bluuebunny/crossref_metadata_2025_split huggingface dataset:
Temporary Cast Application in Dislocated Ankle Fractures Leads to High Rates of Secondary Loss of Reduction: Does the Lauge-Hansen Injury Type Matter?
Authors: Mandelka Eric , Wikanardi Bernhard Arya , Beisemann Nils , Gruetzner Paul Alfred , Franke Jochen , Vetter Sven Yves 
Published: March 2024

Background: For the temporary treatment of ankle fracture dislocations (AFDs), previous studies indicate higher rates of secondary loss of reduction (LOR) with splint immobilization, prompting consideration for expanding indications for external fixation (ExFix). However, these studies did not investigate the influence of fracture morphology to further improve patient selection. The aim of this study was to investigate the influence of Lauge-Hansen injury type on the LOR rate in bimalleolar or trimalleolar AFDs for temporary cast vs ExFix immobilization. Methods: In this retrospective cohort study, patients with isolated AFD cases treated at our institution from 2011 to 2020 were reviewed. Inclusion criteria required radiographs depicting initial dislocation and appropriate reduction after Cast or ExFix immobilization. Exclusion criteria encompassed concomitant injuries, open fractures, conservative management as well as surgery performed within 48 hours or at a different facility. Patients were grouped by temporary treatment (Cast or ExFix). The primary endpoint was LOR prior to definitive surgery across various Lauge-Hansen types. Results: The LOR rate was significantly higher in the cast group (40/152, 26.3%) compared to the ExFix group (5/191, 2.6%; P < .0001). In the cast group, LOR was associated with an increase in time to definitive surgery by a mean of 3 days ( P < .002). During cast treatment, LOR was significantly more likely for pronation abduction ( P = .001) and supination external rotation injuries ( P < .0001), whereas no significant differences were observed for pronation external rotation ( P = .006), supination adduction ( P > .99), and fractures not classifiable ( P > .99). Conclusion: In cases of AFDs resulting from supination external rotation or pronation abduction trauma according to the Lauge-Hansen classification, especially in the setting of an additional posterior malleolar fracture, primary application of external fixation should be considered to reduce the risk for secondary loss of reduction. Level of Evidence: Level III, retrospective cohort study.
The Impact of Sex on Cognitive Control in ADHD: Girls Slow to Inhibit, Boys Inhibit Less, and Both Show Higher Response Variability
Authors: Ojuri Beatrice , DeRonda Alyssa , Plotkin Micah , Mostofsky Stewart H. , Rosch Keri S. 
Published: March 2024

Objective: To determine whether girls and boys with ADHD show distinct impairments in components of cognitive control across multiple tasks (go/no-go, stop signal, and flanker) and performance metrics (response speed, variability, and errors). Method: A total of 300 children, ages 8 to 12 years with ADHD ( n = 210, 58 girls) or typically developing (TD; n = 99, 37 girls), completed all tasks. Traditional response measures (e.g., mean and standard deviation of reaction time, inhibition errors, and stop signal reaction time) and ex-Gaussian modeling of reaction times (mu, sigma, and tau) were analyzed. Results: Girls showed intact response inhibition in the context of slower response speed, while boys made more inhibition errors and did not slow their response speed. Both girls and boys with ADHD showed higher response variability and poorer interference control than TD children. Conclusion: Girls and boys with ADHD show distinct impairments in cognitive control that may be important for understanding the pathophysiology of ADHD.
Who Provides Outpatient Clinical Care for Adults With ADHD? Analysis of Healthcare Claims by Types of Providers Among Private Insurance and Medicaid Enrollees, 2021
Authors: Danielson Melissa L. , Claussen Angelika H. , Arifkhanova Aziza , Gonzalez Maria G. , Surman Craig 
Published: March 2024

