bluuebunny/crossref_metadata_2025_split huggingface dataset:
Local Anesthesia With 1% Lidocaine Versus General Anesthesia for Percutaneous Endoscopic Interlaminar Discectomy at L5/S1 Disc Herniation​​​
Authors: Wang Xin , Shen Junjie , Chen Zhiheng , Cai Bin , Chen Yuanyuan , Zhang Guowang , Xu Jianguang , Lian Xiaofeng 
Published: December 2024

Study Design:
A prospective randomized clinical trial.

Objective:
In this study, we compared local anesthesia with 1% lidocaine (LA) and general anesthesia (GA) utilized in PEID at L5/S1 disc herniation.

Summary of Background Data:
Given the anatomic characteristics of L5/S1 segment, interlaminar approach was preferred to perform endoscopic discectomy for L5/S1 disc herniation. Typically, general anesthesia was used for interlaminar approach. However, with general anesthesia, nerve damage during surgery due to being unable to monitor patient status is a main concerned for surgeons. As an alternative option, local anesthesia has been developed recently. But, the optimal type of anesthesia for PEID remains controversial.

Methods:
From March 2021 to March 2023, 103 consecutive patients with L5/S1 disc herniation who planned to undergo PEID in our unit were randomized to the LA group (n=53) or GA group (n=50). Both groups were followed up for at least 24 months. Surgical-related parameters, clinical outcomes, and complications were compared between the 2 groups.

Results:
The mean operative time and bed rest time were shorter in the LA group than in the GA group (both P<0.001). The estimated blood loss in the LA group was greater than that in the GA group (P<0.001). The cost of hospitalization in the LA group was significantly lower than that in the GA group (P<0.001). At every time point of follow-up, there was no significant difference between the 2 groups in terms of VAS, ODI, and modified MacNab criteria. The satisfaction surveys showed that more patients in the LA group would choose contrary anesthesia, including 6 patients who were administered extravenously injected sufentanil intraoperatively due to intensive pain. Postoperative neuropathic abnormalities were rarer in the LA group.

Conclusions:
Both local anesthesia using 1% lidocaine and general anesthesia are effective and safe for PEID at the L5/S1 segment. The use of local anesthesia is preferable due to its associated reductions in operative time, bed rest duration, and economic costs.
Crystalloid Liberal or Vasopressors Early Resuscitation in Sepsis-Study of Treatment’s Echocardiographic Mechanisms (CLOVERS-STEM)
Authors: Lanspa Michael J. , Khan Akram , Lyons Patrick G. , Gong Michelle N. , Naqvi Ali A. , Dugar Siddharth , Duggal Abhijit , Johnson Nicholas J. , Schoeneck Jacob H. , Smith Lane , Bose Somnath , Shapiro Nathan I. , Shvilkina Tatyana , Groat Danielle , Jacobs Jason R. , Olsen Troy D. , Cannavina Steven , Knox Daniel B. , Hirshberg Eliotte L. , Self Wesley H. , Brown Samuel M. 
Published: December 2024

IMPORTANCE:
Receipt of fluid and vasopressors, common treatments in septic shock, may affect cardiac function.

OBJECTIVES:
We sought to determine whether a liberal or restrictive fluid resuscitation strategy was associated with changes in cardiac function.

DESIGN:
We prospectively studied a subset of patients enrolled in the Crystalloid Liberal or Vasopressors Early Resuscitation in Sepsis (CLOVERS) trial, performing echocardiography at baseline and at 24 hours after randomization. Among patients who had an echocardiogram performed at 24 hours, we measured left ventricular global longitudinal strain (LV GLS) and right ventricular free-wall longitudinal strain (RVFWLS). We performed linear regressions with dependent variables of LV GLS, change in LV GLS (ΔLV GLS), and RVFWLS using treatment assignment as an independent variable. We adjusted for ratio of early diastolic mitral inflow velocity to early diastolic mitral annulus velocity, mean arterial pressure, and history of congestive heart failure and myocardial infarction.

SETTING:
Emergency department and ICUs.

PATIENTS:
Adults with sepsis enrolled in the CLOVERS trial.

MAIN OUTCOMES AND MEASURES:
We enrolled 180 patients. Our analytic cohort comprised 131 patients with an echocardiogram performed at 24 hours. We observed no differences between treatment arms with respect to demographic, clinical, or echocardiographic data at baseline. We observed no association between restrictive fluid assignment and LV GLS (coefficient, 1.22; p = 0.23), ΔLV GLS (–1.97; p = 0.27), or RVFWLS (2.33; p = 0.19).

