bluuebunny/crossref_metadata_2025_split huggingface dataset:
Performance of the Fresno-Quebec Rule in identifying patients with concomitant fractures not requiring a radiograph before shoulder dislocation reduction: a multicenter retrospective cohort study
Authors: Benhamed Axel , Bonnet Margot , Miossec Auriane , Mercier Eric , Hernu Romain , Douplat Marion , Gorincour Guillaume , L’Huillier Romain , Abensur Vuillaume Laure , Tazarourte Karim 
Published: August 2023

Background and importance
Although shoulder dislocation diagnosis is often solely based on clinical examination, physicians may order a radiograph to rule out a concomitant shoulder fracture before performing reduction. The Fresno-Québec decision rule aims to identify patients requiring a radiograph before reduction to avoid unnecessary systematic imaging. However, this novel approach needs further validation.

Objective
To evaluate the performance of the Fresno-Québec rule in identifying patients who do not require a prereduction radiograph and assess the variables associated with a clinically significant fracture.

Design, settings, and participants
A multicenter, retrospective cohort study from 2015 to 2021. Data were extracted from three ED university-affiliated tertiary-care centers. Patients aged ≥18 years with a final diagnosis of anterior glenohumeral dislocation were included.

Outcomes measure and analysis
Accuracy metrics [sensitivity (Se), specificity (Sp), positive (PPV), negative predictive value (NPV), positive likelihood ratio (PLR) and negative likelihood ratio (NLR)] of the Fresno-Québec rule were measured. Multivariable logistic regression model was used to identify variables associated with the presence of a concomitant clinically significant fracture.

Main results
A total of 2129 patients were included, among whom 9.7% had a concomitant fracture. The performance metrics of the Fresno-Québec rule were as follows: Se 0.96 95% confidence interval (0.92–0.98), Sp 0.36 (0.34–0.38), PPV 0.14 (0.12–0.16), NPV 0.99 (0.98–0.99), PLR 1.49 (1.42–1.55) and NLR 0.12 (0.06–0.23). A total of 678 radiographs could have been avoided, corresponding to a reduction of 35.2%. Age ≥40 years, first dislocation episode [odds ratio (OR) = 3.18 (1.95–5.38); P < 0.001], the following mechanisms: road collision [OR = 6.26 (2.65–16.1)], low-level fall [OR = 3.49 (1.66–8.28)], high-level fall [OR = 3.95 (1.62–10.4)], and seizure/electric shock [OR = 10.6 (4.09–29.2)] were associated with the presence of a concomitant fracture.

Conclusion
In this study, the Fresno-Québec rule has excellent Se in identifying concomitant clinically significant fractures in patients with an anterior glenohumeral dislocation. The use of this clinical decision rule may be associated with a reduction of approximately a third of unnecessary prereduction radiographs.
Macrophage inflammarafts in atherosclerosis
Authors: Li Shenglin , Navia-Pelaez Juliana M. , Choi Soo-Ho. , Miller Yury I. 
Published: August 2023

Purpose of review
Advances in single cell techniques revealed a remarkable diversity in macrophage gene expression profiles in atherosclerosis. However, the diversity of functional processes at the macrophage plasma membrane remains less studied. This review summarizes recent advances in characterization of lipid rafts, where inflammatory receptors assemble, in macrophages that undergo reprogramming in atherosclerotic lesions and in vitro under conditions relevant to the development of atherosclerosis.

Recent findings
The term inflammarafts refers to enlarged lipid rafts with increased cholesterol content, hosting components of inflammatory receptor complexes assembled in close proximity, including TLR4-TLR4, TLR2-TLR1 and TLR2-CD36 dimers. Macrophages decorated with inflammarafts maintain chronic inflammatory gene expression and are primed to an augmented response to additional inflammatory stimuli. In mouse atherosclerotic lesions, inflammarafts are expressed primarily in nonfoamy macrophages and less in lipid-laden foam cells. This agrees with the reported suppression of inflammatory programs in foam cells. In contrast, nonfoamy macrophages expressing inflammarafts are the major inflammatory population in atherosclerotic lesions. Discussed are emerging reports that help understand formation and persistence of inflammarafts and the potential of inflammarafts as a novel therapeutic target.

