bluuebunny/crossref_metadata_2025_split huggingface dataset:
Extracranial internal carotid artery aneurysm: Surgical approach to a rare entity
Authors: Oztas Didem Melis , Cobanoglu Seckin , Cakir Asli , Kuguoglu Okan , Oteyaka Emre , Ugurlucan Murat 
Published: October 2024

Background Extracranial internal carotid artery aneurysms are rare entities that arise within the carotid triangle. Although rare, they are clinically significant due to the risk of neurologic thromboembolic events, compression of cranial nerves and vasculature, rupture, and ischemia. Objective Surgery is the gold-standard treatment for symptomatic patients of all ages with extracranial internal carotid artery aneurysm. Method A 26-year-old female patient was admitted to our institution with complaints of left auricular pain, hoarseness, and uncontrollable hypertension. She had a pulsatile mass located at the left cervical region. After diagnosing the extracranial internal carotid artery aneurysm, it was decided that surgery was necessary to relieve the patient’s discomfort and prevent possible complications from the aneurysm in the left carotid artery. Result In the operation, the aneurysmatic segment was resected and sent for histopathological evaluation. Saphenous vein graft was interposed as end to end anastomosis to the proximal and distal healthy segments of the internal carotid artery. Conclusion This case report highlights the surgical management of a 26-year-old female patient who presented to our institution with complaints of left auricular pain, hoarseness, uncontrolled hypertension, and a pulsatile mass localized at the left cervical region and diagnosed extracranial internal carotid artery aneurysm.
Three-dimensional MRI analysis of elbow anatomy and kinematics in children with ulnar dimelia
Authors: Libberecht Katleen , Huelsemann Wiebke , Hessman Per , Mann Max , Aslam Mohammad Asif , Björkman Anders 
Published: October 2024

Ulnar dimelia often presents with restricted elbow movement. To develop a treatment strategy to improve elbow mobility, a detailed understanding of the skeletal deformity is needed. We created 3-D models of the cartilage and bone in the elbows of four children with ulnar dimelia by segmentation of MRI scans. We analysed the anatomy and performed a kinematic analysis. In all four children, the distal humerus was triangular in shape and consisted of a medial epicondyle, an enlarged lateral epicondyle and an anterior epicondyle. By comparing the 3-D images with conventional radiographs, we found that the projection of the enlarged lateral epicondyle created two longitudinal lines, which is a radiographic hallmark feature of the triangular-shaped distal humerus. In addition, during elbow flexion, the radial forearm bone slides along the lateral trochlea rather than rotates. This knowledge can aid surgeons to plan treatment for improving elbow mobility in ulnar dimelia. Level of evidence: IV
Real-world efficacy of PD-1/PD-L1 inhibitors in patients with advanced pulmonary neuroendocrine carcinoma: a single-center analysis
Authors: Zhai Wanchen , Yu Ying , Wu Haicheng , Zhang Qian , Chen Yunfei , Yang Yehao , Fan Yun 
Published: October 2024

Background: Immunotherapy blocking programmed death-1 (PD-1)/programmed death ligand-1 (PD-L1) has revolutionized the treatment of extensive-stage small-cell lung cancer (SCLC), but only with limited real-world efficacy data; evidence from immunotherapy for other pulmonary neuroendocrine carcinoma (PNEC) is scarce. Objective: The purpose of this study is to evaluate the efficacy of receiving PD-1/PD-L1 inhibitors in patients with advanced PNEC and explore factors related to survival prognosis, providing clues for treatment for patients with advanced PNEC. Methods: In all, 203 patients with advanced PNEC who received PD-1/PD-L1 inhibitors between January 2019 and December 2021 were retrospectively analyzed. Kaplan–Meier curves were constructed for progression-free survival (PFS) and overall survival (OS). Results: For the 203 patients, the objective response rate (ORR) was 48.3%, the disease control rate (DCR) was 83.3%, the median PFS (mPFS) was 6.0 months, and the median OS (mOS) was 13.1 months. Among them, the histology was 166 SCLC, 13 large-cell neuroendocrine carcinoma, and 24 other unspecified PNEC. Histologically, no significant difference was observed in PFS ( p = 0.240) or OS ( p = 0.845). In first-line (1L) treatment ( N = 125), patients received chemoimmunotherapy and had an ORR of 64.8%, DCR of 92.0%, mPFS of 6.6 months, and mOS of 14.9 months. In second-line (2L) or later-line setting, the ORR, DCR, mPFS, and mOS were 21.8%, 69.2%, 4.4, and 9.4 months; immunotherapy plus small-molecule antiangiogenic agents showed significantly greater PFS than immunotherapy monotherapy or chemoimmunotherapy (6.4 vs 1.4 vs 3.7 months, p = 0.041). Patients without liver metastasis had superior PFS (7.0 vs 5.1 months, p < 0.001) and OS (19.2 vs 9.6 months, p < 0.001) than those with liver metastasis. Conclusion: In clinical practice, PD-1/PD-L1 inhibitors are effective in patients with advanced PNEC, regardless of the pathological histology. The efficacy of 1L immunochemotherapy is worthy of recognition, and the addition of small-molecule antiangiogenic agents to immunotherapy in 2L or later-line treatment provides a better survival trend. Design: Retrospective study.
Low-frequency repetitive transcranial magnetic stimulation for the treatment of post-traumatic stress disorder and its comparison with high-frequency stimulation: a systematic review and meta-analysis
Authors: Jiang Che , Yang Yong , Wu Lili , Liu Weizhi , Zhao Gang 
Published: October 2024

