bluuebunny/crossref_metadata_2025_split huggingface dataset:
ETV2 Upregulation Marks the Specification of Early Cardiomyocytes and Endothelial Cells During Co-differentiation
Authors: Cao Xu , Mircea Maria , Yakala Gopala Krishna , van den Hil Francijna E , Brescia Marcella , Mei Hailiang , Mummery Christine L , Semrau Stefan , Orlova Valeria V 
Published: December 2022

AbstractThe ability to differentiate human-induced pluripotent stem cells (hiPSCs) efficiently into defined cardiac lineages, such as cardiomyocytes and cardiac endothelial cells, is crucial to study human heart development and model cardiovascular diseases in vitro. The mechanisms underlying the specification of these cell types during human development are not well understood which limits fine-tuning and broader application of cardiac model systems. Here, we used the expression of ETV2, a master regulator of hematoendothelial specification in mice, to identify functionally distinct subpopulations during the co-differentiation of endothelial cells and cardiomyocytes from hiPSCs. Targeted analysis of single-cell RNA-sequencing data revealed differential ETV2 dynamics in the 2 lineages. A newly created fluorescent reporter line allowed us to identify early lineage-predisposed states and show that a transient ETV2-high-state initiates the specification of endothelial cells. We further demonstrated, unexpectedly, that functional cardiomyocytes can originate from progenitors expressing ETV2 at a low level. Our study thus sheds light on the in vitro differentiation dynamics of 2 important cardiac lineages.
“The Feeling of Failure Is Immense”: A Qualitative Analysis of the Experiences of Unmatched Residency Applicants Using Reddit
Authors: Morrissette Anita , Morrissette Matthew 
Published: December 2022

Purpose
The increasing number of applicants who do not match to a residency program has been identified as an issue in Canada and the United States, yet the experiences of those individuals going unmatched have remained largely unexplored. By better understanding such experiences, medical schools will be better equipped to support unmatched graduates. The authors sought to understand the shared experiences of unmatched residency applicants, including those who did not match to American residency programs.

Method
The authors turned to the social media platform Reddit as their source of data to further understand the experiences of unmatched residency applicants, using a thematic analysis of comments posted on the subreddit r/medicalschool. The subreddit was searched for comments containing the term unmatched on August 16, 2021. A total of 206 comments containing content about first-person experiences of going unmatched were included in the thematic analysis.

Results
The 206 comments were authored by 124 unique usernames between the years of 2012 and 2021. Two primary themes emerged in the analysis: perceptions of insufficient return for investments made in medical education and concern about the possibility of going unmatched again in the future. Subthemes identified for the first theme were regret for pursuing medical school, perceptions of failure, and considering an alternative career. Subthemes identified for the second theme were perceived lack of transparency and fairness in the match process and desire to improve future applications, which sometimes involved considering applying to other specialties.

Conclusions
The results of this study suggest unmatched applicants are prone to a range of negative cognitive and emotional reactions. In light of these findings, medical schools should ensure effective supports are being offered to unmatched applicants in a timely and nonjudgmental manner. Future work should focus on investigating the outcomes of interventions for supporting unmatched applicants.
Nonoperative Versus Operative Treatment of Type IIA Supracondylar Humerus Fractures: A Prospective Evaluation of 99 Patients
Authors: Sanders Julia S. , Ouillette Ryan J. , Howard Roland , Boutelle Kelly , Carroll Alyssa N. , Bastrom Tracey P. , Paik Christina , Stearns Philip , Pennock Andrew T. , Upasani Vidyadhar V. 
Published: December 2022

Background:
Although current clinical practice guidelines from the American Academy of Orthopaedic Surgeons suggest that Type II and III supracondylar humerus (SCH) fractures be treated by closed reduction and pin fixation, controversy remains as to whether type IIa fractures with no rotation or angular deformity require surgery. The purpose of our study was to prospectively compare radiographic and functional outcomes of type IIa SCH fractures treated with or without surgery.

