bluuebunny/crossref_metadata_2025_split huggingface dataset:
The role of inflammation and antithrombin supplementation on thromboelastographic parameters during veno-venous ECMO for respiratory failure
Authors: Meli Andrea , De Falco Stefano , Novembrino Cristina , Boscolo Anzoletti Massimo , Arcadipane Antonio , Panarello Giovanna , Occhipinti Giovanna , Grasselli Giacomo , Panigada Mauro 
Published: April 2024

Introduction Extracorporeal membrane oxygenation (ECMO) may act as a driver or propagator of systemic inflammation. In turn, cytokine release can modify thromboelastographic (TEG) tests which are commonly used for anticoagulation monitoring. In this context, antithrombin (AT) supplementation might further modify TEG. Methods This is a pre-specified sub-study of the “Randomized Controlled Trial of Antithrombin Supplementation During Extracorporeal Membrane Oxygenation” study (investigator-initiated, randomized, single-blind, two-arm trial) conducted in two Italian ECMO referral ICUs. Adult patients requiring vv-ECMO for respiratory failure and undergoing unfractioned heparin (UFH) administration were enrolled and randomized whether to receive AT supplementation. Plasma samples for cytokine assay (IL-8, IL-10, IL-6, IL-1β, TNF-α and Pro-ADM) and heparinase TEG were collected from every patient before ECMO start, 24 h and 72 h after ECMO start, before ECMO removal, and 7 days after ECMO removal or upon ICU discharge whichever happened first. AT concentration, coagulation and clinical data were collected before ECMO start and at pre-fixed time points. Results Thirty-nine patients were enrolled (21 treatments, 18 controls). TEG-R had a weak-to-moderate positive correlation with IL-8, IL-6, IL-10 and TNF-α and a moderate positive correlation with Pro-ADM. TEG-ANG showed a weak negative correlation with IL-8, IL-6 and TNF-α, while TEG-MA negatively correlated with IL-8, TNF-α and Pro-ADM. AT supplementation seemed to modify the association between TEG-MA and IL-8, IL-10 and Pro-ADM; conversely, AT did not affect the relationship among TEG-R or TEG-ANG and the studied cytokines. Conclusions High concentrations of systemic cytokines correlated with longer reaction times and decreased angle and amplitude at TEG, suggesting that an increase in inflammation is related with hypocoagulability as revealed by thromboelastography.
Individual patient data meta-analysis on awake pediatric extracorporeal life support: Feasibility and safety of analgesia, sedation and respiratory support weaning, and physiotherapy
Authors: Cucchi Marta , Mariani Silvia , Kawczynski Michal J. , Shkurka Emma , Ius Fabio , Comentale Giuseppe , Hoskote Aparna , Lorusso Roberto 
Published: April 2024

Objective Awake Extracorporeal Life Support (aECLS) with active mobilization has gained consensus over time, also within the pediatric community. This individual patient data (IPD) meta-analysis summarizes available evidence on pediatric aECLS, its feasibility, and safety regarding sedation weaning, extubation, and physiotherapy. Methods PubMed/Medline and Cochrane Database were screened until February 2022. Articles reporting on children (≤18 years) undergoing aECLS were selected. IPD were requested, pooled in a single database, and analyzed using descriptive statistics. Primary outcome was survival to hospital discharge. Secondary outcomes included extubation during ECLS, physiotherapy performed, tracheostomy, and complications. Results Nineteen articles and 65 patients (males: n = 30/59,50.8%) were included. Age ranged from 2 days to 17 years. ECLS configurations included veno-venous ( n = 42/65, 64.6%), veno-arterial ( n = 18/65, 27.7%) and other ECLS settings ( n = 5/65, 7.7%). Exclusive neck cannulation was performed in 51/65 (78.5%) patients. Extubation or tracheostomy during ECLS was reported in 66.2% ( n = 43/65) and 27.7% ( n = 18/65) of patients, respectively. Physiotherapy was reported as unspecified physical activity ( n = 34/63, 54%), mobilization in bed ( n = 15/63, 23.8%), ambulation ( n = 14/63, 22.2%). Complications were reported in 60.3% ( n = 35/58) of patients, including hemorrhagic (36.2%), mechanical (17.2%), or pulmonary (17.2%) issues, and need for reintubation (15.5%). Survival at discharge was 81.5% ( n = 53/65). Conclusion Awake ECLS strategy with active physiotherapy can be applied in children from neonatal age. Ambulation is also possible in selected cases. Complications related to such management were limited. Further studies on aECLS are needed to evaluate safety and efficacy of early physiotherapy and define patient selection.
Radiomic nomogram based on lumbar spine magnetic resonance images to diagnose osteoporosis
Authors: Kang Si-ru , Wang Kai 
Published: April 2024

