bluuebunny/crossref_metadata_2025_split huggingface dataset:
Pediatric Type I Open Both Bone Forearm Fractures: Predicting Failure of Nonoperative Management
Authors: Noe McKenna C. , Link Robert C. , Warren Jonathan R. , Goodrich Ezra , Sinclair Mark , Tougas Caroline 
Published: March 2024

Background:
In recent years, nonoperative treatment of pediatric type I open both bone forearm fractures (OBBFFs) with bedside irrigation, antibiotics, closed reduction, and casting has yielded low infection rates. However, risk factors for failure of type I OBBFF closed reduction have not been well described. Our purpose was to describe management of patients with type I OBBFFs at our institution and determine what factors are associated with failure of closed reduction in this population.

Methods:
This was a review of patients between 5 and 15 years of age who received initial nonoperative management for type I OBBFFs at one institution between 2015 and 2021. Primary outcome was success or failure of nonoperative management (defined as progression to surgical management). Secondary outcomes included infections, compartment syndromes, and neuropraxias. Other variables of interest were demographic information, prereduction and postreduction translation and angulation of the radius and ulna, cast index, and antibiotic administration.

Results:
Sixty-one patients (67.7% male) with 62 type I OBBFFs were included in this study. Following initial nonoperative management, 55 injuries (88.7%) were successfully treated in casts, while the remaining 7 (11.3%) required surgical intervention following loss of acceptable reduction in cast. Median cast index (0.84, IQR 0.8 to 0.9 vs. 0.75, IQR 0.7-0.8, P=0.020) and postreduction radius translation on anteroposterior films (32.0%, IQR 17.0% to 40.0% vs. 5.0%, IQR 0.0% to 26.0%, P=0.020) were higher among those who failed nonoperative management. Multivariable logistic regression models identified increased odds of failure for every SD (0.7) increase in cast index (OR 3.78, P=0.023, 95% CI: 1.4-14.3) and 25% increase in postreduction radius translation on anteroposterior films (OR 7.39, P=0.044, 95% CI 1.2-70.4). No infections or compartment syndromes and 2 transient ulnar neuropraxias occurred.

Conclusions:
Closed reduction of type I OBBFFs was successful in 88.7% of cases. There were no infections after nonoperative management. Increases in cast index of 0.7 and postreduction radius translation on anteroposterior radiographs of 25% were associated with increased likelihood of failure, thus requiring surgery; age was not.

Level of Evidence:
Level IV—retrospective comparative study.
Machine learning algorithms for predicting Cobb angle beyond 25 degrees in female adolescent idiopathic scoliosis patients
Authors: Ohyama Shuhei , Maki Satoshi , Kotani Toshiaki , Ogata Yosuke , Sakuma Tsuyoshi , Iijima Yasushi , Akazawa Tsutomu , Inage Kazuhide , Shiga Yasuhiro , Inoue Masahiro , Arai Takahito , Toshi Noriyasu , Tokeshi Soichiro , Okuyama Kohei , Tashiro Susumu , Suzuki Noritaka , Eguchi Yawara , Orita Sumihisa , Minami Shohei , Ohtori Seiji 
Published: March 2024

Study Design:
Retrospective cohort study.

Objective:
To develop a machine learning (ML) model that predicts the progression of AIS using minimal radiographs and simple questionnaires during the first visit.

Summary of Background Data:
Several factors are associated with angle progression in patients with AIS. However, it is challenging to predict angular progression at the first visit.

Methods:
Among female patients with AIS treated at a single institution from July 2011 to February 2023, 1119 cases were studied. Patient data, including demographic and radiographic data based on anterior-posterior and lateral whole-spine radiographs, were collected at the first and last visits. The last visit was defined differently based on treatment plans. For patients slated for surgery or bracing, the last visit occurred just before these interventions. For others, it was their final visit before turning 18 years. Angular progression was defined as a Cobb angle greater than 25 degrees for each of the proximal thoracic (PT), main thoracic (MT), and thoracolumbar/lumbar (TLL) curves at the last visit. ML algorithms were employed to develop individual binary classification models for each type of curve (PT, MT, and TLL) using PyCaret in Python. Multiple models were explored and analyzed, with the selection of optimal models based on the area under the curve (AUC) and Recall scores. Feature importance was evaluated to understand the contribution of each feature to the model predictions.

