bluuebunny/crossref_metadata_2025_split huggingface dataset:
Dual Inhibition of Factor XIIa and Factor XIa Produces a Synergistic Anticoagulant Effect
Authors: Jiang Shuai , Li Yitong , Zhang Jiali , Jia Wenhui , Zheng Yizheng , Jia Zhiping , Yu Chenming , Kong Yi 
Published: April 2024

Abstract:
Clinical practice shows that a critical unmet need in the field of thrombosis prevention is the availability of anticoagulant therapy without bleeding risk. Inhibitors against FXIa or FXIIa have been extensively studied because of their low bleeding risk. However, whether these compounds produce synergistic effects has not yet been explored. In this study, analyses of activated partial thromboplastin time in combination with the FXIa inhibitor PN2KPI and the FXIIa inhibitor Infestin4 at different proportions were performed using the SynergyFinder tool identifying synergistic anticoagulation effects. Both an FeCl3-induced carotid artery thrombosis mouse model and a transient occlusion of the middle cerebral artery mouse model showed that the combination of PN2KPI and Infestin4, which are 28.57% and 6.25% of the effective dose, respectively, significantly prevents coagulation, and furthermore, dual inhibition does not cause bleeding risk.
Immediate Lymphatic Reconstruction with Vascularized Omentum Lymph Node Transplant: Reducing the Risk of Both Painful Contracture and Lymphedema
Authors: Brown Stav , Kokosis George , Graziano Francis D. , Haran Oriana , Smith-Montes Elizabeth , Zivanovic Oliver , Ariyan Charlotte E. , Coit Daniel G. , Coriddi Michelle , Mehrara Babak J. , Dayan Joseph H. 
Published: April 2024

Summary:
Patients undergoing extensive lymph node dissection and radiation are at high risk for not only lymphedema but also painful contracture. In a standard lymphadenectomy, immediate lymphatic reconstruction using a lymphovenous bypass is effective in reconstructing the lymphatic defect. However, a more aggressive nodal clearance leaves the patient with a large cavity and skeletonized neurovascular structures, often resulting in severe contracture, pain, cosmetic deformity, and venous stricture. Adjuvant radiotherapy to the nodal bed can lead to severe and permanent disability despite physical therapy. Typically, these patients are referred to us after the fact, where surgery will rarely restore the patient to normal function. In an effort to avoid lymphedema and contracture, we have been reconstructing both the lymphatic and soft tissue defect during lymphadenectomy, using vascularized omentum lymphatic transplant (VOLT). A total of 13 patients underwent immediate reconstruction with VOLT at the time of axillary (n = 8; 61.5%) or groin (n = 5; 38.5%) dissection. No postoperative complications were observed. The mean follow-up time was 15.1 ± 12.5 months. Only one lower extremity patient developed mild lymphedema (11% volume differential), with excellent scores in validated patient-reported outcomes. All patients maintained full range of motion with no pain. None of the 13 patients required a compression garment. Immediate lymphatic reconstruction with VOLT is a promising procedure for minimizing the risk of lymphedema and contracture in the highest risk patients undergoing particularly extensive lymph node dissection and radiotherapy.
Utilizing the Subunit Concept to Achieve Better Outcomes in Lower Limb Reconstruction: A Clinical Experience in an Asian Population
Authors: Hong Qi En , Kua Jonah Ee Hsiang , Tay Vincent K.S. , Chan Stephanie L.S. , Ho Christopher Wei Guang , Sun Jeremy Mingfa 
Published: April 2024

Background:
The goals of reconstruction have progressed from filling a defect to enhancing function and aesthetic appearance. We aimed to achieve better aesthetic and functional outcomes in terms of shoe fitting and mobility. This is accomplished via a classification of the subunits and aesthetic considerations of the lower limb.

Methods:
Between April 2017 and December 2021, 66 cases of lower extremity free fasciocutaneous flap reconstruction cases were included in this retrospective study. Data parameters include age, sex, comorbidities, etiology of lower limb wounds, choice of free flap reconstruction, recipient arterial vessels, complications of flap reconstruction, and need for secondary debulking procedures. Physiotherapy records were also examined to determine the time to independent ambulation.

Results:
In total, 66 subjects were identified. The mean age was 48.6. An estimated 74.2% (n = 49) were men, 50% (n = 33) had diabetes, and 16.6% (n = 11) had peripheral vascular disease. Of the total wounds, 65.1% (n = 43) were caused by infection, whereas the remaining 34.9% (n = 23) were due to trauma. Of the cases, 72.7% (n = 48) had free anterolateral thigh flap reconstruction, 25.8% (n = 17) were reconstructed with superficial circumflex iliac artery perforator flaps, and 1.5% (n = 1) was reconstructed with medial sural artery perforator flaps. Cases that required secondary debulking procedures comprised 7.6% (n = 5).

