bluuebunny/crossref_metadata_2025_split huggingface dataset:
Risk Factors for Recurrent Instability After Arthroscopic Bankart Repair in Pediatric and Adolescent Patients: A Systematic Review
Authors: Warner Tyler , Kay Jeffrey , McInnis Shane , Heyworth Benton E. 
Published: January 2025

Background: While risk factors for recurrent instability (RI) after arthroscopic Bankart repair (ABR) for anterior glenohumeral instability (aGHI) have been well established in adult populations, there is much less evidence in pediatric and adolescent patients, despite being the most affected epidemiologic subpopulation. Purpose: To identify the clinical, demographic, radiologic, and operative risk factors for RI after ABR for aGHI in pediatric and adolescent patients. Study Design: Systematic review; Level of evidence, 4. Methods: This systematic review was performed according to the PRISMA guidelines (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). Three databases (PubMed, Embase, and Ovid [MEDLINE]) were searched from data inception to July 5, 2023, using the terms “pediatric,”“shoulder instability,” and “Bankart repair,” allowing data on patients with age up to 19 years. The Methodological Index for Non-randomized Studies tool was used to assess the quality of included studies. Results: Eleven studies met the criteria, with 767 patients (770 shoulders) with a mean age of 16.4 years (range, 12-19; 18% female). The pooled RI rate was 28%, and the revision aGHI surgery rate was 20%. The following risk factors were identified for RI after ABR, in descending order of frequency of identification, in terms of number of studies: younger age and greater glenoid bone loss, as well as the presence and/or greater size of a Hill-Sachs lesion (HSL) (2 studies each), followed by off-track HSL, >1 dislocation before index surgery, overhead and/or contact sports participation, larger anterior labral tear size, loss of glenoid retroversion, greater number of anchors used, lower postoperative patient-reported outcome scores (PROs), nonunion after bony Bankart repair, and absence of concomitant remplissage (1 study each). Conclusion: In pediatric and adolescent patients with aGHI, the most common risk factors identified for RI after ABR were younger age, greater glenoid bone loss, and the presence and greater size of an HSL. Other risk factors included >1 dislocation before index surgery, participation in overhead and/or contact sports, larger anterior labral tear size, loss of glenoid retroversion, greater number of anchors used, lower postoperative PROs, nonunion after bony Bankart repair, and absence of concomitant remplissage.
The Association Between Delaying Anterior Cruciate Ligament Reconstruction in Adolescents and Increasing Meniscal and Chondral Pathology: A Cohort Study of 2740 Adolescents
Authors: Hickie Kirsten L. , Salmon Lucy J. , Gooden Benjamin R. , Lyons Matthew C. , Sundaraj Keran , Carmody David , Huang Phil , Pinczewski Leo A. , Roe Justin P. 
Published: January 2025

Background: A growing body of evidence surrounds secondary meniscal and cartilage pathology after delay to anterior cruciate ligament (ACL) reconstruction (ACLR). Many of these studies focus on or include an adult population. Purpose: To elucidate the prevalence of secondary meniscal and chondral pathology with delay to ACLR in the adolescent population as well as examine the influence of sex, skeletal maturity, and trends over the years. Study Design: Cohort study; Level of evidence, 3. Methods: A prospective database was used to identify all patients younger than 19 years who underwent ACLR at the authors’ center between January 1993 and April 2023. Operative data including meniscal and chondral injury and treatment were prospectively recorded at the time of ACLR. A retrospective analysis was performed assessing the relationship between meniscal treatment and chondral injury at ACLR and the time from injury to ACLR, controlling for age, sex, and decade of surgery with multiple regression analysis. Prevalence of meniscal and chondral surgery at ACLR was examined over time and compared between sexes and age groups. Results: A total of 2740 patients were identified with a median age of 17 years (range, 7-19 years). Surgical delay of 5 to 12 months increased the risk of medial meniscal tear requiring surgery by 1.6 (95% CI, 1.1-2.2; P = .007). Surgical delay >12 months increased the risk of medial meniscal tear requiring surgery by 4.2 (95% CI, 3.1-5.8; P = .001) and medial chondral injury by 3.4 (95% CI, 2.2-5.1; P = .001). The repairability of medial meniscal tears decreased with greater delay to reconstruction (57% before 5 months vs 19% after 12 months; P = .001). Lateral meniscal tear repairability followed a similar trend. More male than female participants had secondary pathology (46% vs 39%; P = .001). Patients aged 14-19 years had more meniscal surgery and chondral pathology compared with those younger than 14 years (45% vs 30%, P = .001). Conclusion: Surgical delay >4 months from injury is associated with a steady increase in the prevalence of medial meniscal and chondral pathology in adolescents with ACL rupture. If ACL surgery is delayed >12 months, the odds of requiring medial meniscal surgery is increased by a factor of 4 and the odds of having a chondral lesion is increased by a factor of 3. Timely diagnosis of ACL injury and early surgical referral are important for reducing the odds of meniscal and chondral pathology in adolescents.
Enhanced swin transformer based tuberculosis classification with segmentation using chest X-ray
Authors: Visu P , Sathiya V , Ajitha P , Surendran R 
Published: January 2025