Background: Repetitive transcranial magnetic stimulation (rTMS) showed potentially beneficial effects for the treatment of post-traumatic stress disorder (PTSD). Low-frequency (LF) rTMS decreases neuronal excitability and may have better safety compared to high-frequency (HF) rTMS. However, there lacks meta-analysis specifically focusing on LF rTMS. Objectives: To specifically explore the efficacy and safety of LF rTMS for treating PTSD. Methods: Databases including PubMed, EMBASE, MEDLINE, and Web of Science were systematically searched from inception to October 17, 2023. Both randomized controlled trials (RCTs) and open trials of LF rTMS on PTSD were included, and we additionally included RCTs comparing HF rTMS and sham treatment on PTSD. First, we qualitatively summarized parameters of LF rTMS treatment; then, we extracted data from the LF rTMS treatment subgroups of these studies to examine its effect size and potential influencing factors; third, we compared the effect sizes among LF rTMS, HF rTMS and sham treatment through network meta-analysis of RCTs. Results: In all, 15 studies with a sample size of 542 participants were included. The overall effect size for LF rTMS as a treatment for PTSD was found as Hedges’ g = 1.02 (95% CI (0.56, 1.47)). Meta-regression analysis did not reveal any influencing factors. Network meta-analysis showed that compared to sham treatment, only HF rTMS on the right dorsolateral prefrontal cortex (DLPFC) demonstrated a significant advantage in ameliorating PTSD symptoms, while LF rTMS on the right DLPFC showed a trend toward advantage, but the difference was not significant. Conclusion: The current literature shows LF rTMS has effect in treating PTSD caused by various traumatic events. However, present limited number of RCT studies only showed LF rTMS to have a trend of advantage compared to sham treatment in treating PTSD caused by external traumatic events. In the future, more RCTs are needed to be made to confirm the efficacy of LF rTMS. Additionally, studies are required to elucidate the underlying mechanism in order to further improve its efficacy in different traumatic populations. PROSPERO registration number: CRD42023470169.
Impact of a new post-emergency teleconsultation procedure on overcrowding
Authors: Chavda Emmanuelle , Norberciak Laurene , Guedon Moreau Laurence , Casalino Enrique , Williatte Lina , Wiel Eric , Thellier Nicolas , Cordova Enrique 
Published: October 2024

Background Saint Vincent de Paul Hospital is using a post-emergency teleconsultation solution (TELESCOPE). Target patients are discharged early, freeing up examination rooms and hospital beds, and the patient's clinical evolution is monitored by teleconsultation 24 hours after discharge. This study aims to evaluate this pioneering procedure, firstly to assess the impact of TELESCOPE on ED overcrowding, and secondarily to evaluate 72-hour post-emergency hospitalization rates, throughput times, and patient satisfaction. Methods This is a prospective, comparative, before/after type study. The National Emergency Department Overcrowding Scale (NEDOCS) score was used to measure the impact of TLC on ED congestion. It was calculated every hour, every day during the two study periods. The 72-hour post-emergency hospitalization rates were cross-compared for the patients who had a TLC, those who did not have a TLC during the same period, and those from the control period. The patient flow was evaluated by comparing the average length of stay of patients invited to a TLC against those from the control period. The patient’s satisfaction was measured through a telephone survey. Findings The mean difference in NEDOCS score is −3.1 [−4.14; −1.85]. Compared to the control phase, ED spent an additional 160 hours at a ‘normal’ level during the test period. The time spent in the ‘busy’ or ‘overcrowded’ categories was reduced by 129 and 19 hours. There is a significant reduction in the hospitalization rate between teleconsultation patients and all other patients. The patients discharged and invited to a TLC waited 87 minutes longer on average [56 minutes; 119 minutes]. Patient satisfaction is high (91.8%). Interpretation Additional statistical strength would be needed to prove a reduction in overcrowding. The low hospitalization rate reflects adequate recruitment. ED visit times were unexpectedly longer. TELESCOPE seems useful for defining a new type of care. A further multicentre study is scheduled for 2024.
The Association Between Hounsfield Units and Mechanical Failure in ASD Patients
Authors: Heegaard Martin , Ingadottir Kristin , Ragborg Lærke , Dahl Benny , Hansen Lars Valentin , Ohrt-Nissen Søren , Gehrchen Martin 
Published: October 2024

