bluuebunny/crossref_metadata_2025_split huggingface dataset:
Gamified mobile learning: An escape room chatbot to enhance medical terminology acquisition
Authors: Wang Yi-Fan , Hsu Mei-Hua , Yue-Feng Wang Max 
Published: February 2025

Objective: The medical terminology escape room game (MTEG) is a chatbot designed for gamified education that aims to transform memorizing complex medical terminology into an enjoyable experience for medical students. By combining elements of ARCS (Attention, Relevance, Confidence and Satisfaction) theory with escape room adventures, the MTEG aims to enhance medical students’ learning outcomes by making the vocabulary memorization process more immersive. Method: This study involved 48 first-year nursing students, divided into an experimental group ( n = 24) and a control group ( n = 24). The experimental group utilized the MTEG for self-study, while the control group relied on traditional learning methods. The study assessed learning outcomes through pre-tests and post-tests and used the ARCS Learning Motivation Questionnaire to assess learning motivation. Results: Results showed that the experimental group significantly improved learning motivation, with an average ARCS score increased from 3.82 to 4.33 on a 5-point scale. A medical terminology test result also revealed that the experimental group (mean score: 95.83, SD = 5.22) performed better than the control group (mean score: 91.22, SD = 6.21), with a larger effect size (Cohen’s d = 1.52). Conclusion: These findings highlight the potential of gamification techniques to enhance medical terminology acquisition and language learning experience. By incorporating gamification elements, MTEG greatly increased the enjoyment of the learning process, encouraged active participation and significantly improved motivation and performance.
Effect of solution-blown polyamide-6 nanofiber interlayer on drilling performance of carbon fiber reinforced composites
Authors: Ayten Ali İmran , Şahbaz Mehmet , Morkavuk Sezer , Polat Yusuf , Seyhan Aybeniz 
Published: February 2025

This study examines the effect of solution-blown polyamide-6 (PA6) nanofiber interlayers on the drilling performance of carbon fiber reinforced polymer (CFRP) composites. Results demonstrate that PA6 nanofiber interlayers significantly reduce drilling thrust force and improve surface quality. Specifically, at a spindle speed of 1000 r/min and a feed rate of 1500 mm/min, the maximum thrust force was reduced by 17%, from 683.33 N in neat composites to 583.13 N in nanofiber-reinforced composites. At a higher spindle speed of 8000 r/min and a feed rate of 500 mm/min, thrust force decreased by 18%, from 80.22 N to 65.46 N. Surface roughness analysis revealed that nanofiber interlayers reduced Ra values by up to 44%, with a minimum roughness of 0.529 µm compared to 1.196 µm in neat composites. Optical and SEM analyses confirmed fewer plucking zones, reduced fiber pull-out, and improved fiber-matrix bonding in nanofiber-reinforced samples, particularly at higher spindle speeds. These findings indicate that PA6 nanofiber interlayers enhance drilling performance, offering reduced machining forces and superior hole quality for precision applications in the aerospace and automotive industries.
Venous sinus stenting for management of spontaneous skull-base CSF leaks: A systematic review and meta-analysis
Authors: Rasmussen Jordan M. , Patel Kautilya R. , Surdell Daniel L. , Thorell William E. , Borg Nicholas , Opperman Patrick J. , Casazza Geoffrey , Maxwell Anne K. , Barnes Christie , Pate Samuel , Schmidt Cindy M. , Sattur Mithun G. 
Published: February 2025

