bluuebunny/crossref_metadata_2025_split huggingface dataset:
Perceptual Awareness in Human Infants: What is the Evidence?
Authors: Dehaene-Lambertz Ghislaine 
Published: March 2024

Abstract
Perceptual awareness in infants during the first year of life is understudied, despite the philosophical, scientific, and clinical importance of understanding how and when consciousness emerges during human brain development. Although parents are undoubtedly convinced that their infant is conscious, the lack of adequate experimental paradigms to address this question in preverbal infants has been a hindrance to research on this topic. However, recent behavioral and brain imaging studies have shown that infants are engaged in complex learning from an early age and that their brains are more structured than traditionally thought. I will present a rapid overview of these results, which might provide indirect evidence of early perceptual awareness and then describe how a more systematic approach to this question could stand within the framework of global workspace theory, which identifies specific signatures of conscious perception in adults. Relying on these brain signatures as a benchmark for conscious perception, we can deduce that it exists in the second half of the first year, whereas the evidence before the age of 5 months is less solid, mainly because of the paucity of studies. The question of conscious perception before term remains open, with the possibility of short periods of conscious perception, which would facilitate early learning. Advances in brain imaging and growing interest in this subject should enable us to gain a better understanding of this important issue in the years to come.
Early Experiences With Bundled Payments for Care Improvement for Major Bowel Surgery
Authors: Sibia Udai S. , Klune John R. , Saiolghalam Said , Bilchik Anton 
Published: March 2024

Background Bundled Payment (BP) models are becoming more common in surgery. We share our early experiences with Bundled Payments for Care Improvement for major bowel surgery. Methods Patients undergoing major bowel surgery between January and October 2021 were identified using Medicare Severity-Diagnosis Related Group (MS-DRG) codes. Major drivers of cost in a BP model are reported and compared to the Fee-For-Service (FFS) payment model. Results A total of 202 cases (173 FFS vs 29 BP) were analyzed. The mean BP cost per Clinical Episode was $28,340. Eleven patients (38%) in the BP model had costs greater than the Target Price. The drivers of cost in the BP model were 59% acute care facility, 17% physician services, 9% post-acute care facilities, 8% other, and 7% readmissions. Clinical Episode of care costs varied considerably by MS-DRG case complexity. Robotic surgery increased costs by 35% (mean increase $3724, P < .01). The 90-day readmission rate was 17% for a mean cost of $11,332 per readmission. Three patients (10%) were discharged to a skilled nursing facility at an average cost of $11,009, while fifteen patients (52%) received home health services at a mean cost of $2947. Acute care facility costs were similar in the BP vs FFS groups (mean difference $1333, P = .22). Conclusions Patients undergoing major bowel surgery are a heterogeneous population. Physicians are ideally positioned to deliver high-value, patient-centered care and are crucial to the success of a BP model. The post-acute care setting is a key component of improving efficiency and quality of care.
Factors Associated With Respiratory Failure After Open Ventral Hernia Repair: An Evaluation of the NSQIP Database
Authors: Lorenz William R. , Holland Alexis M. , Mead Brittany S. , Scarola Gregory T. , Augenstein Vedra A. , Heniford B. Todd 
Published: March 2024

An analysis of ACS-NSQIP open ventral hernia repair (OVHR) data (2017-2019) was performed. Respiratory failure (RF) occurred in 643 patients (1%) and not in 63,213 (99%) (nRF). Respiratory failure patients were older (63.7 vs 57 years, P < .001) and more comorbid: insulin-dependent diabetes (14.7% vs 5.8%, P < .001), COPD (19.4% vs 5.2%, P < .001), BMI (36.0 vs 32.8, P < .001), and current tobacco use (24.9% vs 17.6%, P < .001). Respiratory failure patients had greater ASA scores (ASA 3: 63.3% vs 47.8%, P < .001), bowel resection (8.2% vs 1.3%, P < .001), component separation (20.1% vs 9.0%, P < .001), operative times (178.4 vs 98.8 minutes, P < .001), complications (deep wound infections 3.6% vs 1.0%, organ space infections 13.2% vs 1.0%, wound dehiscence 3.1% vs 0.6%, acute renal failure 11.7% vs 0.1%), and hospital stay (13.7 vs 2.3 days), with fewer home discharges (44.3% vs 96.4%) (all P < .001). Respiratory failure patients had higher mortality compared to nRF (20.2% vs 0.1%, P < .001). Respiratory failure after OVHR is rare but correlates closely with significant wound, systemic, and social complications. Preoperative management of risk factors would be appropriate in high-risk patients.
The Anterior Saphenous Vein. Part 2. Anatomic considerations in normal and refluxing patients. Endorsed by the American Vein and Lymphatic Society, the American Venous Forum and the International Union of Phlebology
Authors: Caggiati Alberto , Labropoulos Nicos , Boyle Edward M , Drgastin Rachel , Gasparis Antonios , Doganci Suat , Meissner Mark 
Published: March 2024

