bluuebunny/crossref_metadata_2025_split huggingface dataset:
National digital health legislation: lessons and recommendations
Authors: Venkatasubramanian Akarsh , Patnaik Amar 
Published: July 2023

Abstract
All Member States of the United Nations have committed to achieve the UN Sustainable Development Goals (SDGs) and Universal Health Coverage (UHC), but several policy and system challenges remain unaddressed. Technology innovation and digital health have the potential to find equitable, sustainable and rights-based solutions to many of these issues, but must be coupled with effective and appropriate national legislation. In the backdrop of today's global digital health landscape, this manuscript explores the urgent need for the national legislation on digital health and recommends a way forward for legislators to meaningfully address this need. It also presents direction for global and national stakeholders to coordinate their efforts towards supporting countries to enable meaningful digital health transformations. The recommendations below are informed by perspectives from international organizations, national parliaments, policy think tanks and civil society.
Establishment and validation of a calibration curve for dicentric chromosome induced by 6MV X-ray
Authors: Kosarnia Morteza , Bahreyni-Toossi Mohammad-Taghi , Gholamhosseinian Hamid , Dolat Elham , Fakour-Mollaee Parisa , Azimian Hosein 
Published: July 2023

Abstract
Radiation during radiotherapy and nuclear accidents is currently one of the biggest concerns for the international community. Biological dosimetry examines the amount of damage caused by radiation at the cellular level by quantifying a radiation biomarker. In particular, the dicentric chromosome assay is a biodosimetric technique that can quantify radiation damage by correlating radiation dose exposure with the frequency of dicentric chromosomes in the peripheral lymphocytes extracted from exposed individuals. This study aims to present of the reference dose–response calibration curve for biodosimetry laboratory of Mashhad University of Medical Sciences (north-east of Iran). In all, 40 samples of peripheral blood from four healthy volunteers were irradiated at doses of 0–5 Gray in a customised water phantom using a 6 MV X-rays at dose rate of 2 Gy/min from a linear accelerator. The irradiated samples were cultured and analysed according to the International Atomic Energy Agency Cytogenetic Dosimetry Protocol (2011) with some modifications. Linear-quadratic model curve fitting and further statistical analysis were done using Chromosome Aberration Calculation Software Version 2.0 and Dose Estimate (Version 5.2). The curve equation obtained was ${Y}_{dic}=0.0533{D}^2+0.0231D+0.0001$ and was in the range of other studies. Validation of the calibration curve was done by estimating the dose of blind samples.
Effects of Substance Use and Antisocial Personality on Neuroimaging-Based Machine Learning Prediction of Schizophrenia
Authors: Taipale Matias , Tiihonen Jari , Korhonen Juuso , Popovic David , Vaurio Olli , Lähteenvuo Markku , Lieslehto Johannes 
Published: July 2023

Abstract

Background and hypothesis
Neuroimaging-based machine learning (ML) algorithms have the potential to aid the clinical diagnosis of schizophrenia. However, literature on the effect of prevalent comorbidities such as substance use disorder (SUD) and antisocial personality (ASPD) on these models’ performance has remained unexplored. We investigated whether the presence of SUD or ASPD affects the performance of neuroimaging-based ML models trained to discern patients with schizophrenia (SCH) from controls.

Study design
We trained an ML model on structural MRI data from public datasets to distinguish between SCH and controls (SCH = 347, controls = 341). We then investigated the model’s performance in two independent samples of individuals undergoing forensic psychiatric examination: sample 1 was used for sensitivity analysis to discern ASPD (N = 52) from SCH (N = 66), and sample 2 was used for specificity analysis to discern ASPD (N = 26) from controls (N = 25). Both samples included individuals with SUD.

Study results
In sample 1, 94.4% of SCH with comorbid ASPD and SUD were classified as SCH, followed by patients with SCH + SUD (78.8% classified as SCH) and patients with SCH (60.0% classified as SCH). The model failed to discern SCH without comorbidities from ASPD + SUD (AUC = 0.562, 95%CI = 0.400–0.723). In sample 2, the model’s specificity to predict controls was 84.0%. In both samples, about half of the ASPD + SUD were misclassified as SCH. Data-driven functional characterization revealed associations between the classification as SCH and cognition-related brain regions.

