bluuebunny/crossref_metadata_2025_split huggingface dataset:
Outcomes of Limb Lengthening With Computer-assisted Hexapod External Fixators in the Treatment of Fibular Hemimelia
Authors: Bakircioglu Sancar , Goker Barlas , Yilmaz Abdurrahman , Aksoy Taha , Aksoy Mehmet Cemalettin , Yilmaz Guney 
Published: May 2023

Background:
Fibular hemimelia (FH) represents the most common deficiency of the long bones and is associated with multiple deformities. Reconstructive treatment with external fixators in FH restores normal lower extremity alignment and length with plantigrade feet for a balanced and effective gait. The aim of this study is to evaluate the outcomes of lower limb lengthening and simultaneous tri-plane deformity correction with a computer-assisted hexagonal external fixator in children with FH.

Methods:
A retrospective review was performed for FH cases treated with a computer-assisted hexagonal external fixator in a tertiary referral center. Leg length discrepancy (LLD), interphyseal angles, tibiocalcaneal distances, healing index (HI), and callus shapes were analyzed for radiologic evaluation, and the Pediatric Quality of Life Inventory (PedsQL) was used for functional assessment. Limbs with HI <50 days/cm, PedsQL >75, and without regenerate fractures were considered successful lengthenings.

Results:
Twenty-four limbs of 23 patients were included. The limbs were lengthened for a mean of 7.24 cm (range, 4.7 to 15.6). The initial LLD of 5.6 cm (range, 0.5 to 19 cm) increased to 1.7 cm (range, 0.1 to 6 cm), and the mean interphyseal angle was 12.7 degree (range, 1.5 to 54.2 degree), tibiocalcaneal distance was 0.85 cm (range, 0.1 to 1.7) at final follow-up. The most common regenerated bone morphology was cylindrical, as seen in 11 limbs (45.8%). The average PedsQL score was 83.5 (range, 69.5 to 96.7). Sixteen limbs (66.7%) had successful lengthening at their first, and 4 limbs (80%) had successful lengthening at their second surgeries. Seven limbs had complications requiring surgical intervention (29.1%), with 3 (12.5%) regenerate fractures after external fixators removal.

Conclusions:
Limb reconstruction with computer-assisted hexapod fixators is a successful and reliable option for the treatment of LLD in FH, and patients demonstrate good functional outcomes. Surgeons should be aware of potential complications and should utilize prophylactic measures when necessary.

Levels of Evidence
Level III, retrospective comparative study
Achilles Tendon Injuries in the Pediatric Population
Authors: Ashebo Leta , Stevens Alexandra C. , MacAlpine Elle M. , Wittstein Jocelyn R. , Bradley Kendall E. , Lawrence J. Todd R. 
Published: May 2023

Background:Achilles tendon injuries are common in adults, and there is extensive literature describing the injury characteristics and treatment of these adult injuries. However, Achilles injuries are rare in the pediatric population and as a result, there is limited research reported on this age group. We therefore sought to characterize the injury presentation, treatment and outcomes for pediatric patients with partial and complete Achilles injuries.Methods:A retrospective chart review was conducted of patients aged 0-18 treated for Achilles tendon injuries at 2 geographically distinct tertiary institutions between 2008 and 2021. Data collected included demographics, injury characteristics, and treatment course. Injury types were separated into 2 cohorts: traumatic Achilles injuries and ruptures due to muscular contraction. Traumatic injuries were further delineated into 2 injury mechanisms: open injuries related to penetrating trauma and closed injuries related to blunt trauma. Standard descriptive analyses were utilized to summarize findings.Results:Thirty-nine patients (43.6% female, median age 15 years) were identified, 29 (74.4%) of whom had complete tears. Twenty-five patients (64.1%) presented with traumatic injuries; among these, 48.0% (n=12/25) were ≤12 years. All patients ≤12 years sustained a traumatic injury. The most common traumatic mechanism was an open laceration due to penetrating trauma (68.0%), followed by closed ruptures associated with blunt trauma (32.0%). Fourteen patients (35.9%) presented with closed ruptures due to muscular contraction. Four patients (10.2%) had a prior history of clubfoot treated with Achilles tenotomy. Thirty-five patients (89.7%) were surgically treated with an open repair. The median immobilization period across all patients was 11 weeks (interquartile range: 10-12), starting most commonly with a posterior splint (46.2%) and concluding with a CAM boot (94.9%). Of patients with full follow-up data (n=22/39), all resumed normal activities, with a median clearance time of 6 months (interquartile range: 5-7.9).Conclusions:We found that older adolescents (≥14 y) were more likely to rupture their Achilles tendon through a forceful muscular contraction, whereas younger patients (≤12 y) were more likely to injure their Achilles via a traumatic mechanism. Most patients were treated operatively and returned to sports at a median time of 6 months. A further prospective study is warranted to better characterize treatment protocols and patient outcomes in this population.Level of Evidence:Level—IV.
Trade-off Between Quarantine Length and Compliance to Optimize COVID-19 Control
Authors: Zou Kaiyue , Hayashi Michael , Simon Sophia , Eisenberg Joseph N.S. 
Published: May 2023

