bluuebunny/crossref_metadata_2025_split huggingface dataset:
Using the Standing and Walking Assessment Tool at Discharge Predicts Community Outdoor Walking Capacity in Persons With Traumatic Spinal Cord Injury
Authors: Hong Heather A , Walden Kristen , Laskin James J , Wang Di , Kurban Dilnur , Cheng Christiana L , Guilbault Lindsey , Dagley Erica , Wong Chelsea , McCullum Shane , Gagnon Dany H , Lemay Jean-François , Noonan Vanessa K , Musselman Kristin E ,   The Canadian SCI Standing and Walking Measures Group
Published: August 2023

Abstract

Objective
The Standing and Walking Assessment Tool (SWAT) standardizes the timing and content of walking assessments during inpatient rehabilitation by combining 12 stages ranging from lowest to highest function (0, 0.5, 1A, 1B, 1C, 2A, 2B, 2C, 3A, 3B, 3C, and 4) with 5 standard measures: the Berg Balance Scale, the modified Timed “Up & Go” test, the Activities-specific Balance Confidence Scale, the modified 6-Minute Walk Test, and the 10-Meter Walk Test (10MWT). This study aimed to determine if the SWAT at rehabilitation discharge could predict outdoor walking capacity 1-year after discharge in people with traumatic spinal cord injury.

Methods
This retrospective study used data obtained from the Rick Hansen Spinal Cord Injury Registry from 2014 to 2020. Community outdoor walking capacity was measured using the Spinal Cord Independence Measure III (SCIM III) outdoor mobility score obtained 12 (±4) months after discharge. Of 206 study participants, 90 were community nonwalkers (ie, SCIM III score 0–3), 41 were community walkers with aids (ie, SCIM III score 4–6), and 75 were independent community walkers (ie, SCIM III score 7–8). Bivariate, multivariable regression, and an area under the receiver operating characteristic curve analyses were performed.

Results
At rehabilitation discharge, 3 significant SWAT associations were confirmed: 0–3A with community nonwalkers, 3B/higher with community walkers with and without an aid, and 4 with independent community walkers. Moreover, at discharge, a higher (Berg Balance Scale, Activities-specific Balance Confidence Scale), faster (modified Timed “Up & Go,” 10MWT), or further (10MWT) SWAT measure was significantly associated with independent community walking. Multivariable analysis indicated that all SWAT measures, except the 10MWT were significant predictors of independent community walking. Furthermore, the Activities-Specific Balance Confidence Scale had the highest area under the receiver operating characteristic score (0.91), demonstrating an excellent ability to distinguish community walkers with aids from independent community walkers.

Conclusion
The SWAT stage and measures at discharge can predict community outdoor walking capacity in persons with traumatic spinal cord injury. Notably, a patient’s confidence in performing activities plays an important part in achieving walking ability in the community.

Impact
The discharge SWAT is useful to optimize discharge planning.
The prime number theorem for primes in arithmetic progressions at large values
Authors: Lee Ethan Simpson 
Published: August 2023

Abstract
Assuming the Riemann hypothesis, we prove the latest explicit version of the prime number theorem for short intervals. Using this result, and assuming the generalised Riemann hypothesis for Dirichlet L-functions is true, we then establish explicit formulae for $\psi(x,\chi)$, $\theta(x,\chi)$ and an explicit version of the prime number theorem for primes in arithmetic progressions that hold for general moduli $q\geq 3$. Finally, we restrict our attention to $q\leq 10\,000$ and use an exact computation to refine these results.
E36 Juvenile scleroderma in rheumatology unit Tripoli children hospital
Authors: Hashad Soad S , Etayari Hala M , Almsellati Iman A , Etfil Majda N , Altwati Aya , Awhida Zuhaira 
Published: August 2023

Abstract

Introduction
Juvenile scleroderma is a rare chronic systemic connective tissue disease. It is classified into two main forms: localized scleroderma and systemic sclerosis. Since it is rare in children, many aspects of the disease remain undiscussed.