Background We aimed to establish a novel model using a radiomics analysis of magnetic resonance (MR) images for predicting osteoporosis. Purpose To investigate the effectiveness of a radiomics approach utilizing magnetic resonance imaging (MRI) of the lumbar spine in identifying osteoporosis. Material and Methods In this retrospective study, a total of 291 patients who underwent MRI were analyzed. Radiomics features were extracted from the MRI scans of all 1455 lumbar vertebrae, and build the radiomics model based on T2-weighted (T2W), T1-weighted (T1W), and T2W + T1W imaging. The performance of the combined model was assessed using metrics such as the area under the receiver operating characteristic curve (AUC), sensitivity, specificity, and accuracy. The AUCs of these models were compared using the DeLong test. Their clinical usefulness was assessed using a decision curve analysis. Results T2W, T1W, and T1W + T2W imaging retained 27, 27, and 17 non-zero coefficients, respectively. The AUCS about radiomics scores based on T2W, T1W, and T1W + T2W imaging were 0.894, 0.934, and 0.945, respectively, which all performed better than the clinical model significantly. The rad-signatures based on T1W + T2W imaging, which exhibited a stronger predictive power, were included in the creation of the nomogram for osteoporosis diagnosis, and the AUC was 0.965 (95% confidence interval (CI)=0.944–0.986) in the training cohort and 0.917 (95% CI=0.738–1.000) in the test cohort. The calibration curve indicated that the radiomics nomogram had considerable clinical usefulness in prediction, observation, and decision curve analysis. Conclusion A reliable and powerful tool for identifying osteoporosis can be provided by the nomogram that combines the T1W and T2W imaging radiomics score with clinical risk factors.
Augmented Ulnar Collateral Ligament Repair With Structural Bioinductive Scaffold: A Biomechanical Study
Authors: Lin Kenneth M. , Brinson Kenneth , Atzmon Ran , Chan Calvin K. , Sherman Seth L. , Safran Marc R. , Freehill Michael T. 
Published: April 2024

Background: Elbow ulnar collateral ligament (UCL) repair with suture brace augmentation shows good time-zero biomechanical strength and a more rapid return to play compared with UCL reconstruction. However, there are concerns about overconstraint or stress shielding with nonabsorbable suture tape. Recently, a collagen-based bioinductive absorbable structural scaffold has been approved by the Food and Drug Administration for augmentation of soft tissue repair. Purpose/Hypothesis: This study aimed to assess the initial biomechanical performance of UCL repair augmented with this scaffold. We hypothesized that adding the bioinductive absorbable structural scaffold to primary UCL repair would impart additional time-zero restraint to the valgus opening. Study Design: Controlled laboratory study. Methods: Eight cadaveric elbow specimens—from midforearm to midhumerus—were utilized. In the native state, elbows underwent valgus stress testing at 30o, 60o, and 90o of flexion, with a cyclical valgus rotational torque. Changes in valgus rotation from 2- to 5-N·m torque were recorded as valgus gapping. Testing was then performed in 4 states: (1) native intact UCL—with dissection through skin, fascia, and muscle down to an intact UCL complex; (2) UCL-transected—distal transection of the ligament off the sublime tubercle; (3) augmented repair with bioinductive absorbable scaffold; and (4) repair alone without scaffold. The order of testing of repair states was alternated to account for possible plastic deformation during testing. Results: The UCL-transected state showed the greatest increase in valgus gapping of all states at all flexion angles. Repair alone showed similar valgus gapping to that of the UCL-transected state at 30° ( P = .62) and 60° of flexion ( P = .11). Bioinductive absorbable scaffold–augmented repair showed less valgus gapping compared with repair alone at all flexion angles ( P = .021, P = .024, and P = .024 at 30°, 60°, and 90°, respectively). Scaffold-augmented repair showed greater gapping compared with the native state at 30° ( P = .021) and 90° ( P = .039) but not at 60° of flexion ( P = .059). There was no difference when testing augmented repair or repair alone first. Conclusion: UCL repair augmented with a bioinductive, biocomposite absorbable structural scaffold imparts additional biomechanical strength to UCL repair alone, without overconstraint beyond the native state. Further comparative studies are warranted. Clinical Relevance: As augmented primary UCL repair becomes more commonly performed, use of an absorbable bioinductive scaffold may allow for improved time-zero mechanical strength, and thus more rapid rehabilitation, while avoiding long-term overconstraint or stress shielding.
Associations of Cognitive Impairment with All-Cause and Cardiovascular Mortality Among Individuals with Diabetes: A Prospective Cohort Study
Authors: Shang Yanchang , Wang Shuhui , Wei Chao , Xie Hengge 
Published: April 2024

