bluuebunny/crossref_metadata_2025_split huggingface dataset:
Development of Consensus-Based Best Practice Guidelines for the Perioperative and Postoperative Care of Pediatric Patients With Spinal Deformity and Programmable Implanted Devices
Authors: Truong Walter H. , Matsumoto Hiroko , Brooks Jaysson T. , Guillaume Tenner J. , Andras Lindsay M. , Cahill Patrick J. , Fitzgerald Ryan E. , Li Ying , Ramo Brandon A. , Soumekh Benhoor , Blakemore Laurel C. , Carter Christopher , Christie Michelle R. , Cortez Daniel , Dimas V. Vivian , Hardesty Christina K. , Javia Luv R. , Kennedy Benjamin C. , Kim Peter D. , Murphy Robert F. , Perra Joseph H. , Polly David W. , Sawyer Jeffrey R. , Snyder Brian , Sponseller Paul D. , Sturm Peter F. , Yaszay Burt , Feyma Tim , Morgan Sara J. 
Published: June 2024

Study Design.
Modified Delphi consensus study.

Objective.
To develop consensus-based best practices for the care of pediatric patients who have implanted programmable devices (IPDs) and require spinal deformity surgery.

Summary of Background Data.
Implanted programmable devices (IPDs) are often present in patients with neuromuscular or syndromic scoliosis who require spine surgery. Guidelines for monitoring and interrogating these devices during the perioperative period are not available.

Methods.
A panel was assembled consisting of 25 experts (i.e., spinal deformity surgeons, neurosurgeons, neuroelectrophysiologists, cardiologists, and otolaryngologists). Initial postulates were based on a literature review and results from a prior survey. Postulates addressed the following IPDs: vagal nerve stimulators (VNS), programmable ventriculoperitoneal shunts (VPS), intrathecal baclofen pumps (ITBP), cardiac pacemakers and implantable cardioverter-defibrillators (ICD), deep brain stimulators (DBS), and cochlear implants. Cardiologist and otolaryngologist participants responded only to postulates on cardiac pacemakers or cochlear implants, respectively. Consensus was defined as ≥80% agreement, items that did not reach consensus were revised and included in subsequent rounds. A total of 3 survey rounds and 1 virtual meeting were conducted.

Results.
Consensus was reached on 39 total postulates across 6 IPD types. Postulates addressed general spine surgery considerations, the use of intraoperative monitoring and cautery, the use of magnetically controlled growing rods (MCGRs), and the use of an external remote controller to lengthen MCGRs. Across IPD types, consensus for the final postulates ranged from 94.4% to 100%. Overall, experts agreed that MCGRs can be surgically inserted and lengthened in patients with a variety of IPDs and provided guidance for the use of intraoperative monitoring and cautery, which varied between IPD types.

Conclusion.
Spinal deformity correction surgery often benefits from the use of intraoperative monitoring, monopolar and bipolar cautery, and MCGRs. The final postulates from this study can inform the perioperative and postoperative practices of spinal deformity surgeons who treat patients with both scoliosis and IPDs.

Level of Evidence.
V-Expert opinion.
Self-Reported Religiosity and Spirituality of Registered Nurses in Virginia
Authors: Akers Shanna W. , Miller Kathryn M. 
Published: June 2024

ABSTRACT:
The professional nurse cares for an increasingly diverse population, varying in ethnicity, culture, and faith beliefs that influence health and wellness. The moral obligation of the nurse to provide individualized, holistic care of clients includes spiritual care. Supported by the Agape Model of Nursing, nurses should understand their personal religiosity and its impact on the care they provide. The purpose of this study was to better understand the self-reported religiosity and spirituality of registered nurses licensed to practice in the Commonwealth of Virginia.
Rhinomanometry evidence in children treated by Furlow’s palatoplasty for velopharyngeal insufficiency correlated to cleft palate
Authors: Rizzo Maria Ida , Fallico Nefer , Palmieri Annapina , Ciofalo Andrea , Ruoppolo Giovanni , Greco Antonio , Zama Mario 
Published: June 2024

Background:
Speech surgery outcomes for velopharyngeal insufficiency (VPI) are difficult to quantify. We investigated the correlation between objective measurements of nasal emission and speech assessment ratings in children undergoing Furlow palatoplasty for the treatment of cleft-related VPI.

