bluuebunny/crossref_metadata_2025_split huggingface dataset:
Outperformance of Combined Artificial Anterolateral Ligament and ACL Reconstruction Compared With Isolated Artificial ACL Reconstruction in Knees With Anterolateral Structure and ACL Deficiency: A Biomechanical Analysis
Authors: Cheng Rongshan , Dimitriou Dimitris , Yao Gai , Li Xianghui , Lv Xiaolong , Yang Yangyang , Ying Hua , Wang Ziming , Tsai Tsung-Yuan 
Published: February 2025

Background: Despite the promising clinical outcomes of artificial polyethylene terephthalate (PET) ligaments in isolated anterior cruciate ligament reconstruction (ACLR), their biomechanical performance after combined anterolateral ligament reconstruction (ALLR)/ACLR in anterolateral structure (ALS)/anterior cruciate ligament (ACL)–deficient knees has not been investigated. Purpose/Hypothesis: The purpose of this study was to compare biomechanical performance in cadaveric knees between combined artificial ALLR/ACLR and isolated artificial ACLR using PET ligaments. It was hypothesized that combined artificial ALLR/ACLR would restore native knee stability and outperform isolated artificial ACLR in ALS/ACL-deficient knees. Study Design: Controlled laboratory study. Methods: Eight fresh-frozen cadaveric knees were tested using a robotic manipulator. Each knee was tested in 4 states: (1) ALS/ACL intact, (2) ALS/ACL deficient, (3) ACLR, and (4) ALLR/ACLR. The anterior tibial translation (ATT) and tibial internal rotation (IR) in each knee condition were measured under 3 loads: (1) 89 N of anterior tibial loading, (2) 5 N·m of IR torque, and (3) simulated pivot shift (combined 5 N·m of IR torque and 7 N·m of valgus load). Results: During 89 N of anterior tibial loading, there were no significant differences in ATT between the isolated ACLR and ALLR/ACLR knees. During 5 N·m of IR torque, the mean tibial IR at 45° of flexion was significantly higher in the ACLR knees (32.49°± 7.96°) than in the ALLR/ACLR knees (21.78°± 3.03°) ( P < .05). During the simulated pivot shift, the mean ATT and tibial IR at 30° and 45° of flexion were significantly higher in the ACLR knees (ATT: 5.09 ± 2.74 mm at 30°, 5.43 ± 2.79 mm at 45°; IR: 30.08°± 7.31° at 30°, 32.55°± 6.48° at 45°) than in the ALLR/ACLR knees (ATT: 1.93 ± 2.71 mm at 30°, 1.17 ± 2.26 mm at 45°; IR: 22.12°± 4.05° at 30°, 22.18°± 3.37° at 45°) ( P < .05). Conclusion: Combined artificial ALLR/ACLR restored native knee stability across multiple flexion angles and outperformed isolated artificial ACLR in ALS/ACL-deficient knees, particularly with respect to ATT and tibial IR during the pivot-shift test. Clinical Relevance: The indications of the artificial PET ligament may be expanded to include combined ALLR/ACLR to restore knee stability better than isolated artificial ACLR in ALS/ACL-deficient knees.
Comparison of Arthrofibrosis After ACL Reconstruction According to Graft Choice: Quadriceps Tendon Versus Bone-Patellar Tendon-Bone Autograft
Authors: Johnson Bailey E. , Smith Chelsea L. , Smith Cory D. , Quilligan Edward J. , Deshpande Viraj A. , Gardner Vance O. , Parvaresh Kevin C. , Shepard Michael F. , Petrie Russell S. , Prietto Carlos A. , Grumet Robert C. , Gazzaniga David S. 
Published: February 2025

