bluuebunny/crossref_metadata_2025_split huggingface dataset:
Neurodevelopment of Children Whose Mothers Were Randomized to Low-Dose Aspirin During Pregnancy
Authors: Hoffman Matthew K. , Goudar Shivaprasad , Dhaded Sangappa , Figueroa Lester , Mazariegos Manolo , Krebs Nancy F. , Westcott Jamie , Tikmani Shiyam Sunder , Karim Fatima , Saleem Sarah , Goldenberg Robert L. , Lokangaka Adrien , Tshefu Antoinette , Bauserman Melissa , Patel Archana , Das Prabir , Hibberd Patricia , Chomba Elwyn , Mwenchanya Musaku , Carlo Waldemar A. , Trotta Marissa , Williams Alexis , Moore Janet , Nolen Tracy , Goco Norman , McClure Elizabeth M. , Lobo Michele A. , Cunha Andrea B. , Derman Richard J. 
Published: January 2024

OBJECTIVE:
Because low-dose aspirin is now commonly prescribed in pregnancy, we sought to assess the association between early antenatal exposure and child neurodevelopment.

METHODS:
We performed a noninferiority, masked, neurodevelopmental follow-up study of children between age 33 and 39 months whose mothers had been randomized to daily low-dose aspirin (81 mg) or placebo between 6 0/7 and 13 6/7 weeks of gestation through 37 weeks. Neurodevelopment was assessed with the Bayley-III (Bayley Scales of Infant and Toddler Development, 3rd Edition) and the ASQ-3 (Ages and Stages Questionnaire, 3rd Edition). The primary outcome was the Bayley-III cognitive composite score with a difference within 4 points demonstrating noninferiority.

RESULTS:
A total of 640 children (329 in the low-dose aspirin group, 311 in the placebo group) were evaluated between September 2021 and June 2022. The Bayley-III cognitive composite score was noninferior between the two groups (−1, adjusted mean −0.8, 95% CI, −2.2 to 0.60). Significant differences were not seen in the language composite score (difference 0.7, 95% CI, −0.8 to 2.1) or the motor composite score (difference −0.6, 95% CI, −2.5 to 1.2). The proportion of children who had any component of the Bayley-III score lower than 70 did not differ between the two groups. Similarly, the communication, gross motor, fine motor, problem-solving, and personal–social components of the ASQ-3 did not differ between groups. Maternal characteristics, delivery outcomes, breastfeeding rates, breastfeeding duration, and home environment as measured by the Family Care Indicators were similar.

CONCLUSION:
Antenatal low-dose aspirin exposure was not associated with altered neurodevelopmental outcomes at age 3 years.

CLINICAL TRIAL REGISTRATION:

ClinicalTrials.gov, NCT04888377.
Characteristics and outcomes of non-operatively managed hip fracture patients using the Dutch Hip Fracture Audit (DHFA).
Authors: Bremen Hanne-Eva van , Seppala Lotta J. , Hegeman Johannes H. , van der Velde Nathalie , Willems Hanna C. ,   on behalf of Dutch Hip Fracture Audit Group
Published: January 2024

OBJECTIVE:
This study aims to identify and compare characteristics of hip fracture patients treated non-operatively versus those treated operatively.

METHODS:

Design:
Retrospective cohort study.

Setting:
Hip fracture population-based study.

Patient Selection Criteria:
All adult patients with hip fractures (OTA/AO 31A and 31B) were included. Patients with pathological or periprosthetic hip fractures were excluded.

Outcome Measures and Comparisons:
Patients were categorized according to the type of management (operative vs non-operative) and type of fracture (nondisplaced vs other). Patient- and fracture characteristics associated with non-operative management were analyzed.

RESULTS:
A total of 94.930 hip fracture patients were included. 3.2% of the patients were treated non-operatively. Patients receiving non-operative management were older (86 years [interquartile range 79-91] vs 81 years [interquartile range 72-87] P <.001), more frequently institutionalized (42.4% vs 17.6%), and were more dependent in activities of daily living (22.2% vs 55.0%) . Various clinical characteristics, including dementia (odds ratio 1.31 [95% confidence interval, 1.18-1.45] P < .001), no functional mobility (odds ratio 4.39 [95% confidence interval 3.14-3.68] P <.001), and KATZ-6-ADL (OR 1.17 [95% CI 1.14-1.20] P < .001) were independently associated with non-operative management. 7-day mortality was 37.6%, and 30-day mortality was 57.1% in patients treated nonoperatively.

