bluuebunny/crossref_metadata_2025_split huggingface dataset:
Morbidity and mortality rates among children aged 0–59 months: a cross-sectional study from Mogadishu, Somalia
Authors: Malin Jibril Abdi , Mohamud Hafsa Mohamed , Hassan-Tuuryare Sakariye Abdullahi , Mohamed Suleyman Abdullahi , Kimutai Timothy Kiprotich 
Published: February 2025

Background:
The under-five mortality rate is the likelihood of a child passing away before reaching the age of 5, calculated based on the number of deaths per 1,000 live births. High under-five mortality rates often reflect inadequate access to healthcare, sanitation, and nutrition, while low rates indicate a more favorable environment for child survival. The child mortality rate in Somalia is among the highest in the world.

Methods:
This cross-sectional study examined morbidity and mortality rates among children aged 0–59 months at a referral hospital in Mogadishu, Somalia. With a total sample size of 1675 patients, we analyzed leading causes of mortality and admissions among children aged 0–59 months to identify urgent healthcare needs in this vulnerable population.

Results
The results showed that preterm birth (26.00%), acute respiratory diseases (18.50%), and birth asphyxia (17.40%) were the leading causes of admission among newborns. Gastrointestinal diseases were the leading cause of admission among infants and children, accounting for 43.80% of cases among those aged 6 months to 1 year and 44.90% among those aged 1–5 years. The mortality rate was highest among newborns, with a rate of 22.40%, and decreased with age. The leading causes of death were preterm birth (60 deaths, 30.80% of preterm cases), birth asphyxia (50 deaths, 38.50% of asphyxia cases), and meconium aspiration syndrome (24 deaths, 20.50% of MAS cases), accounting for a significant proportion of deaths. Congenital diseases represented 1.60% of admissions with approximately 14.80% of children under five with congenital disorders dying from related complications. Overall, the study found that 10.30% of pediatric patients under 5 years old died, highlighting the need for targeted interventions to address these leading causes of morbidity and mortality.

Conclusions:
This study highlights the urgent need for comprehensive strategies to reduce preterm births, enhance neonatal care, and tackle the leading causes of infant mortality. By implementing targeted interventions and strengthening healthcare systems, we can alleviate the burden of infant mortality and promote healthier futures for children globally.
Near infrared spectroscopy in the pediatric cardiac intensive care unit: accurately interpreting the data
Authors: Iliopoulos Ilias , Flores Saul , Loomba Rohit 
Published: February 2025

Purpose of review
Near infrared spectroscopy (NIRS) has been increasingly adopted as standard monitoring in postoperative care of pediatric cardiac patients. Several reports have established its association with both markers of perfusion and adverse outcomes. The correlation with markers of perfusion is not strong and exhibits wide limit of agreement, making the determination of critical thresholds and its integration in treatment algorithms challenging.

Recent findings
A growing body of literature support the use of NIRS for hemodynamic monitoring in pediatric cardiac patients. Recent reports corroborate prior findings of weak to moderate correlation of NIRS with markers of global and regional perfusion and confirm its association with adverse outcomes. The challenge of lack of treatment thresholds remains, limiting clinical utility. Evidence of improvement of outcomes with the use of NIRS remains limited.

Summary
NIRS is a useful monitor of regional and global perfusion and can inform management decisions but cannot be used as the sole decision-making tool. Large, randomized studies are needed to define its use as decision making tool and facilitate its integration in treatment algorithms.
Mitigating heart failure risk in patients with diabetes and chronic kidney disease
Authors: Kowalczyk Nicholas S. , Prochaska Megan 
Published: February 2025

Purpose of review
Patients with chronic kidney disease and diabetes are at high risk of cardiovascular disease, including heart failure. Risk mitigation requires a comprehensive approach with lifestyle modifications, blood pressure management, renin-angiotensin blockade, and sodium-glucose cotransporter 2 inhibitors. Recent trials have shown that nonsteroidal mineralocorticoid receptor antagonists (ns-MRA) and glucagon-like peptide 1 receptor agonists (GLP-1 RA) should also be components of this approach. This review will discuss the comprehensive approach to mitigating risk in these high-risk patients and highlight the recent trials of ns-MRAs and GLP-1 RA.

