bluuebunny/crossref_metadata_2025_split huggingface dataset:
Investigation of the Association Between Hyperlipidemia and Ossification of the Posterior Longitudinal Ligament Through Two-Sample Mendelian Randomization Analysis
Authors: Zhang Ranxi , Yang Qiujun , Wang Yang , Zhao Yongsheng 
Published: November 2024

Study Design.
A 2-sample Mendelian randomization (MR) analysis.

Objective.
This study aimed to investigate the association between genetically predicted hyperlipidemia and ossification of the posterior longitudinal ligament (OPLL) using a 2-sample MR analysis.

Background.
Several observational studies suggested associations between hyperlipidemia and OPLL.

Materials and Methods.
Genome-wide association study summary statistics for hyperlipidemia and OPLL were retrieved from the public database. The MR analysis employed the inverse variance weighted method, which was supplemented by MR-Egger, weighted median, and weighted mode analyses. Sensitivity analyses, incorporating the Cochran Q test, MR-Egger regression, and the MR pleiotropy residual sum and outlier test, in addition, assessed the robustness of the findings.

Results.
The inverse variance weighted analysis revealed a significant association between total cholesterol levels and OPLL (odds ratio: 1.44, 95% CI: 1.06–1.96, P = 0.02). Similarly, a significant association was observed between low-density lipoprotein (LDL) cholesterol and OPLL (odds ratio: 1.31, 95% CI: 1.05–1.63, P = 0.02). Supplementary analyses further supported the significant association of total cholesterol levels and LDL cholesterol on OPLL (P < 0.05). In sensitivity analyses, LDL cholesterol exposure showed robust results, with no outliers detected by loo or mrpresso, despite MR-Egger hints at pleiotropy. For total cholesterol exposure, MR-Egger suggested no pleiotropy, though heterogeneity and outliers were present. Outlier removal confirmed the initial positive association, underlining study stability. However, no significant associations were found between hyperlipidemia, triglycerides, and high-density lipoprotein (HDL) cholesterol in OPLL.

Conclusion.
This study suggests an association between total cholesterol levels and LDL cholesterol levels in OPLL. Further research is warranted to validate these findings and explore potential therapeutic implications.
The Impact of Disc Height on Outcomes Following Cervical Disc Replacement
Authors: Kazarian Gregory S. , Cecere Robert , Zabat Michelle A. , Dekhne Mihir S. , Sheha Even , Dowdell James , Iyer Sravisht , Qureshi Sheeraz 
Published: November 2024

Study Design.
Systematic review.

Objective.
To describe the impact of disc height (DH) on outcomes after cervical disc replacement (CDR).

Background.
Implant sizing and positioning may impact outcomes after CDR.

Materials and Methods.
A systematic review was performed in accordance with the “Preferred Reporting Items for Systematic Reviews and Meta-Analyses” guidelines using the EMBASE and PubMed databases. The goal of this review was to assess the impact of postoperative “DH” on clinical and radiologic outcomes after CDR.

Results.
A total of 12 studies were included in the systematic review. In the literature, “DH” was assessed using multiple different measures: postoperative DH (n = 4), DH change (DHC; n = 4), degree of disc distraction (n = 2), prosthesis height (n = 2), functional spinal unit height (n = 2), and facet distraction (n = 1). DH and DHC were the most common measures studied. DHC was associated with statistically and clinically significant differences in several patient-reported outcomes measures (PROMs). However, DH was not associated with any statistically or clinically significant differences in PROMs. With respect to cervical range of motion (ROM), DHC appeared to demonstrate statistically and clinically relevant differences in some of the studies included in this review, while DH was associated with statistically, but not clinically, significant differences. The majority of studies identified DHC <2 mm as an important cutoff to optimize outcomes.

Conclusions.
“DH,” especially as measured by DHC, may be an important intraoperative consideration when selecting implant size during CDR. Maintaining DHC <2 mm may optimize PROMs and ROM. Improving technique and implant sizing may aid in translating ex vivo advantages in implant mobility to in vivo improvements in ROM and PROMs.
Predicting blood pressure response to renal denervation based on a new approach
Authors: Bytyqi Venera , Kannenkeril Dennis , Striepe Kristina , Bosch Agnes , Karg Marina V. , Schmid Axel , Schiffer Mario , Uder Michael , Schmieder Roland E. 
Published: November 2024

Background:
Identifying predictors of blood pressure (BP) response to renal denervation (RDN) is crucial for patient selection. According to Wilder's principle, baseline BP predicts BP change after any antihypertensive intervention. Thus, any observed BP change after RDN is the sum of the BP change depending on the baseline BP and the specific BP reduction due to RDN. Based on this concept, we propose a new definition of BP responders.

