bluuebunny/crossref_metadata_2025_split huggingface dataset:
Hypotension after unilateral versus bilateral spinal anaesthesia
Authors: Gong Cansheng , Ye Xiuming , Liao Yanling , Ye Peng , Zheng Ting , Zheng Xiaochun 
Published: November 2024

BACKGROUND
Spinal anaesthesia is frequently used in surgical procedures involving the lower abdomen and extremities, however, the occurrence of hypotension remains a common and clinically important adverse effect. Unilateral spinal anaesthesia seems to be a promising approach to minimise this complication but the effectiveness of this remains controversial.

OBJECTIVE
A meta-analysis was undertaken to evaluate the superiority of unilateral spinal anaesthesia over bilateral spinal anaesthesia with regard to the incidence of hypotension and other complications.

DESIGN
Systematic reviews and meta-analysis of randomised controlled trials (RCTs).

DATE SOURCES
PUBMED, Embase, Web of Science and Cochrane Central Register of Controlled Trials databases were searched from their inception to 5 March 2024.

ELIGIBILITY CRITERIA
Randomised controlled trials (RCTs) comparing unilateral spinal anaesthesia with bilateral spinal anaesthesia were eligible for inclusion. Observational studies, case reports, case series, and studies not conducted in humans were excluded. The incidence of hypotension, vasopressor requirement, and other complications were compared. Heterogeneity was assessed by subgroup analyses and sensitivity analysis.

RESULTS
Twenty-one trials involving 1358 patients undergoing unilateral lower extremity surgery or lower abdominal surgery were included in the meta-analysis. Hyperbaric solutions were used in most trials. The Mantel–Haenszel random-effect model was used for the analysis of binary endpoints, reported as relative risk (RR) with a 95% confidence interval (CI). The incidence of hypotension was significantly lower in the unilateral spinal anaesthesia group compared with the bilateral spinal anaesthesia (RR 0.38, 95% CI 0.27 to 0.55; P < 0.001; I
2 = 38%). Subgroup analysis shows that the occurrence of hypotension was significantly lower in the unilateral subgroup, regardless of dosage, surgical site, adjuvants to the local anaesthetics, and different definitions of hypotension.

CONCLUSIONS
Unilateral spinal anaesthesia is associated with a significant reduction in the occurrence of hypotension, despite variations in the definition of hypotension, adjuvants, and site of surgery. These results favour the use of lateral spinal anaesthesia in patients undergoing unilateral lower abdominal or lower limb surgery. However, the GRADE assessment of the quality of evidence was ‘low’ due to the high risk of bias and heterogeneity. All the results should be treated with caution.
Recurrent Gallstone Ileus, A Deadly Encounter
Authors: Zen Ong Xin , Mohamad Ikhwan Sani , Ramasamy Umasangar , Shah Mohd Shahrulsalam Mohd 
Published: November 2024

Abstract
Gallstone disease is rampant due to global shift towards an unhealthy lifestyle. Gallstone ileus is a rare occurrence, accounting for 1-4% of all cases of mechanical small bowel obstructions. Computed tomography (CT) scan is a good preliminary diagnostic tool to assess patient suspicious of gallstone ileus. Incidence of recurrent gallstone ileus is as high as 20% and poses a diagnostic dilemma in the immediate postoperative week. Despite advancement in modern medicine, surgical intervention for gallstone ileus is associated with high mortality rate. This could be attributed by the elderly patient cohort with multiple comorbidities.
Surgery With Peripheral Nerve Block Under Dexmedetomidine Sedation for Foot Ulcer
Authors: Nakamura Hideharu , Makiguchi Takaya , Yamada Yumi , Sakurai Kei , Tsunoda Aya , Tomaru Nana , Shirabe Ken , Yokoo Satoshi 
Published: November 2024

Background:
Patients who require surgical treatment for diabetic foot ulcer (DFU) or chronic limb-threatening ischemia (CLTI) are often in generally poor condition and have complications. General anesthesia may be risky in surgery for such patients. Thus, the authors perform surgery using peripheral nerve block under dexmedetomidine sedation for patients with DFU and CLTI.

Methods:
This study evaluated intraoperative stress, anxiety, and safety in 18 patients undergoing peripheral nerve block with dexmedetomidine. Sedation levels were assessed using the observer’s assessment of alertness/sedation (OAA/S) score on a 5-point scale from 5 (awake) to 1 (deeply sedated). Postoperatively, a questionnaire was administered to assess intraoperative stress and memory. Intraoperative stress was assessed using a 6-point face scale (0 to 6: not at all to unbearably high), and intraoperative memory was rated on a 5-point numeric scale (1 to 5: no memory to everything).

