bluuebunny/crossref_metadata_2025_split huggingface dataset:
Development and comprehensive validation of a predictive prognosis model for very early HCC recurrence within one year after curative resection: a multicenter cohort study
Authors: Liu Lei , Qin Shangdong , Lin Kongying , Xu Qingguo , Yang Yuan , Cai Jinzhen , Zeng Yongyi , Yuan Shengxian , Xiang Bangde , Lau Wan Yee , Zhou Weiping 
Published: April 2024

Background:
The high incidence of early recurrence after liver resection (LR) for hepatocellular carcinoma (HCC) is the main obstacle in achieving good long-term survival outcomes. The aim of the present study is to develop a prognostic model in predicting the risk of very early (1-year) recurrence.

Material and methods:
Consecutive patients who underwent LR for HCC with curative intent at multicenters in China were enrolled in this study. The VERM-pre (the Preoperative Very Early Recurrence Model of HCC) with good performance was derived and validated by internal and external cohorts retrospectively and by another two-center cohort prospectively.

Results:
Seven thousand four hundred one patients were enrolled and divided randomly into three cohorts. Eight variables (tumor diameter, tumor number, macrovascular invasion, satellite nodule, alpha-fetoprotein, level of HBV-DNA, γ-GT, and prothrombin time) were identified as independent risk factors for recurrence-free survival on univariate and multivariate analyses. The VERM-pre model was developed which showed a high capacity of discrimination (C-index: 0.722; AUROC at 1-year: 0.722)) and was validated comprehensively by the internal, external, and prospective cohorts, retrospectively. Calibration plots showed satisfactory fitting of probability of early HCC recurrence in the cohorts. Three risk strata were derived to have significantly different recurrence-free survival rates (low-risk: 80.4–85.4%; intermediate-risk: 59.7–64.8%; high-risk: 32.6–42.6%). In the prospective validation cohort, the swimming plot illustrated consistent outcomes with the beginning predictive score.

Conclusion:
The VERM-pre model accurately predicted the 1-year recurrence rates of HCC after LR with curative intent. The model was retrospectively and prospectively validated and then developed as the online tool.
Family caregiver outcomes after participating in a hospital-based family involvement program after major gastrointestinal surgery: a subgroup analysis of a patient preferred cohort study
Authors: Musters Selma C.W. , Kreca Sani M. , van Dieren Susan , van der Wal-Huisman Hanneke , Romijn Johannes A. , Chaboyer Wendy , Nieveen van Dijkum Els J.M. , Eskes Anne M. ,   on behalf of the ARTIS Consortium
Published: April 2024

Background:
Engaging families in postsurgical care is potentially beneficial for improving cancer patient outcomes and quality of care. The authors developed a family involvement program (FIP) and in this study, the authors aim to evaluate the impact of the FIP on family caregiver burden and well-being. Moreover, the authors aim to assess the fidelity of the program.

Materials and methods:
This is a preplanned subgroup analysis of a patient-preferred prospective cohort study that included family caregivers of patients who underwent major oncological surgery for gastrointestinal tumors. Only patient-nominated family caregivers could participate in the FIP. Caregivers received structured training in fundamental caregiving tasks from healthcare professionals and then actively participated in these tasks. Caregiver burden and well-being were measured four times (at hospital admission, at hospital discharge, and at 1 and 3 months posthospital discharge) using the Caregiver Strain Index+ (CSI+) and the Care-related Quality of Life instrument (CarerQoL-7D). The fidelity of the FIP was assessed by recording completion of care activities. In addition, family caregivers were asked whether they would participate in the FIP again.

Results:
Most of the 152 family caregivers were female (77.6%), and their mean age was 61.3 years (SD=11.6). Median CSI+ scores ranged between −1 and 0 and remained below the cutoff point of experiencing burden. CarerQoL-7D results indicated no significant differences in family caregivers’ well-being over time. Upon discharge, over 75% of the family caregivers stated that they would recommend the FIP to others. The highest compliance with all fundamental care activities was observed during postoperative days 2–4.