Summary
Chronic maintenance of inflammarafts in nonfoamy macrophages serves as an effector mechanism of inflammatory macrophage reprogramming in atherosclerosis.
Techniques and Complications of Anesthesia in Pediatric Radiotherapy: A Retrospective Cohort Study
Authors: Villablanca Nicolás , Valls Nicolás , González Roberto 
Published: August 2023

Background:
Anesthesia during pediatric external beam radiation therapy poses a challenge, as radiotherapy rooms are not designed for the administration of anesthesia.

Aims:
We conducted a retrospective cohort study of children who underwent radiation therapy to describe the anesthetic approach and assess anesthetic-related complications.

Materials and Methods:
Data of all, who underwent radiation therapy under general anesthesia between November 2019 and January 2021, were recorded. Data were obtained from medical records, including demographic characteristics and information, regarding the anesthetic procedure and its associated complications. We describe our protocols for preoperative assessment, anesthetic procedures, and postanesthetic discharge evaluation.

Results:
Over the reporting period, 739 sessions of general anesthesia were performed. The mean number of radiation therapy rounds per patient was 23.5 sessions. Anesthetic induction was accomplished by sevoflurane inhalation in 639 sessions (86.4%) and intravenous propofol in the remaining 13.6%. General anesthesia was maintained with sevoflurane in all cases. Anesthesia-related complications occurred in 118 sessions (15.7%). The most frequent was nausea in 48 (6.4%) cases, followed by hypotension in 38 (5.1%). Airway-related complications occurred at a low frequency (2.3%), and all were resolved successfully with positive pressure ventilation. No patient hospitalizations were required because of any anesthetic complications.

Conclusions:
Inhalation anesthesia is reliable and safe for pediatric patients undergoing radiation therapy.
Splenic Artery Embolization in a Patient With Intracranial Hemorrhage Due to Refractory Persistent Immune Thrombocytopenia
Authors: Sarper Nazan , Çam İsa , Aylan Gelen Sema , Sönmez Hafize Emine , Sakarya Güneş Ayfer , Zengin Emine 
Published: August 2023

Background:
Managing intracranial bleeding in patients with refractory immune thrombocytopenia is difficult.

Observation:
A 16-year-old female refractory to prednisolone, intravenous immunoglobulin, eltrombopag, and cyclosporin exhibited heavy menstrual bleeding requiring packed red blood cell transfusions. Autoimmune antibodies were detected, indicating of lupus, and hydroxychloroquine sulfate was administered. In month 6 following the diagnosis, the patient presented with intracranial hemorrhage. Splenic artery embolization promptly increased platelets, and the patient was discharged without any neurological sequela. In month 5 of embolization, the patient’s platelet count continued to exceed 300,000/µL without any medical treatment.

Conclusions:
Splenic artery embolization is a life-saving procedure in refractory immune thrombocytopenia.
Neurologic Complications in Patients With Lymphoreticular Malignancy: A Descriptive Cohort Study
Authors: Baloda Renuka , Sharma Suvasini , Anand Rama , Mandal Piali , Parakh Nupur , Katti Bharat , Singh Varinder , Chandra Jagdish 
Published: August 2023

Objectives:
The objectives of this study were to study the spectrum of neurologic complications in children with lymphoreticular malignancy (acute lymphoblastic leukemia, Hodgkin, and non-Hodgkin lymphoma) at diagnosis and during treatment and to determine the etiology of these complications.

Materials and Methods:
In this descriptive cohort study, conducted between November 2018 and March 2020, 204 children with a diagnosis of lymphoreticular malignancy were enrolled. The baseline investigations were done in all the cases. Those who developed neurological symptoms were evaluated with cerebrospinal fluid examination and radiologic and electrophysiologic studies as per indication and were managed according to standard management guidelines.