Methods:
A total of 20 patients with VPI after primary cleft palate repair were recruited for Furlow’s palatoplasty. All participants completed rhinomanometry (RM) and speech evaluation scored by two blinded speech-language pathologists. Pre- and postoperative results were compared using the paired t test. Statistical significance was set for P values < 0.05. Correlation tests were performed to identify the correspondence of the RM findings with the speech assessment ratings.

Results:
RM quantified a reduction of the expiratory flow postoperatively. The sensitivity for the RM was 1.00 and the specificity 0.95. The mean of the pre- versus postoperative values was 0.52 ± 0.43 (range: 0.14–1.69) versus 0.51 ± 0.54 (range: 0.18–1.8), P < 0.05. These values confirmed a reduction of the nasal emission postoperatively, which was consistent with the speech assessment reports.

Conclusions:
Combined subjective and objective measurements can complete the clinical assessment of these patients. RM measurements confirmed the velopharyngeal changes achieved with speech surgery.
A New Measuring Approach in Assessing Hamstring Flexibility: Reliability, Validity, and Applicability of Isolated Hamstring Flexibility Test
Authors: Talu Yasin , Tuncer Aysenur , Talu Burcu 
Published: June 2024

Objective:
This study was planned to determine the reliability, validity, and applicability of the isolated hamstring flexibility test (IHFT).

Design:
A cohort study (diagnosis); level of evidence, 2.

Setting:
It was performed in the research and application laboratory.

Participants:
Seventy-five individuals aged 18 to 25 years, selected through simple probability random sampling, with a normal Beighton Horan and Joint Mobility Index scores, and who volunteered to participate, were included for evaluation.

Interventions:
On then first and third days, participants underwent muscle strength, sit-and-reach test, active knee extension test, IHFT for validity and reliability. Stretching exercises were prescribed as a home program for 31 patients with limited knee extension, and measurements were repeated at the end of the eighth week.

Main outcome measures:
Sit-and-reach test, active knee extension test, IHFT.

Results:
The test–retest reliability was high (intraclass correlation coefficient, 0.993). Our test demonstrated validity when compared in terms of flexibility gained. A significant difference was found between pre–post stretching exercise training in all 3 tests (P < 0.05).

Conclusion:
It was observed that the IHFT is reliable and applicable in determining hamstring flexibility. Given the absence of another test specifically measuring hamstring flexibility in isolation, its indirect validity was established through analysis with other tests using the gold standard for assessing gains in hamstring flexibility.
Prevalence of Red Blood Cell Alloimmunization Among Pediatric Patients With Sickle Cell Disease in Saudi Arabia
Authors: Al-Asmari Badriah , Baothman Abdullah , Almohammadi Mohammed , Aljuaid Mohammed , Jastaniah Wasil 
Published: June 2024

Objective:
Sickle cell disease (SCD) is a common hereditary hemoglobin disorder worldwide. One of the main treatments for patients with SCD is the requirement for blood transfusions. Posttransfusion alloimmunization with red blood cell (RBC) antigens continues to be a major risk factor for SCD. The objective of this study was to determine the rate, nature, and risk factors of red cell alloimmunization among pediatric patients with SCD in our center and compare our results with published reports from Saudia Arabia SA, regional countries, and some international countries.

Materials and Methods:
A retrospective chart review of patients with SCD at King Abdulaziz Medical City–Jeddah, between 2008 and 2019 was performed. Demographic characteristics and transfusion histories were recorded. Blood samples were analyzed for alloimmunization using immunohematologic techniques.

Results:
In total, 121 patients were analyzed. Alloantibodies were detected in 21 patients (17.4%) and were mostly single in 15 patients (71.4%), anti-K (23.7%), anti-E (19.0%), and anti-S (9.5%). The other 6 patients (28.6%) had multiple alloantibodies, especially the combination of anti-C and anti-K (9.5%) and the combination of anti-C and anti-E (9.5%). Alloantibody levels were significantly higher in patients with frequent hospital admissions (>5 times annually), those who had an exchange blood transfusion, those younger than 3 years old, and those who received a larger number of blood units (P ≤0.05).