Conclusion
Altogether, ASPD and SUD appear to have effects on ML prediction performance, which potentially results from converging cognition-related brain abnormalities between SCH, ASPD, and SUD.
Increased hippocampal efficiency is associated with greater headache frequency in adolescents with chronic headache
Authors: Cobos Karen L , Long Xiangyu , Lebel Catherine , Rasic Nivez , Noel Melanie , Miller Jillian Vinall 
Published: July 2023

Abstract
Adults with chronic headache have altered brain hippocampal efficiency networks. Less is known about the mechanisms underlying chronic headache in youth. Twenty-nine youth with chronic headache (10–18 years), and twenty-nine healthy, age- and sex-matched controls tracked their headache attacks daily for one-month period. Following this, they underwent a resting state functional magnetic resonance imaging (rs-fMRI) scan and self-reported on their pubertal status, PTSD, anxiety, and depression symptoms. Graph-based topological analyses of brain networks, rendering hippocampal efficiency values were performed. T-tests were used to compare hippocampal efficiency metrics between patients and controls. Linear regression was used to examine significant hippocampal efficiency metrics in relation to headache frequency in patients, controlling for age, sex, PTSD, pubertal status, anxiety, and depression symptoms.
Patients had higher right hippocampal global efficiency, shorter right hippocampal path length, and higher right hippocampal clustering coefficient compared to controls (P &lt; 0.05). Higher right hippocampal global efficiency, shorter right hippocampal path length, and higher right hippocampal clustering coefficients were positively associated with greater headache frequency (P &lt; 0.05). The hippocampus is largely involved in memory formation and retrieval, and this data provides additional support for previous findings demonstrating the importance of the hippocampus and pain memories for the chronification of pain.
Comparison of the Analgesic Efficacy between Arthroscopically Placed Continuous Suprascapular Nerve Block and Ultrasound-guided Continuous Superior Trunk Block: A Double-blinded Randomized Controlled Trial
Authors: Kim Ha-Jung , Koh Kyoung Hwan , Park Ji In , Kim Yeon Ju , Kim Min-Ju , Kim Hyojune , Kim Hyungtae , Ro Young-Jin , Koh Won Uk 
Published: July 2023

Background
Single-shot suprascapular nerve block and superior trunk block have been reported to provide a noninferior analgesic effect after shoulder surgery with a lesser incidence of hemidiaphragmatic paresis compared with interscalene brachial plexus block. This study hypothesized that continuous suprascapular nerve block provides noninferior analgesia with minimal effects on diaphragmatic movement compared with continuous superior trunk block in patients undergoing arthroscopic shoulder surgery.

Methods
100 patients were randomized undergoing arthroscopic shoulder surgery between December 2020 and October 2021 into continuous suprascapular nerve block and continuous superior trunk block groups. Before the surgery, patients received either a single-shot superior trunk block or subomohyoid suprascapular nerve block. Thereafter, a superior trunk catheter was inserted by anesthesiologists in patients in the continuous superior trunk block group, and a posterior suprascapular nerve catheter was inserted with arthroscopic assistance during the surgery by surgeon in the continuous suprascapular nerve block group. The primary outcome was the postoperative pain score at postoperative 24 h, and the incidence of hemidiaphragmatic paresis was also compared.

Results
Overall, 98 patients were included in the final analysis. The worst and resting pain scores at postoperative 24 h in the continuous suprascapular nerve block group were inferior compared with those in the continuous superior trunk block group in the test with a noninferiority margin of 1 (worst pain score: mean difference, 0.9; 95% CI, 0.1 to 1.7; resting pain score: mean difference, 0.5; 95% CI, 0.0 to 1.0). However, the continuous suprascapular nerve block group had a significantly lower incidence of hemidiaphragmatic paresis at postoperative 24 h than the continuous superior trunk block group.

Conclusions
Continuous suprascapular nerve block provides statistically inferior analgesia compared to the continuous superior trunk block; however, the continuous suprascapular nerve block had a minimal effect on the phrenic nerve function.

