bluuebunny/crossref_metadata_2025_split huggingface dataset:
Additional Imaging is of Limited Value in Traumatic Hip Fractures With a History of Distant Malignancy and No Suspicious Lesion on Plain Radiographs
Authors: Sharrock Martin , Mati Wael , Peng Koh Shang , Abdullah Mustafa , Charalambous Charalambos P. 
Published: May 2022

Objective:
To determine the value of obtaining additional preoperative imaging in patients with a traumatic hip fracture and a history of malignancy in whom plain radiographs show no lesion suspicious for metastases.

Design:
Retrospective review.

Setting:
Teaching NHS Trust in the United Kingdom, over an 8-year period treating 4421 hip fractures.

Patients/Participants:
Three hundred sixty-seven patients with hip fracture and a history of malignancy at a site distant to the hip. Three hundred thirty patients had a history of trauma and no lesion on the plain radiograph suspicious for metastases.

Main Outcomes Measurements:
Whether obtaining additional imaging preoperatively (MRI, CT, and bone scan) identified metastases or affected management.

Results:
32/330 patients had further preoperative imaging, none of which demonstrated a pathological fracture secondary to malignancy. On follow-up, 3/330 (0.9%) cases were found to have occult metastasis at the hip fracture site. All 3 had only plain radiographs before surgery. In 2, this was identified on histological examination of intraoperative samples, and in 1, radiologically as a metastatic metaphyseal lesion 18 months after a hemiarthroplasty. Only in the latter case, preoperative identification of hip metastasis could have altered surgical management. Patients undergoing further preoperative imaging waited significantly longer for surgery (35 ± 26 vs. 51 ± 26 hours, P = 0.0011).

Conclusions:
In the absence of a suspicious metastatic lesion on initial plain radiographs, further preoperative imaging is unlikely to identify a lesion that will affect management and confers significant delays to surgery. Sending intraoperative histological samples may help guide postoperative oncological management, but further work is needed to prove its utility.

Level of Evidence:
Diagnostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Implementation of a Dedicated Orthopaedic Trauma Room in Hip and Femur Fracture Care: A 17-Year Analysis
Authors: Denisiuk Marek , Layson James T. , Bandovic Ivan , Waldron Jacob , Diedring Benjamin , Frisch Nicholas B. , Afsari Alan , Hayward R. David , Best Benjamin 
Published: May 2022

Objective:
To examine the effects of implementing a dedicated orthopaedic trauma room (DOTR) on hip and femur fracture care.

Design:
A retrospective cohort study. Setting: Level 1 trauma center. Patients: 2928 patients with femoral neck, pertrochanteric, and femoral shaft and distal femur (FSDF) fractures.

Intervention:
Implementation of a DOTR.

Main Outcome Measures:
Hospital length of stay (LOS), emergency department (ED) LOS, intensive care unit (ICU) LOS, and time to operating room (TTOR).

Results:
Implementation of a DOTR resulted in significant improvement in TTOR for all patient groups (P < 0.05). We found shorter TTOR for pertrochanteric (P < 0.001), femoral neck (P = 0.039), and FSDF groups (P = 0.046). Total hospital LOS was shorter for patients with pertrochanteric (P < 0.001) and femoral neck fractures (P = 0.044). Patients with pertrochanteric hip fractures demonstrated shorter ICU LOS (P < 0.001). No LOS improvements were observed among patients in the FSDF group. ED LOS was significantly longer in all patient groups (P < 0.001).

Conclusions:
Implementation of a DOTR was associated with shorter TTOR, shorter hospital and ICU LOS, and longer ED LOS. There was a greater number of patients transferred into the investigating institution and fewer patients transferred out. These data support the utility of a DOTR as it relates to an improvement in hospital stay–related outcomes in patients with fractures of the hip and femur. Our results suggest that a DOTR in a Level I trauma hospital is associated with improvement in patient care.