Background: Arthrofibrosis is a complication of anterior cruciate ligament reconstruction (ACLR), and it is possible that graft choice such as the quadriceps tendon (QT) autograft may be a risk factor. With the increasing popularity of the QT autograft, it is important to compare it with other graft choices. Purpose/Hypothesis: The purpose of this study was to identify whether graft choice, QT versus bone–patellar tendon–bone (BTB) autograft, is a risk factor for early return to the operating room for arthrofibrosis after ACLR. It was hypothesized that the rate of arthrofibrosis surgery would be higher for the QT autograft recipients. Study Design: Cohort study; Level of evidence, 3. Methods: A single-center retrospective chart review was conducted between January 2010 and November 2022. Skeletally mature patients who underwent primary ACLR with either QT or BTB autograft were considered for inclusion. Patients who received an alternate graft or those undergoing revision ACLR were excluded. The primary outcome of interest was return to the operating room for arthrofibrosis release (either manipulation under anesthesia or lysis of adhesions). Results: Of 1726 included patients (1155 receiving a BTB autograft and 571 receiving a QT autograft), 5.2% (n = 60) of BTB recipients and 6.5% (n = 37) of QT recipients required subsequent arthrofibrosis. There was no significant association between graft type and subsequent arthrofibrosis ( P = .275). There was a significant association with graft type and presence of a cyclops lesion (65.0% of BTB grafts and 40.5% of QT grafts; P = .018). After removing those patients with chronic tears who underwent ACLR at >1 year, patients who required arthrofibrosis were found to have a significantly shorter time between injury and ACLR (mean, 59.23 ± 48.46 days) than those who did not require arthrofibrosis (mean, 81.7 ± 72.63 days) ( P≤ .01). Significantly more female patients (9.25%) than male patients (2.79%) required arthrofibrosis (hazard ratio, 3.82; P < .001), and patients who required arthrosis were significantly younger (mean, 22.52 ± 9.35 years) than those who did not (mean, 25.74 ± 10.83 years) ( P = .001). Conclusion: Study findings indicated no statistically significant difference in the rate of secondary arthrofibrosis surgery between patients who underwent ACLR with either QT or BTB autograft.
Government CEO pay regulation and corporate innovation performance: The role of CEO’s career horizon and shareholding
Authors: Maqsood Umer Sahil , Li Qian , Wang Shihao , Zahid R. M. Ammar 
Published: February 2025

This study investigates the effect of government pay policy for chief executive officer’s (CEO’s) compensation on corporate innovation (CI). Furthermore, it explores the role of the CEO’s career horizon and shareholding in this nexus. Utilizing the difference-in-differences method to analyze Chinese-listed state-owned enterprises from 2010 to 2020, the baseline findings indicate that government pay policies have had a negative impact on CI. In addition, CEOs with shorter career horizons and higher shareholding demonstrate an enhanced ability to counteract the adverse effects of pay policy, thereby sustaining high levels of innovation. Our findings indicate a necessity for regulatory bodies to re-evaluate mandated constraints on CEO compensation. These restrictions lead to a decline in firm innovation, ultimately affecting shareholder interests. Importantly, the study conclusions remain robust even after rigorous analysis using parallel trend assumptions, propensity score matching, alternative pay policy and innovation metrics, and placebo tests. JEL CLASSIFICATION: J3, M1, K2, O3
First ischemic stroke in young adults: Sex and age-related differences in stroke rates, risk factors, and etiologies
Authors: Schneider Thomas R , Dittrich Tolga D , Kahles Timo , Katan Mira , Luft Andreas R , Mono Marie-Luise , Bolognese Manuel , Arnold Marcel , Heldner Mirjam , Michel Patrik , Dirren Elisabeth , Rodic Biljana , Cereda Carlo W , Peters Nils , Bonati Leo H , Renaud Susanne , Humm Andrea M , Medlin Friedrich , Albert Sylvan , Sturzenegger Rolf , Tarnutzer Alexander A , Siebel Philip , Baumgärtner Markus , Berger Christian , Mordasini Pasquale , Vehoff Jochen , Nedeltchev Krassen , De Marchis Gian Marco 
Published: February 2025

Introduction: Sex differences in stroke incidence, vascular risk factors (VRFs), and etiologies among young adults remain underexplored, particularly regarding age-related patterns. Patients and Methods: We retrospectively analyzed young adults (18–55 years) with first-ever ischemic stroke treated at certified acute stroke units/centers between 2014 and 2022, using Swiss Stroke Registry data. Stroke rates (per 100,000 person-years), VRFs, and etiologies were assessed by age and sex. Results: Among 3,995 stroke patients, stroke rates were similar between sexes until age 35, after which men showed a more pronounced exponential increase. This rise was particularly notable in patients with elevated BMI and ⩾2 VRFs. The proportion of patients with ⩾2 VRFs rose with age (18–35: 22%; 36–50: 48%; 51–55: 63%). While no statistically significant differences in VRF profiles were observed between men and women aged 18–35, men accumulated VRFs about five years earlier than women, leading to a higher prevalence of multiple VRFs in men aged 36–50, with the gap narrowing in the 51–55 group. Stroke etiologies shifted with age: patent foramen ovale and cervical artery dissection predominated in younger patients, while large artery atherosclerosis, small vessel disease, and strokes of undetermined etiology increased with age, with notable sex differences. Discussion and Conclusions: This study highlights sex and age differences in ischemic stroke rates, VRFs, and etiologies among adults under 55 years. After 35, stroke rates rose more sharply in men, paralleling their higher VRF burden. These findings emphasize the importance of early management of VRFs—including overweight—to mitigate stroke risk.
Knowledge, Self-Efficacy, and Correlates in Palliative and End-of-Life Care: Quantitative Insights from Final-Year Nursing and Medical Students in a Mixed-Methods Study
Authors: Natuhwera Germanus , Namisango Eve , Ellis Peter 
Published: February 2025