Conclusion:
The rate of RBC alloimmunization is determined and considered relatively low compared with that in other nations. Matching for extended RBC antigens to include ABO, RH (D, C, c, E, e), K, Fya, Fyb, Jka, and Jkb antigens in the screening panel for donors and recipients is highly recommended to ensure better transfusion practices and avoid transfusion-related complications.
Stop Ischemic Event to the Brain
Authors: Yang Shi-Chang , Zhang Xing-Wen , Nie Xi-Ting , Liu Ying-Lu , Su Hui , Wang Yan , Cao Ya , Yuan Hui-Juan , Yu Zhe , Kong Shan-Shan , Yu Sheng-Yuan 
Published: June 2024

Objectives:
In this study, we investigated the difference in risk factors between the 2 diseases, aiming to further clarify who needs to do ischemic cerebrovascular disease (ICVD)-related screening among coronary artery disease (CAD) patients.

Methods:
Clinical data of 326 patients with first-episode CAD from June 1, 2017, to July 31, 2020, in the Chinese PLA General Hospital were retrospectively reviewed. Outcomes, including clinical features and laboratory examination, were taken. Features related to ICVD including the extension of intracranial arterial (internal carotid artery intracranial segment, middle cerebral artery M1 segment, anterior cerebral A1 segment, vertebrobasilar artery intracranial segment, posterior cerebral artery P1 segment) and carotid arterial (internal carotid artery extracranial segment, common carotid artery, subclavian artery) stenosis were detected. Risk factors for the occurrence of ICVD in patients with CAD were analyzed.

Results:
Among patients with the onset of CAD, in comparison of the nonstenosis and stenosis of intracranial artery subgroups, there were statistical differences in the onset age, hypertension, and duration of hypertension as well as the biochemical indicators, including high-density lipoprotein and glycosylated hemoglobin. In addition, statistical differences were detected in the onset age as well as the biochemical indicators, including glycosylated hemoglobin and blood glucose serum protein, along with the difference in the degree of cardiovascular stenosis.

Conclusions:
The onset age of CAD was shown to serve as a vital risk factor for ICVD. The primary prevention of ICVD in patients with CAD should lay more emphasis on the management of hypertension and diabetes.
Predictive Value of Serum Inflammatory Factors and FT3 for Stroke-Associated Pneumonia in Patients With Acute Ischemic Stroke
Authors: Li Xin , Xie Xiaomei , Cheng Shenju , Luo Shan , Zhu Yancui , Wu Kun 
Published: June 2024

Objective:
The ability of serum inflammatory factors and free triiodothyronine (FT3) in predicting the occurrence of stroke-associated pneumonia (SAP) in patients with acute ischemic stroke (AIS) was assessed in this study.

Methods:
A retrospective analysis was conducted on 285 consecutive patients with AIS initially diagnosed and admitted to our hospital from January to December 2022. Patients were categorized into SAP and non-SAP groups based on the presence of SAP. Both groups were compared in terms of baseline characteristics, including National Institute of Health Stroke Scale (NIHSS) score, SAP risk assessment (A2DS2), TOAST classification. Independent risk factors for SAP were identified using multivariate logistic regression analysis, and the predictive value of inflammatory markers was evaluated through ROC curves.

Results:
Among 285 patients with AIS, 40 (14.03%) were found to have developed SAP. Higher NIHSS and A2DS2 scores, elevated serum IL-1β, IL-8, and IL-33 levels, increased age, atrial fibrillation, swallowing difficulties, and a higher proportion of patients with low FT3 levels were observed in the SAP group compared with the non-SAP group (all P<0.05). Significant risk factors for SAP in patients with AIS were identified through multivariate logistic regression analysis, including age, swallowing difficulties, NIHSS, A2DS2 , IL-1β , IL-8 , IL-33, and FT3 (P<0.05). The highest predictive values were observed for A2DS2, FT3, and IL-8 with AUC values of 0.854, 0.844, and 0.823, respectively.