Objective: To characterize provider types delivering outpatient care overall and through telehealth to U.S. adults with ADHD. Method: Using employer-sponsored insurance (ESI) and Medicaid claims, we identified enrollees aged 18 to 64 years who received outpatient care for ADHD in 2021. Billing provider codes were used to tabulate the percentage of enrollees receiving ADHD care from 10 provider types overall and through telehealth. Results: Family practice physicians, psychiatrists, and nurse practitioners/psychiatric nurses were the most common providers for adults with ESI, although the distribution of provider types varied across states. Lower percentages of adults with Medicaid received ADHD care from physicians. Approximately half of adults receiving outpatient ADHD care received ADHD care by telehealth. Conclusion: Results may inform the development of clinical guidelines for adult ADHD and identify audiences for guideline dissemination and education planning.
Teachers’ beliefs and reproduction of language ideologies in English-medium instruction programs in Nepal
Authors: Sah Pramod K. 
Published: March 2024

Aims: This study explored the language ideologies that guide teachers’ language beliefs and practices in English-medium instruction (EMI) classrooms. It also sought to uncover the ways teachers’ beliefs and practices reproduce language ideologies and, thereby, social hierarchies within educational contexts. Design: Drawing on a narrative research design, the study utilized semi-structured interviews and focus groups to examine the language beliefs of content subject teachers from EMI higher education programs in Nepal. The data were analyzed through a thematic approach. Findings: The study’s results shed light on the prevailing language ideologies in EMI classrooms, where English holds a dominant position, followed by Nepali and other local/Indigenous languages. This linguistic hierarchy reflects deeply ingrained nationalist and neoliberal beliefs inherent in Nepal’s educational landscape. Moreover, the research underscores how these ideologies perpetuate societal hierarchies as educators emphasize the pivotal role of English proficiency for students’ upward socioeconomic mobility and access to global opportunities, while concurrently endorsing a deficient perspective on local/Indigenous languages. Consequently, this linguistic hierarchy perpetuates disparities in language treatment, thereby prompting concerns regarding equity and inclusivity in EMI programs. Originality: It sheds light on teachers’ complex beliefs and practices regarding the use of different languages in EMI settings. The study also highlights the language hierarchy that emerges within these classrooms, emphasizing the original contribution to understanding the complexities and implications of language ideologies within EMI programs. Significance: The study’s findings serve as a valuable resource for fostering meaningful discussions and facilitating evidence-based practices in the field of EMI, ultimately contributing to the improvement of multilingual higher education settings worldwide.
Sweden’s excess mortality in 2020–2022 and reporting in the media
Authors: Lindström Martin 
Published: March 2024

Aim: The aim was to scrutinize the report in March 2023 that Sweden’s excess mortality was lowest in 2020–2022 compared with other European Union and Nordic countries, a report that received great national and international attention. Study design: Comparison of excess mortality in Sweden and Norway. Methods: Excess mortality for 2020–2022 was calculated for Sweden and Norway, the country with per-capita excess mortality closest to Sweden’s, compared with the average mortality for 2017–2019 in the respective country, following the definitions by Statistics Sweden reported in a daily newspaper. Results: Excess mortality is a measure with low misclassification compared with other pandemic outcome measures. Following the definitions, total excess mortality for the years 2020–2022 was 11,897 individuals in Sweden and 6089 in Norway. However, the distributions of excess mortality across the 3 years strongly differed. In Sweden, 60% of excess mortality was observed in 2020, 8% in 2021 and 32% in 2022. In sharp contrast, 0% of excess mortality was observed in Norway in 2020, 20% in 2021 and 80% in 2022. If the relative distribution of excess mortality in Sweden had been the same as in Norway in 2020–2022, approximately 7000 individuals who died in 2020 would instead have died as excess mortality in 2022, saving approximately 14,000 person-years in Sweden. Conclusions: The report disregards residual confounding due to the broad definition of the period 2020–2022. Mass media should avoid one-sided reporting.
Efficacy and Safety of Covered Stents Versus Bare-Metal Stents for Aortoiliac Occlusive Disease: A Systematic Review and Meta-Analysis
Authors: Hu Chenming , Chen Lang , Wu Min , Ye Qianling , Zou Jun , Zhao Bin , Li Xiang , Wu Huaping 
Published: March 2024

