bluuebunny/crossref_metadata_2025_split huggingface dataset:
Theta burst stimulation for enhancing upper extremity motor functions after stroke: a systematic review of clinical and mechanistic evidence
Authors: Zhang Jack Jiaqi , Sui Youxin , Sack Alexander T. , Bai Zhongfei , Kwong Patrick W. H. , Sanchez Vidana Dalinda Isabel , Xiong Li , Fong Kenneth N. K. 
Published: April 2024

Abstract
This systematic review aimed to evaluate the effects of different theta burst stimulation (TBS) protocols on improving upper extremity motor functions in patients with stroke, their associated modulators of efficacy, and the underlying neural mechanisms. We conducted a meta-analytic review of 29 controlled trials published from January 1, 2000, to August 29, 2023, which investigated the effects of TBS on upper extremity motor, neurophysiological, and neuroimaging outcomes in poststroke patients. TBS significantly improved upper extremity motor impairment (Hedge’s g = 0.646, p = 0.003) and functional activity (Hedge’s g = 0.500, p < 0.001) compared to controls. Meta-regression revealed a significant relationship between the percentage of patients with subcortical stroke and the effect sizes of motor impairment (p = 0.015) and functional activity (p = 0.018). Subgroup analysis revealed a significant difference in the improvement of upper extremity motor impairment between studies using 600-pulse and 1200-pulse TBS (p = 0.002). Neurophysiological studies have consistently found that intermittent TBS increases ipsilesional corticomotor excitability. However, evidence to support the regional effects of continuous TBS, as well as the remote and network effects of TBS, is still mixed and relatively insufficient. In conclusion, TBS is effective in enhancing poststroke upper extremity motor function. Patients with preserved cortices may respond better to TBS. Novel TBS protocols with a higher dose may lead to superior efficacy compared with the conventional 600-pulse protocol. The mechanisms of poststroke recovery facilitated by TBS can be primarily attributed to the modulation of corticomotor excitability and is possibly caused by the recruitment of corticomotor networks connected to the ipsilesional motor cortex.
Enhancing Falling Weight Deflectometer (FWD) Testing: Comprehensive Review and Development of Robust Procedure in the United States
Authors: Pandya Harshdutta I. , Ali Ayman A. , Mehta Yusuf A. 
Published: April 2024

Abstract
The Falling Weight Deflectometer (FWD) is a widely used nondestructive testing equipment for assessing the structural condition of pavements. The FWD measures the vertical deflection response of a pavement surface under a dynamic load applied by a falling weight. The deflection data collected from an FWD test can be used to determine the structural capacity of a pavement system, including the pavement layer thickness, elastic modulus, and subgrade strength, and to identify pavement areas that may require maintenance or rehabilitation. Despite the widespread use of the FWD, there are some concerns regarding the consistency and reliability of FWD test results. These inconsistencies have led to the need for a comprehensive evaluation of the current state of practice of FWD testing. The overall goal of this study was to conduct a comprehensive review of the literature and synthesize the best practices and areas of inconsistency in FWD testing for rehabilitation applications. This review will also allow for developing a robust FWD testing procedure across the states. Different agencies nationwide employ similar yet different FWD testing procedures, mainly in sensor configuration, load sequences, test plans, and data processing. Reviewing these testing procedures highlighted the similarities and differences and identified the potential items to improve. These potential items include but are not limited to sensor configuration, load sequences, test frequency, test spacing, and temperature measurements. This study will help state highway agencies and the industry identify best practices, improve consistency, enhance data comparability, increase efficiency, and improve decision-making for nationwide road construction and maintenance (or rehabilitation) projects.
The Role of Leu-Enkephalin Synthetic Analogue in Regulation of Systemic Inﬂammatory Response and Prevention of ARDS in Severe Combined Injury
Authors: Ryzhkov A. Y. , Antonova V. V. , Cherpakov R. A. , Chernevskaya E. A. , Shabanov A. K. , Ostapchenko D. A. , Magomedov M. A. , Grebenchikov O. A. 
Published: April 2024

