bluuebunny/crossref_metadata_2025_split huggingface dataset:
Does Approach Matter? Comparison of Early Postoperative Life-threatening Complications in Elderly Patients With Multilevel Cervical Stenosis
Authors: Asada Tomoyuki , Akosman Izzet , Lovecchio Francis C﻿.﻿ , Subramanian Tejas , Shahi Pratyush , Maayan Omri , Singh Nishtha , Araghi Kasra , Korsun Maximilian K.﻿ , Tuma Olivia C.﻿ , Pajak Anthony , Lu Amy Z. , Mai Eric , Kim Yeo Eun , Dowdell James E. , Sheha Evan D. , Iyer Sravisht , Qureshi Sheeraz A. 
Published: December 2024

Study Design:
Retrospective cohort study.

Summary of Background Data:
The optimal surgical approach for multilevel cervical stenosis in elderly patients is controversial because of the risk of life-threatening complication.

Objective:
To compare life-threatening early complication rates between ≥3 levels anterior and posterior cervical surgery in elderly patients.

Methods:
Data from the American College of Surgeons National Surgical Quality Improvement Program database (NSQIP) were queried for patients 65 years or older who underwent ACDF or PS between 2016 and 2021. Patients with subaxial cervical degenerative disorders were identified using ICD10 codes. Surgical procedures were defined with CPT code indicating ACDF (3–5 levels; ACDF3+), laminoplasty or laminectomy (3–5 levels), and posterior decompression and fusion (3–5 levels). Outcomes of interest including reoperation, airway complications, venous thromboembolism (VTE), surgical site infections (SSIs), and urinary tract infections (UTI) were compared by utilizing 1:1 propensity score matching between the 2 approaches.

Results:
We identified 568 patients who underwent ACDF3+ and 1590 patients who underwent PS. After propensity score matching, the cohorts with 568 patients each were well-balanced with a mean age of 70.9 years. All 17 patients with dialysis and 24 of 28 patients with congestive heart failure in the PS group before the matching were excluded through the matching process. Complications rates between ACDF3+ and PS group were similar in reoperation (2.1% vs. 3.3%; P=0.275), airway complications (0.9% vs. 0.9%; P=1.000), and VTE (1.1% vs. 0.7%; P=0.751), whereas the PS group had a higher rate of SSI (0.2% vs. 1.4%; P=0.045), UTI (1.1% vs. 3.0%; P=0.035), and LOS (2.5±6.1 vs, 4.3±3.9 d; P<0.001).

Conclusions:
Among elderly patients undergoing 3 or more levels of cervical spine surgery, there were comparable rates of 30-day life-threatening complications between the 2 approaches. However, potential selection bias exists, with surgeons possibly favoring posterior surgery for patients with higher-risk comorbidities.
Sickle Cell Retinopathy Lost to Follow-up Study
Authors: Wong Jovi C. Y. , Sivalingam Meera D. , Griffin Matthew , Magagna John , Momenaei Bita , Wakabayashi Taku , Ni Roselind L. , Wang Kristine Y. , Ammar Michael J. , Hsu Jason , Yonekawa Yoshihiro 
Published: December 2024

Purpose
To determine the outcomes of sickle cell retinopathy (SCR) patients who experienced at least one episode of being lost to follow-up (LTFU) compared to those who attended all appointments.

Methods
Adult SCR patients who visited Wills Eye Hospital Retina service (January 2012-December 2021) with >2 visits were reviewed for LTFU events, defined as failure to return for a follow-up appointment within 6 months of the scheduled date.

Results
One hundred and eighty-one eyes of 94 patients were included. Fifty-one patients (99 eyes) attended all appointments (“attended group”) whilst 43 patients (82 eyes), or 46%, had at least one LTFU event (“LTFU group”). The mean (standard deviation, SD) LTFU duration was 470 (329) days. In the LTFU group, mean (SD) VA was significantly worse at the final visit (logMAR 0.45 (0.63), Snellen 20/56) and at the post-LTFU visit (0.36 (0.59), 20/46) compared to the pre-LTFU visit (0.3 (0.47), 20/40, p = 0.001). In the attended group, mean (SD) VA was significantly better at the final visit (0.41 (0.63), 20/51) compared to the initial visit (0.52 (0.78), 20/66, p = 0.038).

