bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Impact of Anxiety and Depression on Postoperative Pain Management and Emergency Room Visits in Pediatric Patients With Surgically Treated Lower Extremity Fractures: A Propensity-matched Cohort Analysis
Authors: Momtaz David , Jahn Jacob , Eskenazi Jordan , Peterson Blaire , Lawand Jad , Ghali Abdullah , Hosseinzadeh Pooya 
Published: February 2025

Background:
Anxiety and depression (AD) are prevalent comorbidities in pediatric patients and may influence postoperative outcomes. The impact of AD on postoperative pain medication use and emergency room (ER) visits in children with surgically treated lower extremity fractures has not been well-documented. This study aimed to evaluate the association between AD and outpatient postoperative pain medication requirements as well as ER visits in this population.

Methods:
A retrospective cohort study was conducted using electronic medical records from 2000 to 2023 in a large national database of health care organizations across the United States. Pediatric patients (age below 18) with surgically treated lower extremity fractures were included. Patients were categorized into 2 groups: those with AD and those without (No-AD). Patients were further dichotomized into 2 groups based on fracture location: femur (femur) versus tibia or ankle (tibia/ankle). Outcomes of interest included the use of intravenous (IV) opiates within 3 days postoperatively, the number of outpatient oral (PO) opiate prescriptions, and the proportion of patients with at least one ER visit within 1 year postsurgery. Hazard ratios (HRs) were calculated using Cox proportional hazard models, adjusting for demographic and clinical characteristics.

Results:
A total of 25,658 patients with either femur or tibia/ankle fractures were included. After matching, 735 patients were included in the AD femur cohort, and 945 in the AD tibia/ankle cohort. Each cohort was matched 1:1 with their control counterparts. In the femur fracture cohort, 49.80% of AD patients and 46.53% of No-AD patients required IV opiates within the first 3 days after surgery (HR, 1.09; P=0.21). Outpatient PO opiate use was significantly higher in AD patients (55.78% vs. 38.50%, HR, 1.64; P<0.001). In addition, AD patients had a higher proportion of ER visits (20.3% vs. 11.7%, HR, 1.68; P<0.001). In the tibia/ankle fracture cohort, 55.2% of AD patients and 48.3% of No-AD patients required IV opiates within the first 3 days (HR, 1.18; P<0.001). Outpatient PO opiate use was also higher in AD patients (46.35% vs. 32.06%, HR, 1.55; P<0.001). ER visits were more frequent in AD patients (21.26% vs. 9.63%, HR, 2.08; P<0.001).

Conclusions:
Pediatric patients with AD undergoing surgery for lower extremity fractures have increased postoperative pain medication requirements and higher rates of ER visits compared with those without AD. These findings highlight the need for targeted interventions, such as the use of preoperative counseling or multimodal pain regimens, to manage postoperative pain and reduce ER visits in this vulnerable population.

Level of Evidence:
Prognostic level III.
PETS (Percutaneous Epiphysiodesis Using Transphyseal Screws) in the Proximal Tibia: Deep Peroneal Nerve Proximity
Authors: Cha Myung-Jin , Avendano John P. , Buchanan Brienna K. , Zastrow Ryley K. , Ahlawat Shivani , Lee Rushyuan J. 
Published: February 2025

Background:
Percutaneous epiphysiodesis with transphyseal screws (PETS) is commonly used to treat limb-length discrepancy and angular knee deformity in children. PETS carries a small but serious risk of nerve injury from mechanical and/or thermal damage caused by instrumentation near the deep peroneal nerve (DPN). Our goals were to (1) characterize the location of the DPN to an ideally placed PETS screw in pediatric patients undergoing medial proximal tibia hemiepiphysiodesis; and (2) describe the optimal PETS screw trajectory in this location.

Methods:
This was a retrospective study of lower-extremity magnetic resonance imaging (MRI) of pediatric patients at our institution between January 2017 and July 2024. MRIs were excluded for incomplete visualization of the proximal tibia or the presence of tumors or fractures. Multiplanar reformations were generated to simulate the ideal medial proximal tibia PETS trajectory, defined as a screw crossing the medial 1/6 of the proximal tibia physis at a 55 degrees angle relative to the physis. Distances between the DPN and the ideal PETS trajectory were measured at the lateral cortical entry site on the proximal tibia, the point nearest the nerve, and the superficial fascia.