Results:
For PT, MT, and TLL progression, the top-performing models exhibit AUC values of 0.94, 0.89, and 0.84, and achieve recall rates of 0.90, 0.85, and 0.81. The most significant factors predicting progression varied for each curve: initial Cobb angle for PT, presence of menarche for MT, and Risser grade for TLL.

Conclusions:
This study introduces an ML-based model using simple data at the first visit to precisely predict angle progression in female patients with AIS.
A Challenging Case of Thumb Replantation Aided by Intraoperative Indocyanine Green Fluorescence Angiography
Authors: Budini Valentina , Costa Alfio L. , Sofo Giuseppe , Bassetto Franco , Vindigni Vincenzo 
Published: March 2024

Background:
This study presents a case of thumb replantation performed despite several risk factors: age, comorbidities, and trauma mechanism are major adverse prognostic factors directly impacting thumb replantation. Most of the literature backs up this claim that a thumb that works, even partially, is a better outcome for the patient than amputation.

Methods:
We performed thumb replantation on a 94-year-old patient with type 2 diabetes mellitus who arrived at the emergency department with a thumb avulsion due to a dog bite. The intraoperative indocyanine green fluorescence angiography method aided us in carrying out the operation.

Results:
We successfully used indocyanine green angiography intraoperatively to guide surgical debridement and evaluate the efficacy of anastomosis and reperfusion of the replanted segment during surgery. Two months after the operation, the patient had regained satisfactory hand function.

Conclusions:
Although indocyanine green angiography is not a technology created for revascularization procedures, it is instrumental in assessing vascular function and predicting a successful outcome. Given its undeniable potential, more research is needed on the possibility of widespread use in hand surgery and its indications.
Revision Rates in Cosmetic Plastic Surgery with and without Resident Involvement
Authors: Newman Ashley , Caudill Antonina R , Ball Eleanor , Davison Steven P. 
Published: March 2024

Background:
Changes in surgical education have caused concern over residents’ preparedness for independent practice. As the field of otolaryngology requires such a wide breadth of expertise, ill preparation becomes especially costly. This study explores how the presence and participation of a postgraduate year 3 (PGY3) otolaryngology resident in surgery impacts revision rates and operating time as gauges for the resident competency and indirect training costs.

Methods:
A retrospective chart analysis of patients who underwent cosmetic plastic surgery at sites for PGY3 otolaryngology residents’ facial plastic surgery rotations was conducted. Residents performed one side of bilateral procedures (eg, blepharoplasties) and approximately 50% of midline procedures (eg, rhinoplasties). Chi-squared testing and odds/risk ratios were done to assess the effect of resident involvement on revision rates. Operating time was compared using t tests.

Results:
When a resident was involved in cosmetic surgery, the revision rate was 22.2% compared with 3.6% without. The likelihood of a future revision surgery was 7.57 times higher when a resident participated in the original operation. Resident involvement was not a statistically significant predictor of exceeding the allotted operating time.

Conclusions:
The revision rate of cosmetic surgery was much higher when a resident was involved. Otolaryngology residents would benefit from increased facial plastic and reconstructive surgery training. As a response to this analytical study, this clinical rotation was moved to be offered at a later stage of postgraduate surgical training to allow residents to gain more experience and be better set up for success in the rotation.
A blunted nocturnal blood pressure decline is associated with all-cause and cardiovascular mortality
Authors: de la Sierra Alejandro , Staplin Natalie , Ruilope Luis M. , Gorostidi Manuel , Vinyoles Ernest , Segura Julián , Baigent Colin , Williams Bryan 
Published: March 2024

Objective:
It has been suggested that a blunted nocturnal blood pressure (BP) decline is associated with a poor prognosis. Nevertheless, it remains unclear if an abnormal dipping is deleterious per se or it merely reflects an elevated BP during sleep. We aimed to assess the prognostic value of nocturnal BP decline, with or without concomitant elevated nocturnal BP.

Methods:
Vital status and cause of death were obtained from death certificates in 59 124 patients, enrolled in the Spanish ABPM Registry between 2004 and 2014 (median follow-up: 10 years). The association between night-to-day ratio (NDR) and dipping patterns (extreme dippers, dippers, reduced dippers, and risers) with all-cause and cardiovascular mortality were evaluated by Cox-proportional models adjusted for clinical confounders and 24 h blood pressure.