Conclusion:
SAP can be highly predicted by A2DS2, FT3, and IL-8, enabling the early identification of patients with high-risk SAP and facilitating timely intervention and treatment.
Investigation of factors that may affect the foveal avascular zone: An optical coherence tomography angiography study
Authors: Scanlon Grainne , O'Shea Susan , Amarandei George , Butler John S. , O'Dwyer Veronica 
Published: June 2024

SIGNIFICANCEAn understanding of factors that affect the foveal avascular zone (FAZ) in healthy eyes may aid in the early identification of patients at risk of retinal pathology, thereby allowing better management and preventive measures to be implemented.PURPOSEThe size and shape of the FAZ can change due to retinal diseases associated with oxidative stress, including diabetic retinopathy, glaucoma, and macular degeneration. This study aimed to assess the relationship, if any, between factors that may affect the superficial FAZ (i.e., vessel density, vessel perfusion, overweight/obesity) and possible links with macular pigment optical density in young, healthy participants.METHODSOne hundred thirty-nine participants aged 18 to 35 years were recruited to this cross-sectional study. The superficial FAZ area, foveal vascularity, and central macular thickness (CMT) were assessed using the Cirrus 5000. Health parameters, body mass index, trunk fat %, and macular pigment were analyzed to determine possible associations with the superficial FAZ.RESULTSMean FAZ area was 0.23 ± 0.08 mm2. Females had a significantly larger mean FAZ area than males (p=0.002). The FAZ area was positively correlated with body mass index (Pearson'sr= 0.189, p=0.026). Significant correlates of the FAZ area in the multivariate model included vessel perfusion (central), CMT, and trunk fat %, collectively explaining 65.1% of the overall variability.CONCLUSIONSStudy findings suggest that reduced vessel perfusion, thinner CMT, and higher trunk fat % are plausible predictors of a larger FAZ area in healthy Caucasian adults. Low macular pigment optical density was, however, not associated with increased FAZ size in young healthy eyes. Noninvasive optical coherence tomography angiography testing, in association with these predictors, may aid in the early detection and monitoring of retinal diseases associated with oxidative stress.
Preexpanded Brachial Artery Perforator Propeller Flap: An Addition to the Armamentarium for Postburn Axillary Contracture Reconstruction
Authors: Wang Yiou , Li Shanshan , Zhou Hongru , Zhu Shan , Zang Mengqing , Chen Zixiang , Han Tinglu , Jin Shengyang , Liu Yuanbo 
Published: June 2024

Background:
Postburn axillary contracture is a common complication that leads to functional impairment and unsatisfactory aesthetic outcomes. The authors present their experience with axillary contracture reconstruction using preexpanded brachial artery perforator propeller (BAPP) flaps and provide a systematic review of other regional or free flaps.

Methods:
This retrospective study included patients who underwent postburn axillary contracture reconstruction using preexpanded BAPP flaps from 2015 to 2022. Data on the flap characteristics and function of the affected shoulders were recorded. A systematic review was conducted by retrieving studies that assessed the outcomes of regional or free cutaneous/fasciocutaneous flaps for treating axillary contracture from PubMed, Web of Science, Embase, and Scopus published before October 1, 2023.

Results:
Twelve preexpanded BAPP flaps measuring up to 26 × 11 cm (mean, 116.9 cm2) survived completely with no major complications, and the donor sites were closed primarily. The average range of shoulder abduction increased from 77.9 to 141.7 degrees (P = 0.002). The systematic review included 34 articles, reporting 12 regional and 3 free flaps. The most commonly reported flaps were the thoracodorsal artery perforator flap, scapular flap, and parascapular flap. The overall complication rate ranged from 0 to 25%, and the average change in shoulder abduction ranged from 72.5 to 99.4 degrees.

Conclusions:
Preexpanded BAPP flaps can be used effectively for reconstructing postburn anterior axillary fold contracture. Donor-site availability and the specific axillary contracture type should be considered when selecting a regional or free flap.
Intramuscular Breast Augmentation in Secondary Mastopexy Augmentation
Authors: Graf Ruth M. , Ono Maria C. C. , de Paula Dayane R. 
Published: June 2024

Background:
Breast augmentation with implants is one of the most performed aesthetic surgical procedures performed worldwide. The authors describe a new option for breast implant secondary procedures, the intra–pectoralis major pocket, as a feasible and reproducible surgical technique.

Methods:
A retrospective chart review was conducted on all patients who underwent a revision augmentation or mastopexy augmentation procedure between 2005 and 2022 performed by the senior author (R.M.G.). The intramuscular pocket is dissected between the pectoralis muscle fascicles where it is almost not bleeding.

