bluuebunny/crossref_metadata_2025_split huggingface dataset:
Longitudinal associations of objectively measured physical activity and sedentary time with leg muscle strength, balance and falls in middle‐aged women
Authors: Wang Mengmeng , Wu Feitong , Callisaya Michele L. , Jones Graeme , Winzenberg Tania M. 
Published: June 2023

ABSTRACTWe examined the longitudinal associations of accelerometer‐measured physical activity and sedentary time with leg muscle strength (LMS), balance, and falls in middle‐aged women. This was a 5‐year cohort study among 308 women aged 36–56 years. We used linear mixed‐effects models to examine associations of baseline and change in accelerometer‐measured sedentary time, light physical activity (LPA) and moderate‐to‐vigorous physical activity (MVPA) with baseline and 5‐year change in LMS and balance (timed up and go test [TUG], functional reach test [FRT], lateral reach test [LRT], and step test [ST]), and negative binomial/Poisson and log‐binomial regression as appropriate to assess associations with falls after 5‐year follow‐up. Greater baseline MVPA was associated with better baseline LMS (β = 4.65 kg/SD, 95% CI: 1.37, 7.93) and TUG (β = −0.09 s/SD, 95% CI: –0.18, –0.01) but not with change in them over 5 years. Baseline MVPA was not associated with FRT at baseline but associated with a greater decrease in FRT (β = −0.87 cm/SD, 95% CI: –1.57, –0.17). Increased MVPA over 5 years was associated with less deterioration in FRT (β = 0.88 cm/SD, 95% CI: 0.14, 1.61). Increased sedentary time over 5 years was associated with a larger decrease in FRT (β = −0.82 cm/SD, 95% CI: –1.58, –0.07). Higher baseline LPA was associated with higher falls risk (IRR = 1.27, 95% CI: 1.02, 1.57). Higher baseline MVPA may benefit LMS and balance, while increasing MVPA in the medium term has little effect on change in these outcomes in mid‐life. Detrimental association of LPA with falls may be due to greater exposures to environmental hazards.Highlights

Our study for the first time examined the longitudinal associations of objectively measured physical activity and sedentary time with leg muscle strength, balance and falls in middle‐aged women.
Higher baseline moderate‐to‐vigorous physical activity (MVPA) may be beneficial for muscle strength and balance at baseline but increasing MVPA in the medium term has little effect on change in LMS or balance outcomes in middle‐aged women.
Higher baseline light physical activity (LPA) was associated with an increased risk of falls.
The detrimental association of LPA with falls may be due to a greater exposure to environmental hazards in midlife, which needs to be clarified in future research.
Japan and the liberal international order: rules-based, multilateral, inclusive and localized
Authors: Nakano Ryoko 
Published: June 2023

Abstract
This article examines Japan's security and foreign policy as an example of how a major power engages in the liberal international order (LIO) and what this implies for the future of that order. Facing China's increased power and influence in the past two decades, Japan has made strategic adjustments in response to regional and global power transitions while developing an idea of a wider geopolitical landscape on Prime Minister Shinzo Abe's initiative. However, this article argues that Japan's idea of an expanded regional scope and its vision of order were addressed decades earlier through ‘comprehensive security’ (sogo anzen hosho). While the country is an ally of the United States and clearly accepts the alliance as a key part of international order, Japan has its own ideas about international order; these accept much of the LIO but go beyond it, particularly in the articulation and operationalization of comprehensive security. By adopting the concept of norm localization, this article argues that Japan does not have the power to coerce others to take any actions to defend the current international order, but it can adapt and tweak the dominant LIO norms, principles and practices to build congruence with local norms of sovereignty and territorial integrity embedded in its own region. To create a broader consensus in favour of sustaining the LIO, major powers like Japan can approach the sceptics by presenting an alternative to either total rejection or total acceptance of the LIO norms.
Ceratal autotomy as a defensive mechanism of the sacoglossan sea slug Placida kingstoni against a generalist crustacean predator
Authors: Gutierrez-Andrade D , Middlebrooks M L 
Published: June 2023