Recent findings
In recent years, large, randomized controlled trials of ns-MRA and GLP-1 RA have shown benefit in kidney and cardiovascular outcomes for patients with chronic kidney disease and diabetes.

Summary
The substantial benefits and overall favorable safety profiles for ns-MRA and GLP-1 RA in patients with chronic kidney disease and diabetes demonstrate that these medications should be considered as a part of a comprehensive approach to cardiovascular risk reduction in this high-risk population. Future studies should consider different combination therapies and guide how and when to initiate these therapies.
Advances in the management of obesity and heart failure: latest evidence from clinical trials
Authors: Costa Thomaz Alexandre , Harrington Josephine L. 
Published: February 2025

Purpose of review
Obesity is an important risk factor for heart failure with preserved ejection fraction (HFpEF). In patients who already have HFpEF, obesity contributes to high symptom burden and increased risk for heart failure (HF) hospitalization. This review examines the latest clinical trials assessing the efficacy of pharmacological interventions in the treatment of obesity-related HFpEF.

Recent findings
Recent results from randomized clinical trials (RCTs) suggest that incretin-based therapies, including glucagon-like peptide-1 receptor agonists (GLP-1 RAs) (e.g., semaglutide) and dual glucose-dependent insulinotropic polypeptide (GIP)/GLP-1 RAs (e.g., tirzepatide), can improve quality of life, exercise tolerance, and markers of HF severity while promoting weight loss in patients with obesity and HFpEF. Some evidence also suggests that these therapies may reduce risk for HF hospitalizations. Additionally, exploratory analyses of the nonsteroidal mineralocorticoid receptor antagonist finerenone has been associated with reduced cardiovascular mortality and total worsening HF events across all body mass index (BMI) levels, with greater benefits observed in patients with higher BMIs.

Summary
Antiobesity medications such as semaglutide and tirzepatide may represent important treatment options for patients with obesity-related HFpEF. Additional evidence suggests that certain other HF medications may have increased efficacy in patients with obesity.
Dosimetry Testing for a New In Vivo X-ray Fluorescence Measurement System
Authors: Burgos Chandler J. , Read Daniel E. , Grier Thomas R. , Khan Maruf , Weisskopf Marc G. , Taylor Kathryn M. , Specht Aaron J. 
Published: February 2025

Abstract
Lead exposure poses severe health risks to individuals, impacting cognitive function, growth, learning, and behavior. Current lead detection methods, primarily blood testing and x-ray fluorescence (XRF) of bone, have limitations. This study introduces a novel in vivo XRF measurement system using K-shell energies of lead, addressing limitations of previous methods. The study aimed to characterize beam directionality, subject radiation dose, and operator occupational exposure. Using a high-energy x-ray tube and room-temperature detectors, various parameters were assessed with bone and tissue phantoms. Dose measurements were taken by altering voltage, current, and shielding. Scatter and spatial measurements highlighted increased scatter with bone and tissue presence, emphasizing the safest positions for bystanders and operators. Results exhibited expected dose rate changes with varying parameters, showcasing the impact of bone and tissue on scatter radiation. The system’s total body effective dose (with an 8-mm molybdenum shielding indicating minimal risk compared to established public dose limits) for an adult was 1.94 μSv; for a child aged 10 y, it was 3.28 μSv. This system demonstrates promising capabilities for lead exposure monitoring, offering negligible occupational exposure and minimal risk to individuals being scanned. Its safety and efficacy position it as a valuable tool in assessing lead exposure, potentially improving preventive measures.
Exercise Tolerance in Pediatric Concussion: An 8-Year Longitudinal Study
Authors: Cassimatis Maree , Orr Rhonda , Fyffe Andrew , Browne Gary 
Published: February 2025

Objectives:
To determine the relationship between exercise tolerance and post-concussion symptom deficits, cognitive function, and recovery duration; (2) examine the longitudinal effect of exercise tolerance on symptom burden over the clinical timecourse of a child’s recovery from concussion; and (3) explicate whether exercise intolerance is a significant determinant of recovery in pediatric concussion.