Results:
Patients were followed up for an average of 21.5 months. A total of 319 patients underwent revisionary breast augmentation/mastopexy performed by the senior author (R.M.G.). Indications for reoperation were based both on specific patient dissatisfaction with their original surgery and the surgeon’s physical examination and assessment. In 196 cases, the authors performed the intramuscular pocket technique. None of the intramuscular pockets had capsular contracture or animation deformity in the follow-up period.

Conclusion:
The intramuscular pocket technique is a valuable and safe technique for secondary breast augmentation.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, IV.
Monitoring for Breast Cancer Recurrence Following Goldilocks Breast Reconstruction
Authors: Wang Jennifer , Ghanouni Arian , Losken Albert , Thompson Peter 
Published: June 2024

Background
The Goldilocks breast reconstruction utilizes redundant mastectomy skin flaps to fashion a breast mound; however, there is concern that imbrication of these skin flaps may predispose to fat necrosis and make detection of local breast cancer recurrence more difficult. Goldilocks patients follow a traditional postmastectomy screening pathway that includes clinical examination for locoregional recurrence, but it is unclear if this is sufficient. We evaluate our Goldilocks reconstruction case series to determine rates of diagnostic imaging, biopsy, and locoregional and distant recurrence.

Methods
Sixty-six patients (94 breasts) undergoing Goldilocks breast reconstruction were retrospectively reviewed. Any diagnostic postoperative imaging/biopsies performed and that confirmed local or distant breast cancer recurrence were noted.

Results
Average time of follow-up was 45 months. Most patients in this cohort had stage 0 (27.3%) or stage I (40.9%) breast cancer. There were a total of 11 (11.7%) concerning breast masses identified. Seven (7.4%) masses were biopsied, of which 5 were benign and 2 were invasive cancer recurrence. Four masses (4.3%) underwent diagnostic imaging only, all with benign findings. Five patients in this series were found to have either distant disease or a second primary cancer in the nonoperative contralateral breast.

Conclusions
Rates of local recurrence following Goldilocks are not higher than expected after other types of postmastectomy reconstruction. Clinical monitoring successfully detected local recurrence in all affected patients in this series. More definite guidelines around the routine screening of Goldilocks mastectomy patients may aid in early detection of local breast cancer recurrence.
The Modified Frailty Index Predicts Major Complications in Oncoplastic Reduction Mammoplasty
Authors: Brown Ciara A. , Ash Makenna E. , Styblo Toncred M. , Carlson Grant W. , Losken Albert 
Published: June 2024

Background
An important component of preoperative counseling and patient selection involves surgical risk stratification. There are many tools developed to predict surgical complications. The Modified Frailty Index (mFI) calculates risk based on the following five elements: hypertension, chronic obstructive pulmonary disease, congestive heart failure, diabetes, and functional status. Recent literature demonstrates the efficacy of the mFI across multiple surgical disciplines. We elected to investigate its utility in oncoplastic reductions (OCR).

Methods
A retrospective review of all patients with breast cancer who underwent OCR from 1998 to 2020 was queried from a prospectively maintained database. Patient demographics, comorbidities, and surgical details were reviewed. The mFI was computed for each patient. The primary clinical outcome was the development of complications.

Results
547 patients were included in the study cohort. The average age was 55 and the average body mass index was 33.5. The overall complication rate was 19% (n = 105) and the major complication rate was 9% (n = 49). Higher frailty scores were significantly associated with the development of major complications (P < 0.05). mFI scores of 0 had a major complication rate of 5.7%; scores of 1, 13%; and scores of 2, 15.1%. The relative risk of a major complication in patients with elevated mFI (>0) was 2.2. Age, body mass index, and resection weights were not associated with complications (P = 0.15, P = 0.87, and P = 0.30 respectively) on continuous analysis.

Conclusions
Elevated mFI scores are associated with an increased major complication profile in patients who are undergoing OCR. Hypertension and diabetes are the most common comorbidities in our population, and this tool may assist with preoperative counseling and risk stratification. Benefits of this risk assessment tool include its ease of calculation and brevity. Our study is the first to demonstrate its utility in OCR; however, further study in high-risk patients would strengthen the applicability of this frailty index.