bluuebunny/crossref_metadata_2025_split huggingface dataset:
Robotic-assisted versus conventional total knee arthroplasty: a systematic review and meta-analysis of alignment accuracy and clinical outcomes
Authors: Mostafa Omar , Malik Maymunah , Qayum Kaif , Ishaq Usman , Khan Abdul Muhaymin , Wasim Abdus Samee , Alsoud Zain , Quraishi Sohail 
Published: January 2025

Background:
Robotic-assisted total knee arthroplasty (RA-TKA) has emerged as an alternative to conventional TKA (C-TKA), aiming to improve surgical precision and patient outcomes. This systematic review and meta-analysis study compares the efficacy of RA-TKA versus C-TKA.

Methods:
A comprehensive search of five databases (PubMed, EMBASE, Web of Science, SCOPUS, and Cochrane Library) was conducted. We included all published randomized controlled trials (RCTs) from inception to August 2024. Meta-analysis was done using RevMan 5.4 package.

Results:
Twenty-one RCTs involving 2692 patients were involved. RA-TKA demonstrated significantly lower mechanical alignment outlier rates (risk ratio = 0.33, 95% confidence interval (CI)[0.19, 0.59], P = 0.0002) and less deviation from neutral mechanical axis (mean difference, MD = −0.93° [−1.20, −0.66], P < 0.00001) compared to C-TKA. No significant differences were found in WOMAC or Oxford Knee Scores at various follow-up points. RA-TKA was associated with longer operative times (MD = 19.94 minutes [9.2, 30.68], P = 0.0003) but showed no significant difference in intraoperative blood loss. Postoperative Knee Society Scores were slightly higher in the RA-TKA group (MD = 1.03 [0.50, 1.57], P = 0.0002).

Conclusion:
RA-TKA offers improved mechanical alignment accuracy compared to C-TKA but does not demonstrate superior short to medium-term functional outcomes. The technology is associated with longer operative times. These findings suggest that while RA-TKA may enhance surgical precision, its clinical benefits and cost-effectiveness require further evaluation, particularly in long-term studies.
Quadricuspid aortic valve in an asymptomatic young adult: a case report
Authors: Karki Parag , KC Sharada , Bastakoti Aashish , Khatiwada Abhikanta 
Published: January 2025

Introduction:
Quadricuspid aortic valve (QAV) is a rare congenital heart disease, ranking behind bicuspid and unicuspid aortic valves in terms of the incidence of congenital aortic valve abnormalities. When symptoms are present, they are typically related to aortic regurgitation, manifesting as shortness of breath, nocturnal dyspnea, and palpitations, or aortic stenosis, which presents with exertional dyspnea, angina, or syncope.

Case presentation:
We present the case of an asymptomatic male, diagnosed with a QAV during a routine examination. Despite the absence of clinical symptoms, a thorough general physical examination, including cardiac auscultation, revealed signs suggestive of valvular abnormality. The diagnosis was confirmed via transthoracic echocardiography.

Clinical discussion:
For QAV, the diagnostic process typically includes transthoracic echocardiography, which allows for initial confirmation of the valve morphology. In addition, computed tomography (CT) coronary angiography provides detailed information on valvular morphology and helps identify any associated coronary stenosis. In cases of QAV, a CT aortogram is also crucial to assess potential aortic root dilation, a known complication of this congenital anomaly.

Conclusion:
This case emphasizes the importance of routine physical examination in diagnosing rare congenital heart conditions like QAV, even in asymptomatic individuals. Early diagnosis and appropriate imaging are essential for timely management, particularly in preventing the progression of associated complications such as aortic regurgitation or root dilation.
Detecting ectopic thymus in thymoma-associated myasthenia gravis through flow cytometry analysis of CD3mediumTCRvβmediumCD4+CD8+ T cells and its clinical significance
Authors: Ao Yongqiang , Deng Jie , Jiang Jiahao , Yao Min , Gao Jian , Wang Shuai , Jin Chun , Liu Qiuyue , Zhai Yunze , Du Fengxue , Zhang Yu , Zhang Juan , Zheng Yuejuan , Ren Jiazi , Yu Zuoren , Shen Yunli , Ke Aiwu , Cao Yongbing , Wang Haikun , Ding Jianyong 
Published: January 2025

Background:
Traditional histological methods for identifying ectopic thymus (ET) have significant limitations including high risk of false negatives. This study aims to evaluate the effectiveness of flow cytometry in detecting ETs in patients undergoing total thymectomy.