Methods:
In our center, 148 patients with uncontrolled hypertension underwent RDN, and 24-h ambulatory BP (ABP) was measured at baseline, and 6 months after the procedure. The decrease in 24-h systolic BP (SBP) correlated with baseline SBP (P = <0.001, r = −0.374). We determined the RDN-specific effect by subtracting the predicted SBP decrease from the observed SBP decrease. The cohort was divided into RDN responders, neutral responders, and nonresponders.

Results:
Our study population had a mean age of 59 ± 10.4 years and was 74% male. The RDN-specific (residual) 24-h ABP decreased by −14.9 ± 6.3/−8.2 ± 3.8 mmHg (responder group), 1.0 ± 3.2/0.2 ± 1.9 mmHg (neutral group), and 14.2 ± 10.4/8.3 ± 3.9 mmHg (nonresponder group) 6 months after RDN. Responders had fewer antihypertensive medications (P = 0.018), higher baseline office heart rate (HR) (P = 0.019), higher 24-h ambulatory HR (P = 0.003), lower BMI (P < 0.038), and absence of type 2 diabetes (T2D) (P = 0.020).

Conclusion:
Our definition of BP responders to RDN separates baseline BP-related changes from RDN-specific changes. Positive predictors for BP response to RDN include low BMI, fewer antihypertensive medications, high baseline office HR, high 24-h ambulatory HR, and absence of T2D.
The Bloom Syndrome and Retinoblastoma patient exhibits two RB1 gene mutations in the germline
Authors: Rangel-Charqueño Martha , Flores Cynthia Soto , Sánchez Dra Mayra Martínez , Moctezuma-Dávila Mariana , Illana Dra Vanesa Olivares 
Published: November 2024

Purpose:
To report the case of a patient with Bloom Syndrome and retinoblastoma from a genetic perspective. The patient exhibits two RB1 gene mutations in the germline.

Methods:
The patient underwent an ultrasound study, followed by enucleation of the left eye. Peripheral venous blood samples were collected to isolate mononuclear cells for total RNA and DNA extraction. Subsequently, cDNA synthesis and RT-qPCR were performed. The DNA was used for PCR amplification of the 27 exons. The sequence of the exons of RB1 was analysed.

Results:
The patient with Bloom Syndrome (BS) and retinoblastoma underwent treatment, and blood samples from the patient and a family member were analysed. The results revealed two germline mutations on exons 13 and 17. The levels of RB1 mRNA were found to be low compared to those of a healthy control and a family member.

Conclusion:
Without a family history of cancer, a patient with retinoblastoma and BS presents two mutations in the germline on the RB1 gene; this results in very low levels of RB1 mRNA systemically, thereby increasing the patient´s risk of developing another type of cancer throughout his life.
A prediction model of echocardiographic variables to screen for potentially correctable shunts in adult atrial septal defect-pulmonary hypertension patients
Authors: Li He-Zhi , Wen Song , Huang Ze-Han , Fei Hong-Wen , Zhang Cao-Jin 
Published: November 2024

Background:
Atrial septal defect (ASD) is a prevalent congenital heart condition in adults that leads to pulmonary hypertension (PAH) and right heart failure if left untreated. During a routine follow-up of adult ASD-PAH patients, the suitability of shunt closure depends on the invasive right heart catheterization (RHC). Nevertheless, performing RHC at every follow-up is impractical and may be harmful. The present retrospective cross-sectional study was designed to investigate which echocardiographic variables were associated with pulmonary vascular resistance (PVR) in adult ASD-PAH patients and propose a model using these variables to screen for patients with a correctable shunt.

Methods:
A total of 530 adult ASD-PAH patients with pulmonary arterial systolic pressure (PASP) of ≥60 mmHg measured using transthoracic echocardiogram (TTE) were included in the study. All RHCs were performed within 3 months after TTE. The correctable shunt was defined as PVR ≤3 Wood units (WU). Multivariable regressions were performed utilizing echocardiographic variables. A scoring system was constructed based on the predictors of PVR ≤3 WU using multivariable logistic regression analysis. The scoring system was then examined using a receiver operating characteristic (ROC) analysis. In addition, clinical utility of the model was determined based on decision curve analysis, and a calibration curve was used to evaluate model conformity.