Background Idiopathic intracranial hypertension (IIH) is strongly associated with spontaneous skull-base cerebrospinal fluid (CSF) leaks. Venous sinus stenting (VSS) has proven effective for the treatment of IIH. Hence, its role in spontaneous skull-base CSF leaks is being explored actively. Methods We performed a systematic literature search across EMBASE, MEDLINE, Scopus, The Cochrane Library, and Google Scholar to identify studies reporting the use of VSS for spontaneous skull-base CSF leaks. Studies with pediatric patients, non-English articles, and nonspontaneous leaks were excluded. Failure of treatment (persistence / recurrence of CSF leak) was regarded as the primary outcome. Results Eight studies with 62 patients undergoing VSS for spontaneous skull-base CSF leaks were included. Mean age of the patients was 51.9 years; 87.5% were females. Obesity was highly prevalent, with a mean body mass index of 33.9 kg/m2 (4 studies). IIH was noted in 74.6% patients (7 studies). Twenty-six patients (41.9%) underwent VSS alone whereas 36 patients (58.1%) underwent surgical repair + VSS. Seven patients (11.3%) had a failure of treatment. Three failures from one study could not be definitively ascribed to either of the groups. Hence, the estimated failure rate for VSS alone ranged from 18.6% (95% CI [0.02 – 0.46]) to 26.4% (95% CI [0.11 – 0.46]), whereas that for surgical repair + VSS ranged from 5.5% (95% CI [0.00 – 0.16]) to 12.2% (95% CI [0.01 – 0.32]). Furthermore, the estimated rate for resolution of concomitant IIH-related symptoms was 88.7% (95% CI [0.75 – 0.98%]). Majority of the studies did not report any serious complications or mortality related to VSS. Conclusion VSS has a potential role in the management of spontaneous skull-base CSF leaks. Its exact indications as a standalone treatment versus as an adjuvant to surgical repair, and the predictors for successful treatment remain to be defined.
Comparison of Clinical, Radiologic, and Arthroscopic Outcomes Between the Microfracture and Microdrilling Techniques for Articular Cartilage Defects in Medial Opening-Wedge High Tibial Osteotomy
Authors: Park Ji-Soo , Jung Se-Han , Jung Min , Chung Kwangho , Kim Jae Hong , Choi Chong Hyuk , Kim Sung-Hwan 
Published: February 2025

Background: Microfracture is the most common procedure for cartilage lesions during medial opening-wedge high tibial osteotomy (MOWHTO), but microdrilling has recently been introduced as an alternative technique. Purpose: To compare the clinical, radiologic, and arthroscopic outcomes of microfracture and microdrilling during MOWHTO. Study Design: Cohort study; Level of evidence, 3. Methods: Included were 92 patients who underwent MOWHTO with either microfracture (n = 46) or microdrilling (n = 46), with a minimum follow-up of 24 months. Clinical outcomes included visual analog scale (VAS) for pain, Lysholm score, International Knee Document Committee (IKDC) subjective score, Western Ontario and McMaster Universities index (WOMAC), and objective IKDC grade. Medial femoral condyle (MFC) cartilage repair status was evaluated at 12 months postoperatively using the MOCART (magnetic resonance observation of cartilage repair tissue) 2.0 and the International Cartilage Regeneration & Joint Preservation Society (ICRS) Cartilage Repair Assessment (CRA) grade. Results: At 6 months postoperatively, the microdrilling group exhibited higher minimal clinically important difference achievement rates than the microfracture group for VAS pain (63.1% vs 41.3%; P = .04), Lysholm (61.2% vs 41.3%; P = .02), and IKDC subjective score (78.3% vs 45.7%; P = .001). At 12 months postoperatively, the microdrilling group exhibited significantly better VAS pain (33.7 ± 17.6 vs 25.7 ± 18.1; P = .03), Lysholm (57.8 ± 12.2 vs 67.9 ± 21.4; P = .007), and IKDC subjective score (52.9 ± 13.5 vs 61.9 ± 10.4; P = .001) compared with the microfracture group, but this difference was not observed at 24 months. WOMAC scores were superior in the microdrilling group at 6 months (32.1 ± 16.7 vs 48.4 ± 16.2; P = .004), 12 months (25.4 ± 15.4 vs 38.1 ± 17.0; P = .03), and 24 months (21.4 ± 13.9 vs 37.3 ± 14.6; P = .02). MFC cartilage repair status was superior in the microdrilling versus microfracture group (ICRS CRA grade, 8.2 ± 2.2 vs 6.7 ± 2.1 [ P = .005]; MOCART 2.0 score, 56.3 ± 12.8 vs 49.7 ± 8.9 [ P = .02]). At 24 months postoperatively, the microdrilling group had a higher proportion of IKDC A or B grades (84.8% vs 50.0%; P = .001). Conclusion: Combining MOWHTO with microdrilling for MFC defects resulted in earlier clinical recovery and superior functional outcomes over 24 months postoperatively compared with microfracture and demonstrated excellent cartilage repair on postoperative evaluation.
Racial Concordance Between NBA and MLB Players and Their Team Physicians
Authors: Gaetano Andrew , Shivdasani Krishin , Chen Andrew , Garbis Nickolas , Salazar Dane 
Published: February 2025