Background:
Guidance on COVID-19 quarantine duration is often based on the maximum observed incubation periods assuming perfect compliance. However, the impact of longer quarantines may be subject to diminishing returns; the largest benefits of quarantine occur over the first few days. Additionally, the financial and psychological burdens of quarantine may motivate increases in noncompliance behavior.

Methods:
We use a deterministic transmission model to identify the optimal length of quarantine to minimize transmission. We modeled the relation between noncompliance behavior and disease risk using a time-varying function of leaving quarantine based on studies from the literature.

Results:
The first few days in quarantine were more crucial to control the spread of COVID-19; even when compliance is high, a 10-day quarantine was as effective in lowering transmission as a 14-day quarantine; under certain noncompliance scenarios a 5-day quarantine may become nearly protective as 14-day quarantine.

Conclusion:
Data to characterize compliance dynamics will help select optimal quarantine strategies that balance the trade-offs between social forces governing behavior and transmission dynamics.
Wildfire Exposure and Health Care Use Among People Who Use Durable Medical Equipment in Southern California
Authors: McBrien Heather , Rowland Sebastian T. , Benmarhnia Tarik , Tartof Sara Y. , Steiger Benjamin , Casey Joan A. 
Published: May 2023

Background:
People using electricity-dependent durable medical equipment (DME) may be vulnerable to health effects from wildfire smoke, residence near wildfires, or residence in evacuation zones. To our knowledge, no studies have examined their healthcare utilization during wildfires.

Methods:
We obtained 2016–2020 counts of residential Zip Code Tabulation Area (ZCTA) level outpatient, emergency department (ED), and inpatient visits made by DME-using Kaiser Permanente Southern California members 45+. We linked counts to daily ZCTA-level wildfire particulate matter (PM)2.5 and wildfire boundary and evacuation data from the 2018 Woolsey and 2019 Getty wildfires. We estimated the association of lagged (up to 7 days) wildfire PM2.5 and residence near a fire or in an evacuation zone and healthcare visit frequency with negative binomial and difference-in-differences models.

Results:
Among 236,732 DME users, 10 µg/m3 increases in wildfire PM2.5 concentration were associated with the reduced rate (RR = 0.96; 95% confidence interval [CI] = 0.94, 0.99) of all-cause outpatient visits 1 day after exposure and increased rate on 4 of 5 subsequent days (RR range 1.03–1.12). Woolsey Fire proximity (<20 km) was associated with reduced all-cause outpatient visits, whereas evacuation and proximity were associated with increased inpatient cardiorespiratory visits (proximity RR = 1.45; 95% CI = 0.99, 2.12, evacuation RR = 1.72; 95% CI = 1.00, 2.96). Neither Getty Fire proximity nor evacuation was associated with healthcare visit frequency.

Conclusions:
Our results support the hypothesis that wildfire smoke or proximity interrupts DME users’ routine outpatient care, via sheltering in place. However, wildfire exposures were also associated with increased urgent healthcare utilization in this vulnerable group.
Examining the Relationship Between Extreme Temperature, Microclimate Indicators, and Gestational Diabetes Mellitus in Pregnant Women Living in Southern California
Authors: Teyton Anais , Sun Yi , Molitor John , Chen Jiu-Chiuan , Sacks David , Avila Chantal , Chiu Vicki , Slezak Jeff , Getahun Darios , Wu Jun , Benmarhnia Tarik 
Published: May 2023

Introduction:
Few studies have assessed extreme temperatures’ impact on gestational diabetes mellitus (GDM). We examined the relation between GDM risk with weekly exposure to extreme high and low temperatures during the first 24 weeks of gestation and assessed potential effect modification by microclimate indicators.