Methods:
We analyzed 864 samples from 103 patients using flow cytometry and hematoxylin and eosin (H&E) staining. ETs were identified by the presence of CD3mediumTCRvβmediumCD4+CD8+ T cells in flow cytometry or Hassall’s corpuscles in H&E staining.

Results:
In the discovery set, flow cytometry detected ETs in 69.2% of samples, compared to 23.6% by histological methods. The validation set showed a higher incidence of ETs in myasthenia gravis (MG) patients than in non-MG patients (73.5% vs. 58.0%, P < 0.0001) and in those with thymic epithelial tumors versus normal thymus (68.1% vs. 58.1%, P = 0.0088). MG patients exhibited a higher prevalence of active ETs, characterized by a high proportion of CD4+CD8+ T cells, indicating robust thymopoiesis, compared to those without MG (P = 0.0001). Specific regions, such as the left cervical root, areas along the right and left phrenic nerves, and the left innominate vein, showed significantly higher activity (P < 0.05). Additionally, ETs were more frequently found in the cervical region than in the mediastinum (75.0% vs. 60.8%, P = 0.0012), and in patients aged 40 years or younger compared to those older than 40 years (73.0% vs. 60.6%, P = 0.0027).

Conclusions:
Flow cytometry is a viable alternative for ET detection, providing a novel distribution map that enhances surgical decision-making in MG treatment.
Efficacy and safety of ketorolac and dexamethasone for preventing renal colic post stent removal: a randomized triple-blind, placebo-controlled clinical trial
Authors: Mahmoudiandehkordi Shaghayegh , Morovatshoar Reza , Hadipour Pedram , Fooladi Sarabi Shahnaz , Fadaei Mahta , Ansari Abtin , Farhadi-Shahi Mohammad , Noroozi Mohammadreza 
Published: January 2025

Background:
Renal colic following stent removal post-ureteroscopy is a significant clinical issue. This study aims to evaluate the efficacy and safety of intramuscular ketorolac and dexamethasone in preventing renal colic after stent removal.

Methods:
A randomized, triple-blind, placebo-controlled clinical trial was conducted with 147 patients. Participants were allocated to three groups: ketorolac only, ketorolac plus dexamethasone, and placebo. The primary outcome was the visual analog scale (VAS) score for pain, assessed at 1- and 7-days post-stent removal. Secondary outcomes included opioid use, emergency department visits, renal colic symptoms, and missed workdays.

Results:
The combination group (ketorolac and dexamethasone) demonstrated significantly lower VAS scores at 24 hours compared to the placebo group (2.95 vs. 4.30, P = 0.008). Additionally, this group had fewer emergency department visits (2.0% vs. 22.4%, P = 0.010) and lower incidences of subjective renal colic (2.0% vs. 20.4%, P = 0.017). No significant differences were observed at 7 days post-stent removal.

Conclusion:
Intramuscular ketorolac and dexamethasone significantly reduce pain and related complications following stent removal, providing an effective alternative to opioid analgesics.
Impact of Biodegradable Stent on Pancreatic Leakage After Pancreatoduodenectomy – Systematic Review
Authors: Farooqui Waqas , Tschuor Christoph , Storkholm Jan Henrik , Krohn Paul Suno , Hansen Carsten Palnæs , Burgdorf Stefan Kobbelgaard 
Published: January 2025

Purpose:
Postoperative pancreatic fistula (POPF) is a serious complication following pancreatoduodenectomy, due to the risk of complications related to the leak. Intraoperative internal and external stenting of the pancreaticojejunostomy, have been used as a prophylactic measure with mixed results and with a risk of complications. Biodegradable stents could be a potential way to avoid complications associated with traditional stents and reduce the risk of pancreatic leaks and fistulas.

Methods:
A systematic review was conducted to investigate the effectiveness of biodegradable stents in reducing POPF after pancreatoduodenectomy. Studies using biodegradable stents and reporting the incidence of POPF were included. Reviews, case reports, and non-English studies were excluded.

Results:
Eight observational studies with a total of 155 patients were included. A meta-analysis was conducted, and the pooled incidence of POPF was around 7% (18 out 155 patients). Apart from one study (comparing biodegradable stent to regular stent), there were no comparator groups. Using ROBINS-I tool to assess the risk of bias, there was overall a moderate risk of bias.