Results:
NDR was associated with all-cause mortality [hazard ratio for 1SD change: 1.15; 95% confidence interval (CI) 1.13–1.17]. Reduced dippers (1.13; 1.06–1.20) and risers (1.41; 1.32–1.51) were associated with an increased risk of all-cause death, whereas extreme dippers (0.90; 0.79–1.02) were not. Elevated NDR (≥0.9) in the absence of elevated night SBP (<120 mmHg) was associated with an increased risk of death (1.13; 1.04–1.22), as well as elevated night SBP but normal NDR (1.38; 1.26–1.50), and the combination of both abnormalities (1.56; 1.46–1.66). Similar results were obtained for cardiovascular mortality.

Conclusion:
Abnormalities in the circadian pattern are associated with an increased risk of all-cause and cardiovascular mortality. This is maintained even in the absence of nocturnal BP elevation.
In vivo assessment of antimicrobial activity and toxicity of repeated 1% povidone–iodine applications vs a single 5% povidone–iodine application
Authors: Teren David , Neuman Gil , Abulafia Adi , Gelman Evgeny , Assayag Elishai , Hajj Abeer , Shwartz Orna , Zadok David 
Published: March 2024

Purpose:
To demonstrate the noninferiority in antimicrobial effectiveness of thrice-repeated applications of 1% povidone–iodine (PI) compared with a single application of 5% PI on the ocular surface in vivo and to evaluate potential toxicity of PI to the corneal epithelium.

Setting:
Department of Ophthalmology, Shaare Zedek Medical Center, Jerusalem, Israel.

Design:
Prospective, randomized, double-blind study.

Methods:
Patients randomly received either a single application of 5% PI or repeated irrigations of 1% PI on the ocular surface preoperatively. Bacterial colony counts were quantitatively analyzed by taking standardized conjunctival swabs before and after irrigation, and differences in bacterial colony counts were compared between the 2 groups. The presence of superficial punctate keratopathy was evaluated in all patients by the National Eye Institute grading system.

Results:
The study comprised 102 eyes of 102 patients. Both 1% and 5% PI yielded a marked decrease in bacterial colonies compared with before application (P < .001). The repeated application of 1% PI showed a significantly lower bacterial count compared with the single application of 5% PI (P < .05) and resulted in significantly less damage to the corneal epithelium compared with a single 5% PI application (P < .001).

Conclusions:
Preoperative repeated applications of 1% PI effectively eradicated ocular surface bacteria equal to that of 5% PI with a less deleterious effect on the corneal epithelium. Our findings suggest that 1% PI may be a promising alternative to 5% PI.
Physiological Stress Responses to a Live-Fire Training Evolution in Career Structural Firefighters
Authors: Gonzalez Drew E. , Dillard Courtney C. , Johnson Sarah E. , Martin Steven E. , McAllister Matthew J. 
Published: March 2024

Objective
This study assessed firefighters’ physiological stress response to a live fire training evolution (LFTE).

Methods
Seventy-six (n = 76) firefighters completed an LFTE. Salivary samples were collected pre-, immediately post, and 30-min post-LFTE and analyzed for α-amylase (AA), cortisol (CORT), and secretory immunoglobulin-A (SIgA).

Results
Concentrations of AA, CORT, and SIgA were elevated immediately post LFTE versus pre (P<0.001) and 30-min post (P<0.001). Cohen’s d effect size comparing pre and immediately-post means were 0.83, 0.77, and 0.61 for AA, CORT, and SIgA and were 0.54, 0.44, and 0.69 for AA, CORT, and SIgA, comparing immediately-post and 30-min post, respectively.