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Blood Pressure Management Goals in Critically Ill Aneurysmal Subarachnoid Hemorrhage Patients in Australia and New Zealand
Authors: Betteridge Toby , Finnis Mark , Cohen Jeremy , Delaney Anthony , Young Paul , Udy Andrew ,   for the PROMOTE-SAH Investigators
Published: July 2023

Introduction:
Blood pressure (BP) management is common in patients with aneurysmal subarachnoid hemorrhage (SAH) admitted to an intensive care unit. However, the practice patterns of BP management (timing, dose, and duration) have not been studied locally.

Methods:
This post hoc analysis explored BP management goals (defined as the setting of a minimum systolic BP target or application of induced hypertension) in patients enrolled into the PROMOTE-SAH study in eleven neurosurgical centers in Australia and New Zealand. The primary outcome was ‘dead or disabled’ (modified Rankin Score ≥4) at 6 months, with the hypothesis being that setting BP management goals would be associated with improved outcomes.

Results:
BP management goals were recorded in 266 of 357 (75%) patients, of which 149 were recorded as receiving induced hypertension for delayed cerebral ischemia (DCI) or vasospasm on 738 (19%) study days. In patients with a minimum systolic BP goal recorded (on 2067 d), the indication for the BP management goal was vasospasm or DCI on 651 (32%) days; no indication for BP management goals was documented on 1416 (69%) days. Crude analysis demonstrated an association between setting BP management goals and reduced death or disability (P=0.03), but this association was not significant after adjustment for the presence of DCI or vasospasm and clustered by the site.

Conclusions:
BP management goals are commonly ‘prescribed’ to aSAH patients admitted to an intensive care unit in Australia and New Zealand, but BP management goal setting was not associated with improved outcomes in the adjusted analysis.
Posteromedial Surgical Approach for Fixation of Haraguchi Type 2B Posterior Malleolar Fracture
Authors: Solasz Sara , Ganta Abhishek , Konda Sanjit R. 
Published: July 2023

Summary:
A case of a 26-year-old man with a displaced medial malleolus fracture with extension into the posteromedial aspect of the posterior malleolus is presented. A CT scan of the ankle is obtained demonstrating a Haraguchi type 2B posterior malleolus fracture with a posteromedial and posterolateral fragment. The posteromedial fragment extends into the posterior colliculus of the medial malleolus and has a subchondral impaction fracture. There is also a 1 × 1 cm piece of the articular surface of the posterior malleolus that has flipped 90 degrees and lodged itself between the posterolateral fracture fragment. This video overview and case presentation demonstrates a posteromedial approach with fixation strategy for the posterior malleolus.
High Nonunion and Amputations Rates with either Early Intramedullary Nail Removal versus Retention for Tibial Shaft Fracture Related Infections
Authors: Jones Jenna , Ngo Daniel , Cardon Morgan , Mullis Brian , Weaver Bree , Slaven James E. , McCaskey Meghan , Mir Hassan , Warner Stephen , Achor Timothy , Natoli Roman M. 
Published: July 2023

AbstractObjectives:To compare debridement, antibiotics, and implant retention (DAIR) and intramedullary nail (IMN) removal with subsequent strategy for fracture stabilization in the treatment of tibia fracture related infections (FRIs) occurring within 90 days of initial IMN placement.Design:Retrospective case-controlSetting:Four academic, level 1 trauma centersPatients:66 patients that subsequently received unplanned operative treatment for FRI diagnosed within 90 days of initial tibia IMNIntervention:DAIR versus IMN removal pathwaysMain Outcome Measurements:Fracture unionResults:Twenty-eight patients (42.4%) were treated with DAIR and 38 (57.6%) via IMN removal with subsequent strategy for fracture stabilization. Mean follow-up was 16.3 months. At final follow-up, ultimate bone healing was achieved in 75.8% (47/62), whereas 24.2% (15/62) had persistent nonunion or amputation. No significant difference was seen in ultimate bone healing (p=.216) comparing DAIR and IMN removal. Factors associated with persistent nonunion or amputation were time from injury to initial IMN (p<.001), McPherson systemic host grade B (p=.046), as well as increasing open fracture grade, with Gustilo-Anderson IIIB/IIIC fractures being the worst (p=.009). Fewer surgeries following initial FRI treatment were positively associated with ultimate bone healing (p=.029).Conclusions:Treatment of FRI within 90 days of tibial IMN with either DAIR or IMN removal with subsequent strategy for fracture stabilization results in a high rate, nearly 1 in 4, of persistent nonunion or amputation, with neither appearing superior for improving bone healing outcomes.Level of Evidence:Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
Familial Analysis of Nonunion in a Genealogic Population Database Demonstrates No Evidence of Heritable Risk
Authors: Kantor Adam H. , O’Neill Dillon C. , Steffenson Lillia N. , Meeks Huong D. , Fraser Alison M. , Marchand Lucas M. , Haller Justin M. 
Published: July 2023