CONCLUSIONS AND RELEVANCE:
In a subset of patients enrolled in CLOVERS, we observed no association between receipt of fluid and vasopressors and short-term changes in cardiac function. Decreased enrollment may limit inferences.
Per- and poly-fluoroalkyl substances exposure and risk of gastrointestinal cancers: a systematic review and meta-analysis
Authors: Zhang Sirui , Kappil Elizabeth Maria , Zheng Tongzhang , Boffetta Paolo , Seyyedsalehi Monireh Sadat 
Published: December 2024

Background
Per- and poly-fluoroalkyl substances (PFASs) are a group of synthetic chemicals used since the 1940s in industrial and consumer applications. These substances are known or suspected to cause cancer, particularly kidney and testicular cancer. However, their association with other types of cancer is not well understood. This review aims to investigate the link between PFAS exposure and the risks of other cancers, including gastrointestinal cancers such as esophageal, gastric, colorectal, and pancreatic cancer.

Methods
We conducted a systematic review of literature from the International Agency for Research on Cancer Monographs, Agency for Toxic Substances and Disease Registry documents, and PubMed (up to January 2024) focusing on the association between PFAS exposure and gastrointestinal cancers. Four independent reviewers screened the studies, extracted the information, and evaluated the quality of the studies using a modified Newcastle-Ottawa Scale. Meta-analyses were performed with random-effects models, including stratified analyses and dose-response assessments.

Results
The meta-analysis included 17 studies. The summary relative risks (RR) of esophageal cancer for perfluorooctanoic acid (PFOA) exposure was 0.75 (95% confidence interval [CI], 0.35–1.60; n = 2), and for perfluorooctane sulfonic acid (PFOS) was 1.76 (95% CI, 0.32–9.68; n = 1). The RR for gastric cancer and PFOA was 0.59 (95% CI, 0.28–1.21; n = 2) and PFAS was 0.96 (95% CI, 0.83–1.12; n = 2). The RR for colorectal cancer and PFOA was 0.83 (95% CI, 0.65–1.06; n = 6) and PFOS was 0.71 (95% CI, 0.22–2.27; n = 4). The RR for pancreatic cancer was 1.02 (95% CI, 0.90–1.15; n = 9) and PFOS was 0.92 (95% CI, 0.76–1.11; n = 2). Stratified analyses by geographical region, study design, quality score, year of publication, gender, and outcome revealed no associations for colorectal and pancreatic cancers. No dose-response trends were identified. Publication bias was suggested for gastric cancer.

Conclusion
Our study suggested no association between PFAS exposure and esophageal, gastric, colorectal, or pancreatic cancer. More rigorous research is needed to investigate this relationship in different settings, with precise PFAS quantification, a wider range of compounds, larger sample sizes for specific cancers, and better control for potential confounders. Our meta-analysis suggests inconclusive evidence, highlighting the need for further research.
Unveiling the molecular and cellular links between obstructive sleep apnea-hypopnea syndrome and vascular aging
Authors: Liu Wei , Zhang Le , Liao Wenhui , Liu Huiguo , Liang Wukaiyang , Yan Jinhua , Huang Yi , Jiang Tao , Wang Qian , Zhang Cuntai 
Published: December 2024

Abstract
Vascular aging (VA) is a common etiology of various chronic diseases and represents a major public health concern. Intermittent hypoxia (IH) associated with obstructive sleep apnea-hypopnea syndrome (OSAHS) is a primary pathological and physiological driver of OSAHS-induced systemic complications. A substantial proportion of OSAHS patients, estimated to be between 40% and 80%, have comorbidities such as hypertension, heart failure, coronary artery disease, pulmonary hypertension, atrial fibrillation, aneurysm, and stroke, all of which are closely associated with VA. This review examines the molecular and cellular features common to both OSAHS and VA, highlighting decreased melatonin secretion, impaired autophagy, increased apoptosis, increased inflammation and pyroptosis, increased oxidative stress, accelerated telomere shortening, accelerated stem cell depletion, metabolic disorders, imbalanced protein homeostasis, epigenetic alterations, and dysregulated neurohormonal signaling. The accumulation and combination of these features may underlie the pathophysiological link between OSAHS and VA, but the exact mechanisms by which OSAHS affects VA may require further investigation. Taken together, these findings suggest that OSAHS may serve as a novel risk factor for VA and related vascular disorders, and that targeting these features may offer therapeutic potential to mitigate the vascular risks associated with OSAHS.
Evaluation of Nursing Program Values in Nursing Course Assignments
Authors: Hostetler Theda 
Published: December 2024

