bluuebunny/crossref_metadata_2025_split huggingface dataset:
Progression From Steroid Injection to Surgery in Carpal Tunnel Syndrome Patients With Concurrent Ulnar Nerve Compression: A Retrospective Analysis
Authors: Mubin Nailah F. , Mubin A. Numa , Fogel Joshua , Morrison Elizabeth 
Published: September 2023

Background: Steroid injections are a common treatment option in the management of carpal tunnel syndrome (CTS). This study assesses various prognostic factors for progression to carpal tunnel release (CTR) after a first-time steroid injection for CTS with specific focus on concomitant ulnar nerve compression (UNC). Methods: This is a retrospective study of 426 hands with CTS treated with a first-time steroid injection in the Long Island region of New York. The main predictor variable was UNC measured in two analytical models of positive UNC and location of UNC (wrist or elbow). Multivariate logistic regression analyses adjusted for demographic, medical, and CTS-related variables for 2 study outcomes occurring within 1 year: (1) CTR; and (2) steroid reinjection. Results: Overall progression to CTR within 1 year of steroid injection was 23.0%. Ulnar nerve compression was present in 16.7% of patients and was significantly associated with increased odds for CTR but not with steroid reinjection. These results were further localized to be specific for UNC at the elbow. A moderate or severe result on electrodiagnostic studies was associated with increased odds for CTR. Increased age was associated with slightly increased odds of steroid reinjection while a history of distal radius fracture was associated with decreased odds of steroid reinjection. Conclusions: Carpal tunnel syndrome patients with UNC may benefit from earlier definitive treatment with CTR rather than attempting steroid injections, as they are more likely to seek reintervention within 1 year of their initial injection.
Where Does Ultrasound Fit in the Diagnostic Algorithm for Cubital Tunnel Syndrome?
Authors: Chirokikh Alexander Alexei , Carroll Thomas John , Hoffman Samantha , Speach David , Jones Courtney Marie Cora , Ketonis Constantinos 
Published: September 2023

Background: Ultrasound (US) has emerged as a promising supplement to electrodiagnostic studies (EDX) in the diagnosis of cubital tunnel syndrome (CuTS) and has potential to be performed by novice operators. Our objective is to understand the discrepancies in assessment between the two modalities and to assess the utility of US in CuTS diagnosis by a novice operator. Methods: Patients who presented to a single tertiary academic medical center and clinically diagnosed with CuTS were prospectively enrolled. Electrodiagnostic studies were performed along with US measurements of the cross-sectional area (CSA) of the ulnar nerve by both a board-certified physiatrist and novice operator. Electrodiagnostic study and US outcomes were compared among four diagnostic impression groups: EDX–/US–, EDX+/US–, EDX–/US+, and EDX+/US+. Results: Sixteen patients were classified as abnormal by both EDX and US, 14 were classified abnormal by US only, 3 were classified abnormal by EDX only, and 6 were classified normal by both EDX and US ( P = .008, K = 0.14). The EDX+/US+ group had a significantly reduced sensory amplitude compared with the EDX–/US+ ( P = .04) group. Diagnostic classifications between a board-certified physiatrist and novice operator were in moderate agreement (K = 0.58, P = .08). Conclusions: Ultrasound detected a greater proportion of patients as abnormal than EDX. A subset of patients with clinical diagnoses of CuTS had normal sensory amplitudes but increased maximum nerve CSAs. Competency in US may be easily acquired with minimal training, suggesting its potential to be extended for use by other members of the health care team.
Patient-reported outcomes after free muscle flap coverage for therapy-resistant neuropathic pain from the ulnar nerve
Authors: List Emile B. , Boers Nadine , Martin Enrico , Krijgh David D. , Henk Coert J. 
Published: September 2023