Conclusion:
The family caregivers of oncological surgical patients who participated in the FIP exhibited acceptable levels of caregiver burden and well-being. These findings suggest that the FIP is a valuable intervention to equip family caregivers with the skills to navigate the uncertain period following a patient’s hospital discharge.
Clinical outcomes of on-pump versus off-pump coronary-artery bypass surgery: a meta-analysis
Authors: He Liaoming , Tiemuerniyazi Xieraili , Chen Lianxin , Yang Ziang , Huang Shengkang , Nan Yifeng , Song Yangwu , Feng Wei 
Published: April 2024

Background:
The ongoing debate regarding off-pump coronary artery bypass grafting (CABG) and on-pump CABG has endured for over three decades. Although numerous randomized controlled trials (RCTs) and meta-analyses have been reported, new evidence has emerged. Therefore, an updated and comprehensive meta-analysis to guide clinical practice is essential.

Materials and Methods:
A comprehensive search for eligible articles published after 2000, reporting RCTs involving at least 100 patients and comparing off-pump CABG with on-pump CABG, was performed throughout the databases including Embase, Ovid Medline, and Web of Science. The primary interested outcomes included the short-term incidence of stroke and long-term mortality. The primary analysis utilized fixed-effect model with the inverse variance method. The Grade of Recommendations Assessment, Development, and Evaluation (GRADE) was used to evaluate the certainty of evidence.

Results:
After thorough screening, 39 articles were included, consisting of 28 RCTs and involving a total of 16 090 patients. Off-pump CABG significantly reduced the incidence of short-term stroke (1.27 vs. 1.78%, OR: 0.74, P=0.03, high certainty). However, it was observed to be associated with increased mid-term coronary reintervention (2.77 vs. 1.85%, RR: 1.49, P<0.01, high certainty) and long-term mortality (21.8 vs. 21.0%, RR: 1.09, P=0.02, moderate certainty).

Conclusions:
Off-pump CABG significantly reduces the short-term incidence of stroke, but it also increases the incidence of mid-term coronary reintervention. Moreover, it may increase long-term mortality.
Running Biomechanics and Clinical Features Among Adolescent Athletes With Lower Leg Chronic Exertional Compartment Syndrome
Authors: Chanchi Mayela Leal , DeJong Lempke Alexandra F. , Kocher Mininder , Shore Ben , Meehan William , Willwerth Sarah , Dawkins Corey , Hunt Danielle , d’Hemecourt Pierre , Stracciolini Andrea , Whitney Kristin 
Published: April 2024

Objective:To compare clinical measures between patients with chronic exertional compartment syndrome (CECS) and healthy controls and evaluate running biomechanics, physical measurements, and exertional intracompartmental (ICP) changes in adolescent athletes with lower leg CECS.Design:Cross-sectional case–control study.Setting:Large tertiary care hospital and affiliated injury prevention center.Participants:Forty-nine adolescents with CECS (39 F, 10 M; age: 16.9 ± 0.8 years; body mass index (BMI): 23.1 ± 2.9 kg/m2; symptom duration: 8 ± 12 months) were compared with 49 healthy controls (39 F, 10 M; age: 6.9 ± 0.8 years; BMI: 20.4 ± 3.7 kg/m2).Interventions:All participants underwent gait analyses on a force plate treadmill and clinical lower extremity strength and range of motion testing. Patients with chronic exertional compartment syndrome underwent Stryker monitor ICP testing.Main Outcome Measures:Symptoms, menstrual history, and ICP pressures of the patients with CECS using descriptive statistics. Mann–WhitneyUand χ2analyses were used to compare CECS with healthy patients for demographics, clinical measures, and gait biomechanics continuous and categorical outcomes, respectively. For patients with CECS, multiple linear regressions analyses were used to assess associations between gait biomechanics, lower extremity strength and range of motion, and with ICP measures.Results:The CECS group demonstrated higher mass-normalized peak ground reaction force measures (xBW) compared with controls (0.21 ± 0.05 xBW (P< 0.001) and were more likely to have impact peak at initial contact (P= 0.04). Menstrual dysfunction was independently associated with higher postexertion ICP (ß = 14.6;P= 0.02).Conclusions:The CECS group demonstrated increased total force magnitude and vertical impact transient peaks. In women with CECS, menstrual dysfunction was independently associated with increased postexertion ICP. These biomechanical and physiological attributes may play a role in the development of CECS.
Appraisal of a newly developed ALBI-sarcopenia score as a prognostic marker in patients with hepatocellular carcinoma
Authors: Elsabaawy Maha , Badran Hanaa , Ragab Amr , Abdelwahab Rasha , Sayed Eman , Afify Sameh , Othman Warda 
Published: April 2024

Objective
This study aimed to evaluate the impact of the combined Albumin–bilirubin (ALBI)/sarcopenia score as a newly developed prognostic model for hepatocellular carcinoma (HCC), with a focus on its utility in predicting mortality.