Introduction: About a decade after the introduction of palliative care teaching for undergraduate nurses and medical students in Uganda, no research has examined students’ knowledge and self-efficacy to provide palliative and end-of-life care and their correlates. Aims: To: (1) estimate final-year undergraduate nursing and medical students’ knowledge of and self-efficacy to provide palliative and end-of-life care, (2) identify correlates of knowledge and self-efficacy to provide palliative and end-of-life care. Design: A multicentre cross-sectional quantitative study. Setting/participants: Final-year undergraduate medical and nursing students in eight medical and nursing schools in Uganda. Instruments included biodata sheet, the Palliative Care Quiz for Nursing questionnaire and the Palliative Care Self-Efficacy scale. Statistical analyses were performed using STATA version 14.0. Results: The mean age of the participants ( n = 466) was 24.45 ± 3.31 years. Participants’ knowledge of palliative care scores was low in all domains ‘Philosophy and principles of palliative care’ 1.46 ± 0.93 (range: 0–4), ‘Psychosocial and spiritual care’ 0.61 ± 0.73 (range: 0–3) and ‘Management of pain and other symptoms’ 6.32 ± 1.75 (range: 0–13). Predictors of knowledge were Gender ( p = 0.0242), course of study ( p = 0.0001) and religion ( p = 0.0338). Participants had very low self-efficacy scores in the three domains of the Palliative Care Self-Efficacy scale. Conclusion: Participants generally demonstrated limited knowledge and insufficient self-efficacy in providing palliative and end-of-life care. There is a need to integrate and strengthen practical, pedagogical and experiential teaching, review the palliative care curriculum. Future evaluative, longitudinal and interventional as well as qualitative studies are needed to gain deeper insights into this topic.
Key challenges in providing assisted dying in Belgium: a qualitative analysis of health professionals’ experiences
Authors: Archer Madeleine , Willmott Lindy , Chambaere Kenneth , Deliens Luc , White Ben P. 
Published: February 2025

Background: Assisted dying or ‘euthanasia’ has been legal in Belgium since 2002. Extensive research has been conducted which investigates Belgian euthanasia practice, however, the current challenges that health professionals face when providing euthanasia are not well known. This knowledge is important for evaluating the current system, especially in light of recent developments in Belgian euthanasia law and practice including judicial decisions, legislative amendments and research highlighting the complexity of its governing regulatory framework. Objectives: This study investigates the key challenges that health professionals experience when providing euthanasia in Belgium. Design: A qualitative interview study with reflexive thematic analysis. Methods: Twenty interviews were conducted between September 2022 and March 2024 using Microsoft Teams videoconferencing. Eligible participants were physicians and nurses who spoke English or Dutch and who had been involved in the euthanasia assessment of at least two patients in the past year. Results: Four themes were generated: (1) the framing of the euthanasia legislation poses challenges; (2) providing euthanasia can place considerable burdens on health professionals; (3) clashing views about euthanasia can hamper opportunities for balanced discussions and (4) euthanasia and processes relating to euthanasia are not always well-understood. Conclusion: This study highlights the numerous and varied challenges physicians and nurses experience when providing euthanasia in Belgium, even 20 years after its law passing. This study contributes to a wider understanding of universal challenges associated with providing assisted dying and sheds light on issues specific to Belgium. The results provide an opportunity for policymakers to take action to better support providers to manage these challenges, including through a formal review of the legislation and the broader system.
Association of co-existing vitamin B6 and B12 deficiency with polyneuropathy, organomegaly, endocrinopathy, M protein, and skin changes (POEMS) syndrome: a case report
Authors: Hu Stephan , Brown-Kunin Sharon , Martin Paul , Wang Yujie 
Published: February 2025

Abstract

Background
Both vitamin B6 deficiency and vitamin B12 deficiency can present with symptoms that appear like polyneuropathy, organomegaly, endocrinopathy, M protein, and skin changes (POEMS) syndrome, with painful peripheral neuropathy and sensorimotor dysfunction. There are rare reports of an association between vitamin B12 deficiency and POEMS syndrome, and even rarer reports of an association between vitamin B6 deficiency and POEMS syndrome. To our knowledge, this is the first described case with deficiencies in both vitamin B6 and vitamin B12 in association with POEMS syndrome.

