bluuebunny/crossref_metadata_2025_split huggingface dataset:
Association Between Surgeon Volume and Patient Outcomes After Elective Patellofemoral Arthroplasty
Authors: Vella-Baldacchino Martinique , Davies Andrew Rhys , Bottle Alex , Cobb Justin , Liddle Alex D. 
Published: February 2025

Background:
The objective of this study was to determine the relationship between surgical volume and patient outcome after arthroplasty of the patellofemoral joint, to improve patient outcomes and inform future resource planning.

Methods:
All patellofemoral arthroplasty (PFA) records in the National Joint Registry from January 2003 to December 2021 were linked to the Hospital Episode Statistics database for England. The main outcome measure was revision surgery. Secondary outcome measures were serious adverse effects, patient selection characteristics, and implant designs used. Associations of early and late revision with surgical volume were examined based on surgical volume, and reasons for revision were explored.

Results:
Of the knee arthroplasty surgeons in the database, 858 (26%) performed ≥1 PFA during the study period; 14,615 PFA cases were available for analysis. The modal caseload was 2 per year. High-volume surgeons were defined as surgeons performing >5 PFAs per year. The hazard ratio (HR) for a high-volume surgeon was 0.98 per additional PFA per year, and the patients treated by these surgeons had a lower risk of revision than than those treated by low-volume surgeons irrespective of the patient’s age. High-volume surgeons were more likely to identify and treat patients with patellar disorders than low-volume surgeons (odds ratio [OR], 1.34; 95% confidence interval [CI], 1.09 to 1.77; p < 0.05), and their patients were less likely to have serious adverse effects as these surgeons’ experience increased (OR per additional PFA per year, 0.97; 95% CI, 0.95 to 0.99; p = 0.02). Inlay implants had a higher risk of revision than onlay implants irrespective of surgical experience: for low-volume surgeons, inlays had an HR of 1.68 (95% CI, 1.23 to 2.30; p = 0.01), and for high-volume surgeons, inlays had an HR of 2.38 (95% CI, 1.83 to 3.11; p = 0.01). The most common reason for revision was progressive osteoarthritis. High-volume surgeons’ patients were less likely than low-volume surgeons’ patients to have an early revision (<2 years postoperatively) (OR, 0.72; 95% CI, 0.55 to 0.93; p < 0.05).

Conclusions:
An association was found between surgeons performing >5 PFAs per year and a lower revision rate. This study should inform surgical planning services to improve the outcomes of PFA.

Level of Evidence:
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
Risk of Fracture at External Fixator Pin Hole After Lateral Tibial Plateau Fracture Plating
Authors: Massey Patrick A. , Scalisi Wayne , Duval Chloe , Lowery Michael , Chauvin Brad , Solitro Giovanni F. 
Published: February 2025

Background:
External fixation of tibial plateau fractures commonly provides temporary stabilization before definitive fixation with plate and screws. The purpose of this study was to determine if an external fixator pin hole distal to a tibial plate in a synthetic fracture model would increase the risk of fracture after fixation. Another objective was to determine the ideal configuration when placing tibial plate screws near an external fixator pin hole.

Methods:
Thirty synthetic tibiae were tested and evenly divided into 5 groups. Tibial plateau plates were placed with 4 different screw configurations for the distal-most screw near the external fixator pin hole. The 5 groups tested were control (fixation with no external fixator hole), unicortical (distal fixation with a unicortical locking screw), bicortical (distal fixation with a bicortical locking screw), oblique (distal fixation with an oblique cortical screw angled 30° proximally from the external fixator hole), and hole-bridging (hole-bridging fixation in which the plate was placed bridging the external fixator hole). The bone surrogates were potted and tested using an Instron 8874 Testing System.

Results:
There was a significant difference in failure load among the 5 groups (p = 0.005). The mean peak loads were 1,259 N (control), 835 N (unicortical), 831 N (bicortical), 943 N (oblique), and 993 N (hole-bridging). There was a higher failure load in the control group compared with the bicortical group (p = 0.007) and the unicortical group (p = 0.007). There was no difference in failure load between the control group and the hole-bridging group (p = 0.16) and the oblique group (p = 0.067).