Methods
This prospective study was conducted on HCC patients who were followed for 1 year or until death. Sarcopenia was assessed radiologically by computed tomography at the level of L3. The study consisted of two sets: a development set in which the new ALBI-sarcopenia score was created, comprising 262 HCC patients, followed by an internal validation set with 100 patients.

Results
The development cohort primarily included males (69.5%), aged 59.6 ± 8.09 years. In patients with sarcopenia, the ALBI score was −2.03 ± 0.42 (P < 0.006), the model for end-stage liver disease (MELD) score was 11.29 ± 2.43 (P < 0.001*), and the MELD-sarcopenia score was 21.29 ± 2.43 (P < 0.001*). The distribution of barcelona clinic liver cancer (BCLC) staging was as follows: BCLC A 18 (15.9%), BCLC B 63 (55.8%) and BCLC C 32 (28.3%) (P < 0.001*), with a notable association with higher mortality (P < 0.001). Multivariate analysis identified sarcopenia and ALBI scores as independent predictors of mortality in HCC (P < 0.001*). In the development set, the ALBI-sarcopenia score successfully predicted mortality at a cutoff >−11 with an area under a curve of 0.837 (95% CI, 0.784–0.889), while in the validation set, it predicted mortality at a cutoff >−11.55 with an area under a curve of 0.842 (95% CI, 0.753–0.930).

Conclusion
The newly introduced ALBI-sarcopenia score has demonstrated superior effectiveness in comparison to MELD-sarcopenia score, overcoming the shortcomings associated MELD score in forecasting outcomes for patients with HCC.
Improvement of quality of care provided to outpatients with hepatic cirrhosis after an educational intervention
Authors: Amador Alberto , Salord Silvia , Xiol Xavier , Garcia-Guix Marta , Cachero Alba , Rota Rosa , Hernandez Aretxabaleta Nerea , Baliellas Carme , Castellote Jose 
Published: April 2024

Objective
A set of indicators has been reported to measure the quality of care for cirrhotic patients, and previously published studies report variable adherence rates to these indicators. This study aimed to assess the quality of care provided to cirrhotic outpatients before and after an educational intervention by determining its impact on adherence to quality indicators.

Methods
We conducted a quasi-experimental, cross-sectional study including 324 cirrhotic patients seen in 2017 and 2019 at a tertiary teaching hospital in Spain. Quality indicators were assessed in five domains: documentation of cirrhosis etiology, disease severity assessment, hepatocellular carcinoma (HCC) screening, variceal bleeding prophylaxis, and vaccination. After identifying areas for improvement, an educational intervention was implemented. A second evaluation was performed after the intervention to assess changes in adherence rates.

Results
Before the intervention, adherence rates were excellent (>90%) for indicators related to variceal bleeding prophylaxis and documentation of cirrhosis etiology, acceptable (60–80%) for HCC screening and disease severity assessment, and poor (<50%) for vaccinations. After the educational intervention, there was a statistically significant improvement in adherence rates for eight indicators related to HCC screening (70–90%), disease severity assessment (90%), variceal bleeding prophylaxis (>90%), and vaccinations (60–90%).

Conclusion
Our study demonstrates a significant improvement in the quality of care provided to cirrhotic outpatients after an educational intervention. The findings highlight the importance of targeted educational interventions to enhance adherence to quality indicators in the management of cirrhosis.
Turner syndrome with isochromosome Xq as a cause of granulomatous hepatitis: a case report
Authors: Ali Ayman F. , Haffar Lina 
Published: April 2024

Introduction:
Turner syndrome (TS) is the most common sex chromosome abnormality in women, caused by a complete or partial absence of the second sex chromosome. The karyotype 46, X,i(Xq) is the underlying cause in about 10% of the cases of TS. Hepatic abnormalities are frequent in TS. Granulomas are relatively common in liver samples but are very rarely reported in TS.