Results:
Estimated PASP, velocity through the pulmonary valve, tricuspid annulus early diastolic velocity, and maximum defect dimension were identified as independent predictors. The area under the ROC curve of the predictive value in the model was 0.905 (95% CI, 0.878-0.931, sensitivity: 84.3%, specificity: 83.6%). The net benefit of the model was notable in terms of a wide-range probability threshold in decision curve analysis, indicating that the prediction model had good clinical applicability. The model’s calibration curve was close to an ideal diagonal line, showing good predictive accuracy between the actual and predictive probabilities.

Conclusion:
The study provided a valuable model in predicting adult ASD-PAH patients with a correctable shunt, which may help clinicians to make appropriate treatment decision for follow-up patients.
Effects of Resilience and Personal Accomplishment on the Relationship Between Quality of Work Life and Turnover Intention Among Newly Employed Nurses
Authors: LEE Huan-Fang , CHIANG Hui-Ying , CHANG Ying-Ju , CHANG Mei-Yu , LEE Chiu-Hsiang , WU Hsiu-Chuan , LIU Doressses , FETZER Susan 
Published: November 2024

ABSTRACT

Background
Turnover among newly employed nurses is an indicator of workforce stability in healthcare organizations. The factors influencing turnover intention in this group are complex and differ by generation. The relationships among variables including work-life quality, personal accomplishment, resilience, and turnover intention have been explored separately. However, a knowledge gap exists in terms of scholarly understanding regarding the respective impacts of perceived personal accomplishment and resilience on the relationship between work-life quality and turnover intention.

Purpose
This study was designed to explore the respective effects of resilience and personal accomplishment on the relationship between work-life quality and turnover intention.

Methods
A cross-sectional approach was used, and 387 newly employed nurses who had worked for just 1 month at six medical centers in Taiwan were enrolled as participants. The following four instruments were used for data collection: Quality of Nurse Work-life Scale, Connor–Davidson Resilience Scale, the personal accomplishment subscale of the Maslach Burnout Inventory, and Turnover Intention Scale. Hayes PROCESS analysis method was used to analyze the influence of resilience and personal accomplishment on the relationship between work-life quality and turnover intention.

Results
There was a positive correlation among work-life quality, resilience, and personal accomplishment, and a negative correlation was found between all three variables and turnover intention. Resilience was found to negatively mediate the relationship between work-life quality and turnover intention (B = −.032, p < .001). The moderating effect of work-life quality on personal accomplishment was significant (B = .012, p < .05). Work-life quality and sense of personal accomplishment explained 61% of the variance in resilience. Work-life quality and resilience explained 50.5% of the variance in turnover intention. Furthermore, sense of personal accomplishment moderated the mediating effect of resilience on the relationship between work-life quality and turnover intention.

Conclusions/Implications for Practice
Resilience mediates the relationship between work-life quality and turnover intention, whereas personal accomplishment may moderate the mediating effect of resilience in the relationship. Administrators should provide strategies to improve professional competence and improve psychological capacity in new nurses to increase their sense of personal accomplishment and resilience to decrease turnover intention.
Pretransplant metabolic tumor volume predicts recurrence following liver transplantation for colorectal metastasis: A multicenter study
Authors: Wehrle Chase J. , Chávez-Villa Mariana , Byrne Matthew , Kusakabe Jiro , Gross Abby , Mahajan Paresh , Ruffolo Luis , Whitsett Linganna Maureen , Sobotka Annie , Naffouje Samer , Khalil Mazhar , Pita Alejandro , Fujiki Masato , Tomiyama Koji , Schlegel Andrea , Kwon David C.H. , Line Pal-Dag , Miller Charles , Hashimoto Koji , Hernandez-Alejandro Roberto , Aucejo Federico 
Published: November 2024