ABSTRACT
Sacoglossan sea slugs have developed a variety of defence mechanisms against predation. Research on these mechanisms has focused primarily on the chemical defences of these slugs, and little information is available on nonchemical modes of defence, such as autotomy, a behaviour in which an organism voluntarily detaches body structures at a predetermined breakage point in response to danger or stress. Autotomy is diverse in sacoglossan sea slugs and has been well documented. Within Oxynidae, members can autotomize their tail and parapodial lobes, and slugs in Limapontiidae and Hermaeidae can detach their cerata. More recently, reports have been made of Elysia with the capacity to autotomize most of their body. However, despite the widespread assumption that autotomy in this group serves a defensive purpose, the effectiveness of the behaviour in ensuring survival against predation has seldom been examined. The objective of this study was to evaluate the role of autotomy in sacoglossans by assessing the effectiveness of ceratal autotomy in ensuring survival against the attacks of a generalist predator. Placida kingstoni is a small sacoglossan native to Florida and the Caribbean with the ability to autotomize its cerata. Individual P. kingstoni were exposed to shrimps of the Lysmata wurdemanni species complex for 10-min interactions. Most sea slugs were attacked by the predator, often more than once, but the majority of the slugs readily autotomized cerata and survived. Structure detachment was accompanied by the secretion of a mucus that facilitated the formation of ceratal clumps. Most of these clumps were consumed by the predator and effectively diverted their attention, allowing P. kingstoni to crawl away. In this species, the success of autotomy as a defensive strategy appears to be directly related to the palatability of autotomized cerata. The results of this study show that ceratal autotomy in P. kingstoni is an effective defence against predation. Autotomy is a behaviour with a high-energetic cost; however, it has convergently evolved within Heterobranchia on multiple occasions, and it is highly prevalent in cerata-bearing slugs. Although in sacoglossans much of this behaviour remains a mystery, this study provides a clear example of autotomy as a defensive mechanism.
A Rare Case of Complete Sequestration of the Patella: an Unusual Presentation of Patellar Tuberculosis
Authors: Thakkar Samarth , Hegde Atmananda , Mane Prajwal , Shetty Chethan , Tripathi Anshul 
Published: June 2023

Abstract
Osteoarticular tuberculosis affecting the knee with isolated involvement of the patella is rare, accounting for less than 0.09% to 0.15% of cases. We present a case of 48-year-old man presenting with chronic knee swelling, pain, and stiffness. Radiographs revealed a completely sclerotic patella with erosions and irregular margins. Magnetic resonance imaging revealed chronic synovitis, joint effusion, and bony erosions with full-thickness cartilage defects in the patella. He underwent surgical debridement with extensive synovectomy, and a total patellectomy was performed. Intraoperative samples conclusively diagnosed it as a tubercular infection of the patella and synovium. The patient was started on antitubercular chemotherapy. A 2-year follow-up revealed good knee function with an extensor lag of 100. There has been no recurrence of infection. This report is a rare case of complete patellar sequestration secondary to tuberculosis patella, which was successfully treated with radical debridement and patellectomy.
Influence of endotamponade on anterior chamber depth and refractive outcome after combined phacovitrectomy: case-control study
Authors: Chatzimichail Eleftherios , Wertheimer Christian , Kilani Adnan , König Susanna , Gatzioufas Zisis , Wolf Armin , Vounotrypidis Efstathios 
Published: June 2023

Purpose:
To compare the changes in the anterior chamber depth (ACD) and in the refractive outcomes after combined phacovitrectomy with respect to the endotamponade (balanced salt solution, air, sulfur hexafluoride [SF6, gas]).

Setting:
Department of Ophthalmology, University Hospital Ulm, Ulm, Germany.

Design:
Retrospective, longitudinal case-control study.

Methods:
160 eyes of 160 patients were included in the study. 120 eyes underwent phacoemulsification with in-the-bag implantation combined with vitrectomy and were divided into 3 groups according to tamponade (balanced salt solution, air, gas). 40 control eyes with cataract surgery only were included. Further inclusion criteria were uneventful surgery, no postoperative complications and absence of corneal pathology. Endpoints were ACD as measured by swept-source optical coherence tomography-based biometry (IOLMaster 700) preoperatively, 1 to 2 days and 6 weeks postoperatively and refractive prediction error (PE) using the Barrett and Haigis formulas.