CONCLUSIONS:
The first step in understanding which patients potentially benefit from non-operative management is evaluating the current standard of care. This study provides insight to the current hip fracture population treated non-operatively. These patients are older, have higher percentage of dementia, more dependent and show higher short-term mortality rates.

LEVEL OF EVIDENCE:
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
Gamification in Critical Care Education and Practice
Authors: Bass Gary Alan , Chang Cherylee W. J. , Sorce Lauren R. , Subramanian Sanjay , Laytin Adam D. , Somodi Reka , Gray Jaime R. , Lane-Fall Meghan , Kaplan Lewis J. 
Published: January 2024

OBJECTIVES:
To explore gamification as an alternative approach to healthcare education and its potential applications to critical care.

DATA SOURCES:
English language manuscripts addressing: 1) gamification theory and application in healthcare and critical care and 2) implementation science focused on the knowledge-to-practice gap were identified in Medline and PubMed databases (inception to 2023).

STUDY SELECTION:
Studies delineating gamification underpinnings, application in education or procedural mentoring, utilization for healthcare or critical care education and practice, and analyses of benefits or pitfalls in comparison to other educational or behavioral modification approaches.

DATA EXTRACTION:
Data indicated the key gamification tenets and the venues within which they were used to enhance knowledge, support continuing medical education, teach procedural skills, enhance decision-making, or modify behavior.

DATA SYNTHESIS:
Gamification engages learners in a visual and cognitive fashion using competitive approaches to enhance acquiring new knowledge or skills. While gamification may be used in a variety of settings, specific design elements may relate to the learning environment or learner styles. Additionally, solo and group gamification approaches demonstrate success and leverage adult learning theory elements in a low-stress and low-risk setting. The potential for gamification-driven behavioral modification to close the knowledge-to-practice gap and enable guideline and protocol compliance remains underutilized.

CONCLUSIONS:
Gamification offers the potential to substantially enhance how critical care professionals acquire and then implement new knowledge in a fashion that is more engaging and rewarding than traditional approaches. Accordingly, educational undertakings from courses to offerings at medical professional meetings may benefit from being gamified.
Delayed Postnatal Synostosis without Spheno-occipital Synchondrosis Fusion: A Curious Case of Apert Syndrome
Authors: Ng Jinggang J. , Massenburg Benjamin B. , Wu Meagan , Romeo Dominic J. , Swanson Jordan W. , Taylor Jesse A. , Bartlett Scott P. 
Published: January 2024

Summary:
Apert syndrome classically presents with craniosynostosis at birth, most commonly of the bilateral coronal sutures, which may lead to cephalocranial disproportion and elevated intracranial pressure, the latter of which is associated with optic atrophy, visual loss, and developmental delays. A small number of patients with syndromic craniosynostosis demonstrate open sutures at birth; however, all previously reported patients of this subtype have been reported to develop premature suture fusion in the early postnatal period and/or require cranial vault expansion for increased intracranial pressure. Here, we report on a patient with Apert syndrome who did not have closed sutures at birth, and only began to demonstrate unilateral coronal suture fusion between ages 4 and 6 years, yet neither developed phenotypic signs of craniosynostosis nor evidence of intracranial hypertension. Moreover, despite demonstrating patency of the spheno-occipital synchondrosis, the patient developed progressive midface hypoplasia, requiring a subcranial Le Fort 3 advancement with external distraction at age 9. Now at skeletal maturity, this patient has a normal cranial shape and will likely never require cranial vault surgery for functional or aesthetic concerns. We are not aware of any prior reports of a patient with Apert syndrome who did not require intracranial surgery over long-term follow-up.
Educating Future Generations of Surgeons across Borders: Novel Global Linked Hybrid Live Cadaveric Peripheral Nerve Surgical Training Course
Authors: Burahee Abdus S. , Duraku Liron S. , Hundepool Caroline A. , Eberlin Kyle R. , Moore Amy , Dy Christopher J. , Abdullah Shalimar , Rajaratnam Vaikunthan , Zuidam J. Michiel , Power Dominic M. 
Published: January 2024

Background:
This study aimed to evaluate a novel, multi-site, technology-facilitated education and training course in peripheral nerve surgery. The program was developed to address the training gaps in this specialized field by integrating a structured curriculum, high-fidelity cadaveric dissection, and surgical simulation with real-time expert guidance.

