bluuebunny/crossref_metadata_2025_split huggingface dataset:
A prospective observational study of pH testing to confirm ongoing nasogastric tube position
Authors: Glen Kate , Weekes Christine Elizabeth , Banks Merrilyn , Arbi Ismail , Hannan‐Jones Mary 
Published: May 2024

AbstractAims and ObjectivesTo measure the reliability of pH testing to confirm ongoing nasogastric tube (NGT) position and to document associated complications.BackgroundConfirming NGT position is essential, as use of an incorrectly positioned tube can cause harm. Substantial evidence examines initial confirmation of NGT position, yet limited evidence exists considers NGT displacement which is identified via ongoing NGT position tests. In the NHS, pH testing is recommended to confirm ongoing NGT position; however, there may be an association with excess X‐rays and missed enteral nutrition and/or medications.DesignProspective observational study using STROBE checklist.MethodsData collected from medical records of 136 patients with NGTs in a London NHS Trust included pH tests, test results and complications related to ongoing pH tests which failed to confirm the tube was positioned in the stomach, that is, X‐rays, and disruptions to enteral nutrition and medication. Cohen's Kappa determined pH test reliability.ResultsOf 1381 pH tests conducted to confirm NGT position, five (0.3%) correctly identified an NGT displacement, and one (0.07%) failed to identify displacement before use. The reliability of ongoing pH tests using Cohen's Kappa was minimal (0.29). Ongoing pH tests that failed to confirm a correctly positioned NGT led to 31 (22.8%) patients having X‐rays, 24 (17.6%) missing >10% of prescribed enteral nutrition and 25 (18.4%) missing a critical medication.ConclusionOngoing NGT position testing using pH tests did not prevent the use of a displaced tube, and more than one‐fifth of patients required X‐rays to confirm a correctly position NGT, contributing to missed medications and enteral nutrition.Relevance to Clinical PracticeCaution should be used when confirming ongoing NGT position with a pH test. Future guidelines should balance the risk of using a displaced tube with potential delays to nutrition and/or medication. More research is needed to explore alternative methods of ongoing NGT position testing.
A core competency evaluation index system for the graded use of clinical nurse specialists: A Delphi study
Authors: Zhao Yafang , Lai Xiaoxing , Zheng Danping , Zhang Hongmei , Zhang Xinyue , Huo Xiaopeng 
Published: May 2024

AbstractAims and ObjectivesTo describe a grading system that can be used to evaluate core competency of clinical nurse specialists (CNSs) at different levels.BackgroundEvaluate core competence of CNSs at different levels reflects the quality of nursing and the development of the nursing profession.DesignThis research employed the Delphi method.MethodsThe STROBE checklist for observational cross‐sectional studies was followed to report this research study. This study consisted of two main phases: a literature review and semistructured interviews. Individual semistructured interviews were conducted with 11 healthcare experts and two patients. Two rounds of questionnaire surveys were administered to 21 nursing experts using the Delphi method. The CNSs were classified as primary, intermediate or advanced based on their years of work, professional titles and educational qualifications.ResultsThe graded competency evaluation system consisted of five first‐level indicators (clinical practice, consulting guidance and teaching, scientific research innovation, management and discipline development, and ethical decision‐making), 15 second level indicators, and 40 third‐level indicators. The authority coefficients (Cr) of the experts were .865 and .901. The Kendall's concordance coefficients of the three‐level indicators were .417, .289 and .316 for primary CNSs; .384, .294 and .337 for intermediate CNSs; and .489, .289 and .239 for advanced CNSs.ConclusionThe graded use evaluation system in clinical practice initially involves a comprehensive evaluation of the core abilities of CNSs. This is a tool for cultivating and grading the abilities of specialised nurses that can promote a practical upwards spiral.Relevance to Clinical PracticeThe evaluation system can promote the scientific management and continuous improvement of CNSs in clinical nursing and can serve as a practical and objective reference for the effective management and development of CNSs.Patient or Public ContributionPatients participated in the data collection process, during which they shared their health‐seeking experience with our research team.
Nerve cross‐sectional area in advanced uremic neuropathy: A nerve ultrasound pilot study
Authors: Tosberg Jan‐Hendrik , Mork Hannah , Klimas Rafael , Radermacher Jörg , Schellinger Peter Dieter , Philipps Jörg 
Published: May 2024