Results:
The intraoperative OAA/S score was 3–5, indicating that appropriate sedation was obtained. The mean intraoperative stress score was 0.72 (range: 0–3), and the mean intraoperative memory score was 2.44 (range: 1–4). One patient had bradycardia and 9 had hypoxemia. All of these cases were improved by decreasing the dose of dexmedetomidine and encouraging deep breathing on call.

Conclusions:
These results suggest that this procedure is a useful method to reduce patient burden and alleviate stress and anxiety during surgery. However, dexmedetomidine may cause hypoxemia in patients with DFU or CLTI; thus, attention should be paid to hypoxemia and countermeasures should be taken against this adverse effect.
New Findings in Prominent Lower Eyelid Fat Pads Possibly Contributing to Their Etiology: Two Prospective Studies
Authors: Sweis Iliana E. , Cressey Bryan C. 
Published: November 2024

Background:
Little is known about the actual composition of prominent orbital fat pads. It was incidentally noted that hyaluronidase injections in prominent lower eyelid fat pads attenuated them, suggesting prevalence of hyaluronic acid (HA), and raising questions regarding their etiology. This led to 2 institutional review board studies: The first quantified HA concentration in orbital fat pads and assessed possible correlation between HA levels and degree of lower eyelid puffiness. The second determined if regular hyaluronidase injections in prominent lower eyelid fat pads impacted their size to uncover a possible role of intrinsic HA and its hydrophilic properties in their etiology.

Methods:
Lower eyelid orbital fat harvested from 20 filler-naive blepharoplasty patients underwent enzyme linked immunosorbent assay for HA quantification. A separate group of 14 filler-naive patients requesting nonsurgical treatment of lower eyelid puffiness were treated with a series of hyaluronidase injections.

Results:
HA levels in prominent eyelid orbital fat pads averaged 39.3 µg/mg of the dry weight, higher than reported in other solid human tissues. Orbital fat HA levels correlated with the degree of clinical puffiness. Hyaluronidase attenuated lower eyelid puffiness in 78.6% of patients. The extent and duration of improvement varied between responders but increased with repetitive injections.

Conclusions:
Prominent orbital fat pads have a higher HA concentration than reported in other solid human tissues. HA hydrophilic properties likely contribute to fat pad edema manifesting as puffiness. Attenuation of prominent lower eyelid fat pads following hyaluronidase injections further implicates intrinsic HA in the etiology of prominent eyelid fat pads.
TNF alpha Inhibitors in Cardiac Sarcoidosis: A Systematic Review and Meta-Analysis
Authors: Mahmood Asma , Raja Mahnoor Farooq , Imran Habiba , Zahoor Bushra , Khan Khakwani Mohammad Sadiq , Duseja Nikhil , Rahman Ihtisham , Murtaza Aiman , Abid Hafiz Muhammad Faizan , Sattar Muhammad Sohail , Bajaj Neha , Bajaj Saneha , Tariq Laiqa , Shafiq Aimen 
Published: November 2024

Background:
Recent studies have focused on treating cardiac sarcoidosis (CS) with corticosteroids primarily mitigating symptoms and reducing the risk of mortality and other cardiovascular complications. A promising new treatment approach involves tumor necrosis factor (TNF) alpha inhibitors.

Methodology:
A systematic search was conducted on PubMed, the Cochrane Library, and Elsevier’s Science Direct databases to identify studies comparing TNF alpha inhibitors with other drugs in CS patients who had heart failure. The analyses were conducted using the random-effects model.

Results:
The study’s primary outcome is an increase in ejection fraction (EF), secondary outcomes include a reduction in the dose of prednisone at 6 and 12 months, maximum standardized uptake value by cardiac tissue, and fluorodeoxyglucose uptake by cardiac myocytes on positron emission tomography scan. The total number of pooled participants was 154 out of which 140 met the Heart Rhythm Society criteria for CS. The pooled analysis showed that treatment with the TNF alpha inhibitors was associated with a significant increase in EF [weighted mean difference (WMD), 46.272; 95% confidence interval (CI), 40.60–51.94, P < 0.001; I
2, 75.74%], reduction in the dose of prednisone at 6 months (WMD, 9.20; 95% CI, 7.65–10.75; P < 0.001; I
2, 13.33%) and at 12 months (WMD, 6.40; 95% CI, 4.74–8.07; P < 0.001; I
2, 9.37%); decrease in myocardial maximum standardized uptake value (WMD, 1.99; 95% CI, 0.91–3.06; P < 0.001; I
2: 97%) and reduction in fluorodeoxyglucose uptake by cardiac myocytes (WMD, 1.55; 95% CI, 1.09–2.00; P < 0.001; I
2, 32.29) on positron emission tomography scans.

