bluuebunny/crossref_metadata_2025_split huggingface dataset:
A New Approach for Diagnosis and Surveillance of Infantile Subglottic Hemangioma in the Era of Propranolol Use: A Case Series
Authors: Ezeh Uche C. , Ben-Dov Tom , Taufique Zahrah M. , Gaffey Megan M. , Blei Francine , April Max M. 
Published: August 2023

Objective: To report our institutional experience in diagnosing and surveilling patients with infantile subglottic hemangioma (SGH) using in-office flexible fiberoptic laryngoscopy (FFL) with video technology, without requiring operative endoscopy in the era of propranolol use. Methods: A retrospective case series was conducted on 4 children diagnosed with SGH between 2016 and 2022 at our institution. Results: Awake FFL with video technology provided adequate visualization of SGH lesions for diagnosis, without any complications. Serial examinations of the airway were performed in the outpatient setting and each SGH gradually regressed, with marked improvement in respiratory symptoms within 48 hours of oral propranolol initiation. Conclusion: Our findings showed that in select patients, FFL with video technology can successfully identify SGH lesions without general anesthesia exposure. FFL may be used as a low-risk screening tool for propranolol therapy initiation in some patients, but operative endoscopy should remain the gold standard procedure for others. By utilizing FFL in this manner, it is possible to diagnose SGH lesions and start propranolol therapy without exposing all patients to the risks of operative endoscopy.
Platelet-Derived Exosomes Alleviate Knee Osteoarthritis by Attenuating Cartilage Degeneration and Subchondral Bone Loss
Authors: Xu Chenyue , Mi Ziyue , Dong Zhenyue , Chen Xiaobo , Ji Gang , Kang Huijun , Li Kehan , Zhao Bo , Wang Fei 
Published: August 2023

Background: Osteoarthritis (OA) is the most prevalent chronic degenerative joint disease among the aged population. However, current treatments for OA are limited to alleviating symptoms, with no therapies that prevent and regenerate cartilage deterioration. Purpose: To assess the effects of platelet-derived exosomes (Plt-exos) on OA and then to explore the potential molecular mechanism. Study Design: Controlled laboratory study. Methods: Exosomes derived from human apheresis platelets were isolated and identified. The effects of Plt-exos in protecting chondrocytes under interleukin 1β stimulation were evaluated by analyzing the proliferation and migration in human primary chondrocytes. RNA sequencing was later performed in vitro for primary chondrocytes to reveal the underlying mechanisms of Plt-exo treatment. Anterior cruciate ligament transection was used to construct an OA mice model, and intra-articular injection of Plt-exos was given once a week for 6 weeks. Mice were sacrificed 4 weeks after the last injection. Histologic and immunohistochemistry staining and micro–computed tomography analysis were performed to assess alterations of articular cartilage and subchondral bone. Results: Plt-exos significantly promoted proliferation and migration of chondrocytes within a dose-dependent manner, as well as dramatically promoted cartilage regeneration and attenuated abnormal tibial subchondral bone remodeling, thus slowing the progression of OA. After being treated with Plt-exos, 1797 genes were differentially expressed in chondrocytes (923 upregulated and 874 downregulated genes). Functional enrichment results and hub genes were mainly involved in anti-inflammatory effects, mediating cell adhesion, stimulating cartilage repair, promoting anabolism, and inhibiting catabolism. Conclusion: Our results demonstrated that Plt-exos promoted chondrocyte proliferation and migration in vitro, as well as attenuated cartilage degeneration, improved the microarchitecture of subchondral bone, and retarded OA progression in vivo. Clinical Relevance: Our study illustrated that the administered Plt-exos could alleviate knee OA by attenuating cartilage degeneration and subchondral bone loss, possibly serving as a novel promising treatment for OA in the future.
Association Between Symptom Cluster Endorsement at Initiation of a Graduated Return-to-Activity Protocol and Time to Return to Unrestricted Activity After Concussion in United States Service Academy Cadets
Authors: Aderman Michael J. , Brett Benjamin L. , Ross Jeremy D. , Malvasi Steven R. , McGinty Gerald , Jackson Jonathan C. , Estevez Carlos A. , Brodeur Rachel M. , Svoboda Steven J. , McCrea Michael A. , Broglio Steven P. , McAllister Thomas W. , Pasquina Paul F. , Cameron Kenneth L. , Roach Megan H. 
Published: August 2023