Level of Evidence:
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
Prospective Characterization of Pain and Function in Patients With Unstable Pelvic Fractures Treated With Posterior Screw Fixation
Authors: O'Hara Nathan N. , Sim Danielle , Moore Darby , Campbell Peter , Allen Vincent , Nascone Marco , Hasan Sania , Stockton David J. , Demyanovich Haley , Sciadini Marcus F. , O'Toole Robert V. , Slobogean Gerard P. 
Published: May 2022

Objectives:
Describe patient-reported pain and function within 24 months of a pelvic fracture treated with posterior screw fixation and identify factors associated with increased pain.

Design:
Prospective case series.

Setting:
Academic trauma center.

Patients/Intervention:
Eighty-eight patients with adult pelvic fracture treated with sacroiliac or transiliac screws.

Main Outcome Measures:
Average pain measured with the Brief Pain Inventory (BPI); function measured with the Majeed Pelvic Outcome Score from 6 to 24 months postinjury.

Results:
The mean pain from 6 to 24 months postinjury was 2.22 on the 10-point BPI scale (95% CI, 0.64–3.81). Sixty-nine patients (78.4%) reported mild to no pain at 6 months; 12 (13.6%) patients had severe pain. Two years after injury, 71 patients (80.6%) exhibited mild to no pain. Within 24 months of injury, the mean pelvic function was 71 on the 100-point Majeed scale (95% CI, 60–82). Half of the sample (n = 44) had good to excellent pelvis function by 6 months postinjury; 55 patients (62.5%) attained this level of function by 24 months. A history of chronic pain (1.31; 95% CI, 0.26–2.37; P = 0.02), initial fracture displacement (≥5 mm) (0.99; 95% CI, 0.23–1.69; P = 0.01), and socioeconomic deprivation (0.28; 95% CI, 0.11–0.44; P < 0.01) were significantly associated with increased pain.

Conclusion:
Our findings suggest that most patients with unstable pelvic ring fractures treated with posterior screw fixation achieve minimal to no pelvis pain and good to excellent pelvic function 6–24 months after injury.

Level of Evidence:
Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Spinal Fusion in Pediatric Patients With Low Bone Density: Defining the Value of DXA
Authors: Cohen Lara L. , Berry Jay G. , Ma Nina S. , Cook Danielle L. , Hedequist Daniel J. , Karlin Lawrence I. , Emans John B. , Hresko Michael Timothy , Snyder Brian D. , Glotzbecker Michael P. 
Published: May 2022

Background:
Children with medical complexity are at increased risk of low bone mineral density (BMD) and complications after spinal fusion compared with idiopathic scoliosis patients. Our aim was to compare treatments and outcomes of children with medical complexity undergoing spinal fusion in those who had dual-energy x-ray absorptiometry (DXA) scans versus those who did not in an effort to standardize the workup of these patients before undergoing spinal surgery.

Methods:
We conducted a retrospective review of patients with low BMD who underwent spinal fusion at a tertiary care pediatric hospital between 2004 and 2016. We consulted with a pediatric endocrinologist to create standard definitions for low BMD to classify each subject. Regardless of DXA status, all patients were given a clinical diagnosis of osteoporosis [at least 2 long bone or 1 vertebral pathologic fracture(s)], osteopenia (stated on radiograph or by the physician), or clinically low bone density belonging to neither category. The last classification was used for patients whose clinicians had documented low bone density not meeting the criteria for osteoporosis or osteopenia. Fifty-nine patients met the criteria, and 314 were excluded for insufficient follow-up and/or not meeting a diagnosis definition. BMD Z-scores compare bone density ascertained by DXA to an age-matched and sex-matched average. Patients who had a DXA scan were also given a DXA diagnosis of low bone density (≤−2 SD), slightly low bone density (−1.0 to −1.9 SD), or neither (>−1.0 SD) based on the lowest BMD Z-score recorded.

Results:
Fifty-nine patients were analyzed. Fifty-four percent had at least 1 DXA scan preoperatively. Eighty-one percent of DXA patients received some form of treatment compared with 52% of non-DXA patients (P=0.03).

Conclusions:
Patients referred for DXA scans were more likely to be treated for low BMD, although there is no standardized system in place to determine which patients should get scans. Our research highlights the need to implement clinical protocols to optimize bone health preoperatively.

