bluuebunny/crossref_metadata_2025_split huggingface dataset:
Risk of Acute Compartment Syndrome in Pediatric Patients With Tibial Tubercle Avulsion Fractures: A Retrospective Review
Authors: Bergen Michael A. , Vutescu Emil Stefan , McKinnon Samuel , Canastra Neal , Boulos Alexandre , Schiller Jonathan R. , Eberson Craig P. , Cruz Aristides I. 
Published: June 2024

Objective:
Tibial tubercle avulsion fractures (TTAFs) represent 0.4% to 2.7% of pediatric physeal injuries. These injuries are thought to confer a risk of acute compartment syndrome (ACS), and these patients are often admitted for compartment monitoring and, in many cases, undergo prophylactic fasciotomy. This study sought to review our institution’s experience with TTAF and associated compartment syndrome in pediatric patients.

Methods:
All patients aged 8 to 18 years with TTAF at our institution from January 1, 2017 to January 1, 2023 were retrospectively reviewed. Patient demographics, injury mechanism, fracture morphology, and postinjury course were reviewed. ACS was diagnosed by clinical exam or necessitating therapeutic compartment fasciotomy.

Results:
A total of 49 TTAFs in 47 patients were included in the final analysis. The mean age was 14.5 ± 1.2 years (range: 11 to 17), and males were significantly older than females (14.6 ± 1.1 vs 13.3 ± 1.3 y, P = 0.01). The average body mass index was 27.1 ± 7.0, and males had a significantly lower body mass index than females (26.3 ± 6.5 vs 34.1 ± 8.5, P = 0.03). Basketball was the most common mechanism of injury (49%), followed by soccer (13%), football (11%), trampoline (6%), fall (6%), jumping (4%), lacrosse (4%), running (4%), and softball (2%). The Ogden fracture types were as follows: I: 10%; II: 16%; III: 41%; IV: 24%; V: 8%. Thirty-four patients (69%) were admitted to the hospital for at least one night after presentation. Forty-six (96%) underwent surgical fixation an average of 3.5 days after injury. No patients developed ACS during their post-injury or postoperative course. Three patients underwent the removal of hardware. No other complications were observed. The average follow-up duration was 238 days.

Conclusions:
The results of this study suggest that the risk of ACS in pediatric patients with TTAF may be small enough to allow for same-day discharge after diagnosis or operative management in patients deemed to be sufficiently low risk by clinical judgment.

Level of Evidence:
Level III—retrospective comparative study.
Ten-Year Heterogeneity of Minimal Important Change and Patient Acceptable Symptom State After Lumbar Fusions
Authors: Toivonen Leevi A. , Laurén Jenna L.C. , Kautiainen Hannu , Häkkinen Arja H. , Neva Marko H. 
Published: June 2024

Study Design.
Cohort study.

Objective.
To evaluate heterogeneity (fluctuation) in minimal important change (MIC) and patient-acceptable symptom state (PASS) for patient-reported outcomes (PROMs) through 10 years after lumbar fusion.

Summary of Background Data.
PROMs have become key determinants in spine surgery outcomes studies. MIC and PASS were established to aid PROM interpretations. However, their long-term stability has not yet been reported.

Methods.
A consecutive series of elective lumbar fusions were followed up using the Oswestry Disability Index (ODI) and Visual Analogue Scale (VAS) for pain. Improvement was rated by a 4-point Likert scale into “improved” or “nonimproved.” Satisfaction-to-treatment was rated by the patients’ willingness to undergo surgery again. Receiver operating characteristics (ROC) curve analysis estimated MIC (95% confidence interval, CI) as the PROM change that best predicted improvement at distinct time-points. PASS (CI) was estimated as the lowest PROM score at which the patients were still satisfied. Heterogeneity across thresholds was evaluated using the DeLong algorithm.

Results.
MIC for ODI represented heterogeneity across 10 years, ranging from −21 (−24 to −16) at two years to −8 (−7 to −4) at five years, P<0.001. The areas under the ROC curves (AUCs) (0.79 to 0.85) indicated acceptable to excellent discrimination. Heterogeneity was not significant in the MICs for the pain scores. At one year, MIC for back pain was −24 (−38 to −15), AUC 0.77, and for leg pain, it was −26 (−44 to −8), AUC 0.78. No significant heterogeneity was observed in 10-year PASS scores. At 1-year, PASS for ODI was 22 (15 to 29), AUC 0.85. Similarly, the one-year PASS for back pain was 38 (20 to 56), AUC 0.81, and for leg pain, it was 49 (26 to 72), AUC 0.81.