Setting:
Pediatric tertiary referral concussion clinic.

Participants:
Children and adolescents (aged 6-18 years) presenting to the concussion clinic between January 2015 and December 2022.

Design:
Retrospective longitudinal study.

Main Measures:
Graded exercise test (GXT) data, derived from a standardized treadmill test (Bruce Protocol), was used to measure exercise tolerance following concussion. Based on initial GXT times, participants were dichotomized into 2 groups: (1) exercise tolerant (GXT time ≥9 minutes), or (2) exercise intolerant (GXT time <9 minutes). Symptom burden, cognitive function, and recovery duration were compared between groups. A subgroup analysis of participants requiring multiple clinic visitations was conducted to explore the longitudinal effect of post-concussion exercise tolerance over time.

Results:
Of the 603 children presenting to the concussion clinic, 313 participants (mean age ± SD: 13 ± 2 years, 79% male) were eligible. Exercise-intolerant participants (mean GXT [95% confidence interval, CI], 6.9 [6.5-7.3] minutes) reported 2 times greater initial symptom severity (P < .001) and performed poorly in visual memory (P = .002) and reaction time (P = .02) cognitive domains compared to exercise-tolerant participants (mean GXT [95% CI], 12.3 [12.0-12.5] minutes). Recovery time was longer in exercise-intolerant participants than exercise-tolerant participants (mean recovery time [95% CI], 94 [71-116] vs 69 [57-81] days, P = .002). Participants requiring multiple clinic visitations showed improvements in exercise tolerance and symptom burden over time (P < .001). Significant predictors of prolonged concussion recovery were delayed presentation time (P < .001), high initial symptom burden (P < .001), and exercise intolerance (P < .001).

Conclusion:
GXT is a clinically relevant measure to identify children and adolescents at risk of a prolonged concussion recovery.
Maximizing oral intake tolerance in malignant gastric outlet obstruction – a Markov decision tree analysis comparing duodenal stenting, endoscopic ultrasound-guided gastroenterostomy and surgical gastrojejunostomy based on a meta-analysis of randomized controlled trials
Authors: Chue Koy Min , Douglass Benjamin Robert , Lin Lester Ong Wei , Hui Jeremy Tan Tian , Teh Jonathan Guo Xiang , Putera Martin , Kwan Clarence Kah Wai , Wong Wai Keong , Man Baldwin Yeung Po 
Published: February 2025

Introduction:
Malignant gastric outlet obstruction (GOO) has a significant impact on quality of life. Endoscopic ultrasound-guided gastroenterostomy (EUS-GE) has shown promising results. Traditional isolated outcome measures do not sufficiently address critical considerations for end-of-life patients like oral intake tolerance. This study aimed to determine via a probabilistic approach, the optimal management strategy for GOO patients that maximizes their oral intake tolerance.

Methods:
A Markov decision model was developed, with input variables based on a systematic review and meta-analysis of randomized controlled trials (RCT) comparing duodenal stenting (DS), EUS-GE and surgical gastrojejunostomy (GJ). A prospective cohort study with a comparator group was also included for EUS-GE model given the scarcity of RCTs. Model assumption was a patient with malignant GOO, with equal probabilities of being allocated to 1 of 3 treatment options. Each data point was evaluated using pooled probabilities from the meta-analysis of clinical outcomes. Primary outcome was successful oral intake tolerance at various time points of 1–6 months post-intervention.

Results:
Fifteen studies were included into the Markov model. Based on 10 000 simulations in each arm, at a survival of 1-month, DS and EUS-GE had the highest likelihood of oral intake (81.2% and 80.4%) compared to GJ (75.5%). However, at a survival of 6-month, EUS-GE and GJ were better at palliating GOO, with likelihood of oral intake at 23.8% and 25.2%, compared to 21.3% for DS.

