bluuebunny/crossref_metadata_2025_split huggingface dataset:
Biomechanical Study of Intramedullary Versus Extramedullary Implants for Four Types of Subtrochanteric Femoral Fracture
Authors: Wang Jie , Jia Haobo , Ma Xinlong , Ma Jianxiong , Lu Bin , Bai Haohao , Wang Ying 
Published: June 2022

ObjectivesTo compare the biomechanical performance of proximal femoral nail anti‐rotation (PFNA), the “upside‐down” less invasive plating system (LISS), and proximal femoral locking plate (PFLP) in fixing different fracture models of subtrochanteric fractures.MethodsThirty composite femurs were divided into three equal groups (PFNA, PFLP, and reverse LISS). The implant‐femur constructs were tested under axial compression load (0–1400 N) from models I to IV, which represented the Seinsheimer type I subtrochanteric fracture, type IIIa subtrochanteric fracture with the posteromedial fragment reduced; type IIIa subtrochanteric fracture with the posteromedial fragment lost; and type IV subtrochanteric fracture, respectively. Axial stiffness was analyzed for each group. Each group was then divided into two subgroups, one of which underwent torsional and axial compression failure testing, while the other subgroup underwent axial compression fatigue testing. The torsional stiffness, failure load, and cycles to failure were analyzed.ResultsPFNA had the highest axial stiffness (F = 761.265, p < 0.0001) and failure load (F = 48.801, p < 0.0001) in model IV. The axial stiffness and failure load of the PFLP were significantly higher than those of the LISS (p < 0.0001, p = 0.001). However, no significant difference in axial stiffness was found between models I to III (model I: F = 2.439, p = 0.106; model II: F = 2.745, p = 0.082; model III: F = 0.852, p = 0.438) or torsional stiffness in model IV (F = 1.784, p = 0.187). In fatigue testing, PFNA did not suffer from construct failure after 90,000 cycles of axial compression. PFLP and LISS were damaged within 14,000 cycles, although LISS withstood more cycles than PFLP (t = 3.328, p = 0.01).ConclusionThe axial stiffness of the three implants was similar in models I to III. The biomechanical properties of PFNA were the best of the three implants in terms of axial stiffness, failure load, and fatigue testing cycles in model IV. The axial stiffness and failure load of the PFLP were better than those of the reverse LISS, but PFLP had fewer cycles in the fatigue tests than the reverse LISS.
Transnasal Endoscopic and Transoral Approaches in the Biopsies of Ventral Atlas and Axis Vertebrae: A Comprehensive Retrospective Study for Preprocedural Scheme, Biopsy Procedure, Core Technique Analysis, Diagnostic Yield and Clinical Outcome
Authors: Shao Xianhao , Li Jianmin , Yang Qiang , Li Ka , Yao Yuan , Sun Feifei , Li Zhenfeng 
Published: June 2022

