bluuebunny/crossref_metadata_2025_split huggingface dataset:
Maternal plasma urocortin level as a biomarker of preterm birth: a prospective cohort study in Sulaimaniyah city in Iraq
Authors: Nasir Sallama Kamel 
Published: January 2025

Objective To evaluate the value of the urocortin (UCN) level to predict preterm delivery in women with threatened preterm labour. Methods This prospective cohort study included 96 women with a singleton pregnancy between 28 and 34 weeks of gestation who were admitted with threatened preterm labour. The participants were monitored until delivery. The UCN level was compared between those with preterm and with full-term deliveries. Results The mean UCN level was higher for preterm deliveries (96 ± 24.34 pg/mL) than for full-term deliveries (62.62 ± 23.63 pg/mL). A UCN cutoff level of 92 pg/mL had 20% sensitivity, 100% specificity, 100% positive predictive value, and 10% negative predictive value. Thus, 17.7% of women had a UCN level ≥ 92 pg/mL, and all delivered preterm. Among the 82.3% of women who had a UCN level < 92 pg/mL, 88.6% delivered preterm, and 11.4% delivered at full term. Moreover, 88.2% of women who had a UCN level ≥ 92 pg/mL delivered within 7 days and only 11.8% delivered after 7 days. However, 58.2% of women with a UCN level < 92 pg/mL delivered within 7 days and 41.8% delivered after 7 days. Conclusion A UCN cutoff level of ≥92 pg/mL predicts preterm delivery within 7 days of admission.
Trochlear Morphological Changes in Skeletally Immature Patients Across Consecutive MRI Studies
Authors: Orellana Kevin J. , Lee Julianna , Yang Daniel , Kell David , Nguyen Jie , Lawrence J. Todd , Williams Brendan A. 
Published: January 2025

Background: Trochlear dysplasia is a consistent risk factor for recurrent patellofemoral instability (PFI), but there is limited understanding of how the trochlea develops during growth. The aim of this study was to evaluate serial magnetic resonance imaging (MRI) studies performed in skeletally immature patients with and without PFI to characterize changes in trochlear anatomy over time. Hypothesis: PFI leads to progressive worsening of trochlear dysplasia over time. Study Design: Cohort study; Level of evidence, 3. Methods: A retrospective case-control study was conducted on pediatric patients (<18 years of age) with and without a diagnosis of PFI who had multiple ipsilateral MRI studies of the knee at least 6 months apart. Inclusion criteria were patients with open distal femoral physes at the initial MRI study and no intervening surgery between MRI studies. All patients with PFI were included, and 30 patients without PFI were identified for comparison. MRI scans were retrospectively reviewed to evaluate trochlear morphology using the Dejour and Oswestry-Bristol classifications and to measure the sulcus angle, trochlear depth index, medial condylar trochlear offset, and lateral trochlear inclination (LTI). Univariate and bivariate statistics were performed to evaluate differences in morphology between MRI studies and between groups. Results: A total of 128 patients were identified (98 in the PFI group, 30 in the non-PFI group) with a mean age of 12.3 ± 2.4 years and mean time between MRI studies of 2.3 ± 1.5 years (range, 0.5-6.5 years). Among patients with PFI, rates of moderate to severe (Dejour grades B-D and Oswestry-Bristol classification flat or convex) trochlear dysplasia increased from the initial to most recent imaging study (67% vs 89%; P < .001), and statistically significantly more dysplastic LTI and sulcus angle were observed on follow-up ( P < .05). Among the non-PFI group, the percentage of patients with normal trochlear morphology increased from 53% to 87% ( P < .001), and less dysplastic measures of trochlear depth index, LTI, and sulcus angle were seen on follow-up imaging ( P < .05). When comparing rates of change, trochlear metrics changed toward a more shallow and dysplastic direction in the PFI cohort and toward a deeper and less dysplastic direction in the non-PFI group. Conclusion: Skeletally immature patients with untreated PFI have trochlear dysplasia that progressively worsens over time. Conversely, those without PFI have trochlear characteristics that appear to normalize with growth.
Exploring issues related to disappearing rural areas in the UAE: In search of the critical role of social workers
Authors: Gad Salah , Egorova Zhanna , Youssef Enaam 
Published: January 2025