Level of Evidence:
Level II—retrospective prognostic study.
Extracorporeal Immunomodulation Treatment and Clinical Outcomes in ICU COVID-19 Patients
Authors: Yessayan Lenar T. , Neyra Javier A. , Westover Angela J. , Szamosfalvi Balazs , Humes H. David 
Published: May 2022

OBJECTIVES:
To evaluate safety and clinical outcomes of extracorporeal immunomodulation treatment with a selective cytopheretic device (SCD) in COVID-19 ICU patients with multiple organ failure.

DESIGN:
Two-center, prospective, single-arm treatment clinical trial.

SETTING:
ICUs at two academic medical centers between September 2020 and July 2021.

PATIENTS:
Twenty-two COVID-10 patients in the ICU with acute respiratory distress syndrome who required mechanical ventilation. Nearly all included patients in the intervention group except one had acute kidney injury requiring continuous renal replacement therapy (CRRT). Sixteen subjects meeting enrollment criteria were selected as contemporaneous controls from a concurrent prospective registry CRRT trial.

INTERVENTION:
Treatment with an SCD integrated into a continuous renal replacement extracorporeal blood circuit for up to 10 days to provide autologous leukocyte cell processing to immunomodulate the hyperinflammatory disease state of COVID-19.

MEASUREMENTS AND MAIN RESULTS:
SCD treatment in COVID-19 ICU patients with multiple organ failure demonstrated an acceptable safety profile with no device-related serious adverse events. Treatment of these patients resulted in the selective removal of highly activated circulating leukocytes as determined by flow cytometry. Significant reductions were observed in the elevated plasma levels of eight cytokines and biomarkers, including interleukin (IL)6, IL15, IL10, and soluble ST2, which are predictive of mortality in COVID-19 patients. Significant improvements of leukocytosis and Po
2/Fio
2 ratios occurred during treatment not observed in the control group. SCD-treated subjects had a reduction in 60-day mortality of 50% compared with 81% in the control cohort. The subjects who received greater than 96 hours of SCD treatment, per protocol, had a further reduction in mortality to 31% (p < 0.012).

CONCLUSIONS:
Extracorporeal immunomodulation therapy with an SCD demonstrated safety without any device-related serious adverse events. As a rescue therapy in COVID-19 ICU patients progressing to multiple organ failure despite maximal pharmacologic and organ support interventions, SCD treatment resulted in improved clinical outcomes. This autologous leukocyte cell processing technology may provide a new approach in the treatment of unremitting hyperinflammation of COVID-19.
Brachial Plexus Birth Injury: Trends in Early Surgical Intervention over the Last Three Decades
Authors: Wells Matthew E. , Tihista Mikel C. , Diamond Shawn 
Published: May 2022

Background:
Early surgical management of brachial plexus birth injury has advanced owing to targeted surgical techniques and increases in specialty-centers and multi-institutional collaboration. This study seeks to determine trends in the early surgical management of BPBI over the last 30 years.

Methods:
A systematic review was performed through MEDLINE (PubMed) identifying studies limited to the early surgical management of BPBI from 1990 to current. Patients treated after 1 year of age (ie, tendon transfers and secondary reconstructive efforts) were excluded. Diagnostic tests, age of intervention, surgical treatment modalities, and outcome scoring systems were extrapolated and compared so as to determine trends in management over time.

Results:
Seventeen studies met criteria, summating a total of 883 patients. The most commonly reported physical examination classifications were the Mallet and AMS scoring systems. Most patients underwent neuroma excision and sural nerve autografting (n = 618, 70%) when compared with primary nerve transfers (148, 16.8%), primary nerve transfer with autografting combinations (59, 6.7%), or neurolysis alone (58, 6.6%). There was no significant change in the proportion of patients treated with sural nerve grafting, combination graft and transfer procedures, or isolated neurolysis over time. However, there has been a significant increase in the proportion of patients treated with primary nerve transfer procedures (τ
b = 0.668, P < 0.01) over time.