ObjectiveThis study aims to describe and analyze the transoral and transnasal approaches for pathologies of the ventral atlas and axis vertebrae, which are considered technically challenging regions for diagnostic biopsy.MethodsA series of transnasal endoscopic approach (TNA) and transoral approach (TOA) biopsies for the pathologies of the first and second cervical vertebrae were conducted and retrospectively analyzed from July 2014 to May 2021. The depth of the biopsy trajectory was measured on computed tomography images for all nine patients (eight males and one female with an average age of 58.11 ± 11.60 years), as were the coronal, sagittal, and vertical biopsy safe ranges. The characteristics of each lesion, including radiographic features, blood supply, and destruction of anterior or posterior vertebral body edges, were evaluated to guide the biopsy. Four biopsy core techniques (BCTs), including “lesion perforating”, “aspiration”, “cutting‐and‐scraping” and “biopsy forceps utilization” were elaborated in this study. The biopsy procedures and periprocedural precautions were demonstrated. Patient demographics, clinical data, lesion characteristics, diagnostic yield, and complications were recorded for each case.ResultsEight TOA biopsies for the axis vertebral body and one TNA biopsy for the atlas anterior arch were successfully performed and yielded adequate pathologies. All biopsies were organized based on the preprocedural radiographic measurements, which showed that the average length of biopsy trajectory and coronal, sagittal, and vertical safe biopsy ranges were 85.00 ± 5.88, 20.63 ± 4.75, 16.25 ± 1.49, and 24.63 ± 2.26 mm, respectively, and these corresponding data were 95, 36, 9, and 26 mm in the TNA patient. Six osteolytic lesions (66.7%), one osteoblastic lesion (11.1%), and two mixed lesions (22.2%) were observed, among which seven lesions had a rich blood supply. Biopsy forceps and core needles were utilized to obtain samples in six and three patients, respectively. All the TNA and TOA biopsies were performed with cooperative application of multiple BCTs under compound anatomic and stereotactic navigations. Intraprocedural or postprocedural complications occurred in no patients who underwent the biopsy in the follow‐up period (1–39 months). No significant differences were found between the preprocedural and postprocedural blood indexes and visual analogue scale scores.ConclusionWith a sophisticated preprocedural arrangement, cooperative application of BCTs, and careful periprocedural precautions, transnasal endoscopic and transoral biopsies are two feasible, efficient, and well‐tolerated procedures that achieve satisfactory diagnostic yield, complication rate, and clinical outcome.
Successful treatment of ivermectin overdose in a bearded dragon (Pogona vitticeps) using gastric lavage and intravenous lipid emulsion
Authors: DeMel Danielle , Gleeson Molly , Schachterle Karen , Thomer Amanda 
Published: June 2022

AbstractObjectiveTo describe the clinical signs and outcome following ivermectin overdose in a bearded dragon. This case also describes the novel use of intravenous lipid emulsion (ILE) as a rescue therapy in reptiles, as well as the use of aggressive gastrointestinal decontamination.Case SummaryA 4‐year‐old female intact bearded dragon (Pogona vitticeps) (0.6 kg) was admitted to the ICU at a specialty hospital following accidental overdose of 40 mg (66.7 mg/kg) of ivermectin enterally. The patient was physically inverted to allow passive reflux of the medication, then sedated for gastric lavage. A 20% ILE was administered intravenously due to the high risk for fatality. Additional treatments included 2 doses of activated charcoal, as well as SC fluids, enteral nutrition, and sucralfate. The patient was profoundly sedate until day 4 when mild improvements in mentation were noted. The patient started ambulating on its own on day 6 and was discharged from the hospital on day 13. The patient was alive 720 days postdischarge.New or Unique Information ProvidedThis is the first case report describing the events following ivermectin overdose and the use of ILE therapy and activated charcoal in a bearded dragon. These therapies were tolerated with no adverse effects noted in this patient. This report provides evidence that complete recovery from ivermectin overdose is possible.
Mechanical Properties of Prismatic Li-Ion Batteries—Electrodes, Cells, and Stacks
Authors: Sahraei Elham , Keshavarzi Mohammad Mehdi , Zhang Xiaowei , Lai Benjamin 
Published: June 2022

Abstract
Mechanical abusive loadings, as an inevitable consequence of road accidents, can damage the embedded energy storage system in an electric vehicle and deform its constitutive parts, e.g., the lithium-ion batteries. Therefore, to study the mechanical responses of these batteries and avoid expensive testing equipment and rigorous safety percussions, researchers are propelled toward utilizing numerical models. Computationally cost-efficient homogenized finite element models that represent the whole battery in the form of a uniform medium are the most feasible solution, especially in large-scale battery stacks simulations. Compared to the other form factors of the batteries, prismatic cells have been understudied even though they have higher packaging efficiency, by making optimal use of space. In this article, a comprehensive homogenization and failure calibration method was developed for these prismatic cells. The homogenization was done through extensive uniaxial components tests of the jellyroll and the shell casing. In addition, biaxial tensile tests and simulations were used to calibrate strain-based failure criteria for the components. The calibrated homogenized model is validated in various punch loading scenarios and used in the characterization of the load–displacement responses and failure modes of the stacked cell configurations. In the stacked simulations, due to the cushion-like behavior of the other cells, the failure happens in higher values of displacement compared to a single cell. However, the normalized intrusion percentages for the battery stacks are lower compared to a single battery cell. This emphasizes the importance of the safety assessment of an electric vehicle based on the failure analysis of the battery stacks rather than a single cell. This goal would be feasible through simulations of only homogenized cell models in the stacked configurations, which are elaborated in this article for prismatic cells.
Conversion of Thermally Amplified Hydraulic Shock for Power Generation: Modeling and Experimental Analyses
Authors: Abebe Ashenafi , Tadesse Yilma , Beyene Asfaw 
Published: June 2022

