bluuebunny/crossref_metadata_2025_split huggingface dataset:
Does Skeletal Maturity Predict the Pattern of Tibial Tubercle Avulsion Fracture?
Authors: Yang Daniel , Kell David , Syed Akbar , Huang Kevin , Sarkar Sulagna , Goodbody Christine M. , Williams Brendan A. 
Published: May 2023

Background:Proximal tibial physeal development and closure is thought to relate to tibial tubercle avulsion fracture (TTAF) patterns. Prior work has yet to formally evaluate the relationship between skeletal maturity and fracture pattern.  Using 2 knee radiograph-derived skeletal maturity assessments [growth remaining percentage (GRP) and epiphyseal union stage], we examined their association with TTAF injury patterns using the Ogden and Pandya fracture classifications. We hypothesized that different TTAF injuries would occur during unique periods of skeletal development.Methods:Pediatric patients sustaining TTAFs treated at a single institution (2008–2022) were identified using diagnostic and procedural coding. Demographics and injury characteristics were collected. Radiographs were reviewed to assign epiphyseal union stage, Ogden and Pandya classifications and for measurements to calculate GRP. Univariate analyses examined the relationship between injury subgroups, patient demographics, and skeletal maturity assessments.Results:Inclusion criteria identified 173 patients with a mean age of 14.76 (SD: 1.78) and 2.95% (SD: 4.46%) of growth remaining. The majority of injuries were classified Ogden III/Pandya C. Most (54.9%) were the result of the axial loading mechanism. Ogden groups showed no significant differences across all patient characteristics studied including age and GRP. With the exception of Pandya A fractures, we did not identify a direct relationship between GRP, age, and Pandya groups. Epiphyseal union stage differed for Pandya A and D groups.Conclusions:A predictable pattern in TTAF characteristics across skeletal (GRP), epiphyseal union, or chronologic age was not identified in this study. Distal apophyseal avulsions (Ogden I/II and Pandya A/D) occurred across a broad chronologic and skeletal age range. No differences were identified in epiphyseal or posterior extension (Ogden III/IV and Pandya B/C) injuries. Although differences in age and GRP were identified among Pandya As, this is thought to be due to the degree of skeletal immaturity that is a prerequisite for differentiation from Pandya Ds.Level of Evidence:Level III—retrospective cohort study.
Developmentally-Trained Primary Care Clinicians: A Pipeline to Improved Access?
Authors: Roberts Mona Doss , Christiansen Audrey , O'Hagan Belinda , Jansen Emily , Augustyn Marilyn 
Published: May 2023

ABSTRACT:

Objective:
The purpose of this study is to decrease wait time and improve access to developmental-behavioral pediatric (DBP) evaluation in children 4 years of age and younger as part of a quality improvement (QI) initiative in an urban safety-net hospital.

Methods:
A primary care pediatrician received DBP minifellowship training 6 hours per week for 1 year to become a developmentally-trained primary care clinician (DT-PCC). DT-PCCs then conducted developmental evaluations that consisted of using a Childhood Autism Rating Scale and Brief Observation of Symptoms of Autism to evaluate children 4 years and younger referred within the practice. Baseline standard practice involved a 3-visit model: DBP advanced practice clinician (DBP-APC) intake visit, neurodevelopmental evaluation by a developmental-behavioral pediatrician (DBP), and feedback by a developmental-behavioral pediatrician. Two QI cycles were completed to streamline the referral and evaluation process.

Results:
Seventy patients with a mean age of 29.5 months were seen. The average days to initial developmental assessment decreased from 135.3 days to 67.9 days with a streamlined referral to the DT-PCC. Of the 43 patients who required further evaluation by a DBP, the average days to developmental assessment reduced from 290.1 to 120.4 days.

Conclusion:
Developmentally-trained primary care clinicians allowed for earlier access to developmental evaluations. Further research should explore how DT-PCCs can improve access to care and treatment for children with developmental delays.
The Peripheral Nerve Surgeon’s Role in the Management of Neuropathic Pain
Authors: Caragher Seamus P. , Khouri Kimberly S. , Raasveld Floris V. , Winograd Jonathan M. , Valerio Ian L. , Gfrerer Lisa , Eberlin Kyle R. 
Published: May 2023