Methods:
Between 2017 and 2019, 105 patients between 2 and 12 years of age presenting with type IIa SCH fractures and without prior elbow trauma, neuromuscular or metabolic conditions, were prospectively enrolled. Ten orthopaedic surgeons managed the patients with 5 preferring surgical treatment and 5 preferring an initial attempt at nonoperative treatment. Patients in the nonoperative cohort were managed with a long-arm cast and close radiographic follow-up. Patients underwent a standardized protocol, including 3 to 4 weeks of casting, bilateral radiographic follow-up 6 months postinjury, and telephone follow-up at 6, 12, and 24 months.

Results:
Ninety-nine patients met the inclusion criteria (45 nonoperative and 54 operatives). Of the nonoperative patients, 4 (9%) were converted to surgery up to their first clinical follow-up. No differences were identified between the cohorts with respect to demographic data, but patients undergoing surgery had on average 6 degrees more posterior angulation at the fracture site preoperatively (P<0.05). At the final clinical follow-up (mean=6 mo), the nonoperative group had more radiographic extension (176.9 vs 174.4 degrees, P=0.04) as measured by the hourglass angle, but no other clinical or radiographic differences were appreciated. Complications were similar between the nonoperative and operative groups: refracture (4.4 vs 5.6%), avascular necrosis (2.2 vs 1.9%) and infection (0 vs 1.9%) (P>0.05). Patient-reported outcomes at a mean of 24 months showed no differences between groups.

Conclusion:
Contrary to American Academy of Orthopaedic Surgeons guidelines, about 90% of patients with type IIa supracondylar fractures can be treated nonoperatively and will achieve good radiographic and functional outcomes with mild residual deformity improving over time. Patients treated nonoperatively must be monitored closely to assess for early loss of reduction and the need for surgical intervention.
Supracondylar Dome Osteotomy With a Posterior Triceps-splitting Approach for Acute Correction of Posttraumatic Cubital Axis Deformities in Adolescent Patients
Authors: Herzog Alexander N. , Wirth Thomas , Fernandez Francisco F. 
Published: December 2022

Background:
Fractures around the elbow are common in children. Their management remains challenging. Inadequate treatment often leads to malunion, causing growth disturbance or avascular necrosis. This can develop into cubital axis deformities. This study evaluated our modified supracondylar dome osteotomy technique for acute correction of posttraumatic cubital axis deformities in adolescent patients.

Methods:
Eighteen cases of posttraumatic cubital axis deformity that underwent acute correction through supracondylar dome osteotomy in our department between 2012 and 2019 were retrospectively evaluated. The radiologic results were measured through the carrying angle. The clinical functional outcomes were assessed using the Mayo Elbow Performance Index.

Results:
No neurovascular injuries occurred and there was no notable loss of muscular strength or functional deficiencies in any of the patients. Symmetrical cubital axes were achieved in all cases. All cases were consolidated in a timely matter and no malunion was observed upon consolidation. Besides 1 case of hardware damage caused by a severe fall due to heavy alcohol intoxication, there was no correction loss, no secondary displacement, and no implant-related discomfort. None of the patients were left with a limited range of motion or reduced weight-bearing capacity. An excellent level of elbow functionality was achieved in all cases, with an average Mayo Elbow Performance Index of 97.8.

Conclusions:
The supracondylar dome osteotomy technique showed promising results in both radiologic outcomes and clinical performance, with a low complication rate. The dome-shaped osteotomy allows simultaneous multiplanar correction of not only varus or valgus deformities but also additional extension or flexion deformities. This technique also enables translation of the distal fragment in the frontal plane, which contributes to a more balanced anatomic geometry of the distal humerus. We consider the posterior triceps-splitting approach to be a safe technique that preserves muscle strength and improves the cosmetic appearance of the surgical scar. We recommend a cast-free plate fixation to allow early movement after surgery. We believe any residual deformities that present 18 months after the initial trauma should be addressed through surgical correction before clinical symptoms become apparent to avoid the chronic manifestation of functional deficiencies.