Extensive microsurgical neurolysis followed by free gracilis muscle flap coverage can be performed as a last resort for patients with persistent neuropathic pain of the ulnar nerve. All patients who had this surgery between 2015 and 2021 were identified. Data were collected from the medical records of 21 patients and patient-reported outcomes were collected from 18 patients, with a minimum follow-up of 12 months. The median visual analogue pain score decreased significantly 8 months postoperatively from 8.0 to 6.0 and stabilized to 5.4 at the 3-year follow-up. Health-related quality-of-life scores remained diminished compared to normative data. In the treatment of therapy-resistant neuropathic pain of the ulnar nerve, extensive neurolysis with a subsequent free gracilis muscle flap coverage shows a promising reduction of pain that persists at long-term follow-up. Level of evidence: IV
Stroke Unit as an alternative to Intensive Care Unit for initial hospital admission of low-grade non-aneurysmal subarachnoid haemorrhage: A safety and cost-minimisation analysis
Authors: Santana Daniel , Mosteiro Alejandra , Llull Laura , Massons Miquel , Zattera Luigi , Pujol-Fontrodona Gabriel , Werner Mariano , Torné Ramón , Amaro Sergio , Chamorro Angel 
Published: September 2023

Introduction: Stroke Units (SU) have been suggested as an alternative to Intensive Care units (ICU) for initial admission of low-grade non-aneurysmal spontaneous subarachnoid haemorrhage (naSAH). We hypothesised that the incidence of in-hospital complications and long-term clinical outcomes in low-grade naSAH patients would be comparable in both settings, and that a cost-minimisation analysis would favour the use of SU. Patients and methods: Retrospective, single-centre study at a third-level stroke-referral hospital, including low-grade spontaneous naSAH patients with WFNS 1–2. Primary outcomes were death and functional status at 3 months. Secondary outcomes were incidence of in-hospital major neurological and systemic complications. Additionally, a cost-minimisation analysis was conducted to estimate the average cost savings that could be achieved with the most efficient approach. Results: Out of 96 naSAH patients, 30 (31%) were initially admitted to ICU and 66 (69%) to SU. Both groups had similar demographic and radiological features except for a higher proportion of WFNS 2 in ICU subgroup. There were no statistically significant differences between ICU and SU-managed subgroups in death rate (2 (7%) and 1 (2%), respectively), functional outcome at 90 days (28 (93%) and 61 (92%) modified Rankin Scale 0–2) or neurological and systemic in-hospital complications. Cost-minimisation analysis demonstrated significant monetary savings favouring the SU strategy. Discussion and conclusion: Initial admission to the SU appears to be a safe and cost-effective alternative to the ICU for low-grade naSAH patients, with comparable clinical outcomes and a reduction of hospitalisation-related costs. Prospective multicenter randomised studies are encouraged to further evaluate this approach.
Modified Macintosh Extra-Articular Anterior Cruciate Ligament Reconstruction in a 6-Year-Old Patient
Authors: Astur Diego Costa , Costa José Ricardo Dantas Moura , Amaro Joicemar Tarouco , Kaleka Camila Cohen , V. Silva Pedro Debieux , Oliveira Pedro Paulo Paes de , Britto Raymundo José Magalhaes , Silva Gustavo Montibeller da , Cohen Moisés 
Published: September 2023

Background: Anterior cruciate ligament (ACL) injury in children is an increasingly common occurrence. Historically, nonsurgical treatment has been the main treatment option; however, the indication for surgical reconstruction is increasing, as the histological characteristics of the immature skeleton are better known. Indications: The extra-articular surgical technique for ACL reconstruction is a good option for Tanner I patients, aged up to 8 years, with knee instability and recurrent pain. Its advantage in skeletally immature patients is due to the fact that it avoids the bone growth plates. Technique Description: After skin incision and subcutaneous dissection, we isolated the iliotibial band and released the proximal portion of the band. We proceeded with the tubularization of the graft, suturing its edges, and with the aid of radioscopy we marked the top of the lateral femoral condyle. Thus, we transported the graft, in an over-the-top position, to the intercondylar portion of the femur. Femoral fixation is performed by placing the graft close to the lateral femoral condyle. For fixation on the tibia, a second incision is made, preserving the physis, and the graft is fixed to the tibia using an absorbable Swivelock anchor. Results: Six months after the surgery, when his physical rehabilitation was completed, the patient was asymptomatic and able to perform his daily activities, and also returned to sports. Clinical evaluation showed a knee with almost the same functional parameters as the uninjured one. Furthermore, radiographic studies showed no bone abnormalities and magnetic resonance image showed a newly reconstructed ligament with good positioning. Discussion/Conclusion: According to the literature, surgical treatment seems to be better than conservative treatment in skeletally immature patients. However, there is a continuous discussion about the most appropriate surgical technique. The decision is relative to many specific characteristics for these patients: age, bone age, graft choice, sports modality, and surgeon expertise. In this case, we decide to do an ACL extra-articular reconstruction technique with the iliotibial band over the top in the femoral condyle and fixed in the anterior cortical bone of the tibia. Patient Consent Disclosure Statement: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.
No effect of danazol treatment in patients with advanced idiopathic pulmonary fibrosis
Authors: Hoffman Thijs W. , van Moorsel Coline H.M. , van der Vis Joanne J. , Biesma Douwe H. , Grutters Jan C. 
Published: September 2023

