bluuebunny/crossref_metadata_2025_split huggingface dataset:
A Multicenter Validation of a Novel Prediction Model for Elbow Flexion Recovery after Nerve Transfer Surgery in Brachial Plexus Injuries
Authors: Laohaprasitiporn Panai , Kittithamvongs Piyabuth , Monteerarat Yuwarat , Suriyarak Theerawat , Siripoonyothai Sopinun , Neti Nutdanai 
Published: September 2024

Background:
Nerve transfer surgery for brachial plexus injuries exhibits variable success rates, potentially resulting in prolonged limb dysfunction for more than 2 years. A proposed prediction model has been developed to predict the unsuccessful recovery of elbow flexion after the surgery. The model consisted of six variables, namely body mass index 23 kg/m2 or more, smoking, total arm type, donor nerve, ipsilateral upper extremity fracture, and ipsilateral vascular injury. This study aimed to assess the external validity of the model for wider applicability.

Methods:
This retrospective analysis examined the medical records of 213 eligible patients with traumatic brachial plexus injuries who underwent surgery at two referral centers between July 2008 and June 2022. The prediction model was applied to estimate recovery failure probability, which was compared with the observed outcomes for each patient. Both the original and simplified models were validated for discrimination and calibration using metrics including c-statistic, Hosmer–Lemeshow goodness-of-fit test, calibration plot, calibration slope, and intercept.

Results:
Thirty-two percent of patients experienced unsuccessful elbow flexion recovery. Both the original and simplified models demonstrated good discrimination (c-statistics: 0.748 and 0.759, respectively). The Hosmer–Lemeshow test revealed strong agreement between predicted and observed probabilities for both models (P = 0.66 and P = 0.92, respectively). The calibration plot exhibited good agreement, with a calibration slope of 0.928 and an intercept of 0.377.

Conclusions:
The prediction model showed strong external validation, confirming its clinical value. High-risk patients should be educated on the risks and benefits of nerve transfer surgery and consider alternative treatments such as primary free functioning muscle transfer.
Innovating Flexor Tendon Repair Training with a Three-dimensional Printed Model
Authors: Boyajian Michael K. , Davidson Amelia L. , Molair Will , Woo Albert S. , Crozier Joseph W. , Johnson James E. , Bhatt Reena , Danelson Kerry A. , Argenta Anne 
Published: September 2024

Background:
Flexor tendon repair is a technically demanding procedure, with functional outcome directly proportional to skillful execution. A repair must be strong to manage early mobilization and precise to allow for gliding through the tendon sheath. As a result, junior residents face a steep learning curve that may be mitigated by exposure to surgical simulators.

Methods:
To facilitate flexor tendon repair training, a surgical training device and accompanying instructional video were developed. Simulation workshops were held for junior orthopedic and plastic surgery residents (n = 11). To objectively assess validity of the curriculum, study participants performed cadaveric flexor tendon repairs before and after the workshop. Anonymous recordings of these repairs were graded by two certified hand surgeons. Additionally, a tensometer was used to measure strength of repair.

Results:
Model realism, educational utility, and overall usefulness rated high: 4.6 ± 0.52 95% confidence interval (CI) for realism, 4.9 ± 0.42 95% CI for device, 4.7 ± 0.96 95% CI for video, and 4.9 ± 0.66 95% CI overall. Subjective confidence increased after the training session (73% ranked “moderately” or “extremely”). Likewise, scores given by the surgeons grading the repairs improved for overall quality and time of repair (pre: 2.77 ± 0.61, post: 4.22 ± 0.56, P= 0.0002). Strength of repair did not change (P = 0.87).

Conclusions:
The proposed three-dimensional surgical simulator for flexor tendon repair is realistic and useful, with improved surgical technique and improved confidence demonstrated after use. This design can be three-dimensionally printed en masse and provide value to hand surgery training curriculum.
Effect of Masking Secondary to the COVID-19 Pandemic on Functional Capacity Improvement in Cardiac Rehabilitation
Authors: Lu Frederick , Berkowitz Julia , Gaw Arlene , Salvador Vincent , DeAngelis Julianne , Wu Wen-Chih 
Published: September 2024

Purpose:
Given the difficulty to perform exercise training wearing a mask, we examined differences in functional capacity improvement between masking during the coronavirus disease 2019 (COVID-19) pandemic and non-masking prior to the pandemic for patients undergoing cardiac rehabilitation (CR).