Level of Evidence:
Level IV, therapeutic study, case series.
Iliac Crest Bone Graft With Intramedullary Headless Implant for Metacarpal Bone Loss
Authors: Milhoan Madison , Hoelscher Victoria , Pientka William F. 
Published: December 2022

Abstract:
Metacarpal bone loss presents a challenging reconstructive dilemma for hand surgeons. While multiple bone grafting techniques have been described, complications including nonunion, graft resorption, fixation requiring prolonged immobilization, stiffness, and the need for multiple procedures are well-documented. We present a technique for managing metacarpal bone loss utilizing a tri-cortical iliac crest graft and an intramedullary metacarpal nail for the treatment of metacarpal fractures and nonunions that is technically simple, fast, and allows for early initiation of motion to decrease postoperative complications.

Level of Evidence:
Level IV- Therapeutic
Postpartum medical management of hypertension and risk of readmission for hypertensive complications
Authors: Lovgren Todd , Connealy Brendan , Yao Ruofan , D. Dahlke Joshua 
Published: December 2022

Objective:
To compare the risk of readmission in those receiving no treatment, labetalol, nifedipine or both at hospital discharge following delivery complicated by presence of hypertension.

Study design:
Retrospective study at a single tertiary care center over a 4-year period (2017–2020). Those with peripartum hypertension (pHTN), defined as any SBP greater than 140 mmHg or DBP greater than 90 mmHg on two occasions 4 h apart during their admission for delivery were included. The primary outcome was postpartum readmission because of hypertensive complications. Analysis was stratified by medication prescribed at discharge (no treatment prescribed, labetalol, nifedipine, or both). The risks of readmission for the management of pHTN were estimated using logistic regression and adjusted for confounding variables.

Results:
Nineteen thousand, four hundred and twenty-five women gave birth during the study period and 4660 (24.0%) met the described definition of pHTN. Of those, 1232 (26.4%) were discharged on antihypertensive medication (s). There were 217 (4.7%) readmissions for hypertensive complications following discharge. Compared with patients who did not receive antihypertensive medication at discharge, any nifedipine prescription was found to significantly decrease the risk of readmission: monotherapy [aOR 0.27 (0.15–0.48)], nifedipine with labetalol [aOR 0.35 (0.16–0.77)]. Labetalol monotherapy was associated with increased risk of readmission [aOR 1.66 (1.06–2.61)].

Conclusion:
The risk of postpartum readmission for hypertensive complication was reduced by 65% when patients were discharged on nifedipine monotherapy and 56% with combined nifedipine and labetalol treatment when compared with no treatment. Patients discharged on labetalol monotherapy were nearly six times as likely to be readmitted for hypertensive complications when compared with patients on nifedipine monotherapy.
Knowledge and Attitude About Pre-exposure Prophylaxis Among Primary Care Clinicians at a Federally Qualified Health Center in Central Texas: A Cross-sectional Study
Authors: Norwood Aliza , Zuñiga Julie A. 
Published: December 2022

Abstract
Pre-exposure prophylaxis (PrEP) for HIV prevention is a highly effective tool in preventing HIV, yet PrEP is underprescribed. Primary care providers are ideally positioned to increase access to and awareness of PrEP, but health care providers' knowledge of PrEP greatly varies. To evaluate PrEP knowledge and attitudes of primary care providers, we conducted a descriptive cross-sectional study examining primary providers' knowledge and concerns about PrEP. Participants (n = 122) included physicians, nurses, pharmacists, and residency trainees in family medicine, internal medicine, and obstetrics. Despite high awareness of PrEP among these primary care providers (91.7%), fewer reported feeling comfortable prescribing PrEP (62.5%), and the average number of PrEP prescriptions per provider written in the last 6 months was less than 1. PrEP remains key to preventing HIV, but prescriptions remain low. Health care providers would benefit from additional education and training on communicating with their patients about sexual health and HIV prevention.
Barriers and facilitators to nurse practitioner buprenorphine prescribing for opioid use disorder in primary care settings
Authors: Speight Chandra , Caiola Courtney , Tyndall Deborah E. , Scott Elaine S. 
Published: December 2022

ABSTRACT

Background:
Increasing access to opioid use disorder (OUD) treatment is critical to curbing the opioid epidemic, particularly for rural residents who experience numerous health and health care disparities, including higher overdose death rates and limited OUD treatment access compared with urban dwellers. Buprenorphine–naloxone is an evidence-based treatment for OUD that is well suited for rural areas. However, providers must have a specialized federal waiver to prescribe the medication. Despite the acceleration of the opioid epidemic in rural areas and the recent liberalization of federal buprenorphine–naloxone prescribing laws, few providers hold buprenorphine–naloxone prescribing waivers and even fewer prescribe the medication.