Conclusions.
MIC for ODI fluctuated over 10 years after lumbar fusions. PASS values for all PROMs seemed most stable over time. Caution is needed when generic MIC values are used in long-term studies.

Level of Evidence.
Level III
Immunotherapy for hepatocellular carcinoma
Authors: Wang Xiaoxia , Lu Jun 
Published: June 2024

Abstract
Hepatocellular carcinoma (HCC) is a leading cause of cancer-related deaths worldwide. Its high recurrence rate and lack of effective control drugs result in a 5-year survival rate of only about 10%. HCC is a tumor regulated by the immune system. Significant breakthroughs have occurred in treating solid tumors with immunotherapy in recent years. Various immunotherapies, such as immune checkpoint inhibitors (ICIs), including combination therapies, have demonstrated promising therapeutic effects in both clinical applications and research. Other immunotherapies, such as adoptive cell therapies and oncolytic viruses, are also emerging, offering hope for addressing long-term survival issues in HCC. This article reviews current commonly used immunotherapy strategies and the latest research findings for reference.
Mechanism of mitochondrial oxidative phosphorylation disorder in male infertility
Authors: Meng Kai , Liu Qian , Qin Yiding , Qin Wenjie , Zhu Ziming , Sun Longlong , Jiang Mingchao , Adu-Amankwaah Joseph , Gao Fei , Tan Rubin , Yuan Jinxiang 
Published: June 2024

Abstract
Male infertility has become a global concern, accounting for 20–70% of infertility. Dysfunctional spermatogenesis is the most common cause of male infertility; thus, treating abnormal spermatogenesis may improve male infertility and has attracted the attention of the medical community. Mitochondria are essential organelles that maintain cell homeostasis and normal physiological functions in various ways, such as mitochondrial oxidative phosphorylation (OXPHOS). Mitochondrial OXPHOS transmits electrons through the respiratory chain, synthesizes adenosine triphosphate (ATP), and produces reactive oxygen species (ROS). These mechanisms are vital for spermatogenesis, especially to maintain the normal function of testicular Sertoli cells and germ cells. The disruption of mitochondrial OXPHOS caused by external factors can result in inadequate cellular energy supply, oxidative stress, apoptosis, or ferroptosis, all inhibiting spermatogenesis and damaging the male reproductive system, leading to male infertility. This article summarizes the latest pathological mechanism of mitochondrial OXPHOS disorder in testicular Sertoli cells and germ cells, which disrupts spermatogenesis and results in male infertility. In addition, we also briefly outline the current treatment of spermatogenic malfunction caused by mitochondrial OXPHOS disorders. However, relevant treatments have not been fully elucidated. Therefore, targeting mitochondrial OXPHOS disorders in Sertoli cells and germ cells is a research direction worthy of attention. We believe this review will provide new and more accurate ideas for treating male infertility.
Supporting Spiritual Care With the Saline Process™
Authors: Rowley Carol 
Published: June 2024

ABSTRACT:
Living one's Christian faith and providing appropriate spiritual care in professional nursing practice can seem challenging. The IHS Global® Saline Process™ course equips Christian healthcare workers with knowledge and tools to provide appropriate spiritual support and consider how God is calling them to share his truth and love. After participating in a Saline Process™ course, ongoing engagement helps clinicians grow in practicing what they have learned. Nurses Christian Fellowship International (NCFI) partners with IHS Global® to bring the Saline Process™ to Christian nurses and other clinicians around the world, building the community of providers offering whole-person care.
Vertebral artery dissection with cerebellar infarction due to sudden head turning: A case report
Authors: Huang Yu-Ting , Ou Chien-Yu 
Published: June 2024

Abstract
A 27-year-old man upon quickly turning his head experienced sudden dizziness, unilateral limb weakness, neck pain, and paralysis. He was transported to the emergency department by ambulance. Computed tomography, computed tomography angiography, and magnetic resonance imaging of the brain identified a left vertebral artery dissection with cerebellar infarction without subarachnoid hemorrhage. The patient's blood pressure was controlled, and he was placed on bed rest, but no surgical intervention was undertaken. A cerebral angiography performed 2 months after the dissection found the previously stenosed site fully patent with no further stenosis. Our case suggests that for extracranial vertebral dissection, the patient must be first checked for intracranial subarachnoid hemorrhage, and in its absence, conservative treatment can be considered. Many studies have examined surgical intervention to address vertebral artery dissection; however, our case report presents a literature review regarding suitability for surgery in these patients.
Benefits and Barriers of Using Virtual Reality in Teaching Undergraduate Nursing Students
Authors: George Ragi , Titus Sharon K. 
Published: June 2024