Results:
Within the first 2 days after surgery the ACD was shallower in the eyes left with gas or air tamponade, when compared with balanced salt solution or cataract surgery alone (P < .001). This effect diminished 6 weeks later, and all eyes reached comparable ACD (P = .396). The refractive PE was slightly, but statistically significantly higher in the gas group when compared with cataract surgery alone (P = .012 for Barrett, P = .006 for Haigis).

Conclusions:
The resulting ACD after combined phacovitrectomy was independent of the tamponade used, but a gas-tamponade was associated with a higher refractive PE.
Subcutaneous versus intravenous tramadol for extremity injury with moderate pain in the emergency department: a randomised controlled noninferiority trial
Authors: Bustam Aida , Poh Khadijah , Zambri Aliyah , Mohd Nazri Mohd Zahir Amin , Subramaniam Thayaharan , Abdullah Adlina Athilah , Nor Azman Amyrul Ikmal Haziq , Ang Bin Ting , Noor Azhar Abdul Muhaimin 
Published: June 2023

Background and importance
Musculoskeletal trauma is a common presentation in the emergency department (ED). Tramadol as an analgesic has been recommended by pain management guidelines for musculoskeletal pain. Parenteral tramadol in the ED is commonly administered intravenously. Subcutaneously administered tramadol may have other advantages such as easier and faster preparation, avoids the need for intravenous (i.v.) access, and reduces the incidence of respiratory and gastrointestinal effects. However, studies comparing subcutaneous (s.c.) and i.v. tramadol for the management of acute moderate pain in patients with extremity injury are lacking.

Objective
The objective of this study was to compare the clinical efficacy of s.c. tramadol vs. i.v. tramadol in patients with moderate pain due to extremity injury in the ED.

Design, settings, and participants
This non-inferiority randomized controlled trial included adult patients presented to an academic, tertiary hospital ED with moderate pain (pain score of 4–6 on the visual analog scale) due to extremity injury. Intervention patients stratified to pain score were randomized to receive 50 mg of i.v. or s.c. tramadol.

Outcomes measure and analysis
Primary outcome measure was the difference in the pain score reduction at 30 min after tramadol administration between the two groups. The noninferiority null hypothesis was that the therapeutic difference in terms of pain score reduction of more than 0.8 exists between the two treatment groups at the endpoint.

Main results
In total 232 patients were randomized to i.v. (n = 115) or s.c. (n = 117). Although 225 were analyzed in the per-protocol population (i.v. = 113; s.c. = 112). The baseline median pain score was 6 (IQR, 5–6). Median pain score reduction at 30 min after administration was 2 (IQR, 1–3) in the IV group vs. 2 (IQR, 1–2) in the s.c. group with a median difference of 0 (IQR, 0–0), which was below the prespecified noninferiority margin of 0.8. Adverse events in the i.v. group were higher compared to the s.c. group (33.6% vs. 8.9%, P ≤ 0.001).

Conclusions
The s.c. tramadol is noninferior to i.v. tramadol in the treatment of moderate pain from extremity injuries.
Derivation, Validation, and Clinical Relevance of a Pediatric Sepsis Phenotype With Persistent Hypoxemia, Encephalopathy, and Shock*
Authors: Sanchez-Pinto L. Nelson , Bennett Tellen D. , Stroup Emily K. , Luo Yuan , Atreya Mihir , Bubeck Wardenburg Juliane , Chong Grace , Geva Alon , Faustino E. Vincent S. , Farris Reid W. , Hall Mark W. , Rogerson Colin , Shah Sareen S. , Weiss Scott L. , Khemani Robinder G. 
Published: June 2023