This study explored the association between diabetes, cognitive imFpairment (CI), and mortality in a cohort of 2931 individuals aged 60 and above from the 2011 to 2014 NHANES. Mortality data was gathered through 2019, and multivariable Cox proportional hazards models were used to determine the association between diabetes, CI, and mortality adjusting for sociodemographic characteristics, lifestyle factors, and comorbidity conditions. The study spanned up to 9.17 years, observing 579 deaths, with individuals having both diabetes and CI showing the highest all-cause mortality (23.6 events per 100 patient-years). Adjusted analysis revealed a 2.34-fold higher risk of all-cause mortality for this group, surpassing those with diabetes or CI alone. These results held after a series of stratified and sensitivity analyses. In conclusion, CI was linked to higher all-cause mortality in individuals with diabetes, emphasizing the need to address cognitive dysfunction in diabetic patients.
Computational analysis of electrical stimulation to promote tissue healing for hernia repair at varying mesh placement planes
Authors: Mosier Savannah , Berbel German , Friis Elizabeth A 
Published: April 2024

Development of a tear in the abdominal wall allowing for protrusion of intra-abdominal contents is known as a hernia. This can cause pain, discomfort, and may need surgical repair. Hernias can affect people of any age or demographic. In the USA, over 1 million hernia repair procedures are performed each year. During these surgeries, it is common for a mesh to be utilized to strengthen the repair. Different techniques allow for the mesh to be placed in different anatomical planes depending on hernia location and approach. The locations are onlay, inlay, and sublay, with sublay being split into retromuscular or preperitoneal with sublay being the most commonly used. The use of an electrically active hernia repair mesh is of interest to model as electrical stimulation has been shown to improve soft tissue healing which could reduce recurrence rates. Theoretical 3D COMSOL models were built to evaluate the varying electric fields of an electrically active hernia repair mesh at each of the different anatomical planes. Three voltages were chosen (10, 20, and 30 mV) for the study to simulate a low-level electrical signal and the electric field from a piezoelectric material at the tissue layers surrounding the mesh construct. Based on the model outputs, the optimal mesh placement location was the sublay-retromuscular as this location had the highest electric field values in the connective tissues and rectus abdominis muscle, which are the primary tissues of concern for the healing process and a successful repair.
The relationship between the self-confidence in clean urinary intermittent catheterisation and self-efficacy of home care patients
Authors: Kaplan Mehmet , Çelik Hanife , Kaplan Feride 
Published: April 2024

Background: Home care patients experience great difficulty in fulfilling their daily activities. One of these difficulties is related to urinary excretion. It is necessary for individuals to possess self-efficacy as well as self-confidence in order to be able to perform self-administered clean intermittent catheterisation (CIC). Aims: The present study aims to determine the relationship between the self-confidence and self-efficacy of home care patients in CIC. Method: The data were collected from patients receiving home care services from a hospital in eastern Turkey between November 2022 and February 2023. The study data were collected online via google forms. No sample selection was made and the entire population was included in the study (372). The study was completed with 240 patients. Results: A significant positive correlation was found between the scores obtained from the self-confidence and self-efficacy inventories for CIC. It was found that the self-efficacy total score had an effect size of 66% on self-confidence inventories for CIC. In addition, age, education level and working status also affect self-efficacy. Conclusions: In the present study, it was concluded that the level of self-confidence affects the level of self-efficacy in self-catheterisation. The success rate of catheterisation increases in parallel with self-confidence.
Exploring the lived and coping experiences of patients with kidney failure undergoing haemodialysis in Malaysian private hospitals
Authors: Woei Ling Tan , Khuan Lee , Baharom Anisah , Arshad Mohd Mursyid 
Published: April 2024