Background:  Tuberculosis disease is the disease that causes significant morbidity and mortality worldwide. Thus, early detection of the disease is crucial for proper treatment and controlling the spread of Tuberculosis disease. Chest X-ray imaging is one of the most widely used diagnostic tools for detecting the Tuberculosis, which is time-consuming, and prone to errors. Nowadays, deep learning model provides the automated classification of medical images with promising outcome. Objective:  Thus, this research introduced a deep learning based segmentation and classification model. Initially, the Adaptive Gaussian Filtering based pre-processing and data augmentation is performed to remove artefacts and biased outcome. Then, Attention UNet (A_UNet) based segmentation is proposed for segmenting the required region of Chest X-ray. Methods:  Using the segmented outcome, Enhanced Swin Transformer (EnSTrans) model based Tuberculosis classification model is designed with Residual Pyramid Network based Multi-layer perceptron (MLP) layer for enhancing the classification accuracy. Results:  Enhanced Lotus Effect Optimization (EnLeO) Algorithm is employed for the loss function optimization of the EnSTrans model. Conclusions:  The proposed methods acquired the Accuracy, Recall, Precision, F-score, and Specificity of 99.0576%, 98.9459%, 99.145%, 98.96%, and 99.152% respectively.
Ethical considerations in the UK-Nepal nurse recruitment: Nepali nurses’ perspectives
Authors: Ghimire Animesh , Qiu Yunjing , Neupane Mamata Sharma , Ghimire Purushottam 
Published: January 2025

Background The global migration of nurses from resource-constrained to affluent nations raises complex ethical concerns, often rooted in historical power imbalances and neocolonial legacies. The Nepal-UK Memorandum of Understanding (MoU) on nurse recruitment, while presented as a solution to workforce shortages, exemplifies this complex dynamic, prompting critical questions about its implications for individual nurses and the healthcare systems involved. Aim This qualitative study explored the ethical complexities and dilemmas associated with the Nepal-UK nurse recruitment Memorandum of Understanding (MoU). This bilateral agreement has sparked debate about its potential impact on both individual nurses and the healthcare systems of Nepal and the UK. Research Design A qualitative exploratory design utilizing semi-structured interviews was employed. Data were analyzed using reflexive thematic analysis. Participants and Research Context Twelve Nepali nurses from two private hospitals in Kathmandu, Nepal, participated in the study. Ethical Considerations The study was approved by the Nepal Health Research Council. All participants provided informed consent and were assured of confidentiality and anonymity. Results Four themes emerged from the data: (1) The lingering legacy of colonialism casts a shadow on the Nepal-UK relationship, raising concerns about potential exploitation and unequal power dynamics. (2) Nepali nurses grapple with the ethical dilemmas of pursuing personal dreams while acknowledging their responsibilities towards their communities and Nepal’s healthcare system. (3) The MoU’s claims of ethical recruitment are scrutinized, with nurses questioning its fairness and sustainability. (4) The agreement is challenged as a potential band-aid solution that may perpetuate global health inequities rather than fostering a genuine partnership. Conclusions The Nepal-UK MoU, while offering opportunities for individual nurses, also raises alarms about brain drain, exploitation, and the perpetuation of global health disparities. The study underscores the urgent need for a paradigm shift in international nurse recruitment practices, prioritizing genuine partnership, equitable distribution of benefits, and sustainable solutions that address the root causes of healthcare workforce challenges in both source and destination countries.
Use of Local Anesthesia in Adolescent and Adults Undergoing Cleft Lip Repair or Revision: A Systematic Review
Authors: Mansour Amer , Najjar Wassim , Garcia-Garcia Jose A , Annan Beyhan , Vyas Raj M. , Hamdan Usama S. 
Published: January 2025

