bluuebunny/crossref_metadata_2025_split huggingface dataset:
Correlation of Clinical Outcomes and Relative Position of the First Metatarsal After the Modified Lapidus Procedure
Authors: Cychosz Chris C. , Mizher Rami , Digiovanni Grace M. , Jones Agnes Cororaton , Conti Matthew S. , Ellis Scott J. 
Published: June 2024

Background: Hallux valgus is a complex 3-dimensional deformity, and the modified Lapidus is a commonly used procedure to correct moderate to severe cases. Shortening and elevation of the first ray can occur with this procedure, which may result in increased pressure on the lesser metatarsal heads. However, there is currently no consensus regarding an accepted length and elevation of the first ray following the modified Lapidus. Therefore, the purpose of this study is to evaluate the impact of the position of the first ray on patient-reported outcome measures. Methods: This retrospective study identified 68 patients (72 feet) who underwent the modified Lapidus bunionectomy over a 4-year period at a single institution with a median follow-up of 24 months (range, 11-35.6 months). Patients were included if they were over 18 years of age, had pre- and postoperative weightbearing computed tomography (WBCT) scans, and preoperative and minimum 1-year postoperative Patient-Reported Outcome Measurement Information System (PROMIS) scores. PROMIS scores from 6 domains including physical function, pain interference, pain intensity, global physical health, global mental health, and depression were evaluated and compared pre- and postoperatively. Radiographic parameters were measured and compared before and after surgery. Paired t tests were used to evaluate the significance of pre- to postoperative changes. Differences between cohorts were compared using Mann-Whitney U test for continuous variables or Fisher exact test for categorical variables. Correlation between radiographic measurements and patient-reported outcomes were assessed using the Spearman rank rho estimate and visualized with scatterplots with a linear regression. Results: PROMIS physical function, pain interference, pain intensity, and global physical health improved significantly following the modified Lapidus (all P < .001); however, scores did not show any significant correlation with shortening of the first ray up to a maximum shortening of 4.8 mm. The length of the first metatarsal relative to the second decreased by an average of 2.7 mm following the procedure when measured on WBCT ( P < .001), and 2.6 mm when measured on plain radiographs ( P < .001). No significant elevation of the first ray was observed postoperatively. Conclusion: This study revealed that the Lapidus bunionectomy resulted in significantly improved pain and physical function at short-term follow-up. The amount of first ray shortening and elevation that occurred in this cohort did not adversely affect patient-reported outcomes.
Custom Patient-Specific 3D-Printed Titanium Truss Tibiotalocalcaneal Arthrodesis Implants for Failed Total Ankle Replacements: Classification, Technical Tips, and Treatment Algorithm
Authors: Lewis Thomas L. , Walker Roland , Alkhalfan Yousif , Latif Ahmed , Abbasian Ali 
Published: June 2024

Background: The management of failed total ankle replacements, with significant loss of bone stock, is challenging with high rates of complications and associated morbidity. Recent technological advances have enabled the development of patient-customized 3D-printed titanium truss arthrodesis implants, which offer an alternative salvage option for failed total ankle replacements. Methods: A prospective observational study was performed of 6 cases of failed total ankle replacements that were managed using custom patient-specific 3D-printed titanium truss arthrodesis implants. Technical tips, classification, and a treatment algorithm were developed based on our initial experience. Results: Between November 2018 and March 2022, 6 patients underwent arthrodesis for failed total ankle replacements. Follow-up was available for all cases. The mean follow-up was 3.0 years (range 1-4.5). The mean MOXFQ Index improved from 73.1 to 32.3 ( P < .05). The mean EQ-5D-5L Index improved from 0.366 to 0.743 ( P < .05) and the EQ-VAS also improved from 53.0 to 63.3 ( P = .36). The mean VAS-Pain score at final follow-up was 27.5. There were no cases of nonunion. None of the patients were smokers. The overall complication rate was 50%. Two patients returned to surgery: one for wound washout following TAR explantation and a second for removal of metalwork 2 years following surgery for a prosthetic joint infection secondary to hematogenous spread. No patients underwent revision fixation or amputation. Conclusion: Custom patient-specific 3D-printed titanium truss arthrodesis implants are a viable treatment option for failed total ankle replacements.
Developing Machine Learning–Based Predictive Models for Hallux Valgus Recurrence Based on Measurements From Radiographs
Authors: Zhao Rui , Wang Guobin , Li Fengtan , Wang Jinchan , Zhang Yuan , Li Dong , Liu Shen , Li Jie , Song Jiajun , Wei Fangyuan , Wang Chenguang 
Published: June 2024