Methods:
A collaboration between the Global Nerve Foundation and Esser Masterclass facilitated the program, which was conducted across three international sites. The curriculum was developed by a panel of experienced peripheral nerve surgeons and included both text-based and multimedia resources. Participants’ knowledge and skills were assessed using pre- and postcourse questionnaires.

Results:
A total of 73 participants from 26 countries enrolled and consented for data usage for research purposes. The professional background was diverse, including hand surgeons, plastic surgeons, orthopedic surgeons, and neurosurgeons. Participants reported significant improvements in knowledge and skills across all covered topics (p < 0.001). The course received a 100% recommendation rate, and 88% confirmed that it met their educational objectives.

Conclusions:
This study underscores the potential of technology-enabled, collaborative expert-led training programs in overcoming geographical and logistical barriers, setting a new standard for globally accessible, high-quality surgical training. It highlights the practical and logistical challenges of multi-site training, such as time zone differences and participant fatigue. It also provides practical insights for future medical educational endeavors, particularly those that aim to be comprehensive, international, and technologically facilitated.
Identifying and Predicting Subgroups of Veterans With Mild Traumatic Brain Injury Based on Distinct Configurations of Postconcussive Symptom Endorsement: A Latent Class Analysis
Authors: Kinney Adam R. , Schneider Alexandra L. , King Samuel E. , Yan Xiang-Dong , Forster Jeri E. , Bahraini Nazanin H. , Brenner Lisa A. 
Published: January 2024

Objective:
To identify distinct subgroups of veterans with mild traumatic brain injury (mTBI) based on configurations of postconcussive symptom (PCS) endorsement, and to examine predictors of subgroup membership.

Setting:
Outpatient Veterans Health Administration (VHA).

Participants:
Veterans with clinician-confirmed mTBI who completed the Neurobehavioral Symptom Inventory (NSI), determined using the Comprehensive Traumatic Brain Injury Evaluation database. Individuals who tended to overreport symptoms were excluded via an embedded symptom validity scale.

Design:
Retrospective cohort study leveraging national VHA clinical data from 2012 to 2020. Latent class analysis (LCA) with a split-sample cross-validation procedure was used to identify subgroups of veterans. Multinomial logistic regression was used to examine predictors of subgroup membership.

Main Measures:
Latent classes identified using NSI items.

Results:
The study included 72 252 eligible veterans, who were primarily White (73%) and male (94%). The LCA supported 7 distinct subgroups of veterans with mTBI, characterized by diverging patterns of risk for specific PCS across vestibular (eg, dizziness), somatosensory (eg, headache), cognitive (eg, forgetfulness), and mood domains (eg, anxiety). The most prevalent subgroup was Global (20.7%), followed by Cognitive-Mood (16.3%), Headache-Cognitive-Mood (H-C-M; 16.3%), Headache-Mood (14.2%), Anxiety (13.8%), Headache-Sleep (10.3%), and Minimal (8.5%). The Global class was used as the reference class for multinomial logistic regression because it was distinguished from others based on elevated risk for PCS across all domains. Female (vs male), Black (vs White), and Hispanic veterans (vs non-Hispanic) were less likely to be members of most subgroups characterized by lesser PCS endorsement relative to the Global class (excluding Headache-Mood).

Conclusion:
The 7 distinct groups identified in this study distill heterogenous patterns of PCS endorsement into clinically actionable phenotypes that can be used to tailor clinical management of veterans with mTBI. Findings reveal empirical support for potential racial, ethnic, and sex-based disparities in PCS among veterans, informing efforts aimed at promoting equitable recovery from mTBI in this population.
Automated detection of vitritis using ultrawide-field fundus photographs and deep learning
Authors: Mhibik Bayram , Kouadio Desire , Jung Camille , Bchir Chemsedine , Toutée Adelaide , Maestri Federico , Gulic Karmen , Miere Alexandra , Falcione Alessandro , Touati Myriam , Monnet Dominique , Bodaghi Bahram , Touhami Sara 
Published: January 2024

Purpose:
Evaluate the performance of a deep learning (DL) algorithm for the automated detection and grading of vitritis on ultra-wide field (UWF) imaging.