Conclusion:
For patients with a prognosis of more than 1-month, a surgical GJ, or EUS-GE if technical expertise is available, is preferred for GOO palliation.
Differences in the Clinicopathologic and Radiological Characteristics of Patients with Microcystic and Macrocystic Serous Cystadenoma of the Pancreas
Authors: Lu Xiaozhi , Dai Yuran , Liu Xinchun , Jiang Lei , Zhang Kai , Wu Junli , Gao Wentao , Jiang Kuirong , Dai Cuncai , Miao Yi , Li Mingna , Wei Jishu 
Published: February 2025

Abstract

Objectives
To elucidate the clinicopathological characteristics, imaging features, and surgical outcomes of patients with serous cystic neoplasms (SCNs), and to compare the features between microcystic (MiC) and macrocystic (MaC) SCNs.

Methods
In this single-center retrospective study, information of patients with SCN between 2016 and 2022 at our institution was collected and analyzed.

Results
A total of 105 patients with SCNs were identified, including 58 (55.2%) with MiC type and 47 (44.8%) with MaC type. Patient age and American Society of Anesthesiologists (ASA) grade in the MiC group were significantly higher than those in the MaC group. The overall preoperative diagnostic accuracy was 7.6%, with no patients in the MaC group correctly diagnosed before surgery. In imaging examinations, almost all (97.1%) exhibited a lobulated pattern. Internal septation, honeycomb pattern, central scar, and calcification were common, with a significantly higher incidence in the MiC group. No in-hospital deaths occurred, and the incidence of major complications were comparable in both groups.

Conclusions
Although many patients presented with typical imaging features, accurate diagnosis of SCN remained difficult. Except for older age and higher ASA grade in the MiC group, there were no significant differences in the clinicopathological characteristics between MiC and MaC SCN patients.
Student and Educator Evaluation of the Five-Minute Peer Writing Activity
Authors: Richards Andrew J. , Hall Zachary 
Published: February 2025

Background:
Educators look for practical and engaging classroom assessment techniques (CATs) to enhance the learning experience.

Problem:
Many CATs are individual activities that only engage learners at lower levels of Bloom’s Taxonomy. The Five-Minute Peer Writing Activity (FMPWA) was developed to address this problem. This study compared student grades, engagement, and satisfaction between the FMPWA and One-Minute Paper (OMP) CAT and the effectiveness and acceptability of the FMPWA among nurse educators.

Approach:
Nursing students completed the OMP and FMPWA and rated both by engagement and satisfaction. Nurse educators attending conference workshops experienced the OMP and FMPWA and had the opportunity to complete a short survey.

Outcomes:
This innovative CAT showed a statistically significant increase in student grades, engagement, and satisfaction scores. Educators reported higher engagement, satisfaction, and likelihood of trying the FMPWA.

Conclusions:
The FMPWA is an effective strategy to engage nursing students in the classroom.
Associations between HIV serostatus and coronary artery plaque volume progression
Authors: Whelton Seamus P. , Haberlen Sabina A. , Zhang Long , Herrschaft Ryan , Witt Mallory D. , Jacobson Lisa P. , Margolick Joseph B. , Magnani Jared W. , Palella Frank J. , Brown Todd T. , Budoff Matthew , Post Wendy S. 
Published: February 2025

Objective:
Men with HIV have more coronary atherosclerosis than men without HIV. We examined whether plaque progression differed based on HIV serostatus.

Design:
We examined plaque progression over a median of 4.5 years (IQR 3.9-4.9) among 548 men with (n = 313) or without (n = 235) HIV from the Multicenter AIDS Cohort Study using coronary CT angiography.

Methods:
Change in coronary plaque volume was calculated for 1) total, 2) calcified, 3) noncalcified, and 4) low attenuation plaque and categorized by tertile. Multinomial logistic regression models estimated the association between HIV and coronary plaque progression.

Results:
The median age was 53 years old and 30% were Black. Total plaque volume regressed among 2%, 20% remained without plaque, and 78% had progression with a median progression of 34 mm3 (IQR 3-106). Compared to men without HIV, men with HIV had a statistically significant 1.99 higher odds of calcified plaque progression (95%CI:1.16,3.44, p = 0.01) and elevated odds for progression in total plaque (OR1.62, 95%CI:0.94,2.77, p = 0.08) and noncalcified plaque volume (OR1.64, 95%CI:0.97,2.79, p = 0.07), although the latter findings did not meet the cutpoint for statistical significance. The progression of low attenuation plaque did not significantly differ by HIV serostatus (OR1.34, 95%CI:0.88,2.05, p = 0.18). HIV was significantly associated with the progression of total, calcified, and noncalcified plaque among nonBlack participants, but not Black participants.