Background: Machine learning (ML) is increasingly used to predict the prognosis of numerous diseases. This retrospective analysis aimed to develop a prediction model using ML algorithms and to identify predictors associated with the recurrence of hallux valgus (HV) following surgery. Methods: A total of 198 symptomatic feet that underwent chevron osteotomy combined with a distal soft tissue procedure were enrolled and analyzed from 2 independent medical centers. The feet were grouped according to nonrecurrence or recurrence based on 1-year follow-up outcomes. Preoperative weightbearing radiographs and immediate postoperative nonweightbearing radiographs were obtained for each HV foot. Radiographic measurements (eg, HV angle and intermetatarsal angle) were acquired and used for ML model training. A total of 9 commonly used ML models were trained on the data obtained from one institute (108 feet), and tested on the other data set from another independent institute (90 feet) for external validation. Optimal feature sets for each model were identified based on a 2000-resample bootstrap-based internal validation via an exhaustive search. The performance of each model was then tested on the external validation set. The area under the curve (AUC), classification accuracy, sensitivity, and specificity of each model were calculated to evaluate the performance of each model. Results: The support vector machine (SVM) model showed the highest predictive accuracy compared to other methods, with an AUC of 0.88 and an accuracy of 75.6%. Preoperative hallux valgus angle, tibial sesamoid position, postoperative intermetatarsal angle, and postoperative tibial sesamoid position were identified as the most selected features by several ML models. Conclusion: ML classifiers such as SVM could predict the recurrence of HV (an HVA >20 degrees) at a 1-year follow-up while identifying associated predictors in a multivariate manner. This study holds the potential for foot and ankle surgeons to effectively identify individuals at higher risk of HV recurrence postsurgery.
The Outcome of Walking Cold Patients with Potential Mild Hypothermia to Safety—A Mountain Rescue Case Series
Authors: Greene Mike , Dodds Naomi , Gordon Les 
Published: June 2024

Introduction Some experts recommend that ambulant hypothermic patients should be rewarmed, fed, and not permitted to exercise for 30 min because of concerns that afterdrop can cause cardiac instability. We investigated the outcome of ambulant hypothermic patients in a case series from mountain rescue teams in Great Britain. Methods A questionnaire was used to collect information on a series of adult patients with a clinical diagnosis of mild hypothermia. All patients were alert on the AVPU scale and evacuated by walking from the mountain. The outcome measures were survival or a change in management because of medical deterioration during evacuation. Results A series of 108 eligible cases were reported over a 5-year period. When rescuers arrived on the scene, 98 (91%) patients were stationary, and 10 (9%) were still mobile. Thirty-eight (39%) of the stationary cases were walked immediately off the mountain without any on-scene delay. In the remaining 60 (61%) stationary cases, the decision was taken to delay evacuation to provide food, drinks, and additional clothing. In 3 cases, the use of heat packs indicated an intention to actively rewarm. In cases where the on-scene time was reported, 27 (79%) were known to be mobile again within 20 min. All patients survived, and no adverse medical events occurred in all 108 cases. Conclusions In this study, no adverse events occurred because of immediate mobilization, suggesting that in these cases, there appears to be minimal risk of early activity.
Learning Qur’anic Arabic in a virtual village: Family religious language policy in transnational Indonesian Muslim families
Authors: Sari Artanti Puspita , Moore Leslie C. 
Published: June 2024