Purpose: This study aimed to assess the efficacy and safety outcome of covered stents (CSs), as compared with bare-metal stents (BMSs), for the treatment of patients with aortoiliac occlusive disease (AIOD). Materials and methods: A systematic literature search was conducted in PubMed, Embase, and Cochrane Library up to August 2023 to identify all studies comparing efficacy and safety outcomes of CSs versus BMSs for treating AIOD. Our outcome was primary patency, secondary patency, technical success, ankle-brachial index (ABI) variation, target lesion revascularization (TLR), limb salvage, complications, and long-term survival. Dichotomous outcomes were pooled as relative risks (RR) or hazard ratio with the 95% confidence interval (CI). Continuous outcomes were pooled as weighted mean differences and 95% CI. Model selection was based on the heterogeneity of the included studies. Results: There were 10 studies (2 randomized controlled trials, 8 retrospective cohort studies), comprising 1676 sample size. Compared with BMSs, CSs use was associated with better primary patency of patients with a Trans-Atlantic Inter-Society Consensus II (TASC) D lesion (RR, 1.15, 95% CI, 1.04 to 1.27, p=0.007), TLR (RR, 0.39, 95% CI, 0.27 to 0.56, p<0.001), technical success (RR, 1.01, 95% CI, 1.00 to 1.02, p=0.010), and long-term survival (RR, 1.06, 95% CI, 1.01 to 1.11, p=0.020). There is no difference between CSs and BMSs regarding primary patency of all patients, secondary patency, variation in ABI, limb salvage, and complications. Conclusions: Compared with BMSs, CSs used in AIOD was associated with more favorable primary patency in patients with TASC D lesions, TLR, technical success rates, and patient long-term survival. These results provide evidence of the advantages of using CSs for AIOD treatment. Future studies focusing on long-term variations in ABI, primary patency of different degrees of calcification, vascular segments, and TASC classification are warranted. Clinical Impact Although several studies evaluated the clinical efficacy of CS in the context of AIOD treatment, the significance and consistency of these findings were not determined to date. We found that CS was used in AIOD associated with better technical success rate, long-term patient survival, lower target lesion revascularization, and higher primary patency of patients with a Trans-Atlantic Inter-Society Consensus II D lesion when compared with BMSs. Our study provides evidence supporting the superiority of CSs over BMSs in the treatment of AIOD, and furnishing clinicians with guidance for treatment decisions.
Endovascular Therapy for Vascular Graft Infection After Multiple Bypass Surgeries for Aorto-Iliac Occlusive Disease
Authors: Fujioka Kensuke , Nishida Yuji , Eguchi Yuya , Fujita Takashi , Uchiyama Katsuharu , Fujimoto Manabu 
Published: March 2024

Background Vascular graft infection is a very complex disease. Although complete excision of the infected grafts with extra-anatomic bypass or in situ reconstruction is a general treatment strategy, some concerns including reinfection in the new graft remain. Case Report An 88 year-old man presented to the hospital with abdominal swelling and bleeding. The patient had undergone revascularization for aorto-iliac occlusive disease twice in the past. The first procedure had been performed 15 years previously, with right ilio-femoral bypass grafting for right iliac artery occlusion and stent implantation for left iliac artery stenosis. The second procedure had been performed 10 years previously, with aorta-to-left femoral and left-to-right femoro-femoral bypass grafting because the terminal aorta, the first ilio-femoral bypass graft, and the stent of the left iliac artery had been occluded. The patient was diagnosed with vascular graft infection, and endovascular therapy was selected as the revascularization method prior to graft excision. It was successfully performed using various devices and techniques, followed by graft excision without critical limb ischemia. Conclusion This case demonstrates that endovascular therapy prior to graft excision can be an alternative revascularization method for vascular graft infection after bypass surgery for aorto-iliac occlusive disease.
Return to Sports Following Spondylolysis Surgery in Children and Adolescents: A Systematic Review
Authors: Gross Preston W. , Yang Michelle , Jones Ruth H. , Doyle Shevaun M. 
Published: March 2024