Results:
Of the 204 patients, 30 (14.7%) developed neurological complications. The majority of these complications (n=20/30; 87%) occurred during the intensive chemotherapy period. Common complications included acute methotrexate neurotoxicity (n=7), vincristine-induced neurotoxicity (n=7), central nervous system (CNS) relapse (n=4), and posterior reversible encephalopathy syndrome (n=2). L-asparaginase-induced thrombosis (n=1), intramedullary compression syndrome (n=1), CNS infection (n=2), CNS hemophagocytic lymphohistiocytosis (n=1), and steroid-induced myopathy (n=1) were also observed. The complications resolved in 21/30 (70%) patients after receiving appropriate treatment while the neurological complication persisted in 2/30 (6.7%) patients. Three patients (10%) abandoned the treatment, and 4 (13.3%) patients expired.

Conclusions:
Neurologic complications in patients with lymphoreticular malignancy are quite variable, having common presenting symptoms but varying imaging abnormalities. By close follow-up and effective treatment, the morbidity and mortality of these complications can be minimized.
Mechanical Hemolytic Anemia Associated With Mitral Valve Repair: A Case Report With Literature Review
Authors: Restivo Giulia A. , Scalzo Simona , Di Palermo Antonio 
Published: August 2023

Hemolytic anemia could be caused by several conditions, depending on intrinsic or extrinsic defects of the erythrocyte. The latter group includes mechanical intravascular hemolysis, generally related to malfunctioning prosthetic heart valves or, rarely, heart valves repair.
We describe a case of a child with Down syndrome, who developed hemolytic anemia after mitral valve repair. We observed that this condition is a rare complication in pediatrics, with only 7 cases reported in literature.
Mechanical hemolysis should always be considered in the differential diagnosis of a new-onset hemolytic anemia, especially in patients with valvular heart disease, undergoing cardiac surgery.
Concealed Homicides—A Postmortem Study and Review
Authors: Byard Roger W. 
Published: August 2023

Abstract
A study was undertaken at Forensic Science SA, Adelaide, South Australia, of all cases of homicide (January 2003–December 2022) where the victims' bodies had been concealed. Three hundred twenty-six homicides were identified, which included 27 cases where bodies had been deliberately hidden (8%) (age range, 2–82 years; ave, 34.9 years; M:F = 1.5:1). Deaths were due to blunt force trauma (n = 11), sharp force trauma (n = 4), asphyxia (n = 4), gunshot wound (n = 2), and a combination of drowning and asphyxia (n = 1). In 5 cases, the cause of death was not determinable. The methods of concealment (which were sometimes overlapping) included the following: dumping at a hidden/isolated location (n = 8), burial (n = 7), dismembering (n = 3), incinerating (n = 3), hiding in a wheeled garbage bin (n = 2), disposing in garbage resulting in the remains being located at waste disposal facilities (n = 2), hiding in a shed (n = 1), under a concrete floor (n = 1), in a suitcase (n = 1), in a river (n = 1), in a mine shaft (n = 1), and in a septic tank (n = 1). Although it has been asserted that concealed homicides are rarely encountered in forensic practice, the current study has demonstrated that the bodies in at least 8% of victims of homicide in South Australia have undergone some form of concealment.
Non-HLA Antibodies to G Protein–coupled Receptors in Pediatric Kidney Transplant Recipients: Short- and Long-term Clinical Outcomes
Authors: Pearl Meghan H. , Chen Lucia , Zuckerman Jonathan E. , Weng Patricia L. , Chambers Eileen T. , Zhang Qiuheng , Reed Elaine F. 
Published: August 2023

Background.
Angiotensin II type 1 receptor antibodies (AT1R-Abs) and endothelin-type A receptor antibodies (ETAR-Abs) are G protein–coupled receptor activating autoantibodies associated with antibody-mediated rejection, vascular pathology, increased cytokines, allograft dysfunction, and allograft loss in pediatric kidney transplant recipients in the first 2 y posttransplantation. The impact of AT1R-Ab and ETAR-Ab positivity on longer-term 5-y transplant outcomes is unknown.

Methods.
One hundred pediatric kidney transplant recipients were tested for ETAR-Ab and AT1R-Ab on serially collected blood samples in the first 2 y posttransplant. Biopsies were collected per protocol and 6, 12, and 24 mo posttransplant and at any time during the 5-y follow-up period for clinical indication. Clinical outcomes, including renal dysfunction, rejection, HLA donor-specific antibodies, and allograft loss, were assessed through 5 y posttransplantation.