Background The term Anterior Accessory of the Great Saphenous Vein suggest this is a branch tributary vein despite this vessel’s anatomic features of a truncal vein. A multisocietal group suggested to designate this the Anterior Saphenous Vein (ASV). This study was aimed to evaluate its ultrasound anatomy in normal and varicose limbs. Methods The clinical anatomy of the ASV was evaluated by narrative review of the literature. Additionally, the course of the ASV was evaluated in 62 limbs with no evidence of venous disease and 62 limbs with varicosities. Results The ASV length, patterns of origin and termination are reported in both normal and patients with varicose veins. Discussion of the patterns is supported by the narrative review of the literature. Conclusions The ASV must be considered a truncal vein and its treatment modalities should be the same that for the great and small saphenous veins rather than a tributary vein.
Interrogating Climate Change Education Epistemology: Identifying Hindrances to Curriculum Development
Authors: Eilam Efrat 
Published: March 2024

Purpose This conceptual paper aims to interrogate the current epistemological and cross-cultural approaches used to conceptualize climate change (CC) education, to critically point out ineffective approaches and false assumptions, and to propose practical suggestions that may support the development of a defensible and well-argued CC curriculum. Design/Approach/Methods Building on the author's earlier work in developing a systematic literature review and using a range of literary sources, the study examines CC epistemologically as a body of knowledge using various lenses. It further interrogates the suitability of Education for Sustainable Development (ESD) to act as a framework for CC education. Findings The findings suggest that CC as a body of knowledge, lacks a shared conceptualization and shared terminology. An in-depth interrogation of the ESD framework reveals that it is a problem-based agenda, unfit as a framework for hosting CC curriculum. A range of hindrances were found to be associated with this agenda, including its transient, ephemeral nature, tensions between ESD and the content-based curriculum and between ESD and CC science basis. Additionally, ESD's overall poor theorizing is noted. Originality/Value The study makes a set of recommendations, which includes dissociating CC education from ESD, considering implementation of CC as a curricular topic in its own right, and using commonly agreed CC terminology.
Definition, Frequency and Risk Factors for Intra-Operative Spinal Cord Injury: A Knowledge Synthesis
Authors: Fehlings Michael G. , Quddusi Ayesha , Skelly Andrea C. , Brodt Erika D. , Moghaddamjou Ali , Malvea Anahita , Hejrati Nader , Srikandarajah Nisaharan , Alvi Mohammed Ali , Stabler-Morris Shay , Dettori Joseph R. , Tetreault Lindsay A. , Evaniew Nathan , Kwon Brian K. 
Published: March 2024

Study Design Mixed-methods approach. Objectives Intra-operative spinal cord injury (ISCI) is a devastating complication of spinal surgery. Presently, a uniform definition for ISCI does not exist. Consequently, the reported frequency of ISCI and important risk factors vary in the existing literature. To address these gaps in knowledge, a mixed-methods knowledge synthesis was undertaken. Methods A scoping review was conducted to review the definitions used for ISCI and to ascertain the frequency of ISCI. The definition of ISCI underwent formal review, revision and voting by the Guidelines Development Group (GDG). A systematic review of the literature was conducted to determine the risk factors for ISCI. Based on this systematic review and GDG input, a table was created to summarize the factors deemed to increase the risk for ISCI. All reviews were done according to PRISMA standards and were registered on PROSPERO. Results The frequency of ISCI ranged from 0 to 61%. Older age, male sex, cardiovascular disease including hypertension, severe myelopathy, blood loss, requirement for osteotomy, coronal deformity angular ratio, and curve magnitude were associated with an increased risk of ISCI. Better pre-operative neurological status and use of intra-operative neuromonitoring (IONM) were associated with a decreased risk of ISCI. The risk factors for ISCI included a rigid thoracic curve with high deformity angular ratio, revision congenital deformity with significant cord compression and myelopathy, extrinsic intradural or extradural lesions with cord compression and myelopathy, intramedullary spinal cord tumor, unstable spine fractures (bilateral facet dislocation and disc herniation), extension distraction injury with ankylosing spondylitis, ossification of posterior longitudinal ligament (OPLL) with severe cord compression, and moderate to severe myelopathy. Conclusions ISCI has been defined as “a new or worsening neurological deficit attributable to spinal cord dysfunction during spine surgery that is diagnosed intra-operatively via neurophysiologic monitoring or by an intraoperative wake-up test, or immediately post-operatively based on clinical assessment”. This paper defines clinical and imaging factors which increase the risk for ISCI and that could assist clinicians in decision making.
Evaluation of time to reimplantation as a risk factor in two-stage revision with static spacers for periprosthetic knee joint infection
Authors: Puetzler Jan , Hofschneider Marc , Gosheger Georg , Theil Christoph , Schulze Martin , Schwarze Jan , Koch Raphael , Moellenbeck Burkhard 
Published: March 2024