Background: Spondylolysis is common in athletes participating in gymnastics, football, dance, and weightlifting. Few studies have reviewed return to sports (RTS) rates in young athletes after surgical intervention for spondylolysis. Purposes: We sought to review the literature on RTS frequencies and timing, as well as postoperative treatment, in children and adolescents who underwent spondylolysis surgery. Methods: This was a systematic review, using the PubMed, Embase, and Cochrane databases, of primary, peer-reviewed studies published from 2014 to 2022 that investigated child and adolescent RTS after spondylolysis surgery. Each author independently reviewed each study’s design, number of participants, age range, fixation, postoperative course of treatment, frequency of RTS, and reasons for failure of RTS. Results: The initial search produced 106 articles; 25 were reviewed in full and 9 were included in the final analysis, with a combined total of 177 patients. Sample sizes ranged from 5 to 52 participants. The most common fixations were direct repair (6 studies, n = 120), indirect repair (3 studies, n = 22), and fusion (2 studies, n = 35). Five studies mentioned the use of immediate postoperative immobilization. Physical therapy programs were initiated most often at 6 weeks postoperatively. The RTS rate of the 177 athletes (median age younger than 23 years) was 76% to 100%. The most common reason for failure to RTS was lower back pain. Conclusions: This systematic review suggests that young athletes RTS at a high rate following spondylolysis surgery, but more rigorous study is warranted. The review also found varied preferred fixation methodologies and postoperative treatment regimens across the available studies.
Choroid plexus calcifications are not associated with putative markers of glymphatic dysfunction: A population study in middle-aged and older adults
Authors: Castillo Pablo R , Patel Vishal , Mera Robertino M , Rumbea Denisse A , Del Brutto Oscar H 
Published: March 2024

Background and Purpose Recent studies have suggested an association between dysfunction of the choroid plexus and the glymphatic system. However, information is inconclusive. Following a population-based study design, we aimed to assess the association between choroid plexus calcifications (CPCs)—as a surrogate of choroid plexus dysfunction—and severity and progression of putative markers of glymphatic dysfunction, including white matter hyperintensities (WMH) of presumed vascular origin and abnormally enlarged basal ganglia perivascular spaces (BG-PVS). Methods This study recruited community-dwellers aged ≥40 years living in neighboring Ecuadorian villages. Participants who had baseline head CTs and brain MRIs were included in cross-sectional analyses and those who additional had follow-up MRIs (after a mean of 6.4 ± 1.5 years) were included in longitudinal analyses. Logistic and Poisson regression models, adjusted for demographics and cardiovascular risk factors, were fitted to assess associations between CPCs and WMH and enlarged BG-PVS severity and progression. Results A total of 590 individuals were included in the cross-sectional component of the study, and 215 in the longitudinal component. At baseline, 25% of participants had moderate-to-severe WMH and 27% had abnormally enlarged BG-PVS. At follow-up, 36% and 20% of participants had WMH and enlarged BG-PVS progression, respectively. Logistic regression models showed no significant differences between CPCs volumes stratified in quartiles and severity of WMH and enlarged BG-PVS. Poisson regression models showed no association between the exposure and WMH and enlarged BG-PVS progression. Baseline age remained significant in these models. Conclusions Choroid plexus calcifications are not associated with putative markers of glymphatic system dysfunction.
Transradial access for the endovascular treatment of intracranial aneurysms using the Woven EndoBridge device: A systematic review and pooled analysis
Authors: Batista Sávio , Andreão Filipi Fim , Bertani Raphael , de Barros Oliveira Leonardo , Oberman Dan Zimelewicz , Palavani Lucca B , Filho Cesar Augusto Ferreira Alves , de Oliveira Braga Fausto , Machado Elias Antônio Tanus , da Mata Pereira Paulo José , Filho Paulo Niemeyer , Almeida Filho José Alberto 
Published: March 2024