Summary:
Neuropathic pain (NP) underlies significant morbidity and disability worldwide. Although pharmacologic and functional therapies attempt to address this issue, they remain incompletely effective for many patients. Peripheral nerve surgeons have a range of techniques for intervening on NP. The aim of this review is to enable practitioners to identify patients with NP who might benefit from surgical intervention. The workup for NP includes patient history and specific physical examination maneuvers, as well as imaging and diagnostic nerve blocks. Once diagnosed, there is a range of options surgeons can utilize based on specific causes of NP. These techniques include nerve decompression, nerve reconstruction, nerve ablative techniques, and implantable nerve-modulating devices. In addition, there is an emerging role for preoperative involvement of peripheral nerve surgeons for cases known to carry a high risk of inducing postoperative NP. Lastly, we describe the ongoing work that will enable surgeons to expand their armamentarium to better serve patients with NP.
Peroxisome proliferator-activated receptor γ activation ameliorates liver fibrosis—differential action of transcription factor EB and autophagy on hepatocytes and stellate cells
Authors: Yum Yunjin J. , Yoo Jin , Bang Kyuhoon , Jun Ji Eun , Jeong In-Kyung , Ahn Kyu Jeung , Chung Ho Yeon , Hwang You-Cheol 
Published: May 2023

Background:
Peroxisome proliferator-activated receptor γ (PPARγ) activation suppresses HSC activation and liver fibrosis. Moreover, autophagy is implicated in hepatic lipid metabolism. Here, we determined whether PPARγ activation ameliorates HSC activation by downregulating transcription factor EB (TFEB)-mediated autophagy.

Methods and Results:

Atg7 or Tfeb knockdown in human HSC line LX-2 cells downregulated the expression of fibrogenic markers including α smooth muscle actin, glial fibrillary acidic protein, and collagen type 1. Conversely, Atg7 or Tfeb overexpression upregulated fibrogenic marker expression. Rosiglitazone (RGZ)-mediated PPARγ activation and/or overexpression in LX-2 cells and primary HSCs decreased autophagy, as indicated by LC3B conversion, total and nuclear-TFEB contents, mRFP-LC3 and BODIPY 493/503 colocalization, and GFP-LC3 and LysoTracker colocalization. RGZ treatment decreased liver fat content, liver enzyme levels, and fibrogenic marker expression in high-fat high-cholesterol diet-fed mice. Electron microscopy showed that RGZ treatment restored the high-fat high-cholesterol diet-mediated lipid droplet decrease and autophagic vesicle induction in primary HSCs and liver tissues. However, TFEB overexpression in LX-2 cells offset the aforementioned effects of RGZ on autophagic flux, lipid droplets, and fibrogenic marker expression.

Conclusions:
Activation of PPARγ with RGZ ameliorated liver fibrosis and downregulation of TFEB and autophagy in HSCs may be important for the antifibrotic effects of PPARγ activation.
Magnetic resonance elastography-based prediction model for hepatic decompensation in NAFLD: A multicenter cohort study
Authors: Kim Beom Kyung , Bergstrom Jaclyn , Loomba Rohan , Tamaki Nobuharu , Izumi Namiki , Nakajima Atsushi , Idilman Ramazan , Gumussoy Mesut , Oz Digdem K. , Erden Ayse , Truong Emily , Yang Ju Dong , Noureddin Mazen , Allen Alina M. , Loomba Rohit , Ajmera Veeral 
Published: May 2023

Background and Aims:
Magnetic resonance elastography (MRE) is an accurate, continuous biomarker of liver fibrosis; however, the optimal combination with clinical factors to predict the risk of incident hepatic decompensation is unknown. Therefore, we aimed to develop and validate an MRE-based prediction model for hepatic decompensation for patients with NAFLD.

Approach and Results:
This international multicenter cohort study included participants with NAFLD undergoing MRE from 6 hospitals. A total of 1254 participants were randomly assigned as training (n = 627) and validation (n = 627) cohorts. The primary end point was hepatic decompensation, defined as the first occurrence of variceal hemorrhage, ascites, or HE. Covariates associated with hepatic decompensation on Cox-regression were combined with MRE to construct a risk prediction model in the training cohort and then tested in the validation cohort. The median (IQR) age and MRE values were 61 (18) years and 3.5 (2.5) kPa in the training cohort and 60 (20) years and 3.4 (2.5) kPa in the validation cohort, respectively. The MRE-based multivariable model that included age, MRE, albumin, aspartate aminotransferase, and platelets had excellent discrimination for the 3- and 5-year risk of hepatic decompensation (c-statistic 0.912 and 0.891, respectively) in the training cohort. The diagnostic accuracy remained consistent in the validation cohort with a c-statistic of 0.871 and 0.876 for hepatic decompensation at 3 and 5 years, respectively, and was superior to Fibrosis-4 in both cohorts (p < 0.05).