Conclusions:
The research findings suggest that TNF alpha inhibitors improve EF, reduce required steroid dosage, and improve clinical outcomes. Nonetheless, further high-quality randomized controlled trials with large sample sizes are needed to assess other impacts of this therapy on patients with CS.
Patient-triggered Events Poorly Predict the Presence of Atrial Tachyarrhythmia on Ambulatory Electrocardiogram Monitors in Patients With Heart Failure
Authors: Herner Maranda , Abedin Zameer , Torre Michael , Zhang Yue , Orton Cody , Lyons Ann , Steinberg Benjamin A. 
Published: November 2024

Background:
Ambulatory electrocardiogram (AECG) monitoring is an attractive method for objectively identifying atrial fibrillation (AF) symptoms by documenting simultaneous arrhythmia with symptomatic episodes. However, no study yet has evaluated this simultaneous symptom-rhythm correlation in patients with heart failure (HF). We aimed to measure the correlation between symptoms and atrial arrhythmia (ATAF) episodes among patients with HF and known AF using prolonged AECG monitoring.

Methods:
We analyzed ATAF events and patient-triggered symptomatic events (PTSEs) on AECG monitors in adults with a history of AF and HF.

Results:
Among 959 monitors, we identified a total of 26,634 events, including 15,787 ATAF events and 4950 PTSE. The mean age was 70 years, 48% were female, and 91% were Caucasian. Among 4950 PTSEs, only 1116 demonstrated ATAF (23%). PTSE showed a low correlation with ATAF, with a moderate inverse tetrachoric correlation of −0.62 (bootstrapped 95% confidence interval: −0.61 to −0.63). The mean heart rate (HR) of symptomatic ATAF events was 115 bpm (SD: 33), compared with asymptomatic ATAF (107 bpm, SD: 33, P < 0.001). The mean HR of all symptomatic events was 92 bpm (SD: 28) and of asymptomatic events was 99 bpm (SD: 30), P < 0.001.

Conclusions:
Our study found that symptomatic events on AECG monitors poorly predict ATAF episodes, ATAF episodes are rarely noted as symptomatic, and poor HR control fails to fully explain AF symptoms in patients with known AF and HF. Our study encourages further research into other symptom assessments, such as patient-reported outcomes and a more comprehensive approach to AF treatment in HF rather than primarily symptom based.
Even a Low Comorbidity Burden Predicts Poor Outcomes in Chronic Heart Failure
Authors: Elias Catarina , Neves Ana , Gouveia Rita , Madureira Sérgio , Ribeirinho-Soares Pedro , Soares-Carreira Marta , Pereira Joana , Almeida Jorge , Lourenço Patrícia 
Published: November 2024

Background:
Patients with heart failure often have multiple cardiovascular risk factors (CVRFs) and comorbidities (CMBs). We evaluated the impact of additive CMB and CVRF on heart failure prognosis.

Methods:
We retrospectively analyzed ambulatory patients with systolic dysfunction between January 2012 and May 2018. Follow-up was until January 2021. The endpoint was all-cause death. CVRF analyzed arterial hypertension, diabetes mellitus, and smoking. CMB evaluated coronary artery disease, noncoronary atherosclerotic disease, respiratory disease, dementia, anemia, chronic kidney disease, inflammatory/autoimmune disease, active cancer, and atrial fibrillation. Classification according to the number of CVRFs and/or CMBs is <2 and ≥2. The independent prognostic impact of CVRF/CMB burden was assessed with multivariate Cox regression.

Results:
Most patients had ≥2 CMBs (67.9%). Regarding CVRF, 14.9% presented none, 40.2% had 1, and 32.1% had 2. During a median 49-month follow-up, 419 (49.1%) patients died. Mortality was higher among patients with ≥2 CVRFs (56.1 versus 43.4% in those with <2) and in those with ≥2 CMBs (57.7 versus 31.0%). While patients with 1 CMB had similar mortality than those with none. Patients with ≥2 CMBs had higher long-term mortality risk: hazard ratio (HR), 2.47 (95% CI, 1.95–3.14). In patients with ≥2CVRFs, the HR of dying is 1.39 (95% CI, 1.14–1.70). When taken together, there was a clear survival disadvantage for patients with ≥2 CVRFs/CMBs—adjusted HR, 2.20 (95% CI, 1.45–3.34).