The aim of the study. To study the eﬀect of ley-enkephalin synthetic analogue on the dynamics of inﬂammatory response markers and organ dysfunction in patients with severe combined trauma.Materials and methods. A prospective clinical study with historical control from two clinical centers — N. I. Pirogov State Clinical Hospital No. 1 and N.V. Sklifosovsky Clinical and Research Institute for Emergency Medicine — included men and women with severe combined trauma and the ISS scores values of 18–44, aged 18 to 70 years. Diagnostic and therapeutic approaches in all patients followed current international, national& local protocols and 2022 clinical recommendations of the Russian Society of Surgeons «Combined and multiple trauma in combination with shock (Polytrauma)». In the study group, treatment was supplemented with extended (72 hours from the admission) infusion of the test drug through a syringe dispenser following the study protocol. Eﬀects of the test drug prolonged infusion were evaluated for the following laboratory parameters: levels of cortisol, procalcitonin, interleukin 6, NTproBNP and leukocyte count. Laboratory tests were performed at 4 time points: prior to test drug infusion, 24 hours and 72 hours after initiation of infusion, and on Day 7. The study evaluated patient’s dynamics using APACHE II, SOFA and SAPS II scales and percentage of patients developing organ dysfunction (renal, respiratory, cardiovascular), rates of sepsis complications and mortality.Results. Patients who received the test drug had signiﬁcantly lower concentrations of systemic inﬂammatory response markers, i. e. PCT (P=0.001) and IL-6 (P=0.010) after 24 hours of follow-up vs the control group patients. The incidence of ARDS has also decreased in the study group (P=0.011 vs control). Acute kidney injury (AKI) rate was insigniﬁcantly higher in the control group (P=0.349). The duration of hospital stay in the control group was 35 (17; 51) days vs 18 (14; 30) days in the study group (P=0.140)Conclusion. The use of ley-enkephalin synthetic analogue inhibits production of such key systemic inﬂammatory response markers as PCT and IL-6, and reduces PCT concentrations within 24 hours in patients with severe combined trauma. ARDS developed less frequently in the study group, but there was no signiﬁcant diﬀerence in the incidence of AKI, AHF and infectious complications between the groups.
Asphyxial Circulatory Arrest with a Complex of Resuscitation Measures in an Experimental Model
Authors: Dubensky A. Y. , Ryzhkov I. A. , Lapin K. N. , Kalabushev S. N. , Varnakova L. A. , Tsokolaeva Z. I. , Dolgikh V. T. , Grechko A. V. 
Published: April 2024

The majority of asphyxial circulatory arrest (CA) models have a number of disadvantages, such as the lack of uniform criteria for ﬁxing CA and recovery of spontaneous circulation, short duration of CA episode and limited volume of post-resuscitation intensive care, poor similarity with resuscitation measures in current clinical anesthesiology/intensive care settings.The aim of the study: to improve the experimental model of asphyxicial CA by standardizing experimental procedures and using a complex of resuscitation measures replicating current CA management in clinical anesthesiology-intensive care.Materials and methods. The experiments were conducted on 34 male Wistar rats, distributed into 2 groups: Group I included animals subjected to sham procedure (SP, N=12) and Group II – animals subjected to asphyxial circulatory arrest (CA, N=22) and subsequent resuscitation. Asphyxia in anesthetized rats was induced by rocuronium bromide injection, followed by recording of electrocardiogram (ECG), parameters of invasive blood pressure (BP) measurement and laser Doppler ﬂuxmetry (LDF) to assess skin perfusion. CA episode was maintained for 2 min, followed by a series of resuscitation measures and intensive therapy for 2 h. Circulatory parameters (ECG, BP, LDF), gas composition and arterial blood acid-base state (ABS) dynamics were evaluated.Results. Monitored parameters were comparable in both groups at baseline after stabilization period. After exclusion criteria were applied 11 animals from SP group and 18 — from CA were included in the analysis. Tachycardia (heart rate, beats/min–1, SP vs CA) was documented in the CA group: 218 [205; 236] vs 286 [272; 305], P⩽0.0001), as well as recovery of skin perfusion to subnormal parameters in the ﬁrst minutes after successful resuscitation. At minute 10 in the post-resuscitation period worsening of skin perfusion (M, perfusion units, SP vs CA): 14.7 [12.1; 16.5] vs 10.1 [7.0; 12.5], P=0.0014), and decompensated mixed acidosis (pH, SP vs CA): 7.42 [7.40; 7.43] vs 7.20 [7.13; 7.23], P⩽0.0001) were documented in the CA group, however BP values were comparable (BP, mmHg, SP vs CA): 60 [58; 72] vs 67 [62; 82], P=0.482). At minute 120 post-resuscitation and at the end of intensive care period, both groups demonstrated similar values of the monitored parameters. Three out of 18 animals in the CA group died after resuscitation.Conclusion. Electromechanical dissociation underlies CA in rats subjected to asphyxia. The use of LDF to assess peripheral blood ﬂow makes it possible to standardize the severity of ischemic reperfusion injuries and improve reproducibility of the model. Series of resuscitation measures in experimental setting is justiﬁed from a bioethical point of view, and makes it possible to improve repeatability of preclinical research results in clinical practice.
Nutritional and Metabolic Status Control and Nutritional Support in Patients with Pancreatic Sepsis (Review)
Authors: Zhukov A. V. , Gritsan A. I. , Belyaev K. Y. , Belyaeva I. P. 
Published: April 2024