Background:The endorsement of symptoms upon initiation of a graduated return-to-activity (GRTA) protocol has been associated with prolonged protocols. It is unclear whether there are specific symptom clusters affecting protocol durations.Purpose:To describe the endorsement of specific concussion symptom clusters at GRTA protocol initiation and examine the association between symptom cluster endorsement and GRTA protocol duration.Study Design:Cohort study; Level of evidence, 2.Methods:This study was conducted among cadets enrolled at 3 US service academies. Participants completed an evaluation upon GRTA protocol initiation. Participants endorsing symptoms were binarized based on 6 symptom clusters (cognitive, emotional, insomnia, physical, sensitivity, and ungrouped). The primary outcome of interest was GRTA protocol duration based on symptom cluster endorsement severity. Prevalence rates were calculated to describe symptom cluster endorsement. Kaplan-Meier survival estimates and univariate and multivariable Cox proportional hazards regression models were calculated for all 6 symptom clusters to estimate GRTA protocol duration while controlling for significant covariates.Results:Data from 961 concussed participants were analyzed. Of these, 636 participants were asymptomatic upon GRTA protocol initiation. Among the 325 symptomatic participants, the physical symptom cluster (80%) was most endorsed, followed by the cognitive (29%), insomnia (23%), ungrouped (19%), sensitivity (15%), and emotional (9%) clusters. Univariate results revealed a significant association between endorsing cognitive (hazard ratio [HR], 0.79; p = .001), physical (HR, 0.84; p < .001), insomnia (HR, 0.83; p = .013), sensitivity (HR, 0.70; p < .001), and ungrouped (HR, 0.75; p = .005) symptom clusters and GRTA protocol duration. Endorsing physical (HR, 0.84; p < .001) and sensitivity (HR, 0.81; p = .036) clusters maintained a significant association with GRTA protocol duration in the multivariable models.Conclusion:Participants endorsing physical or sensitivity symptom clusters displayed GRTA protocols prolonged by 16% to 19% compared with participants not endorsing that respective cluster after controlling for significant covariates.
A novel multi-element flame retardant containing phosphorus, nitrogen and sulfur for enhancing the fire safety of epoxy resin composites
Authors: Li Junwei , Liu Quanyi , Zhou Yumei , Cai Yuming , Shi Kaikai , Zhao Haihan , Meng Yawei , Zheng Penglun 
Published: August 2023

To gain insight into more about how flame retardants containing phosphorus, sulfur, and nitrogen affect epoxy resin (EPs), a multicomponent flame retardant (Sp-ACDH) containing P/N/S was synthesized from sodium p-aminobenzene sulfonate (Sp-A), cinnamaldehyde and 9,10-dihydro-9-oxa-10-phosphaphenanthrene-10-oxide (DOPO) and applied to epoxy resin. Sp-ACDH enables the epoxy resin to achieve the desired flame retardancy. For example, with the addition of 10 wt% Sp-ACDH, the epoxy composite passed the UL-94 V-0 rating and achieved an LOI of 32.7%. Additionally, Sp-ACDH effectively slowed down EP’s ability to release heat, with EP-15 Sp-ACDH exhibiting a peak heat release rate (PHRR) that was 680 kW/m2 rather than pure EP’s 1204.4 kW/m2. Eventually, the samples were characterized using Scanning electron microscopy (SEM), Raman spectroscopy, and Thermogravimetric analysis-fourier transform infrared spectroscopy (TG-FTIR) spectra, and the samples were analyzed, it revealed that Sp-ACDH’s flame-retardant properties were active in both the gas and condensed phases.
Association between serum complement 1q and the associated factors of acute ischemic stroke in patients with type 2 diabetes
Authors: Hu Zhen-ping , Wu Fang , Du Yuan-hong , Ye Mao 
Published: August 2023