Methods:
We utilized 2008–2018 data for pregnant women from Kaiser Permanente Southern California electronic health records. GDM screening occurred between 24 and 28 gestational weeks for most women using the Carpenter-Coustan criteria or the International Association of Diabetes and Pregnancy Study Groups criteria. Daily maximum, minimum, and mean temperature data were linked to participants’ residential address. We utilized distributed lag models, which assessed the lag from the first to the corresponding week, with logistic regression models to examine the exposure-lag-response associations between the 12 weekly extreme temperature exposures and GDM risk. We used the relative risk due to interaction (RERI) to estimate the additive modification of microclimate indicators on the relation between extreme temperature and GDM risk.

Results:
GDM risks increased with extreme low temperature during gestational weeks 20–-24 and with extreme high temperature at weeks 11–16. Microclimate indicators modified the influence of extreme temperatures on GDM risk. For example, there were positive RERIs for high-temperature extremes and less greenness, and a negative RERI for low-temperature extremes and increased impervious surface percentage.

Discussion:
Susceptibility windows to extreme temperatures during pregnancy were observed. Modifiable microclimate indicators were identified that may attenuate temperature exposures during these windows, which could in turn reduce the health burden from GDM.
Cobicistat as a Potential Booster of Ponatinib and Dasatinib Exposure in a CML Patient: A Case Study
Authors: Hofman Susan , Touw Daan J. , Span Bart F. R. , Oude Munnink Thijs H. 
Published: May 2023

Abstract:
The authors present a case of a 57-year-old patient with chronic myeloid leukemia who was treated with ponatinib and subsequently treated with dasatinib. The patient showed a major molecular response; however, the BCR-ABL1 signal increased with low ponatinib and dasatinib trough concentrations. Cobicistat was used as a pharmacokinetic booster to increase ponatinib and dasatinib exposure, as opposed to increasing the dose. However, ponatinib exposure was not sufficiently increased by cobicistat. The peak dasatinib concentration was successfully increased with cobicistat treatment. Dasatinib and cobicistat cotreatment induced a response in BCR-ABL1 PCR signal, was well tolerated, and led to a substantial reduction in drug costs.
Surrogate and modified endpoints for immunotherapy in advanced hepatocellular carcinoma
Authors: Lim Mir , Muquith Maishara , Miramontes Bernadette , Lee Chieh-Ju , Espinoza Magdalena , Huang Yi-Hsiang , Hsiehchen David 
Published: May 2023

Background and Aims:
Immunotherapies have altered the treatment paradigm in HCC. Surrogate and modified endpoints are used to assess early success in clinical studies and guide clinical practice. We sought to determine whether surrogate endpoints and modifications to the conventional criteria for tumor response (RECIST), including modified RECIST (mRECIST) and immune-modified RECIST (imRECIST), are valid measures to predict overall survival (OS) in HCC treated with immunotherapies.

Approach and Results:
We performed an individual-level post hoc analysis of patients treated with atezolizumab and bevacizumab in the IMbrave150 trial (N = 279) and a cross-sectional analysis of a multicenter real-world patient cohort treated with immunotherapy (N = 328). Landmark analyses showed that objective response rates by RECIST were associated with greater OS including among Child-Pugh A and B patients and among patients treated with immunotherapies in the first- or second-line setting (IMbrave150: HR 0.24, 95% CI, 0.17–0.33; RW: HR 0.25, 95% CI, 0.15–0.43). Objective response rates by mRECIST or imRECIST were not associated with the greater predictive power of OS benefit (mRECIST: HR 0.30, 95% CI, 0.22–0.42; imRECIST: HR 0.36, 95% CI, 0.30–0.51). Progression-free survival determined by RECIST was only moderately correlated with OS, and this association was not improved using mRECIST or imRECIST.

Conclusions:
Our results clarify the utility of surrogate and modified endpoints in HCC treated with immunotherapies and support the use of RECIST objective response rates as an appropriate signal-finding measure for the evaluation of emerging treatments. Contrary to their intended purpose, mRECIST and imRECIST did not provide meaningful improvements in predicting OS benefits.
Convulsive Syncope as a Complication of Outpatient Procedures: A Case Series and Review of the Literature
Authors: Carino Mason Marisa R. , Vu Ly , Horn Danielle , Tiu Timothy 
Published: May 2023