Acute pancreatitis (AP) is associated with pancreonecrosis in 30% of patients, who may fall at 80% high risk of death when infected pancreatic necrosis progresses to sepsis. Given the catabolic nature of the disease and the signiﬁcant inﬂuence of nutritional status on its course and outcome, these patients require an adequate nutritional support (NS) based on an adequate assessment and control of nutritional and metabolic status.The aim of the study: to identify trends in developing new tools for assessment of nutritional and metabolic status, and provision of NS in patients with pancreatic sepsis (PS).Materials and methods. Keyword search in the PubMed, Scopus and E-library databases for the period from 2018 to 2023 yielded 95 publications, of which 16 meta-analyses and 6 systematic reviews met the requirements.Results. all existing to date scales for assessment of nutritional deﬁciency in patients with PS have low prognostic value. Of them, mNUTRIC scale seems to be the most appropriate assessment tool. Recommended by EPSEN guidelines tools to assess the risk of nutritional deﬁciency it is not suitable for ICU patients. Indirect calorimetry should be preferred vs routine calculation formulas in assessing patient’s energy needs in case of PS. It was also found that «standard» anthropometric values, such as BMI, are not always informative and prognostically signiﬁcant in patients with severe AP in the ICU. Analgesia, infusion therapy, as well as detection and correction of intraperitoneal hypertension are not only integral components of intensive care for PS but are indispensable for supplying adequate NS in PS patients. It was found that early enteral nutrition is the preferred method of NS, although questions concerning choice of tube insertion site, as well as all parameters of tube feeding remain unanswered. The optimal composition of enteral nutrition for patients with PS has not been established, which is indirectly conﬁrmed by the variety of enteral mixtures available on the market. The refeeding syndrome that occurs at initiation of NS was characterized as a life-threatening condition.Conclusion. NS, based on adequate assessment of disorders and control of the nutritional and metabolic status is an integral component of intensive care in PS patients. It can reduce the probability and number of potential complications, time of stay in the ICU, cost of treatment, and improve patient’s prognosis.
Acetabular Fracture Outcomes and Complications: An International Comparison
Authors: Dallman Johnathan , Ayres Jack , Nolte Jack , Everist Brian , Crist Jamie , Frager Luke , Sojka John , Malancea Radu , Heddings Archie 
Published: April 2024

Introduction
While there have been many technological advances in the treatment of acetabular fractures since the landmark article by Judet and Letournel, the effectiveness of many of these advances have not been definitively determined. Comparing patient outcomes between two countries with differing amounts of technological resources may identify the efficacy of such resources.

Methods
This study retrospectively compared 489 patients (373 US, 116 Romania) who underwent open reduction and internal fixation (ORIF) for acetabular fracture(s) in a Romanian trauma center and a United States (US) trauma center between February 2011 and August 2018.