Conclusions:
The presence of only 2 CVRFs/CMBs more than doubles the patients´ risk of dying. CVRF and CMB should be assessed as part of routine patient management.
Characteristics and Outcomes of Descemet Membrane Endothelial Keratoplasty for Treatment of Failed Endothelial Keratoplasty
Authors: Price Marianne O. , Navarro Luis Valdes , Feng Matthew T. , Gang Anjulie , Price David A. , Price Francis W. 
Published: November 2024

Purpose:
To evaluate Descemet membrane endothelial keratoplasty (DMEK) for failed endothelial keratoplasty (EK).

Methods:
We reviewed 362 consecutive DMEK cases for failed EK (Descemet stripping endothelial keratoplasty (DSEK) or DMEK), 118 for early EK failure, and 244 for late failure in 333 eyes of 323 patients without penetrating keratoplasty. Rejection and graft survival rates were assessed with Kaplan–Meier analysis.

Results:
Overall, 85% of cases had 1 prior EK and 15% had 2 to 5. The rate of medically or surgically managed glaucoma was 21% in eyes with 1 failed EK, 51% in eyes with 2, and 80% in eyes with ≥3, P <0.0001. The mean postoperative corrected visual acuity was 20/25 ± 1 line at 1 and 5 years in eyes without vision-limiting comorbidity. The 5-year rejection episode rate was 4%. One- and 5-year survival rates of DMEK regrafts for early failure of an initial EK were 98% and 94%, respectively. One- and 5-year survival rates among all cases of DMEK for EK failure were 96% and 91% in eyes not treated for glaucoma preoperatively, 88% and 81% in eyes with medically managed glaucoma, and 88% and 30% in eyes with a trabeculectomy or tube shunt.

Conclusions:
DMEK for failed EK provided rapid visual rehabilitation with low risk of rejection. Graft survival was associated with glaucoma status and original indication for keratoplasty, with Fuchs dystrophy having the most favorable prognosis. Survival rates were highest in eyes treated for early failure of an initial EK.
Definitive Treatment of Lisch Epithelial Corneal Dystrophy via Staged Keratectomy and Targeted Minor Limbal Excision With Cautery
Authors: Tuteja Sahib Y. , Lockington David 
Published: November 2024

Purpose:
We demonstrate a novel approach for the definitive treatment of Lisch epithelial corneal dystrophy via an unintentionally staged alcohol keratectomy and intentionally targeted minor limbal excision with cautery.

Methods:
A 46-year-old woman presented with visually significant corneal changes, suspected to be Lisch epithelial corneal dystrophy after clinical examination, anterior segment optical coherence tomography, and confocal microscopy. Alcohol keratectomy was performed with complete resolution, but there was visually significant recurrence at 2 years. As the abnormal epithelial recurrence originated in a linear tapered pattern from a focal superior limbal region, minor limbal excision with cautery and alcohol keratectomy was performed.

Results:
Histopathological analysis demonstrated cytoplasmic vacuolation and glycogen granules. The limbal tissue demonstrated normal histological features. The patient's vision returned to baseline on reepithelialization with a clear cornea, with no recurrence in over 5-year follow-up.

Conclusions:
Our targeted two-staged approach provides definitive treatment for Lisch epithelial corneal dystrophy and highlights the focal limbal origin of abnormal cells.
Fasciotomy for Chronic Exertional Compartment Syndrome of the Deep Posterior Lower Leg Compartment: A Prospective Study
Authors: van den Heuvel-Weiss Chris , Goossens Sari , Janssen Loes , van Eerten Percy , de Bie Rob , Scheltinga Marc 
Published: November 2024

Objective:
Patients with lower leg deep posterior chronic exertional compartment syndrome (dp-CECS) experience exercise-induced calf pain and tightness. Retrospective studies suggest that outcome after a fasciotomy is suboptimal. This prospective case series determined success rates of a fasciotomy and identified factors predicting outcome.

Design:
Severity and intensity of pain and tightness were scored at baseline (BL) and 3 and 12 months postoperatively (follow-up [FU]3, FU12). Outcome measures were symptoms, return to sports, and patient-reported success.

Patients:
Data of patients with dp-CECS (n = 74, 51% males, age 28 ± 12 years) operated between 2013 and 2022 in a single center were analyzed.

Results:
Pain scores during rest and during exercise were greatly attenuated (rest BL: 8 ± 1, FU3: 4 ± 1, FU12: 3 ± 0; exercise BL: 20 ± 1, FU3: 8 ± 1, FU12: 8 ± 1; both P < 0.001). At FU3, rates of success and return to sports were 56% and 63%, respectively. At FU12, success was maintained in 48% and 80% had returned to sports. Length of symptom duration and not opening the flexor hallucis compartment were related to a lower chance of return to sports (P < 0.05).