BackgroundTelomere dysfunction can underly the development of idiopathic pulmonary fibrosis (IPF), and recent work suggests that patients with telomere syndromes might benefit from treatment with androgens, such as danazol.MethodsThis was a prospective observational cohort study. 50 patients with IPF received off-label treatment with danazol after they showed progressive disease under treatment with pirfenidone or nintedanib. The primary outcome was the difference in yearly decline in forced vital capacity (FVC) prior to (pre) and after (post) start of treatment with danazol.ResultsThere was no significant difference in FVC-decline between 1 year pre and 1 year post start of danazol treatment (mean decline pre 395 mL (95% confidence interval (CI) 290–500) compared to post 461 mL (95% CI 259–712); p=0.46; paired t-test). 11 patients (22%) were still on danazol after 1 year, and 39 patients had stopped danazol, mainly because of side-effects (56%) or death (33%). In patients who were still using danazol after 1 year, FVC-decline significantly slowed down under danazol treatment (mean pre 512 mL (95% CI 308–716)versuspost 198 mL (95% CI 16–380); p=0.04). Median survival post danazol was 14.9 months (95% CI 11.0–18.8).ConclusionDanazol as a treatment of last resort in patients with IPF did not lead to slowing of lung function decline and was associated with significant side-effects. It remains to be determined if earlier treatment or treatment of specific patient subgroups is beneficial.
Metagenomic analysis of herbivorous mammalian viral communities in the Northwest Plateau
Authors: Pan Jiamin , Ji Likai , Wu Haisheng , Wang Xiaochun , Wang Yan , Wu Yan , Yang Shixing , Shen Quan , Liu Yuwei , Zhang Wen , Zhang Keshan , Shan Tongling 
Published: September 2023

Abstract
Background
Mammals are potential hosts for many infectious diseases. However, studies on the viral communities of herbivorous mammals in the Northwest Plateau are limited. Here, we studied the viral communities of herbivorous mammals in the Northwest Plateau using virus metagenomic analysis to analyze and compare the viral community composition of seven animal species.

Results
By library construction and next-generation sequencing, contigs and singlets reads with similar viral sequences were classified into 24 viral families. Analyzed from the perspective of sampling areas, the virus community composition was relatively similar in two areas of Wuwei and Jinchang, Gansu Province. Analyzed from the perspective of seven animal species, the viral reads of seven animal species were mostly ssDNA and dominated by CRESS-DNA viruses. Phylogenetic analysis based on viral marker genes indicated that CRESS-DNA viruses and microviruses have high genetic diversity. In addition to DNA viruses, nodaviruses, pepper mild mottle viruses and picornaviruses were RNA viruses that we performed by phylogenetic analysis. The CRESS-DNA viruses and nodaviruses are believed to infect plants and insects, and microviruses can infect bacteria, identifying that they were likely from the diet of herbivorous mammals. Notably, two picornaviruses were identified from red deer and wild horse, showing that the picornavirus found in red deer had the relatively high similarity with human hepatitis A virus, and the picornavirus carried by wild horse could potentially form a new species within the Picornaviridae family.