Liver transplant (LT) for colorectal cancer liver metastases (CRLM) is increasingly popular, yet the ideal selection criteria remain unknown. Pretransplant positron emission tomography (PET) metabolic tumor volume (MTV) has been described as predicting recurrence, with a proposed cutoff of MTV ≥70 cm3. This approach has not been validated. Patients undergoing LT for CRLM at 2 academic transplant centers (January 1, 2017, to December 1, 2023) were included. PET-MTV was calculated by a staff radiologist from the most recent PET-scan before LT using the published protocol. Twenty-six patients were included. Median follow-up was 609 days (IQR 320–1069) and from PET to LT was 1.9 months (1.3–2.6). Nearly all (n=24, 92.3%) received living donor transplantation. Absolute recurrence rate was 30.8% (n=8). Actuarial unadjusted 1- and 2-year recurrence-free survival (RFS) were 83% (n=15/18) and 62% (n=8/13); 1- and 2-year overall survival were 100% (n=18/18) and 85% (n=11/13). The incidence of recurrence-per-year follow-up was 0.35 when MTV ≥70 cm3 versus 0.10 if MTV <70 cm3 (P<0.001). Median RFS using Kaplan-Meier product-estimate was 0.83 years (95% CI: 0.43–1.23) in MTV≥70 cm3 versus 4.1 years (95% CI: 2.90–5.22) when MTV<70 cm3 (p<0.001); this was also associated with improved overall survival (p=0.003). MTV>70 cm3 demonstrated HR=2.42 (95% CI: 2.2–62.2, p=0.006) for association with RFS on univariate Cox-proportional hazards analysis, and an AUC=0.771 (95% CI: 0.560–0.981) for predicting recurrence (p=0.030). Nineteen patients (69.2%) had histologically viable tumors, which were associated with recurrence (43% vs. 0%, p=0.039) and reduced RFS (log-rank p=0.019). PET-MTV was associated with the presence of histologically viable tumor (AUC=0.763, 95% CI: 0.583–0.944). PET-MTV ≥70 cm3 was associated with reduced RFS and overall survival after LT for CRLM, confirming findings from the Norway group. This is likely due to its ability to identify residual viable tumors, which are independently associated with recurrence. PET-MTV should be a key selection criterion prior to LT for CRLM.
Molecular mechanism analysis of a family with hereditary coagulation FXI deficiency caused by compound heterozygous mutations
Authors: Chen Yuan , Zeng Manlin , Zhang Ke , Ye Longying , Jiang Shuting , Jia Kaiqi , Yang Lihong , Wang MingShan 
Published: November 2024

Objective
The purpose of this study was to determine the molecular basis of a Chinese family with factor XI (FXI) deficiency.

Methods
The qRT-PCR was used to detect the transcription of F11 mRNA in transfected cells. ELISAs and western blot were used to detect the expression of FXI protein in culture media and lysates.

Results
Genetic analysis revealed that the proband carried a heterozygous nonsense mutation c.1107C>A (p.Tyr351stop) in exon 10 and a heterozygous missense mutation c.1562A>G (p.Tyr503Cys) in exon 13. The expression study revealed that p.Tyr351stop mutation resulted in the degradation of F11 mRNA. The p.Tyr503Cys mutation, however, had no effects on biosynthesis and secretion of FXI protein, but it had affected the catalytic activity of FXI.

Conclusion
The inherited FXI deficiency of this family is related to nonsense mutation p.Tyr351stop and missense mutation p.Tyr503Cys.
Management of sedation during weaning from mechanical ventilation
Authors: Vollbrecht Hanna , Patel Bhakti K. 
Published: November 2024

Purposes of review
Critically ill patients frequently require mechanical ventilation and often receive sedation to control pain, reduce anxiety, and facilitate patient-ventilator interactions. Weaning from mechanical ventilation is intertwined with sedation management. In this review, we analyze the current evidence for sedation management during ventilatory weaning, including level of sedation, timing of sedation weaning, analgesic and sedative choices, and sedation management in acute respiratory distress syndrome (ARDS).

Recent findings
Despite a large body of evidence from the past 20 years regarding the importance of light sedation and paired spontaneous awakening and spontaneous breathing trials (SATs/SBTs) to promote ventilator weaning, recent studies show that implementation of these strategies lag in practice. The recent WEAN SAFE trial highlights the delay between meeting weaning criteria and first weaning attempt, with level of sedation predicting both delays and weaning failure. Recent studies show that targeted interventions around evidence-based practices for sedation weaning improve outcomes, though long-term sustainability remains a challenge.