Conclusions:
Free fasciocutaneous flaps are useful in lower extremity reconstruction. Based on the subunit principle and aesthetic considerations for lower limb reconstruction, it can aid in optimizing functional rehabilitation and decreasing secondary procedures.
Delayed Abdominal Flap for Upper Extremity Soft Tissue Coverage
Authors: Bakhos Fadi , Ferri Francisco A. , Andre John , Foran Lindsey , Dreszer George , Fletcher James W. 
Published: April 2024

Summary:
Unlike other body parts, the upper extremity has critical structures close to the skin, making soft tissue injuries more complex. These injuries can result from various causes, including trauma and necrotizing soft tissue infections, necessitating reconstruction. Historically, pedicled flaps from the groin and abdomen were commonly used for upper extremity reconstruction, but they had limitations, such as the need for flap division and debulking, patient discomfort, and stiffness. Free flap reconstruction has become the preferred method, but it still faces challenges like patient and facility issues, the absence of recipient vessels after injury, and multi-surface wounds. This case report describes a 67-year-old patient with a severe necrotizing soft tissue infection in the right upper extremity. After multiple debridement procedures, the patient underwent hand amputation and soft tissue coverage using an abdominal wall-based flap. The objectives of achieving stable soft tissue coverage while preserving maximal length of the upper extremity were successfully achieved, and the patient expressed satisfaction with the outcomes. Inadequate management of upper extremity wounds can lead to amputation and psychological distress. The reconstructive ladder is used to approach upper extremity soft tissue defects, with free tissue transfer being the standard for larger defects. However, abdominal flaps still have indications when free tissue transfer is not feasible or contraindicated. It is imperative that plastic surgeons have these techniques in their armamentarium to provide a service to the ever more complex patient with an upper extremity wound.
Plasma Concentrations of Tranylcypromine in Depressed Patients With Chronic Kidney Disease
Authors: Först Christiane , Ulrich Sven , Zurek Gabriela , Seifert Sabine , Frank Markus , Scheidel Bernhard 
Published: April 2024

Abstract

Purpose
The prevalence of comorbid depression and chronic kidney disease (CKD) is high. The aim of this brief report was to review 2 cases of treatment with tranylcypromine (TCP) in patients with treatment-resistant depression (TRD) and CKD. Tests of the plasma concentration of TCP were included.

Methods
Medical and psychiatric notes of the 2 patients were reviewed with plasma concentrations of TCP as a key aspect of the discussion. The data are evaluated in the context of relevant medical and pharmacokinetic literature.

Findings
Plasma concentrations of TCP are highly variable both in patients with and without CKD. Plasma concentrations of TCP were not increased in the 2 cases with CKD as compared with literature data of patients without CKD. No signs of intoxication were detected in 2 cases with CKD that impaired continuous treatment of depression with TCP.

Implications
TCP may be considered in selected cases of TRD with concomitant CKD. More clinical data and tests of plasma concentrations of TCP are needed in patients with CKD.
Long-Term Impairment From Irritant-Induced Occupational Asthma
Authors: Lantto Jussi , Suojalehto Hille , Vasankari Tuula , Karvala Kirsi , Lindström Irmeli 
Published: April 2024

Objective
The aim of the study is to assess the long-term physical condition, health-related quality of life, employment, and work ability of irritant-induced asthma (IIA) patients.

Methods
Forty-three IIA patients completed a follow-up questionnaire a median of eight (interquartile range 4–11) years after asthma diagnosis. We compared their results with those of 43 low-molecular-weight (LMW) sensitizer-induced occupational asthma (OA) patients and those of 206 adult-onset asthmatics in the general population.

Results
Of the IIA patients, 40% reported depressive symptoms. Of the <65-year-olds, 56% were employed, of whom 39% assessed their work ability as limited. IIA patients had more difficulty climbing several flights of stairs than LMW-induced OA patients (70% vs 47%, OR = 4.83 95% CI: 1.51–15.47). Most of the IIA patients’ outcomes were inferior to those of the adult-onset asthmatics in the general population.