Objective The aim of this study was to examine the association between serum complement 1q (C1q) and the associated factors of acute ischemic stroke in patients with type 2 diabetes (T2DM). Methods The baseline clinical variables of the participants were collected, and the levels of blood lipids, blood sugar, inflammatory cytokines, and C1q in the three groups were then compared. The variables which affected the associated factors of acute ischemic stroke in T2DM cases were determined. Results The levels of C1q in the DAIS group were increased significantly compared with those in the T2DM group. Receiver operating characteristic curve analyses showed that the AUC for C1q and the combined diagnosis of acute ischemic stroke were 0.830 (95%CI 0.747–0.914), with a sensitivity of 0.854 and specificity of 0.780. The results of Pearson’s correlation analyses demonstrated that C1q was associated positively with low-density lipoprotein cholesterol (LDL-C), fasting blood glucose (PBG), 2-h postprandial blood glucose (2h PG), and high-sensitive C reaction protein (hs-CRP) (all p < .05). Stratified analysis showed that there was a positive relationship between C1q and the associated factors of acute ischemic stroke for partial LDL-C, and hs-CRP strata. Logistic model analysis suggested that C1q was an independent risk factor for acute ischemic stroke in patients with T2DM. After adjusting for potential confounders, a one-standard deviation (SD) increase in C1q level was strongly related to an approximately 1.5-fold increased risk of acute ischemic stroke in cases with a hs-CRP ≥1.78 mg/L. Conclusion In DAIS patients, the levels of C1q were increased significantly and were an independent associated factor which affected the occurrence of acute ischemic stroke.
Emigration and Back-Door Brain Drain: Do Restrictive Immigration Policies Make UnequalsWorse Off?
Authors: Chowdhury Sahana Roy 
Published: August 2023

In contrast to the skilled emigration and brain drain literature unskilled labour emigration and its impact on skill accumulation in the source country caught limited attention so far. While skilled emigration pushes up skilled wages and directly impacts the skilled stock of the source country, unskilled emigration pushes up the opportunity cost (unskilled wage) of skill acquisition. This further weakens the incentive to build skills. Economic agents make rational educational investment decisions based on their wealth (inheritance) and endogenous market returns (wages). The wealth distribution of an economy plays a deterministic role in the skill formation process. This is especially when the capital market is imperfect and skill acquisition is costly. Among unequal countries, the article identifies conditions and explains the possibilities of a decrease in skilled stock following emigration. This has significant policy implications. The restrictive immigration policies of the host countries specifically for unskilled immigrants make these unequal economies worse off. JEL: D31, F22, J24
Novel surgical technique to manage iStent inject over-implantation
Authors: Ang Bryan Chin Hou , Chen Elizabeth Jiahui 
Published: August 2023

Purpose To describe a novel surgical technique to manage over-implantation of the iStent inject intra-operatively, utilizing only the iStent inject delivery system itself to perform both device extraction and reimplantation, without the need for additional instrumentation. Methods A demonstration of managing over-implantation of the iStent inject, with two case examples. Results Over-implantation of the iStent inject can be successfully managed intra-operatively to ensure ideal positioning to optimise post-operative outcomes, with the use of only the iStent inject delivery system itself for both device extraction and reimplantation. Conclusion This novel technique provides a cost-effective and feasible means to intra-operatively manage over-implantation of the iStent inject.
Fuyuan Huoxue Decoction Promotes Skin Flap Survival Via the P38MAPK/IKK/NF-κB Pathway in Rats
Authors: Zeng Jingda , Yang Lin , Zhang Jian , Luo Xuchao , Zou Yonggen , Chen XiaoJun 
Published: August 2023

Objective Fuyuan Huoxue decoction (FHD) is a traditional Chinese medicine that can promote blood circulation, inhibit inflammatory reactions and effectively relieve pain. This study investigated the effect of FHD on rat skin flap survival and the p38 MAPK/IKK/NF-κB pathway. Methods The pathological condition of the flap tissue was examined by H&E staining. The expression levels of CD34 and VEGF in skin flap tissues were examined by immunohistochemistry. The levels of TNF-α, IL-6, CRP, and HO-1, superoxide dismutase (SOD) activity, and MDA content were detected by ELISA. The protein expression levels of Bax, Bcl-2, cleaved-caspase 3, p-IKKαβ, p-p38, p-p65, α-SMA, CK14, CK15, and SOX2 were detected by western blotting. Results Fuyuan Huoxue decoction upregulated the levels of CD34, VEGF, and Bcl-2, downregulated the expression of TNF-α, IL-6, p-IKKαβ, P-P38, P-P65, Bax, and cleaved-caspase 3, increased the activity of SOD, and inhibited the level of MDA. In addition, FHD promoted the proliferation and differentiation of skin flap. Conclusions Fuyuan Huoxue decoction improved the survival of the rat skin flap model by regulating the p38MAPK/IKK/NF-κB signaling pathway, and the mechanism may be related to the promotion of skin flap proliferation, differentiation, and revascularization and the inhibition of inflammation and oxidative stress.
Internal but Not External Building Design Associated With More Occupational Physical Activity
Authors: Gallagher Jacob , Carr Lucas J. 
Published: August 2023