Conclusion
Patients with SCR with an LTFU event have worse visual outcomes compared to patients who attend all appointments.
Outcomes of Second Trabeculectomy Versus Glaucoma Drainage Device in Juvenile Open-angle Glaucoma After Primary Trabeculectomy Failure
Authors: Seresirikachorn Kasem , Annopawong Kornkamol , Parivisutt Nucharee , Wanichwecharungruang Boonsong , Friedman David S. , Vu Daniel M. 
Published: December 2024

Precis:
Second trabeculectomy and glaucoma drainage device implantation offer similar success rates for juvenile open angle glaucoma after initial trabeculectomy failure. However, second trabeculectomies required fewer medications. A quarter of patients in both groups required a third operation after 2.5±2.3 years.

Purpose:
To compare outcomes between second trabeculectomy surgery versus glaucoma drainage device (GDD) insertion in juvenile open-angle glaucoma (JOAG) patients after primary trabeculectomy failure.

Method:
A retrospective review was performed on all JOAG patients who underwent a second glaucoma surgery after primary trabeculectomy failure across two tertiary hospitals in Bangkok, Thailand between 2009 and 2020. Demographics, intraoperative reports, and clinical findings were collected. The primary outcomes were complete and qualified success rates at 5 years; secondary outcomes included differences in intraocular pressures and number of glaucoma medications post-operatively.

Results:
Fifty-two eyes of 38 patients underwent a second glaucoma surgery after primary trabeculectomy: 30 had a second trabeculectomy, 17 received a GDD (10 valved, 7 non-valved), and 5 underwent cyclophotocoagulation. Prior to surgery, there were no significant differences except in mean refractive error. Average follow-up length was 66.9±53.7 months. Qualified success rates were 81.5% and 63.2% at 3 and 5 years (complete success: 55.6% and 42.1%) for the second trabeculectomy group and 80.0% and 70.0% (complete success: 53.3% and 50.0%) for the GDD group, respectively. There were no significant differences in group success or IOP post-operatively. The GDD group required more medications at 5 years (1.3±1.9 vs. 2.3±1.5, P=0.03). Two cases of tube exposure in the GDD group resulted in implant removal. About a quarter of patients in both groups required a third operation after 2.5±2.3 years.

Conclusion:
Both second trabeculectomy and GDD insertion are effective treatments for JOAG after trabeculectomy failure. Second trabeculectomy required fewer medications for IOP control.
Using screen-based simulation to examine diagnostic test ordering in family nurse practitioner students
Authors: Hogg Cameron W. , Braungart Carol , Whitt Karen J. , Pericak Arlene , Beebe Sarah L. , Knestrick Joyce , McNelis Angela 
Published: December 2024

ABSTRACT
Excessive ordering of laboratory tests exposes patients to risk of unnecessary treatments, complications, and psychological and financial burden. Nurse practitioner education programs have the opportunity to develop students' test ordering skills. This project examined family nurse practitioner students' appropriate diagnostic test ordering during a screen-based simulation. Students in their final clinical course were invited to complete 25 patient cases in the i-Human Patients (iHP) platform, including the opportunity to order and interpret tests. Quantitative data, collected in the iHP platform, were analyzed using descriptive statistics. Qualitative analysis of transcripts from weekly faculty debriefing sessions identified common themes among student responses. Ninety-eight students completed the intervention. Data from a single patient case of a 65-year-old woman with a chief complaint of insomnia and weight loss were used for this analysis. Only 46% of students ordered the required tests for this case, and all students ordered extraneous tests. Extraneous orders included tests beyond the reasonable standard of care. Qualitative data showed students recognized their test ordering choices were not always appropriate. Top reasons for ordering extraneous tests included fear of missing key data and uncertainty of appropriate tests. Screen-based simulation is effective to assess nurse practitioner students' test ordering skills. Debriefing with experienced faculty provides an opportunity for students to reflect on their diagnostic reasoning and test ordering competencies. Screen-based simulation provided students with a safe, controlled environment to develop awareness of test utilization in the context of delivering efficient and responsible patient care.
Enhancing the prognostic accuracy of the RETREAT score with AFP-L3 and DCP tumor markers
Authors: Norman Joshua S. , Li P. Jonathan , Kotwani Prashant , Yao Francis Y. , Pham Sarah , Gamez Jasmine , Mehta Neil 
Published: December 2024