Conclusions
IIA prognosis appeared poor but resembled that of LMW-induced OA.
Multilevel Mindfulness
Authors: Koopmans Linda , Bruel Danielle , de Geit Ellemarijn , van den Bergh Roos , Bouwens Luuk , de Korte Elsbeth , Wiezer Noortje , van der Torre Wouter 
Published: April 2024

Objective
This study aimed to examine which factors in the organizational context stimulate and/or hinder employee mindfulness. Methods: Two methods were used: 1) scientific literature review, and 2) qualitative interviews with scientists, trainers, and managers. Results: The individual and the work environment interact with each other when it comes to mindfulness in the workplace. Factors at the task, team, supervisor, organizational, and context level stimulate employee mindfulness. Conclusions: Mindfulness is effective in dealing with stress but also positively impacts work-related outcomes such as engagement, concentration, and productivity. A multilevel approach can strengthen the positive effects of individual mindfulness training in the workplace, ultimately contributing to healthy workplaces.
Expressing the Complexities of the Student-Cadaver Relationship Through Visual Artwork
Authors: Loder Rayne , Buyea Beth , Otte Michael , Johansen Krista , Lufler Rebecca 
Published: April 2024

Abstract
Many physician assistant (PA) students first encounter death in the earliest days of their training when working with cadavers in the gross anatomy laboratory. Developing a deep knowledge of human anatomy is fundamental to health profession training programs and modern medical practice. Despite decreased laboratory hours and integration of technology and diagnostic imaging into modern anatomy courses, there remains value in the cadaver dissection experience. Medical learners experience diverse and complex feelings toward cadavers; learning to regulate one's personal responses within the anatomy laboratory is a skill that can be extrapolated to clinical practice. Art is one way for students to process their experiences with cadavers, and creating art for cadaver memorial ceremonies is an opportunity for student emotional processing while honoring the lives of their cadaveric teachers. A PA program in New England incorporated student art into a cadaver memorial ceremony, with 4 pieces of artwork and corresponding artist statements from that ceremony included in this piece. The works of art are visually diverse, but there is a shared sentiment in the artist statements of reflection, awe, appreciation, and humanity. Encouraging students to process complex experiences artistically may provide an enduring practice throughout a career in medicine.
The risk factors for postoperative temporary vocal cord paralysis after thyroid cancer surgery: an observational retrospective cohort study
Authors: Han Yujia , Zhao Yishen , Kou Jiedong , Li Jingting , Li Fang , Du Rui , Dionigi Gianlorenzo , Frattini Francesco , Liang Nan , Sun Hui 
Published: April 2024

Objective:
To analyze the potential factors influencing new-onset postoperative transient vocal cord paralysis (VCP) in thyroid cancer patients.

Methods:
Case information of 8340 thyroid cancer patients hospitalized at China-Japan Union Hospital of Jilin University, Jilin Province, China, in the Thyroid Surgery Department from January 2018 to December 2020 was collected retrospectively and analyzed. The possible influencing factors were analyzed using a χ
2 test, rank-sum test, and multiple logistic regression analysis. A nomogram was used to construct the clinical prediction model that was validated in the validation set by receiver operating characteristic, calibration curves, and Decision curve analysis.

Results:
The strengthening the reporting of cohort, cross-sectional, and case–control studies in surgery (STROCSS) guideline was followed to conduct a retrospective cohort study. A total of 8340 patients, including 1817 (21.8%) men and 6523 (78.2%) women, were enrolled in this study. The rate of temporary VCP was 3.6% (308/8340). Based on the results of postoperative laryngoscopy, the patients were divided into VCP group and non-VCP group. Comparative analysis between the groups revealed that potential factors associated with postoperative transient VCP were tumor location on the dorsal side of the gland (P=0.042), ultrasound showing a maximum nodal diameter >1 cm (P=0.002), multifocal carcinoma (P<0.001), invasion of surrounding tissue (P=0.005), lymph node metastases in the central compartment (P=0.034), lateral cervical lymph node metastasis (P<0.001), and prolonged operation (P<0.001). A multiple logistic regression analysis showed that the independent risk factors in postoperative transient VCP were T stage (OR=1.411, P=0.013, 95% CI: 1.075–1.853), multifocal carcinoma (OR=1.532, P=0.013, 95% CI: 1.095–2.144), and duration of surgery (OR=1.009, P<0.001, 95% CI: 1.006–1.012). Finally, a clinical prediction model was established via a nomogram and was validated in the validation set, although its diagnostic efficacy needs to be improved further.