Aim
To study the clinical and demographic characteristics of patients diagnosed with various types of scleroderma who presented at the pediatric rheumatology unit in Tripoli Children hospital from the year 2000–2022

Materials and methods
This is a retrospective case series conducted by reviewing the files of patients with scleroderma diagnosed and followed up in pediatric rheumatology unit from year 2000–2022 and collecting the data regarding patients’ demographics, time of diagnosis, clinical features, and laboratory results.

Results
Seven patients who met preliminary classification criteria for JSS were included. 2 males and 5 females. 1 patient with systemic sclerosis, 1 patient with linear morphea, 2 patients with generalized morphea, 1 patient with Parry Romberg syndrome, 1 patient with CREST syndrome, and 1 patient with deep morphea. The mean age at diagnosis was 8.2 ± 4.5 years. The first symptom attributable to JSS was hyperpigmented skin patches in 5 cases, no one presented with Raynaud's phenomenon. Respiratory involvement occurred in one patient, and it manifested as dyspnea as well as abnormal imaging and/or pulmonary function tests showed mild restrictive lung disease. Dysphagia was the commonest gastrointestinal symptom (4 patients, 57%). The most frequent musculoskeletal symptom was arthritis found in in 4 (57.1%) patients. Uveitis in 1 (14.3%), ANA was positive in 4 (57%) children: RF positive in 2 (28.6%) patients, ENA negative in the 7 (100%) patients. Skin biopsy was done in 2 patients and was consistent with scleroderma. Regarding treatment, six patients received MTX, one patient received prednisolone and one patient received MMF.

Conclusion
This report is the first describing Libyan patients with scleroderma. As reported in the literature, localized forms are more common than systemic sclerosis. Also a rare form of scleroderma (Parry Romberg syndrome) was present. Data about the disease mainly based on studies on adults and we need more studies on pediatric patients.

Ethics
Our study was approved by local ethical committee of pediatric department at Tripoli children hospital.
Comparison between endocrine activity assessed using ToxCast/Tox21 database and human plasma concentration of sunscreen active ingredients/UV filters
Authors: Onyango David O , Selman Bastian G , Rose Jane L , Ellison Corie A , Nash J F 
Published: August 2023

Abstract
Sunscreen products are composed of ultraviolet (UV) filters and formulated to reduce exposure to sunlight thereby lessening skin damage. Concerns have been raised regarding the toxicity and potential endocrine disrupting (ED) effects of UV filters. The ToxCast/Tox21 program, that is, CompTox, is a high-throughput in vitro screening database of chemicals that identify adverse outcome pathways, key events, and ED potential of chemicals. Using the ToxCast/Tox21 database, octisalate, homosalate, octocrylene, oxybenzone, octinoxate, and avobenzone, 6 commonly used organic UV filters, were found to have been evaluated. These UV filters showed low potency in these bioassays with most activity detected above the range of the cytotoxic burst. The pathways that were most affected were the cell cycle and the nuclear receptor pathways. Most activity was observed in liver and kidney-based bioassays. These organic filters and their metabolites showed relatively weak ED activity when tested in bioassays measuring estrogen receptor (ER), androgen receptor (AR), thyroid receptor, and steroidogenesis activity. Except for oxybenzone, all activity in the endocrine assays occurred at concentrations greater than the cytotoxic burst. Moreover, except for oxybenzone, plasma concentrations (Cmax) measured in humans were at least 100× lower than bioactive (AC50/ACC) concentrations that produced a response in ToxCast/Tox21 assays. These data are consistent with in vivo animal/human studies showing weak or negligible endocrine activity. In sum, when considered as part of a weight-of-evidence assessment and compared with measured plasma concentrations, the results show these organic UV filters have low intrinsic biological activity and risk of toxicity including endocrine disruption in humans.
Self-reported Xylazine Experiences: A Mixed-methods Study of Reddit Subscribers
Authors: Spadaro Anthony , O'Connor Karen , Lakamana Sahithi , Sarker Abeed , Wightman Rachel , Love Jennifer S. , Perrone Jeanmarie 
Published: August 2023

Objectives
Xylazine is an α2-agonist increasingly prevalent in the illicit drug supply. Our objectives were to curate information about xylazine through social media from people who use drugs (PWUDs). Specifically, we sought to answer the following: (1) What are the demographics of Reddit subscribers reporting exposure to xylazine? (2) Is xylazine a desired additive? And (3) what adverse effects of xylazine are PWUDs experiencing?