Conclusions
These data demonstrate the stress response and activation of the hypothalamic-pituitary-adrenal/sympathetic-adreno-medullar axis and immune system immediately after real-world firefighting operations. Future work is needed to understand the impact of elevated stress biomarkers on firefighter performance and disease risk.
Preoperative Imaging in Cochlear Implants
Authors: Lee Andrew Y. , Lee Diana Y. , Saunders James E. 
Published: March 2024

ObjectiveTo determine the utility of computed tomography (CT) and magnetic resonance imaging (MRI) in cochlear implant candidates.Study DesignRetrospective case review.SettingTertiary referral hospital.PatientsA total of 207 cochlear implanted patients with CT and/or MRIIntervention(s)N/A.Main Outcome Measure(s)Age versus abnormal radiologic findings, imaging abnormality versus postoperative outcomes, postoperative outcomes versus electrode design, Cambridge Cochlear Implant Protocol (CCIP) status for imaging abnormalities, sensitivity and specificity of CT and MRI for round-window/cochlear occlusion, and MRI for incomplete partitions.ResultsA total of 207 patients with CT, MRI, or both were reviewed retrospectively. Less than half (15.5%) of CT scans had findings that might affect surgical intervention compared with 5.9% of MRI. No significant difference was found between children and adults for relevant imaging abnormalities (grade 4 or higher) with either CT (p= 0.931) or MRI (p= 0.606). CCIP status correlated with cochlear abnormalities (p= 0.040); however, only 46.2% of radiographic abnormalities on CT would be identified by these criteria. For detecting cochlear occlusion requiring surgical intervention, the sensitivity and specificity for CT were 40% (4 of 10; 95% confidence interval [CI], 12.16–73.76) and 95.73% (95% CI, 91.40–98.27), respectively. For MRI, the sensitivity and specificity were 33.33% (1 of 3; 95% CI, 0.84–90.57) and 96.97% (63 of 65; 95% CI, 89.32–99.63), respectively. There was no difference for postoperative AzBio scores for higher-grade imaging abnormalities (p= 0.6012) or for electrode designs (p= 0.3699).ConclusionsSignificant radiographic abnormalities were relatively uncommon in cochlear implant patients on either CT or MRI at our single-center institution. If present, abnormal imaging findings rarely translated to management changes. CCIP status does not reliably predict which patients are likely to have abnormalities. Both MRI and CT have low sensitivity for round-window or cochlear occlusion, but detection likely leads to changes in surgical management.
Time trends in liver cancer mortality rates in Montenegro from 1990 to 2018
Authors: Vuković Mirjana Nedović , Jakšić Marina , Stojanović Danijela , Smolović Brigita 
Published: March 2024

Objective
Liver cancer is the third most common cause of cancer-related deaths worldwide. Hepatitis B and C infections are the main factors affecting mortality. During recent years, Montenegro conducted activities on eradication of viral hepatitis according to the global strategy for the primary prevention of liver cancer mortality. The objective of this study was to assess the liver cancer mortality trend in Montenegro for the period of 1990–2018 using regression techniques.

Methods
liver cancer mortality data in Montenegro from 1990 to 2018 were collected. Mortality rates were age standardized to the World Standard Population. The joinpoint, linear and Poisson regressions were used to assess liver cancer mortality trends both overall and gender specific.

Results
The mortality trend was constant, with no significant increase or decrease in mortality rates both at the overall level and by gender. The number of cases, however, increases significantly at the overall level by an average of 1.4% per year [average annual percentage change (AAPC) (95% confidence interval, CI): 1.4 (0.5–2.3); P = 0.004] and in women by 1.9% per year [AAPC (95% CI): 1.9 (0.8–3.1); P = 0.002]. In men, there was no change in the number of cases. The three age groups most burdened by mortality from liver cancer were 65–74 (34.9%), 75–84 (26.6%) and 55–64 (25.8%).

Conclusion
The consistent implementation of prevention measures and hepatitis virus infection treatment has played a role in partially favorable liver cancer mortality trends in Montenegro. It is crucial to closely monitor guidelines for this cancer and give particular attention to the elderly population as the most affected.
Alport syndrome and Alport kidney diseases – elucidating the disease spectrum
Authors: Puapatanakul Pongpratch , Miner Jeffrey H. 
Published: March 2024

Purpose of review
With the latest classification, variants in three collagen IV genes, COL4A3, COL4A4, and COL4A5, represent the most prevalent genetic kidney disease in humans, exhibiting diverse, complex, and inconsistent clinical manifestations. This review breaks down the disease spectrum and genotype–phenotype correlations of kidney diseases linked to genetic variants in these genes and distinguishes “classic” Alport syndrome (AS) from the less severe nonsyndromic genetically related nephropathies that we suggest be called “Alport kidney diseases”.