Conclusions
This study explored the herbivorous mammalian virus community in the Northwest Plateau and the genetic characteristics of viruses that potentially threaten human health. It reveals the diversity and stability of herbivorous mammalian virus communities in the Northwest Plateau and helps to expand our knowledge of various herbivorous mammalian potentially pathogenic viruses.
Staff knowledge, attitudes and confidence levels for fall preventions in older person long-term care facilities: a cross-sectional study
Authors: Albasha Neah , McCullagh Ruth , Cornally Nicola , Timmons Suzanne 
Published: September 2023

Abstract
Background
Falls are the most common health problem affecting older people in long-term care facilities (LTCFs), with well-recognised adverse psychological and physical resident outcomes, and high staff burden and financial cost. LTCF staff knowledge and skills can play a vital role in providing and promoting fall prevention care.

Methods
A descriptive cross-sectional survey study was conducted across 13 LTCF sites in the Southwest of Ireland; a sampling frame facilitated inclusion of a range of provider types and facility sizes. An existing questionnaire, based on fall prevention guidance, and examining staff knowledge, skills and attitudes, was distributed in physical and online formats.

Result
The response rate was 15% (n = 155), predominantly healthcare assistants, staff nurses and senior nurses. Almost 90% expressed high confidence levels for delivering fall prevention interventions and being aware of how falls affect LTCFs. However, over half underestimated the fall rate in LTCFs, and only 60% had adequate knowledge. Longer experience in working with older people in healthcare services was associated with greater knowledge (p = .001) and confidence in fall prevention interventions (p = .01), while senior nurses had more knowledge than others (p = .01). LTCF staff had lowest knowledge about “identification systems for residents at high risk of falling”, “keeping confused residents near nursing stations”, “the effect of using antipsychotic medicine on falls”, “using a toileting regimen” and “staff responsibility regarding fall prevention efforts”. Despite their knowledge gaps, nearly 50% thought they had enough fall prevention training; their main preference for any further fall education training was face-to-face education.

Conclusion
The results, with the caveat of a low response rate, show the need for interdisciplinary fall prevention training that is tailored to both the perceived learning needs and actual knowledge gap of LTCF staff and their preferences for learning delivery, as part of an overall approach to reducing fall-related adverse outcomes.
Recurrent endometrial atypical hyperplasia diagnosed by pathological examination of the placenta from a live birth: a case report
Authors: Wu Weilu , Wang Wei , Zou Juan 
Published: September 2023

Abstract
Background
Pregnancy complicated with endometrial atypical hyperplasia, which is often observed during early pregnancy, is extremely rare.

Case presentation
The patient was a 30-year-old woman who had premature delivery at 30+ 1 weeks gestation, and endometrial atypical hyperplasia was discovered by placental examination.

Conclusions
For patients who undergo fertility-sparing treatment for endometrial atypical hyperplasia, the evaluation of the decidua via the placental pathological examination is particularly important. These examinations make a great clinical contribution to the early detection and diagnosis of endometrial atypical hyperplasia.
Validity and reliability of the Persian version of the machiavellian personality scale and its association with social adjustment and risky behaviors in Iranian college students
Authors: Asadi Mitra , Yoosefi Somayeh 
Published: September 2023

Abstract
Objective
The present study aims to develop and assess the psychometric properties of the Persian version of the Machiavellian Personality Scale (P-MPS), and evaluate its relationship with social adjustment and risky behaviors in Iranian college students.

Methods
Participants were 500 healthy college students (270 females and 230 males) from medical and non-medical universities in Sanandaj, Iran. They completed the P-MPS, the social adjustment subscale of the Bell Adjustment Inventory, and the Youth Risk Behavior Surveillance System (YRBSS) questionnaire. The factor structure of the P-MPS was evaluated by exploratory factor analysis followed by confirmatory factor analysis (CFA). Cronbach’s alpha coefficient was used to examine the internal consistency of the P-MPS and Pearson correlation test was used to investigate the relationship of the P-MPS score with the scores of social adjustment subscale and YRBSS.