Conclusions:
External fixator pin holes distal to a tibial plateau plate may increase the risk of tibial fracture through the pin hole. This risk may be mitigated by placing the distal screw oblique and angled proximally away from the external fixator pin hole or by placing the external fixator pin proximally with subsequent bridging of the external fixator pin hole with the plate.
Excellent mechanical properties obtained in Si3N4/Cu joint with a network structure via brazing with AgCuTi/porous Cu foam/AgCuTi sandwich composite filler
Authors: Wang Ying , Feng Wei , Zhang Ruizhi , Liu Ruxia , Xiao Yong , Luo Guoqiang , Shen Qiang , Zhang Jian 
Published: February 2025

Abstract

AgCuTi/porous Cu foam/AgCuTi sandwich composite filler was used as the interlayer to enhance the brazing strength of the Si3N4/Cu joints. The typical microstructure of the joint brazed with the sandwich composite filler at 880 ℃ was Si3N4/TiN/Ti5Si3 + CuTi/Ag(s,s) + Cu(s,s)/Cu, where the Ag(s,s) + Cu(s,s) layer is an interpenetrating network structure. And the thickness of the TiN reaction layer increased from 0.58 µm to 1.28 µm when the thickness of the porous Cu foam layer increased from 100 µm to 300 µm. The Si3N4/Cu joint obtained with 300 µm porous Cu foam owned the highest shear strength of 121.7 MPa, which improved by 281% than that with the use of AgCuTi filler alone. Further EBSD analysis and finite element simulation revealed that the reduction in residual stress and the increase in plastic deformation effect induced by the Ag(s,s) + Cu(s,s) interpenetrating network structure are the key factor for the enhancement of the mechanical properties of this Si3N4/Cu joint brazed with AgCuTi/porous Cu foam/AgCuTi sandwich composite filler.
Influence of powder preparation technique on microstructure, densification, mechanical and tribological properties of composites based on Al₂O₃ with addition of WC-Co hard metal
Authors: Azevêdo Heytor V.S.B. , Raimundo Rafael A. , Morais Luís M.F. , Lourenço Cleber S. , Câmara Nailton T. , Macedo Daniel A. , Cavalcante Danielle G.L. , Gomes Uílame U. 
Published: February 2025

Abstract

In the present work, the influence of the powder preparation technique on the sintering behavior of 80 wt.% Al2O3-18 wt.% WC-2 wt.% Co composites was investigated. The powders were mixed with a mechanical stirrer for 10 min (MM) and by high-energy milling (HEM) for 50 h. They were then compacted at 200 MPa and sintered in a resistive dilatometric furnace for 1 h under argon atmosphere at a heating rate of 10°C/min for two sintering temperatures (1300°C and 1550°C). The powders prepared by MM and HEM were further characterized by XRD, SEM and dynamic light scattering (DLS), while the sintering kinetics was evaluated by dilatometry. The powders processed by HEM presented better dispersion and homogenization than those obtained by mechanical mixing (MM). The HEM approach enhances the sintering of immiscible systems that present low sinterability, as well as improves dispersion, phase refining and produces composite particles with greater interaction of the milled elements. In addition, HEM decreases the particle/crystallite size and increases the microstrain. The results showed that composites prepared by HEM and sintered at 1550 ºC presented better densification, Vickers microhardness and tribological behavior.
Rhizobium rhizogenes -elicited hairy root cultures of Sida acuta Burm.f.: extracts attenuate streptozotocin-induced hyperglycaemic effects in Wistar rats
Authors: Jena Somanatha , Rout Kedar K. , Mishra Sagar K. , Chand Pradeep Kumar 
Published: February 2025