Abstract
Hydraulic shock, also colloquially known as hydram, or hydraulic ram pump, or water hammer, or fluid hammer is a high-pressure shock wave that propagates at the speed of sound through a piping system when a fluid in motion is forced to change direction or stop abruptly. This destructive force can be converted into useful work, i.e., to pump the water to higher elevation, thereby increasing its potential energy, i.e., lifts the water using the high-pressure shockwave. Its low performance combined with affordability of fuels has put this otherwise longstanding technology in the backburner of science and research for a long time, yielding to electric or fuel powered pumps. However, growing concerns about the impacts of fossil fuel use on the environment as well as the rising price of electricity has generated a renewed interest in such technology. The ram pump’s operation in remote areas where the power grid is not available adds research value to the technology. In this paper, a novel approach, i.e., adding thermal energy to the flow to assist the water hammer pressure was modeled. Computational fluid dynamics (CFD) simulations were conducted using ansys. The results were validated experimentally in a 32 mm (27 mm internal diameter) drive pipe and a supply head of 2.18 m ram pump. The exhaust pressure can also be used to produce power using a hydraulic turbine, hence our claim of multi-purpose application as a theme of this project. The results between simulation and experiment were consistent, with only 6.99% error for pressure, and 10.16% for flowrate. The results show that pressure increased from 183.33 kPa to 342.32 kPa when thermally assisted to reach 106.75 °C. The experimental discharge flow increased from 11.72 l/min to 16.41 l/min for the corresponding temperature, a 42.01% increase. The system in power mode produced 91.28 W and 35.81 W with and without thermal infusion, respectively. The Rankine efficiency of thermally assisted hydraulic ram for combined application was above 10% whereas with power generation only, the efficiency was 1.4% at a net delivery head of 5 m for both scenarios. It was observed that in general, the efficiency increases proportionally with delivery flow.
Daily-Seasonal Variation in the Number of Remotely Observed, Pulsed, ULF Electromagnetic Earthquakes and the Spatial Distribution of Their Generation Zones on the Earth’s Surface
Authors: Dovbnya B. V. 
Published: June 2022

Abstract
Based on data from long-term observations at two geophysical observatories, Borok and College, distantly spaced in latitude and longitude, the results of remote observation of pulsed electromagnetic, ultralow-frequency (ULF) signals detected from distant earthquakes are analyzed withinminutes of the seismic event. The daily and seasonal dependences of the frequency of occurrence of precursors in observatories and the nature of the spatial distribution of their generation zones on the Earth’s surface are studied. Two maxima are distinguished in the daily distribution of the recurrence frequency: in the evening and morning hours of local time. In the seasonal course, there is a maximum in the spring and an increase in the winter months. In the spatial distribution, there is an uneven location of sources around the globe: they are grouped into separate zones and cells that reflect separate regions on the map with manifestations of seismoelectromagnetic activity. Examples are given to illustrate the appearance of precursors. It is noted that the dynamic spectra of signals from earthquakes occurring in different regions of the Earth’s surface were similar. They were repeated at different magnitudes and focus depths and were observed in one time interval allocated relative to the moment of the earthquake. The results of the analysis indicated the universality of the processes of the generation of impulsive precursors preceding an earthquake, as well as the fundamental possibility of a short-term warning (of a few minutes) of an approaching earthquake.
Adherence to the 2015 and 2020 British Society of Paediatric Endocrinology and Diabetes guidelines and outcomes in critically ill children with diabetic ketoacidosis: a retrospective cohort study
Authors: Edwards Victoria Mary , Procter Claire , Jones Andrew J , Randle Elise , Ramnarayan Padmanabhan 
Published: June 2022