Results:
Of the 56 MRIs identified, 19 were included (mean patient age, 10.8 y, 68% female). Mean±SD distance from the DPN to the lateral cortical entry site of the tibia was 1.4±0.4 cm. The closest mean distance between the screw and DPN was 1.0±0.5 cm. Mean distance between the DPN and the superficial fascia was 2.4±0.7 cm. The screw trajectory was always anterior to the DPN.

Conclusions:
Given the proximity of transphyseal screws to the DPN during percutaneous epiphysiodesis of the medial proximal tibia, correct screw trajectory and a thorough understanding of the neurovascular anatomy in relation to bony landmarks is crucial to prevent nerve injury. In addition, biasing the screw path anteriorly can assist in maintaining a “safe zone” between the instrumentation and the DPN.

Level of Evidence:
Level III—retrospective cohort study.
Large L5–S1 Lordosis is an Independent Risk Factor for recurrENCE AFTER BOne Union of Pediatric Lumbar Spondylolysis at L5
Authors: Kuroshima Kohei , Miyazaki Shingo , Hiranaka Yoshiaki , Ryu Masao , Inoue Shinichi , Yurube Takashi , Kakutani Kenichiro , Tadokoro Ko 
Published: February 2025

Study Design:
Retrospective case-control study.

Objective.
To determine risk factors for recurrence of pediatric lumbar spondylolysis at L5 after return to sport in patients who achieved bone union with conservative treatment.

Summary of Background Data.
Pediatric lumbar spondylolysis is a stress fracture commonly observed in adolescent athletes, particularly at the L5 vertebra. Because some patients experience a recurrence of spondylolysis after bone fusion with conservative treatment, identifying risk factors for recurrence may help athletes continue sports activities, maintain performance levels, and preserve mental health.

Methods.
Of the 375 pediatric patients (<18 years of age) who received conservative treatment for lumbar spondylolysis at L5 between 2015 and 2021, 296 patients who achieved bone fusion and returned to their original sports activities were analyzed. Recurrence rate, sports, pathological stage of spondylolysis at initial examination, presence of spina bifida occulta (SBO), duration of conservative treatment for initial spondylolysis, and radiological parameters including lumber lordosis, L5–S1 lordosis, and sacral slope were examined. Recurrence and non-recurrence groups were compared using univariate and multivariate analyses to investigate risk factors for recurrence. A receiver operating characteristic (ROC) curve was drawn to determine cut-off values of the parameters to predict spondylolysis recurrence.

Results.
Recurrence was observed in 52 out of 296 patients (17.6%). Multivariate logistic regression analysis revealed that a large L5–S1 lordosis was a significant independent risk factor for recurrence. ROC analysis demonstrated a cut-off value of 24.5° for L5–S1 lordosis. Age, sex, SBO, and duration of conservative treatment for initial spondylolysis were not significant predictors of recurrence.

Conclusion.
We identified large L5–S1 lordosis as an independent risk factor for recurrence of pediatric lumbar spondylolysis at L5 following conservative treatment. Intensive athletic rehabilitation to prevent recurrence and follow-up measures to monitor and detect recurrence are recommended for patients with large L5–S1 lordosis.
Computer-aided diagnosis based on 3D deep convolutional neural network system using novel 3D magnetic resonance imaging sequences for high-grade prostate cancer
Authors: Oka Ryo , Li Bochong , Kato Seiji , Utsumi Takanobu , Endo Takumi , Kamiya Naoto , Nakaguchi Toshiya , Suzuki Hiroyoshi 
Published: February 2025

Abstract

Background
With the rising incidence of prostate cancer (PCa), there is a global demand for assistive tools that aid in the diagnosis of high-grade PCa. This study aimed to develop a diagnostic support system for high-grade PCa using innovative magnetic resonance imaging (MRI) sequences in conjunction with artificial intelligence (AI).

Materials and methods
We examined image sequences of 254 patients with PCa obtained from diffusion-weighted and T2-weighted imaging, using novel MRI sequences before prostatectomy, to elucidate the characteristics of the 3-dimensional (3D) image sequences. The presence of PCa was determined based on the final diagnosis derived from pathological results after prostatectomy. A 3D deep convolutional neural network (3DCNN) was used as the AI for image recognition. Data augmentation was conducted to enhance the image dataset. High-grade PCa was defined as Gleason grade group 4 or higher.

Results
We developed a learning system using a 3DCNN as a diagnostic support system for high-grade PCa. The sensitivity and area under the curve values were 85% and 0.82, respectively.