OBJECTIVES:Untangling the heterogeneity of sepsis in children and identifying clinically relevant phenotypes could lead to the development of targeted therapies. Our aim was to analyze the organ dysfunction trajectories of children with sepsis-associated multiple organ dysfunction syndrome (MODS) to identify reproducible and clinically relevant sepsis phenotypes and determine if they are associated with heterogeneity of treatment effect (HTE) to common therapies.DESIGN:Multicenter observational cohort study.SETTING:Thirteen PICUs in the United States.PATIENTS:Patients admitted with suspected infections to the PICU between 2012 and 2018.INTERVENTIONS:None.MEASUREMENTS AND MAIN RESULTS:We used subgraph-augmented nonnegative matrix factorization to identify candidate trajectory-based phenotypes based on the type, severity, and progression of organ dysfunction in the first 72 hours. We analyzed the candidate phenotypes to determine reproducibility as well as prognostic, therapeutic, and biological relevance. Overall, 38,732 children had suspected infection, of which 15,246 (39.4%) had sepsis-associated MODS with an in-hospital mortality of 10.1%. We identified an organ dysfunction trajectory-based phenotype (which we termed persistent hypoxemia, encephalopathy, and shock) that was highly reproducible, had features of systemic inflammation and coagulopathy, and was independently associated with higher mortality. In a propensity score-matched analysis, patients with persistent hypoxemia, encephalopathy, and shock phenotype appeared to have HTE and benefit from adjuvant therapy with hydrocortisone and albumin. When compared with other high-risk clinical syndromes, the persistent hypoxemia, encephalopathy, and shock phenotype only overlapped with 50%–60% of patients with septic shock, moderate-to-severe pediatric acute respiratory distress syndrome, or those in the top tier of organ dysfunction burden, suggesting that it represents a nonsynonymous clinical phenotype of sepsis-associated MODS.CONCLUSIONS:We derived and validated the persistent hypoxemia, encephalopathy, and shock phenotype, which is highly reproducible, clinically relevant, and associated with HTE to common adjuvant therapies in children with sepsis.
Characteristics of Transport of Ill Pediatric Patients in the Emergency Department
Authors: Yock-Corrales Adriana , Curto Danila Andrea , Gerolami Andrea , Mota Cesar , Vigna Andrés , Camacho Edgardo , González-Vallejos Silvia Catalina , Copana-Olmos Raúl , Gómez-Vargas Jessica , Cassón Nils ,   On Behalf of the Transport Working Group of the Red de Investigación y Desarrollo de la Emergencia Pediátrica Latinoamericana (RIDEPLA)
Published: June 2023

Objective
The aim was to describe the characteristics of the transport system of critically ill pediatric patients in the emergency departments (EDs) in Latin America (LA).

Methodology
This is a prospective cross-sectional study in a 1-year period. Patients were recruited on days 1, 7, 14, 21, and 28 of each month in the EDs in LA. We included ill-pediatric patients aged 1 month to 18 years. Patients who needed transfer for a diagnostic study, with arrival mode not by ambulance, or with the impossibility of interviewing the transfer team were excluded from the study.

Results
A total of 389 patients were included in the study. The majority were males (57%) with a median age of 49 months (interquartile range, 10–116). Thirty-three percent (129) of transfers had the participation of a coordinating center; 97.1% (375) were carried out by road ambulance, and 84.3% (323) were interhospital transfers, with a mean distance traveled of 83.2 km (SD, 105 km). The main reason for transfer in 88.17% (343) was the need for a more complex health center. The main diagnosis was respiratory distress (71; 18.2%), acute abdomen (70; 18%), Traumatic Brain Injury (33; 8.48%), multiple trauma (32; 8.23%), septic shock (31; 7.9%), and COVID-19–related illness (19; 4.8%). A total of 296 (76.5%) patients had peripheral vascular access, and 171 (44%) patients had oxygen support with 49 (28.6%) having invasive ventilation; the most frequent monitoring method (67.8%) was pulse oximetry, and 83.4% (313) did not record adverse events. Regarding the transfer team, 88% (342) had no specialized personnel, and only 62.4% (243) had a physician on their teams.

Conclusions
In LA, there is great variability in personnel training, equipment for pediatric transport, team composition, and characterization of critical care transport systems. Continued efforts to improve conditions in our countries may help reduce patient morbidity and mortality.
Regional Anesthesia as an Alternative to Procedural Sedation for Forearm Fracture Reductions in the Pediatric Emergency Department
Authors: Sulton Carmen D. , Fletcher Nicholas , Murphy Joshua , Gillespie Scott , Burger Rebecca K. 
Published: June 2023

Background
Pediatric forearm fractures are common injuries in the pediatric emergency department (PED). Pediatric procedural sedation (PPS) is often required for forearm fracture reductions and pain control for casting. Bier blocks and hematoma blocks are types of regional anesthesia (RA) procedures that can be performed as a potential alternative to PPS.