ObjectivesTo compare clinical management and key outcomes of critically ill children with diabetic ketoacidosis (DKA) in two cohorts (2015 cohort: managed according to the 2015 British Society of Paediatric Endocrinology and Diabetes (BSPED) guidelines; 2020 cohort: managed according to the 2020 BSPED guidelines).DesignRetrospective cohort study using prospectively collected data.SettingA critical care advice and transport service based in London, and referring hospitals within the critical care network.PatientsAll children 0–17 years referred for advice and/or critical care transport with a clinical diagnosis of DKA over a 30-month period (from September 2018 to March 2021).InterventionsNone.Main outcome measuresAdmission to intensive care unit (ICU), clinically diagnosed cerebral oedema and death.ResultsThere were significant differences in fluid and insulin administration practices between the 2015 and 2020 cohorts (fluid bolus >20 mL/kg: 3% vs 30%, p<0.001; median total fluid given in the first 24 hours: 84 mL/kg vs 117 mL/kg, p<0.01; starting insulin infusion rate 0.1 U/kg/hour: 54% vs 31%, p<0.01). However, these differences were consistent with guideline recommendations (initial fluid infusion rate within 5% of guideline-recommended rate: 80% in the 2015 group vs 84% in the 2020 group). There were no significant differences in outcomes (ICU admission: 26% vs 35%, p=0.2; cerebral oedema: 21% vs 23%, p=0.8).ConclusionsOur study findings indicate that changes to fluid and insulin administration occurred after the 2020 BSPED guideline publication, with strong adherence to the guideline, but these changes were not associated with changes in key outcomes.
Prospectively evaluating maternal and fetal outcomes in the era of CFTR modulators: the MAYFLOWERS observational clinical trial study design
Authors: Jain Raksha , Magaret Amalia , Vu Phuong T , VanDalfsen Jill M , Keller Ashley , Wilson Alexandra , Putman Melissa S , Mayer-Hamblett Nicole , Esther Charles R , Taylor-Cousar Jennifer L 
Published: June 2022

IntroductionTherapeutic advances have markedly increased life expectancy for those with cystic fibrosis (CF), resulting in a median predicted survival over 50 years. Consequently, people with CF (pwCF) are living through their reproductive years and the rate of pregnancy is rapidly rising. Despite the increased relevance of this topic, multicentre studies investigating the association between maternal health and choices made during pregnancy on maternal and fetal outcomes do not exist. Furthermore, there are very limited data on the outcomes following CF transmembrane conductance regulator (CFTR) modulator use during pregnancy and lactation.Methods and analysisMaternal andFetal Outcomes in theEra of Modulators(MAYFLOWERS) is a prospective, multicentre observational clinical trial which will enrol approximately 285 pregnant pwCF including those who are modulator ineligible and those who choose to continue or discontinue CFTR modulator therapy during pregnancy and lactation. The primary aim of this 35-month study is to assess whether lung function changes during pregnancy differ based on the continued use of modulators or other factors such as pre-existing comorbid conditions. Secondary objectives include evaluation of pregnancy related and obstetrical complications and changes in mental health.Ethics and disseminationThe design of this study required special consideration of study burden on pregnant and lactating people with chronic illness in the setting of a substantial number of unanswered questions under these conditions. MAYFLOWERS is the first prospective clinical trial examining pregnancy in CF; the outcomes will guide providers on pregnancy management in pwCF and others with chronic respiratory disease.
Acceptability of a task sharing and shifting model between family physicians and physiotherapists in French multidisciplinary primary healthcare centres: a cross-sectional survey
Authors: Kechichian Amélie , Desmeules François , Girard Pauline , Pinsault Nicolas 
Published: June 2022