The RETREAT (Risk Estimation of Tumor Recurrence After Transplant) Score is a validated tool to predict post-transplant HCC recurrence risk. Alpha-fetoprotein (AFP) bound to Lens culinaris agglutinin (AFP-L3) and des-gamma-carboxyprothrombin (DCP) measured at transplant predict worse post-LT survival and may improve the RETREAT score. Our cohort comprised 284 patients transplanted for HCC who were within or downstaged to Milan, with 23 (8.1%) experiencing HCC recurrence. The modified RETREAT (mRETREAT) score assigns AFP-L3 ≥15% 2 points and DCP ≥7.5 ng/mL 3 points. Patients with a modified RETREAT score ≥4 showed a 3-year recurrence-free survival of 73.2% versus 97.8% recurrence-free survival if <4. In comparison, the original RETREAT score had a 3-year recurrence-free survival of 80.0% if ≥2 versus 98.0% if <2. mRETREAT demonstrated a superior AUC of 0.86, compared to the original RETREAT’s 0.82, and enhanced calibration and accuracy with a lower Brier score (0.04). The integration of AFP-L3 and DCP into the RETREAT score appears to enhance the prediction of post-LT HCC recurrence. Given these promising results, further study in a larger multicenter cohort is warranted for empiric derivation and validation of a modified RETREAT score, including AFP-L3 and DCP.
Clot waveform analysis in hemophilia carriers
Authors: Drissi Eya , Ben Lakhal Fatma , Ghali Ons , Fekih Salem Sarra , El Borgi Wijden , Thabet Lina , Zahra Kaouther , Gouider Emna 
Published: December 2024

In recent years, there has been a growing interest in the activated partial thromboplastin time clot waveform analysis (APTT-CWA), which reflects clot formation. It was mainly studied in hemophilia and disseminated intravascular coagulation.
The aim of this study was to evaluate the usefulness of APTT-CWA in hemophilia carriers.
This was a cross-sectional study including hemophilia carriers and healthy women volunteers. Bleeding assessment was performed using the ISTH-BAT. Laboratory assessment included APTT, APTT-CWA and FVIII:C or FIX:C.
Thirty-two hemophilia carriers and 30 women as a control group were recruited. APTT was prolonged in 14 carriers and none of controls. Tmax 1 and Tmax 2 were significantly prolonged in hemophilia carriers compared to controls. Max 1 and Max 2 were significantly lower in carriers. Using ROC analysis, APTT-CWA parametrs cut-offs showed good sensitivity and specificity in discriminating between carriers and controls. When comparing bleeders and nonbleeders carriers, a significant difference was noted in Max 2, Min 2, Tmax 1 and Tmax 2. No correlation was found between APTT and bleeding score, nor between FVIII:C and Max 1. A positive significant correlation of FVIII:C with Max 2 was found. A negative and significant correlation of FVIII:C with Tmax 1, Tmax 2 and Min 2 was noticed.
The APTT-CWA seems to be a good tool to evaluate bleeding tendency or detecting coagulation factor deficiency. Additional research efforts are warranted to explore the potential of APTT-CWA for identifying hemophilia carriers.
What's new about hydration in dementia?
Authors: Theodoridis Xenophon , Poulia Kalliopi Anna , Chourdakis Michail 
Published: December 2024

Purpose of review
The aim of this study was to conduct a review of the literature published over the past 18 months and present the latest findings on hydration in individuals with dementia.

Recent findings
A systematic review identified sarcopenia, polypharmacy, delayed oral transit, and poor rinsing ability as markers of eating-drinking-swallowing difficulties in early-stage dementia. A cross-sectional study found a high prevalence of dehydration (57–68%) among dementia patients, associated with hypertension, diabetes, chronic kidney disease, dysphagia, and cognitive decline. An analysis of national dementia care guidelines showed that only the UK and Switzerland addressed assisted nutrition and hydration. “Jelly Drops,” a hydrating product for dementia patients, received innovation awards. A study on US Physician Orders for Life Sustaining Treatment forms highlighted inconsistent terminology for end-of-life nutrition and hydration, calling for clearer language to aid decision-making.