Summary This study aims to identify and quantitatively assess the challenges faced by residents of disappearing rural areas, which present significant obstacles for social workers, and to outline potential solutions using the example of the United Arab Emirates (UAE). For this purpose, interviews were conducted with social workers ( n = 112), and questionnaires were administered to residents of disappearing rural areas ( n = 101) and prosperous villages ( n = 121). Findings The results of the questionnaire were compared using Student's t-test, which showed statistically significant differences for UAE citizens between the components combined in the categories Loss of home ( pvalue = .01, at p < .05), Material reasons ( pvalue = .043 at p < .05), Privacy ( pvalue = .039, at p < .05), and Medical support ( pvalue = .05 at p < .05). According to the ratings provided by participants, the component that received the highest weight was Loss of home, with an average rating of 4.5 points across the sample of citizens. In contrast, noncitizens assigned equal importance to Loss of home and Medical support, with an average rating of 4.3 points for each of these components. To solve the problems identified with the help of a social worker, it is proposed to actively use modern technology to find and perform work, obtain information, and consult with doctors and psychologists through video communication, with the social worker acting as a prompting and technical assistant. Applications In addition to offering suggestions to social workers, this study provides important information for policymakers at different levels of government to adopt constructive social welfare reforms for residents of disappearing rural settlements.
Semi-Branched Endovascular Aortic Repair: A New Feature in the Treatment of Complex Aortic Aneurysms
Authors: Bilman Victor , Silverberg Daniel , Speter Chen , Halak Moshe 
Published: January 2025

Purpose: To report a case series on using a novel semi-branch feature in custom-made stent-grafts in the endovascular treatment of complex aortic aneurysms and summarize the contemporary usage of this technology. Case series: Four patients underwent endovascular aortic aneurysm repair (EVAR) with a custom-made semi-branch stent-graft (Semi-Branch Endovascular Aortic Aneurysm Repair [SBEVAR]). Two male patients, 75- and 76-year-old, were treated due to failed EVAR with late-type Ia endoleak, and the other two, 80- and 55-year-old male patients, due to a juxta-renal aortic abdominal aneurysm (JRAAA). In 3 cases, the celiac trunk (CT) vessel was targeted through an inner semi-branch; in the other case, all target vessels were bridged through inner semi-branches. Intra-operative technical success was accomplished in all 4 patients. Post-operative recovery was uneventful in all cases. The 30-day computed tomography angiography (CTA) follow-up for each patient showed patent target vessels, excellent apposition of the bridging stent to the semi-branch, and complete exclusion of the aneurysm. Conclusion: The present report and the literature review demonstrate that introducing this novel semi-branch technology for the endovascular treatment of complex aortic aneurysms is feasible and holds great potential. The encouraging outcomes in cases of JRAAA and failed EVAR with late-type Ia endoleak inspire further studies to explore additional uses of this new tool in treating aortic pathologies. Clinical Impact The inner semi-branch is a novel technology for the incorporation of the renal and mesenteric vessels during complex endovascular aortic aneurysm repair. This new feature allows the use of a branched stent graft with a shorter length of the proximal sealing zone, reducing, consequently, the aortic coverage. It efficiently treats pathologies in which fenestrations could be inappropriate because precise stent graft placement might be difficult and in which tiny diameters leave inadequate room for typical inner branches. Although encouraging findings have been reported, long-term outcomes in target vessel stability have yet to be described.
Secondary metacarpal fracture after malunion of the little metacarpal
Authors: Zhang Jiangchao , Xiong Ge , Yu Deshui 
Published: January 2025