ObjectivesThe rising prevalence of musculoskeletal disorders increases pressure on primary care services. In France, patients with musculoskeletal disorders are referred to physiotherapist (PT) by family physician (FP). To improve access to musculoskeletal care, a new model of task sharing and shifting is implemented between FPs and PTs for patients with acute low back pain. This new model enables French PTs to expand their usual scope of practice by receiving patients as first-contact practitioner, diagnosing low back pain, prescribing sick leave and analgesic medication. The aim of this study is to investigate the acceptability of FPs and PTs regarding this new model.DesignA cross-sectional survey design was used. Acceptability was measured using a questionnaire on the perception of the model and the perception of PTs’ skills to manage low back pain. Descriptive analyses were performed to compare results among participants.SettingFrench FPs and PTs working in multidisciplinary primary healthcare centres were invited to complete an online survey.ParticipantsA total of 174 respondents completed the survey (81 FPs and 85 PTs).ResultsA majority of participants had a positive perception of the task sharing and shifting model. A majority of the participants were mostly or totally favourable towards the implementation of the model (FPs: n=46, 82% and PTs: n=40, 82%). The perceived level of competencies of PTs to manage acute low back pain was high. The confidence level of FPs was higher than that of PTs regarding PTs’ ability to adequately diagnose low back pain, refer patient to physiotherapy and prescribe sick leave or analgesic medication.ConclusionBased on this limited sample of participants, there appears to be good acceptability of the task sharing and shifting model for acute low back pain. Additional studies are needed to better determine the factors affecting the acceptability of such a model.
Integrated use of PD-1 inhibition and transarterial chemoembolization for hepatocellular carcinoma: evaluation of safety and efficacy in a retrospective, propensity score-matched study
Authors: Marinelli Brett , Kim Edward , D'Alessio Antonio , Cedillo Mario , Sinha Ishan , Debnath Neha , Kudo Masatoshi , Nishida Naoshi , Saeed Anwaar , Hildebrand Hannah , Kaseb Ahmed O , Abugabal Yehia I , Pillai Anjana , Huang Yi-Hsiang , Khan Uqba , Muzaffar Mahvish , Naqash Abdul Rafeh , Patel Rahul , Fischman Aaron , Bishay Vivian , Bettinger Dominik , Sung Max , Ang Celina , Schwartz Myron , Pinato David J , Marron Thomas 
Published: June 2022

BackgroundImmune checkpoint inhibitors (ICIs) have revolutionized treatment of advanced hepatocellular carcinoma. Integrated use of transarterial chemoembolization (TACE), a locoregional inducer of immunogenic cell death, with ICI has not been formally assessed for safety and efficacy outcomes.MethodsFrom a retrospective multicenter dataset of 323 patients treated with ICI, we identified 31 patients who underwent >1 TACE 60 days before or concurrently, with nivolumab at a single center. We derived a propensity score-matched cohort of 104 patients based on Child-Pugh Score, portal vein thrombosis, extrahepatic metastasis and alpha fetoprotein (AFP) who received nivolumab monotherapy. We described overall survival (OS), progression-free survival (PFS), objective responses according to modified RECIST criteria and safety in the multimodal arm in comparison to monotherapy.ResultsOver a median follow-up of 9.3 (IQR 4.0–16.4) months, patients undergoing multimodal immunotherapy with TACE achieved a significantly longer median (95% CI) PFS of 8.8 (6.2–23.2) vs 3.7 (2.7–5.4) months (log-rank 0.15, p<0.01) in the monotherapy group. Multimodal immunotherapy with TACE demonstrated a numerically longer OS compared with ICI monotherapy with a median 35.1 (16.1–Not Evaluable) vs 16.6 (15.7–32.6) months (log-rank 0.41, p=0.12). In the multimodal treatment group, there were three (10%) grade 3 or higher adverse events (AEs) attributed to immunotherapy compared with seven (6.7%) in the matched ICI monotherapy arm. There were no AEs grade 3 or higher attributed to TACE in the multimodal treatment arm. At 3 months following each TACE in the multimodal arm, there was an overall objective response rate of 84%. There were no significant changes in liver functional reserve 1 month following each TACE. Four patients undergoing multimodal treatment were successfully bridged to transplant.ConclusionsTACE can be safely integrated with programmed cell death 1 blockade and may lead to a significant delay in tumor progression and disease downstaging in selected patients.