Aims and Objectives: This paper investigates how two Indonesian Muslim families in the United States used digital technology to support their children in learning Qur’anic Arabic in translocal and transnational contexts in which to connect with family, friends, Qur’anic Arabic educators, and voluntary kin (members of a network of people who consider themselves family but have no blood or legal ties). Methodology: We analyze the family religious language policy (FRLP) of two families to provide descriptive accounts that illustrate why and how families integrated digital technologies into their repertoire of practices for supporting children’s Qur’anic Arabic learning. Data and Analysis: Data were collected through observations and video/audio recordings of naturalistic interaction, semistructured interviews, and the collection of artifacts over the course of 10 months. We applied Strauss and Corbin’s three-step coding procedures to identify patterns in behavior and belief with regard to children’s sacred language learning, particularly in digital spaces. Findings/Conclusion: We found that the families adapted the “traditional” FRLP to the context of migration, integrating digital spaces and practices to create a virtual village to support children’s sacred language learning. These adaptations were intertwined with and contributed to the maintenance of relationships with extended family, voluntary kin, co-religionists, and co-nationals. Originality: The study examines FRLP in digital contexts, focusing on the use of information and communication technologies (ICTs) to create a community for children’s sacred language learning. Significance/Implications: Sacred language learning is an important part of millions of children’s lives. In focusing on digital spaces, the study contributes to the emerging subfield of applied linguistic research focused on religion and language teaching and learning.
Development and prima facie validation of the Dementia-Specific Ethical Self-Efficacy scale for professional caregivers
Authors: Schou-Juul Frederik , Ferm Lucca-Mathilde Thorup , Boje Ida Rübot , Rise Jens Elmelund , Skov Sofie Smedegaard , Ritz Christian , Lauridsen Sigurd 
Published: June 2024

Aim To develop and validate a scale for measuring professional caregivers’ ethical self-efficacy in dementia care. Background Professional caregivers of people with dementia make ethical decisions on a day-to-day basis, and it is important that they feel confident when doing so. Moreover, confidence, or self-efficacy, influences caregivers’ behaviour and well-being and may be a predictor of competence. However, there is no scale for measuring ethical self-efficacy. This study aims to fill this gap. Methods This study concerns the development and prima facie validation of the Dementia-Specific Ethical Self-Efficacy (DemESE) scale. During development, we identified dementia-specific ethical principles and generated items representing ethical conflicts of principles. In the subsequent validation, we administered the scale to experts and professional caregivers in dementia care. We assessed the relevance of the scale using a content validity index and tested validity and reliability using Cronbach’s alpha. To further enhance validity, we compared the scale with analogous self-efficacy scales using Pearson’s correlation coefficient. Results The quantitative testing of DemESE revealed that the scale exhibited acceptable levels of internal consistency and reliability. This finding was supported by Cronbach’s alpha. In addition, the content validity index and Pearson correlation coefficient provided evidence of the scale’s relevance and validity. Conclusion The results suggest that DemESE is a promising tool for assessing professional caregivers’ ethical self-efficacy in dementia care and may be used to measure ethical self-efficacy – that is, confidence in ethical decision-making in dementia care.
Predictors of overall mortality after endovascular abdominal aortic repair – A single centre study
Authors: RAŠIOVÁ Mária , KOŠČO Martin , PAVLÍKOVÁ Veronika , HUDÁK Marek , MOŠČOVIČ Matej , KOČAN Ladislav 
Published: June 2024

Objectives A current and ongoing challenge is to reduce patient mortality after endovascular abdominal aortic repair (EVAR). This study aimed to assess the predictors of all-cause mortality after EVAR. Methods Data regarding the demographic characteristics, comorbidities, laboratory values, selected anatomical factors, post-EVAR treatment, surveillance and complications of patients who underwent elective EVAR for non-ruptured abdominal aortic aneurysm (AAA) between January 2010 and January 2021 were evaluated. Mortality was assessed until 10 October 2023. Multivariate analyses were performed after adjusting for age, hypertension, diabetes mellitus, dyslipidaemia, sex, smoking, number of lumbar arteries, patency of inferior mesenteric artery (IMA), IMA diameter and reinterventions. Results This study included 196 patients (183 men and 13 women) with a mean age of 72.4 ± 7.67 years. The overall mortality rate during a mean follow-up period of 5.75 ± 3.1 years was 50.0% ( N = 98). The 2-, 5- and 10-year mortality rates were 9.7%, 32.0% and 66.6%, respectively. The mortality rates decreased by 59% in patients with reinterventions (hazard ratio [HR]: 0.41; 95% confidence interval [CI]: 0.23–0.73; p = .002) and by 59% in patients treated with angiotensin-converting enzyme (ACE) inhibitors or angiotensin II receptor blockers (ARBs) (HR: 0.41; 95% CI: 0.26–0.66; p < .001). Chronic anticoagulation was associated with 2.09-fold higher mortality (HR: 2.09; 95% CI: 1.19–3.67; p = .010), and coronary artery disease (CAD) was associated with 1.74-fold higher mortality (HR: 1.74; 95% CI: 1.09–2.78; p = .021). Pre-EVAR AAA diameter and 1-year post-EVAR sac diameter were positively associated with mortality (HR: 1.05; 95% CI: 1.03–1.08; p < .001, and HR: 1.05; 95% CI: 1.03–1.07; p < .001, respectively), that is, an increase of pre-EVAR and/or 1-year post-EVAR AAA diameter by 1 mm was associated with a 5% higher risk of all-cause mortality. Conclusions Reinterventions and treatment with ACE inhibitors or ARBs may be associated with decreased post-EVAR mortality. A greater pre-EVAR, a post-EVAR AAA diameter, CAD and chronic anticoagulation were associated with higher all-cause mortality post-EVAR.
Scaling and interpreting treatment effects in clinical trials using restricted mean survival time
Authors: Karrison Theodore , Hu Chen , Dignam James 
Published: June 2024

