bluuebunny/crossref_metadata_2025_split huggingface dataset:
Utility of Intraprocedural Luminal Diameter and Distensibility Measurements During the Esophageal Peroral Endoscopic Myotomy Procedure
Authors: Eke Chiemeziem , Greenberg Ian , Bushe Bryce , Joelson Andrew , Acharya Priyanka , Lee David , Sethi Amrita , Kedia Prashant 
Published: January 2024

Goals:
Through evaluation of the lower esophageal sphincter immediately before and after myotomy using an endoluminal functional lumen imaging probe (EFLIP), our study aimed to determine the clinical response to peroral endoscopic myotomy (POEM) and the incidence of postprocedure reflux.

Background:
Achalasia is a rare esophageal motility disorder characterized by impaired relaxation of the lower esophageal sphincter (LES) and diminished peristalsis. POEM is a therapeutic option for durable management of achalasia. However, symptomatic acid reflux and esophagitis are well-known adverse effects of the procedure.

Study:
Electronic medical records of 168 patients who underwent POEM for achalasia at 2 tertiary care referral centers from May 2014 to May 2021 were reviewed. EFLIP was used at a range of catheter fill volumes to assess LES dynamics. Preprocedure and postprocedure Eckardt Symptom Scores were recorded.

Results:
Significant clinical improvement from POEM was sustained in over 94% of patients after 1 year. EFLIP changed intraprocedural management 5% of the time by means of myotomy extension. In patients with reflux>1 year following POEM, there was no significant difference in post-POEM LES diameter or change in LES diameter compared with those without reflux. However, post-POEM LES distensibility index (DI) was significantly higher in patients with reflux after 1 year compared with those without reflux.

Conclusions:
POEM is a safe and increasingly effective therapy for patients with symptomatic achalasia. Intraprocedural EFLIP measurements suggest that post-POEM reflux may be correlated more with DI than LES diameter. Yet, more data is needed to substantiate these outcomes.
The Effect of Renin-Angiotensin System Inhibitors in Patients Undergoing Pancreatic Cancer Resection
Authors: Abe Satoru , Nakai Yousuke , Arita Junichi , Ichida Akihiko , Kawaguchi Yoshikuni , Akamatsu Nobuhisa , Kaneko Junichi , Ijichi Hideaki , Koike Kazuhiko , Fujishiro Mitsuhiro , Hasegawa Kiyoshi 
Published: January 2024

Objectives
The local renin-angiotensin system promotes angiogenesis and proliferation via vascular endothelial growth factor or epidermal growth factor receptor expression. In this study, we aimed to evaluate the impact of angiotensin system inhibitors (ASIs) on long-term outcomes in patients undergoing surgical resection of pancreatic ductal adenocarcinoma (PDAC).

Methods
A single institutional retrospective analysis was performed using the medical records of patients who underwent pancreatic resection with curative intent for PDAC between January 2005 and December 2018. Patient characteristics and surgical outcomes were compared between patients taking ASIs and those who are not.

Results
A total of 272 patients were included in the study and classified into the ASI group (n = 121) and the non-ASI group (n = 151). The median overall survival times in the ASI group and non-ASI group were 38.0 and 34.0 months (P = 0.250), and the median recurrence-free survival times were 24.0 and 15.0 months (P = 0.025), respectively. Multivariate analysis for recurrence-free survival identified the use of ASIs (P = 0.020), CA19-9 level >500 IU/L (P = 0.010), positive lymph node metastasis (P < 0.001), and no adjuvant chemotherapy (P < 0.001) as independent prognostic factors.

Conclusions
The use of ASI may improve long-term outcomes after surgery for PDAC.
Anaesthetic managements of 16 days’ neonate with large occipital meningeoencephalocele in a resource-limited setting, Ethiopia: a clinical case report and review of literature
Authors: Ibrahim Amelmasin Faris , Ayen Biresaw , Belayneh Tadesse , Dereje Tesera 
Published: January 2024