ABSTRACT:
Using Burris and Owens' (2024) values-based framework, nursing faculty at a Christian university evaluated curriculum and organizational core values (I-CARE values) to identify how the values were incorporated in nursing program course assignments. The university's I-CARE values are considered a means to develop professionalism in nursing students. The evaluation identified gaps in implementation of the organizational core I-CARE values in assignments at the baccalaureate and graduate levels. Resulting implications for nurse educators provide insights that can be applied to other nursing courses and programs. Applicable Scripture and ethical considerations are discussed.
The Origin of Pediatric Hand Molds and Proof of Concept
Authors: Upton Joseph , Khouri Kimberly S. 
Published: December 2024

Background:
The art of casting and creating molds of the hands for teaching anatomy and strategic planning was introduced by Dr. Adrian Flatt and later modified by Dr. Joseph Upton. This article reports on the material and methods of creating low cost and easy to perform 3-dimensional molds that have proven educational for patients, families, residents, and pivotal for surgical planning.

Methods:
Using materials readily available in pediatric operating rooms, the details of the simple, efficient, and cost-effective method of creating hand molds are outlined. Photographs of a small sample size of the mold collection as well as congenital hand deformities are included in this article.

Results:
Over 40 years of molding hands for surgical planning as well as patient and resident education is highlighted. There is also profound public education using these molds as there has been a display of the collection at the Boston Museum of Science for more than 40 years.

Conclusions:
This article provides proof of concept that the use of molds in pediatric hand surgery is low cost, easy to perform, and useful for surgical planning as well as family and resident education.
Stard1 promotes cholestatic liver injury and disease progression by sensitizing to bile acid hepatotoxicity
Authors: Conde de la Rosa Laura , Fàbrega Laura , Torres Sandra , Nuñez Susana , Ribas Vicent , Segalés Paula , Espinosa-Escudero Ricardo , Solsona Estel , Monte María Jesús , Diaz-Gonzalez Alvaro , Marin José J. G. , García-Ruiz Carmen , Fernandez-Checa Jose C. 
Published: December 2024

Background and Aims:
Cholestatic liver diseases are often accompanied by hepatocellular injury, fibrosis, and cirrhosis due to the intracellular accumulation of solutes that cannot be excreted into bile, including bile acids (BAs). These are synthesized in hepatocytes from cholesterol mainly via the classic pathway and in a lower proportion through the mitochondrial acidic pathway. The latter requires STARD1-dependent cholesterol transport to the mitochondrial inner membrane for metabolism, whose contribution to BA-induced hepatotoxicity and cholestatic liver disease is unknown.

Approach and Results:
Here we show that patients with primary biliary cholangitis exhibit increased expression of STARD1 compared to control subjects. Mice with hepatocyte-specific Stard1 deletion (Stard1
Δhep) were more resistant to experimental models of complete (bile duct ligation) and chemical obstructive cholestasis-induced liver injury, inflammation, and fibrosis than Stard1

f/f
mice. Stard1
Δhep mice exhibited reduced hepatic BAs and mitochondrial cholesterol accumulation but increased mitochondrial glutathione levels following bile duct ligation compared to Stard1

f/f
mice. Pharmacological mGSH depletion sensitized primary mouse hepatocytes to a mix of BAs mimicking the profile seen in Stard1
f/f mice after bile duct ligation leading to increased inflammatory response and cytotoxicity.

Conclusions:
These findings highlight a role for STARD1 in cholestatic liver injury and suggest that its targeting may be of relevance for cholestatic liver disease.
=Retinal ischemic perivascular lesions are associated with increased carotid artery stenotic degree
Authors: Wang Hang , Cao Le , Kwapong William Robert , Liu Ruishan , Yan Yuyin , Wan Jincheng , Liu Guina , Hu Fayun , Wu Bo 
Published: December 2024

Purpose:
Retinal ischemic perivascular lesions (RIPLs) have been reported as potential biomarkers for cardiovascular diseases and stroke. We aimed to investigate the RIPLs in carotid artery stenosis (CAS) patients and their association with stenotic degree.