Background: Restricted mean survival time is the expected duration of survival up to a chosen time of restriction [Formula: see text]. For comparison studies, the difference in restricted mean survival times between two groups provides a summary measure of the treatment effect that is free of assumptions regarding the relative shape of the two survival curves, such as proportional hazards. However, it can be difficult to judge the magnitude of the effect from a comparison of restricted means due to the truncation of observation at time [Formula: see text]. Methods: In this article, we describe additional ways of expressing the treatment effect based on restricted means that can be helpful in this regard. These include the ratio of restricted means, the ratio of life-years (or time) lost, and the average integrated difference between the survival curves, equal to the difference in restricted means divided by [Formula: see text] These alternative metrics are straightforward to calculate and provide a means for scaling the effect size as an aid to interpretation. Examples from two randomized, multicenter clinical trials in prostate cancer, NRG/RTOG 0521 and NRG/RTOG 0534, with primary endpoints of overall survival and biochemical/radiological progression-free survival, respectively, are presented to illustrate the ideas. Results: The four effect measures (restricted mean survival time difference, restricted mean survival time ratio, time lost ratio, and average survival rate difference) were 0.45 years, 1.05, 0.81, and 0.038 for RTOG 0521 and 1.36 years, 1.17, 0.56, and 0.12 for RTOG 0534 with [Formula: see text] = 12 and 11 years, respectively. Thus, for example, the 0.45-year difference in the first trial translates into a 19% reduction in time lost and a 3.8% average absolute difference between the survival curves over the 12-year horizon, a modest effect size, whereas the 1.36-year difference in the second trial corresponds to a 44% reduction in time lost and a 12% absolute survival difference, a rather large effect. Conclusions: In addition to the difference in restricted mean survival times, these alternative measures can be helpful in determining whether the magnitude of the treatment effect is clinically meaningful.
Incidence of recurrent and chronic pancreatitis after acute pancreatitis: a systematic review and meta-analysis
Authors: Gagyi Endre-Botond , Teutsch Brigitta , Veres Dániel Sándor , Pálinkás Dániel , Vörhendi Nóra , Ocskay Klementina , Márta Katalin , Hegyi Péter Jenő , Hegyi Péter , Erőss Bálint 
Published: June 2024

Background: Acute pancreatitis (AP) has a high incidence, and patients can develop recurrent acute pancreatitis (RAP) and chronic pancreatitis (CP) after AP. Objectives: We aimed to estimate the pooled incidence rates (IRs), cumulative incidences, and proportions of RAP and CP after AP. Design: A systematic review and meta-analysis of studies reporting the proportion of RAP and CP after AP. Data sources and methods: The systematic search was conducted in three (PubMed, EMBASE, and CENTRAL) databases on 19 December 2023. Articles reporting the proportion of RAP or CP in patients after the first and multiple episodes of AP were eligible. The random effects model was used to calculate the pooled IR with 95% confidence intervals (CIs). The I2 value assessed heterogeneity. The risk of bias assessment was conducted with the Joanna Briggs Institute Critical Appraisal Tool. Results: We included 119 articles in the quantitative synthesis and 29 in the IRs calculations. Our results showed that the IR of RAP in adult patients after AP was 5.26 per 100 person-years (CI: 3.99–6.94; I2 = 93%), while in children, it was 4.64 per 100 person-years (CI: 2.73–7.87; I2 = 88%). We also found that the IR of CP after AP was 1.4 per 100 person-years (CI: 0.9–2; I2 = 75%), while after RAP, it increased to 4.3 per 100 person-years (CI: 3.1–6.0; I2 = 76%). The risk of bias was moderate in the majority of the included studies. Conclusion: Our results showed that RAP affects many patients with AP. Compared to patients with the first AP episode, RAP leads to a threefold higher IR for developing CP. Trial registration: Our protocol was registered on PROSPERO (CRD42021283252).
Unveiling the Anti-Diabetic Potential: A Comparative Study on the Vitamin and Amino Acid Profiles of Bioactive Compounds in Fermented and Raw Tamarind (Tamarindus indica L) Seeds
Authors: Nwanna Esther Emem , Aro Olayemi Philemon , Ogunsuyi Opeyemi Babatunde , Shodehinde Sidiqat A , Oboh Ganiyu 
Published: June 2024