Background: Few studies have explored the impact of internal building design features on physical activity. The purpose of this study is to determine building design features associate with physical activity and sedentary behaviors. Methods: Full-time workers ( n = 114) wore an ActivPal monitor for 4 work days to measure physical activity and sedentary behaviors. Participants completed a 25-item survey about the presence of external, internal, and staircase design features at their worksite. Participants also reported their desk type. General linear models were used to examine relations between the number of features present for each category and physical activity (steps per hour) and sedentary behavior (sitting time per hour). Results: Internal design scores were positively associated with occupational physical activity. Each single item increase in facilitating internal design features was associated with +64.5 steps/hr ( p = .045) at work. Workers who reported having a desk job walked 538 fewer steps/hr ( p < .01) and sat 17 min more/hr at work than workers who reported not having a desk. Conclusion: These results suggest that internal design features can promote more movement and less sitting at work. Future studies that examine the longitudinal effect of changing internal design features on occupational physical activity and sedentary behaviors are warranted.
Predictors of Prolonged Length of Stay After Pituitary Adenoma Resection: A Large Cohort Analysis Using the National Inpatient Sample (2016-2019)
Authors: Vasan Vikram , Dullea Jonathan T , Devarajan Alex , Vasa Devarshi , Ali Muhammad , Nichols Noah , Henson Philip , Porras Christian , Lopez Christine , Luna Diego , Liou Lathan , Iloreta Alfred Marc , Govindaraj Satish , Bederson Joshua , Shrivastava Raj K 
Published: August 2023

Objective In this nationwide retrospective study, the authors aimed to identify demographic, clinical, and baseline health risk factors predictive of a prolonged length of stay (PLOS) for patients with pituitary adenomas (PAs). Methods The National Inpatient Sample dataset from 2016 to 2019 was utilized to identify all included hospitalizations for PA resection as identified by the appropriate diagnosis-related group code. Comorbidities were classified based on the Charlson Comorbidity Index mapping of ICD-10 codes, and PLOS was identified as any stay longer than 3 days. Univariable and multivariable logistic regression models, accounting for the sample design, were built to determine factors associated with PLOS and emergent surgery. Results Overall, 30 945 patients were included in this study with 10 535 patients having PLOS. Female patients experienced an increased odds of PLOS (odds ratio [OR]: 1.29; P < .001). Black patients (OR: 1.49; P < .001) and Hispanic patients (OR: 1.30; P = .003) had 1.49 times and 1.30 times the odds of PLOS compared to White patients, respectively. Compared to patients insured by Medicare, patients insured by Medicaid had an increased odds of PLOS (OR: 1.36; P = .007) as well as emergent surgery (OR: 5.40; P < .001). When stratified by emergent surgeries, Black patients (OR: 1.89; P < .001), Hispanic patients, (OR: 2.14; P < .001), and patients on Medicaid insurance (OR: 1.71; P < .001) were at an increased risk of emergent procedures. However, female sex (OR: 0.65; P < .001), upper third quartile (OR: 0.73; P = .017), and fourth quartile (OR: 0.69; P = .014) of patients categorized by zip code income were at decreased odds of an emergent procedure. Conclusions Black and Hispanic patients, patients with Medicaid insurance, and patients of low socioeconomic status patients are at significantly higher risk of emergent PA resection and PLOS. Efforts to prevent emergent surgeries and shorten hospitalization after pituitary surgery may need to primarily focus on patient groups with select sociodemographic characteristics.
HaEmaturia After Transurethral resection of bladder Tumour (HEATT): A multicentre, regional collaborative analysis of factors associated with emergency re-admission with haematuria following TURBT
Authors: Sarmah Piyush B ,   West Midlands Urology Research Collaborative HEATT study group, Al-Dhahir Wesam , Chellapuri Akhil , Damola Adebiyi , Eli Nnaemeka , Foulger Rebecca , Harrington-Vogt Maria , Hulligan Stephen , Kanthabalan Abi , Kitchen Mark O , Malik Salim , Moore Madeline , Nyanhongo Donald , Sohawon Ridwaan , Thursby Helen , Yallappa Sachin , Mak David , Chakravarti Aniruddha 
Published: August 2023