Design:
Cross-sectional non-interventional study.

Method:
UWF fundus retinophotographs of uveitis patients were used. Vitreous haze was defined according to the 6 steps of the SUN classification. The DL framework TensorFlow and the DenseNet121 convolutional neural network were used to perform the classification task. The best fitted model was tested in a validation study.

Results:
1181 images were included. The performance of the model for the detection of vitritis was good with a sensitivity of 91%, a specificity of 89%, an accuracy of 0.90 and an area under the ROC curve of 0.97. When used on an external set of images, the accuracy for the detection of vitritis was 0.78. The accuracy to classify vitritis in one of the 6 SUN grades was limited (0.61), but improved to 0.75 when the grades were grouped in three categories. When accepting an error of one grade, the accuracy for the 6-class classification increased to 0.90, suggesting the need for a larger sample to improve the model performances.

Conclusion:
We describe a new DL model based on UWF fundus imaging that produces an efficient tool for the detection of vitritis. The performance of the model for the grading into 3 categories of increasing vitritis severity was acceptable. The performance for the 6-class grading of vitritis was limited but can probably be improved with a larger set of images.
NON-EXUDATIVE INTRARETINAL FLUID IN INTERMEDIATE AGE-RELATED MACULAR DEGENERATION
Authors: Servillo Andrea , Kesim Cem , Sacconi Riccardo , Battist Marco , Capuano Vittorio , Fragiotta Serena , Querques Lea , Parravano Mariacristina , Souied Eric H. , Bandello Francesco , Querques Giuseppe 
Published: January 2024

Background:
To describe the occurrence of non-exudative intraretinal fluid (IRF) in intermediate age-related macular degeneration (iAMD).

Methods:
A retrospective study was designed to include consecutive cases with iAMD associated with IRF. A multimodal imaging (MMI) approach was used to confirm diagnosis of IRF in iAMD. MMI included color fundus photograph, fundus autofluorescence, fluorescein angiography (FA), indocyanine green angiography (ICGA), optical coherence tomography (OCT) and OCT angiography (OCT-A).

Results:
Ten eyes of 10 patients (2 males and 8 females, ages 68-80) showing IRF in iAMD were included in the study. Mean best-corrected visual acuity was 20/40 Snellen equivalent. MMI including FA/ICGA, and OCT demonstrated the absence of macular neovascularization (MNV) in all cases; OCT-A did not detect any abnormal flow signal associated with IRF. Seven out of 10 patients developed IRF in correspondence of pigment epithelium detachment. Three out of 10 patients presented IRF in correspondence of an area of nascent geographic atrophy.

Conclusion:
Non-exudative intraretinal fluid in intermediate AMD is a novel, distinctive feature that is characterized by the presence of IRF with no evidence of MNV. We described different phenotypes of IRF in iAMD. The definite diagnosis of this condition requires further studies with thorough application of multimodal imaging.
Ten-year results of scleral-fixated intraocular lens implantation: outcomes of ab externo scleral fixation with 10-0 polypropylene suture
Authors: Desai Arjun , Pappuru Rajeev Reddy , Tyagi Mudit 
Published: January 2024

Purpose:
To describe long-term visual and anatomical outcomes of sutured scleral-fixated intraocular lens (SF IOL) implantation.

Setting:
Tertiary eyecare hospital in India.

Design:
Retrospective interventional noncomparative study.

Methods:
Postoperative change in corrected distance visual acuity (CDVA) and occurrence of complications were assessed from the patient medical records. Long-term SF IOL survival rates and factors affecting the occurrence of postoperative IOL-related complications were assessed. Patients with postoperative follow-up less than 10 years or incomplete medical records were excluded.