Nineteen patients presenting with a secondary metacarpal fracture after a previously fractured little metacarpal were retrospectively reviewed. The new injury was more likely to be at the original fracture site in patients with shaft fractures than those with neck fractures. Level of evidence: IV
The impact of preexisting psychiatric disorders on patient outcomes following primary total shoulder arthroplasty: A systematic review and quantitative synthesis
Authors: Sun Bryan , Thangavelu Vetri , Yakubov Rose , Sun Clare , Khan Moin , Chaudhari Sumit , Sheth Ujash 
Published: January 2025

Purpose To summarize complication rates, reoperation rates, length-of-stay (LOS), patient-reported outcome measures (PROMs), and range of motion following total shoulder arthroplasty (TSA) in patients with preexisting psychiatric disorders (PDs) compared to controls. Methods Three databases (MEDLINE, PubMed, and EMBASE) were searched from inception to 4 March 2024 to identify studies comparing outcomes between patients undergoing anatomic (aTSA) or reverse TSA (rTSA) with or without a preexisting psychiatric condition. The authors adhered to the preferred reporting items for systematic reviews and meta-analyses and revised assessment of multiple systematic review guidelines. Data on demographics, as well as postoperative complication rates, reoperation rates, LOS, PROMs, and range of motion were extracted from included studies. PROMs included the American Shoulder and Elbow Surgeons (ASESs) score, and visual analogue scale (VAS) pain score. Meta-analyses were conducted for outcomes reported by multiple studies, with odds ratios (ORs) and mean differences (MDs) as effect measures for continuous and dichotomous outcomes, respectively. Results Thirteen studies were included in this review, comprising a total of 820,831 TSA patients. The PD group (71.0% female) consisted of 150,432 patients (mean age: 67.6 ± 9.9) with a mean follow-up time of 34.1 ± 30.1 months. The control group (58.1% female) consisted of 670,399 patients (mean age: 69.4 ± 10.7) with a mean follow-up time of 39.1 ± 36.0 months. The PD group had significantly higher rates of complications and reoperation. The PD group also reported significantly lower postoperative ASES scores, higher postoperative VAS scores, and inferior postoperative abduction. There were no significant differences in postoperative LOS, forward flexion, internal rotation, or external rotation. Conclusion Patients with preexisting PDs may have a one-and-a-half times higher odds of postoperative complication or reoperation, as well as significantly worse postoperative pain and PROMs. Identification of at-risk individuals with preexisting psychiatric conditions and preoperative referral to a mental health specialist to optimize psychiatric conditions may benefit this patient cohort ahead of their shoulder arthroplasty procedure. Level of evidence IV.
Streamlining the Journey of Research Into Clinical Practice: Making Your Patients and Practice Flourish Evaluation and Treatment of Pyogenic Spondylodiscitis of the Spine: AO Spine Knowledge Forum Trauma and Infection
Authors: Bigdon Sebastian F. , Vialle Emiliano , Dandurand Charlotte , Scherer Julian , Camino-Willhuber Gaston , Joaquim Andrei F. , Chhabra Harvinder S. , El-Sharkawi Mohammad , Bransford Richard , Fisher Charles G , Schnake Klaus J. , Schroeder Gregory D ,   The AO KF Trauma and Infection Members
Published: January 2025