AbstractBackground and PurposeUremic neuropathy (UN) is a disabling neuropathy in end‐stage kidney disease (ESKD) affecting the majority of patients receiving long‐term hemodialysis (HD). One previous nerve ultrasound study reported an increased cross‐sectional area (CSA) of the median nerve in moderate UN, while another study found enlarged sural nerves in small‐fiber polyneuropathy associated with ESKD. The present cohort study aims to analyze bilateral CSA of multiple nerves in UN.MethodsTen nondiabetic ESKD patients with UN on HD for at least 2 years and 10 healthy age‐matched controls underwent bilateral ultrasound examinations with CSA measurements in 13 arm and leg nerve sites. Nerve conduction studies (NCS) and the total neuropathy score (TNS) were recorded. Pearson's coefficient and the Mann‐Whitney U‐test were used to analyze correlations and compare groups.ResultsESKD patients presented advanced neuropathic symptoms (mean TNS 15.9). NCS showed significantly reduced motor and sensory amplitudes in the UN group compared to the control group, and a slightly reduced nerve CSA was observed in 5 of 13 nerve sites (p < .05); the other nerve sites were not enlarged. Sural nerve CSA (p < .05) and sensory amplitude (p < .01) were negatively correlated with the TNS.ConclusionsNerve enlargement was not observed in the present study in advanced UN. A reduced nerve CSA observed in the sural nerve suggests an axonal loss associated with long‐term HD in ESKD. During clinical workup of an acute disease of the peripheral nervous system in ESKD patients, nerve enlargement might be attributable to other causes than chronic UN.
Contribution of nanotechnology to greater efficiency in animal nutrition and production
Authors: Almeida Carina F. , Faria Márcia , Carvalho Josué , Pinho Eva 
Published: May 2024

AbstractFeed costs present a major burden in animal production for human consumption, representing a key opportunity for cost reduction and profit improvement. Nanotechnology offers potential to increase productivity by creating higher‐quality and safer products. The feed sector has benefited from the use of nanosystems to improve the stability and bioavailability of feed ingredients. The development of nanotechnology products for feed must consider the challenges raised by biological barriers as well as regulatory requirements. While some nanotechnology‐based products are already commercially available for animal production, the exponential growth and application of these products requires further research ensuring their safety and the establishment of comprehensive legislative frameworks and regulatory guidelines. Thus, this article provides an overview of the current state of the art regarding nanotechnology solutions applied in feed, as well as the risks and opportunities aimed to help researchers and livestock producers.
A generative adversarial network approach for removing motion blur in the automatic detection of pavement cracks
Authors: Zhang Yu , Zhang Lin 
Published: May 2024

AbstractAdvancements in infrastructure management have significantly benefited from automatic pavement crack detection systems, relying on image processing enhanced by high‐resolution imaging and machine learning. However, image and motion blur substantially challenge the accuracy of crack detection and analysis. Nevertheless, research on mitigating motion blur remains sparse. This study introduces an effective image processing system adept at deblurring and segmentation, employing a generative adversarial network (GAN) with UNet as the generator and Wasserstein GAN with Gradient Penalty (WGAN‐gp) as the loss function. This approach performs exceptionally in deblurring pavement crack images and improves segmentation accuracy. Models were trained with sharp and artificially blurred images, with WGAN‐gp surpassing other loss functions in effectiveness. This research innovatively suggests assessing deblurring quality through segmentation accuracy in addition to peak signal‐to‐noise ratio (PSNR) and structural similarity (SSIM), revealing that PSNR and SSIM may not fully capture deblurring effectiveness for pavement crack images. An extensive evaluation of various generators, including UNet, lightweight UNet, TransUNet, DeblurGAN, DeblurGAN‐v2, and MIMO‐UNet, identifies the superior performance of UNet on simulated motion blur. Validation with actual motion‐blurred images confirms the effectiveness of the proposed model. These findings demonstrate that GAN‐based models have great potential in overcoming motion blur challenges in pavement crack detection systems, marking a notable advancement in the field.
Unraveling the drivers and impacts of leaf phenological diversity in a subtropical forest: A fine‐scale analysis using PlanetScope CubeSats
Authors: Wang Jing , Li Yuanzhi , Rahman Md Mizanur , Li Buhang , Yan Zhengbing , Song Guangqin , Zhao Yingyi , Wu Jin , Chu Chengjin 
Published: May 2024

Summary

Leaf phenology variations within plant communities shape community assemblages and influence ecosystem properties and services. However, questions remain regarding quantification, drivers, and productivity impacts of intra‐site leaf phenological diversity.