Abstract:
Sports medicine providers often perform various outpatient procedures to manage musculoskeletal and neuropathic conditions. Vasovagal syncope is a rare but a possible complication. Convulsive syncope is one subtype that involves brief extensor stiffening and nonsustained myoclonus and can be easily mistaken for seizures. We present a case series of convulsive syncope as a complication of common sports medicine outpatient procedures. We aim to describe how to identify this condition, and offer risk stratification and management strategies to mitigate the risks of this complication. Sports medicine providers who routinely practice outpatient procedures should be aware of this complication. Simple changes in approaching the procedure may mitigate these risks. High- and intermediate-risk features of the syncopal episode should prompt physicians to seek further evaluation by a specialist to rule out more serious conditions. In all instances, appropriate on-site support and equipment for emergent resuscitation and management should be prepared.
Association between Cannabis Use and Tinnitus in US Adults
Authors: Reyes Orozco Francis , Lin Matthew , Clark Bhavishya , Doherty Joni K. , Oghalai John S. , Voelker Courtney C.J. , Choi Janet S. 
Published: May 2023

Objective
Assess the association between cannabis use and tinnitus in a nationally representative sample of US adults.

Study Design
Cross-sectional.

Setting
Population-based.

Patients
Adults aged 20 to 59 years who participated in 2011 to 2012 and 2015 to 2016 National Health and Nutrition Examination Survey (NHANES) with available data on tinnitus, audiometry, and substance use.

Intervention
None.

Main Outcome Measure
Tinnitus, demographic information, and medical history were obtained from NHANES questionnaires. Tinnitus was defined as bothersome tinnitus in the past year. Cannabis use was categorized as never use, low-volume use (1–2 pipes/joints per day), and high-volume use (3+ pipes/joints per day). Multivariable regression models with interaction and mediation analyses were conducted. Sampling weights were incorporated to yield results generalizable to the US population.

Results
Tinnitus prevalence was significantly higher among high-volume cannabis users (odds ratio [OR], 20.5%; 95% confidence interval [CI], 16.0–26.0%]) and low-volume users (OR, 17.0%; 95% CI, 14.3–20.0%) than nonusers (OR, 12.0%; 95% CI, 10.4–13.9%). High-volume cannabis use was significantly associated with tinnitus relative to nonusers in multivariable models adjusting for demographics, cardiovascular factors, hearing loss, noise exposure, and depression (OR, 2.05; 95% CI, 1.1–3.9). Tinnitus severity was comparable among high volume, low volume, and noncannabis users. There was no significant mediation or interaction of depression affecting the association between cannabis use and tinnitus.

Conclusions
Bothersome tinnitus prevalence was significantly higher among cannabis users relative to nonusers. High-volume cannabis use was independently associated with tinnitus in a multivariable model accounting for relevant factors including depression. Future study is warranted to elucidate the impact of various levels of cannabis use on tinnitus.
The Relationship between the Subjective Visual Horizontal and Ocular Vestibular Evoked Myogenic Potentials in Acute Vestibular Neuritis
Authors: Hannigan Imelda P. , Nham Benjamin , Wang Chao , Rosengren Sally M. , Kwok Belinda Y.C. , McGarvie Leigh A. , Reid Nicole M. , Curthoys Ian S. , Halmágyi Gabor Michael , Welgampola Miriam S. 
Published: May 2023

Object
Vestibular evoked myogenic potentials (VEMPs) and the subjective visual horizontal (SVH) (or vertical [SVV]) have both been considered tests of otolith function: ocular-VEMPs (oVEMPs) utricular function, cervical VEMPs (cVEMPs) saccular function. Some studies have reported association between decreased oVEMPs and SVH, whereas others have not.

Design
A retrospective study of test results.

Setting
A tertiary, neuro-otology clinic, Royal Prince Alfred Hospital, Sydney, Australia.

Method
We analyzed results in 130 patients with acute vestibular neuritis tested within 5 days of onset. We sought correlations between the SVH, oVEMPs, and cVEMPs to air-conducted (AC) and bone-conducted (BC) stimulation.

Results
The SVH deviated to the side of lesion, in 123 of the 130 AVN patients, by 2.5 to 26.7 degrees. Ninety of the AVN patients (70%) had abnormal oVEMPs to AC, BC or both stimuli, on the AVN side (mean asymmetry ratio ± SD [SE]): (64 ± 45.0% [3.9]). Forty-three of the patients (35%) had impaired cVEMPs to AC, BC or both stimuli, on the AVN side, [22 ± 41.6% (4.1)]. The 90 patients with abnormal oVEMP values also had abnormal SVH. Correlations revealed a significant relationship between SVH offset and oVEMP asymmetry (r = 0.80, p < 0.001) and a weaker relationship between SVH offset and cVEMP asymmetry (r = 0.56, p < 0.001).