Conclusions
The 3DCNN-based AI diagnostic support system, developed in this study using innovative 3D multiparametric MRI sequences, has the potential to assist in identifying patients at a higher risk of pretreatment of high-grade PCa.
Robot-assisted Pelvic Reconstruction Using Rectus Abdominis Flap: Efficiency Evaluation of Adding a Third Surgeon
Authors: Kelecy Matthew W. , Iftekhar Noama , Allen Brett , Ezeanolue Edozie , Baynosa Richard C. 
Published: February 2025

Background:
The open rectus abdominis flap has long been a versatile workhorse in pelvic reconstruction. In an effort to reduce morbidity of open approach, robotic harvest techniques have been developed. Our institution previously published a retrospective study that compared outcomes between the robotic and open approaches between 2014 and 2019. Since then, our technique has evolved to include the addition of a general surgeon for simultaneous harvest site closure and flap insetting.

Methods:
This is an institutional review board–approved single-institution retrospective review of patients who underwent robotic rectus harvest using Da Vinci surgical system for perineal reconstruction between 2018 and June 2023. The dataset was stratified into patients who underwent 3-surgeon reconstruction versus 2-surgeon reconstruction. Data collected included demographics, risk factors, perioperative information, and postoperative outcomes.

Results:
In total, 21 patients underwent robotic rectus repair from 2018 to 2023 with operations occurring at 3 different hospitals. Of those patients 7 were excluded, resulting in 14 patients included for evaluation: 8 patients who underwent 3-surgeon operation and 6 in the 2-surgeon cohort. We found no difference in total operative time (508.1 versus 506.8, P = 0.48), total robotic console time (445.7 versus 424.0, P = 0.46), hospital length of stay (11.4 versus 8.0, P = 0.27), or overall complication rate (0.75 versus 0.83, P = 0.36).

Conclusions:
Although this is a small study, the data suggest that plastic surgeons trained in robotic techniques are well-equipped to perform the harvest, mesh repair, and flap inset without the addition of a general surgeon.
Coil or Plug-Assisted Retrograde transvenous obliteration (CARTO/PARTO) for treating portal hypertensive variceal bleeding: A multi-center, real-world 10-year retrospective study
Authors: Lee Edward Wolfgang , Saab Sammy , Eghbalieh Navid , Ding Peng-xu , Jeon Ung Bae , Ohm Joon Young , Chen Ronnie C. , Kim Man-Deuk , Han Kichang , Shim Dong Jae , Shin Jong Soo , Mirakhur Anirudh , Liu Chien-An , Park Jonathan , Hao Frank , Wong Man , Moreno Antonio , Singh Jasleen , Kaldas Fady , Farmer Douglas G. , Gonzalez-Abraldes Juan 
Published: February 2025

Background & Aims:
CARTO and PARTO are well-accepted treatment for gastric variceal (GV) bleeding. However, long-term (>2 years) clinical outcomes have yet to be studied. In this study, we investigated long-term clinical outcomes, including overall survival (OS) in 10 years

Methods:
We performed a multi-national, multi-center, retrospective study of CARTO/PARTO in GV treatments between 05/2012 and 07/2024. The primary study outcomes were a long-term OS and prognostic factors of CARTO/PARTO. The secondary outcomes were long-term clinical/technical success, complications, clinical changes including portal hypertensive symptoms.

Results:
A total of 311 patients (41% female; 69% CARTO) from 13 centers in five countries were included. The cumulative 1-, 3-, 5-, 7-, and 10-year OS rates were 98, 80, 68, 52, and 33%, respectively, with a median OS of 99 months. Prophylactic CARTO/PARTO showed a better OS than CARTO/PARTO for active bleeding (p=0.00035). The independent prognostic factors of OS were having high pre-MELD, concurrent HCC, treating GOV2, history of esophageal variceal bleeding, high pre-TBili, and ammonia levels. Notably, a high pre-MELD score >27 had a significantly higher mortality rate (92.6%) than a lower pre-MELD score (p<0.001). The overall cumulative 1-, 3-, 5-, 7-, and 10-year recurrent GV bleeding rates were 0.9, 3.2, 4.0, 4.5, and 5.4%, respectively. The overall technical and clinical success rates were 96.5% and 95.3%, respectively, with a 4.5% major complication rate over 10 years.

