bluuebunny/crossref_metadata_2025_split huggingface dataset:
Adolescent elbow osteochondral lesions following prior elbow fracture pinning
Authors: Padaki Ajay S , Allahabadi Sachin , Pandya Nirav K 
Published: October 2022

Purpose: Pinning of pediatric elbow fractures has been shown to be a safe procedure with a low complication profile. This study identified patients who underwent cartilage surgery for elbow osteochondral lesions or osteochondritis dissecans who had prior ipsilateral elbow pinning. Methods: Records of patients who underwent ipsilateral cartilage surgery for osteochondritis dissecans and prior percutaneous pinning for elbow fractures were identified. Demographics were compiled and the clinical, radiographic, and surgical results were tabulated for patients with at least 1-year of follow-up from initial presentation. Results: In total, 6/52 (11.5%) pediatric patients from 2012 to 2021 who underwent isolated elbow osteochondritis dissecans surgery (mean age at surgery 13.4 ± 1.5 years) had a history of ipsilateral elbow pinning (mean age at surgery 6.9 ± 2.4 years). Of these, five had a history of a supracondylar fracture while one patient sustained a lateral condyle fracture. Overall, three of six patients had mechanical symptoms at presentation and three had abnormal radiographs. All patients underwent pre-operative magnetic resonance imaging and the five patients with an osteochondritis dissecans lesion <1cm2 underwent arthroscopy and microfracture while one with a 4-cm2 lesion underwent open osteochondral allograft transfer. All patients demonstrated improved motion at final follow-up and all patients were able to return to full desired activity following surgery. Conclusion: This study demonstrates that the history of elbow fracture pinning may predispose patients to future elbow chondral injuries in adolescence. Although patients appear to do well following consequent osteochondritis dissecans surgery, patients and parents may be advised of possible association of elbow pinning and elbow osteochondral lesions. Level of Evidence: III, case–control study
A Cadaveric Study Verifying the Potential of a Rotational Biplanar Chevron Osteotomy to Correct the 3-Dimensional Hallux Valgus Deformity
Authors: Hamre Mikaela Engarås , Molund Marius , Nilsen Fredrik 
Published: October 2022

Introduction Metatarsal pronation is present in 87% of patients with hallux valgus (HV) deformity. The chevron osteotomy is commonly used worldwide to correct mild to moderate HV deformities. Many modifications have been described, but few address the rotational deformity of the first metatarsal. The rotational biplanar chevron osteotomy (RBCO), described by M. Prado et al, presents a variation of a biplanar chevron osteotomy that can be used to address first metatarsal rotation. The objective of this study is to investigate and verify the technique of the RBCO. Methods We conducted our study performing an RBCO on 9 cadaveric limbs. The technique uses a medial-based wedge parallel to the plantar limb of the osteotomy to make the distal fragment free to correct rotation. A goniometer was used by 2 individual surgeons to control the rotational correction achieved. Results The osteotomy was considered simple to perform and we experienced no complications, such as fractures or instability. The result was satisfactory alignment and adequate stability. On average, a 2 mm wedge resulted in 11° of rotational correction. Conclusion We predict that RBCO can safely be used for correcting the metatarsal rotation when necessary in mild to moderate HV deformity foot. Levels of Evidence: Level IV
Delirium Following Anticholinergic Use in Hospitalized Patients With Dementia
Authors: Hale Elijah W. , Macchi Zachary A. , Pressman Peter S. 
Published: October 2022

We sought to explore rates of delirium amongst hospitalized patients with dementia following orders for anticholinergic medications. We hypothesized that patients receiving anticholinergic medications would have higher rates of delirium than similar, unexposed patients. We performed a retrospective chart review of 23 031 hospitalized individuals with Alzheimer’s disease, vascular dementia, or unspecified dementia from 2011-2018. Rates of delirium diagnosis and haloperidol orders following anticholinergic administration were compared to patients with dementia without anticholinergic orders. Significant differences in rates of delirium and orders for haloperidol were observed between exposed and unexposed groups, with delirium having a relative risk of 2.3 and orders for haloperidol having a relative risk of 10.4. The number needed to harm for anticholinergic exposure was 5.45 for delirium and 7.09 for haloperidol. The identified difference suggests that inpatient use of anticholinergic medications may increase the risk of delirium in hospitalized patients with dementia. Despite this risk, our review suggests that anticholinergic administration is common during hospital stays among patients with dementia. Anticholinergic use may be a modifiable risk factor for delirium prevention, which could improve inpatient management of patients with dementia.
Feasibility, acceptability and effects of a group pelvic floor muscle telerehabilitation program to treat urinary incontinence in older women
Authors: Le Berre Mélanie , Filiatrault Johanne , Reichetzer Barbara , Dumoulin Chantale 
Published: October 2022