Recent findings
Several research studies have focused on the genotype–phenotype correlation under the latest classification scheme of AS. The historic diagnoses of “benign familial hematuria” and “thin basement membrane nephropathy” linked to heterozygous variants in COL4A3 or COL4A4 are suggested to be obsolete, but instead classified as autosomal AS by recent expert consensus due to a significant risk of disease progression.

Summary
The concept of Alport kidney disease extends beyond classic AS. Patients carrying pathogenic variants in any one of the COL4A3/A4/A5 genes can have variable phenotypes ranging from completely normal/clinically unrecognizable, hematuria without or with proteinuria, or progression to chronic kidney disease and kidney failure, depending on sex, genotype, and interplays of other genetic as well as environmental factors.
Fatal Iron Tablet Aspiration
Authors: Hojberg Yvonne , Abdeljaber Mahmuod , Milewski Yvonne , deJong Joyce , Prahlow Joseph A. 
Published: March 2024

Abstract
Pill aspiration is a significant source of foreign body aspiration in the United States and can occur without swallowing dysfunction or illness. Consequences depend on various factors, such as the pill's chemical composition, size, and diagnostic delay. Aspiration of iron tablets poses a higher risk because of hydroxyl radical formation and subsequent caustic burns, inflammation, obstruction, and/or necrosis. We present a case of a middle-aged obese woman who died 3 weeks after aspirating an iron tablet. Autopsy revealed morbid obesity, a necrotic focus in the right middle lobe of the lung, bronchiolar granulation tissue with iron staining foreign matter, extending into an adjacent arteriole, and mural perforation of the hilar right middle lobe. Despite seeking medical attention twice, the patient was only accurately diagnosed postmortem. This case highlights the importance of accurate and timely diagnosis in preventing fatal outcomes. To enhance diagnostic accuracy and reduce morbidity and mortality associated with pill aspiration, clinicians should maintain a high level of suspicion for foreign body aspiration in patients with persistent or worsening respiratory symptoms. Furthermore, it is crucial for forensic pathologists to have a high index of suspicion about the potential for lethal pill aspiration and complications days after the acute event.
IRF3 regulates neuroinflammatory responses and the expression of genes associated with Alzheimer’s disease
Authors: Joshi Radhika , Brezani Veronika , Mey Gabrielle M , Guixé-Muntet Sergi , Ortega-Ribera Marti , Zhuang Yuan , Zivny Adam , Werneburg Sebastian , Gracia-Sancho Jordi , Szabo Gyongyi 
Published: March 2024

SummaryThe pathological role of interferon signaling is emerging in neuroinflammatory disorders, yet, the specific role of Interferon Regulatory Factor 3 (IRF3) in neuroinflammation remains poorly understood. Here, we show that global IRF3 deficiency delays TLR4-mediated signaling in microglia and attenuates the hallmark features of LPS-induced inflammation such as cytokine release, microglial reactivity, astrocyte activation, myeloid cell infiltration, and inflammasome activation. Moreover, expression of a constitutively active IRF3 (S388D/S390D:IRF3-2D) in microglia induces a transcriptional program reminiscent of the Activated Response Microglia and the expression of genes associated with Alzheimer’s Disease, notablyapolipoprotein-e. Lastly, using bulk-RNAseq of IRF3-2D brain myeloid cells, we identified Z-DNA binding protein-1 as a target of IRF3 that is relevant across various neuroinflammatory disorders. Together, our results identify IRF3 as an important regulator of LPS-mediated neuroinflammatory responses and highlight IRF3 as a central regulator of disease-specific gene activation in different neuroinflammatory diseases.
The molecules lost NEW COMPOUNDS BINDING AT THE HISTAMINE SITE OF THE NMDA RECEPTOR (NMDA(HA)R)
Authors: Armand V. 
Published: March 2024

AbstractNMDA receptor ligands have been the target of intensive research for the treatment of psychotic diseases and central nervous system diseases. Our group published the characterization of the NMDA receptor histamine site. We developed modulators for this site, about 500 drugs were tested and we finally have a partial agonist FUBn293 with a nanomolar affinity and also an antagonist ST-579 with a nanomolar affinity. We suggest that agonists at the (NMDA(HA)R) constitute an innovative class of antipsychotics for the treatment of schizophrenia and other neurological or psychiatric disorders.