Abstract
Introduction
We investigated the time to reimplantation (TTR) during two-stage revision using static spacers with regard to treatment success and function in patients with chronic periprosthetic joint infection (PJI) of the knee.

Methods
163 patients (median age 72 years, 72 women) who underwent two-stage exchange for chronic knee PJI between 2012 and 2020 were retrospectively analyzed (based on the 2011 Musculoskeletal Infection Society criteria). A cutoff TTR for increased risk of reinfection was identified using the maximally selected log-rank statistic. Infection control, aseptic revisions and overall survival were analyzed using Kaplan–Meier survival estimates. Adjustment for confounding factors—the Charlson Comorbidity Index (CCI) and C-reactive protein (CRP)—was done with a Cox proportional hazards model.

Results
When TTR exceeded 94 days, the adjusted hazard of reinfection was increased 2.8-fold (95% CI 1.4–5.7; p = 0.0036). The reinfection-free rate was 67% (95% CI 52-79%) after 2 years and 33% (95% CI 11–57%) after 5 years for a longer TTR compared to 89% (95% CI 81–94%) and 80% (95% CI 69–87%) at 2 and 5 years, respectively, for a shorter TTR. Adjusted overall survival and number of aseptic revisions did not differ between the longer TTR and shorter TTR groups. Maximum knee flexion was 90° (IQR 84–100) for a longer TTR and 95° (IQR 90–100) for a shorter TTR (p = 0.0431), with no difference between the groups in Oxford Knee Score. Baseline characteristics were similar (body mass index, age, previous surgeries, microorganisms) for the two groups, except that there was a higher CCI (median 4 vs. 3) and higher CRP (median 3.7 vs 2.6 mg/dl) in the longer TTR group.

Conclusion
A long TTR is sometimes unavoidable in clinical practice, but surgeons should be aware of a potentially higher risk of reinfection.
Level of evidence: III, retrospective comparative study.
Histomorphometric changes in testis following administration of tenofovir nanoparticles in an animal model
Authors: Naidu Edwin Coleridge , Olojede Samuel Oluwaseun , Lawal Sodiq Kolawole , Azu Onyemaechi Okpara 
Published: March 2024

Abstract
Background
Nanoparticle-based drugs are new inventions in the management of the Human immunodeficiency virus (HIV) pandemic, especially resistant forms of the virus in anatomical sanctuary sites and organs such as the testis. However, safety issues must be resolved to attain the optimal potential of newer nano-drug formulations.

Aim
The study investigated the toxicological potential of synthesized Tenofovir Nanoparticles (TDF-N) on testicular indices when used for the prevention and treatment of HIV.

Methodology
Fifteen male Sprague–Dawley (SD) rats with weight ranging from 230 g to 250 g were randomly assigned into groups A (control, saline), B (TDF), and C (TDF-N). The testes were removed for sperm analysis and processed for H/E and PAS stains. Cell counts and cellular measurements; the diameter and the area of the testicular seminiferous tubules were measured using ImageJ and Leica software 2.0.

Results
A significant reduction (p < 0.05) in sperm count was noticed in the TDF-N group. Also observed in the TDF and TDF-N groups was a significant reduction (p < 0.05) in sperm motility and in the number of dead sperms compared with the control. Sperm abnormalities such as distorted basement membranes, loss of germ cells, hypocellular interstitium, and loss of spermatogenic series were increased in the TDF and TDF-N groups. There was also a significant reduction (p < 0.05) in the cell count, diameter, and area of seminiferous tubules observed in these groups.