IntroductionUrinary incontinence (UI) is one of the most prevalent health concerns in women age 65 and over. The recommended first-line treatment for UI is individual pelvic floor muscle training (PFMT). However, healthcare systems worldwide are unable to meet the demand for this resource-intensive approach. Recently, the Group Rehabilitation Or IndividUal Physiotherapy (GROUP) trial showed that group-based PFMT was not inferior to individual PFMT to treat UI in older women, despite using fewer resources. This study aims to assess the feasibility, acceptability and effects on UI-related symptoms and associated quality of life (QoL) of an online adaptation of the GROUP program (teleGROUP) for UI in older women.Methods and analysisThis pilot study will involve the recruitment of 32 older women with UI. Participants’ attendance to online sessions, adherence to weekly home exercises, and side effects, in addition to the physiotherapist's fidelity to the program delivery will be collected to evaluate the program's feasibility. Participants’ dropout rates, reasons for dropout, satisfaction and usability scores will be collected to evaluate the program's acceptability for participants. A survey will evaluate the program's acceptability for the physiotherapists. Additionally, at the end of the study, qualitative semi-structured interviews and focus groups will investigate further feasibility and acceptability. To measure the effects of teleGROUP, number of weekly leakages and percentage reduction will be the primary outcomes.
Glenohumeral Arthropathy After Arthroscopic Surgery for Shoulder Instability: Outcomes at 16-Year Follow-up
Authors: Izquierdo-Fernández Alberto , García-Carmona Manuel , Urbano-Luque Maite , Márquez-Ruiz Javier , Quevedo-Reinoso Rafael , Minarro José Carlos 
Published: October 2022

Background: Glenohumeral arthropathy after surgery for traumatic shoulder instability is a condition whose etiology and long-term course are still unknown. Purpose: To evaluate the risk factors for the onset of arthropathy and to assess the relationship between the degree of arthropathy and final outcomes. Study Design: Case series; Level of evidence, 4. Methods: We included patients who underwent surgery for a shoulder instability at a single institution between 2000 and 2004. The following variables were studied for relationship with functional outcomes: sex, age, body mass index, smoking at the time of surgery, number of episodes of shoulder dislocation, and time from first dislocation to surgery. The number of anchors used and their position were also evaluated. Functional outcomes were assessed using the Constant-Murley, Western Ontario Shoulder Instability Index, and Rowe scores, and results were compared with the onset of arthropathy according to Buscayret classification. Spearman and Pearson correlations were performed for the association between glenohumeral arthritis (Buscayret grade) and the study variables, the Mann-Whitney U test and Student t test were used to compare outcome scores with the study variables, and the Kruskal-Wallis test was used to compare Buscayret grade and outcome scores. Results: A total of 26 shoulders in 25 patients were analyzed, finding a high rate (54%) of arthropathy at a minimum follow-up of 16 years. Patients with Buscayret grade 4 had the worst functional results ( P = .007). However, 80% of patients with Buscayret grade ≤3 had excellent Constant-Murley scores. A significant relationship was found between degree of arthropathy and patients who were smokers before surgery ( P < .01). No relationship was found between the onset of arthropathy and the other variables analyzed. Conclusion: Postinstability glenohumeral arthropathy was not correlated with functional outcomes except in those patients with advanced arthroplasty (Buscayret grade 4). A direct relationship was found between smoking before surgery and the onset of glenohumeral arthropathy.
Candidate genes screening based on phenotypic observation and transcriptome analysis for double flower of Prunus mume
Authors: Zhu Huanhuan , Shi Yan , Zhang Junwei , Bao Manzhu , Zhang Jie 
Published: October 2022

Abstract
Background
Prunus mume is an early spring flower of Rosaceae, which owns high application value in gardens. Being an excellent ornamental trait, the double flower trait has always been one of the important breeding goals of plant breeders. However, the key regulatory genes of double flower traits of P. mume are still unclear at present.

Results
The floral organs’ morphological differences of 20 single and 20 double flower cultivars of P. mume were compared firstly. And it was found that double flower trait of P. mume were often accompanied by petaloid stamen, multiple carpels and an increase in the total number of floral organs. Then, transcriptome sequencing of two representative cultivars P. mume ‘Danban Lve’ and P. mume ‘Xiao Lve’ were conducted at 3 Stage of flower bud development with distinct morphological differentiation. 3256 differentially expression genes (DEGs) were detected, and 20 candidate genes for double flower trait of P. mume were screened out including hub genes PmAP1–1 and PmAG-2 based on DEGs function analysis and WGCNA analysis. And it was found that epigenetic and hormone related genes may also play an important role in the process of double flower.