Abstract

Genetically transformed root (TR) clones (rhizoclones) were developed of an ethno-medicinal plant species, Sida acuta mediated by Rhizobium rhizogenes. Various key factors (bacterium × plant × culture environment) were optimized for the transformation event per se and hairy root growth. RT-PCR amplification demonstrated transcription activity of opine biosynthetic genes and opine production was confirmed in rhizoclones. Anti-hyperglycemic activity of the methanolic/aqueous extracts of a selected rolB ORF-positive fast-proliferating TR clone was investigated vis-á-vis natural roots (NR) employing streptozotocin-induced Wistar diabetic rats. Compared to root extracts of naturally occurring donor plants, aqueous extract of the TR clone caused a more pronounced reducing effect on fasting blood glucose level and normalization of biochemical indices (serum and urine) as hepatic/renal functional markers, Metabolic attenuation was evident in respect of insulin and hepatic glycogen content as well as biochemical levels of blood serum, liver-specific enzymes and urine-specific biochemicals. Aqueous TR extracts, and the purified β-sitosterol isolate from such extracts, at optimal levels, demonstrated anti-hyperglycemic activity, to a considerable extent, which was comparable with that of the commercial drug glibenclamide towards restitution of biochemical homeostasis in the diabetic rats. Our finding on fast-renewable transformed root culture extract, capable of a noteworthy glycemic control in diabetic rats, ushers a possibility of designing and developing potent bioactive anti-diabetic drug(s) to be implicated in human healthcare.
Insights Into Foreign Body Aspiration In Pediatrics: Complications And Predictors At Felege Hiwot And Debre Markos Compressive Specialized Hospitals North West Ethiopia 2024
Authors: Temesgen Abathun , Yeshiwas Almaw Genet , Yenew Chalachew , Gebeyehu Asaye Alamneh , Anteneh Rahel Mulatie , Tsega Tilahun Degu , Bayeh Gashaw Melkie , Ahmed Ahmed Fentaw 
Published: February 2025

Abstract

Background: Foreign body aspiration (FBA) is a major source of morbidity in pediatric patients and can result in serious complications if not addressed quickly. Prompt intervention is essential to avoid life-threatening consequences. This study sought to assess the prevalence and contributing factors of complications in pediatric patients with aerodigestive foreign bodies at FHCSH and DMCSH, North West Ethiopia, 2024.
Methods: A retrospective cohort study was conducted using patient records of children aged 0-14 years diagnosed with aerodigestive foreign bodies. Logistic regression was used to identify determinants associated with airway and esophageal complications. Descriptive and inferential statistics (chi-square and t-tests) were applied, with p < 0.05 considered significant. Data were analyzed using SPSS version 26.
Result: 411 pediatric patients were included in this study, with a response rate of 98.3%. The overall proportion of patients who developed complication was 46.7%. Patients who did not maintain oxygen saturation through atmospheric air (AOR=2.138, 95% CI: 1.334, 3.425), those requiring more than 48 hour for bronchoscopy procedure (AOR=2.786, 95% CI: 1.399, 3.786), needs mechanical ventilation (AOR= 2.618, 95% CI: 1.379, 4.968), Presenting beyond 24 hour after infection (AOR=2.547, CI: 1.457, 4.451), having preoperativeinfection (AOR=5.381, 95% CI: 3.103, 9.332). In addition, with sharp object, teeth and bones asforeign bodies (AOR= 4.944, 95% CI: 1.840, 13.282), were significantly associated with the level of postoperative sore throat.
Conclusion: This study indicates a significant complication rate among pediatric patients, identifying factors such as preoperative infections, oxygen saturation issues, mechanical ventilation, and ingestion of high-risk foreign bodies, prolonged bronchoscopy procedures, and delays in seeking medical care.
Recommendation: Enhancing monitoring, ensuring prompt medical intervention and conducting detailed preoperative assessments are crucial for minimizing complications and improving outcomes in pediatric procedures.
Paleoclimate Transition Recorded by Palynological and Clay Mineral Evidence in the Santanghu Basin during the Middle Jurassic
Authors: Yang Bing , Zhang Di , Zhang Xinzhi , Sun Siyuan , Li Weitong 
Published: February 2025