Conclusion
TDF and TDF-N may be detrimental to the testis and testicular tissue, leading to significantly reduced sperm counts, motility, and ultimately–male fertility.
Egyptian urinary stones in the COVID-19 outbreak: a multi-center study
Authors: kotb Sameh , Ezzat Mohamed , Galal Elsheikh Mohamed , Mohamed Elshorbagy Galal 
Published: March 2024

Abstract
Background
Urolithiasis is a unique disease that can cause emergencies and can impair kidney function over time, especially if infections overlap. This work aimed to compare urolithiasis in the pre- and post-pandemic era and to study the impact of the COVID-19 pandemic on patient preferences and decision-making for symptomatic urolithiasis and consequently complications.

Methods
This case–control multi-center study was conducted at the Urology Department of two tertiary centers in XXX. Participants were divided into two groups: group A: patients who had urolithiasis from March 1, 2018, to February 29, 2020 (pre-COVID-19 period), and group B: patients who had urolithiasis from March 1, 2020, to February 28, 2022 (during COVID-19 period).

Results
Group A had a significantly higher incidence of percutaneous nephrolithotomy (PCNL) without double J stenting (DJ), nephrolithotomy + pyelolithotomy and total PCNL compared to group B which had a lower incidence of URS without DJ and total URS. The operation was delayed among 72 (15.9%) patients during the pandemic. In total, 116 (25.6%) were subjected to previous stone removal surgery. In total, 59 (13%) of patients had COVID-19 infection before stone diagnosis. One hundred thirty-two patients (29.1%) were on vitamin C. The presence of positive family history was statistically significant in patients who underwent ESWL in comparison with patients who underwent endoscopy or surgery (P = 0.03).

Conclusions
COVID-19 significantly impacted endourological services for urinary stones in terms of surgical volume and case complexity.
Relationship between heart failure and intestinal inflammation in infants with congenital heart disease
Authors: Zhang Qi-Liang , Chen Xiu-Hua , Zhou Si-Jia , Lei Yu-Qing , Chen Qiang , Cao Hua 
Published: March 2024

Abstract
Objective
The association between heart failure (HF) and intestinal inflammation caused by a disturbed intestinal microbiota in infants with congenital heart disease (CHD) was investigated.

Methods
Twenty infants with HF and CHD who were admitted to our hospital between October 2021 and March 2022 were included in this study. Twenty age- and sex-matched infants without HF at our hospital were selected as the control group. Faecal samples were obtained from each participant and analysed by enzyme-linked immunoassay and 16 S rDNA sequencing to assess intestinal inflammatory factors and the microbiota.

Results
The levels of intestinal inflammatory factors, including IL-1β, IL-4, IL-6, IL-17 A and TNF-α, were greatly increased, while the levels of IL-10 were significantly decreased in the HF group compared to the control group (p < 0.05). The intestinal microbial diversity of patients in the HF group was markedly lower than that in the control group (p < 0.05). The abundance of Enterococcus was significantly increased in the HF group compared to the control group (p < 0.05), but the abundance of Bifidobacterium was significantly decreased in the HF group compared to the control group (p < 0.05). The diversity of the intestinal microbiota was negatively correlated with the levels of IL-1β, IL-4, IL-6 and TNF-α in the intestinal tract but was positively correlated with that of IL-10. The abundance of Enterococcus was positively associated with the levels of IL-1β, IL-4, IL-6 and TNF-α in the intestinal tract but was negatively correlated with that of IL-10. NT-proBNP was positively associated with the levels of IL-1β, IL-4, IL-6 and TNF-α in the HF group but was negatively correlated with that of IL-10. The heart function score was positively associated with the levels of IL-1β, IL-4, IL-6 and TNF-α in the HF group but was negatively correlated with that of IL-10.

Conclusions
Infants with CHD-related HF had a disordered intestinal microbiota, decreased diversity of intestinal microbes, increased levels of pathogenic bacteria and decreased levels of beneficial bacteria. The increased abundance of Enterococcus and the significant decrease in the diversity of the intestinal microbiota may exacerbate the intestinal inflammatory response, which may be associated with the progression of HF.
A nomogram model for predicting intramyocardial hemorrhage post-PCI based on SYNTAX score and clinical features
Authors: Yang Yin-shuang , Xi De-yang , Duan Yang , Yu Miao , Liu Kai , Meng Yan-kai , Hu Chun-feng , Han Shu-guang , Xu Kai 
Published: March 2024

Abstract
Objective
The aim of this study is to develop a nomogram model for predicting the occurrence of intramyocardial hemorrhage (IMH) in patients with Acute Myocardial Infarction (AMI) following Percutaneous Coronary Intervention (PCI). The model is constructed utilizing clinical data and the SYNTAX Score (SS), and its predictive value is thoroughly evaluated.