Conclusion:
Biodegradable stents may be associated with lower risk of POPF. However, the observational design of the studies, the risk of bias and sample sizes, reduced the significance of the results. Well-designed randomized controlled trials are needed to assess the effectiveness.
Complex orbitocranial penetrating injury-managed through neuroplastic surgery – a rare case report and review of literature
Authors: Udhay Priti , Sathyabal Varsha Coimbatore , Kodeeswaran Om Saran , M Kodeeswaran , Priyadharshan K.P. , Chaurasia Bipin 
Published: January 2025

Introduction and importance:
Orbitocranial penetrating injuries (OPI) are uncommon types of head injuries, accounting for about 0.04% of all head injuries. Foreign bodies penetrating the orbit and cranium cause fractures, leading to ophthalmic and neurological manifestations. These require a specialized treatment approach that mainly depends on the foreign body type, extent of injury, and potential complications. Management involves foreign body removal, reconstruction, and infection control.

Case details:
We discuss a case of a 25-year-old male who presented with a penetrating cranio-orbital injury caused by a wooden stick through the left eye. The transorbital-transcranial wooden foreign body penetrated the orbital roof and temporal bone causing displacement of the orbital contents and extended intracranially into the temporal region. The management was done by a multidisciplinary approach consisting of a team of neurosurgeons and oculoplastic surgeons by extracting the foreign body and reconstruction.

Clinical discussion:
No sound literature on the management of OPI by neuroplastic surgery is available.

Conclusion:
This article highlights the importance of neuroplastic surgery for reconstructing complex fractures involving the cranio-orbital and craniofacial regions for improving patient outcomes, and preventing potential complications. This could potentially revolutionize the management of complex craniofacial abnormalities and a new era for neuro-reconstructive care.
Genetic factors and management strategies in aortic health: a literature review of inherited aortopathy
Authors: Elendu Chukwuka , Nzeako Tochukwu R. , Nwachukwu Nwachukwu O. , Akpa Kenneth N. , Omiko Raymond A. , Ayobami-Ojo Petra S. , Orji Uguru W. , Nwankwo Vivian C. , Amaefule Kingsley C. , Chima Chiamaka S. , Chika Nwafor W. , Olukorode John O. , Oloyede Praise O. , Falade David M. , Fayemi Temiloluwa E. , Ezeamaku-Humphrey Chisom P. , Vansh Roshni R. , Enaholo Tobechukwu M.O. , Anukam Lordsfavour I. , Chukwuneke Osita M. 
Published: January 2025

Inherited aortopathies, including Marfan syndrome, Ehlers-Danlos syndrome, and Loeys-Dietz syndrome, are genetic disorders characterized by structural abnormalities of the aorta that predispose individuals to life-threatening complications like aneurysms and dissections. These conditions result from mutations in genes essential for maintaining aortic wall integrity, such as FBN1, TGFBR1, and COL3A1, affecting extracellular matrix components and the transforming growth factor-beta (TGF-β) pathway. Marfan syndrome has a prevalence of approximately 1 in 5000, while Loeys-Dietz syndrome and vascular Ehlers-Danlos syndrome are rarer, with estimated prevalences of 1 in 100 000 and 1 in 20 000, respectively. Familial thoracic aortic aneurysms and dissections (FTAAD), linked to mutations in genes like ACTA2 and MYH11, highlight the genetic heterogeneity of aortopathies. Management strategies focus on early diagnosis, risk stratification, regular imaging, lifestyle modifications, and timely surgical intervention. Advances in genetic testing and targeted therapies offer promise for personalized care. However, challenges such as genetic heterogeneity, incomplete penetrance, and variability in disease progression limit effective management. Limitations in current research include heterogeneity among studies, which complicates meta-analyses and consensus building. Future directions include exploring novel genetic interventions, optimizing treatment timing, and addressing psychosocial impacts to enhance patient outcomes. By addressing gaps in knowledge and integrating patient-reported outcomes, this study underscores the importance of a multidisciplinary approach to managing inherited aortopathies and improving the quality of life for affected individuals.
Intradiploic epidermoid cyst in a 15-year-old female: a rare case report
Authors: Reshad Payenda Ahmad , Zubair Maimoona , Ahmed Nazmin , Khan Adnan , Dad Khan Waseem , Siddiqui Saad , Hasan Masroor , Shafiq Shabna , Chaurasia Bipin 
Published: January 2025

Introduction and importance:
Intradiploic epidermoid cysts are rare, benign, slow-growing lesions that originate from the inclusion of ectodermal elements during the closure of the neural tube. This article reports a case of a rare, benign intradiploic epidermoid cyst.