Background: Recent efforts aim to determine whether patient-provider race concordance improves health outcomes for minority patient populations. Patient-physician race discordance is uniquely elevated in professional athletics. Purpose: To evaluate racial concordance between rostered players and their respective team physicians in 2 major professional sports leagues in the United States—the National Basketball Association (NBA) and Major League Baseball (MLB). Study Design: Cross-sectional study. Methods: Publicly available data were collected in June of 2023 to identify NBA and MLB players and team physicians. The sex and reported or perceived race of the players and team physicians were determined by 2 independent observers who analyzed reported demographic data, photographs, and names of these individuals, with disagreements resolved by a third independent observer. Team physicians’ medical training, medical specialty, languages spoken, and years in practice were obtained using publicly available internet-based sources or by contacting the clinical staff directly. Results: In both the NBA and the MLB, there was a statistically significant difference in racial composition between players and team physicians ( P < .0001 for both). In addition, despite a high percentage (30.7%) of Hispanic/Latino players in the MLB, just 11.6% of MLB team physicians spoke Spanish, and >50% (18/30) of MLB organizations lacked a team physician who spoke Spanish. Conclusion: Substantial race discordance was found between professional athletes and head team physicians. Physicians more closely mirroring the patient populations that we treat—including professional athletes—may positively affect health care relationships and improve patient/provider barriers.
Effects of Integrating Lower-Leg Exercises Into a Multimodal Therapeutic Approach on Medial Tibial Stress Syndrome Management Among Recreational Runners: A Randomized Controlled Study
Authors: Naderi Aynollah , Fallah Mohammadi Mohammad , Heidaralizadeh Aida , Moen Maarten H. 
Published: February 2025

Background: Medial tibial stress syndrome (MTSS) can impair training and daily activities, underscoring the need for effective treatment. However, there’s limited evidence on using lower-leg exercises for MTSS in recreational runners. Purpose/Hypothesis: The purpose of the present study was to determine whether adding lower-leg exercises to a multimodal therapeutic intervention improves the recovery from MTSS in recreational runners. It was hypothesized that adding lower-leg exercises to a multimodal therapeutic intervention would enhance its effect on foot posture and make MTSS recovery more effective than multimodal therapeutic interventions alone. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: A total of 40 recreational runners diagnosed with MTSS using history and physical examination (40% women; mean ± SD age, 23.9 ± 3.9 years) were then randomly divided into intervention (n = 20) and control (n = 20) groups. Both groups underwent a multimodal therapeutic intervention involving ice massage, foot orthoses, and extracorporeal shockwave therapy. The intervention group additionally received a tailored lower-leg exercise protocol involving stretching, strengthening, sensorimotor exercises, and foam roller myofascial release. Pain intensity, MTSS severity, perceived treatment effect, quality of life (QoL), and static and dynamic foot posture were assessed at baseline, 6-week, and 12-week follow-up evaluations. Results: A mixed model analysis of variance found no significant differences in pain intensity ( P = .17) or MTSS severity ( P = .30) between the intervention group and the control group. However, there were significant improvements in QoL ( P = .003), static foot posture index (FPI) ( P = .02), and dynamic arch index (DAI) ( P < .001), for the intervention group. After 6 and 12 weeks, the intervention group displayed lower DAI scores than controls ( P = .04 and P = .02, respectively). By week 12, the intervention group exhibited significantly higher QoL scores ( P = .02) and lower FPI scores ( P = .04) compared with controls. Conclusion: The study demonstrated that lower-leg exercises within a multimodal treatment positively affected foot posture and QoL, although they did not significantly alleviate pain or affect MTSS severity in recreational runners. Therefore, health care providers are encouraged to integrate these exercises into rehabilitation programs to improve foot posture and QoL for individuals with MTSS. However, future research should focus on larger sample sizes, objective measures, resting control groups, and longer follow-up periods to enhance the understanding of the effects of lower-leg exercises on MTSS management. Registration: IRCT 20170114031942N5 (Iranian Registry of Clinical Trials).
Investigating the Ligament Involvement in High-Energy and Polytraumatic Multiligament Knee Injuries Compared With Low-Energy or Isolated Injuries
Authors: Hunter Collin D.R. , Featherall Joseph , McNamara Natalya , Greis Patrick E. , Maak Travis G. , Aoki Stephen K. , Klasan Antonio , Ernat Justin J. 
Published: February 2025

