Rural adolescent attitudes and use of bicycle helmets in Iowa.

Background: Helmet use significantly decreases head injuries, the most common cause of bicycle-related fatalities in youth. Our objective was to determine bicycle helmet use by rural adolescents, their attitudes regarding helmets, and associated demographic factors.

Methods: A convenience sample of 2022 Iowa FFA (formerly Future Farmers of America) Leadership Conference attendees completed an anonymous electronic or paper survey.

Cervical Cancer Screening Rates Within a Large National Network of Community-Based Health Care Organizations: A Cross-Sectional Study.

Insufficient cervical cancer screening contributes to increased cervical cancer rates, particularly among disadvantaged groups, yet research on screening practices by race and ethnicity is underreported. Our objectives were to find the rates of up-to-date (UTD) cervical cancer screening within a nationwide network. A cross-sectional study was conducted using data from OCHIN, a diverse, national database consisting of over 6 million publicly or underinsured patients in rural and medically underserved communities that provides electronic health records to over 34,500 U.

Scrub Typhus Masquerading As Infectious Mononucleosis: A Case Report.

Scrub typhus is a tick-borne disease caused by the intracellular organism . It typically presents with the cardinal "triad" of fever, rash, and eschar, along with other nonspecific symptoms. We report a case of scrub typhus in a 74-year-old man who did not exhibit the typical rash.

Advanced ocular drug delivery in microgravity: Nanotherapeutic applications as cardiovascular and ophthalmic countermeasures.

Extended space missions significantly affect astronaut health, leading to various systemic and ocular conditions. The ocular surface and cardiovascular system are particularly susceptible to the unique environment within the spacecraft. This can often lead to pathologic issues such as radiation-induced accelerated atherosclerosis (RIAA), spaceflight-associated neuro-ocular syndrome (SANS) and spaceflight-associated dry eye syndrome (SADES).

Clinical and Pathological Features and Survival Outcomes of Breast Cancers with Intermediate ER Expression.

Background: Breast cancer is the most prevalent women's cancer, representing about a third of all cancers diagnosed in women. Estrogen receptor (ER) is an important transcription factor expressed in 70% to 75% of all breast cancers. Of these breast cancers, the majority express ER robustly in 91-100% of tumor cells.

Immunoglobulin G4-related disease of the gallbladder and the biliary tree.

Background: Immunoglobulin G4 (IgG4)-related disease (IgG4-RD) is a rare, immune-mediated fibroinflammatory disorder that can affect multiple organ systems, including the gallbladder and the biliary tree. This study aimed to characterize the clinical, imaging, and histopathologic features of IgG4-related biliary disease, including gallbladder involvement, and to review current medical and surgical management strategies.

Methods: A comprehensive review of the literature was conducted using PubMed and Embase databases for studies published between 2003 and 2025.

Psychological Distress Is Common and Associated with Greater Hip Dysfunction in Adolescents and Young Adults.

Background: Psychological distress is increasing in adolescents and young adults, but comprehensive screening programs are not commonly incorporated into orthopaedic clinical practice. We implemented a screening program for depression symptoms and psychological distress in adolescents and young adults with hip pain. The aims of this study were to report the prevalence and risk factors and determine the relationship with patient-reported pain and dysfunction.

Ophthalmic Knowledge Assessment Program Scores and Written Qualifying Examination Performance.

Importance: The Ophthalmic Knowledge Assessment Program (OKAP) has been widely used to determine readiness to take the high-stakes Written Qualifying Examination (WQE). However, it is unclear how well OKAP performance can predict WQE outcomes.

Objective: To examine the association between the OKAP and WQE nationally.

Prediction of Cerebrospinal Fluid (CSF) Pressure with Generative Adversarial Network Synthetic Plasma-CSF Biomarker Pairing.

Non-invasive intracranial pressure (ICP) monitoring can help clinicians safely and efficiently monitor spaceflight-associated neuro-ocular syndrome (SANS), idiopathic intracranial hypertension, and traumatic brain injury in astronauts. Current invasive ICP measurement techniques are unsuitable for austere environments like spaceflight. In this study, we explore the potential of plasma-derived cell-free RNA (cfRNA) biomarkers as non-invasive alternatives to cerebrospinal fluid (CSF) markers for ICP assessment.

Defining spaceflight associated dry eye syndrome (SADES): Mechanisms, complications, and countermeasures.

There is a high prevalence of dry eye-related symptoms among astronauts during spaceflight. We propose naming this phenomenon: Spaceflight Associated Dry Eye Syndrome (SADES). In this study, we review the potential mechanisms of dry eye in the spaceflight environment, categorizing them into external (radiation, environmental hazards) and microgravity-related (meibum outflow) mechanisms.

Giant Cell Myocarditis Presenting With Cardiogenic Shock: Diagnostic and Therapeutic Challenges.

Giant cell myocarditis (GCM) is a rare but often fatal inflammatory cardiomyopathy characterized by aggressive myocardial inflammation and necrosis. Prompt recognition and immunosuppressive therapy are critical for improving outcomes. A 48-year-old woman with no prior cardiac history presented with dyspnea, orthopnea, and hypotension.

Administration of nivolumab plus ipilimumab: Infusion of the fixed-ratio combination versus sequential infusions in two randomized controlled trials of metastatic melanoma (CheckMate 742) and renal cell carcinoma (CheckMate 800).