Methods:
Records of 660 patients who underwent and completed ≥ 18 sessions of CR in 2018 (n = 318, non-masking) and in 2022 (n = 342, masking) at an academic health system were analyzed. The primary outcome was post-CR change in functional capacity in metabolic equivalents (MET) measured by exercise stress test. Sessions of CR participation and changes in depression, anxiety, and quality of life scores were secondary outcomes. We used multivariable linear regression to adjust for differences in baseline CR outcome measures, demographics, American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR) risk, and comorbid conditions.

Results:
Baseline age (64.6 ± 0.46 yr), sex (28% female), and racial distribution (85% white) were similar between the masking and non-masking groups. Non-masking patients were more likely to be classified in the AACVPR high risk category and had lower anxiety scores at baseline compared to masking patients. After CR, both groups had similar and significant improvements in depression, anxiety, and quality of life scores, but the improvement in functional capacity was lower in the masking group (−0.62 ± 0.12 MET, P < .001) compared to the non-masking group. Results remained significant after multivariable adjustment.

Conclusions:
Cardiac rehabilitation patients requiring masking during the COVID-19 pandemic had less improvement in functional capacity than patients who did not wear masks during CR prior to the pandemic. Interventions to mitigate the potential side effects of masking for CR patients may require further exploration.
Implementation of a Nurse-Initiated Protocol to Improve Enteral Medication Administration Documentation in Stroke Patients
Authors: Drennan John C. , Sheehan Tiffany O. , Schroeder Tracie , Haller J. Tyler 
Published: September 2024

ABSTRACT

BACKGROUND: Medication documentation falls under the “7 rights” of medication administration, but strategies to prevent medication administration documentation errors (MADEs) related to route of administration are underreported in the literature. This study aimed to report the outcomes of a nurse-initiated protocol designed to prevent MADEs and align both actual and documented medication administration routes in hospitalized stroke patients with feeding tubes (FTs). METHODS: This was a retrospective descriptive study conducted at a Comprehensive Stroke Center and large academic medical center in the Western United States. Adults admitted with the diagnosis of stroke between February 2022 and August 2023, who had an FT on arrival, or placed during admission, and received at least 1 enteral medication ordered for by mouth (PO) administration, were included. The protocol allowed nurses to place a communication order to a pharmacist via the electronic health record, requesting all enteral medications ordered for PO administration be changed to FT administration. RESULTS: There were 481 patients included with a median age of 68 years (interquartile range, 58–76 years). The nurse-initiated protocol was used in 170 patients (35.3%), with 99 patients (58.2%) having all enteral medication orders converted completely by a pharmacist. Of the 170 patients in which the protocol was initiated, 145 (85.3%) had all scheduled enteral medication orders converted. For the 71 patients who did not have all enteral medication orders converted completely, the median number of potential MADEs was 2 (1–4.5). CONCLUSION: A nurse-initiated protocol designed to prevent MADEs and improve the accuracy of actual and documented route of medication administration for patients hospitalized for stroke with FTs had modest use. The nurse-initiated protocol in this study is the first of its kind and may help guide further research on preventing and reducing MADEs.
Family Caregivers' Experiences of People With Amyotrophic Lateral Sclerosis Undergoing Gastrostomy Tube Feeding
Authors: Chu Hyeon Sik , Oh Juyeon 
Published: September 2024

ABSTRACT

INTRODUCTION: In amyotrophic lateral sclerosis (ALS) patients with impaired swallowing function, gastrostomy tube (G-tube) placement is recommended, but significantly increases the caregiving burden on families. This study aimed to describe the experiences of family caregivers of patients with ALS receiving home enteral nutrition through a G-tube. METHOD: Using purposive sampling, 8 family caregivers participated in the study. Data collection was conducted between February 2021 and October 2022 at a university hospital in Seoul, Korea. Semistructured face-to-face interviews were used to collect data until saturation. Data were analyzed using Krippendorff's content analysis approach. RESULTS: Qualitative analysis of the data revealed 3 main themes regarding caregiving. The emerging themes included psychological distress, unmet practical needs, and the struggle to provide care. CONCLUSION: After a G-tube placement, family caregivers experience various emotional stresses and have numerous unmet practical needs. Healthcare professionals caring for people with ALS receiving enteral nutrition should provide a tailored support program that addresses the specific needs of these family caregivers.
Safety of acamprosate for alcohol use disorder after liver transplant: A pilot randomized controlled trial
Authors: Ayyala-Somayajula Divya , Bottyan Thomas , Shaikh Suhail , Lee Brian P. , Cho Stephanie H. , Dodge Jennifer L. , Terrault Norah A. , Han Hyosun 
Published: September 2024