Background: Chronic kidney disease is associated with structural and functional abnormalities in the kidney caused by a range of different aetiologies. Purpose: The study’s purpose was to explore the lived and coping experiences of patients with kidney failure undergoing haemodialysis in three private hospitals in Malaysia. Methods: Applying an interpretative phenomenological analysis using a hermeneutic phenomenological design to derive common meaning from participants lived and coping experiences. In the study, data were collected using a semi-structured interview guide from 15 purposefully sampled patients with kidney failure. Data were analysed using the interpretative phenomenological analysis principles. Results: Patients with kidney failure reported emotional distress, life limitations, financial burdens, knowledge deficits and varying perceptions of the haemodialysis treatment. Body image changes, financial assistance, social support and hope were coping strategies used by patients with kidney failure. It was identified that patients with kidney failure used unique coping strategies such as applying perfume and using clothes to conceal the impact of haemodialysis on their bodies, which is not comprehensively discussed in published literature. Conclusion: Nurses who deliver care to patients with kidney failure should focus on mitigating emotional distress, increasing knowledge related to kidney failure and improving perception of the haemodialysis treatment. Delivering and providing social support are indispensable nursing roles to help patients cope with haemodialysis treatment.
A Simplified Preoperative Radiographic Assessment for Metatarsus Adductus Associated With Hallux Valgus
Authors: McAleer Jody P. , DeCarbo William T. , Santrock Robert D. , Hatch Daniel J. , Dayton Paul , Smith W. Bret 
Published: April 2024

Radiographic measurements for the assessment of metatarsus adductus (MTA) have a broad range of interpretation without a consensus regarding surgical indications. The “Plumbline” (PL) radiographic assessment method helps identify MTA and determines if physical space is available to align the first metatarsal to the longitudinal foot axis without the need to realign the lesser metatarsals. Forty-five neutral weight-bearing anterior-posterior (AP) radiographs of patients scheduled for surgical intervention for isolated hallux valgus (HV) or combined MTA/HV deformities were reviewed. The cohort was grouped based on the presence of MTA using a Sgarlato’s angle (SA) of 15°, with 23 patients in the HV-only group and 22 patients in the MTA group. A mean preoperative SA of 8.7° (SD: 2.1; range: 5.4-13.4) and 26.6° (SD: 5.1; range: 18.2-36) were found in the HV-only and MTA groups, respectively. Subjects with an SA ≤ 15° (N = 22) were found to have a negative PL (100%) and subjects with an SA > 15° (N = 23) displayed a positive PL (100%). The PL technique provided a simple method and clear visual reference for determining the presence of MTA in HV patients without the need to measure traditional radiographic angles. Level of Evidence: Retrospective, Level IV, Diagnostic
Primary Care Utilization, Preventative Screening, and Control of Metabolic Syndrome in Metabolic Dysfunction-Associated Steatohepatitis Liver Transplant Recipients
Authors: Flynn Sarah J. , Saxena Varun , Brandman Danielle 
Published: April 2024

Objectives: Patients with pre-transplant metabolic dysfunction-associated steatohepatitis (MASH) are at high risk of metabolic syndrome (MetS) after liver transplant. While many patients are co-managed by a transplant team, most preventative screening and MetS management may occur in the primary care setting. We aimed to evaluate primary care utilization by MASH liver transplant recipients as well as MetS screening and control. Methods: We conducted a retrospective chart review that included adults who underwent liver transplant for MASH or cryptogenic cirrhosis at a single institution from January 2010 to December 2016, had available primary care data, and at least 36-months of follow-up post-transplant. Measures included primary care utilization, adherence to screening guidelines, and control of MetS. We used Fischer’s exact test to explore the association of primary care utilization with screening and control. Results: A total of 37 patients met inclusion criteria with 366 visits reviewed. The median time to first visit was 68 days post-transplant and patients had a median of 9 total visits. Few patients met screening guidelines for diabetes (8.1%) or hyperlipidemia (10.8%). The percentage of patients with control of obesity, hypertension, diabetes, and hyperlipidemia decreased over the 36-month follow-up period. Primary care utilization was not associated with adherence to screening recommendations for diabetes ( P = .141) or hyperlipidemia ( P = .103). Higher primary care utilization was not associated with control of hypertension ( P = .107), diabetes ( P = .871), or hyperlipidemia ( P = .999). Conclusion: More research is needed to investigate barriers to screening and management of MetS conditions in this high-risk patient population in the primary care setting as well as to optimize post-transplant care coordination.
Impact of Climate on Stress Ultrasound Findings of the Elbow Ulnar Collateral Ligament in Professional Baseball Pitchers: An 18-Year Study
Authors: Hanna Adeeb Jacob , Fliegel Brian E. , Sonnier John Hayden , Sherman Matthew B. , Ciccotti Michael G. , Jack Robert A. , Cohen Steven B. 
Published: April 2024