Objective This study aims to assess the safety and efficacy of solely using local anesthetics for cleft lip repair and/or revision in adolescent and adult patients. Design Systematic review. Setting Clinical studies describing the use of local anesthetics in cleft lip repair procedures. Patients, Participants A literature search was conducted using PubMed, Google Scholar, and Embase following the PRISMA 2025 guidelines. Inclusion criteria were studies focusing exclusively on local anesthetic techniques in adolescent or adult patients undergoing cleft lip procedures. Non-English studies, studies involving patients under the age of 10, or those undergoing cleft palate or other otolaryngological procedures were excluded. Risk of bias was addressed by using a modified Downs and Black checklist. Interventions Review of local anesthetic use alone for adult and adolescent patients undergoing cleft lip repair or revision. Main Outcomes The main studied outcomes were any reported general perioperative complications, the necessity of switching to general anesthesia, patients’ self-reported pain during the surgery, wound dehiscence, wound infection, and the need for postoperative narcotics for pain control. Results The included studies demonstrated consistent evidence supporting the sole use of local anesthesia for cleft lip repair and revision, with absence of wound dehiscence or infection. Most patients reported minimal to no pain and required no general anesthesia during the procedures. Conclusions The current literature supports the safety and efficacy of local anesthesia alone for cleft lip repair and revision procedures. This modality offers a promising approach in resource-limited countries where access to general anesthesia is often limited.
RM Pressfit vitamys: the 10-year follow-up
Authors: Haefeli Pascal C , Zwahlen Zinedine M , Baumgärtner Ralf , Link Björn-Christian , Beck Martin 
Published: January 2025

Introduction: The RM Pressfit vitamys is an uncemented, titanium particle-coated, isoelastic monoblock cup made of vitamin E blended highly cross-linked polyethylene. We addressed the following questions: (1) What are the clinical and (2) radiographic outcomes 10 years after implantation? (3) What is the revision rate? Methods: In this prospective observational study in a tertiary care centre we investigated all consecutive cases of total hip replacement with the RM Pressfit vitamys cup between September 2009 and November 2011. It was implanted in 162 hips, 49.4% in women. The mean age was 67.2 years (standard deviation [SD] 9.5), and the mean BMI was 27.3 kg/m2 (SD 4.7). In 153 cases (94.4%), primary or secondary osteoarthritis was the diagnosis. We evaluated preoperative and follow-up data at 6 weeks, 1, 5, and 10 years. A modified Harris Hip Score (mHHS), pain and satisfaction on a visual analogue scale (VAS), radiographic evaluation, complications and revision rate were investigated. Results: At the 10-year follow-up (mean 120.5 months, SD 1.4, range 118–126), 99 hips were available for clinical and radiographic evaluation. (1) The mean mHHS was 94.8 (SD 9.9), rest pain 0.2 (SD 0.6), load pain 0.5 (SD 1.5), and satisfaction 9.5 (SD 1.1). The mean improvement as compared to preoperatively was +33.7 (SD 16.8), -3.3 (SD 2.7), -6.0 (SD 2.4) and +5.7 (SD 2.5), respectively. (2) In the radiographic evaluation, no loose cups, no acetabular lucent lines, or acetabular osteolysis were seen. (3) 2 cups were revised, both due to malpositioning. The 10-year cumulative revision rate was 2.0% (95%CI, 0.0–4.2%). The implant survival rate with aseptic loosening as endpoint was 100%. No adverse events were reported. Conclusions: At the 10-year follow-up, the RM Pressfit vitamys cup still had promising results with good clinical and radiographic outcomes and a low revision rate.
Integrating network pharmacology and component analysis to investigate the potential mechanisms of Sheng-Hui-Yi-Zhi decoction in the treatment of Alzheimer’s disease
Authors: Wang Peng , Dong Yuan-li , Li Shan-shan , Jin Yi , Sun Wei-liang , Zhao Bao-Sheng , Li Qiu-bing , Chen Xin 
Published: January 2025