Study design Retrospective Cohort Study. Objectives Low bone mineral density (BMD) is a known risk factor for revision surgery in patients with adult spinal deformity (ASD). Hounsfield units (HUs) on CT scans have been suggested as a proxy for assessing BMD. This study aimed to determine HUs in the lumbar region and their association with mechanical failure in patients undergoing ASD surgery. Methods We included ASD patients undergoing surgery from 2010-2020 with minimum 2-year follow-up. We excluded patients without preoperative CT scans, or a CT scan more than 1 year before surgery. Mechanical failure was defined as proximal junctional failure, pseudarthrosis, or implant failure requiring revision surgery. On preoperative CT scans, HUs were measured on 3 axial slices on each vertebra from L1-L5 and, if available, at UIV and UIV + 1. Results We included 170 patients, mean age 63 (±12) years, with 108 (64%) females, and 13 [IQR 10-16] instrumented levels. Mechanical failure occurred in 27% (n = 46) of patients at 2-year follow-up. Mean lumbar HUs were 146 (±51) in the mechanical failure group and 135 (±52) in those without revision ( P = .232). Area under the curve was 0.58 (95% CI: 0.48-0.68), corresponding to no to low discriminatory power in predicting mechanical failure using lumbar HUs. Univariate logistic regression revealed no significant difference between mechanical failure and lumbar HUs (OR = 1.00, 95% CI: 1.00-1.01, P = .239). Conclusions We found no association between mechanical failure and HUs on preoperative CT scans in ASD patients. Thus, we cannot recommend using HUs to predict mechanical failure in these patients.
Muscle Architecture Properties of the Deep Region of the Supraspinatus: A Cadaveric Study
Authors: Wu Isabella T. , Hyman Sydnee A. , Norman Mackenzie B. , Sendek Gabriela , Powell Jenna J. , Kirchberg Tyler N. , Berry David B. , Lane John G. , Singh Anshuman , Ward Samuel R. 
Published: October 2024

Background: The supraspinatus is most frequently involved in rotator cuff tears, a common orthopaedic condition. However, the architecture of this muscle has been described only for the superficial, anterior, and posterior regions. Purpose: To determine the muscle architecture of the deep supraspinatus. Study Design: Descriptive laboratory study. Methods: Muscle architecture measurements were collected from 25 cadaveric supraspinatus specimens (13 intact [without tendon tears], 3 with partial-thickness tears, 9 with full-thickness tears). The muscle was divided into deep, superficial anterior, and superficial posterior regions. Pennation angle, raw and normalized fiber length, and sarcomere length and number were compared using repeated-measures analyses of variance. Results: First, mean architecture measurements were compared between regions using only the intact specimens (n = 13). The deep region had a lower mean pennation angle (3.3° ± 1.0°) compared with the posterior region (11.0° ± 3.9°; P < .0001), which in turn had a significantly higher pennation angle compared with the anterior region (7.6 ± 2.6°; P = .0005). Normalized fiber lengths in the deep region were 21.1% ( P = .0052) and 34.5% ( P < .0001) shorter than the posterior and anterior normalized fiber lengths, respectively. Sarcomere lengths in the deep region were longer (3.4 ± 0.2 μm) compared with the posterior (3.1 ± 0.2 μm; P = .0012) and anterior (3.2 ± 0.2 μm; P = .0390) regions. Sarcomere numbers also decreased in the deep region by 21.2% ( P = .0056) and 34.2% ( P < .0001) compared with the posterior and anterior regions, respectively. Conclusion: The deep supraspinatus had significantly lower pennation angles, shorter fiber lengths, and fewer but longer sarcomeres in series compared with other subregions within the muscle. These structural differences suggest a functionally unique “submuscle” within the supraspinatus. Clinical Relevance: Understanding the architecture of the supraspinatus muscle can provide insight into muscle function in health and disease. Specifically, this deep submuscle may play a different role in rotator cuff function than the rest of the muscle.
Evidence Synthesis for the Development of National Nursing-Sensitive Indicators in Malaysia: A Literature Review and Stakeholder Engagement Approach
Authors: Rata Mohan Devi Shantini , Jamalul-lail Nurul Iman , Chong Diane Woei-Quan , Chelladorai Kalvina , Mohammad Zubairi Kartiekasari Syahidda , Rusli Inin Roslyza , Zainuddin Nur Azmiah , Supadi Roslina , Ab Rahman Noor Hasidah , Mohamad Mariyah , Saravana Muthu Devi K. , Narayanan Gowry , Jenny Cheah 
Published: October 2024