Background The Woven EndoBridge (WEB) device is a minimally invasive endovascular treatment option for patients with cerebral aneurysms. Transradial access (TRA) is a technique that involves accessing the arterial system through the radial artery in the wrist rather than the femoral artery in the groin. Several studies have investigated the use of TRA for WEB device deployment in treating intracranial aneurysms. Methods A systematic review was conducted to evaluate the TRA for WEB device deployment in treating intracranial aneurysms. The databases PubMed, Cochrane, Embase, Scopus, and Web of Science were searched. To reduce the risk of bias, this systematic review only included studies reporting on using TRA in WEB device deployment for intracranial aneurysm treatment with a minimum of four patients. Results In this systematic review, 186 patients were included across five studies, with TRA used in 183 cases analyzed. The study population had a higher proportion of females ( n = 118%–69%) than males, with a mean age of 62 years old. Among the aneurysms treated, 46 were ruptured, and 119 were located at bifurcation sites, with a mean maximum diameter/width of 6.6 mm and mean height of 5.9 mm. Adjunctive coiling was used in three cases, and adjunctive stenting was used in nine cases. In two cases, conversion to a femoral artery access was necessary. Conclusion The available results suggest TRA with the WEB device is a safe and effective alternative. However, using TRA versus TFA should be individualized based on patient factors and operator experience.
Operative Treatment of Ulnar Collateral Ligament Injury in Female Athletes
Authors: Gerard Nicholas O. , Clark Sean C. , O’Brien Michael J. , Mulcahey Mary K. , Savoie Felix H. 
Published: March 2024

Background: Ulnar collateral ligament (UCL) reconstruction has been the standard surgical intervention for elite male athletes with UCL insufficiency. Recently, UCL repair and augmentation with an internal brace has been increasingly performed. Purpose: To evaluate the clinical and functional outcomes as well as return-to-sport rate after UCL repair in female athletes. Study Design: Case series; Level of evidence, 4. Methods: Included were 15 female athletes (mean age, 16.5 ± 3.5 years) who underwent UCL repair between 2011 and 2021 at a single institution. Data collected included age, sport played, competition level, symptom onset, previous surgeries, mechanism of injury, surgical intervention, and return to sport. Patients were contacted via phone at minimum 24-month follow-up, and postoperative outcomes were evaluated using the Mayo Elbow Performance Score (MEPS) and the Single Assessment Numeric Evaluation (SANE). Results: Of the 15 female athletes, there were 4 cheerleaders, 3 softball players, 2 volleyball players, 2 soccer players, 1 gymnast, 1 tennis player, 1 dancer, and 1 javelin thrower. Ten of the 15 athletes (67%) competed at the high school level, 4 (26%) at the collegiate level, and 1 patient (7%) was a recreational volleyball player. In all patients, there was an acute onset of symptoms after injury. Ten patients underwent UCL repair with an internal brace (67% of athletes), while 5 underwent standard UCL repair. The median MEPS for athletes with and without an internal brace was 100 (range, 80-100). There was no significant difference of MEPS ( P = .826) or SANE scores ( P = .189) between the patients who received an internal brace and those who did not. Thirteen of the 15 athletes (86.7%) returned to sport. Conclusion: The UCL injuries in the female athletes in this study were the result of acute trauma. Primary UCL repair, both with and without internal bracing, was an effective surgical treatment for returning these athletes to sport.
Impact of diagnostic investigations in the management of CAR T-cell–associated neurotoxicity
Authors: Mauget Matteo , Lemercier Sophie , Quelven Quentin , Maamar Adel , Lhomme Faustine , De Guibert Sophie , Houot Roch , Manson Guillaume 
Published: March 2024

Abstract
International guidelines regarding the management of immune effector cell–associated neurotoxicity syndrome (ICANS) recommend several diagnostic investigations, including magnetic resonance imaging (MRI), lumbar puncture (LP), and electroencephalogram (EEG) based on ICANS grade. However, the impact of these investigations has not yet been evaluated. Here, we aimed to describe the role of MRI, LP, and EEG in the management of ICANS in a cohort of real-life patients treated with chimeric antigen receptor (CAR) T cells at the University Hospital of Rennes, France. Between August 2018 and January 2023, a total of 190 consecutive patients were treated with CAR T cells. Among those, 91 (48%) developed ICANS. MRI was performed in 71 patients (78%) with ICANS, with a therapeutic impact in 4% of patients, despite frequent abnormal findings. LP was performed in 43 patients (47%), which led to preemptive antimicrobial agents in 7% of patients, although no infection was eventually detected. Systematic EEG was performed in 51 patients (56%), which led to therapeutic modifications in 16% of patients. Our study shows that EEG is the diagnostic investigation with the greatest therapeutic impact, whereas MRI and LP appear to have a limited therapeutic impact. Our results emphasize the role of EEG in the current guidelines but question the need for systematic MRI and LP, which might be left to the discretion of the treating physician.