Results.
AT1R-Ab or ETAR-Ab were positive in 59% of patients. AT1R-Ab or ETAR-Ab positivity was associated with greater declines in estimated glomerular filtration rate, and de novo AT1R-Ab or ETAR-Ab was associated with allograft loss in the first 2 y posttransplant. There was no association between antibody positivity and rejection, antibody-mediated rejection, or allograft loss in the first 5 y posttransplant. In a model controlled for age, sex, immunosuppression, and HLA mismatch, AT1R-Ab or ETAR-Ab positivity was significantly associated with the development of HLA donor-specific antibodies at 5 y posttransplant (odds ratio 2.87, P = 0.034).

Conclusions.
Our findings suggest temporally distinct clinical complications associated with AT1R-Ab or ETAR-Ab positivity in pediatric patients; these injury patterns are of significant interest for developing effective treatment strategies.
Three Cases of Myoclonus Secondary to Ciprofloxacin: “Ciproclonus”
Authors: Javed Hamna , Ali Hossam Tharwat , Soliman Ziad Ashraf , Caprara Ana Leticia Fornari , Rissardo Jamir Pitton 
Published: August 2023

Objectives
Ciprofloxacin is a fluoroquinolone that is used for bacterial infections involving different systems. In some cases, ciprofloxacin was reported to induce myoclonus.

Methods
We performed a chart review of 3 patients with myoclonus secondary to ciprofloxacin and reviewed the literature for similar cases. Written consent for publication was obtained from each patient, and their identities were concealed for ethical reasons.

Results
We describe 3 cases of myoclonus secondary to ciprofloxacin, 2 males and a female aged 61, 26, and 48 years, respectively. The myoclonus appeared within 3 days of ciprofloxacin intake. In all 3 cases, ciprofloxacin was prescribed for urinary tract infection. Electroencephalogram and neuroimaging studies were normal and possible causes were excluded. Thus, ciprofloxacin was believed to be the underlying cause and hence it was withdrawn. The patients had complete recovery on follow-up.

Conclusions
Although ciprofloxacin is widely prescribed for different infections, only 13 cases were reported to develop myoclonus secondary to ciprofloxacin. The mean age of patients was 62 years. Fifty-four percent of cases were males. Cessation of ciprofloxacin was the most common management course. All individuals fully recovered after ciprofloxacin withdrawal. The mechanism of ciprofloxacin-induced myoclonus is probably associated with γ-aminobutyric acid and glutamate pathways.
SomaticTET2Mutations are Associated with Giant Cell Arteritis
Authors: Robinette Michelle L. , Weeks Lachelle D. , Kramer Ryan J. , Agrawal Mridul , Gibson Christopher J. , Yu Zhi , Sekar Aswin , Mehta Arnav , Niroula Abhishek , Brown Jared T. , McDermott Gregory C. , Reshef Edith R. , Lu Jonathan E , Liou Victor D. , Chiou Carolina A. , Natarajan Pradeep , Freitag Suzanne K. , Rao Deepak A. , Ebert Benjamin L. 
Published: August 2023

AbstractObjectiveGiant cell arteritis (GCA) is an age-related vasculitis. Prior studies have identified an association between GCA and hematologic malignancies (HM). How the presence of somatic mutations which drive development of HM, or clonal hematopoiesis (CH), may influence clinical outcomes in GCA is not well understood.MethodsTo examine an association between CH and GCA, we analyzed sequenced exomes of 470960 UK Biobank participants for the presence of CH and used multivariable Cox regression. To examine the clinical phenotype of GCA in patients with and without somatic mutations across the spectrum of CH to HM, we performed targeted sequencing of blood samples and electronic health record review on 114 patients with GCA seen at our institution. We then examined associations between specific clonal mutations and GCA disease manifestations.ResultsUKB participants with CH had a 1.48-fold increased risk of incident GCA compared to UKB participants without CH. GCA risk was highest among individuals with cytopenia (HR 2.98, p =0.00178) and withTET2mutation (HR 2.02, p =0.00116). Mutations were detected in 27.2% of our institutional GCA cohort, 3 of whom had HM at GCA diagnosis.TET2mutations were associated with vision loss in patients with GCA (OR 4.33, p = 0.047).ConclusionsCH increases risk for development of GCA in a genotype-specific fashion, with greatest risk being conferred by the presence of mutations inTET2. SomaticTET2mutations likewise increase the risk of GCA-associated vision loss. Integration of somatic genetic testing in GCA diagnostics may be warranted in the future.
How group structure impacts the numbers at risk for coronary artery disease: polygenic risk scores and non-genetic risk factors in the UK Biobank cohort
Authors: Zhao Jinbo , O’Hagan Adrian , Salter-Townshend Michael 
Published: August 2023