Conclusions:
CARTO and PARTO have excellent long-term survival and clinical outcomes. However, these are negatively affected by high MELD scores, concomitant HCC, and coexisting esophageal varices.
“An incomplete Kartagener syndrome presenting with recurrent exacerbation of bronchiectasis: a case report”
Authors: Gupta Pukar , Adhikari Pradeep , Ghimire Prashant , Nepal Susmita , Mandal Anjali , Ghimire Dipendra , Katwal Sitaram , Katwal Prakriti , Thapa Roshni 
Published: February 2025

Background:
Kartagener syndrome (KS), a rare subgroup of Primary Ciliary Dyskinesia (PCD) with an autosomal recessive pattern of inheritance is characterised by the clinical findings affecting the ciliary movement. It typically presents with a triad of sinusitis, bronchiectasis, and situs inversus, while cases lacking situs inversus are termed as incomplete KS posing diagnostic challenges.

Case Presentation:
A 42-year-old; non-smoker, non-alcoholic Nepalese male with a history of recurrent cough, nasal discharge and infertility was diagnosed with incomplete KS. His clinical examination revealed coarse crackles bilaterally and rhonchi while spirometry showed mixed obstruction & restrictive patterns. His imaging findings clearly indicated infective bronchiectasis. Symptomatic management and multidisciplinary care were initiated for him.

Discussion:
This case reveals the complexity of diagnosing incomplete KS, a subgroup of PCD. The presence of post-infective bronchiectasis, recurrent sinusitis strongly supported the diagnosis. Successful medical intervention and ongoing multidisciplinary management are crucial for addressing the patient’s diverse clinical manifestations.

Conclusion:
This case highlights the importance of recognizing the varied presentations of KS and/or PCD and the need for a multidisciplinary approach to its management. Increased clinical awareness and timely diagnosis are essential for improving patient outcomes and effectively managing potential complications.
Exploring the scope and output of neurosurgery in nepal: analysis of workforce development, challenges, and opportunities to neurosurgical care
Authors: Bipin Chaurasia , Kandel Dipendra , Mahat Sangam , Chudal Aakash 
Published: February 2025

Background:
The Lack of access to competent neurosurgical treatment in low-income countries is a serious concern. To advance the field, research plays a crucial role. This article provides an overview of the neurosurgical landscape in Nepal, identifying areas that require further research for better patient outcomes. Recent initiatives offer hope for closing the access gap and improving neurosurgical care globally.

Methodology:
The authors used PubMed database to search for articles containing the keyword “Neurosurgery in Nepal” with at least one Nepali author. All the articles published between 1 January 2000, and 29 March 2023, were included. The data obtained from this search was downloaded in CSV format and manually entered into Excel for analysis. Additionally, data regarding the number of medical colleges that train neurosurgery residents were gathered from the website of the Ministry of Education.

Results:
A review of 316 neurosurgery-related articles in Nepal revealed case reports (93) as the most common, alongside review articles (41) and clinical studies (25). Seven medical colleges provide MCh training, and one institute offers NBMS training, producing 11 neurosurgeons annually. This underscores the need to bridge the neurosurgical gap in Nepal.

Conclusion:
In conclusion, to address the growing demand for specialized care and provide better access to neurosurgical services, it is essential to prioritize the expansion of neurosurgical residency programs and the promotion of evidence-based medicine training.
Assessment of laparotomy-induced stress response in opium- and morphine-addicted rats by measuring serum glucose and corticosterone levels: an animal experiment
Authors: Pakbaz Yegneh , Eydivandi Sepideh , Khandani Ayda , Poursalehian Mohammad , Ghadri Hani , Baghai Wadji Massoud 
Published: February 2025

Background:
Surgical procedures induce stress responses similar to severe illnesses, activating the metabolic and neuroendocrine systems, especially the hypothalamic-pituitary-adrenal (HPA) axis. The resulting cortisol surge maintains homeostasis but can adversely affect recovery by elevating blood glucose levels and increasing the risk of complications. Given the high prevalence of opium use, especially in the Middle East and southwestern Asia, and its suspected impact on HPA axis function, this study assesses corticosterone (CS) and glucose as indicators of impaired neuroendocrine responses to surgical stress in an animal model with chronic opioid use.

Materials and methods:
Thirty-six male Wistar rats were randomly assigned to three groups: morphine-addicted, opium-addicted, and control. Addiction was induced by administering increasing doses of morphine or opium in drinking water, as verified by naloxone injections. Laparotomy was performed under ketamine and xylazine anesthesia. Blood samples were collected post-surgery and post-recovery to measure the CS and glucose levels.