Conclusions:
Outcome after a fasciotomy for lower leg dp-CECS is successful in approximately half of patients. Long duration of symptoms and not opening the flexor hallucis compartment are risk factors for failure.
Platelet-Poor Plasma for the Treatment of Acute Hamstring Muscle Injuries in Collegiate Football Athletes: A Cohort Study
Authors: Kruse Ryan C. , Volfson Elena 
Published: November 2024

Objective:
To evaluate the efficacy of platelet-poor plasma injections for the treatment of acute hamstring muscle strains.

Design:
Cohort study.

Setting:
Outpatient Sports Medicine Clinic.

Participants:
Twenty consecutive patients with an acute hamstring muscle injury from 2021 to 2022 were included.

Interventions:
Platelet-poor plasma injection into the hamstring muscle strain.

Main Outcome Measures:
Time (days) until return to full unrestricted participation in sport.

Results:
All patients were male collegiate football athletes, with an average age of 20 (±1.6) years old. The most commonly injured muscle was the semitendinosus (65%). After treatment with platelet-poor plasma, patients on average returned to full, unrestricted participation in sport at 29.4 (±7.2) days postinjury, with a statistically significant improvement in pain as early as 2 weeks postinjection. No recurrent injuries to the affected hamstring muscles were seen within 12 months.

Conclusions:
PPP may be a safe and effective treatment for acute hamstring muscle strains and may potentially expedite time to return to play.
The Impact of Professional Governance on Hope, Resilience, and Empowerment
Authors: Partridge Alison , Jorgenson Marcey , Johnson Emily , Lott Tanya 
Published: November 2024

OBJECTIVE
The purpose of this cross-sectional descriptive study was to examine the relationship of professional governance, resilience, and empowerment among RNs in clinical practice in 1 healthcare system.

BACKGROUND
Given the emotional and physical demands of nursing, especially in recent years, exploring ways that hope-inducing and resilience-building models can support professional practice is vital to the current and future nursing workforce.

METHODS
An anonymous survey consisting of demographic questions, the Adult Hope Scale, Connor-Davidson Resilience Scale, and the Conditions for Work Effectiveness Questionnaire II was offered to 1450 RNs in a nonprofit community-based healthcare system for volunteer participation.

RESULTS
Nurses who formally participated in professional governance nursing councils reported higher hope, resilience, and work effectiveness scores compared with nurses who did not participate in professional governance.

CONCLUSIONS
Based on these initial results, encouraging and creating avenues for the participation of RNs in professional governance are paramount to build a resilient, hopeful, and empowered workforce.
Nurse Leader Perspectives on Precepting in a Graduate Nursing Administration Practicum
Authors: Hickman Linda J , Petri Laura , Connors James 
Published: November 2024

OBJECTIVE
To describe practicum experiences as perceived by nurse leader preceptors of graduate students in a nursing administration practicum.

BACKGROUND
Practicum experiences in graduate nursing administration programs provide students with exposure to the real-life experiences of nurse leaders, bridging the gap between academic knowledge gained and the application of that information to the workplace. The literature lacks best practices for graduate nursing administration practicum experiences.

METHODS
Eight nurse leaders were interviewed using a semistructured format. Data were transcribed and subjected to selective thematic analysis.

RESULTS
Five themes were identified: professional and personal growth, transition of education into practice, academic partner engagement and support, time, and contributions to the organization.

CONCLUSION
Leadership practicum experiences provide a real-world perspective and are an essential part of growing future nurse leaders. This study yielded invaluable insight from nurse leader preceptors, recommendations for structuring graduate nursing administration practicums, and implications for sustaining resilient academic-practice partnerships.
Key Factors Supporting Nursing Students’ Academic Success and Recommendations to Enhance Learning Outcomes
Authors: Bahari Ghareeb 
Published: November 2024

Background:
Understanding the factors that contribute to nursing students’ low self-efficacy and high stress levels is necessary to improve educational practices.

Purpose:
To determine the impact of self-efficacy and demographic factors on nursing students’ stress levels and academic success and to provide strategic recommendations for nurse educators.

Methods:
This cross-sectional study included data of 145 nursing students collected using a structured questionnaire that assesses self-efficacy, stress, and covariates. Bivariate and multivariate tests were conducted to explore potential relationships among variables.

Results:
The results indicated significant relationships among self-efficacy, stress, and demographic factors. While self-efficacy levels were influenced by gender and marital status, stress levels appeared to be affected by gender, age, and the academic semester. Self-efficacy and stress among nursing students were also significantly associated.

Conclusion:
Nurse educators should develop a supportive learning environment, better mentorship programs, and effective mental health awareness to improve students’ confidence and academic success.