Background: Immune checkpoint inhibitors can be coadministered as a fixed-ratio combination (FRC) or administered as sequential infusions (ASI). Two randomized, open-label trials compared nivolumab + ipilimumab as a FRC versus ASI in patients with melanoma or renal cell carcinoma.

Methods: CheckMate 742 was a Phase 3b study in patients with advanced or metastatic melanoma who received nivolumab 1 mg/kg and ipilimumab 3 mg/kg either concurrently as an FRC or sequentially as ASI every 3 weeks.

Prevalence and biological impact of clinically relevant gene fusions in head and neck cancers.

Head and neck cancer (HNC) is the seventh most common cancer worldwide. Currently-approved systemic therapies include chemotherapy, anti-EGFR antibodies, and PD-1 immunotherapy, with few genomic-based targeted therapies. Gene fusions involving cancer-driving kinase genes such as FGFR, NTRK, and ALK are clinically targetable in other solid tumors; however, there is limited knowledge about their prevalence in HNC.

Outcomes of Patients With Embolic Stroke of Undetermined Source Treated With Antiplatelet Agents or Anticoagulation: A Multicenter Cohort Study.

Background And Objectives: Embolic stroke of undetermined source (ESUS) can be attributed to a variety of potential embolic sources, with differential response to anticoagulation.

Methods: A multicenter, retrospective observational cohort study (27 sites) of consecutive adult patients with acute ischemic stroke due to ESUS (admitted 2015-2024) was conducted. The aim was to compare outcomes after antiplatelet(s) vs anticoagulant (±antiplatelet) treatment in patients with ESUS across potential embolic sources.

Importance of Non-Pharmacologic Interventions in Osteoporosis Management: A Case Series Finding Value in Nutrition and Exercise Counseling by a Fracture Liaison Service.

Background: Bone mineral density (BMD) warrants attention given its role in secondary fracture prevention and pre-surgical optimization in orthopaedic surgery. While fracture liaison services (FLS) offer expertise in the management of osteoporosis medications that are known to increase BMD, these resources further coordinate the prescription of vitamin D supplementation and provide nutritional counseling to include adequate amounts of dietary calcium and protein, along with recommendations of intentional exercise to improve a patient's overall bone health and decrease fall risk. This case series describes patients who experienced increase in bone mineral density with these non-pharmacologic interventions.

Pre-Operative MRA Accurately Predicts Capsulolabral Adhesions at Revision Hip Arthroscopy.

Background: To determine the accuracy of preoperative magnetic resonance arthrogram (MRA) in detecting capsulolabral adhesions in patients undergoing revision hip arthroscopy.

Methods: We retrospectively reviewed revision hip arthroscopies performed by a single surgeon between 2019 and 2022. Patients without preoperative MRA were excluded.

Recognition and Recurrence of Aneurysmal Bone Cyst Secondary to Giant Cell Tumor: A Case Series and Review Of The Literature.

Background: Aneurysmal bone cysts (ABCs) are rare, benign bone lesions with distinct genetic and pathological characteristics. Secondary ABCs arising from giant cell tumors (GCTs) are associated with higher recurrence rates compared to primary ABCs. This study aimed to evaluate recurrence rates and risk factors for primary ABCs, secondary ABCs in GCT, and GCTs, with a focus on radiologic and clinical predictors.

Objective Fluoroscopic Image-Based Assessment of Intraoperative Wire Navigation Skill Agrees with Subjective Expert Opinion.

Background: The current standard for assessing orthopedic technical skill demonstrated in operating room performance relies primarily on subjective evaluations administered by an expert mentor. This study demonstrates the utility of fluoroscopic image-based analysis as an objective mechanism for assessing technical proficiency for a common wire navigation procedure by comparing it for the first time to the gold standard in orthopedic skills assessment: subjective expert opinion.

Methods: The final pin construct achieved during the closed reduction and percutaneous pinning of pediatric supracondylar humerus fractures was assessed for 23 operating room performances from fluoroscopic imaging to produce an objective ranking.

Revision Rates for Acute Versus Delayed Total Hip Arthroplasty After Acetabular Fracture.

Background: Total hip arthroplasty (THA) has demonstrated utility in expediting return to function in the management of acetabular fractures. Despite its increased utilization, optimal timing to minimize complications and need for revision remains controversial and is often left to surgeon discretion. This study seeks to determine if timing, acute versus delayed (>30 days) THA for the management of acetabular fracture impacts rate and indications for revision arthroplasty.

Substantial Loss of Skeletal Muscle Mass Occurs After High Energy Trauma.

Background: The aim of this study was too quantify loss of skeletal muscle mass that occurs early after high energy trauma and determine the association with poor nutrition intake.

Methods: This prospective cohort study was completed at a midwest academic level 1 trauma center. Patients aged 18 - 55 years old with acute open fracture of the extremity/pelvis and/or two or more injured extremities treated with operative fixation were enrolled.

The Causes and Costs of Surgical Site Infection in Total Hip and Total Knee Arthroplasty: A Retrospective Review of 4,973 Procedures.

Background: The purpose of this article is to delineate risk factors associated with SSI (surface, deep tissue, and periprosthetic joint infections) in hip and knee total joint replacement (TJR) surgeries for both primary and revision procedures.

Methods: Retrospective case-control study of non-emergent TJR procedures performed at a tertiary level academic medical center between 2014-2018. Multivariable logistic regression was used to determine which factors are associated with an increased risk for SSI in TJR.