Case presentation:
A 15-year-old female with TS attended a consultation for evaluation of elevated liver enzymes. Her chromosomal analysis showed mosaicism 46, X (iso xq)100%. There were no stigmata of chronic liver disease. A liver biopsy showed granulomatous hepatitis. Other causes of hepatic granulomas have been excluded. Ursodeoxycholic acid (UDCA) therapy leads to the normalization of transaminases.

Clinical discussion:
Although Hepatic involvement is common and mostly asymptomatic in TS, the mechanism of liver injury is not well understood. The hepatic histological changes in these cases are variable and range from minimal abnormalities to nonalcoholic steatohepatitis (NASH), liver architectural changes, and biliary lesions. Hepatic granulomas are associated with a wide range of systemic disorders but are very rarely reported in tuner syndrome. Normalization of liver enzymes after treatment with UDCA was previously reported, but the importance of this approach is to be determined.

Conclusion:
Granulomatous hepatitis may be associated with TS and may be added to the histological patterns encountered in this disorder.
Unmasking Sturge–Weber syndrome in adulthood: a case with extrafacial port-wine stain and delayed neurological symptoms
Authors: Yadav Pramodman Singh , Adhikari Pratik , Mehta Binod , Khadka Shuvam , Bhurtel Min Raj , Dahal Alok , Acharrya Sujan 
Published: April 2024

Background:
Sturge–Weber syndrome (SWS) is a rare neurocutaneous disorder characterized by a facial port-wine birthmark, leptomeningeal angiomatosis, and glaucoma. This case report highlights the challenges of diagnosing SWS when presenting with atypical features. Here, the authors present a 55-year-old man with an extrafacial port-wine stain and delayed-onset seizures, deviating from the classic triad.

Case presentation:
A 55-year-old man presented with a recent seizure and a characteristic port-wine birthmark extending beyond the typical facial region. Neurological examination revealed no weakness, speech difficulties, or coordination problems. Ophthalmological examination didn’t reveal glaucoma. Limited resources restricted access to advanced imaging like MRI scans. However, based on the constellation of clinical findings, including the facial birthmark with angiomatosis and the new-onset seizure, the patient received a diagnosis of SWS. Treatment with Levetiracetam was initiated to prevent future seizures, and patient education on managing diabetes and hypertension was provided.

Clinical discussion:
This case underscores the importance of considering SWS in diagnosing adult-onset seizures, especially with a characteristic facial birthmark. The delayed presentation and isolated seizure suggest potentially less severe brain involvement. Resource limitations necessitated a clinical diagnosis and treatment with readily available medications.

Conclusion:
This case highlights the challenges of diagnosing atypical SWS presentations. Early diagnosis is crucial for prompt management and improved patient outcomes. Future research should focus on developing robust diagnostic tools and exploring novel treatment options for atypical SWS presentations.
Neurotoxicity and acute renal injury secondary to Russell’s viper bite in an individual: a case report from Nepal
Authors: Pahari Nabin , Sharma Bishnu Dhakal , Ghimire Sagun , Sharma Shanta , Kafle Bikram , Upadhaya Tekraj , Montasir Ahmed Al 
Published: April 2024

Introduction and importance:
Owing to the high number of envenomation and fatalities, the Russell’s viper holds greater medicinal significance than any other Asian serpent. South East Asia is one of the most snakebite-prone regions in the world. Dense population, extensive agricultural practices, the abundance of venomous snake species, and an overall lack of knowledge about primary treatment (first aid) are the major culprits associated with snake bite-related morbidity and mortality. The venom of vipers is known to produce vasculotoxicity and contains hemotoxins.

Case presentation:
The authors describe a patient who was bitten by a viperine snake and showed signs of both neurotoxicity and acute kidney injury (AKI). The 20 years male was treated in a tertiary care centre in Nepal. The patient developed respiratory failure and needed ventilator support. Further, more haemodialysis was also done to manage AKI. Later, the patient was discharged after a smooth recovery.

Discussion:
Numerous clinical manifestations, such as neurotoxicity and vasculotoxicity, can result from a viperine bite. The majority of viperine snakebites are hemotoxic. Dual neurotoxic symptoms are possible after a viperine bite despite their rarity. The prevention of respiratory failure depends critically on the early detection of neurotoxicity.