Study Design Literature Review with clinical recommendations. Objective To highlight impactful studies on pyogenic spondylodiscitis (PS), identified by the AO Spine Knowledge Forum Trauma and Infection, with recommendations for their integration into clinical practice. Methods Five influential studies on PS that have the potential to shape current practice in spinal infections were selected and reviewed. Each study was chosen for its contribution to a critical phase in PS management: diagnosis, imaging, surgical vs conservative treatment, and antibiotic duration. Recommendations were graded as strong or conditional following the GRADE methodology. Results Five studies were highlighted. Article 1: Pluemer et al introduced the Spinal Infection Treatment Evaluation (SITE) Score, a novel scoring tool for standardizing treatment decision-making. Conditional recommendation to incorporate the SITE Score or SISS Score for improved treatment outcomes. Article 2: Maamari et al conducted a meta-analysis comparing imaging modalities, with conditional recommendation to consider 18F-FDG PET/CT to diagnosis PS as an adjunct to MRI which remains the gold standard. Article 3: Thavarajasingam et al demonstrated the potential survival benefit of early surgery in specific PS cases, leading to a strong recommendation for early intervention in appropriate patients. Article 4: Neuhoff et al compared conservative and surgical treatments in well-resourced settings, concluding a strong recommendation for early surgery in appropriate patients. Article 5: Bernard et al evaluated antibiotic treatment duration, with a conditional recommendation for a 6-week course in confirmed cases, based on comparable efficacy to a 12-week regimen. Conclusions Management of PS remains complex and varied. This perspective provides spine surgeons with evidence-based recommendations to enhance standardization and effectiveness in clinical practice.
A randomized, placebo-controlled, cross-over trial of ketamine in Rett syndrome
Authors: Campbell Kathleen , Neul Jeffrey L. , Lieberman David N. , Berry-Kravis Elizabeth , Benke Tim A. , Fu Cary , Percy Alan , Suter Bernhard , Morris David , Carpenter Randall L. , Marsh Eric D. , von Hehn Jana 
Published: January 2025

Abstract

Background
Preclinical studies and anecdotal case reports support the potential therapeutic benefit of low-dose oral ketamine as a treatment of clinical symptoms in Rett syndrome (RTT); however, no controlled studies have been conducted in RTT to evaluate safety, tolerability and efficacy.

Design
This was a sequentially initiated, dose-escalating cohort, placebo-controlled, double blind, randomized sequence, cross-over study of oral ketamine in 6–12-year-old girls with RTT to evaluate short-term safety and tolerability and explore efficacy.

Methods
Participants were randomized to either five days treatment with oral ketamine or matched placebo, followed by a nine-day wash-out period and then crossed-over to the opposite treatment. Ketamine was dosed twice daily at 0.75 mg/kg/dose (Cohort 1) or 1.5 mg/kg/dose (Cohort 2). An independent safety monitoring committee evaluated safety and approved proceeding to the next dose cohort. Caregivers, participants, outcome assessors, and study staff except pharmacists were blinded to allocation. The primary endpoint was safety and tolerability. Exploratory efficacy endpoints included change in clinician- and caregiver-rated measures of RTT features, brain activity on electroencephalography, and wearable biosensors to measure respiration, heart rate, sleep, and activity.

Results
Twenty-three participants enrolled (11 in Cohort 1, 12 in Cohort 2) from 3/12/2019–11/22/2021. One participant was excluded from analysis due to not meeting inclusion criteria on blinded review prior to analysis. One participant was withdrawn from the study due to an adverse event (vomiting) after the first dose of ketamine. Although planned for four dose cohorts, the trial was stopped after Cohort 2 due to enrollment challenges associated with the COVID-19 pandemic. Ketamine was safe and tolerated in both cohorts, with 1 related treatment emergent adverse event of vomiting. No difference was observed in efficacy between ketamine and placebo. Electroencephalography showed the expected increase in high frequency power with ketamine.

Conclusions
Short-term, low-dose oral ketamine was safe and well tolerated in girls with RTT. No clinical efficacy of ketamine in treating symptoms of RTT was observed with 5 days of treatment, despite electroencephalography evidence of ketamine target engagement during the first dose. Further studies are needed to evaluate safety and efficacy of higher dose and longer exposure to ketamine in RTT.