With a 50‐ha subtropical forest plot in China's Heishiding Provincial Nature Reserve (part of the global ForestGEO network) as a testbed, we gathered a unique dataset combining ground‐derived abiotic (topography, soil) and biotic (taxonomic diversity, functional diversity, functional traits) factors. We investigated drivers underlying leaf phenological diversity extracted from high‐resolution PlanetScope data, and its influence on aboveground biomass (AGB) using structural equation modeling (SEM).

Our results reveal considerable fine‐scale leaf phenological diversity across the subtropical forest landscape. This diversity is directly and indirectly influenced by abiotic and biotic factors (e.g. slope, soil, traits, taxonomic diversity; r2 = 0.43). While a notable bivariate relationship between AGB and leaf phenological diversity was identified (r = −0.24, P < 0.05), this relationship did not hold in SEM analysis after considering interactions with other biotic and abiotic factors (P > 0.05).

These findings unveil the underlying mechanism regulating intra‐site leaf phenological diversity. While leaf phenology is known to be associated with ecosystem properties, our findings confirm that AGB is primarily influenced by functional trait composition and taxonomic diversity rather than leaf phenological diversity.
Autoimmunity and epithelial dysplasia in patients with oral lichenoid diseases
Authors: Kang Jeong‐Hyun , Kwon Ji Eun 
Published: May 2024

AbstractObjectivesThe primary objective of this study was to explore relationship between autoimmunity and epithelial dysplasia in patients with oral lichenoid diseases.Materials and MethodsA total of 66 patients with oral lichen planus (OLP), 35 with oral lichenoid lesion (OLL), and 85 with oral lichenoid drug reaction (OLDR) were enrolled. OLP, OLL, and OLDR were diagnosed following the definitions of the modified World Health Organization criteria, except for the absence of epithelial dysplasia. All patients underwent diagnostic incisional biopsy and adjunctive direct immunofluorescence assays. An indirect immunofluorescence assay was conducted to determine the antinuclear antibody (ANA) positivity.ResultsOLP and OLDR patients with epithelial dysplasia demonstrated higher prevalence of serum ANA positivity compared to those without epithelial dysplasia. Elevated serum levels of high sensitivity‐C reactive proteins were observed in the OLP, OLL, and OLDR patients with epithelial dysplasia. In the DIF analysis, patients with epithelial dysplasia in the OLP exhibited a higher prevalence of C3 deposition in the basement membrane zone.ConclusionsThis study proposed that autoimmunity may contribute to elevating levels of focal and chronic systemic inflammation, potentially influencing abnormal wound healing and development of dysplastic changes in the oral epithelium among patients with oral lichenoid disease.
Posterior Corrective Surgery for Type II Congenital Kyphosis: SRS‐Schwab Grade 4 Osteotomy or Vertebral Column Resection?
Authors: Ma Hongru , Shi Benlong , Liu Dun , Liu Wanyou , Mao Saihu , Liu Zhen , Sun Xu , Zhu Zezhang , Qiu Yong 
Published: May 2024

ObjectiveSurgical decision‐making for congenital kyphosis (CK) with failure of anterior segmentation (type II) has been contradictory regarding the trade‐off between the pursuit of correction rate and the inherent risk of the osteotomy procedure. This study was designed to compare the clinical and radiographic measurement in type II CK underwent SRS‐Schwab Grade 4 osteotomy and vertebral column resection (VCR), the most‐adapted osteotomy techniques for CK, and to propose the strategy to select between the two procedures.MethodsThis retrospective observational comparative study evaluated surgical outcomes in type II CK patients underwent VCR or SRS‐Schwab Grade 4 osteotomy at our institution between January 2015 and January 2020. Patients operated with VCR and SRS‐Schwab Grade 4 osteotomy were allocated to Group 1 and Group 2 respectively. Radiographic parameters and SRS‐22 quality of life metrics were assessed at pre‐operation, post‐operation, and during follow‐up visits for both groups, allowing for a comprehensive comparison of surgical outcomes.ResultsThirty‐one patients (19 patients in Group 1 and 12 patients in Group 2) aged 16.3 ± 10.4 years were recruited. Correction of segmental kyphosis was similar between groups (51.1 ± 17.6° in Group 1 and 48.4 ± 19.8° in Group 2, p = 0.694). Group 1 had significantly longer operation time (365.9 ± 81.2 vs 221.4 ± 78.9, p < 0.001) and more estimated blood loss (975.2 ± 275.8 ml vs 725.9 ± 204.3 mL, p = 0.011). Alert event of intraoperative sensory and motor evoked potential (SEP and MEP) monitoring was observed in 1 patient of Group 2. Both groups had 1 transient post operative neurological deficit respectively.ConclusionSRS‐Schwab Grade 4 osteotomy was suitable for kyphotic mass when its apex is the upper unsegmented vertebrae or the neighboring disc, or when the apical vertebrae with an anterior/posterior (A/P) height ratio of vertebral body higher than 1/3. VCR is suitable when the apex is located within the unsegmented mass with its A/P height ratio lower than 1/3. Proper selection of VCR and SRS‐Schwab Grade 4 osteotomy according to our strategy, could provide satisfying radiographic and clinical outcomes in type II CK patients during a minimum of 2 years follow‐up. Patients undergoing VCR procedure might have longer operation time, more blood loss and higher incidence of peri‐ and post‐operative complications.
Efficacy and Safety of Orally and Intravenously Administration of Tranexamic Acid in Patients with Elderly Femoral Neck Fracture
Authors: Zhao Ya‐kuan , Zhang Cheng , Zhang Yuan‐wei , Li Ru‐ya , Xie Tian , Bai Li‐yong , Chen Hui , Rui Yun‐feng 
Published: May 2024