Purpose:
This study explores barriers and facilitators to buprenorphine–naloxone prescribing among nurse practitioners (NPs) working in primary care settings in eastern North Carolina.

Methodology:
Individual interviews were conducted with 13 NPs working in primary care settings in eastern North Carolina. Qualitative thematic analysis was used to identify perceived barriers and facilitators to buprenorphine–naloxone prescribing.

Results:
Analysis found prescribing barriers related to OUD stigma, perceived knowledge, federal and state regulation, and prescribing resources and found facilitators related to adopting a person-centered approach, developing prescriber skills, and access to prescribing resources.

Conclusions:
The barriers and facilitators that NPs experience related to buprenorphine prescribing for OUD are similar to those faced by physicians, although the barriers arguably more profound. Future research should consider how to mitigate these prescribing barriers to facilitate NP buprenorphine prescribing for OUD.

Implications:
To our knowledge, this is the first qualitative study of NP buprenorphine–naloxone prescribing in rural areas. Given the prominence of OUD in rural regions and the key role NPs play in primary care provision, this study lays import groundwork for developing interventions to support buprenorphine–naloxone prescribing by NPs practicing in rural regions.
Significance of Baseline Inferior Vestibular Function on the Prognosis of Patients with Labyrinthitis
Authors: Cho Ji-Woong , Cho Sung Il , Baek Wonyong , Kim Min Seok , Nam Gi-Sung 
Published: December 2022

Objective
Acute spontaneous vertigo with idiopathic sudden sensorineural hearing loss (ISSNHL) can be diagnosed as labyrinthitis, which has a poorer prognosis than ISSNHL without vertigo. Thus, we aimed to identify the effect of the baseline vestibular function on the prognosis of labyrinthitis.

Methods
A total of 23 patients with labyrinthitis was retrospectively divided into the recovered group (complete recovery, partial recovery) and the nonrecovered group (slight improvement, no improvement). Differences in caloric weakness and gain in the video head impulse test (vHIT) between the two groups were compared. In addition, the prognostic value of the vHIT on each of the three semicircular canals in predicting hearing recovery was analyzed using a linear regression model.

Results
In final pure-tone audiometry, 2 patients (8.70%) exhibited complete recovery, 4 patients (17.39%) had partial recovery, and 17 patients (73.91%) had slight or no improvement. The initial ipsilesional posterior canal (iPC) gain and the contralesional anterior canal (cAC) gain were significantly decreased in the nonrecovered group (p < 0.013 for iPC and p < 0.007 for cAC, Mann–Whitney U test). The mean hearing gain was positively correlated with the iPC gain (R
2 = 0.36, p = 0.003, Spearman correlation analysis).

Conclusion
An abnormal iPC gain may be a poor prognostic factor for hearing recovery. Additionally, the vHIT on the three semicircular canals can provide prognosis and insights into the pathophysiological mechanisms in patients with labyrinthitis.
Classifying the Large Vestibular Aqueduct: Morphometry to Audiometry
Authors: Deep Nicholas L. , Carlson Matthew L. , Hoxworth Joseph M. , Driscoll Colin L. W. , Lohse Christine M. , Lane John I. , Ho Mai-Lan 
Published: December 2022

Objective
Large vestibular aqueduct (LVA) is the most common inner ear dysplasia identified in patients with hearing loss. Our objective was to systematically quantify LVA morphologies and correlate imaging findings with established audiometric outcomes.

Study Design
Retrospective review.

Setting
Tertiary referral center.

Patients
Patients with large vestibular aqueduct identified radiographically, with or without hearing loss.

Intervention(s)
Diagnostic only.

Main Outcome Measure(s)
Vestibular aqueduct (VA) width at midpoint, width at external aperture, and length were measured on cross-sectional imaging. Morphology was classified as type I (borderline), type II (tubular), or type III (funneled). Audiometric endpoints included air/bone conduction, pure tone averages, and air-bone gaps at 250 and 500 Hz. Statistical associations were evaluated using linear regression models, adjusted for age at first audiogram and sex.