Background:Although studies have been conducted using virtual reality (VR) in nursing education, evidence distinguishing the benefits and barriers of adopting VR pedagogical methods to teach undergraduate nursing students is not well-defined in nursing literature.Purpose:To identify current evidence on the benefits and barriers of adopting VR as a pedagogical method in nursing education.Methods:A scoping review of 6 databases using PRISMA-ScR reporting guidelines. Data were managed using Covidence® software. Table of Evidence illustrates the themes.Results:Seventeen articles identified 5 thematic benefits of VR (knowledge acquisition, student engagement, improved self-confidence, teaching strategy, and cost factors) and 4 barriers (physical discomfort, learning outcome challenges, challenges to integrating into curricula, and technology challenges).Conclusions:VR is an effective teaching-learning strategy to reinforce nursing concepts and build competencies. It is not a substitute for clinical education.
Defining Nurse Practitioner Core Entrustable Professional Activities
Authors: Moore Jeanne , Chan Tracey , Doucette Julianne , Lipps Terri , Slager Dianne 
Published: June 2024

Background:
Gaps between educational preparation and clinical practice readiness have led to innovative approaches to competence assessment. Entrustable professional activities (EPAs) show promise as a competence assessment framework in graduate nursing education.

Purpose:
This study sought to develop and validate a set of EPAs that reflect the core activities performed by all nurse practitioners (NPs).

Methods:
Eight EPAs were developed. A Delphi approach was used to validate the EPAs by NP practice experts located across the United States and representing most NP populations.

Results:
Consensus was reached after 2 Delphi rounds.

Conclusions:
The EPAs developed and validated in this study map multiple advanced-level NP competencies to workplace expectations and provide a shared framework for competency-based workplace assessment among NP preceptors from varied health care professions.
Periorbital Outcomes and Vision Risk Stratification in Treacher Collins Syndrome
Authors: Ng Jinggang J , Zhong Anny , Massenburg Benjamin B , Binenbaum Gil , Wu Meagan , Romeo Dominic J , Katowitz William R , Swanson Jordan W , Bartlett Scott P , Taylor Jesse A 
Published: June 2024

Background:
We examined ophthalmologic outcomes and periorbital management in patients with Treacher Collins syndrome (TCS).

Methods:
A retrospective cohort study was performed of children with TCS treated from 2009 to 2023 at our center. Demographics and medical history were collected. Primary outcomes were periorbital findings, surgical burden, and visual acuity. Patients were stratified by risk of vision loss based on ophthalmologic findings.

Results:
Among 50 subjects, mean follow-up was 10.5±5.9 years. Periorbital findings included downslanting palpebral fissures (100%), eyelash deficiency (70%), eyelid coloboma (54%), and significant refractive error (50%). Twenty (40%) individuals underwent 86 periorbital procedures, including lateral canthopexy (n=23 operations) and malar/zygomatic reconstruction/augmentation (n=20). Lateral canthopexies accompanied by malar fat grafting were less likely to require reoperation (0% versus 72%, p=0.004). Subjects with eyelid coloboma were more likely to have exposure keratopathy (30% versus 4%, p=0.020). Grouped by risk of vision loss, 58% were “High” risk, 18% were “Moderate”, and 24% were “Low”. Among 78 eyes of 39 subjects, vision was “Good” in 90%, “Fair” in 5%, and “Poor” in 6%. Vision risk grading was associated with visual acuity outcomes (n=29) (p=0.050).

Conclusions:
In assessing long-term ophthalmological outcomes, we noted good vision despite significant periorbital anomalies. Though most eyelid colobomas can be managed with lubrication, those threatening corneal integrity should be repaired in infancy. As timely intervention may prevent visual impairment, we recommend perinatal ophthalmologist evaluation for all children with TCS. Our proposed vision risk scale may serve as a helpful paradigm by which to contemplate vision-related issues.
Neuropathic Pain after Major Limb Amputation: A Cross-Sectional Study
Authors: Langeveld Mirte , Raasveld Floris V. , Hundepool Caroline A. , Hagenaars Tjebbe , Spijkerman Dorien C. M. , Eberlin Kyle R. , Zuidam J. Michiel 
Published: June 2024

Background:
Residual limb pain (RLP) and phantom pain can arise following amputation and may require additional treatment or surgery. This study aimed to determine the prevalence of neuropathic RLP following limb amputation and identify prognostic factors for the development of neuropathic RLP.

