, we document an evolution towards multi-piece osteotomies over time. With an appreciation for differential midface hypoplasia, segmentation is associated with more effective normalization of the Apert face.
Pregnancy Termination Policy and Cleft Lip and Palate
Authors: Junn Alexandra , Spoer Daisy L. , Koh Min Jung , Berger Lauren E. , Zuckerman Hannah , Baker Stephen B. , DeLia Derek , Fan Kenneth L. 
Published: March 2024

Background:
Restrictive policies on termination of pregnancy (TOP) may lead to more infants with congenital abnormalities. This study aimed to assess the association between statewide enactment of TOP restriction and cleft lip and/or palate (CL/P) incidence, and to identify mediating demographic characteristics.

Methods:
The authors examined state-specific trends in CL/P incidence in infants before and after implementation of laws restricting TOP in Michigan compared with New York, where no such laws were passed. The percentage change of CL/P incidence per 1000 live births in postpolicy years (2012 to 2015) compared with prepolicy years (2005 to 2011) was compared, with adjustments for confounding factors in multivariate models.

Results:
The incidence of CL/P changed significantly in Michigan (19.1%) compared with New York (−7.31%). Adjusting for sex, race/ethnicity, median household income level, and expected payer, the adjusted percentage difference between Michigan and New York was 53.3% (P < 0.001). Stratification by race/ethnicity and median household income demonstrated that changes were only significant among Black (139%; P < 0.001) and Hispanic (125%; P = 0.045) patients and among those from the lowest (50.3%; P < 0.001) and second lowest (40.1%; P = 0.01) income quartiles.

Conclusion:
The authors’ research, combined with the recent Supreme Court decision in Dobbs v Jackson Women’s Health Organization allowing states to place further restrictions on TOP, suggests that more infants in the future will be born in need of treatment for CL/P.
Regional variation in weight change after the transition to dolutegravir in Uganda and South Africa
Authors: Migisha Richard , Chen Geoffrey , Muyindike Winnie R. , Aung Taing Nandi , Nanfuka Victoria , Komukama Nimusiima , Chandiwana Nomathemba , Shazi Gugulethu , Tien Dessie , Moosa Mahomed-Yunus S. , Gupta Ravindra K. , Pillay Deenan , Marconi Vincent C. , Hedt-Gauthier Bethany , Venter Willem D.F. , Siedner Mark J. , McCluskey Suzanne M. , Manne-Goehler Jennifer 
Published: March 2024

Background:
People with HIV (PWH) on integrase inhibitor-based regimens may be at risk of excess weight gain, but it is unclear if this risk is consistent across settings. We assessed weight change over 48 weeks among PWH who were transitioned to tenofovir disoproxil fumarate/lamivudine/dolutegravir (TLD).

Design:
We conducted a prospective cohort study at public-sector HIV clinics in Uganda and South Africa.

Methods:
Eligible participants were adults who were transitioned to TLD. Weight was measured at enrollment, 24-, and 48-weeks post TLD transition. Our outcomes were weight change, change in waist circumference, and clinically significant weight gain, defined as ≥10% increase in weight from baseline, over 48 weeks. We used linear mixed-effects regression models, adjusted for demographic factors, to estimate weight gain and identify risk factors.

Results:
Weight data were available for 428 participants in Uganda and 367 in South Africa. The mean weight change was 0.6 kg [95% CI: 0.1–1.0] in Uganda and 2.9 kg [2.3–3.4] in South Africa (P < 0.001). The mean change in waist circumference was 0.8 cm [95% CI: 0.0–1.5]) in Uganda and 2.3 cm [95% CI: 1.4–3.2] in South Africa (P = 0.012). Clinically significant weight gain occurred in 9.8% [7.0–12.6] of participants in Uganda and 18.0% [14.1–21.9] in South Africa (P < 0.001). After adjustment, PWH gained significantly less weight in Uganda than in South Africa.

Conclusions:
PWH in South Africa experienced significantly greater weight gain and increases in waist circumference compared to Uganda. Strategies to address weight gain in PWH should be carefully considered and may vary by region.
Oral hygiene in critically ill patients at a tertiary hospital in São Paulo, Brazil: a best practice implementation project
Authors: Ribeiro Bersaneti Mariana Davies , Lobo Renata Desordi , Brandão Thais Bianca , Silva Souza Regina Claudia , Poveda Vanessa de Brito 
Published: March 2024

ABSTRACT

Objectives:
This project aimed to promote evidence-based practices relat. ed to the oral health of critically ill patients in an intensive care unit in Brazil.

Introduction:
The oral hygiene of patients on mechanical ventilation is an essential component of nursing care quality, and well-defined guidelines ensure appropriate care. Mechanical ventilation is associated with the risk of ventilator-associated pneumonia, which can increase mortality, length of stay, time on mechanical ventilation, and hospital costs.

Methods:
This project was guided by the JBI Evidence Implementation Framework, which consists of seven stages: (1) identification of the area of practice to be changed, (2) involvement of change agents, (3) context assessment and readiness for change, (4) review of practices against evidence-based audit criteria, (5) implementation of practice changes, (6) reassessment of practices using a follow-up audit, and (7) consideration of the sustainability of changes in practice.

Results:
Four audit criteria were developed to evaluate compliance with best practices. In the follow-up audit, Criteria 1, 2, and 3 obtained compliance of ≥ 80%. Thus, for Criterion 1, all the patients on mechanical ventilation for more than 24 hours were evaluated by the oral medicine team, resulting in 100% compliance. For Criterion 2 on appropriate oral hygiene measures, a compliance rate of 80% was achieved. For Criterion 3, 39 professionals (90.7%) participated in educational activities related to the oral health protocol for critically ill patients, obtaining 90.7% compliance. For Criterion 4 regarding patients being evaluated before receiving any oral health care, improvement was low (only 50%), revealing the need for further improvement.

Conclusion:
This best practice project improved the professional practice of nursing staff and increased compliance with best practices for the oral health of critically ill patients.

Spanish abstract:

http://links.lww.com/IJEBH/A175
Subclinical variations on ECG and their associations with structural brain aging networks
Authors: Haddad Elizabeth , Matloff William , Park Gilsoon , Liu Mengting , Jahanshad Neda , Kim Ho Sung 
Published: March 2024

AbstractImpaired cardiac function is associated with cognitive impairment and brain imaging features of aging. Cardiac arrhythmias, including atrial fibrillation, are implicated in clinical and subclinical brain injuries. Even in the absence of a clinical diagnosis, subclinical or prodromal substrates of arrhythmias, including an abnormally long or short P-wave duration (PWD), a measure associated with atrial abnormalities, have been associated with stroke and cognitive decline. However, the extent to which PWD has subclinical influences on overall aging patterns of the brain is not clearly understood. Here, using neuroimaging and ECG data from the UK Biobank, we use a novel regional “brain age” method to identify the brain aging networks associated with abnormal PWD. We find that PWD is inversely associated with accelerated brain aging in the sensorimotor, frontoparietal, ventral attention, and dorsal attention networks, even in the absence of overt cardiac diseases. These findings suggest that detrimental aging outcomes may result from subclinically abnormal PWD.