Conclusions
These results indicate that after an acute unilateral vestibular lesion, before there has been a chance for vestibular compensation to occur, there is a significant correlation between the SVH, and oVEMP results. The relationship between SVH offset and oVEMP amplitude suggests that both tests measure utricular function.
Case series of stillbirths due to syphilis in Edmonton, Alberta, Canada
Authors: Robinson Joan L. , Donovan Anna , Gratrix Jennifer , Smyczek Petra , Tse-Chang Alena 
Published: May 2023

Abstract

Background
Data were collected on the incidence and characteristics of stillbirths attributed to congenital syphilis (CS).

Methods
Data were extracted on stillbirths in Edmonton Zone January 1, 2015, through June 30, 2021, born to persons diagnosed with infectious syphilis (primary, secondary, early latent, or early neurosyphilis) during pregnancy or at the time of delivery.

Results
Of 314 infants documented to be exposed to infectious syphilis during gestation, 16 (5.1%) were stillborn. Three of the 16 females with stillbirths diagnosed with syphilis during pregnancy but not treated, 12 were diagnosed only at the time of stillbirth (one of whom was treated early in pregnancy and presumably reinfected), and one had a stillbirth in the week following one dose of benzathine penicillin G.

Conclusion
Stillbirths due to CS were all due to failure to treat syphilis in pregnancy. Innovative strategies to prevent syphilis in the community and to reach those experiencing barriers to care are urgently required to not miss opportunities to diagnose and treat syphilis as early as possible during pregnancy.
Upper Extremity Spasticity: The Quality of Online Patient Resources
Authors: Larkin Tyler , Martinez Victor , Scully Thomas , Martinez Diego , Hayes Corey , Verduzco-Gutierrez Monica 
Published: May 2023

Abstract

Objective
To assess the quality, readability, content, accessibility, and structure of online resources for patients with upper-extremity spasticity.

Design
This was a cross sectional study examined internet searches across three search engines related to patient resources for upper extremity spasticity. Search phrases for either hand or upper-extremity spasticity were used. The top 20 websites from each search were evaluated using the four-readability metrics and the DISCERN scale for quality assessment. YouTube videos with exact search phrases were evaluated using DISCERN. Descriptive statistical analyses were performed using SPSS software.

Results
Thirty-six websites and thirty-three videos met the inclusion criteria for this study. The average Flesh-Kincaid Grade Level of the websites was 11.7 ± 3.1, showing low website readability. According to this index, only two websites were written at the suggested 6th-grade level (5.4%). With a maximum score of 75, the mean DISCERN score for both websites and videos scored in the "good" range (53.5 ± 8 and 50.5 ± 6.6), respectively.

Conclusion
Current online resources for upper extremity spasticity are good in quality but are written above the health literacy level of American citizens. Organizations should consider reviewing their present materials and developing high-quality patient education materials that are easier to understand.
Incidence and Risk Factors of Systemic Adverse Effects and Complications of Ultrasound- and Fluoroscopy-Guided Glucocorticoid Injections
Authors: Lavigne Alexandre , Nguyen Don , Chartrand-Oberoi Olivier , Noyon Brandon , Spiliotopoulos Stevie , Kfoury Céline , Vanasse Lorence , Chamieh Ralph , Bouhadana Haïm , Boudier-Revéret Mathieu , Denis Isabelle , Mares Christopher 
Published: May 2023

Objectives
The aims of the study are to assess the incidence of systemic adverse effects and complications of ultrasound-guided and fluoroscopy-guided glucocorticoid injections and to identify associated risk factors.

Design
This retrospective cohort study compared participants who received a glucocorticoid injection at the outpatient clinic and participants who had an appointment but did not receive a glucocorticoid injection. Participants were called to verify whether they had experienced any of the predetermined systemic adverse effects and complications. Multiple binary logistic regression was used to identify systemic adverse effect and complication risk factors.

Results
There were 1010 participants in the glucocorticoid injection group and 328 in the nonglucocorticoid injection group. There was no statistically significant difference in the occurrence of systemic infection and decompensated heart failure between the two groups. More participants in the glucocorticoid injection group developed abnormal uterine bleeding and erectile dysfunction, but the differences did not reach statistical significance. Female participants were 1.9 times more likely to develop systemic adverse effects (P < 0.001). Younger age (P < 0.001), diabetes (P = 0.012), and higher glucocorticoid injection doses (P = 0.024) were also associated with an increased risk of developing systemic adverse effects.

Conclusions
Identified risk factors for developing glucocorticoid injection systemic adverse effects were younger age, female sex, diabetes, tobacco use, and high glucocorticoid injection doses.