Conclusion:
High T stage, multifocal carcinoma, and prolonged operation time may be independent risk factors for the occurrence of postoperative transient VCP in patients undergoing initial surgery for thyroid cancer.
Atrial fibrillation ablation compared to pacemaker therapy in patients with tachycardia–bradycardia syndrome: A systematic review and updated meta-analysis
Authors: Su Lijun , Wang Xiaoqi , Kang Fengguang , Gong Caidi , Chen Dezhu 
Published: April 2024

Background:
Tachycardia–bradycardia syndrome (TBS) is a subtype of sick sinus syndrome characterized by prolonged sinus pause (≥3 s) following termination of tachyarrhythmias, primarily atrial fibrillation (AF). There is controversy regarding whether the long-term prognosis of AF ablation is superior to pacemaker implantation. This study aimed to compare the effects of AF ablation and pacemaker therapy in patients with TBS.

Methods:
We conducted a comprehensive search of electronic databases, including PubMed, Cochrane, EmBase, Web of Science, and Chinese BioMedical, up until December 1, 2023. We included studies that reported the effects of AF ablation vs pacemaker therapy in patients with TBS. From this search, we identified 5 studies comprising 843 participants with TBS who underwent catheter AF ablation or pacemaker therapy.

Results:
Our meta-analysis revealed that AF ablation and pacemaker therapy had similar effects on cardiovascular death (odds ratio [OR] = 0.62 and 95% confidence interval [CI]: 0.14–2.65), procedural complications (OR = 1.53 and 95% CI: 0.67–3.48), and cardiovascular rehospitalization (OR = 0.57 and 95% CI: 0.26–1.22). However, AF ablation provided greater benefits than pacemaker therapy in terms of all-cause mortality (OR = 0.37 and 95% CI: 0.17–0.82), thromboembolism (OR = 0.25 and 95% CI: 0.12–0.49), stroke (OR = 0.28 and 95% CI: 0.13–0.57), heart failure (OR = 0.27 and 95% CI: 0.13–0.56), freedom from AF (OR = 23.32 and 95% CI: 7.46–72.92), and prevention of progression to persistent AF (OR = 0.12 and 95% CI: 0.06–0.24). Furthermore, AF ablation resulted in a reduced need for antiarrhythmic agents (OR = 0.21 and 95% CI: 0.08–0.59).

Conclusion:
AF ablation can effectively reduce the risk of all-cause mortality, thromboembolism, stroke, heart failure, and progression to persistent AF in patients with TBS. Additionally, it may eliminate the need for further pacemaker therapy in most cases after ablation. Therefore, AF ablation is considered superior to pacemaker therapy in the management of patients with TBS.
Application of OFA-based ERAS for video-assisted thoracoscopic surgery in elderly patients with airway stenosis: A case report
Authors: Yang Mengya , Wang Danmin , Xu Xia , Yu Xiaobo , Xu Hefei , Zeng Zhaoqiang , Dai Jingwei 
Published: April 2024

Background:
Thoracic surgery without general anesthesia can be traced back to the First World War, and thoracic epidural block was used to complete the operation due to a large number of patients with gunshot wounds who needed emergency thoracic surgery. By reducing the intraoperative opioid dose, intraoperative and postoperative opioid-related adverse events such as respiratory depression, nausea and vomiting, delirium, hyperalgesia, and other side effects can be reduced to the benefit of patients.

Methods:
A 72-year-old male patient was admitted to the hospital with a 5-day history of multifocal pain throughout the body caused by a fall. The injury was not treated at that time, and the pain gradually increased, accompanied by cough with difficulty expelling sputum.

Diagnoses:
Left lung contusion; traumatic pneumonia; multiple left rib fractures; left fluid pneumothorax; thyroid tumor of unknown nature, possibly malignant. Grade I tracheal stenosis; Sequelae of cerebral infarction. Because of goiter and severe tracheal compression, the patient was not intubated and received deopiated general anesthesia combined with epidural anesthesia to preserve spontaneous breathing.

Outcomes:
At the end of the video-assisted thoracoscopic exploration, the patient was immediately conscious and returned directly to the ward 6 min later. The patient was able to move freely after surgery and eat normally within 6 h of surgery. The postoperative visual analog scale score was 2 points, and there were no anesthetic complications during the follow-up.