Background Alzheimer's disease (AD) is a progressive neurodegenerative disorder characterized by cognitive impairment. Objective To elucidate the potential mechanisms of Sheng-Hui-Yi-Zhi (SHYZ) for the treatment of AD and explore the effective substances of SHYZ. Methods Liquid chromatography-mass spectrometry (LC-MS) was used to identify the active components of SHYZ. Network pharmacology was employed to predict the potential targets and pathways of SHYZ in the treatment of AD. SAMP8 mice were used as a model for AD and were treated with SHYZ. The Morris water maze was utilized to assess the learning and memory capabilities of mice. Additionally, the levels of TNF-α, IL-1β, and IL-6 in the brain hippocampus of mice were quantified using ELISA. The protein expression of PI3 K/p-PI3 K, AKT/p-AKT, MAPK38/p-MAPK38, and NFκB p65/p-NFκB p65 in the hippocampus was analyzed using Western blotting. Additionally, qRT-PCR was employed to assess the gene expressions of TNF-α, IL-1β, and IL-6 in the hippocampus. Result The network pharmacological prediction results showed that the treatment of AD with SHYZ was closely related to the inhibition of inflammatory response. Behavioral experiments revealed that SHYZ significantly reduced the time taken to escape, increased the number of times the platform was crossed, and prolonged the residence time in the target quadrant. Meanwhile, SHYZ treatment suppressed the expression of Aβ1−42 protein and inflammatory factors. SHYZ significantly inhibited the expression of proteins of PI3 K, AKT, MAPK p38, and NF-κB p65. Conclusions SHYZ has been shown to effectively ameliorate learning and memory impairment in SAMP8 AD mice by inhibiting the expression of Aβ1−42 and reducing the increase of inflammatory factors.
Epilepsy in pregnancy
Authors: Pirie AM 
Published: January 2025

Epilepsy is a domestically intrusive disease which is socially concealed, affects all social classes and ethnic groups, and is common in women of childbearing age. Excellence in care during pregnancy produces significant benefits for these mothers and their families. There were 13 maternal deaths due to suboptimal management of epilepsy in pregnancy in the latest report of the Confidential Enquiry into Maternal Deaths in the UK (see Why Mothers Die by James Drife; http://www.rcpe.ac.uk/fellows/CME/maternal/drife/drife_1.html). One additional death was classified as a head injury but occurred following a seizure. Correct diagnosis, classification and investigation of epilepsy, contraception advice, preconceptual counselling, use of safest monotherapy, close monitoring of drug side-effects and efficacy in pregnancy, screening for fetal anomalies, high dose folic acid and vitamin K, seizure prevention in labour, and supportive advice for parenting are the mainstays of good maternal medicine.
Why mothers die
Authors: Drife J 
Published: January 2025