Summary
The new hydration-related recommendations in the ESPEN 2024 guidelines for dementia reflect a more individualized, proactive, and comprehensive approach to managing hydration. These guidelines emphasize the importance of early detection, personalized interventions, and consistent monitoring to ensure that dehydration is identified and treated promptly. Furthermore, the current literature supports the need for a specific terminology for dementia management using nutrition and hydration to improve patients’ health outcomes.
Perceived anxiety and self-confidence among undergraduate nursing students during clinical practice in selected colleges providing nursing studies in Addis Ababa, Ethiopia, 2023: prospective observational multicenter cross-sectional study
Authors: Gebreegziabher Ayush , Bitsa Yihdego , Bahre Willi , Tesfamicale Yohannes A. 
Published: December 2024

Background:
Two emotional factors that have an impact on how nursing students learn and use clinical decision-making (CDM) are self-confidence and anxiety. These two emotional factors affect their education and clinical practice and may cause them to drop out of the nursing program. Since students’ CDM skills grow with clinical experience at each stage of education, it has been stressed in recent years that various educational approaches should be employed to enhance CDM by reducing anxiety and increasing self-confidence.

Objective:
To assess anxiety and self-confidence among undergraduate nursing students during clinical practice in selected colleges providing nursing studies in Addis Ababa, Ethiopia, 2023.

Methods:
An institutional-based, multicentered, cross-sectional study design was employed to assess anxiety and self-confidence among undergraduate nursing students during clinical practice. A total of 293 students were enrolled. Six nursing colleges were selected by simple sampling technique, two from the government and four from privately owned colleges. The third- and fourth-year students were included from the six colleges proportionally. The students were chosen by a systematic random sampling method from each college proportionally. Data were collected using a self-administered, semi-structured questionnaire through the Nursing Anxiety and Self-confidence with Clinical Decision-Making Scale. It was entered into Epidata 4.6 and then exported to SPSS version 26.0 for final analysis. Bivariate analysis at a P value of 0.25 and multivariable analysis at a P value of 0.05 were applied.

Result:
A total of 275 students participated in this study. The proportion of perceived good self-confidence of nursing students during clinical practice was 49.1%, and for perceived anxiety, it was 46.9%. The sex of the students, their perception that clinical instructors were prepared well during clinical attachments, their belief that a shortage of staff in the hospital affected clinical learning, and the perceived self-confidence of nursing students were significant predictors of the perceived anxiety of the students.

Conclusion and recommendation:
The students who had poor perceived self-confidence were five times more likely to be more anxious than those having good perceived self-confidence. This research strongly recommends that students should be motivated and evaluated regularly for anxiety and self-confidence during clinical practice and provide a pleasant clinical experience.
Rare Delayed Immune Thrombocytopenic Purpura Associated With Neoadjuvant Immunotherapy
Authors: Xiong Teng-Teng , Ma Si-Rui , Yu Zi-Li , Jia Jun 
Published: December 2024

Background:
Immunotherapy targeting the PD-L1/PD-1 checkpoint pathway with monoclonal antibodies has demonstrated significant and durable efficacy across various malignancies. However, these immunotherapies can induce adverse reactions, collectively referred to as immune-related adverse events (irAEs). Most irAEs occur during immunotherapy. To date, there have been no reported cases of immune thrombocytopenia occurring after the cessation of immunotherapy and subsequent surgery. This article aims to detail such an immune-related adverse event.

Methods:
The authors describe a 67-year-old male patient with oral squamous cell carcinoma who underwent 4 cycles of neoadjuvant immunochemotherapy without complications during treatment. On the seventh day post-surgery, the patient developed immune thrombocytopenia. Upon the onset of thrombocytopenia, platelet transfusions and thrombopoietic agents were administered, but without significant improvement. Intravenous immunoglobulin (IVIG) therapy was then initiated.

Results:
The patient received IVIG at a dose of 400 mg/kg for 5 consecutive days. both platelet count and hemoglobin levels stabilized.