Case presentation
A man in his 40s presented with fatigue, imbalance, and painful numbness and tingling. Initial evaluation revealed low vitamin B12 level, and he received oral and IV supplementation for one month with an improvement in vitamin B12 levels, but without improvement in symptoms. Further evaluation revealed both a vitamin B6 deficiency and an IgA lambda monoclonal spike, prompting further investigation and an eventual diagnosis of POEMS syndrome. He underwent an autologous stem cell transplant and has had improvement in his symptoms.

Conclusions
Patients with POEMS syndrome may have symptoms that are difficult to distinguish from deficiencies in vitamin B6 or vitamin B12. Management of POEMS should include screening of vitamin B6 and B12 to ensure other possible associated causes of symptoms are appropriately treated.
The bergen 4-day treatment for panic disorder: a longer-term follow-up
Authors: Eide Thorstein Olsen , Hansen Bjarne , Hjelle Kay Morten , Solem Stian , Wheaton Michael G. , Björgvinsson Thröstur , Kvale Gerd , Hagen Kristen 
Published: February 2025

Abstract

Introduction
Bergen 4-Day treatment (B4DT) is a form of concentrated exposure-based cognitive behavioral therapy (CBT) in which patients receive treatment over four consecutive days. Previous studies have shown B4DT to be a promising treatment format for panic disorder (PD), although the long-term stability of treatment gains requires additional study.

Aim
The aim of the current study was to evaluate the longer-term effectiveness of B4DT for patients with panic disorder with or without agoraphobia. This study extends a previously published study by providing a long-term follow-up of the same cohort (n = 30), initially assessed at three months post-treatment.

Method
Thirty patients with panic disorder were consecutively included in a retrospect open trial. The primary outcome measure was the Panic Disorder Severity Scale. The secondary outcome measures were the Generalized Anxiety Disorder-7 and the Patient Health Questionnaire-9. Outcomes were assessed at pretreatment, posttreatment, 3-month follow-up, and longer-term follow-up (with a mean time of 18 months).

Results
There was a significant reduction in panic disorder symptoms from pretreatment to longer-term follow-up (d = 5.03, 95% CI [18.55, 21.12] to [1.33, 3.87]). The Panic Disorder Severity Scale (PDSS) mean decreased from 19.83 (SD = 0.64, 95% CI [18.55, 21.12]) before treatment, to 4.37 (SD = 0.64, 95% CI [2.98, 5.76]) post-treatment, followed by further decreases at the 3-month follow-up to a mean of 2.84 (SD = 0.64, 95% CI [1.45, 4.22]), and at the longer-term follow-up to 2.60 (SD = 0.64, 95% CI [1.33, 3.87]). There was no significant difference in symptom severity between the 3-month and 18-month assessments, indicating a sustained improvement (p <.001). At the 18-month follow-up, 90% of the patients were classified as being in remission. There were also significant reductions in symptoms of depression (d = 1.44) and generalized anxiety (d = 1.62) that were maintained at the longer-term follow-up assessment.

Conclusion
The results from the current study indicated that the treatment effects of B4DT are stable over time and that the treatment format appears to be promising for PD. Confirming these preliminary results in rigorous study designs is needed.

Trial registration
The study was approved by the Regional Committee for Medical and Health Research Ethics of Northern Norway (REK Nord-2021/209619).
Mobility, ICT, and health: a built environment investigation of older Chinese migrants’ social isolation and loneliness
Authors: DeJohn Amber , Liu Bochu , Ma Xinlin , Widener Michael J. , Liu Zhilin 
Published: February 2025

Abstract

Background
Social isolation and loneliness have detrimental impacts on health, especially for older adults. During the COVID-19 pandemic, physical access to third places (e.g., coffee shops, libraries) decreased due to the closure of non-essential destinations and personal risk assessments. Older adults reported adopting information and communication technology (ICT) during pandemic lockdowns. ICT-mediated socializing may have different impacts on loneliness than in-person equivalents. Understanding access to social connection and their distinct relationships to the built environment and health for older Chinese migrants is critical to supporting equitable, healthy aging in a post-COVID world.