The UK maternal mortality rate is now 13·4 per 100,000 maternities, which is much lower than in the developing world but still too high. For 50 years in England and Wales the CEMD has published triennial reports, and since 1985 the Enquiry has covered the whole of the UK. Its latest report, Why Mothers Die 2000–2002, published in November 2004, includes 106 Direct (due to complications of pregnancy) and 155 Indirect deaths (due to pre-existing conditions made worse by pregnancy). Since 1997, Indirect deaths (which are rising) have outnumbered Direct deaths, which fell in the 1990s. The leading Direct cause is thromboembolism, which accounted for 30 deaths in 2000–2002, mainly in women with predisposing risk factors such as obesity or thrombophilia. The leading Indirect cause is cardiac disease, which led to 44 deaths, including eight from myocardial infarction and eight from cardiomyopathy. Obese women accounted for 35% of all maternal deaths. The increasing tendency to delay pregnancy means that 18% of births are now to women aged 35 or over. Maternal mortality in the UK is related to social class, with the rate among socially excluded women being 20 times higher than that in social class 1. Women from ethnic minorities have three times the rate of the overall population, and the risk among black African women is increased sevenfold. When late deaths (up to one year after delivery) are included, the overall leading cause of pregnancy-related death is psychiatric disease, which accounted for 60 deaths in 2000–2002. Suicide due to puerperal psychosis is usually by violent means and shows no social class gradient. The Enquiry also records Coincidental deaths, among which the leading cause is murder. The 11 murders in 2000–2002, all perpetrated by the woman’s partner, highlight the continuing problem of domestic violence.
The neurofibromatoses: more than just a medical curiosity
Authors: Huson SM 
Published: January 2025

Until modern methods of clinical and scientific research were applied to neurofibromatosis (NF) over the last 30 years, the disease was largely regarded as a medical curiosity. In 1987, a NIH consensus conference agreed a disease classification system and diagnostic criteria for the two main forms. They are defined by the presence/absence of specific nervous system tumours (neurofibromas in NF1, schwannomas in NF2), skin pigmentation, and ophthalmological features. The recognition of the different types is not just an academic exercise (and one geneticists are fond of!), because the natural history and management of each type is distinct. One important feature in both forms of neurofibromatosis, and indeed in other phakomatoses like tuberous sclerosis, is that the different disease features develop at different ages. For example in NF1, the café-au-lait spots develop during the first two years of life but dermal neurofibromas are unusual before the late teens or early twenties. Despite developments in molecular diagnosis it is probably still more cost effective to refer unusual patients to a specialist clinic prior to testing.
Edinburgh and its role in the foundation of Sydney Medical School
Authors: Smith J Walker 
Published: January 2025

In 1882, Thomas Anderson Stuart (1856–1920) was appointed as Foundation Professor of Physiology and Anatomy at the University of Sydney. At the time he was Assistant-Professor of Physiology in the University of Edinburgh. He initiated the building of the Sydney Medical School in Scottish Tudor Gothic style. He attracted notable figures to Sydney Medical School, such as Dr Robert Scot Skirving. The original medical school (now the Anderson Stuart Building) continues today as the pre-clinical medical school of the University of Sydney. Its stained glass windows and many busts of distinguished figures in the history of medicine are a constant reminder of the history of medicine. The building with its gothic architecture and echoes of northern Britain has given generations of Sydney medical students a powerful message, that they were part of an ancient and noble profession. The recruitment of Edinburgh academics to Sydney ended with Professor CG Lambie who retired in 1956. The 1950s were a watershed between the Edinburgh heritage and the Australian future.
Your patient has a blood culture positive for Staphylococcus aureus – what do you do?
Authors: Marwick CA , Ziglam HM , Nathwani D 
Published: January 2025

Staphylococcus aureus bacteraemia is an important clinical problem associated with a high mortality rate and a significant burden on healthcare resources. The severity, rate of complications, and prognosis of the infection depend on a multitude of factors including underlying patient factors, the virulence of the strain of S. aureus, and the timeliness of appropriate antibiotic therapy. Detection of staphylococci in blood culture should trigger a chain of events beginning with assessment of the patient to determine signs of sepsis and the likely significance of the organism isolated. The level of risk of your patient having MRSA must be assessed. A deep-seated source, or metastatic complication, of the bacteraemia must be suspected and sought, with the most important complication being endocarditis. This assessment should not delay urgent treatment with IV antibiotic therapy in a patient with signs of sepsis. Treatment should be guided by local antibiotic policy alongside advice from microbiology and/or infectious diseases consultants. This overview takes the form of a clinical case scenario with a step-wise approach to the management of a patient from first isolation of staphylococci in a blood culture to the management of MRSA endocarditis.