Results
US patients had a higher rate for the following comorbidities: diabetes (p=.0268), obesity (p<.0001), and hypertension (p<.0001). US patients had a significantly shorter pre-op delay (p<.0001). Matta’s criteria for initial quality of reduction did not vary significantly between countries (p=.1101). No significant difference was found in rates of DVT (p=.0722), postoperative infections (p=.2819), sciatic nerve lesions (p=.9999), or loss of reduction (p=.9999). US patients had significantly higher Brooker criteria scores for heterotopic ossification (p<.0001).

Conclusions
There were no significant differences in outcomes between US and Romanian patients even though US patients received treatment using the latest technology while Romanian patients were treated using substantially fewer resources. Given that technological advances in surgical technique come at a considerable price, it makes sense to build upon this study to gain a more precise understanding of how these advances improve outcomes for patients, and whether or not they are worth the added cost.
Maternal near miss mortality: indication of maternal care
Authors: Ali Maryam , Prabhakar Manju , Sai Kuracha Anjani 
Published: April 2024

Maternal mortality is one of the important indicators used for the measurement of maternal health. To overcome this challenge, maternal near miss has been suggested as a compliment to maternal death. The prevalence of near miss is higher in developing countries and causes are similar to those of maternal mortality namely haemorrhage, hypertensive disorders, sepsis and obstructed labor. Reviewing near miss cases provide significant information about the delays in health seeking so that appropriate action is taken. It is useful in identifying health system failures and assessment of quality of maternal health-care. Certain maternal near miss indicators have been suggested to evaluate the quality of care. The near miss approach will be an important tool in evaluation and assessment of the newer strategies for improving maternal health. Here we are presenting case series of near miss mortality cases reported in Muzaffarnagar medical college.
Prominent early adulthood hyperferritinemia in scrub typhus
Authors: Naskar Sayan , Chaudhuri Bhaskar Narayan , Basak Amrita , Guchhait Partha , Das Satadal 
Published: April 2024

Background: Scrub typhus is an acute infectious disease, caused by Orientia tsutsugamushi. It is endemic to a geographically distinct region of Japan, Taiwan, China, and South Korea, known as the tsutsugamushi triangle, as well as in Nepal, Pakistan, and Papua New Guinea. In India, the incidence of this disease varies from 4-46% with high morbidity and mortality.
Methods: In this cross-sectional study at a tertiary care hospital in Kolkata, India we analysed ferritin blood levels along with different demographic and laboratory test parameters of 60 suspected scrub typhus patients who were also scrub typhus IgM antibody positive during a one-year study period.
Results: It was found that serum ferritin levels were unusually high in 21-40 years age group patients along with mildly increased urea and creatinine levels. Other important findings were below 40 years of age males were mostly affected, but above 40 years of age, females were generally affected. Haemoglobin and platelet levels were normal in all age groups. Although WBC count and neutrophils were normal in the 21-40 years age group, in other age groups increased levels were observed. CRP, SGPT, and SGOT levels were uniformly high above 20 years of age. Electrolytes were mildly decreased.
Conclusions: It appears that oxidative stress-induced acute kidney injury may be an important reason for the rising ferritin levels in the 21-40 years age group. These important findings may be helpful to clinicians in management of these patients.
Discharge against medical advice (DAMA) in patients with long bone fractures at YEC: Epidemiological, clinical, evolutionary and medico-legal aspects
Authors: Ngongang Gilbert Frank Olivier , Loic Fonkoue , El Hadj Oumar Ndoye , Saidou Arabo , Conde Namoudou , Mahamed Soumah , Jean Bahebeck 
Published: April 2024