Abstract

The arid event that began in the Middle Jurassic Bathonian stage marks the second major drought event in northern China during the Jurassic period and had a profound impact on the development of modern terrestrial ecosystems. This study reconstructs the paleoclimate and paleoecosystem of the Middle Jurassic Santanghu Basin by analyzing palynological assemblages and clay minerals from the Xishanyao and Toutunhe formations. Two distinct palynological assemblages were identified: the Cyathidites-Deltoidospora-Osmundacidites-Cycadopites(CDOC) assemblage (Aalenian–Bajocian) and the Cyathidites-Classopollis-Quadraeculina(CCQ) assemblage (Bathonian). In terms of vegetation types, during the Aalenian–Bajocian stage, the Santanghu Basin was dominated by ground cover vegetation primarily consisting of ferns, with a midstory composed mainly of cycads/ginkgophytes, and a sparse canopy dominated by conifers. By the Bathonian stage, this shifted to a vegetation structure dominated by coniferous canopy vegetation, a subordinate midstory of cycads/ginkgophytes, and a severely degraded ground cover dominated by ferns. Sporomorph EcoGroup (SEG) analysis indicates that the CDOC assemblage is characterized by high Lowland SEG wetter/drier and warmer/cooler ratios, reflecting a warm and humid climate. In contrast, the CCQ assemblage also shows high Lowland SEG wetter/drier and warmer/cooler ratios but indicates a warm and arid climate. Clay mineral data reveal that the kaolinite content in the CCQ assemblage is significantly lower than in the CDOC assemblage. Evidence from both palynology and clay minerals suggests that the Santanghu Basin experienced a transition from a humid to a semi-arid climate near the Bajocian–Bathonian boundary in the Middle Jurassic.
Smallholder farmers'vulnerability and risk behaviour to climate-induced stresses in the CSVs of Nyando Basin:Effects towards designing household and village level approaches
Authors: Karuku George , Busienei John , Gathiaka John , Njogu Josephine 
Published: February 2025

Abstract

Many African countries have low adaptive capacities of technologies and high dependence on rain-fed agriculture, which makes them more vulnerable to climate change and variability. Climate smart village (CSV) approach not only includes Climate Smart Agriculture (CSA) interventions, but also solutions to improve livelihoods among smallholder farmers. The study objective was to determine to what extent smallholders are exposed to climate-induced stresses, and factors determining behaviour choice for resilience in Nyando basin, Kenya. Data collection used a multi-stage sampling procedure to identify 90 CSA adopters and 32 non-adopters. The results showed that soil degradation, droughts, pests and diseases, including floods were major climate related constraints in Nyando basin. Households’ vulnerability to climate unpredictability showed 8% and 17% of CSA adopters and non-adopters respectively were most vulnerable. Crop diversification had a major contribution to respondents’ adaptive capability suggesting a reduction in vulnerability associated to climatic risks such as droughts and floods. Majority of households exhibited extreme exposure to climate variations with low adaptive capacity. Determinants on use of CSA practices and technologies by farmers included; women increased use of fertilizers, improved seeds and varieties on crop management and conservation agriculture (CA). The influence of cooperative/ joint crop management integrated with CA revealed a vital revolution in household gender equity in relation to crop management. The study recommends application of technologies and practices plus incorporating gender equity in trainings and sharing of information. Also, access to safety nets by the highly exposed vulnerable communities to reduce their sensitivity to climate induced stresses.
Stroke prevalence and associated factors among older patients with hypertension attending public healthcare facilities in Greater Kampala Metropolitan Area, Uganda
Authors: Tamale Bridget Nagawa , Muhumuza Christine , Nalugya Aisha , Isunju John Bosco , Mugambe Richard K , Nakalembe Doreen , Lusabe Asadi , Mbalinda Scovia Nalugo , Kaddumukasa Martin N , Ssekamatte Tonny , Kayemba Christine Nalwadda 
Published: February 2025

Abstract

Background
Globally, stroke is one of the top three leading causes of death and disability. Although several stroke risk factors are modifiable, including hypertension, factors associated with stroke among older patients with hypertension in Uganda remain underexplored. This study assessed the prevalence and factors associated with stroke among older patients with hypertension in public healthcare facilities in the Greater Kampala Metropolitan Area, Uganda.
Methods
A cross-sectional study was conducted among 383 older patients with hypertension. Systematic sampling was used to recruit study participants, and STATA 15.0 was used for analysis. Descriptive statistics were used to present continuous variables, while frequencies and proportions were used to present categorical data. Bivariate analyses identified associations between independent variables and stroke. Multivariable analyses controlled for confounders. A modified Poisson regression analysis with robust standard errors estimated prevalence ratios.
Results
Of the 383 respondents, 71.0% (272/383) were aged 60–69 years (mean age 66.8 ± 7.1), 80.9% (310/383) were female, and 42.8% (164/383) had a primary education level (1–7 years). About 31.9% (122/383) exercised regularly, 94.8% (363/383) consumed carbohydrates frequently, 5.2% (20/383) had ever smoked, and 42.0% (151/383) had ever consumed alcohol. The prevalence of stroke was 18.3% (70/383). The factors associated with stroke included being aged 80 years and above (APR = 2.68, 95% CI: 1.59–4.51), having 8–13 years of formal education (secondary education)(APR = 0.37, 95% CI: 0.14–0.98), possessing health insurance (APR = 3.34, 95% CI: 1.19–9.37), having high knowledge of stroke (APR = 24.72, 95% CI: 6.20-98.55), and receiving stroke-related health information (APR = 1.78, 95% CI: 1.05–3.02).
Conclusion and recommendation:
This study demonstrated a high prevalence of stroke among older patients with hypertension. Public health education and community outreach should be expanded to underserved populations, while age-specific hypertension management and affordable healthcare services are essential. Engaging men and leveraging stroke survivors as peer educators can further strengthen prevention efforts. Future research should explore barriers to prevention and develop tailored interventions for diverse populations
Generalist Large Language Models in a Specialized World: Evidence from the Italian National Medical Education Pathway
Authors: Buonocore Tommaso Mario , Russo Antonio , Mingarelli Dario , Parimbelli Enea 
Published: February 2025