Results
One hundred seventeen patients (197 ears) were included, with mean age at first audiogram of 22.2 years (standard deviation, 21.7 yr). Imaging features associated with poor audiometric outcomes were increasing VA width at midpoint and external aperture, decreasing VA length, dilated extraosseous endolymphatic sac, cochleovestibular malformations, and increasing VA type (III > II > I).

Conclusions
Quantitative LVA measurements and a standardized morphologic classification system aid in prediction of early audiometric endpoints.
Measuring the Angular Accuracy of a Clinician-Performed Epley Maneuver Used to Treat Benign Paroxysmal Positional Vertigo
Authors: Murphy Claudine , Keogh Ivan J. 
Published: December 2022

Introduction
Particle repositioning maneuvers have become the criterion standard for managing benign paroxysmal positional vertigo. The Epley canalolith repositioning maneuver is used to treat posterior canal benign paroxysmal positional vertigo and is successful in up to 90% of cases. However, when performed, there are many clinician variabilities, and angles are approximate. It is not known how accurate each angle needs to be for the target canal to be adequately stimulated. The objective of this study was to measure the angular accuracy of clinician-guided Epley maneuvers using a three-axis accelerometer.

Methods
Ten healthy subjects were recruited; participants had no known audio vestibular pathology. Five right-hand–dominant clinicians performed Epley maneuvers on both ears of two different participants. Twenty maneuvers were carried out in total. Angular movements were recorded using a vestibular feedback electronic device, the SHIMMER accelerometer. Data were recorded and analyzed using the EYESWEB Open Platform.

Results
Results showed that there was angular error at every stage of the clinician-performed Epley maneuver. The most accurate movement was positioning the head to the left of 45 degrees for a left ear maneuver with an average error of 2.94 degrees. The least accurate was when positioning the patient to face the floor at 135 degrees from supine for a right ear maneuver with an average error of 17.6 degrees.

Conclusion
Even when experienced ENT clinicians perform a standard Epley maneuver, there is a wide range of angular inaccuracy at each stage. Face to floor is particularly inaccurate. However, given that a majority of procedures (90%) work on the first attempt, there must be an acceptable but unknown range of angular inaccuracy. Novel technologies could improve the angular accuracy, potentially give better results, and allow a broad range of individuals to perform a more accurate Epley maneuver.
Subtemporalis Muscle Middle Cranial Fossa Bone-Island Craniotomy Technique for Placement of an Active Transcutaneous Bone-Conduction Implant
Authors: Shapiro Scott B. , Llerena Pablo A. , Mowery Todd M. , Miele Erica A. , Wackym P. Ashley 
Published: December 2022

Objective
Placement of an active transcutaneous bone-conduction implant (BCI) requires drilling of a precise bone bed to accommodate the device and allow for fixation points to make appropriate contact with bone, which can be difficult even when lifts are used. We describe a subtemporalis muscle middle cranial fossa bone-island craniotomy technique that simplifies the procedure and obviates the need for lifts in securing the device.

Study Design
Prospective case series.

Setting
Tertiary academic medical center.

Patients
Seventeen patients underwent surgery for placement of 18 transcutaneous BCIs, 14 for conductive or mixed hearing loss, and 4 for single-sided deafness.

Interventions
Surgical placement of a transcutaneous BCI with a bone-island craniotomy technique.

Main Outcome Measures
Functional gain in air-conduction thresholds, aided air-bone gap, frequency of need for lifts, and minor and major complications.

Results
For the conductive or mixed hearing loss cohort, with the transcutaneous BCI in place, there was a highly statistically significant mean functional gain of 35.4 dB hearing level (HL) (range, 16.7–50.25 dB HL; standard deviation, 12.4 dB HL) compared with the unaided condition (p < 0.0001; 95% confidence interval, 36.6–51.6 dB HL). Lifts were not needed in any case. There was one minor complication requiring a second procedure in a patient who had previously received radiation and no major complications. There was no device loss or failure.

Conclusions
A subtemporalis muscle middle cranial fossa bone-island craniotomy technique eliminates the need for lifts and is a safe and effective method for placement of a transcutaneous BCI.