Conclusions
This study suggested that the double flower trait of P.mume is more like accumulation origin based on morphological observation. 20 genes and co-expression network related to the formation of double flower P. mume were preliminarily screened through transcriptomics analysis. The results provided a reference for further understanding of the molecular mechanism of double flower trait in P. mume.
A nomogram for predicting the readmission within 6 months after treatment in patients with acute coronary syndrome
Authors: Li Dongyun , Lin Ying , Dong Wenjing , Hu Yalei , Li Ke 
Published: October 2022

Abstract
Purpose
To explore predictors for readmission within 6 months of ACS patients, and to build a prediction model, and generate a nomogram.

Methods
The retrospective cohort study included 498 patients with ACS in the Second Medical Center of the Chinese People’s Liberation Army General Hospital between January 2016 and March 2019. Univariate and multivariate logistic regression with odds ratios (OR) and two-sided 95% confidence interval (CI) analysis were used to investigate predictors for readmission within 6 months. The cohort was randomly divided into training cohort to develop a prediction model, and the validation cohort to validate the model. The receiver operating characteristic curve (ROC) and the calibration curve was used to assess discriminative power and calibration.

Results
Eighty-three ACS patients were readmitted within six months, with a readmission rate of 16.67%. Predictors included ACS type, treatment, hypertension, SUA, length of stay, statins, and adverse events occurred during hospitalization were used to form a six-month readmission prediction model for readmission within 6 months in ACS patients. The area under the curve (AUC) of the model was 0.788 (95%CI: 0.735–0.878) and 0.775 (95%CI: 0.686–0.865) in the training cohort and the validation cohort, respectively. Calibration curves showed the good calibration of the prediction model. Decision-curve analyses and clinical impact curve also demonstrated that it was clinically valuable.

Conclusion
We used seven readily available predictors to develop a prediction model for readmission within six months after treatment in ACS patients, which could be used to identify high-risk patients for ACS readmission.
A stratified adaptive two-stage design with co-primary endpoints for phase II clinical oncology trials
Authors: Cabarrou Bastien , Leconte Eve , Sfumato Patrick , Boher Jean-Marie , Filleron Thomas 
Published: October 2022

Abstract
Background
Given the inherent challenges of conducting randomized phase III trials in older cancer patients, single-arm phase II trials which assess the feasibility of a treatment that has already been shown to be effective in a younger population may provide a compelling alternative. Such an approach would need to evaluate treatment feasibility based on a composite endpoint that combines multiple clinical dimensions and to stratify older patients as fit or frail to account for the heterogeneity of the study population to recommend an appropriate treatment approach. In this context, stratified adaptive two-stage designs for binary or composite endpoints, initially developed for biomarker studies, allow to include two subgroups whilst maintaining competitive statistical performances. In practice, heterogeneity may indeed affect more than one dimension and incorporating co-primary endpoints, which independently assess each individual clinical dimension, would therefore appear quite pertinent. The current paper presents a novel phase II design for co-primary endpoints which takes into account the heterogeneity of a population.

Methods
We developed a stratified adaptive Bryant & Day design based on the Jones et al. and Parashar et al. algorithm. This two-stage design allows to jointly assess two dimensions (e.g. activity and toxicity) in two different subgroups. The operating characteristics of this new design were evaluated using examples and simulation comparisons with the Bryant & Day design in the context where the study population is stratified according to a pre-defined criterion.

Results
Simulation results demonstrated that the new design minimized the expected and maximum sample sizes as compared to parallel Bryant & Day designs (one in each subgroup), whilst controlling type I error rates and maintaining a competitive statistical power as well as a high probability of detecting heterogeneity.

Conclusions
In a heterogeneous population, this two-stage stratified adaptive phase II design provides a useful alternative to classical one and allows to identify a subgroup of interest without dramatically increasing sample size. As heterogeneity is not limited to older populations, this new design may also be relevant to other study populations such as children or adolescents and young adults or the development of targeted therapies based on a biomarker.
Antibiotic prescribing patterns at children’s outpatient departments of primary care institutions in Southwest China
Authors: Wang Wenju , Yu Shitao , Zhou Xunrong , Wang Lei , He Xun , Zhou Hanni , Chang Yue 
Published: October 2022

Abstract
Background
Inappropriate use of antibiotics in children is common in many countries. The purpose of the study was to explore patterns of antibiotic prescribing in children’s outpatient clinics in primary care institutions in a province of southwest China.