Case presentation:
A 15-year-old female patient had a cystic swelling located in the occipital region, caused the patient to experience a progressively enlarging swelling and intense headaches. It was diagnosed as intradiploic epidermoid cyst on MRI. Surgery was done and removed. Postoperative outcomes were very good.

Clinical discussion:
Intradiploic epidermoid cysts are quite rare. Although these cysts usually happen because of this ectoderm inclusion, the patient’s history of falling raises questions about whether trauma could have caused it too. We really need more research to see if there’s a connection between injuries & these types of cysts.

Conclusion:
The importance of prompt diagnosis and appropriate surgical intervention is necessary while highlighting the rarity of these lesions and their potential traumatic origin.
Systemic TRPV4 inhibition worsens retinal response to acute intraocular pressure elevation in older but not younger mice
Authors: Lee Pei Ying , Greferath Ursula , Zhao Da , Huang Jin Y. , Wang Anna Y. M. , Vessey Kirstan A. , Chrysostomou Vicki , Fletcher Erica L. , Crowston Jonathan G. , Bui Bang V. 
Published: January 2025

SIGNIFICANCE
Previous evidence showed that transient receptor potential vanilloid 4 (TRPV4) inhibition was protective of retinal ganglion cell (RGC) loss after chronic intraocular pressure (IOP) elevation in young animals. However, the role of TRPV4 in mechanosensing IOP changes in the aging eye is not well understood.

PURPOSE
This study compared the recovery of retinal function and structure after acute IOP elevation in 3- and 12-month-old mouse eyes with and without TRPV4 inhibition.

METHODS
We examined retinal TRPV4 expression in 2-month-old rodent eyes using immunohistochemistry and transcript analysis of isolated macroglia and RGCs. To modulate TRPV4, mice were treated daily with either vehicle or a TRPV4 antagonist (HC-067047 10 mg/kg) delivered intraperitoneally for 7 days before and 7 days after IOP elevation (50 mmHg for 30 minutes). Retinal function and structure were assessed using dark-adapted full-field electroretinography and optical coherence tomography, respectively.

RESULTS
We showed that Müller cells strongly expressed TRPV4. Seven days after IOP elevation, RGC functional recovery was significantly poorer in older mice treated with TRPV4 antagonist compared with age-matched vehicle controls (−54 ± 7% vs. −24 ± 10%, p=0.046) and their younger TRPV4 antagonist–treated counterparts (−5 ± 5%, p<0.001).

CONCLUSIONS
This study showed that there was an age-related deficit in RGC functional recovery from IOP elevation with TRPV4 inhibition.
Awaiting insurance coverage: Medicaid enrollment and post-acute care use after traumatic injury
Authors: Haddad Diane N. , Hatchimonji Justin S. , Eisinger Ella C. , Chen Angela T. , Chreiman Kristen M. , Ramadan Omar I. , Morgan Anna U. , Delgado M. Kit , Martin Niels D. , Seamon Mark J. , Knowlton Lisa M. , Kaufman Elinore J. 
Published: January 2025

BACKGROUND
Lack of insurance after traumatic injury is associated with decreased use of postacute care and poor outcomes. Insurance linkage programs enroll eligible patients in Medicaid at the time of an unplanned admission. We hypothesized that Medicaid enrollment would be associated with increased use of postacute care, but also with prolonged hospital length of stay (LOS) while awaiting insurance authorization.

METHODS
We linked trauma registry and EMR data to identify patients ages 18 years to 64 years admitted from 2017 to 2021 to a Level I trauma center. Patients admitted without insurance and retroactively insured (RI) during hospitalization were compared with patients with established Medicaid (MI) and those remaining uninsured (UI). We measured postacute care use including home health care, rehabilitation, and skilled nursing facilities. We tested the association between insurance status and discharge disposition and LOS (primary outcome) using multivariable negative binomial regression. Direct costs were compared between groups.

RESULTS
We compared 494 RI patients to 1706 MI and 148 UI patients. Retroactively insured patients had longer hospitalization (median LOS [interquartile range], 4 days [2–9 days]) than other groups (MI, 4 [2–8] and UI 2 [1–3]), p < 0.001). Retroactively insured patients were more likely to be discharged with home health care and to inpatient rehabilitation than UI patients (p < 0.001). After adjusting for injury and management characteristics, RI was associated with longer LOS compared with MI for patients discharged to inpatient facilities (p < 0.001). Median costs for RI patients discharged to a facility were $10,284 higher than MI patients, ranging from $8,582 for Injury Severity Score <9 to $51,883 for Injury Severity Score ≥25.