Methods
Natural language processing (NLP) was used to identify mentions of “xylazine” from posts by Reddit subscribers who also posted on drug-related subreddits. Posts were qualitatively evaluated for xylazine-related themes. A survey was developed to gather additional information about the Reddit subscribers. This survey was posted on subreddits that were identified by NLP to contain xylazine-related discussions from March 2022 to October 2022.

Results
Seventy-six posts were extracted via NLP from 765,616 posts by 16,131 Reddit subscribers (January 2018 to August 2021). People on Reddit described xylazine as an unwanted adulterant in their opioid supply. Sixty-one participants completed the survey. Of those who disclosed their location, 25 of 50 participants (50%) reported locations in the Northeastern United States. The most common route of xylazine use was intranasal use (57%). Thirty-one of 59 (53%) reported experiencing xylazine withdrawal. Frequent adverse events reported were prolonged sedation (81%) and increased skin wounds (43%).

Conclusions
Among respondents on these Reddit forums, xylazine seems to be an unwanted adulterant. People who use drugs may be experiencing adverse effects such as prolonged sedation and xylazine withdrawal. This seemed to be more common in the Northeast.
Diagnosis and Management of an Intramyometrial Ectopic Pregnancy Within a Septate Uterus
Authors: Gilmore Emma , Gutman Sarah , Kim Hyun Tae , Roe Andrea Hsu 
Published: August 2023

BACKGROUND:
An intramyometrial pregnancy is a rare form of ectopic pregnancy, making up an estimated 1% of all ectopic pregnancies. Previously described management options have included surgical excision in the emergency setting.

CASE:
A 32-year-old woman, gravida 4 para 0, at 6 0/7 weeks of gestation by last menstrual period, was noted to have a gestational sac implanted entirely within the uterine myometrium. Ultrasonography and magnetic resonance imaging confirmed the presence of an intramyometrial ectopic pregnancy within a septate uterus. The patient's abnormal pregnancy was successfully treated with multidose methotrexate.

CONCLUSION:
Intramyometrial pregnancy is a rare entity that should be considered when it is suggested by ultrasonography or if an intrauterine pregnancy is surgically inaccessible from the endometrial cavity. In a stable patient, multidose systemic methotrexate may be a feasible management strategy.
Reproductive Carrier Screening Results With Maternal Health Implications During Pregnancy
Authors: Souter Vivienne , Prigmore Brittany , Becraft Emily , Repass Elizabeth , Smart Trevor , Sanapareddy Nina , Schweitzer Melissa , Ortiz J. Bryce , Wang Yang , Benn Peter 
Published: August 2023

OBJECTIVE:
To identify conditions on a reproductive carrier screening panel with the potential for carrier manifestations during pregnancy and review the implications for obstetric care.

METHODS:
This was a retrospective cross-sectional study of consecutive samples from female patients aged 18–55 years submitted to a commercial laboratory for a 274-gene carrier screening panel (January 2020 to September 2022). A literature review was performed to identify genes on the panel with potential for pregnancy complications in carriers. Carrier expression and published recommendations for clinical management were reviewed.

RESULTS:
We identified 12 genes with potential for carrier manifestations during pregnancy based on reports in the literature: nine with manifestations irrespective of the fetal genetic status (ABCB11, COL4A3, COL4A4, COL4A5, DMD, F9, F11, GLA, and OTC) and three (CPT1A, CYP19A1, and HADHA) with manifestations only if the fetus is affected by the condition. Manifestations included cardiomyopathy, hemorrhage, gestational hypertensive disorders, cholestasis of pregnancy, acute fatty liver, hyperammonemic crisis, and maternal virilization. Published recommendations for carrier management were identified for 11 of the 12 genes. Of 91,637 tests performed during the study period, a pathogenic or likely pathogenic variant was identified in 2,139 (2.3%), giving a carrier frequency for any of the 12 genes of 1 in 43 (95% CI 1/41–45) 1,826 (2.0%) of the study population were identified as carriers for one of the nine genes with the potential for carrier manifestations irrespective of an affected or unaffected fetus.