Conclusions:
An MRE-based prediction model allows for accurate prediction of hepatic decompensation and assists in the risk stratification of patients with NAFLD.
LONG-TERM MICROVASCULAR REMODELING AND CYSTIC CHANGES AFTER RETINAL DETACHMENT TREATED WITH SILICON OIL TAMPONADE
Authors: Pfister Nathalie , Dormegny Léa , Ballonzoli Laurent , Sauer Arnaud , Speeg-Schatz Claude , Bourcier Tristan , Gaucher David 
Published: May 2023

Purpose:
To determine the long-term microvascular alterations associated with macular cystic changes after retinal detachment surgery with silicone oil tamponade.

Methods:
The results of two optical coherence tomography angiographies performed at 11 months and 38 months after silicone removal were retrospectively analyzed for 30 eyes. The data were compared between both measurements and between eyes with macular cysts (MC+) and without macular cysts (MC−). Two patterns of cysts were identified and compared: cysts exclusively involving the inner nuclear layer (INLc) and cysts present in all retinal layers.

Results:
At both end points, 20 eyes (67%) presented with macular cysts, 12 of them (40%) had INLc. At the first end point, vascular density of superficial capillary plexus was higher and superficial foveal avascular zone was smaller in MC+ eyes than in MC− eyes (P = 0.04 and P = 0.017, respectively). At the second end point, vascular density of superficial capillary plexus significantly decreased in MC+ eyes as compared with the first end point (P < 0.001) and superficial foveal avascular zone enlarged (P < 0.001). Macular central thickness decreased between follow-ups only in eyes with INLc (P < 0.01). The final best-corrected visual acuity was better in eyes with INLc than in eyes with cysts present in all retinal layers (P < 0.01). There was no difference between the final best-corrected visual acuity in eyes with INLc and MC− eyes.

Conclusion:
Macular cysts are a common finding long after silicon removal. Vascular remodeling seems characterized by an initial increase of the vascular density of superficial capillary plexus in eyes with cysts, which is followed by its progressive decrease. The INLc is the most common pattern of cysts. They are associated with a progressive decrease of the central macular thickness without visual impairment.
Transcription and secretion of interleukin-1β and HMGB1 in keratinocytes exposed to stimulations mimicking common inflammatory damage
Authors: Wei Xuecui , Chen Yujie , Long Fangyuan , Yu Shanshan , Xu Song , Chen Xu 
Published: May 2023

Objective:
Interleukin-1β (IL-1β) and high-mobility group box 1 (HMGB1) are widely known damage-associated molecular patterns (DAMPs). However, their expression and secretion in different skin diseases, especially in inflammatory skin disorders, remain to be further elucidated. This study was performed to explore and compare the transcriptional and secretory levels of IL-1β and HMGB1 in keratinocytes under three types of stimulation: ultraviolet B (UVB) irradiation; co-stimulation by tumor necrosis factor-α (TNF-α) and interferon-γ (IFN-γ) (simulation of T helper 1 cell inflammatory challenge); and psoriasis-like stimulation by M5, a mixture of five proinflammatory cytokines.

Methods:
We used quantitative reverse-transcription polymerase chain reaction to determine the transcription levels of IL-1β and HMGB1. Western blotting and enzyme-linked immunosorbent assay were used to detect the secretion levels of IL-1β and HMGB1. The results were statistically analyzed by t test.

Results:
A rapid transcriptional and secretory response of IL-1β from keratinocytes occurred in all three types of stimulation mimicking common inflammatory environments (P < 0.05). Transcription of HMGB1 was inhibited in all three types of stimulation (P < 0.05), but secretion was increased after exposure to UVB irradiation and co-stimulation by TNF-α and IFN-γ (P < 0.05). We observed no change in the secretion level of HMGB1 after treatment with M5 (P = 0.196 > 0.05).