Introduction Nursing-sensitive indicators measure and evaluate nursing care quality and its contribution to patient care. The identification of indicators that demonstrate nursing care contribution and the quality of care delivered locally is of paramount importance, and national indicators that demonstrate this are essential. This paper aims to provide an evidence base of nursing-sensitive indicators that can facilitate the conceptualization of local nursing national indicators. Method A multifaceted and iterative approach incorporating literature review, and stakeholder engagements was utilized in evidence synthesis. A review of indicators present internationally complemented by the inclusion of context-specific local NSIs through stakeholder engagements was performed. Secondary data analysis of documents from an environmental scan was also included to highlight areas of concern for nursing-sensitive indicator prioritization from the viewpoint of nurses. Results A total of 64 articles were reviewed and indicators were coded according to the Nursing Care Performance Framework subsystems, dimensions, and variables. All papers reviewed had documented outcome indicators. From our secondary data analysis, nurses identified areas of concern such as nursing staff supply, staff maintenance, nursing processes and risk outcomes, and safety to be prioritized for developing quality indicators. Conclusion This paper provides a list of NSIs coded systematically with definitions to aid stakeholders in prioritizing indicators for national indicator development. The inclusion of areas of concern provides insight into NSIs that nurse practitioners find relevant to the local context. To our knowledge, this is the first paper that includes evidence available in the literature and incorporates stakeholders’ perspectives in synthesizing evidence needed to guide the development of national nursing indicators. This iterative approach is crucial because it enhances the likelihood of knowledge translation.
Endovascular treatment versus medical management for basilar artery occlusion with low-to-moderate symptoms (National Institutes of Health Stroke Scale < 10)
Authors: Dargazanli Cyril , Mourand Isabelle , Mahmoudi Mehdi , Poirier Laurence , Labreuche Julien , Weisenburger-Lile David , Gory Benjamin , Richard Sébastien , Ducroux Célina , Piotin Michel , Blanc Raphael , Lucas Ludovic , Marnat Gaultier , Aubertin Mathilde , Arquizan Caroline , Bourcier Romain , Detraz Lili , Vannier Stéphane , Guillen Maud , Eugene François , Walker Gregory , Lun Ronda , Dowlatshahi Dariush , Shamy Michel , Consoli Arturo , Costalat Vincent , Lapergue Bertrand , Maïer Benjamin , Guenego Adrien , Fahed Robert 
Published: October 2024

Background: Patients with acute basilar artery occlusion (BAO) and low-to-moderate symptoms (National Institutes of Health Stroke Scale [NIHSS] < 10) are poorly represented in thrombectomy trials. Our objective is to compare thrombectomy and best medical management (BMT) in this population. Methods: We compared data of all consecutive patients presenting with an initial NIHSS < 10 and acute symptomatic BAO included in two registries. The main outcome was the proportion of patients achieving a 3-months favorable outcome (mRS 0-2 or equal to the pre-stroke value). Secondary outcomes included the proportion of patients with an excellent outcome (mRS 0-1 or equal to pre-stroke value), overall mRs distribution (shift analysis) and mortality. Effect sizes for thrombectomy versus BMT alone were calculated using binary or ordinal logistic regression model before after considering confounders using the inverse probability of treatment weighting (IPTW) propensity score method. Results: One hundred twenty-seven patients were included: sixty-four patients treated with thrombectomy (mean ± SD age: 63.4 ± 16.1) and sixty-three with BMT (mean ± SD age: 69.0 ± 14.3). There was no significant difference between groups for the rate of 3 month-favorable outcome or mortality. After propensity-score adjustment, thrombectomy was associated with a significantly higher chance of excellent outcome at 3 months (mRS 0-1 or equal to pre-stroke value; adjusted OR, 2.68; 95%CI, 1.04–6.90; p = 0.041). Conclusion: Our study suggests that thrombectomy in patients with low-to-moderate symptoms (NIHSS < 10) due to BAO does not improve the rate of favorable outcome but could lead to a higher chance of excellent outcome at 3 months. Trial Registration: ETIS Registry. http://www.clinicaltrials.govNCT03776877
Using Lean Six Sigma Methods to Develop an Efficient and Sustainable Interdisciplinary Team Program for Chronic Pain in a VA: PREVAIL Interdisciplinary Team Track
Authors: Courtney Rena E. , Schadegg Mary J. , Hicks Natalie , Truitt Melissa , Bolton Rendelle E , Dezzutti Brian , Cannizzo Francis , Darnall Beth D. , Radatz Marilyn , Harden Samantha M. 
Published: October 2024