Conclusion:
Immune thrombocytopenia typically occurs within 10 weeks of initiating immunotherapy. In this case, the patient experienced no hematologic complications during a treatment period extending over 3 months. However, after cessation of immunotherapy and subsequent surgery, delayed onset immune thrombocytopenia occurred. Clinicians must recognize the importance and complexity of diagnosing immune thrombocytopenia (ITP).
Risk Factors, Manifestations, and Implications of Chyle Leak –Following Pancreatic Surgery
Authors: Li Huiliang , Ma Tao , Lin Wei-Chiao , Lao Mengyi , Qian Tao , Liu Ziwei , Gao Shunliang , Bai Xueli , Liang Tingbo 
Published: December 2024

Objective:
To identify the risk factors, manifestations, and clinical implications of chyle leak (CL) after pancreatic surgery, and to reappraise the International Study Group for Pancreatic Surgery (ISGPS) definition and classification of CL.

Summary Background Data:
The risk factors, clinical scenarios, and management of CL after pancreatic surgery remain controversial.

Methods:
Data from patients who underwent pancreatic surgery between January 2019 and July 2023 were retrieved from an institutional database. The risk factors, manifestations, and clinical impact of CL were analyzed.

Results:
Of the 1,063 patients enrolled, 117 (11.0%) developed CL, including 33 grade A and 84 grade B. Minimally invasive approach (OR: 3.087, 95% CI: 1.790-5.236, P<0.001) and maximum daily drainage volume (OR: 1.004, 95% CI: 1.003-1.005, P<0.001) were identified as independent risk factors for CL. Three hundred ninety-six patients (37.3%) presented with triglyceride (TG)-rich (≥1.2 mmol/L) drainage without a milky-colored appearance. The length of postoperative stay for patients with large-volume (≥300 mL/day), TG-rich but non-milky drainage (n=72) was significantly longer than that for patients with small-volume (<300 mL/day) (n=324, median, 19 days vs. 14 days, P<0.001), and it was comparable to that for patients with large-volume (≥300 mL/day), TG-rich, and milky drainage (n=74, median, 19 days vs. 22 days, P=0.126).

Conclusion:
Minimally invasive approach and daily maximum drainage volume were independent risk factors for CL in this cohort. Post-pancreatectomy patients with large-volume, TG-rich but non-milky drainage should be treated like clinically relevant CL.
Differentiating Benign and Hepatocellular Carcinoma Cirrhotic Nodules: Radiomics Analysis of Water Restriction Patterns with Diffusion MRI
Authors: Arian Arvin , Samadi Khoshe Mehr Fardin , Setayeshpour Babak , Delazar Sina , Nahvijou Azin , Nasiri-Toosi Mohsen , Fotouhi Maryam 
Published: December 2024

AbstractObjectivesCurrent study aimed to investigate radiomics features derived from two-center diffusion-MRI to differentiate benign and hepatocellular carcinoma (HCC) liver nodules.MethodsA total of 328 patients with 517 LI-RADS 2-5 nodules were included. MR images were retrospectively collected from 3T and 1.5T MRI vendors. Lesions were categorized into 242 benign and 275 HCC based on follow-up imaging for LR-2,3 and pathology results for LR4,5 nodules, and randomly divided into training (80%) and test (20%) sets. Preprocessing included resampling and normalization. Radiomics features were extracted from lesion volume-of-interest (VOI) on diffusion Images. Scanner variability was corrected using ComBat harmonization method followed by High-correlation filter, PCA filter, and LASSO to select important features. Best classifier model was selected by 10-fold cross-validation, and accuracy was assessed on the test dataset.Results1,434 features were extracted, and subsequent classifiers were constructed based on the 16 most important selected features. Notably, support-vector machine (SVM) demonstrated better performance in the test dataset in distinguishing between benign and HCC nodules, achieving an accuracy of 0.92, sensitivity of 0.94, and specificity of 0.86.ConclusionsUtilizing diffusion-MRI radiomics, our study highlights the performance of SVM, trained on lesions’ diffusivity characteristics, in distinguishing benign and HCC nodules, ensuring clinical potential. It is suggested that further evaluations be conducted on multi-center datasets to address harmonization challenges.Advances in knowledgeIntegration of diffusion radiomics, for monitoring water restriction patterns as tumor histopathological index, with machine learning models demonstrates potential for achieving a reliable noninvasive method to improve the current diagnosis criteria.