Results:
This study included 30 rats, with ten rats per group. Post-surgery, mean CS levels were higher in the control group compared to the addicted groups, although not significantly higher. Thirty minutes post-recovery, CS levels remained elevated in the addicted groups. Mean glucose levels were significantly higher in the control group both immediately and thirty minutes post-recovery, indicating a sustained hyperglycemic response. No significant differences were observed between addicted groups in glucose levels.

Conclusion:
Our study suggests that chronic opioid use may reduce the neuroendocrine response to surgical stress, as shown by lower CS levels in addicted rats. This aligns with existing research on opioids and stress responses. However, the small sample size and lack of baseline measurements limit the findings. Future studies should use larger, more diverse samples and additional biomarkers. This pilot study highlights the need for further research on altered stress responses in opioid-addicted patients undergoing surgery, emphasizing the importance of tailored postoperative care.
Enhancing patient care: pharmacotherapeutic monitoring in community pharmacies - a literature review
Authors: Inshutiyimana Samuel , Ghanem Laura , Ramadan Nagham , Hammoud Doha , Wojtara Magda , Mshaymesh Sarah , Uwishema Olivier 
Published: February 2025

Background:
The role of community pharmacies has been transitioning from traditional drug dispensing methods to include more patient-centred services such as pharmacotherapeutic monitoring. With the increasing complexity of medication regimens and the rising prevalence of chronic diseases, pharmacotherapeutic monitoring plays a crucial role in preventing medication-related problems. This study aims to review patient outcomes of community pharmacies’ involvement in pharmacotherapeutic monitoring services. It also highlights advances in the monitoring process, the challenges involved, and relevant solutions.

Methods:
A narrative review was conducted from 8 April 2024 to 9 May 2024, where data was extracted from multiple research studies indexed in PubMed, EBSCOHost, and Google Scholar databases. This review included only previous articles written in English and had information relevant to community pharmacy, patient care, innovations in pharmacotherapeutic monitoring, and challenges associated with the monitoring process in community pharmacies.

Results:
Implementation of pharmacotherapeutic monitoring in community pharmacies improves patient outcomes and satisfaction. It minimizes adverse events by ensuring optimal dosing and patient adherence, which in turn reduces medical expenses and duration of hospitalization. However, factors such as inefficient analytical resources, lack of skilled personnel, and huge financial costs complicate implementation of pharmacotherapeutic monitoring in community pharmacies.

Conclusion:
Community pharmacies’ participation in therapeutic drug monitoring is a promising development that prioritizes tailored patient care, eliminating the need for hospital visits. We recommend a multidisciplinary collaboration, robust electronic medical record systems, and large-scale research studies to provide sufficient evidence on the application of therapeutic drug monitoring in community pharmacies, to leverage this service. Also, policy and decision-makers should facilitate this practice by investing more in pharmacotherapeutic monitoring tools and training for community pharmacists.
Improving Adherence to the Lead Exposure Protocol at Boston Medical Center’s Pediatric Clinic
Authors: Barzilay Julie R. , Mell Anthony J. , Driscoll MaryKate , Gonzalez Priscilla , Meyers Sarah , Buncher Noah 
Published: February 2025

Introduction:
Using plan-do-study-act cycles, our team aimed to increase mean provider adherence to the Lead Exposure Protocol at the Boston Medical Center Pediatric Primary Care Clinic from 16% (baseline global mean provider adherence) to 80% from April 1, 2021, to February 1, 2023, thereby curbing the secondary effects of lead exposure.

Methods:
Our team performed a chart review of patients 6 months to 5 years of age with blood lead levels (BLLs) ≥2 µg/dL (n = 853) to track provider adherence to Boston Medical Center’s Lead Exposure Protocol. We created p charts to track the efficacy of interventions to improve adherence. Interventions included (1) electronic medical record SmartPhrases, (2) provider education, (3) provider feedback, (4) implementation of a follow-up nursing workflow, and (5) simplification of nursing workflow.

Results:
For BLL 2–4 µg/dL (n = 783), a centerline shift in provider adherence was observed, with >8 points above the preintervention mean after intervention (2) and an increase in mean adherence from 14.1% to 50%. For BLL 5–9 µg/dL (n = 58), no centerline shift was observed, with only 6 points above the upper control limit after intervention (4). The 2–4 µg/dL range changes indicate special cause variance and system change. Global mean provider adherence increased by 3.3 times to 53%.

Conclusions:
Simple, low-cost process changes improved adherence to complex guidelines for managing lead-exposed children in the primary care setting. Similar interventions could be implemented on a broader scale to standardize the management of other routine pediatric screens.