Conclusion:
IL-1β is a critical cytokine for the immunomodulatory functions of keratinocytes in inflammatory responses. In this study, keratinocytes restrained transcription of HMGB1 when the secretion of HMGB1 was induced in certain stimulations (e.g., by UVB exposure or stimulation by TNF-α and IFN-γ).
Prognostic role of minute ventilation/carbon dioxide production slope for perioperative morbidity and long-term survival in resectable patients with non-small-cell lung cancer: A prospective study using propensity score overlap weighting
Authors: Dun Yaoshan , Wu Shaoping , Cui Ni , Thomas Randal J. , Squires Ray W. , Olson Thomas P. , Sylvester Karl P. , Fu Siqian , Zhang Chunfang , Gao Yang , Du Yang , Xu Ning , Liu Suixin 
Published: May 2023

Background:
The role of minute ventilation/carbon dioxide production (

/

CO2) slope, a ventilation efficiency marker, in predicting short- and long-term health outcomes for patients with non-small-cell lung cancer (NSCLC) undergoing lung resection has not been well investigated.

Material and Methods:
This prospective cohort study consecutively enrolled NSCLC patients who underwent a presurgical cardiopulmonary exercise test from November 2014 to December 2019. The association of

/

CO2 slope with relapse-free survival (RFS), overall survival (OS), and perioperative mortality was evaluated using the Cox proportional hazards and logistic models. Covariates were adjusted using propensity score overlap weighting. The optimal cut-off point of the

E/

CO2 slope was estimated using the Receiver Operating Characteristics curve. Internal validation was completed through bootstrap resampling.

Results:
A cohort of 895 patients (median age [interquartile range], 59 [13] years; 62.5% male) was followed for a median of 40 (range, 1-85) months. Throughout the study there were 247 relapses or deaths and 156 perioperative complications. The incidence rates per 1000 person-years for relapses or deaths were 108.8 and 79.6 among patients with high and low

E/

CO2 slope, respectively (weighted incidence rate difference per 1000 person-years, 29.21 [95% CI, 7.30 to 51.12]). A

E/

CO2 slope of ≥31 was associated with shorter RFS (hazard ratio for relapse or death, 1.38 [95% CI, 1.02 to 1.88], P=0.04) and poorer OS (hazard ratio for death, 1.69 [1.15 to 2.48], P=0.02) compared to a lower

/

CO2 slope. A high

E/

CO2 slope increased the risk of perioperative morbidity compared with a low

E/

CO2 slope (odds ratio, 2.32 [1.54 to 3.49], P<0.001).

Conclusions:
In patients with operable NSCLC, a high

E/

CO2 slope was significantly associated with elevated risks of poorer RFS and OS, and perioperative morbidity.
The Effect of Immediate Microsurgical Resection of Vestibular Schwannoma on Hearing Preservation
Authors: Moshtaghi Omid , Dixon Peter R. , Claussen Alexander D. , La Monte Olivia , Tadano Ashley , Gillette Dominique , Tawfik Kareem , Schwartz Marc S. , Friedman Rick A. 
Published: May 2023

Objective
Evaluate for differences in postoperative hearing in patients who undergo immediate versus delayed hearing preservation microsurgical resection of vestibular schwannomas (VS).

Study Design
Retrospective single-institution cohort study spanning November 2017 to November 2021.

Setting
Single-institution tertiary care hospital.

Patients
Sporadic VS in patients with American Academy of Otolaryngology–Head and Neck Surgery hearing classification A or B, with tumor size less than or equal to 2 cm and undergoing hearing preservation microsurgical resection.

Interventions
Delayed surgical intervention defined by time from first diagnostic MRI to date of surgery being greater than 3 months

Main Outcome Measures
Preoperative and postoperative audiometric performance.

Results
In total, 193 patients met inclusion criteria. Within the cohort, 70 (36%) proceeded with surgery within 3 months of diagnostic MRI with a mean observation time of 62 days, whereas 123 (63%) underwent surgery after 3 months with a mean observation time of 301 days. There was no difference in preoperative hearing between the two groups with word recognition score 99% in early intervention group and 100% in delayed intervention group (p = 0.6). However, 64% of those who proceeded with immediate surgery had successful hearing preservation, compared to a 42% of those who had delayed intervention (p < 0.01). In a multivariable logistic regression accounting for preoperative word recognition score, tumor size, and age at diagnosis, the odds of hearing preservation were lower in those who delayed surgery compared to immediate surgery (odds ratio, 0.31; 95% confidence interval, 0.15–0.61).