OBJECTIVE:
To determine if there is evidence of heritable risk for nonunion using a large, state-wide population database.

DESIGN:
Database

SETTING:
Level 1 Trauma Center

POPULATION:
All Utah residents from 1996 – 2021 that sustained a long bone fracture and their family members.

OUTCOMES:
The primary outcome was nonunion and the prevalence of nonunion among the patients’ first-, second-, and third-degree relatives. The secondary objective was to identify demographic, injury, and socioeconomic risk factors associated with nonunion.

RESULTS:
In total, 150,263 fractures and 6,577 (4.4%) nonunions were identified. This was highly refined to a 1:3 matched cohort of 4,667 nonunions of 13,981 fractures for familial clustering analysis. Cox proportional hazards did not demonstrate excessive risk of nonunion amongst first- (p = 0.863), second- (p = 0.509), and third-degree relatives (p = 0.252). Further analysis of the entire cohort demonstrated male sex (RR = 1.15; p < 0.001), Medicaid enrollment (RR = 2.64; p < 0.001), open fracture (RR = 2.53; p < 0.001), age group 41-60 (RR = 1.43; p < 0.001), a history of obesity (RR = 1.20; p < 0.001) were independent risk factors for nonunion.

CONCLUSIONS:
Our results demonstrate no evidence of heritable risk for nonunion. Independent risk factors for nonunion were male sex, Medicaid enrollment, open fracture, middle age, and a history of obesity. While it is important to identify modifiable and non-modifiable risk factors, these results continue to support that the risk of nonunion is multifactorial, relating to injury characteristics, operative techniques, and patient specific risk factors.

Level of Evidence:
Level III. See Instructions for Authors for a complete description of levels of evidence.
Updating the Evidence: Systematic Literature Review of Risk Factors and Strategies for Prevention, Diagnosis, and Treatment of Surgical Site Infection After Pediatric Scoliosis Surgery
Authors: Gupta Arjun , Badin Daniel , Leland Christopher R. , Vitale Michael G. , Sponseller Paul D. 
Published: July 2023

Background:Surgical site infection (SSI) is a major potential complication following pediatric spinal deformity surgery that is associated with significant morbidity and increased costs. Despite this, SSI rates remain high and variable across institutions, in part due to a lack of up-to-date, comprehensive prevention, and treatment protocols. Furthermore, few attempts have been made to review the optimal diagnostic modalities and treatment strategies for SSI following scoliosis surgery. The aim of this study was to systematically review current literature on risk factors for SSI in pediatric patients undergoing scoliosis surgery, as well as strategies for prevention, diagnosis, and treatment.Methods:On January 19, 2022, a systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies reporting risk factors for acute, deep SSI (<90 d) or strategies for prevention, diagnosis, or treatment of SSI following pediatric scoliosis surgery were included. Each included article was assigned a level of evidence rating based on study design and quality. Extracted findings were organized into risk factors, preventive strategies, diagnostic modalities, and treatment options and each piece of evidence was graded based on quality, quantity, and consistency of underlying data.Results:A total of 77 studies met the inclusion criteria and were included in this systematic review, of which 2 were categorized as Level I, 3 as Level II, 64 as Level III, and 8 as Level IV. From these studies, a total of 29 pieces of evidence (grade C or higher) regarding SSI risk factors, prevention, diagnosis, or treatment were synthesized.Conclusions:We present an updated review of published evidence for defining high-risk patients and preventing, diagnosing, and treating SSI after pediatric scoliosis surgery. The collated evidence presented herein may help limit variability in practice and decrease the incidence of SSI in pediatric spine surgery.Level of Evidence:Level III—systematic review.
“Early Efficacy and Safety of Unilateral Biportal Endoscopic Lumbar Interbody Fusion Versus Minimal Invasive in the Treatment of Lumbar Degenerative Diseases”
Authors: Yu Qi , Hu Xuqi , Pan Xuekang , Kong Xiangjia , Zhang Jianqiao , Yu Yefeng , Chen Jiayi , Ren Peng , Lu Huigen 
Published: July 2023