AbstractThe UK Biobank is a large cohort study that recruited over 500,000 British participants aged 40-69 in 2006-2010 at 22 assessment centres from across the UK. Self-reported health outcomes and hospital admission data are two types of records that include participants’ disease status. Coronary artery disease (CAD) is the most common cause of death in the UK Biobank cohort. After distinguishing between prevalence and incidence CAD events for all UK Biobank participants, we identified geographical variations in age-standardised rates of CAD between assessment centres. Significant distributional differences were found between the pooled cohort equation scores of UK Biobank participants from England and Scotland using the Mann-Whitney test. Polygenic risk scores of UK Biobank participants from England and Scotland and from different assessment centres differed significantly using permutation tests. Our aim was to discriminate between assessment centres with different disease rates by collecting data on disease-related risk factors. However, relying solely on individual-level predictions and averaging them to obtain group-level predictions proved ineffective, particularly due to the presence of correlated covariates resulting from participation bias. By using the Mundlak model, which estimates a random effects regression by including the group means of the independent variables in the model, we effectively addressed these issues. In addition, we designed a simulation experiment to demonstrate the functionality of the Mundlak model. Our findings have applications in public health funding and strategy, as our approach can be used to predict case rates in the future, as both population structure and lifestyle changes are uncertain.
The MidPIC study: Midwives’ knowledge, perspectives and learning needs regarding preconception and interconception care
Authors: Bradfield Zoe , Leefhelm Emily , Soh Sze-Ee , Black Kirsten I , Boyle Jaqueline A , Kuliukas Lesley , Harrison Cheryce , Homer Caroline SE , Smith Rachel M , Skouteris Helen 
Published: August 2023

AbstractBackgroundPreconception and interconception care improves the health outcomes of women and communities.ProblemLittle is known about how prepared and willing Australian midwives are to provide preconception and interconception care.AimThe aim of this study was to explore midwives’ knowledge, perspectives and learning needs, and barriers and enablers to delivering preconception and interconception care.MethodsWe conducted a cross-sectional exploratory study of midwives working in any Australian maternity setting. An online survey was administered that included items measuring midwives’ self-rated knowledge; education needs and preferences; attitudes and perceptions towards the pre and interconception care; and views on future service and workforce planning.Quantitative data were analysed descriptively, and demographic characteristics (e.g., years of experience, model of care) associated with knowledge and attitudes regarding pre- and inter-conception care were examined using univariate logistic regression analysis. Qualitative data were captured through open-ended questions and analysed using inductive content analysis.FindingsWe collected responses from (n=338) out of 355 midwives who were eligible for this study working across all Australian models of care (completion rate 96%). Most participants (n=290; 85%) rated their overall knowledge about pre and interconception health for women as excellent, above average or average. The only variable associated with overall knowledge was years of experience, with participants more than 11 years of experience more likely to report above average to excellent knowledge (OR 3.11; 95% CI 1.09, 8.85). The majority (n=257; 76%) were interested in providing pre and interconception care more regularly within their role. Low prioritisation in service planning/budgeting was the most frequently selected barrier to providing preconception and interconception care.ImplicationsFindings revealed that midwives are prepared and willing to provide preconception and interconception care. Pre and post registration professional development; service and funding reform; and policy development are critical to enable Australian midwives’ provision of pre and interconception care.