Background: Multiligament knee injuries (MLKIs) due to high-energy (HE) or polytraumatic (PT) mechanisms result in worse patient outcomes after surgery versus low-energy (LE) or nonpolytraumatic (NPT) mechanisms. There remains a paucity of research in the literature investigating MLKIs resulting from these mechanisms of injury. Purpose: To characterize differences in ligamentous injury/surgery patterns between different mechanism groups: HE versus LE and PT versus NPT. Study Design: Cross-sectional study; Level of evidence, 3. Methods: This is a retrospective chart review of consecutive surgical MLKIs from a single institution. Demographics, clinical/radiographic findings, and intraoperative variables were obtained. HE versus LE mechanisms were stratified. Patients with inadequate data were excluded. PT versus NPT classifications were based on presence of concurrent nonknee injuries. Subgroup comparisons were made based on body mass index, age, sex, number/type of ligaments injured, and surgeries performed. Results: From a total of 226, 176 (78%) patients were included (41 PT [23%] and 135 NPT [77%]; 62 HE [35%] and 114 LE [65%]). PT mean age was 30.7 ± 13.7 years (male, 32 [78%)], while NPT mean age was 27.1 ± 12.3 years [male, 91/135 [67%]). HE mean age was 31.4 ± 13.1 years (male, 49/62 [79%]), and LE mean age was 25.6 ± 11.8 years (male, 73/114 [64%]). Posterior cruciate ligament (PCL) injuries were higher in PT (27/41 [66%]) and HE (42/62 [68%]) versus NPT (58/135 [43%]) and LE (44/114 [39%]), respectively. Lateral collateral ligament (LCL) injuries were higher in PT (29/41 [71%]) and HE (41/62 [66%]) versus NPT (66/135 [49%]) and LE (55/114 [48%]), respectively. The mean number of ligaments injured was higher in PT versus NPT (2.9 vs 2.4) and in HE versus LE (2.8 vs 2.4). LCL surgical interventions were more common in PT (23/41 [55%]) versus NPT (49/135 [36%]) and in HE (33/62 [53%]) versus LE (39/114 [34%]). No other differences in injuries/surgeries existed between PT and NPT or HE and LE, in anterior cruciate, medial collateral, or medial patellofemoral ligaments. Conclusion: PT and HE MLKIs are characterized by increased rates of PCL and LCL injuries compared with LE and NPT. HE and PT patients experience more injured ligaments than LE and NPT and are more likely to require reconstruction/repair of the LCL. These findings suggest injury severity and mechanism may facilitate clinical decision making in MLKIs.
Evaluating the Statistical Fragility of Comparative Studies on Autografts for Pediatric ACL Reconstruction
Authors: Singh Gurbinder , Alexeev Sergei O. , Haugh Patrick , Halvorson Ryan T. , Wang Dean , Pandya Nirav K. , Feeley Brian T. 
Published: February 2025

Background: The literature presents conflicting findings regarding outcomes after pediatric anterior cruciate ligament reconstruction (ACLR) with various autograft options, reflecting a lack of consensus on the standard of practice. Fragility analyses may assist in evaluating the statistical robustness of these studies. Purpose: To evaluate the statistical fragility of comparative studies in pediatric ACLR through the fragility index (FI) and fragility quotient (FQ), as well as qualitative factors such as outcome type, outcome significance, and patients lost to follow-up. Study Design: Systematic review; Level of evidence, 4. Methods: A systematic review conducted in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines identified 1139 studies in the PubMed and Embase databases that met the search criteria; ultimately, 6 studies were selected for inclusion. A total of 32 comparative outcomes were assessed for fragility across the 6 studies. Descriptive statistics were employed to summarize the fragility data and generate subgroup comparisons. Results: The mean FI was 1.5, and the mean reverse FI was 3.19 ( P < .01); the mean FQ was 0.0064, and the mean reverse FQ was 0.028 ( P≤ .0001). No significant difference was found in the FIs between objective outcomes and patient-reported outcomes ( P = .418). These findings suggested that a comparable number of patients would need to transition from a nonevent to an event to alter a statistically significant result to a nonsignificant one. The FI was lower than the estimated number of patients lost to follow-up for 30 of the 32 outcomes (93.7%). Conclusion: Comparative studies on pediatric ACLR autograft outcomes displayed vulnerability when assessed using fragility metrics, indicating a lack of statistically robust data. The findings revealed that many reported outcomes are fragile and may require further investigation. Future research should incorporate fragility analyses—especially in studies with long-term follow-ups—to enhance the reliability of conclusions regarding optimal graft selection in pediatric ACLR.
Incidence and Risk Factors for Posttraumatic Osteoarthritis After Primary ACL Reconstruction in Pediatric Patients: A National Database Study
Authors: Moran Jay , Gouzoulis Michael J. , Kunze Kyle N. , LaPrade Christopher M. , Grauer Jonathan N. , Hewett Timothy E. , Chahla Jorge , Jimenez Andrew E. , McKay Scott D. , Fabricant Peter D. , LaPrade Robert F. , Franklin Corinna C. 
Published: February 2025