Acamprosate is a therapy for alcohol use disorder, but data on feasibility and safety in recipients of liver transplants are lacking. This was a single-center unblinded prospective pilot randomized controlled trial of adults (≥18 y) with liver transplant for alcohol-associated liver disease enrolled between 2021 and 2023, who were randomized 2:1 to the intervention of acamprosate (666 mg dose 3 times daily) or standard of care (SOC) over 14 weeks. Outcomes included safety (prevalence of adverse events [AEs]), feasibility (weekly survey response rate >60%), adherence (self-reported acamprosate use >60%), and efficacy (reduction in Penn Alcohol Craving Scale), and relapse-blood phosphatidylethanol (≥20 ng/mL/reported alcohol use) evaluated by standardized weekly surveys. The efficacy analysis was done in both the intention-to-treat (excluding withdrawals before medication administration) and per-protocol population (excluding withdrawals/<4 weeks participation). Of 78 participants who were approached, 30 enrolled (19 acamprosate and 11 SOC) with similar baseline characteristics. Eight participants withdrew (6 acamprosate before medication administration and 2 SOC). AEs were similar between acamprosate and SOC groups (92.3% vs. 90.0%, p > 0.99), including grade 3 AEs (53.9% vs. 60.0%, p > 0.99) with no reported grade 4/5 AEs. Survey response rates were similar in acamprosate versus SOC groups (61.0% vs. 76.0%, p = 0.19), and 69.0% were acamprosate adherents. Baseline Penn Alcohol Craving Scale values were low with no difference by the group in median absolute change in Penn Alcohol Craving Scale for intention-to-treat (0, IQR: −4 to 0 vs. 0, IQR: 0–0, p = 0.32), and per-protocol analyses (−1, IQR: −6 to 0 vs. 0, IQR: −0 to 0, p = 0.36). There was no reported or biochemical evidence of alcohol relapse. In this pilot study, preliminary data suggest that acamprosate may be safe and feasible. These data can inform larger studies and clinician efforts to address alcohol use disorder in post-liver transplant care (ClinicalTrials.gov, Number: NCT06471686).
What’s Behind it all: A Retrospective Cohort Study of Retrogastric Pancreatic Necrosis Management
Authors: Harrison Jon M , Day Heather , Arnow Katherine , Ngongoni R. Fari , Joseph Abel , Aldridge Taylor , Wheeler Kristan J , DeLong Jon C , Bergquist Jay R , Worth Patrick J , Dua Monica M , Friedland Shai , Park Walter , Eldika Samer , Hwang Joo Ha , Visser Brendan C 
Published: September 2024

Objective:
To compare outcomes of laparoscopic transgastric necrosectomy (LTN) and direct endoscopic necrosectomy (DEN) in the management of retrogastric walled-off necrosis.

Summary of Background Data:
Surgical and endoscopic transgastric approaches are used to manage retrogastric pancreatic necrosis. Studies comparing these treatment modalities are lacking but would influence contemporary practice patterns.

Methods:
LTN or DEN treated patients at Stanford University Hospital between 2011 and 2023 were identified. Cohort data included demographics, core pancreatitis care benchmarks, and clinical outcomes (total debridement time, new-onset endocrine and exocrine pancreatic insufficiency) as well as re-intervention, 30-day readmission, complication, and mortality rates. Long-term follow-up was also compared between intervention arms. Multivariable linear regression was used to assess the interaction between admission APACHE-II score and intervention on length of stay (LOS).