Conclusion:
Unusual neuromuscular paralysis is caused by Russell’s vipers (Daboia russelii) in South East Asia. Physicians should know the exceptional presentations of snakebites to diagnose and treat patients.
Physical Activity Levels and Factors Affecting Them in Hospitalized Children With Leukemia
Authors: Huang Yuru , Zheng Xiaofen , Chen Qianhe , Jiang Kaiyao , Zheng Afen , Jin Liya , Wang Runping , Chen Jun , Zou Ping , Zhang Chunmei 
Published: April 2024

BackgroundPhysical activity promotes healthy physical and mental development in children with leukemia. However, the level of physical activity in hospitalized children with leukemia and the factors that influence it are unknown.ObjectivesThe aims of this study were to understand the physical activity level of hospitalized children with leukemia and to explore the factors influencing it to provide a reference for physical activity assessment and intervention in such children.MethodsA total of 133 hospitalized children with leukemia completed a general information questionnaire, the Chinese University of Hong Kong Physical Activity Rating for Children and Youth, and the Children’s Social Anxiety Scale. A cross-sectional study was used to explore the effects of different variables on the children’s activity levels.ResultsAmong the study participants, 44.4% had a low-intensity activity level, 35.3% had a moderate-intensity activity level, and 20.3% had a high-intensity activity level, with a total physical activity rating of 3 (1, 6). Chemotherapy phase (P= .007), screen time (P= .001), and social anxiety (P= .012) were identified as influential factors.ConclusionsOur results showed that children with hospitalized leukemia had lower-intensity physical activity levels, especially in the chemotherapy phase of induction remission. Furthermore, screen time and social anxiety had negative effects on the children’s activity levels.Implications for PracticeAccording to the physical activity level of the children and the influencing factors, healthcare professionals should gradually improve children’s mobility and promote their physical and mental health development through guidance and encouragement, and the development of personalized activity intervention programs.
A Clinical Nurse Specialist in Home Healthcare
Authors: Hinck Susan M. 
Published: April 2024

Purpose
Opportunities and challenges in home healthcare are discussed from the perspective of a gerontological clinical nurse specialist who has served as an expert clinician, administrator, and compliance director of a home health agency in the Midwest United States.

Description
Home-based nursing care requires a distinct set of knowledge and skills centered on the home environment and the way the home health patient responds emotionally and physically to become confident and self-sufficient. A Theoretical Framework for Home-Based Professional Nursing Practice is presented identifying the 6 concepts (primacy of home, patient authority, patient self-management, caregivers as collaborators, interprofessional clinical team collaboration, nurse autonomy) that are building blocks to describe the experience of patients in their homes and interactions with providers. The quality of clinical care and documentation influence reimbursement for care and the financial survival of the home health agency.

Outcome
Six management priorities both within the administrative office and the clinical teams are highlighted to improve quality of care, promote efficiency, and retain staff.

Conclusion
Exciting opportunities are available for the clinical nurse specialist in home-based care.
Patient Perspectives Following Obstetric Anal Sphincter Injury
Authors: Nutaitis Alexandra C. , Ferrando Cecile A. , Propst Katie 
Published: April 2024

Importance
An obstetric anal sphincter injury can significantly affect patients. Support for these patients is both limited and not well understood.

Objective
The aim of this study was to describe patient experiences after an obstetric anal sphincter injury.

Study Design
This is a prospective cross-sectional qualitative study of patients who experienced an obstetric anal sphincter injury within a tertiary care network between May and June of 2022. Demographic data, clinical data regarding the delivery, and the Edinburgh Postnatal Depression Scale were collected. Prospective semistructured interviews were conducted approximately 5–12 weeks postpartum to address opportunities to improve obstetric anal sphincter injury care. Qualitative analysis was performed using a grounded theory approach.

Results
Fifteen women with a mean age of 31 (±3.93) years participated. The majority identified as White (93.3%) and non-Hispanic (100%). All participants identified as being married to men and completing undergraduate education; 9 (60%) also received postgraduate education. Five participants (33.3%) screened positive (score of 10 or greater) for postnatal depression on the Edinburgh Postnatal Depression Scale. Thematic saturation was reached with 3 major themes identified: (1) pain control, (2) desire for multifactorial support, and (3) obstetric anal sphincter injury knowledge and awareness.

Conclusions
Experiencing an obstetric anal sphincter injury represents a great unknown to most women. This study identifies opportunities for improved postpartum care through education, pain control, and patient support. Interventions are needed to improve the postpartum experience for women who experience an obstetric anal sphincter injury with childbirth.