Objectives Previous study have shown that the seeds of the tamarind tree ( Tamarindus indica) have anti-diabetic properties without any evidence on the processing method. This present study was carried out to investigate the effect of fermentation on antioxidant as well as anti-diabetic properties of Tamarind ( Tamarindus indica) seeds. Methods The sample was pulverized after five days of typical fermentation alongside raw sample and examined for its antioxidant and anti-diabetic properties. Antioxidant assays such as FRAP, ABTS, NO, and DPPH were carried out to determine the in-vitro inhibitory effects on diabetes-related enzymes α-amylase and α-glucosidase, while amino acids, proximate and minerals content were carried out. Results The findings revealed that fermentation changed the antioxidant properties of the seed powder. While total phenols and flavonoids decreased, inhibition was observed with α-amylase and α-glucosidase, although raw has higher results. Interestingly, the analysis of 18 amino acids on raw and fermented samples indicated an increase value with fermentation. Moreover, there were elevations in Zn, Mn, K, and vitamins C, D, E, and B1. Conclusion In summary, the study indicates that tamarind fermented seed powder holds promise for exerting anti-diabetic effects, likely due to its rich content of amino acids and vitamins endowed with antioxidant properties.
The utility of procalcitonin for identifying secondary infections in patients with influenza or COVID-19 receiving extracorporeal membrane oxygenation
Authors: Patel Kajal D. , Aden James K. , Sobieszczyk Michal J. , Marcus Joseph E. 
Published: June 2024

Background: Identifying secondary infections in patients receiving extracorporeal membrane oxygenation (ECMO) presents challenges due to the ECMO circuit’s influence on traditional signs of infection. Objectives: This study evaluates procalcitonin as a diagnostic marker for secondary infections in patients receiving ECMO with influenza or COVID-19 infection. Design: Single-center retrospective cohort study. Methods: All adult patients receiving veno-venous ECMO with underlying influenza or COVID-19 from November 2017 to October 2021 were included. Patient demographics, time receiving ECMO, culture data, and procalcitonin levels were examined. The first procalcitonin within 3 days of infection was compared to negative workups that were collected at least 10 days from the last positive culture. Furthermore, we compared procalcitonin levels by the type of pathogen and site of infection. Results: In this study, 84 patients with influenza or COVID-19 who received ECMO were included. A total of 276 procalcitonin labs were ordered in this cohort, with 33/92 (36%) of the secondary infections having an associated procalcitonin value. When comparing procalcitonin levels, there was no significant difference between the infection and negative workup groups [1 ng/mL (interquartile ranges, IQR: 0.4–1.2) versus 1.3 (0.5–4.3), p = 0.19]. Using 0.5 ng/mL as the cut-off, the sensitivity of procalcitonin was 67% and the specificity was 30%. In our cohort, the positive predictive value of procalcitonin was 14.5% and the negative predictive value was 84%. There was no difference in procalcitonin by type of organism or site of infection. Procalcitonin levels did not routinely decline even after an infection was identified. Conclusion: While procalcitonin is a proposed potential diagnostic marker for secondary infections in patients receiving ECMO, this single-center study demonstrated low sensitivity and specificity of procalcitonin in identifying secondary infections. Furthermore, there was no association of procalcitonin levels with etiology of infection when one was present. Procalcitonin should be used cautiously in identifying infections in veno-venous ECMO.