Results:
106 patients (62% LTN, 38% DEN) were identified. Demographic and core pancreatitis benchmark data were similar between cohorts. 30-day readmission, complication, and mortality rates for surgical and endoscopic approaches were also similar: 23% vs. 25% (P = 0.98), 42% vs. 40% (P = 0.97), and 3% vs. 3% (P > 0.99). Median LTN total debridement time (minutes) was 131 vs. 134 for DEN, however, complete debridement was achieved with only 1 LTN compared to 3 DENs (P<0.01). While not statistically significant, LOS and unplanned intervention rates were less for LTN (8 vs. 10 days, P = 0.41 and 6% vs. 15%, P = 0.24). Multivariable analysis revealed a significant interaction between APACHE-II scores and LOS for LTN compared to DEN, which translated into a length of stay reduction for higher APACHE-II scoring patients (P = 0.02).

Conclusions:
LTN is a safe and efficient treatment modality for walled-off necrosis, and compared to DEN, can reduce the LOS in high APACHE-II score patients. While additional comparative research between the two intervention types is needed, this study supports a role for a surgical approach in the management of retrogastric pancreatic necrosis.
Mid-term Waitlist and Posttransplant Outcomes With Hepatitis C-positive Donor Hearts
Authors: Hong Yeahwa , Couper Caitlin D. , Iyanna Nidhi , Hess Nicholas R. , Ziegler Luke A. , Abdullah Mohamed , Mathier Michael A. , Hickey Gavin W. , Keebler Mary E. , Silvestry Scott C. , Kaczorowski David 
Published: September 2024

Background.
This study evaluates the clinical trends and impact of hepatitis C virus-positive (HCV+) donors on waitlist and posttransplant outcomes after heart transplantation.

Methods.
The United Network for Organ Sharing registry was queried to identify adult waitlisted and transplanted patients from January 1, 2015, to December 31, 2022. In the waitlist analysis, the candidates were stratified into 2 cohorts based on whether they were willing to accept HCV+ donor offers. Waitlist outcomes included 1-y cumulative incidences of transplantation and death/delisting. In the posttransplant analysis, the recipients were stratified into 2 cohorts with and without HCV nucleic acid test (NAT)-positive donors. Outcomes included 1- and 4-y posttransplant survival. Propensity score-matching was performed. Risk adjustment was performed using multivariable Cox regression.

Results.
During the study period, the number of centers using HCV NAT+ donors increased from 1 to 65 centers, along with the number of transplants. In the waitlist analysis, 26 648 waitlisted candidates were analyzed, and 4535 candidates (17%) were approved to accept HCV+ donors. Approval to accept HCV+ donors was associated with a higher likelihood of transplantation and a lower likelihood of death/delisting within 1 y of waitlisting. In the posttransplant analysis, 21 131 recipients were analyzed, and 997 recipients (4.7%) received HCV NAT+ hearts. The 1- and 4-y posttransplant survival were comparable between the recipients of HCV NAT+ and NAT− donors. Furthermore, the similar 1- and 4-y posttransplant survival persisted in the propensity score-matched comparison and multivariable Cox regression analysis.

Conclusions.
Utilization of HCV+ donors is rising. Heart transplants using HCV+ donors are associated with improved waitlist and comparable posttransplant outcomes.
The Impact of COVID-19 Lockdowns on Mental Health: A Comparative Study
Authors: Orgad Kfir 
Published: September 2024

AbstractThe COVID-19 pandemic led to unprecedented global lockdowns aimed at controlling the spread of the virus. While effective in reducing transmission, these lockdowns have had significant repercussions on mental health. This study examines the prevalence and incidence of mental health problems during the COVID-19 lockdowns, comparing countries that implemented strict lockdown measures with those that did not. Using statistical analysis, we demonstrate that lockdowns are associated with a statistically significant increase in mental health issues. These findings suggest that public health policies during pandemics must balance the physical and mental health needs of the population.
Subunit-specific conductance of single HCN pacemaker channels at femtosiemens resolution
Authors: Benndorf Klaus , Enke Uta , Tewari Debanjan , Kusch Jana , Liu Haoran , Sun Han , Schmauder Ralf , Sattler Christian 
Published: September 2024