Methods:
Patients with unilateral CAS or carotid artery occlusion were recruited. Optical coherence tomography (OCT) was conducted for assessing the presence, number, and distribution of RIPLs. OCT angiography (OCTA) was used for evaluating microvascular density in superficial vascular complex (SVC) and deep vascular complex (DVC).

Results:
Eighty hundred and fifty-four eyes from 474 CAS patients were included. Ipsilateral eyes had more PRILs compared to contralateral eyes (all p < 0.01). CAS patients with cerebral infarction had a higher incidence and broader distribution of RIPLs compared to those without infarction (both p <0.05). The presence, number, and distribution of RIPLs were positively associated with stenotic degree (all p < 0.001). Eyes with RIPLs had lower SVC density (p = 0.020) compared to eyes without RIPLs.

Conclusions:
RIPLs are anatomical markers of ischemia and are suggested to be associated with cerebral infarction and stenotic degree in CAS patients. OCT/OCTA is a noninvasive tool to detect retinal ischemic changes and quantitatively measure retinal microvascular changes in CAS patients.
Novel Multimodal Imaging in Bilateral Diffuse Uveal Melanocytic Proliferation and Change in the Findings During Follow-up and Treatment
Authors: Sezenoz Almila Sarigul , Aykut Aslan , Ayres Bernadete , Beser Buse Guneri , Juntipwong Sarinee , Demirci Hakan 
Published: December 2024

Purpose:
To describe the advanced multimodal imaging findings of patients with bilateral diffuse uveal melanocytic proliferation (BDUMP) and the changes in these findings over time.

Methods:
Fundus photography, fundus autofluorescence (FAF), fundus fluorescein angiography (FA), spectral domain optical coherence tomography (OCT), B-scan ultrasonography (US), and ultrasound biomicroscopy (UBM) images of the patients diagnosed with BDUMP at a single institution between years 2006-2023 were evaluated.

Results:
Sixteen eyes of 8 patients with BDUMP were included. The median age was 68 years (Range: 49 – 77 years), and the median follow-up time was 11 months (Range: 1 – 79 months). The most common fundus photography findings were pigmentary changes and diffuse orange pigment patches in the posterior pole. The giraffe/leopard pattern of hyperfluorescence on the posterior pole was the most prominent finding in FAF and FA. Different from previous reports, intraretinal hyperreflective foci, outer retinal tubulations, subretinal fibrosis, and bacillary layer detachment in OCT; optic disc hyperfluorescence, and peripheral vascular leakage in FA; 360° ciliary body thickening, and anterior rotation of the ciliary body in UBM were detected.

Conclusions:
We presented various novel multimodal imaging features of BDUMP that may warrant updating current diagnostic criteria and their changes over time. Our newly defined findings also suggest a possible inflammatory component to BDUMP pathogenesis, which may have implications for treatment.
The Neutrophil-Lymphocyte Ratio in Pediatric Preseptal and Orbital Infectious Cellulitis
Authors: Law James J. , Orgul Sarp , Tomlinson Lauren A. , Wladis Edward J. 
Published: December 2024

Purpose:
The neutrophil-lymphocyte ratio (NLR) is an important biomarker in a variety of systemic conditions, though its role in orbital disease remains unclear. We sought to investigate the utility of the NLR in distinguishing orbital cellulitis (OC) from preseptal cellulitis (PC) in a pediatric population.

Methods:
The earliest available NLRs of immunocompetent pediatric patients who presented to the emergency department with OC and PC were calculated from a single institution’s database. Demographic and interventional data related to each encounter were also gathered. NLRs were compared via the Mann–Whitney test between OC and PC cases. Among patients with OC, the relationship between presenting NLR and requirement for surgical intervention and between presenting NLR and subperiosteal abscess was similarly examined. All statistical analyses were performed in GraphPad Prism 9 (Insight Partners, New York, NY, U.S.A.).

Results:
Forty-three encounters of patients with OC and 23 encounters of patients with PC were identified. Median presenting NLR for the OC group was 4.18 (standard deviation: 5.44), whereas for the PC group, it was 1.96 (standard deviation: 2.38), representing a significant difference between the 2 groups (p < 0.001). The 26 patients with OC who required surgical intervention had significantly greater presenting NLR (median NLR: 6.53, standard deviation: 6.29) as compared to the 17 patients with OC who were managed medically (median NLR: 3.09, standard deviation: 2.37, p = 0.003). There was no statistically significant difference between 34 patients with OC who had a subperiosteal abscess (median NLR: 4.40, standard deviation: 5.91) and the 9 patients with OC who did not (median NLR: 3.84, standard deviation: 2.37, p = 0.401).