Methods
We obtained electronic prescription data from 75 primary care institutions in Guizhou province in 2020. The classification of incorrect spectrum of antibiotics, unnecessary use and combined use of antibiotics was based on the Guiding Principle of Clinical Use of Antibiotics (2015, China) and guidelines from the USA Centers for Disease Control and Prevention. Potential risk factors for inappropriate use of antibiotics were identified using bivariate analyses. The generalized estimation equation was used to identify independent predictors of inappropriate use of antibiotics.

Results
A total of 158,267 antibiotic prescriptions were retrieved. Acute upper respiratory tract infections were the most common diseases, accounting for 74.9% of all prescriptions. The main antibiotic group used was penicillins (63.7%), followed by cephalosporins (18.8%). Of 137,284 visits, 18.3% of antibiotic prescriptions were appropriate and the percentage of unnecessary use, incorrect spectrum of antibiotics and combined use of antibiotics was 76.9, 2.4 and 2.4%, respectively. Physicians with lower professional titles and more than 40 years of work duration were relatively more likely to prescribe inappropriate antibiotics.

Conclusion
The inappropriate use of antibiotics in children is still prominent in primary care institutions of southwest China. The education and training of physicians and caregivers in these institutions should be strengthened.
Mifepristone combined with ethacridine lactate for third-trimester stillbirth induction: a 5-year experience from Shanghai
Authors: Xue Rui-Hong , Li Juan , Yao Yong-Li , Huang Run-Jie , Ma Jue , Zhang Lin 
Published: October 2022

Abstract
Objective
To review and analyze the efficacy and safety of mifepristone combined with ethacridine lactate for induction of stillbirth in the third trimester.

Methods
All patients with stillbirth in late pregnancy (≥ 28 weeks) in a university-affiliated maternity center from October 2016 to September 2021 were included in this study. After exclusion, patients were divided into ethacridine lactate and non-ethacridine lactate groups according to induction methods. Logistic regression was conducted to identify the risks of complications.

Results
We identified 122 patients that experienced stillbirth (5’ Apgar score = 0) in third-trimester from the 5-year total deliveries in the hospital, among whom 39 stillbirths that resulted from termination of pregnancy for severe fetal anomalies and 1 stillbirth that was in twin pregnancy were excluded. Thus, 82 cases with stillbirths (dead before induction) were included in the analyses. In the 82 cases, 49 (59.76%) accepted intra-amniotic ethacridine lactate induction with 47 (95.92%, 47/49) successfully induced. No statistical difference was observed in induction failure rate between ethacridine dosage groups of < 75mg and ≥ 75mg (0/25, vs. 2/24, respectively; P > 0.05). The ethacridine lactate induction group showed no increased risks in complications (6.12%, 3/49), compared with non-ethacridine lactate group (12.12%, 4/33) (P = 0.35, OR, 0.47, 95%CI, 0.10 to 2.27).

Conclusion
Mifepristone combined with ethacridine lactate is a safe and low-risk induction method for patients with stillbirth in the third trimester.
Interventions supporting cancer patients in making decisions regarding participation in clinical trials - a systematic review
Authors: Hillersdal Line , Nielsen Zandra Engelbak , Nørmark Ane Taudorf , Knoop Ann , Piil Karin 
Published: October 2022

Abstract
Objectives
Existing research on the perspectives of patients with cancer and health care professionals indicates that patient decision making on cancer clinical trial participation is a complex process and may be poorly understood, possibly compromising their decision to participate. This systematic review investigates interventions that support patients in their decision-making processes regarding whether to participate or not and assesses the qualities of the interventions, measures used and related outcomes.

Methods
Six databases were systematically searched and only studies evaluating interventions that support the decision making of adult patients offered to enter a cancer clinical trial were included. Ten articles met the criteria and were analysed using a narrative synthesis approach.

Results
The research focus of the included studies reflected the multifactorial nature of what constitutes support for patient decision making in terms of entering a cancer clinical trial. However, most interventions were based on the hypothesis that more information leads to support in decision making, and did not take other factors, such as the relationship to the clinical staff or relatives, the patients’ strong hope for therapeutic benefit or other existential needs into account. The interventions were primarily based on a specific tool, executed once, which seems to imply that decisions need only to be supported once and not at several time points throughout the decision process, and did not assess the importance of a patient’s family- or social relations. Moreover, few interventions focused on the patients’ counselling experience or assessed patient preferences in relation to decision making.

Conclusions
The findings demonstrate a lack of research on interventions to support patients’ decision making that takes other factors, apart from improving knowledge of trials, into account. Limited evidence exists on the effectiveness of decision support interventions to improve the experience of support in adult patients with cancer. Interventions that take patient preferences in relation to decision making and the social context of decision processes into account need to be developed and assessed.