Objective
The objective of this study is to compare the safety of RA with that of PPS. We hypothesized that RA has a safety profile that is equal or superior to PPS as well as a shorter duration of treatment in the PED.

Methods
Pediatric emergency department encounters in patients presenting with a diagnosis of radius fracture, ulna fracture, distal “both-bone” fracture, Monteggia fracture, and/or Galeazzi fracture were included. Outcomes of interest included patient adverse events (AEs), sedation medications used, PED duration of treatment (arrival time to disposition time), sedation failures, and reduction failures.

Results
Propensity matching was performed resulting in 632 well-matched RA-PPS pairs. The PPS cohort had 13% of encounters with at least 1 AE compared with 0.2% in the RA cohort, P < 0.001. The most common AE in the PPS group was hypoxia (9.8%), and the only AE in the RA group was an intravenous infiltrate (0.16%). Within the matched cohorts, PPS required more medications than RA (100% vs 60%, P < 0.001). Ketamine alone was more commonly used in the PPS group than the RA group (86% vs 0.2%, P < 0.001). Propofol was used only in the PPS group. The average duration of treatment was 205 (SD, 81) minutes in the PPS group and 178 (SD, 75) minutes in the RA group (P < 0.001). There were no reduction failures in either group.

Conclusions
Bier blocks and hematoma blocks are an acceptable alternative to PPS for children requiring forearm reductions. The AE rate is low and the reduction success rate is high. Duration of treatment in the PED is shorter for patients receiving RA compared with PPS.
Evaluation of Glomerular Filtration Rate Trends in People Living With HIV Corrected by the Baseline Glomerular Filtration Rate
Authors: Reis Amanda Orlando , Rocco Suassuna José H. , Cunha Cynthia B. , Portela Estevão N. , Veloso Valdilea G. , Grinszteijn Beatriz , Cardoso Sandra Wagner 
Published: June 2023

Background:
Chronic kidney disease, for which estimated glomerular filtration rate (eGFR) trajectories are early markers, is frequent in people living with HIV.

Setting:
Identify eGFR trajectory patterns according to kidney function and assess associated factors over a 13-year follow-up period.

Methods:
We evaluated longitudinal changes and its associated factors in eGFR of 3366 participants according to kidney function with a 2-level, linear, mixed model.

Results:
Participants with initial kidney dysfunction experienced a slight eGFR increase, whereas others showed a slight decrease. A weak relationship was observed between baseline eGFR and its variation over time. Baseline eGFR was affected by age, CD4+ count, viral load, hypertension, hyperlipidemia, AIDS-defining illness and tenofovir (TDF) with integrase inhibitor (INSTI) or efavirenz. Significant factors for eGFR change included the following: in kidney dysfunction, CD4+ cell count of >350 cells per cubic millimeter and undetectable viral load increased eGFR, whereas TDF + protease inhibitor decreased eGFR; in mildly decreased kidney function, CD4+ cell count of >350 cells per cubic millimeter, AIDS-defining illness, and TDF + efavirenz increased eGFR, whereas age, hypertension, hyperlipidemia, and TDF + INSTI decreased eGFR; in normal kidney function, age, CD4+ cell count of > 350 cells per cubic millimeter, undetectable viral load, hypertension, hyperlipidemia, and TDF + INSTI decreased eGFR, whereas TDF + efavirenz increased eGFR (all P value for interaction < 0.05).

Conclusion:
Our findings suggest that eGFR trajectories varied widely between individuals in people living with HIV. In the lower eGFR group, virus-related factors were more relevant, whereas traditional risk factors for renal dysfunction were more prominent in the highest eGFR group.
Relapsing Polychondritis
Authors: Kwok Sing Hon , Choi Frankie 
Published: June 2023

Abstract
We present a 54-year-old woman with 3-month history of skin rash and bilateral hearing loss. Multiple investigations including biopsy failed to reveal the underlying diagnosis of relapsing polychondritis, until 18F-FDG PET/CT demonstrated a characteristic FDG activity pattern—the oto-rhino-tracheobronchial triad. The patient was subsequently diagnosed to have relapsing polychondritis and received treatment. The second FDG PET/CT revealed a differential response in different disease sites, which prompted an escalation of treatment.