Background: The ulnar collateral ligament (UCL) is the primary soft tissue stabilizer to valgus stress in the elbow and is placed under this valgus stress during the throwing motion. Although there are known risk factors for UCL injury, it is unknown whether the UCL undergoes adaptive changes in athletes from different climates. Purpose: To compare elbow stress ultrasound (SUS) findings between professional baseball pitchers from warm climates versus cold climates and assess significant differences in adaptive and morphologic changes in the UCL. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Dynamic SUS evaluations were performed over 18 years on the dominant and nondominant arms of 643 professional pitchers from warm and cold climates as determined by the player's country/state of origin. Studies were compared with respect to relative UCL thickness ( dominant arm vs nondominant arm), relative glenohumeral joint laxity ( joint space distance under stress vs joint space distance at rest), and the presence of morphologic changes such as tears or calcifications. In addition, a subgroup analysis was performed to compare the progression of SUS findings over 3 years in players with sequential yearly data. Results: Players from warmer climates had significantly greater relative UCL thicknesses than players from colder climates (1.75 vs 1.50 mm, respectively; P = .047). There were no differences between these 2 groups in terms of relative ulnohumeral joint laxity ( P = .201), presence of morphologic changes ( P = .433), 3-year progression of relative UCL thickness ( P = .748), or relative joint laxity ( P = .904). Conclusion: Professional pitchers from warm climates had a greater side-to-side difference in UCL thickness between the dominant and nondominant arms. This may be due to the potential for year-round throwing among baseball players from warm climates. There was no difference in laxity, thickness progression, laxity progression, or the presence of additional morphologic changes.
Knowledge, Attitudes, and Practices of Nurses Regarding the Prevention and Control of COVID-19 at a Selected Regional Hospital in Namibia
Authors: Ashipala Daniel. O. , Kaihoto Christine , Munangatire Takaedza 
Published: April 2024

Introduction As the threat of COVID-19 continues, new evidence and knowledge of the disease is coming to light, thus it is critical to evaluate nurses’ knowledge, attitudes, and practices (KAP) regarding the control and prevention of COVID-19 infections. Objective The objective of the study was to assess the KAP of nurses regarding the prevention and control of COVID-19 at a selected regional hospital in Namibia. Methods A quantitative, descriptive cross-sectional study was used to quantify and measure the relationships between the demographic variables and the key variables of KAP regarding the prevention and control of COVID-19. A total of 101 respondents were conveniently sampled. Data were collected online and analyzed using SPSS version 27. Results The mean scores were: knowledge 26.8 (83.8%), attitude 44.8 (70%), and practice 46.8 (78%). The Pearson's correlation showed that the practice score was positively correlated to the attitude score (r = 0.556, p < 0.01), while the independent samples t-test showed that gender, COVID-19 status, and nurse status had no effect on knowledge, attitude, or practices (p > 0.05). There was a significant mean difference in the attitude scores between the vaccinated and the non-vaccinated nurses: t (86.251) = 2.974, p ≤ 0.05, as well as in the practice scores: t (98.956) = 1.989, p < −0.05. Multiple linear regression indicated that the regression model was statistically significant (F = 2.536, p < 0.001, adjusted R2 = 0.145). Conclusion The results of this study revealed that some of the nurses had inadequate KAP related to the prevention and control of COVID-19. Consequently, these nurses need more intensive training to ensure that they display a high level of knowledge, positive attitudes, and good practices regarding the virus. This will both safeguard the nurses and reduce the transmission of COVID-19.