Methods:
A cross-sectional study was performed of patients who underwent upper or lower extremity amputation between 1990 and 2021 with a minimum of 12 months’ follow-up. The primary outcome was the prevalence of neuropathic RLP, defined as a 0 to 10 numeric rating analog scale pain score in the residual limb of greater than or equal to 4, in combination with a score greater than or equal to 4 on the short-form Douleur Neuropathic 4 questionnaire, validated for discriminating between nociceptive and neuropathic pain. The secondary outcome was quality of life for amputation patients with and without (neuropathic) RLP. A multivariable linear regression model was used to identify prognostic factors for neuropathic RLP development.

Results:
A total of 121 patients were included: 87 with lower extremity amputations, 29 with upper extremity amputations, and 5 with both. Neuropathic RLP was experienced by 21.5%, whereas 10.7% reported nonneuropathic RLP. Smoking status and complex regional pain syndrome as indications for limb amputation were associated with more severe neuropathic pain symptoms. Patients experiencing neuropathic RLP reported a significantly lower quality of life compared with patients without neuropathic RLP.

Conclusions:
This study demonstrates that neuropathic RLP is common after limb amputation and impacts daily functioning. The absence of numerous manageable prognostic factors associated with neuropathic pain development emphasizes the importance of the consideration of prophylactic interventions at the time of amputation.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Risk, III.
Satisfaction with Breasts following Autologous Reconstruction: Assessing Associated Factors and the Impact of Revisions
Authors: Kim Minji , Vingan Perri , Boe Lillian A. , Mehrara Babak J. , Stern Carrie S. , Allen Robert J. , Nelson Jonas A. 
Published: June 2024

Background:
Autologous breast reconstruction (ABR) may confer higher patient-reported outcomes than implant breast reconstruction, but an in-depth examination of factors associated with satisfaction after ABR is lacking. The authors aimed to determine independent predictors of 1-year satisfaction with breasts after ABR and assess the importance of elective procedures on satisfaction.

Methods:
A retrospective analysis of patients who underwent abdominally based ABR between 2010 and 2021 and completed the BREAST-Q Satisfaction with Breasts module at 1 year was performed. Elective procedures consisted of breast revision and nipple-areola complex reconstruction.

Results:
A total of 959 patients were included. Satisfaction with Breasts score improved from 53 (interquartile range [IQR], 44 to 64) preoperatively to 64 (IQR, 53 to 78) at 1 year postoperatively (P < 0.001). Factors significantly associated with decreased postoperative score included lower preoperative scores (β = 0.19 [95% CI, 0.08 to 0.31]; P = 0.001), older age (β = −0.17 [95% CI, −0.34 to −0.01]; P = 0.042), Asian race (versus White, β = −6.7 [95% CI, −12 to −1.7]; P = 0.008), and a history of psychiatric diagnoses (β = −3.4 [95% CI, −6.2 to −0.66]; P = 0.015). Patients who received radiation therapy (β = −5.6 [95% CI, −9.0 to −2.3]; P = 0.001) or had mastectomy skin flap/nipple necrosis (β = −3.8 [95% CI, −7.6 to −0.06]; P = 0.046) also had significantly decreased scores. Satisfaction with Breasts scores improved significantly after breast revision procedures (from 54 [IQR, 42 to 65] to 65 [IQR, 54 to 78]; P < 0.001), and nipple-areola complex reconstruction (from 58 [IQR, 47 to 71] to 67 [IQR, 57 to 82]; P < 0.001).

Conclusions:
Multiple independent patient and treatment level factors are associated with lower 1-year Satisfaction with Breasts scores following ABR. Elective procedures have the potential to improve satisfaction. Understanding these findings is imperative for optimizing clinical decision-making and managing expectations.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Risk, III.
Left Atrial Strain for Prediction of Left Ventricular Reverse Remodeling After ST-segment Elevation Myocardial Infarction by Cardiac Magnetic Resonance Feature Tracking
Authors: Yang Zhaoxia , Tang Yuanyuan , Sun Wenzhe , Wen Jinyang , Tang Dazhong , Luo Yi , Xiang Chunlin , Huang Lu , Xia Liming 
Published: June 2024

Purpose:
The study aimed to investigate the potential utility of left atrial (LA) strain by using cardiac magnetic resonance feature-tracking (CMR-FT) to predict left ventricular reverse remodeling (LVRR) following ST-segment elevation myocardial infarction (STEMI).