ObjectiveFor elderly femoral neck fracture patients, anemia is one of the most common complications, increasing the risk of postoperative adverse events. Tranexamic acid (TXA) has been widely applied to the perioperative blood management. However, the optimal route of TXA administration in elderly femoral neck fracture remains unclear. The aim of this study is to evaluate the efficacy and safety of oral and intravenous (IV) application of TXA in elderly patients with femoral neck fracture undergoing total hip arthroplasty (THA) and hemiarthroplasty (HA).MethodsAll elderly patients aged over 65 years old diagnosed with femoral neck fracture admitted to the trauma orthopedics from August 1, 2020 to February 28, 2022 were enrolled in this prospective cohort study. Participants were divided into three groups: oral group: TXA 2g orally 2 h before incision; IV group: intravenous infusion of TXA 1g 15 min before incision; and control group: usual hemostatic method. The primary outcomes were total blood loss, allogeneic transfusion rate, and postoperative thromboembolic events. SPSS 23.0 (IBM, Armonk, NY, USA) was used for statistical analysis, and p ≤ 0.05 was considered statistically significant.ResultsA total of 100 patients were enrolled, including 32 cases in the oral group, 34 cases in the IV group and 34 cases in the control group. Compared with the control group, the total perioperative blood loss in the oral and IV groups was significantly decreased (763.92 ± 358.64 mL vs 744.62 ± 306.88 mL vs 1250.60 ± 563.37 mL, p = 0.048). No significant difference was identified between the oral and IV groups (p = 0.970). The rate of allogeneic transfusion was lower in the oral and IV groups than in the control group, but the difference had no statistical significant (6 vs 5 vs 12, p = 0.108), However, subgroup analysis showed that the IV and oral groups in patients who underwent THA have significant lower transfusion rate compared with the control group (1 vs 3 vs 7, p = 0.02). During 6 months follow‐up, no thromboembolic events were identified. Two patients (one from the oral group and one from the control group) died of respiratory failure. The cost of blood management from the oral group was significantly lower than IV (p < 0.001) and control groups (p = 0.009).ConclusionElderly patients with femoral neck fracture undergoing THA can benefit from both IV and oral administration of tranexamic acid. The results of these two administration routes are similar in safety and effectiveness. A similar tendency was observed in patients undergoing HA. Oral TXA is more cost–benefit compared with intravenous applications.
The Comparison between Spinal Facet Joint Toothed Plate and Traditional Pedicle Screw‐rod on Reduction of Thoracolumbar Fracture
Authors: Qiu Cheng , Cheng Lin , Liu Jingwei , Ding Zhiguo , Sun Musen , Yu Yanyong , An Dingling , Wang Lianlei , Gao Xianlei , Pan Xin , Liu Xinyu , Wang Songgang 
Published: May 2024