Results:
64 eyes of 53 patients were included. Follow-up duration was 11.4 ± 1.2 years. Mean preoperative CDVA was 0.71 ± 0.43 logMAR (Snellen equivalent: 6/30), and mean CDVA at the final visit was 0.52 ± 0.49 logMAR (Snellen equivalent: 6/18) (P < .01). 48% cases had CDVA of 6/12 or better at the last follow-up. 58% cases had coexistent ocular pathology affecting the final visual outcome. IOL and suture-related complications were the commonest and included IOL decentration (17% cases), IOL drop (14%), and suture exposure (6%). The probability of IOL survival (postoperative period without IOL-related complications) was 90.6% at 8 years and 81.2% at 10 years (Kaplan-Meier analysis). Occurrence of postoperative IOL-related complications was unaffected by patient sex, age, indication for surgery (trauma or other), previous intraocular surgery, or technique of scleral fixation (2-point or 4-point) (multivariate regression analysis).

Conclusions:
Although sutured SF IOL implantation is viable with favorable long-term visual outcomes, there is a risk of postoperative IOL-related complications. Occurrence of postoperative IOL-related complications is unaffected by patient and ocular factors.
A Systematic Review of Cochlear Implant-Related Magnetic Resonance Imaging Artifact: Implications for Clinical Imaging
Authors: Berry Joseph M. , Tansey James B. , Wu Lin , Choudhri Asim , Yawn Robert J. , MacDonald Charles Bruce , Richard Celine 
Published: January 2024

ObjectiveTo conduct a systematic review of the existing literature with the aim of evaluating and consolidating the present understanding of strategies for mitigating magnetic resonance imaging (MRI) artifacts related to cochlear implants in adult and pediatric patients, covering both in-vivo and ex-vivo investigations.Data SourcesA systematic review of MEDLINE-Ovid, Embase, Google Scholar, The Cochrane Library, and Scopus was performed from inception through April 2022. The protocol was registered with PROSPERO before commencement of data collection (CRD CRD42022319651).Review MethodsThe data were screened and collected by two authors independently, and eligibility was assessed according to Cochrane Handbook and Preferred Reporting Items for Systematic Review and Meta-Analysis recommendations, whereas the quality of the articles was evaluated using the NIH Study Quality Assessment.ResultsThe search yielded 2,354 potentially relevant articles, of which 27 studies were included in the final review. Twelve studies looked at 1.5-T MRI, four studies looked at 3-T MRI, eight studies looked at both 1.5 and 3 T, one study looked at 0.2 and 1.5 T, and one study looked at 3- and 7.0-T MRI. Nineteen studies focused on MRI sequences as a means of artifact reduction, nine studies focused on implant magnet positioning, two studies focused on head positioning, and one study focused on both magnet and head positioning. In terms of MRI sequences, diffusion-weighted imaging produced larger artifacts compared with other sequences, whereas fast spin echo/turbo spin echo sequences and fat suppression techniques produced smaller artifacts. The position of the magnet was also found to be important, with a magnet position more than 6.5 cm posterior to the external auditory canal producing the best images with the least distortion. The angle at which the magnet is placed also affects visibility of different brain structures.ConclusionProper head positioning, magnet placement at a distance of over 6.5 cm from the external auditory canal, use of spin echo sequences, and fat suppression techniques reduce the size and shape of MRI artifacts.
Tight junction proteins and biliary diseases
Authors: Merlen Grégory , Tordjmann Thierry 
Published: January 2024

Purpose of review
In the pathophysiological context of cholangiopathies and more broadly of hepatopathies, while it is conceptually clear that the maintenance of inter-cholangiocyte and inter-hepatocyte tight junction integrity would be crucial for liver protection, only scarce studies have been devoted to this topic. Indeed, in the liver, alteration of tight junctions, the intercellular adhesion complexes that control paracellular permeability would result in leaky bile ducts and bile canaliculi, allowing bile reflux towards hepatic parenchyma, contributing to injury during the disease process.

Recent findings
Last decades have provided a great deal of information regarding both tight junction structural organization and signaling pathways related to tight junctions, providing clues about potential intervention to modulate paracellular permeability during cholangiopathies pathogenesis. Interestingly, several liver diseases have been reported to be associated with abnormal expression of one or several tight junction proteins. However, the question remains unanswered if these alterations would be primarily involved in the disease pathogenesis or if they would occur secondarily in the pathological course.

Summary
In this review, we provide an overview of tight junction disruptions described in various biliary diseases that should pave the way for defining new therapeutic targets in this field.