Conclusion:
The opioid-free anesthesia strategy of tubeless general anesthesia, allowing spontaneous breathing combined with epidural anesthesia in elderly patients with tracheal stenosis undergoing video-assisted thoracoscopic surgery can not only avoid accidents and injuries caused by tracheal intubation and mechanical ventilation, but can also significantly reduce postoperative respiratory complications, optimize postoperative analgesia, and help achieve enhanced recovery after surgery.
Acute right extremity deep vein thrombosis and left-sided inferior vena cava thrombosis treated by percutaneous mechanical thrombectomy (PMT) combined with catheter directed thrombolysis (CDT): A case report
Authors: Ju Zhinan , Chen Wei , Min Xixi , Dai Kanghui , Zheng Henan , Qiu Jiehua 
Published: April 2024

Introduction:
Left-sided inferior vena cava (IVC) is an uncommon condition with a prevalence rate of 0.2% to 0.5%. Most of them remain asymptomatic and are discovered incidentally. The patient condition in this case is critical, and conventional procedures are not applicable. The surgical approach being considered is innovative, but it carries significant risks and uncertain therapeutic efficacy.

Patient concerns:
A 42-year-old male presented with acute right lower extremity pain with swelling for 2 days.

Diagnosis:
The patient was subsequently diagnosed with acute right lower extremity deep vein thrombosis, inferior vena cava thrombosis, and a left-sided IVC.

Interventions:
Based on the treatment guidelines for lower extremity deep venous thrombosis.

Outcomes:
We successfully cured him with percutaneous mechanic thrombectomy (PMT) combined with catheter directed thrombolysis (CDT).

Conclusion and significance:
The relatively low incidence of left-sided IVC does not diminish the significance of its identification. PMT combined with CDT is a safe way to treat acute thrombosis. It provides a new approach for similar patients in the future.
A novel ABCD1 gene mutation causes adrenomyeloneuropathy presenting with spastic paraplegia: A case report
Authors: Liu Jinxin , Wang Xin , Huang Di , Qi Yuna , Xu Lei , Shao Yankun 
Published: April 2024

Rationale:
X-linked adrenoleukodystrophy (X-ALD) is caused by mutations in the ABCD1 gene leading to very long chain fatty acid (VLCFA) accumulation. The disease demonstrates a spectrum of phenotypes including adrenomyeloneuropathy (AMN). We aimed to identify the genetic basis of disease in a patient presenting with AMN features in order to confirm the diagnosis, expand genetic knowledge of ABCD1 mutations, and elucidate potential genotype-phenotype associations to inform management.

Patient concerns:
A 29-year-old male presented with a 4-year history of progressive spastic paraplegia, weakness of lower limbs, fecal incontinence, sexual dysfunction, hyperreflexia, and positive Babinski and Chaddock signs.

Diagnoses:
Neuroimaging revealed brain white matter changes and spinal cord thinning. Significantly elevated levels of hexacosanoic acid (C26:0) and tetracosanoic acid (C24:0) suggested very long chain fatty acids (VLCFA) metabolism disruption. Genetic testing identified a novel hemizygous ABCD1 mutation c.249dupC (p.F83fs). These findings confirmed a diagnosis of X-linked ALD with an AMN phenotype.

Interventions:
The patient received dietary counseling to limit VLCFA intake. Monitoring for adrenal insufficiency and consideration of Lorenzo’s oil were advised. Genetic counseling and testing were offered to at-risk relatives.

Outcomes:
At present, the patient continues to experience progressive paraplegia. Adrenal function remains normal thus far without steroid replacement. Family members have undergone predictive testing.

Lessons:
This case expands the known mutation spectrum of ABCD1-linked X-ALD, providing insight into potential genotype-phenotype correlations. A thoughtful diagnostic approach integrating clinical, biochemical and genetic data facilitated diagnosis. Findings enabled genetic counseling for at-risk relatives regarding this X-linked disorder.
Improving Self-Reported Person-centered Care Competency in Nursing Students
Authors: Zadvinskis Inga M. , Hoying Jacqueline , Martini Kady , Taylor Tracy , Czaja Rebecca , Terry Ayanna E. , Fortney Christine A. 
Published: April 2024

Background:
To prepare nursing students to deliver high-quality care, educators need strategies to foster person-centered care (PCC).

Purpose:
This pilot study evaluated an intervention with interactive case studies on undergraduate nursing students’ PCC competency.

Methods:
We conducted a pilot study with sophomore undergraduate nursing students (n = 39) from a Midwestern US university. We developed a 90-minute class seminar with interactive case studies highlighting how patient preferences, values, and circumstances could influence fall risk. We assessed PCC using the Patient-Centered Care Competency Scale.

Results:
Although there was no statistically significant change in overall PCC competency before and after the intervention, we noted a small to medium effect size on PCC competency per Cohen’s d standards (d = 0.35). Content analysis of students’ open-ended responses reflected PCC and clustered into 5 themes.

Conclusions:
Findings suggest that educators may use interactive case studies to foster nursing student PCC competency.