Summary
Light or no sedation strategies that prioritize analgesia prior to sedatives along with paired SATs/SBTs promote ventilator liberation. Dexmedetomidine may have a role in weaning for agitated patients. Further investigation is needed into optimal sedation management for patients with ARDS.
How to prevent postextubation respiratory failure
Authors: Hernández Gonzalo , Hill Nicholas S. 
Published: November 2024

Purpose of review
Postextubation respiratory support treatment approaches, indications, and subgroups of patients with different responses to those therapies are rapidly changing. Planning optimal therapy in terms of choosing devices, timing of application and selecting settings with the goal of minimizing extubation failure is becoming a challenge. This review aims to analyze all the available evidence from a clinical point of view, trying to facilitate decision making at the bedside.

Recent findings
There is evidence for high flow nasal cannula support in patients at low risk of extubation failure. Noninvasive ventilation based strategies should be prioritized in patients at very high risk, who are obese or are hypercapnic at the end of a spontaneous breathing trial. Patients not included in the previous groups merit a tailored decision based on more variables.
Optimizing the timing of therapy can include facilitation of extubation by transitioning to noninvasive respiratory support or prolonging a planned preventive therapy according to clinical condition.

Summary
Planning postextubatin respiratory support must consider the risk for failing and the presence of some clinical conditions favoring noninvasive ventilation.
Extubation can be safely accelerated by modifying screening criteria and spontaneous breathing trial settings, but there is room to increase the role of postextubation noninvasive respiratory support for this indication, always keeping in mind the dangers of delaying a needed intubation.
Spontaneous breathing-induced lung injury in mechanically ventilated patients
Authors: Hoshino Taiki , Yoshida Takeshi 
Published: November 2024

Purpose of review
Recent experimental and clinical studies have suggested that spontaneous effort can potentially injure the lungs. This review summarizes the harmful effects of spontaneous breathing on the lungs during mechanical ventilation in ARDS and suggests potential strategies to minimize spontaneous breathing-induced lung injury.

Recent findings
Recent clinical and experimental studies have shown that vigorous spontaneous breathing during mechanical ventilation can potentially injure the lungs due to high transpulmonary pressure, the Pendelluft phenomenon, increased pulmonary perfusion, and patient–ventilator asynchrony. A definitive approach to minimize spontaneous breathing-induced lung injury is the systemic use of neuromuscular blocking agents; however, there is a risk of muscle atrophy. Alternatively, partial paralysis, bilateral phrenic nerve blockade, and sedatives may be useful for decreasing force generation from the diaphragm while maintaining muscle function. A higher positive end-expiratory pressure (PEEP) and prone positioning may reduce force generation from the diaphragm by decreasing neuromechanical efficiency.

Summary
Several potential strategies, including neuromuscular blockade, partial paralysis, phrenic nerve blockade, sedatives, PEEP, and prone positioning, could be useful to minimize spontaneous breathing-induced lung injury.
V–V ECMO for severe Chlamydia psittaci pneumonia presenting with sudden cardiac arrest: A case report and literature review
Authors: Chen Juan , Sun Yong , Luo Jian , Wu Yang , Wang Kaiyu , Zhang Weiwen , Fang Honglong 
Published: November 2024

Rationale:
Psittacosis, also known as parrot fever, is an infectious disease caused by Chlamydia psittaci, which can lead to C psittaci pneumonia. Clinical manifestations are highly nonspecific, which can vary from asymptomatic infection to severe pneumonia and even death.

Patient concerns:
In this case presentation, we reported one 65-year-old male case of C psittaci pneumonia who was admitted to our hospital on December 2, 2022 due to the chief complaints of poor appetite and fatigue for 3 days as the clinical manifestations. He denied contact with birds but admitted riding horses 1 week ago.

Diagnoses:
Chlamydia psittaci pneumonia of patient was confirmed through metagenomic sequencing of bronchoalveolar lavage fluid under bronchoscopy.

Intervention:
Patient was treated with V-V ECMO, invasive mechanical ventilation and CRRT.

Outcomes:
On December 12, the patient was successfully weaned off V–V ECMO and discharged on December 20, 2022. During postoperative follow-up, CT scan in a local hospital revealed the infiltrative lesions of the lung were absent.

Lessons:
This case prompts that metagenomic next-generation sequencing is a feasible diagnostic tool for psittacosis, which can rapidly worsen and even cause sudden cardiac arrest. V–V ECMO might be a viable emergency therapeutic option.