Study Design:
This was a retrospective cohort study.

Objective:
To compare the early clinical efficacy and radiologic outcomes between unilateral biportal endoscopic lumbar interbody fusion (ULIF) and minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF).

Summary of Background Data:
Along with the continuous development of endoscopic technology, the early safety and effectiveness of ULIF technology are still unknown.

Materials and Methods:
This retrospective study included 61 patients who underwent fusion surgery through ULIF or MIS-TLIF in 2021. Twenty-nine patients underwent ULIF (group A), and 32 underwent MIS-TLIF (group B). Fusion rate, bone graft volume, hidden blood loss (HBL), C-reactive protein level, operative time, Oswestry Disability Index , Visual Analog Scale score, and MacNab criteria were assessed in both groups.

Results:
The Visual Analog Scale score for back pain in the early postoperative period was significantly lower in group A than in group B (P<0.05). All other clinical scores showed improvement, with no significant difference between the 2 groups (P>0.05). There was no statistically significant difference in postoperative C-reactive protein levels and fusion rates between the 2 groups (P>0.05). However, HBL was higher and operative time was longer in group A than in group B (P<0.05). Most importantly, there were no statistically significant differences between groups A and B in fusion rate, length of stay and bone graft volume (P>0.05). No serious surgical complications occurred in our study.

Conclusions:
ULIF is a new option for lumbar fusion. Despite the drawbacks of longer operation time and higher HBL, ULIF may be a viable alternative to MIS-TLIF as technology advances.
Risk Factors for Postoperative Surgical Site Infection in Patients Undergoing Spinal Tumor Surgery
Authors: Xin Baoquan , Cao Shuang , Bai Guangjian , Huang Xing , Ye Chen , Hu Runlin , Gao Xin , Zou Weiwei , Liu Tielong 
Published: July 2023

Study Design:
A retrospective comparative case-control study.

Objective:
The aim of this study was to determine the risk factors for postoperative surgical site infection (SSI) in patients with spinal tumors requiring reoperation during the perioperative period.

Summary of Background Data:
SSI is a common postoperative complication of spinal surgery. The occurrence of SSI not only increases the mortality rate but prolongs the patient’s hospital stay and increases the medical cost.

Methods:
Included in this study were 202 patients with spinal tumors who received surgical treatment between January 2008 and December 2018, of whom 101 patients who developed SSI and underwent secondary surgery were used as the SSI group, and the other 101 patients with no SSI who were matched with the SSI group by age (±10), pathologic diagnosis (malignant/no-malignant), tumor site (C/T/L/S), surgical approach (anterior/posterior/combined), and surgical team were used as the control group. The clinical data of the 202 patients in both groups were analyzed by logistic regression modeling to identify SSI-associated risk factors.

Results:
Multivariate logistic regression analysis showed that the revision status (B=1.430, P=0.028), the number of spinal levels fused ≥4 (B=0.963, P=0.006), and the use of bone cement (B=0.739, P=0.046) were significantly associated with the increased risk of developing postoperative SSI.

Conclusions:
This study identified the revision status, the number of spinal levels fused ≥4, and the use of bone cement as independent risk factors for SSI in patients with spinal tumors who underwent reoperation during the perioperative period.