AbstractHyperpolarization-activated cyclic nucleotide-modulated (HCN) channels are tetramers that generate rhythmic electrical activity in neuronal and cardiac pacemaker cells1. The channels are activated by hyperpolarisation of the membrane voltage and additionally tuned by the second messenger cAMP at sympathetic stimulation. There are four mammalian isoforms, HCN1-42–4. The single-channel conductance,γ, of HCN channels remains debated, with conflicting results ranging from near 1.5 pS for HCN25,6to tens of pS for HCN17, HCN27and HCN47,8, though the pore structure, viewed to determine the conductance9,10, is either identical or highly conserved. To resolve this controversy, we analyzed all four mouse isoforms mHCN1-4 at femtosiemens resolution. We show that mHCN1, mHCN3 and mHCN4 also generate small conductance values, even smaller than that of mHCN2 with the sequenceγmHCN2=1.54 pS >γmHCN1=0.84 pS >γmHCN3=0.54 pS ≍γmHCN4=0.51 pS. As shown by systematic mutagenesis and molecular dynamic simulations, the differences in the conductance are neither generated by the selectivity filter nor the inner gate9, but by defined negative charges in the outer channel vestibule increasing cation occupation. In line with these results, heteromers of mHCN2 with either mHCN1, mHCN3 or mHCN4 lead to graded single-channel currents in-between those of the respective homomeric channels. Our approach at femtosiemens resolution provides insight into the function of recombinant and native HCN channels at the level of single subunits and is thus promising for the development of subunit-specific drugs acting on these clinically highly relevant channels11.
Systematic Review on the Role of Microbial Activities on Nutrient Cycling and Transformation Implication for Soil Fertility and Crop Productivity
Authors: Bayu Tesfaye 
Published: September 2024

AbstractSoil microorganisms play a vital role in the regulation of the transformation and cycle of soil nutrients, thereby improving soil fertility and crop productivity. These microbes, associated with plants, contribute significantly to plant growth and development by improving nutrient cycling and crop productivity by improving soil fertility. This systematic review aims to assess the impact of microbial activity on nutrient cycle and transformation, which includes soil fertility and crop productivity improvement. The PRISMA flow methodology systematically included articles from various geographic regions. Through analyzing 120 articles, this review sought to address the question at hand. Among the articles analyzed, 31.4% indicate that soil microbial activity directly regulates nutrient cycling, while 68.6% suggest that microbial activity enhances soil fertility and crop productivity. The systematic review concludes that microbial activity has a significant effect on nutrient cycle and transformation, as well as on improving soil fertility and crop productivity. Farmers, policymakers, and experts are encouraged to manage soil microorganisms to regulate nutrient cycling, directly influencing soil fertility and crop productivity, thus promoting sustainable agricultural development.
PREVALENCE AND TREATMENT OUTCOME OF ANORECTAL MALFORMATION AT MNAZI MMOJA REFERRAL HOSPITAL 2018-2022
Authors: Chongera Ahmad Moshi , Ally Abdulkarim Hamad , Mussa Mwanakhamis Vuai , Mnyaruge Yasinta Edison , Said Said A , Haji Mwanabaraka Saleh 
Published: September 2024

ABSTRACTBACKGROUNDAnorectal Malformations (ARM) are congenital defects where the anus and rectum do not form correctly, presenting a range of complexities that often necessitate intricate surgical interventionist global incidence of ARM is approximately 1 in 2000 to 5000 live births. In developing countries like Tanzania, managing ARMs poses significant challenges due to late presentations, shortage of trained pediatric surgeons and inadequate diagnostic facilities. This study aimed to evaluate the prevalence and treatment outcomes of ARM at Mnazi Mmoja Hospital (MMH) over five years 2018 to 2022OBJECTIVESincluding analyzing patient demographics (age and sex), the prevalence of ARMs, common types, surgical procedure used and associated complications. A retrospective, descriptive cross-sectional study was conducted using data from structed questionnaire, which were analyzed with SPSS software.RESULTSrevealed that the sex distribution of patients was nearly equal, with ARM cases increasing from 8 (9.9%) in 2018 to 33(40.7%) in 2022. The majority of cases were in Urban Wes (49.9%), and most patients (90.1%) had major ARMs. Surgical treatments included three-stage procedures (65.4%) and one-stage procedures (13.6%), with a postoperative complication rate of 17.2%. survival was high, with 90.1% survival rate and low mortality rate of 9.9%CONCLUSIONARM remains a prevalent and challenging surgical issue in Zanzibar, constituting 35% 0f pediatric gastrointestinal surgeries. Implementing modern single-stage surgical approaches could potentially improve patient outcomes and reduces complications