Background Chronic pain is highly prevalent in US military Veterans, and pain interdisciplinary teams (IDTs) are the gold standard in pain care. There is no standard or guidance for how best to develop and implement pain interdisciplinary teams within complex health care systems. Objectives The purpose of this quality improvement project was to evaluate the effectiveness of the standard 9-step Lean 6 Sigma (LSS) methodology in redesigning a pre-existing VA outpatient pain clinic solely offering interventional pain services into an efficient, sustainable pain IDT program. Methods The initial evaluation process at a VA Medical Center that primarily serves rural Veterans was redesigned with the a priori goal of developing an efficient, sustainable IDT program that decreased driving days (ie, in-person appointments) required for a comprehensive initial pain evaluation, decreased number of consults required for initial pain evaluations, increased the number of consults to Whole Health services, and increased compliance with policies and standards. Feedback from administrators, clinicians, and Veterans was used to identify inefficiencies then iteratively design, test, and finalize a redesigned service called the PREVAIL Interdisciplinary Team Track (PREVAIL IDT Track). Baseline data was collected for 1 year followed by sustainment data for 14 months. Results were analyzed using descriptive statistics. Results PREVAIL IDT Track decreased the number of in-person appointments from 5 to 2, decreased consults required for evaluations from 5 to 1, increased the number of unique consults to Whole Health education classes, and made the VA fully compliant with policies and standards. To date, 486 Veterans have participated in the redesigned program, including 167 graduates and 212 current enrollees in this sustained clinical program. Conclusion The success of PREVAIL IDT Track suggests that LSS may be a promising method for redesigning sustainable pain IDTs in VA that improve efficiency.
Origin and distribution of clay minerals in semi-arid Sahelian soils: case of Kori Ouallam watershed, south-western Niger
Authors: Noma Adamou Salifou , Daoudi Lahcen , Abdourhamane Touré Amadou , Fagel Nathalie 
Published: October 2024

AbstractThis study examines the origin and distribution of clay minerals of the pedological horizons of Kori Ouallam watershed (south-western Niger). It is based on field sampling campaigns and a series of laboratory analyses. A total of 49 samples were analysed, 28 from surface horizons (0–10 cm depth) and 21 from pedological profiles (0–1 m depth). The samples were analysed by X-ray diffraction on bulk and clay (<2 μm) fractions, X-ray fluorescence spectrometry, laser granulometry, organic matter and calcium carbonate content, macroscopic observations (binocular loupe) and scanning electron microscopy equipped with an energy-dispersive spectrometry system. The pedological horizons are characterized by low organic matter contents (<1%) and no calcium carbonate. The particle-size distribution shows net textural differentiation, with a predominance of sandy loam to sandy clay loam textures in the upper horizons and clay loam to clay in the deep horizons. The main major oxides were SiO2 (46.3–89.0%), Al2O3 (5.0–24.2%) and Fe2O3 (1.0–27.9%). Kaolinite (64–98%) is the predominant clay mineral at all horizons, associated with low to moderate proportions of illite (1–34%) and traces of chlorite. Kaolinite is essentially inherited from the parent rock, whereas illite results from chemical alteration by bisialitization of the primary minerals initially rich in potassium feldspar contained in the parent rock. However, soil texture and organic matter vary independently with clay mineralogy. An extended study of all of the pedological facies that make up south-western Niger, combined with supplementary analyses, would further improve our understanding of clay mineralogy in the Sahelian zone.