Discharge against medical advice (DAMA) is a term used in healthcare establishments when a patient leaves a hospital against the advice of their doctor.The aim of this study was to describe the epidemiological, clinical, evolutionary and medico-legal aspects of patients with long bone fractures discharged against medical advice at the Yaoundé Emergency Centre (YEC). This was a retrospective descriptive and analytical study conducted between January 2016 and December 2022 at the YEC. All patients aged 18 years or older with at least one long bone fracture and discharged against medical advice from our study site during the study period were included. Patients were then contacted to collect the reasons for DAMA, the therapeutic itinerary, the type of treatment undertaken, direct costs, and evolutionary data. Statistical analyses were performed using SPSS version 26 software. Six hundred and forty-seven patients were enrolled during the study period, representing a prevalence of DAMA of 45.7%. The mean age of the patients was 35.47 (± 13.86) years, and 475 (73.4%) were men. Socioeconomic status was low in 72.4% of cases. All religions and ethnic groups were represented. Road traffic accidents (RTA) were the cause of trauma in 83% of cases. The main site of injury was the tibia, in 253 (39.1%) cases. Open fractures accounted for 38.8% of cases. The median time to discharge against medical advice was 16 [6-26], , , hours, with 73.4% of DAMA within 24 hours. Lack of financial resources, the choice of traditional treatment and the preference for another hospital were the three main reasons. In our setting, 45.7% of patients with long bone fractures initially admitted to hospital were discharged against medical advice. The type of injury was varied, with 38.8% open fractures, some of which were complex.
Особенности развития спорта слепых в Белгородской области на современном этапе
Authors: Никулин Игорь Николаевич , Малахов Роман Евгеньевич , Войкина Дарья Владимировна 
Published: April 2024

Целью исследования является выявление особенностей развития спорта слепых в Белгородской области на современном этапе. Выявлены основные детерминанты развития спорта слепых в Белгородской области на современном этапе. Спорт слепых в Белгородской области представлен в следующих спортивных дисциплинах: лёгкая атлетика, армрестлинг, плавание, шахматы, шашки. Определены ведущие спортсмены и команды. Установлена доля занимающихся спортсменов с нарушениями зрения в 2022 году в разрезе этапов спортивной подготовки. Наибольший процент занимающихся представлен в учебно-тренировочных группах – 34,6%. Установлена положительная динамика по количеству занимающихся адаптивной физической культурой и спортом в Белгородской области слабовидящих спортсменов после спада в 2019 и 2020 годах. Показатели 2023 года – 430 человек, впервые превысили данные 2018 года. Установлены основные проблемы, сдерживающие темпы развития спорта слепых в Белгородской области. Среди которых: отсутствие федерации спорта слепых, сложность сбора спортсменов одновременно в местах проведения тренировочных занятий; дети с серьёзным нарушением зрения обучаются в специализированных интернатах; взрослые, по окончании учебных заведений, слабо мотивированы к занятиям спортом.
Prototypes of SARS-CoV-2 virus “traps” based on enterosorbents
Authors: Shulmeyster G. A. , Cheburkin Yu. V. , Chekmeneva Yu. D. , Edemskaya E. V. , Bondarenko A. B. , Postnov V. N. , Korolev D. V. 
Published: April 2024

Background. Despite the ongoing mutations of the SARS-CoV-2 virus, the causative agent of the COVID-19 disease, its mechanism of entry into the cell remains unchanged, which can be used to create virus “traps”. Intravenous medications aggravate the symptoms of the disease. An alternative means of combating the virus could be enterosorbents synthesized on nanosized carriers that intercept SARS-CoV-2 directly at the site of its introduction into the body, namely in the gastrointestinal tract. Objective. To study and refine the methods of synthesis of different spacer types on the surface of aerosil nanoparticles, immobilization of model protein with the possibility of using the compounds as enterosorbents of SARS-CoV-2 virus. Design and method. Aerosil A-200 grade was used as carrier nanoparticles. The chemical composition of the obtained compounds was studied by FTIR spectroscopy. The absorption spectra of the samples were studied using a spectrophotometer. The dimensions of nano-objects were determined by dynamic light scattering. Qualitative and quantitative determination of protein chemisorption on the synthesized particles was carried out. Results. Prototypes of SARS-CoV-2 enterosorbents on aerosil particles were developed. The efficacy of the spacers was tested on the model protein, albumin. Conclusion. Further research may be directed to the development of an oral drug that reduces the viral load of SARS-CoV-2.