Trial registration
Registered at clinicaltrials.gov NCT03633058.
Anesthesia depth monitoring during opioid free anesthesia – a prospective observational study
Authors: Mogianos Krister , Persson Anna KM 
Published: January 2025

Abstract

Background
Patients undergoing general anesthesia are more frequently monitored for depth of anesthesia using processed electroencephalography. Opioid-free anesthesia is nowadays an accepted modality for general anesthesia, however it is unclear how to interpret data from processed electroencephalography when using a mixture of non-opioid anesthetic drugs. Our objective was to describe density spectral array patterns and compare processed encephalographic data indices between opioid-free and routine opioid based anesthesia.

Methods
This prospective observational cohort study was conducted on 30 adult patients undergoing laparoscopic surgery in a non-tertiary regional hospital. The patients underwent general anesthesia with three different methods and were monitored for anesthesia depth using processed encephalography and density spectral array. Primary outcome is a group-derived mean difference in patient state index and spectral edge frequency. As a secondary outcome a descriptive comparison of the spectral power, derived from the density spectral array, was done between groups.

Results
The opioid-free anesthesia group had significantly higher patient state index and spectral edge frequency compared to routine anesthesia. Density spectral array patterns were also different, most notably lacking the high power in alpha frequency spectrum seen in the other routine anesthesia methods.

Conclusions
Processed electroencephalography monitoring can be used in opioid-free anesthesia, however clinicians should expect higher values in monitoring indices. The density spectral array pattern using a common protocol for opioid-free anesthesia, with mainly sevoflurane combined with low doses of dexmedetomidine and esketamine, differs from well described opioid and GABA-ergic anesthesia methods. These findings should be further validated using other protocols for opioid-free anesthesia in order to safely monitor anesthesia depth.

Trial registration
Clinicaltrials.gov registration number NCT06227143, registration date; 26th of January 2024.
Psychological responses to acute exercise in patients with stress-induced exhaustion disorder: a cross-over randomized trial
Authors: Kling Jenny , Persson Asplund Robert , Ekblom Örjan , Blom Victoria 
Published: January 2025

Abstract

Background
Understanding psychological responses to acute exercise, defined as a single bout of physical exercise, in clinical populations is essential for developing tailored interventions that account for the psychological benefits and challenges of exercise. Given its effectiveness in reducing symptoms in various psychological disorders, exercise should be further explored in Exhaustion Disorder ICD-10-SE: F43.8A (ED), characterized by persistent exhaustion following long-term psychosocial stress. Currently, no studies address the psychological responses to acute exercise in ED patients.

Aims
This study aims to (1) compare the psychological responses to acute exercise between ED patients and healthy controls and (2) assess response differences between low and moderate exercise intensities.

Methods
We conducted a two-armed cross-over trial comparing ED patients (n = 30) and healthy controls (n = 30). Participants completed a 22-min exercise at low or moderate intensity on a cycle ergometer, on separate occasions, in randomized order. The primary outcome was perceived fatigue (POMS); secondary outcomes included feelings of energy, anxiety, stress, exertion, and psychological discomfort, measured before, during, and up to 24 h post-exercise. Exercise effects were assessed using repeated measures analysis of variance.

Results
ED patients reported higher levels of exertion, psychological discomfort, fatigue, anxiety, and stress but lower energy throughout the trial compared to controls. Unlike controls, the ED group showed significant fatigue and stress reductions post-exercise (p < 0.05). Additionally, ED patients showed a more elevated energy after moderate-intensity exercise compared to controls (p < 0.05). Both groups experienced anxiety reductions post-exercise, with no group interactions over time. No differences were observed between pre- and 6 or 24 h post-exercise in any variables. The only intensity effect (p < 0.05) in the ED patients was a more pronounced energy decline 30 min after moderate-intensity exercise.

Conclusions
A 22-min exercise session was perceived as more strenuous by patients with exhaustion disorder (ED) and generated greater improvements in feelings of fatigue, energy, and stress compared to healthy individuals without delayed negative effects. These findings highlight the specific psychological responses in ED to exercise and can inform intervention design tailored specifically to this population.

Trial registration
The study was retrospectively registered on 05/30/2024 at Clinical Trials.gov, with trial registration number 2022–04943-01.