CONCLUSION:
Approximately 1 in 40 female patients were identified as carriers for a condition with potential for maternal manifestations in pregnancy, including some serious or even life-threatening complications. Obstetric care professionals should be aware of the possibility of pregnancy complications among carriers and the available recommendations for management.

FUNDING SOURCE:
This study was funded by Natera, Inc.
Do Long-Segment Blocking Screws Increase the Stability of Intramedullary Nail Fixation in Proximal Tibia Fractures, eliminating the “Bell-clapper Effect?”
Authors: Stenquist Derek S , McCaskey Meghan , Diaz Miguel , Munassi Steven D , Ayala Giovanni , Donohue David , Mir Hassan R 
Published: August 2023

Abstract

Objectives:
To determine change in stiffness and horizontal translation of a geriatric extra-articular proximal tibia fracture model after intramedullary nailing with distal (long) segment blocking screws versus proximal (short) segment blocking screws.

Methods:
Unstable extra-articular proximal tibia fractures (OTA/AO 41-A3) were created in twelve geriatric tibias. Intramedullary nails were locked with a standard construct (4 proximal screws and 2 distal screws). Specimens were then divided into 2 groups (6 matched pairs per group). Group 1 had a blocking screw placed lateral to the nail in the proximal segment (short-segment). Group 2 had a blocking screw placed 1cm distal to the fracture and medial to the nail (long segment). Specimens were then axially loaded and cycled to failure or cycle completion (50,000 cycles).

Results:
Long segment blocking screws significantly decreased the amount of horizontal translation at the fracture site compared to short segment screws (0.77 mm vs. 2.0 mm (p=.039). They also resulted in greater baseline stiffness, although this difference was not significant (807.32± 216.95N/mm vs 583.12 ± 130.1 N/mm, p=.072). There was no difference in stiffness after cyclic loading or survival through 50,000 cycles between the long- and short-segment groups.

Conclusion:
Long-segment blocking screws added to an intramedullary nail construct resulted in decreased horizontal translation at the fracture site compared to short-segment screws in this model of a geriatric proximal tibia fracture.

Clinical Relevance:
Blocking screws are commonly used to aid in fracture alignment during intramedullary nailing of proximal tibia fractures. Even when not required to attain or maintain alignment, the addition of a blocking screw in the distal (long) segment may help mitigate the “Bell-clapper Effect” in geriatric patients.
Early Treatment of Acetabular Fractures via an Anterior Approach Increases Blood Loss but not Packed Red Blood Cell Transfusion
Authors: Mullis Brian H. , Chang Joshua HS , Shah Nihar , Sabbagh Ramsey S. , Yu Qing , Archdeacon Michael T. , Sagi H Claude , Natoli Roman M. 
Published: August 2023

Abstract

Objective:
To determine if time from hospital admission to surgery for acetabular fractures using an anterior intrapelvic (AIP) approach affected blood loss.

Design:
Multicenter retrospective study.

Setting:
Three level 1 trauma centers at 2 academic institutions.

Patients:
195 adult (age >18) patients with adequate records to complete analysis and no pre-existing coagulopathy.

Intervention:
AIP approach without other significant same day procedures (irrigation and debridement and external fixation were the only other allowed procedures).

Outcome Measurements:
Multiple methods for evaluating blood loss were investigated, including estimated blood loss (EBL), calculated blood loss (CBL), and packed red blood cell (PRBC) transfusion requirement.

Results:
On continuous linear analysis, increasing time from admission to surgery was significantly associated with decreasing CBL at 24 hours (-1.45 mL per hour by Gross, p=0.003; -0.440 g of Hgb per hour by Hgb balance, p=0.003) and 3 days (-1.69 mL per hour by Gross, p=0.013; -0.497 g of Hgb per hour by Hgb balance, p=0.010) postoperative, but not EBL or PRBC transfusion. Using 48-hours from admission to surgery to define early versus delayed, blood loss was significantly greater in the early group compared to delayed [453 (IQR 277-733) mL early versus 364 (IQR 160-661) delayed by Gross, p=0.017; 165 (IQR 99-249) g early versus 143 (IQR 55-238) g delayed by Hgb balance, p=0.035], but not EBL or PRBC transfusion. Additionally, in multivariate linear regression, neither giving tranexamic acid nor administering prophylactic anticoagulation for venous thromboembolism on the morning of surgery affected blood loss at 24 hours or 3 days postoperative.