Materials and Methods:
Patients with a first STEMI treated by primary percutaneous coronary intervention were consecutively enrolled in the prospective study and underwent CMR scans at 5 days and 4 months. LA global longitudinal strain (reservoir strain [εs], conduit strain [εe], booster strain [εa]) and corresponding strain rate were assessed by CMR-FT using cine images. LVRR was defined as a reduction in the LV end-systolic volume index of >10% from baseline to follow-up. Logistic regression analyses were performed to determine the predictors of LVRR.

Results:
Of 90 patients analyzed, patients with LVRR (n=35, 39%) showed higher values of LA strain and strain rate and less extensive infarct size (IS) compared with patients without LVRR (n=55, 61%) at initial and second CMR. The LVRR group demonstrated significant improvements in LV and LA cardiac function over time, especially the obvious increase in LA strain and strain rate. In multivariate logistic regression analyses, εs and εe, together with IS, were independent predictors of LVRR. The combination of εs and IS could optimally predict the LVRR with the highest area under the curve of 0.743.

Conclusions:
Post-STEMI patients with LVRR presented better recovery from cardiac function and LA deformation compared with patients without LVRR. Assessment of εs and εe by using CMR-FT after STEMI enabled prediction of LVRR.
Discriminative Ability of Dye Injected Into a Meat Model to Determine Accuracy of Ultrasound-Guided Injection
Authors: Brownbridge Regan G. , Kiberd Mathew B. , Werry Daniel , Bailey Jonathan G. 
Published: June 2024

Introduction
The utility of using meat models for ultrasound-guided regional anesthesia simulation training has been well established. Feedback is considered the most important element of successful simulation-based education, and simulation offers an opportunity for evaluation. The objective of this study was to establish the discriminative ability of dye injected into a meat model to determine whether injectate is properly placed in the perineural (PN) space, thus providing an additional tool for learner feedback and evaluation.

Methods
Meat models containing a beef tendon (simulating a nerve) were injected with dye in one of 3 locations: PN, intraneural, and intramuscular. Blinded assessors then independently interpreted the dye staining on the models, marked the interpreted injection location, ease of interpretation, and whether staining was present on the beef tendon.

Results
Thirty meat models were injected with dye and independently assessed. Determining the location of injection was deemed to be easy or very easy in 72% of the models. Assessors correctly identified PN, intraneural, and intramuscular injections 100%, 95%, and 85% of the time, respectively. Assessor agreement was 87%.

Conclusions
The location of dye injected into a meat model, simulating a peripheral nerve blockade, can be accurately and reliably scored to provide feedback to learners. This technique offers a novel means of providing feedback to trainees and assessing block success in ultrasound-guided regional anesthesia simulation.
Characteristics and Usefulness of Neurophysiological Monitoring in Corrective Procedures for Abnormally Curved Spine in Young Patients
Authors: Michaeli Avner , Miller Sara , Danto Joseph , Arzi Harel , Schroeder Josh E. , Ovadia Dror 
Published: June 2024

Purpose:
To identify and characterize events of deterioration in intraoperative neuromonitoring data during correction procedures for thoracic and lumbar abnormal spinal curvature in young patients.

Methods:
Records of 1,127 cases were retrospectively reviewed to identify events with deterioration of the neuromonitoring data. General etiological and demographic variables were summarized, and neuromonitoring events were studied and characterized.

Results:
Adolescent idiopathic cases were associated with female dominance and older age. Nonadolescent idiopathic cases were associated with a higher rate of neuromonitoring events. The neuromonitoring events evolved during the different procedural stages, were primarily reflected in the motor-evoked potential data and affected a range of neural structures to varying degrees. Most of the events were resolved, partially or completely, following a corresponding intervention by the surgical team, before the end of the procedure. Significant immediate weakness of the lower extremities was demonstrated in patients with unresolved neuromonitoring events, most of them were nonadolescent idiopathic patients.

Conclusions:
Neurophysiological monitoring enables the intraoperative assessment of the integrity of neural pathways and allows the detection of surgery-related impending neural injuries. Neuromonitoring contributes to intraoperative decision making, either when data are uneventful and allow confident continuation or when data deteriorate and lead to corresponding intervention. Further awareness should be paid to the vulnerable characteristics of the patient, surgery course, and neuromonitoring data. Proper interpretation of the neuromonitoring data, together with corresponding intervention by the surgeon when necessary, has the potential to reduce postoperative neurological insults and improve clinical outcomes.