Methods
Using a survey of older Chinese migrants in the Greater Toronto Area (GTA) during the extended COVID-19 lockdown, we investigate how community mobility and ICT use, two mechanisms of socializing, relate to the built environment and influence loneliness (De Jong Gierveld 6-item scale), as well as mental and physical health (SF-12). Specifically, we use a structural equation model to test a theoretical framework of older adult social isolation.

Results
Our model demonstrates the importance of community mobility for reducing feelings of loneliness, while ICT use is significantly related to better physical health. Both community mobility and ICT use have significant, although opposite, relationships to transit density.

Conclusions
Results indicate that ICT use might have limited ability to reduce loneliness and support mental health when mobility is limited. Addressing older migrants’ barriers to community mobility is critical to reducing feelings of loneliness.
Evaluation of primary health care nurses’ knowledge and neonatal screening performance for phenylketonuria in Alexandria
Authors: El-Samie Ismail Esraa Mohammed Abd , Elarousy Wafaa Mohamed , Badawe Shaymaa Saeed Mohamed , Abohadida Rasha Mohamed 
Published: February 2025

Abstract

Introduction
Nurses play a crucial role in the primary prevention of phenylketonuria (PKU) within national screening programs for newborns. This is achieved through consult with the child’s provider promptly to arrange a PKU test, accurate collection of blood samples at maternal and child health centers, enable early detection of potential cases.

Aim
This study aimed to assess the level of primary health care nurses’ knowledge and neonatal screening performance for phenylketonuria in Alexandria

Methods
A descriptive research design was used. The study included all nurses (50 nurses) who are responsible for obtaining newborn screening test from 5 primary health care centers in Alexandria. Two tools were used to collect the necessary data: nurses’ knowledge regarding phenylketonuria disease assessment sheet and nurses’ performance about newborn screening for phenylketonuria observational checklist.

Results
It was found that the mean age of participant was 42.94 ± 5.0 and 52% of them had completed their technical level of education and the means years of experience was 17.64 ± 4.84. The total mean score of nurses’ knowledge regarding phenylketonuria screening was 16.24 ± 1.99 with the mean percent score of 72.72 ± 8.27. It was also found the total score of nurses’ screening performance was 11.0 ± 0.97 with the mean percent score of 64.71 ± 5.70. A significant positive correlation was found between nurses’ knowledge and their screening performance with P = < 0.001.

Conclusion
It was concluded that majority of participant nurses had correct knowledge in neonatal screening and many aspects of phenylketonuria disease. However, they still needed support in steps related to infection control.
Comparative experimental anesthesia efficacy study of epidural injection at the sacrococcygeal space using ultrasound guidance versus blindness technique in Egyptian donkeys (Equus asinus)
Authors: Hamed Mohamed A. , Hamouda Hazem , Elmetwally Mohammed , Farrag Foad , Rizk Mohamed Abdo , Abumandour Mohamed M. A. , Hegazy Yamen Mohammed , Samy Alaa 
Published: February 2025

Abstract
The study investigates the effectiveness of blind and ultrasound-guided epidural injections in Egyptian donkeys in the sacrococcygeal region, a topic of limited research, by comparing and assessing their onset in 20 healthy adult donkeys of both sexes. In the first group, we used ten cadaver donkeys that were humanely euthanized. In the second group, we used 10 live, healthy adult donkeys to assess the efficacy and time of analgesia onset for blind and ultrasound-guided epidural injections at the sacrococcygeal region. Cadavers were randomly designated to blind (n = 5) or US-guided (n = 5) epidural injections at the sacrococcygeal region in sternal recumbency in donkeys using Methylene Blue (1%) as a diagnostic marker for caudal epidural injection. The injection criteria were comparatively assessed between the two techniques of injection. Our findings comparing the blind and US-guided injection approaches showed substantially higher needle accuracy penetration to comparatively assess these two injection techniques. Both injection difficulties and trial numbers were significantly greater in blind techniques as opposed to US-guided procedures. US-guided injection procedures revealed the effectiveness of the time needed for perfect placement of the needle was significantly less than with a blind one. A shorter time for the onset of analgesia was achieved with the ultrasound-guided method, although the difference was not statistically significant (P < 0.09). In conclusion, the ultrasound-guided technique of the epidural injection provided a number of benefits over the blind one, including the capacity to directly view the needle and distribute local anesthetic and avoid unintentional vascular damage, in comparison with traditional blind techniques. Our study aims to enhance the accuracy and safety of epidural anesthesia injection at the sacrococcygeal space in Egyptian donkeys using ultrasound guidance in the veterinary surgical field.