Conclusion:
Although neuroma excision and sural nerve autografting has been the historic gold-standard treatment for brachial plexus birth injury, peripheral nerve transfers have become increasingly utilized for surgical management.
Perspectives About Transition Readiness Among Adolescents and Young People Living With Perinatally Acquired HIV in Rural, Southwestern Uganda: A Qualitative Study
Authors: Ashaba Scholastic , Zanoni Brian C. , Baguma Charles , Tushemereirwe Patricia , Nuwagaba Gabriel , Nansera Denis , Maling Samuel , Tsai Alexander C. 
Published: May 2022

ABSTRACT
Despite the availability of antiretroviral therapy, treatment outcomes are worse among adolescents and young adults living with perinatally acquired HIV (AYLPHIV). These disparities are magnified during the transition from pediatric to adult-based HIV care. We conducted in-depth interviews with AYLPHIV aged 15–24 years (n = 30), their caregivers (n = 10), and health care providers (n = 10). All participants provided written assent and/or informed consent to enroll. Thematic content analysis was used to identify and analyze themes relevant to transition readiness. We grouped perspectives on transition readiness into 4 themes: preparation for transition, communication between stakeholders, social support, and timing of transition. AYLPHIV in sub-Saharan Africa who are facing a transition to adult HIV care should be equipped with relevant information about their illness, self-advocacy skills, and support from caregivers and health care providers to remain engaged in HIV care.
Prosthetic and orthotic students' perceptions on online courses during the COVID-19 pandemic in Japan
Authors: Aduayom-Ahego Akouetevi , Arayama Motohide , Ehara Yoshihiro 
Published: May 2022

Background:
The effects of the novel coronavirus (COVID-19) pandemic have changed both the traditional teaching methods and clinical placements.

Objectives:
To investigate the effects of COVID-19 on the prosthetics and orthotics (P&O) training program in Japan.

Study design:
A cross-sectional national survey.

Methods:
A Google form survey was distributed to students through the heads of the department of P&O program across Japan. Descriptive statistics were used to analyze the data.

Results:
One hundred sixty-six students (107 males and 59 females) responded to the survey. The respondents' grades were as follows: freshman, 22.3% (n = 37); sophomore, 33.7% (n = 56); junior, 27.1% (n = 45); and senior, 16.9% (n = 28). Forty-seven percent (n = 78) reported that their clinical placements have been cancelled because of the COVID-19 pandemic. Only 15.1% (n = 25) have performed their clinical placements during the pandemic. Regarding career preparation, 16.3% (n = 27) had face-to-face interviews and 10.2% (n = 17) have reported being interviewed online. Of a total of 44 respondents who were interviewed for jobs in P&O industries and rehabilitation centers, 79.5% (n = 35) job appointments have been cancelled and 15.9% (n = 7) postponed.

Conclusions:
The event of the COVID-19 pandemic has proved necessary to renew the traditional teaching and learning model in colleges worldwide. Most students have been affected by clinical placements and career preparation. Therefore, promoting telehealth in the existing rehabilitation facilities and P&O industries to provide services might be an alternative method to address students' clinical placements in similar life condition events.
FDG PET/CT in Prostate Metastasis From Gastric Cancer
Authors: Ji Xia , Dong Aisheng 
Published: May 2022

Abstract
Prostate metastasis from gastric cancer is rare. We report MRI and FDG PET/CT findings in a case with prostate metastasis from gastric cancer. In this case, the prostate metastasis was the first manifestation of the gastric cancer. This case demonstrates the usefulness of FDG PET/CT in identifying the primary gastric cancer and its contribution for an accurate staging. Familiarity with the FDG PET/CT findings of the prostate metastasis may be useful for the differential diagnosis of the hypermetabolic prostate lesions.
Computational analysis of peripheral blood smears detects disease-associated cytomorphologies
Authors: de Almeida José Guilherme , Gudgin Emma , Besser Martin , Dunn William G. , Cooper Jonathan , Haferlach Torsten , Vassiliou George S. , Gerstung Moritz 
Published: May 2022