Conclusions
Patients who underwent microsurgical resection within 3 months of diagnosis demonstrated a hearing preservation advantage compared to those who did not. Findings of this study highlight the counseling challenges associated with the timing of surgical treatment of VS in patients presenting with good preoperative hearing and small tumors.
Direct antiglobulin test-negative autoimmune hemolytic anemia associated with erythropoiesis stimulating agent resistance in a CKD patient with IgG4-related disease: A case report
Authors: Kitamura Koichi , Hayashi Koichi , Iwanami Keiichi , Kamesaki Toyomi , Suzuki Toshihiko 
Published: May 2023

Rationale:
Direct antiglobulin test (DAT)-negative autoimmune hemolytic anemia (AIHA) is an important differential diagnosis for erythropoiesis-stimulating agents-resistant renal anemia with hemolysis.

Patient concerns:
An 82-year-old female with a past medical history of diabetes, end-stage kidney disease (estimated glomerular filtration rate: 6.9 mL/min/1.73 m2), post-transcatheter aortic valve implantation, and IgG4-related retroperitoneal fibrosis on prednisolone therapy was referred to our department for assessment of severe anemia. The patient underwent immunohematological testing for serological evaluation.

Diagnoses:
DAT-negative AIHA and IgG4-RD was established based on DAT-negative and immunohematological tests.

Interventions:
Glucocorticoid was administered to the patient.

Outcomes:
The patient’s condition including hemoglobin level was relieved.

Lessons:
In chronic kidney disease, AIHA may contribute to the development of severe anemia and erythropoiesis-stimulating agents-resistance, irrespective of the results of Coombs test. Reticulocytosis, undetectable haptoglobin and a fall in hemoglobinA1c despite sustained hyperglycemia may be a clue to the diagnosis of hemolysis.
Cognitive performance of Brazilian patients with favorable outcomes after severe traumatic brain injury: a prospective study
Authors: Vascouto Helena Dresch , Melo Hiago Murilo , Rodrigues de Oliveira Thais Maria Emília , Libório Schwarzbold Marcelo , Lin Katia , Dal Pizzol Felipe , Kupek Emil , Walz Roger 
Published: May 2023

Abstract

Objective
Investigate the cognitive performance of patients with favorable outcomes, determined by the Glasgow Outcome Scale (GOS) one year after hospital discharge due to severe traumatic brain injury (TBI).

Design
Prospective case-control study. From 163 consecutive adult patients with severe TBI included in the study, 73 patients had a favorable outcome (GOS 4 or 5) one year after hospital discharge and were eligible for the cognitive evaluation of which 28 completed the evaluations. The latter were compared with 44 healthy controls.

Results
The average loss of cognitive performance among participants with TBI varied between 13.35% and 43.49% compared to the control group. Between 21.4% and 32% of the patients performed below the 10th percentile on three language tests and two verbal memory tests, whereas 39% to 50% performed below this threshold on one language test and three memory tests. Longer hospital stay, older age, and lower education were the most important predictors of worse cognitive performance.

Conclusion
One year after a severe TBI, a significant proportion of Brazilian patients with the favorable outcome determined by GOS still showed significant cognitive impairment in verbal memory and language domains.
Residents' Perceptions of a Novel Virtual Livestream Cadaveric Teaching Series for Musculoskeletal Anatomy Education
Authors: Le Andy , Satkunam Lalith , Yu Jaime C. 
Published: May 2023

Abstract
Musculoskeletal anatomy education is essential to many healthcare providers, but has consistently been considered difficult for various reasons. Traditional methods have focused on in-person cadaveric teaching, which became inaccessible during the COVID-19 pandemic; therefore, new teaching methods were developed to address this gap in education. This project implemented novel virtual livestream musculoskeletal anatomy teaching methodology with cadaveric prosections and evaluated the efficacy of this modality compared to traditional in-person cadaveric teaching. A targeted musculoskeletal anatomy curriculum was developed and delivered via livestream to 12 Canadian physiatry residents. Upon completing the virtual curriculum, residents completed an anonymous survey assessing this new virtual livestream cadaveric methodology compared to prior experiences with traditional in-person anatomy teaching. The survey response rate was 92%. Most participants (73%) rated the virtual livestream sessions as better than traditional in-person teaching. Reasons included better visualization of cadaveric anatomy and easy discussion amongst the group. T-test analysis comparing both methods demonstrated the livestream method was equivalent or better across several domains. Virtual livestream teaching is a viable method for teaching the important subject of musculoskeletal anatomy. Educators should consider how to best integrate this approach into future anatomy curricula.