Results
The P-MPS showed good content validity (Content validity ratio = 0.73, content validity index = 0.90), construct validity, and internal consistency (α = 0.802). The CFA results supported the four-factor solution of the questionnaire. The total score of P-MPS and its dimensions showed a significant negative relationship with social adjustment (p < 0.05). Moreover, its score was significantly correlated with risky behaviors (p < 0.05).

Conclusion
The Persian version of MPS can be used for assessing Machiavellianism in the Iranian population.
The causal effect of schizophrenia on fractures and bone mineral density: a comprehensive two-sample Mendelian randomization study of European ancestry
Authors: Jia Ningning , Dong Lin , Lu Qingxing , Li Xinwei , Jin Mengdi , Yin Xuyuan , Zhu Zhenhua , Jia Qiufang , Ji Caifang , Hui Li , Yu Qiong 
Published: September 2023

Abstract
Background
Schizophrenia was clinically documented to co-occur with fractures and aberrant bone mineral density (BMD), but the potential causal relationship remained unclear. This study aimed to test the causal effects between schizophrenia and fractures as well as aberrant BMD by conducting Mendelian randomization (MR) analyses.

Methods
Two-sample MR was utilized, based on instrumental variables from large genome-wide association studies (GWAS) of schizophrenia as exposure, to identify the causal association of schizophrenia with mixed fractures, fractures at different body sites (including skull and facial bones, shoulder and upper arm, wrist and hand, and femur) and BMDs of forearm (FA), femoral neck (FN), lumbar spine (LS) and estimated BMD (eBMD). Multivariable Mendelian randomization (MVMR) analysis was performed to minimize the confounding effect of body mass index (BMI).

Results
Result from inverse variance weighting (IVW) method provided evidence schizophrenia increased the risk of fractures of skull and facial bones [odds ratio (OR) = 1.0006, 95% confidence interval (CI): 1.0003 to 1.0010] and femur [OR =1.0007, 95% CI: 1.0003 to 1.0011], whereas, decreased the level of eBMD [β (95%CI): -0.013 (-0.021, -0.004)]. These causal effects still existed after adjusting for BMI. Sensitivity analyses showed similar results. However, no causal effect of schizophrenia on fracture or BMD in other parts was detected.

Conclusion
The current finding confirmed that schizophrenia was causally associated with the fractures of skull, face and femur as well as eBMD, which might remind psychiatrists to pay close attention to the fracture risk in schizophrenic patients when formulating their treatment strategies.
TT-TG distance decreases after open wedge distal femoral varization osteotomy in patients with genu valgum & patellar instability. A pilot 3D computed tomography simulation study
Authors: Gür Volkan , Yapici Furkan , Subaşi İzzet Özay , Gökgöz Mehmet Burak , Tanoğlu Oğuzhan , Koçkara Nizamettin , Tandoğan Nevzat Reha 
Published: September 2023

Abstract
Background
Genu valgum is considered to be a risk factor for patellar instability. Correction of valgus alone or combined with a tibial tuberosity medialization has been described. However, changes occurring in the tibial tuberosity-trochlear groove (TT-TG) distance after a lateral distal femoral opening wedge osteotomy (LDF-OWO) are not known.

Purpose
This study aimed to define changes in TT-TG distance with increasing amounts of valgus correction after LDF-OWO.

Methods
Three-Dimensional Computed Tomography (3D-CT) scans of six patients (two females and four males) aged between 19 and 35 years with genu valgum and patellar instability were analyzed. 3D models of femoral, tibial, and patellar bones were created with the advanced segment option of Mimics 21® software. An oblique lateral opening wedge osteotomy of the distal femur was simulated in 2-degree increments up to 12 degrees of varus opening. Change in TT-TG distance was measured in mm on 3D models of the knee.

Results
Compared to baseline without osteotomy, the TT-TG distance decreased significantly (p < 0.05) for all corrections from 2 to 12 degrees in 2° steps. The TT-TG distance decreased by an average of 1.7 mm for every 2 degrees of varus opening.

Conclusion
Lateral opening wedge distal femoral osteotomy causes a decrease in TT-TG distance. The surgeon should be aware of the magnitude of this change (1.7 mm decrease for every 2° increment of valgus opening).