Objective: To calculate the re-admission rate with haematuria within 30 days of elective transurethral resection of bladder tumour (TURBT), and identify factors associated with this. Materials and Methods: This was a multicentre, retrospective audit, identifying all adult patients over the age of 16 who underwent elective TURBT between 1 September and 30 November 2019. Data were collected from medical records and operation notes on patient demographics, intra-operative factors and post-operative management. Primary outcome measure was the proportion of patients emergently re-admitted with haematuria. Secondary outcome measures were the re-operation rate for haematuria, and the rate of new acute thrombotic event (TE). Fisher’s exact test was used to calculate p values within subgroups for re-admission rates. Results: 443 patients from 12 hospitals were included. Median age was 75 years (17–99). 15 patients (3.4%) were re-admitted with haematuria. Subgroup analysis demonstrated higher rate of re-admission for pre-existing antithrombotic agents (ATAs) (2.0% vs. 6.1%, p = 0.046), increased for non-Aspirin ATAs (10.5%, p = 0.0015). 52% of non-Aspirin ATAs were restarted within 48 hours of surgery; post-operative plan for restarting was not documented in 22.1%. One patient (0.23%) developed acute TE (pulmonary embolus). Conclusion: Pre-existing use of non-Aspirin ATAs is associated with increased risk of post-TURBT haematuria, with variable practice in post-operative recommencement. Level of evidence: Level 3
Low-Threshold-For-Surgery Versus Primarily-Conservative Treatment for Odontoid Fractures in the Elderly: Evaluating Practice Variation in The Netherlands
Authors: Huybregts Jeroen G. J. , Polak Samuel B. , Jacobs Wilco C. H. , Krekels-Huijbregts Ilse A. , Smeets Anouk Y. J. M. , Arts Mark P. , Slooff Willem-Bart M. , Öner F. Cumhur , Peul Wilco C. , van Santbrink Henk , Vleggeert-Lankamp Carmen L. A. 
Published: August 2023

Study Design Retrospective cohort study. Objectives Odontoid fractures are the most common cervical spine fractures in the elderly. The optimal treatment remains controversial. The aim of this study was to compare results of a low-threshold-for-surgery strategy (surgery for dislocated fractures in relatively healthy patients) to a primarily-conservative strategy (for all patients). Methods Patient records from 5 medical centers were reviewed for patients who met the selection criteria (e.g. age ≥55 years, type II/III odontoid fractures). Demographics, fracture types/characteristics, fracture union/stability, clinical outcome and mortality were compared. The influence of age on outcome was studied (≥55-80 vs ≥80 years). Results A total of 173 patients were included: 120 treated with low-threshold-for-surgery (of which 22 primarily operated, and 23 secondarily) vs 53 treated primarily-conservative. No differences in demographics and fracture characteristics between the groups were identified. Fracture union (53% vs 43%) and fracture stability (90% vs 85%) at last follow-up did not differ between groups. The majority of patients (56%) achieved clinical improvement compared to baseline. Analysis of differences in clinical outcome between groups was infeasible due to data limitations. In both strategies, patients ≥80 years achieved worse union (64% vs 30%), worse stability (97% vs 77%), and – as to be expected – increased mortality <104 weeks (2% vs 22%). Conclusions Union and stability rates did not differ between the treatment strategies. Advanced age (≥80 years) negatively influenced both radiological outcome and mortality. No cases of secondary neurological deficits were identified, suggesting that concerns for the consequences of under-treatment may be unjustified.
Interaction between activity and movement control during one-leg standing in parameters of bone strength in patients with hip fractures—a cross-sectional study
Authors: Umehara Takuya , Kaneguchi Akinori , Watanabe Keita , Katayama Nobuhisa , Kuwahara Daisuke , Kaneyashiki Ryo , Kito Nobuhiro , Kakehashi Masayuki 
Published: August 2023

Background/Purpose We aimed to investigate whether there is an interaction between life-space assessment (LSA) and movement control during one-leg standing on bone strength on the non-fractured side in patients with hip fracture. Methods Two-way analysis of variance (ANOVA) was applied for osteoporosis parameter to examine the interaction and main effects of LSA and movement control during one-leg standing. Results Two-way ANOVA revealed significant interaction and main effects of LSA and movement control during one-leg standing on bone mineral density (BMD) and Z-score. In parameters of hip structural analysis (HSA), the interaction and main effect of movement control during one-leg standing were detected only in cross-sectional area (CSA). Conclusion The results of this study suggest that both high LSA and good movement control during one-leg standing are necessary to maintain or improve some parameters of bone strength, such as BMD (neck and total hip), Z-score (neck and total hip), and CSA.