Conclusions:
These results suggest that men with HIV may have greater plaque progression, which may contribute to the observed higher incidence of coronary heart disease among men with HIV.
Posterior Vault Distraction Osteogenesis: A Systematic Review and Single-Arm Metanalysis
Authors: Franco-Mesa Camila , De La Cruz Ku Gabriel , Palackic Alen , DeJesus Jana E. , Konofaos Petros 
Published: February 2025

Introduction:
The purpose of this study is to describe the technique and outcomes of posterior vault distraction osteogenesis (PVDO) in patients with syndromic and nonsyndromic craniosynostosis.

Methods:
Studies from MEDLINE, Scopus, and Cochrane Central Register of Controlled Trials were systematically searched for patients with posterior cranial vault distraction osteogenesis. Inclusion criteria encompassed all studies with 3 or more patients per cohort who underwent posterior cranial vault distraction osteogenesis and had a follow-up of at least 1 month. Patients with both syndromic and nonsyndromic synostosis were included. The risk of bias in nonrandomized studies of intervention tool (ROBINS-I) was applied.

Results:
A total of 19 manuscripts with 403 patients met the criteria. All but one study included patients with syndromic craniosynostosis. In total, 5.9% of cases used one distractor, 72.5% two, 3.7% three, and 7.4% four. The distraction achieved ranged from 18.7 to 35 mm with an average of 23.54 mm. Distraction protocol was, on average, 1 mm/d. The duration of the distractors from placement to extraction was 10.1 weeks. Follow-up after surgery was 27.09 months on average. Ninety-nine (26.3%) complications in 376 patients were reported, of which 31 required unplanned surgical intervention. Single-arm metanalysis of the complications associated with PVDO revealed 13.71 events (CI: 8.9–19.8) per 50 cases with moderate heterogeneity per Cochrane Q test (χ2=47.12 P<0.01) and I
2 test (68%).

Conclusions:
PVDO is an effective technique to increase cranial vault volume. Factors such as distraction protocol selected based on the patient's needs and age at the time of surgery are crucial for successful outcomes. Furthermore, distraction protocols can be tailored to specific needs, permitting a patient-centered approach. Complications are variable both in incidence as well as severity.
Efficacy of Bone Morphogenetic Protein-2 Peptide-Modified Nano-Hydroxyapatite Alginate Hydrogel in Vertebral Bone Defect Repair
Authors: Zhao Xuchen , Xu Dingli , Luo Jianguang 
Published: February 2025

For the effective treatment of vertebral bone defects (BDs), the authors constructed an innovative hydroxyapatite (HAP) nanoparticle–hyaluronic acid (HA)–alginate (ALG) scaffold loaded with recombinant human bone morphogenetic protein-2 (rhBMP-2). The particle size of HAP was around 80 to 100 nm, and its addition markedly reduced the swelling rate and degradability of the HA-ALG scaffold while enhancing its compression resistance, enabling it to better support the BD site and provide a good proliferation environment for osteoblasts. Furthermore, HAP-HA-ALG effectively extended the half-life of rhBMP-2 by nearly 50-fold, allowing it to exert its osteogenic effects more consistently. In cellular experiments, the authors found that rhBMP-2@HAP-HA-ALG significantly enhanced the activity and migration ability of bone marrow mesenchymal stromal cells, as well as the expression level of related osteogenic proteins in cells, which better exerted osteoinductive and osteoconductive functions. In animal tests, rhBMP-2@HAP-HA-ALG could better facilitate the generation of new bone and bone trabecula at BD sites and markedly enhance the bone density level, thus shortening the repair time of BDs. Therefore, rhBMP-2@HAP-HA-ALG shows great potential in the restoration of vertebral BDs.