CONCLUSION
Enrollment in Medicaid after traumatic injury is associated with postacute care use, but the current enrollment process may delay discharge. Streamlining insurance enrollment and permitting discharge with pending application status could reduce unnecessary hospital days, saving costs and improving improve patient experience.

LEVEL OF EVIDENCE
Prognostic and Epidemiological; Level IV.
Survival of Patients at a Neurology Clinic
Authors: Steenland Kyle , Tan Youran , Mullins Shirley M. , Kidd Taylor E. , Gong Qiyun , Lah James J. 
Published: January 2025

Introduction:
We previously followed Emory patients with neurodegenerative disease from 1993 to 2006. Here, we follow survivor and new patients for 2007 to 2018.

Methods:
We studied mortality from 10 different diagnostic groups among 4322 research volunteers, and compared mortality rates to controls with normal cognition, using Cox regression. We assessed mortality through the National Death Index, controlling for sex, education, race, comorbidities, and age. Supplemental analyses considered APOE and cognitive test scores.

Results:
Fifty-nine percent of patients died during follow-up. Mortality rate ratios, compared with controls (n=641) in descending order were 12.54, 6.61, 4.77, 4.92, 3.36, 2.25, 2.21 1.71, 1.39, and 1.17 for diagnostic groups ALS, (n=571), FTD (n=197), LBD (n=134), PD (n=584), AD (n=1118), MCI/dementia (n=82), dementia not specified (n=165), PD symptoms (n=256), vascular dementia (n=234), and MCI (n=340), respectively. Women, non-whites, those with higher education, with no comorbidities, and lower ages had lower mortality rates for most diagnostic groups. Mortality rates were higher in the presence of APOE4 variants for several diagnostic groups. Lower MMSEs predicted worse survival for most diseases. Overall, 41% of patients survived during 12 years of follow-up, compared with an expected 75% in the US population.

Conclusion:
Survival times for different diagnostic groups have changed little over several decades.
Human-inspired strategies for controlling swarm systems
Authors: Nalepka Patrick , Patil Gaurav , Kallen Rachel W. , Richardson Michael J. 
Published: January 2025

The control of swarms has emerged as a paradigmatic example of human-autonomy teaming. This review focuses on understanding human coordination behaviours, while controlling evasive autonomous agents, to inform the design of human-compatible teammates. We summarize the solutions employed by human dyads, as well as the verbal communication and division of labour strategies observed in four-person teams using virtual simulations. Additionally, we provide an overview of the design of artificial agents that replicate human-like dynamics using task-dynamical models, and which can be integrated into human-autonomy teams. Finally, we conclude with open questions regarding the preservation of situation awareness and trust within human-autonomous swarming teams.
This article is part of the theme issue ‘The road forward with swarm systems’.
Behavioural evidence of a humidistat: a temperature-compensating mechanism of hydroregulation
Authors: Giacometti Danilo , Tattersall Glenn J. 
Published: January 2025

AbstractThe ability to control hydration state essential for terrestrial species, especially amphibians, which are highly susceptible to dehydration. Here, we examined how temperature (17°C vs. 22°C) influenced behavioral hydroregulation in spotted salamanders (Ambystoma maculatum) using a laboratory humidity gradient. Salamanders defended a constant vapour pressure deficit (VPD) between temperatures by targeting higher RH at 22°C than at 17°C, possibly to compensate for increased evaporative demand at warmer temperatures. Individuals selecting higher VPDs experienced greater evaporative water loss (EWL), with larger salamanders losing more water than smaller ones after accounting for temperature. Together, these results highlight a trade-off among body size, humidity preference, and desiccation tolerance. Salamanders also rehydrated faster at 22°C than 17°C, highlighting temperature-dependent water uptake rates. Our finding that salamanders regulated a constant driving force of evaporation between temperatures suggests the ability to detect rates of EWL. Local cooling of the skin arising from evaporation is a plausible mechanism: if moist-skinned ectotherms allow for a specific, fixed decline in skin relative to core temperature, they can effectively detect the drive for evaporation. Ultimately, our study underscores the complexity of amphibian hydroregulation and emphasises the role of behaviour in maintaining hydration state.