Abstract

Creating language-specific and domain-specific large language models presents substantial challenges, including computational demands and limited data availability. While it is commonly believed that the benefits of specialized models justify these challenges, we dispute this notion with a comparative evaluation in a low-resourced language and medical-specific domain. In our study, we analyze the performance of various LLMs applied to the Italian healthcare domain using novel unpublished datasets, consisting of five-choice questions from national pre-university and post-university medical exams, covering clinical and preclinical fields. As part of this work, we release these datasets to the research community. We evaluated multilingual and Italian-specific models, along with general-purpose and healthcare-specific models, spanning both open-source and proprietary architectures of varying sizes. Our results demonstrate that multilingual, general-purpose large models consistently exceed the pass threshold across all tests, with the best models achieving over 90% accuracy on postgraduate-level exams. Model size emerged as the most critical factor influencing performance, whereas domain specialization and single-language localization offered no measurable advantage. These findings challenge the traditional pretrain-then-finetune paradigm for domain and language localization in language models, suggesting that advancements in generic-purpose multilingual models may render domain-specific pretraining unnecessary in many specialized cases.
Utilizing Machine Learning Models for Predicting Outcomes in Acute Pancreatitis: Development and Validation in Three Retrospective Cohorts
Authors: Gu Kaier , Liu Yang 
Published: February 2025

Abstract

Background
Acute pancreatitis (AP) is an acute abdominal disorder with diverse severity and prognosis. Machine learning (ML) technology has been increasingly integrated into the advancement of medical care, and the risk prediction models developed with ML show excellent predictive capabilities, thus manifesting considerable potential for application. This research aims to develop and validate an individualized predictive model to identify the short-term and long-term prognosis of AP patients utilizing machine learning models and dynamic measurement indicators.
Methods
The data of AP patients was sourced from the MIMIC database, which served as the training set and internal validation set. Meanwhile, external validation sets were obtained from eICU database and Wenzhou Hospital in China. Experimental indicator variables repeatedly measured during hospitalization were collected, including their maximum, average, and minimum values. In the training set, key variables were screened using univariate logistic regression and the LASSO method. ML models built include K-Nearest Neighbor, light gradient boosting machine, logistic regression (LR), random forest (RF), support vector machine, and eXtreme gradient boosting (XGB). This study had six clinical endpoints, including in-hospital mortality, readmission within 30 days, 60 days, and 90 days after discharge, and mortality within 180 and 365 days after discharge. Validation was conducted in the validation sets, and the efficacy of the prediction models was evaluated using area under the curve (AUC), sensitivity, specificity, positive predictive value, negative predictive value, and decision curve analysis (DCA), where AUC was the principal indicator for the assessment of model performance.
Results
A total of 2,559 AP patients were included. There were 12–26 clinical features selected for model training. Among the six ML prediction models under assessment, the AUCs of the LR, RF, and XGB models manifested superior performance. DCA further disclosed that these ML models displayed elevated predictive accuracy with respect to in-hospital mortality of AP patients admitted to the ICU. In the external validation sets, the XGB model has the best AUC, recorded as 0.930 and 0.827, showing its good versatility.
Conclusions
The XGB model is conducive to identifying the short-term and long-term prognoses of AP patients and facilitating the decision-making of clinicians.