Conclusions:
An elevated NLR is a useful adjunct to the clinical examination in discerning OC from PC or in risk stratification for patients with OC who may need surgical treatment of their periocular infectious disease. In select cases, a reassuring NLR may allow the cost and radiation exposure associated with radiographic assessment to be avoided.
Symptom Management Guideline Implementation Among Nurses in Cancer-Specific Outpatient Settings
Authors: Teggart Kylie , Silva Amina , Lopez Christian J. , Bryant-Lukosius Denise , Neil-Sztramko Sarah E. , Ganann Rebecca 
Published: December 2024

Background
Oncology outpatients experience high levels of distressing cancer-related symptoms. Nurses can provide high-quality outpatient cancer symptom management following clinical practice guideline recommendations; however, these guidelines are inconsistently used in practice. Understanding contextual factors influencing implementation is necessary to develop tailored implementation strategies.

Objectives
To identify and describe (1) barriers and facilitators influencing symptom management guideline adoption, implementation, and/or sustainability among nurses in cancer-specific outpatient settings and (2) components of strategies used to enhance guideline implementation.

Methods
A scoping review was conducted following Joanna Briggs Institute methodology. CINAHL, EMBASE, EMCARE, MEDLINE, and gray literature sources were searched. Eligibility screening and data extraction were performed in duplicate. The updated Consolidated Framework for Implementation Research and Expert Recommendations for Implementing Change taxonomy informed data extraction and descriptive analysis.

Results
Thirty-six projects from 2004 to 2023 were included; most used quality improvement (n = 14) or quasi-experimental (n = 10) designs. Determinants were most often mapped to the “inner setting” and “individuals—roles/characteristics” Consolidated Framework for Implementation Research domains. Most projects used multiple discrete implementation strategies within the “train and educate stakeholders” (n = 29, 85%) and/or “develop stakeholder interrelationships” (n = 20, 59%) categories.

Conclusions
Nurses may face several barriers to symptom management guideline implementation within cancer-specific outpatient setting workflows and may have limited opportunity to implement guidelines within their current roles. Most projects used educational strategies, which alone may be insufficient to address reported barriers.

Implications for Practice
By identifying barriers, facilitators, and strategies, this scoping review can be used to design tailored strategies to implement symptom management guidelines within outpatient oncology nursing care.
Physical, Social, Psychological, and Environmental Predictors of Life Satisfaction Among Older Adults
Authors: Siegmund Lee Anne , Siedlecki Sandra L. , Bena James F. 
Published: December 2024

Abstract
Life satisfaction is a multidimensional construct impacted by many variables and needs to be explored within that context. A correlational design was used to survey community-dwelling older adults to determine perceptions of life satisfaction and its association with physical, social, psychological, and environmental factors. The sample was primarily White (n = 474 [93%]) but balanced between male (n = 253 [50%]) and female (n = 258 [50%]). The mean age was 73.1 (SD, 4.8) years. Associations with life satisfaction were evaluated using linear regression models. In multivariable modeling, social isolation, living alone, depression, sleep disturbance, social vulnerability, and physical ability predicted life satisfaction. Physical ability was the only predictor of high life satisfaction. Findings underscore the importance of helping older adults with improvements in physical ability and addressing social, psychological, and environmental influences that may lead to low life satisfaction.
Garbage Out: A Radiologist's Guide to Hospital Waste Streams
Authors: White-Dzuro Claire E. , Doyle Patrick W. , Larson Michael C. , Frederick-Dyer Katherine C. 
Published: December 2024

Abstract
What happens to trash after disposal? The management and processing of discarded items is often opaque and taken for granted, but an understanding of hospital waste streams is important for radiology departments and hospital systems for economic, regulatory, and environmental reasons. In this paper, we discuss the numerous waste pathways including general, hazardous, pharmaceutical, radioactive, and electronic waste as well as sustainable waste streams including laundry services, composting, and recycling. Costs, regulatory issues, and environmental considerations associated with each pathway are reviewed. We also describe radiology's specific contributions to each waste stream as well as variations in department practices, tips for optimal use, and future research investigations that could impact waste volume. Healthcare garbage disposal pathways will only increase in importance as our healthcare needs and systems continue to grow, and waste optimization efforts yield benefits to operation costs, environmental ecosystems, and human health.