Background: The development of posttraumatic osteoarthritis (PTOA) of the knee after anterior cruciate ligament (ACL) reconstruction (ACLR) leads to additional morbidity in adults. Purpose: To determine the 5-year incidence of and risk factors for PTOA diagnoses after primary ACLR in pediatric patients. Study Design: Case control study, Level of evidence, 3. Methods: A United States-based insurance database was used to identify patients aged ≤16 years who underwent primary ACLR from 2010 to 2019 and had at least 5 years of follow-up data. Patients with multiligament knee injuries, tibial eminence avulsion fractures, congenital/syndromic ACL absence syndrome, juvenile idiopathic arthritis, previous knee osteoarthritis or PTOA diagnoses, or previous knee injuries/surgeries were excluded. Demographic factors and concomitant meniscal and cartilage procedures at the time of primary ACLR were recorded. Delayed ACLR was defined as ≥3 months between initial ACL injury diagnosis and ACLR. We also recorded the presence of subsequent motion restoration reoperations, including lysis of adhesions and/or manipulation under anesthesia, after primary ACLR but before PTOA diagnosis. Risk factors for PTOA were evaluated using multivariable logistic regression. Results: Included were 16,935 patients (mean age at surgery, 15.1 ± 1.2 years; 62% women). PTOA was diagnosed in 267 patients (1.6%) within 5 years after ACLR; 148 of these patients (55.4%) were diagnosed within 2 years after ACLR. Independent risk factors associated with PTOA diagnosis included subsequent motion restoration procedures (odds ratio [OR], 5.03 [95% CI, 3.31-8.25]; P < .001), age ≥12 years at the time of ACLR (OR, 4.82 [95% CI, 1.54-29.20]; P = .027), delayed ACLR (OR, 1.87 [95% CI, 1.43-2.43]; P < .001), obesity (OR, 1.40 [95% CI, 1.01-1.94]; P = .046), and male sex (OR, 1.36 [95% CI, 1.06-1.74]; P = .015). Performing concomitant partial meniscectomy, meniscus repair, and cartilage restoration at the time of ACLR was not significantly associated with PTOA. Conclusion: The incidence of PTOA diagnoses was low within 5 years after primary ACLR in patients ≤16 years old with no subsequent cartilage, meniscus, and/or revision ligament procedures. The need for subsequent motion restoration procedures, age ≥12 years at the time of ACLR, delayed ACLR, obesity, and male sex were significant risk factors associated with a PTOA diagnosis.
Lactoferrin alleviates the adverse effects of early-life inflammation on depression in adults by regulating the activation of microglia
Authors: Wang Wenli , An Qin , Zou Yunxia , Dai Yunping , Meng Qingyong , Zhang Yali 
Published: February 2025

Abstract
Lactation is a crucial phase of brain development, and the events and nutrients during this period have long-term consequences for the occurrence of depression. This study investigated the effect and mechanism of lactoferrin (LF) deficiency during lactation on depression in adulthood. Lactation LF-deficient mice were established by nursing wild-type mice using LF systemic knockout mother mice. Additionally, 14-day-old mice were injected with lipopolysaccharide (LPS) and subjected to chronic unpredictable mild stress when they reached 6 weeks of age. The results show that lactation lactoferrin deficiency increases depression-like behavior in adult mice, and the mechanism is associated with heightened neuronal damage, abnormal microglial activation, and decreased BDNF in the hippocampus. In contrast, recombinant human lactoferrin promotes neuronal proliferation by upregulating ERK 1 and 2 phosphorylation and attenuates LPS-induced neuronal injury and microglial activation by inhibiting the activation of Toll-like receptor 4—nuclear factor-kappa B pathway in vitro. Our findings suggest that lactoferrin intake during lactation protects neurons by regulating microglial activation, thereby effectively reducing depressive symptoms in adults.