Methods
A retrospective study was conducted, including 216 patients with AMI who underwent Cardiac Magnetic Resonance (CMR) within a week post-PCI. Clinical data were collected for all patients, and their SS were calculated based on coronary angiography results. Based on the presence or absence of IMH as indicated by CMR, patients were categorized into two groups: the IMH group (109 patients) and the non-IMH group (107 patients). The patients were randomly divided in a 7:3 ratio into a training set (151 patients) and a validation set (65 patients). A nomogram model was constructed using univariate and multivariate logistic regression analyses. The predictive capability of the model was assessed using Receiver Operating Characteristic (ROC) curve analysis, comparing the predictive value based on the area under the ROC curve (AUC).

Results
In the training set, IMH post-PCI was observed in 78 AMI patients on CMR, while 73 did not show IMH. Variables with a significance level of P < 0.05 were screened using univariate logistic regression analysis. Twelve indicators were selected for multivariate logistic regression analysis: heart rate, diastolic blood pressure, ST segment elevation on electrocardiogram, culprit vessel, symptom onset to reperfusion time, C-reactive protein, aspartate aminotransferase, lactate dehydrogenase, creatine kinase, creatine kinase-MB, high-sensitivity troponin T (HS-TnT), and SYNTAX Score. Based on multivariate logistic regression results, two independent predictive factors were identified: HS-TnT (Odds Ratio [OR] = 1.61, 95% Confidence Interval [CI]: 1.21–2.25, P = 0.003) and SS (OR = 2.54, 95% CI: 1.42–4.90, P = 0.003). Consequently, a nomogram model was constructed based on these findings. The AUC of the nomogram model in the training set was 0.893 (95% CI: 0.840–0.946), and in the validation set, it was 0.910 (95% CI: 0.823–0.970). Good consistency and accuracy of the model were demonstrated by calibration and decision curve analysis.

Conclusion
The nomogram model, constructed utilizing HS-TnT and SS, demonstrates accurate predictive capability for the risk of IMH post-PCI in patients with AMI. This model offers significant guidance and theoretical support for the clinical diagnosis and treatment of these patients.
Evaluating the efficacy of different volume resuscitation strategies in acute pancreatitis patients: a systematic review and meta-analysis
Authors: Kumari Roopa , Sadarat FNU , Luhana Sindhu , Parkash Om , Lohana Abhi Chand , Rahaman Zubair , Wang Hong Yu , Mohammed Yaqub N , Kumar Sanjay Kirshan , Chander Subhash 
Published: March 2024

Abstract
Introduction
Acute pancreatitis poses a significant health risk due to the potential for pancreatic necrosis and multi-organ failure. Fluid resuscitation has demonstrated positive effects; however, consensus on the ideal intravenous fluid type and infusion rate for optimal patient outcomes remains elusive.

Methods
A comprehensive literature search was conducted using PubMed, Embase, the Cochrane Library, Scopus, and Google Scholar for studies published between 2005 and January 2023. Reference lists of potential studies were manually searched to identify additional relevant articles. Randomized controlled trials and retrospective studies comparing high (≥ 20 ml/kg/h), moderate (≥ 10 to < 20 ml/kg/h), and low (5 to < 10 ml/kg/h) fluid therapy in acute pancreatitis were considered.

Results
Twelve studies met our inclusion criteria. Results indicated improved clinical outcomes with low versus moderate fluid therapy (OR = 0.73; 95% CI [0.13, 4.03]; p = 0.71) but higher mortality rates with low compared to moderate (OR = 0.80; 95% CI [0.37, 1.70]; p = 0.55), moderate compared to high (OR = 0.58; 95% CI [0.41, 0.81], p = 0.001), and low compared to high fluids (OR = 0.42; 95% CI [0.16, 1.10]; P = 0.08). Systematic complications improved with moderate versus low fluid therapy (OR = 1.22; 95% CI [0.84, 1.78]; p = 0.29), but no difference was found between moderate and high fluid therapy (OR = 0.59; 95% CI [0.41, 0.86]; p = 0.006).

Discussion
This meta-analysis revealed differences in the clinical outcomes of patients with AP receiving low, moderate, and high fluid resuscitation. Low fluid infusion demonstrated better clinical outcomes but higher mortality, systemic complications, and SIRS persistence than moderate or high fluid therapy. Early fluid administration yielded better results than rapid fluid resuscitation.