Conclusion:
There is higher blood loss with early surgery using an AIP approach, but early surgery did not affect PRBC transfusion and may not be clinically relevant.

Level of Evidence:
Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
99mTc-HFAPi imaging identifies early myocardial fibrosis in the hypertensive heart
Authors: Xie Boqia , Li Lina , Lin Mingming , Nanna Michele , Su Yao , Hua Cuncun , Leng Chenlei , Gan Qianqian , Xi Xiao-Ying , Wang Yidan , Yao Dandan , Wang Li , Yu Liping , Zhao Lei , Zhang Ye-ping , Dou Kefei , Su Pixiong , Lv Xiuzhang , Jia Bing , Yang Min-Fu 
Published: August 2023

Background:
This study aimed to explore whether 99mTc-radiolabeled fibroblast activation protein inhibitor (99mTc-HFAPi) imaging can detect early myocardial fibrosis in the hypertensive heart.

Methods:
In the experimental model, spontaneously hypertensive rats (SHRs) and age-matched Wistar Kyoto rats (WKYs) were randomly divided into three groups (8, 16, and 28 weeks). The animals underwent 99mTc-HFAPi imaging and echocardiography. Autoradiography and histological analyses were performed in the left ventricle. The mRNA and protein expression level of the fibroblast activation protein (FAP) and collagen I were measured using quantitative PCR and western blot. In the clinical investigation, a total of 106 patients with essential hypertension and 20 gender-matched healthy controls underwent 99mTc-HFAPi imaging and echocardiography.

Results:
In-vivo and in-vitro autographic images demonstrated diffusely enhanced 99mTc-HFAPi uptake in the SHR heart starting at week 8, before irreversible collagen deposition. The mRNA and protein levels of FAP in SHRs began to increase from week 8, whereas changes in collagen I levels were not detected until week 28. In the clinical investigation, even in hypertensive patients with normal diastolic indicators, normal left ventricular geometry, and normal global longitudinal strain (GLS), the prevalence of increased 99mTc-HFAPi uptake reached 34, 41, and 20%, respectively, indicating that early fibrogenesis precedes structural and functional myocardial abnormalities.

Conclusion:
In hypertension, 99mTc-HFAPi imaging can detect early fibrotic process before myocardial functional and structural changes.
Comparative effectiveness of pain control between opioids and gabapentinoids in older patients with chronic pain
Authors: Kim Emily , Raji Mukaila A. , Westra Jordan , Wilkes Denise , Kuo Yong-Fang 
Published: August 2023

Abstract
Gabapentinoid (GABA) prescribing has substantially increased while opioid prescribing has decreased since the 2016 Centers for Disease Control and Prevention Guidelines restricted opioid prescribing for chronic pain. The shift to GABA assumes equal analgesic effectiveness to opioids, but no comparative analgesic effectiveness data exist to support this assumption. We compared GABA to opioids by assessing changes in pain interfering with activities (activity-limiting pain) over time in patients with chronic pain. We used 2017 to 2019 data from a 20% national sample of Medicare beneficiaries diagnosed with chronic pain who initiated a GABA or opioid prescription for ≥30 continuous days and received home health care in the study year. The main outcome was the difference in reduction in pain score from pre- to post-prescription assessments between the 2 groups. Within a 60-day window before-and-after drug initiation, our sample comprised 3208 GABA users and 2846 opioid users. Reduction in post-prescription scores of pain-related interference with activities to less-than-daily pain was 48.1% in the GABA group and 41.7% in the opioid group; this remained significant (odds ratio = 1.29, 95% confidence interval: 1.17-1.43, P < 0.0001) after adjustment for patient demographics and comorbidities. The adjusted difference in reduced pain-related interference score between the 2 groups was −0.10 points on a 0 to 4 scale (P = 0.01). Gabapentinoid use had greater odds of less-than-daily pain post-prescription, in a dose-dependent manner. Thus, GABA use was associated with a larger reduction in chronic pain than opioids, with a larger effect at higher GABA dosage. Future research is needed on functional outcomes in patients with chronic pain prescribed GABA or opioids.