AbstractMany hematological diseases are characterized by altered abundance and morphology of blood cells and their progenitors. Myelodysplastic syndromes (MDS), for example, are a type of blood cancer manifesting via a range of cytopenias and dysplastic changes of blood and bone marrow cells. While experts analyze cytomorphology to diagnose MDS, similar alterations can be observed in other conditions such as haematinic deficiency anemias, and definitive diagnosis requires complementary information such as blood counts, karyotype and molecular testing. However, recent works demonstrated that computational analysis of bone marrow slides predicts not only MDS or AML but also the presence of specific mutations. Here, we present and make available Haemorasis, a computational method that detects and characterizes white and red blood cells (WBC and RBC, respectively) in peripheral blood slides, and apply it to over 300 individuals with different conditions (SF3B1-mutant andSF3B1-wildtype MDS, megaloblastic anemia and iron deficiency anemia), where Haemorasis detects over half a million WBC and millions of RBC. We then show how these large sets of cell images can be used in diagnosis and prognosis, whilst identifying novel associations between computational morphotypes and disease. We find that hypolobulated neutrophils and large RBC are characteristic ofSF3B1-mutant MDS, and, while prevalent in both iron deficiency and megaloblastic anemia, hyperlobulated neutrophils are larger in the latter. Finally, we externally validate these methods, showing they generalize to other centers and scanners.
Do Some Super-Spreaders Spread Better? Effects of individual heterogeneity in epidemiological traits
Authors: Beagle Alexis S. , Budischak Sarah A. , Craft Meggan E. , Forbes Kristian , Hall Richard , Nguyen David , Cressler Clay E. 
Published: May 2022

AbstractMany high-profile outbreaks are driven by super-spreading, including HIV, MERS, Ebola, and the SARS-Cov-2 pandemic. That super-spreading is a common feature of epidemics is immutable, however, the relative importance of 2super-spreaders to the outcome of an epidemic, and the individual-level traits that lead to super-spreading, is less clear. For example, an individual may contribute disproportionately to transmission by way of an extremely high contact rate or by way of low recovery, but how these two super-spreaders differ in their effect on epidemiological dynamics is unclear. Furthermore, epidemiological traits may often covary with one another in ways that promote or inhibit super-spreading. What patterns of covariation, and between what traits, are most likely to lead to large epidemics driven by super-spreading? Using stochastic individual-based simulations of an SIR epidemiological model, we explore how variation and covariation between transmission-related traits (contact rate and infectiousness) and duration-related traits (virulence and recovery) of infected individuals affects super-spreading and peak epidemic size. We show that covariation matters when contact rate and infectiousness covary: peak epidemic size is largest when they covary positively and smallest when they covary negatively. We did not see that more super-spreading always leads to larger epidemics, rather, we show that the relationship between super-spreading and peak epidemic size is dependent on which traits are covarying. This suggests that there may not necessarily be any general relationship between the frequency of super-spreading and the size of an epidemic.
Whole-Genome Sequencing Of Omicron Identified Multiple Outbreaks And Introduction Events In India During November 2021 and January 2022
Authors: Marathe Shreedhanya D , Shamanna Varun , Nagaraj Geetha , Nischita S , Bhaskaran Muthumeenakshi , Ravikumar K L 
Published: May 2022

ABSTRACTThe variant of Concern(VOC), Omicron is the predominant variant circulating throughout the world of the SARS COV2 pandemic during the third wave including India. The World Health Organisation has designated this highly mutated variant as a VOC due to its high transmissibility and risk of reinfection. Whole-genome sequencing and analysis were performed for SARS-CoV2 PCR positive samples between Dec21 to Jan22. From the 133 omicron variants detected, genomic analysis was carried out by contextualizing them with 1586 complete genomes of Omicron from India obtained from GISAID.The Omicron variant prevalence in India has increased in a log phase within 3 months in most of the metropolitan cities. The sublineage BA.1 was first observed in the country, while the BA.2 sublineage was introduced to Delhi in the mid of December 2021. The two outbreaks observed were of BA.2 variant and were observed to spread to multiple cities in a short time. The rapid spread and specific mutations in the outbreak samples of Omicron indicate that the variant is highly transmissible when compared to previous variants. The study shows the importance of genomic sequence to identify the emergence of clusters and take actions to prevent further spreading events.