ObjectiveThoracolumbar fractures are one of the most common fractures in clinical practice. Surgical intervention is recommended to restore spinal alignment or decompress the nerves when there are unstable fractures or neurological injuries. However, after excessive forward thrust force restoration, facet joint dislocation often occurs between the upper vertebra and the fractured vertebra, which usually leads to unsatisfactory reduction outcomes. Herein, we propose a novel spinal facet joint toothed plate to assist in fracture reduction. The purpose of this study is to evaluate the effectiveness of the new spinal facet joint toothed plate in preventing facet joint dislocation, and its advantages compared to traditional pedicle screw‐rod decompression.MethodsA total of 26 patients in the toothed plate group and 93 patients in the traditional group who experienced thoracolumbar fracture with reduction were retrospectively included. Relevant patients' information and clinical parameters were collected. Furthermore, visual analogue scores (VAS) scores and Oswestry disability index (ODI) scores were also collected. Moreover, imaging parameters were calculated based on radiographs. Correlated data were analyzed by χ2 test and t test.ResultsAll patients in this study had no postoperative complications. Postoperative VAS scores and ODI scores (p < 0.001) were statistically significant (p < 0.001) in both groups compared with preoperative scores and further decreased (p < 0.001) at final follow‐up. In addition, the postoperative vertebral margin ratio (VMR) (p < 0.001) and vertebral angle of the injured vertebrae (p < 0.001) were significantly improved compared with the preoperative period. There were no significant differences in postoperative VAS scores and ODI scores between the two groups. However, toothed plate reduction significantly improved the VMR (p < 0.05) and vertebral angle (p < 0.05) compared with conventional reduction. Ultimately, the total screw accuracy was 98.72% (sum of levels 0 and I), with 100% screw accuracy in the segment related to the tooth plate in the tooth plate group. The dislocation rate was higher in the conventional group (6.45%) than in the new serrated plate repositioning group (0.00%).ConclusionThe facet toothed plate assisted reduction method prevents facet joint dislocation and improves fracture reduction compared to traditional reduction technique, hence it could be considered as a novel surgical strategy for thoracolumbar fracture reduction.
Radiological Verification for the Suitability of Using the Quadriceps Angle to Represent Orientation of the Quadriceps Femoris
Authors: Wu Chi‐Chuan 
Published: May 2024

ObjectivesThe orientation of the quadriceps femoris can be represented by the quadriceps angle (Q‐angle) has not yet been approved because of the high incidence of patellar instability. In this study, the correlations among components of the quadriceps femoris and the Q‐angle using the plain radiographic technique were assessed. This retrospective study aims to use the radiographic technique to clarify these doubts from anatomic viewpoints.MethodsOne hundred consecutive young adult patients (50 men and 50 women; aged, 34 ± 5 and 33 ± 6 years, respectively) who sustained chronic unilateral lower extremity injuries (unilateral femoral, tibial nonunions or malunions) were enrolled. The contralateral intact lower extremity was used for the study. The full‐length standing scanogram (FLSS) was used to evaluate the rectus Q‐angle (R‐Q angle), vastus Q‐angle (V‐Q angle), and clinical Q‐angle (C‐Q angle; i.e., known as the Q‐angle). The three Q‐angles were compared statistically. The Mann–Whitney U test and the Kruskal–Wallis test were used for comparison among groups. The Spearman rank correlation coefficient was used to evaluate the degree of relationship between two groups.ResultsThe C‐Q angle or the V‐Q angle was statistically different from the R‐Q angle (p < 0.001). The C‐Q angle between sexes was not different (p = 0.25). High correlation occurred among the C‐Q angle, the R‐Q angle, and the V‐Q angles (correlation coefficient, 0.886–0.979). The multiple linear regression revealed of C‐Q angle = 0.72; R‐Q angle, p < 0.001 + 0.21; and V‐Q angle, (p = 0.009) + 2.61° in 100 patients.ConclusionOrientation of the quadriceps femoris can be represented by the Q‐angle. Compared to the rectus femoris, the three vastus muscles of the quadriceps femoris are more correlated to the Q‐angle.
Strategies for choosing the best living donor: A review of the literature and a proposal of a decision‐making paradigm
Authors: Charnaya Olga , Van Arendonk Kyle , Segev Dorry L. 
Published: May 2024

AbstractTransplantation remains the gold‐standard treatment for pediatric end‐stage kidney disease. While living donor transplant is the preferred option for most pediatric patients, it is not the right choice for all. For those who have the option to choose between deceased donor and living donor transplantation, or from among multiple potential living donors, the transplant clinician must weigh multiple dynamic factors to identify the most optimal donor. This review will cover the key considerations when choosing between potential living donors and will propose a decision‐making algorithm.