Introduction:Meningoencephalocele is a rare congenital neural tube defect that results in herniation of brain tissue, necessitating surgical treatment. However, anaesthetic management of meningoencephalocele is challenging because of the giant occipital mass in airway management, particularly for anaesthetists working in resource-limited settings. Therefore, this case report aimed to share the challenges encountered during the perioperative anaesthesia management of a giant occipital meningoencephalocele in Ethiopia.Case presentation:A 16-day-old female neonate was referred from a health centre in Ethiopia for surgical excision and repair of a giant occipital meningoencephalocele (GOM). The main challenges were hemodynamic instability and airway management due to the giant mass on neck movement and inability to achieve the optimal position for intubation.Methods:A single clinical case report discussed challenges encountered during perioperative anaesthesia management of GOM in a resource-limited setting in Ethiopia, and this work has been reported in line with the SCARE 2023 criteria.Conclusion:Anaesthesia management in neonates with GOM is challenging for anaesthetists in resource-limited settings because of the scarcity of different airway equipment and large masses. Another concern was to avoid pressure on the GOM due to rupture, which may result in hemodynamic instability and hypothermia. Therefore, attention should be paid to proper handling of the airway, hypothermia, and fluid loss. Generally, managing an occipital meningoencephalocele poses challenges for anaesthetists, particularly in terms of securing the airway. Despite these challenges, the authors managed with locally available resources.
Evaluating and Enhancing Nursing Caregiver Well-being Using a Systematic Approach
Authors: Galuska Lee , Phillips Jessica M. , Anderson Kelley , Meyer Ana-Liezl , Lor Kannitha , Mahnovski Susan , Miller Pamela S. 
Published: January 2024

OBJECTIVE
The aims of this study were to evaluate nursing caregiver well-being and identify interventions for improving well-being and practice environments.

BACKGROUND
Healthcare worker well-being and burnout command increasing attention in the wake of the pandemic. Experts recommend utilization of validated measurements to assess burnout, well-being, and contributing factors.

METHODS
Using a descriptive, cross-sectional, mixed-methods study design, an online survey, which included the Professional Quality of Life-5, Meaning and Joy in Work Questionnaire, and open-ended questions, was administered to nurses and unlicensed assistive caregivers in an academic health system.

RESULTS
Caregivers reported moderate compassion satisfaction, low burnout and compassion fatigue, and low-moderate levels of meaning and joy in work. Overall and subscale scores varied primarily based on age, experience, and role. Top causes of stress and recommendations for improvement were identified.

CONCLUSION
The levels of meaning and joy in work among nursing caregivers continue to be of concern for organizational leaders. The engagement of nurses and other caregiver team members in a systematic mixed-methods approach, including using validated tools to evaluate caregiver well-being, can lead to meaningful, data-driven action planning to promote well-being and increase the meaning and joy of the work they perform.
The Relationship Between Depressive Symptoms and Psychological Variables in Patients With Schizophrenia
Authors: Kirpinar Mehmet Murat , Demirel Omer Faruk 
Published: January 2024

Introduction:
Depressive symptoms are common in schizophrenia and can be seen at any stage of the disease. Although various models have been proposed to explain the development of depression in schizophrenia, studies investigating related psychological factors are scarce and the studies that have been done usually focus on only a small number of possible factors.

Objective:
The goal of this study was to investigate the predictability of some psychological factors on depression in patients with schizophrenia. For this purpose, patients with high and low depression scores were compared.

Methods:
Two groups of individuals with schizophrenia, with (n=29) and without (n=31) depression, as determined by scores on the Calgary Depression Scale in Schizophrenia, were compared using a sociodemographic data form, the Positive and Negative Syndrome Scale (PANSS), the Beck Anxiety Inventory, the Rotter Internal-External Locus 2024 of Control Scale, the Multidimensional Scale of Perceived Social Support, and the Stress Coping Styles Scale.

Results:
No differences were found between the 2 groups in terms of sociodemographic and clinical characteristics, social support scores, and coping styles. Statistically significant differences were found between the groups on the PANSS positive, negative, and general psychopathology subscales, in PANSS total scores, in anxiety scores, and in locus of control scores.

Conclusions:
This study showed that high levels of negative, positive, and general psychopathological symptoms, external locus of control, and high anxiety scores may be predictive of depression in individuals with schizophrenia. Studies that examine psychological factors in larger patient groups may provide the opportunity to detect and target these factors earlier in the course of schizophrenia, thereby reducing morbidity and mortality.
Characterization of Psychiatric Inpatients: The Role of Gender Differences in Clinical and Pharmacological Patterns
Authors: Berardelli Isabella , Aguglia Andrea , Amerio Andrea , Sarubbi Salvatore , Rogante Elena , Trocchia Maria A. , Zelletta Davide , Longhini Ludovica , Erbuto Denise , Pastorino Fabrizio , Lamis Dorian A. , Innamorati Marco , Serafini Gianluca , Pompili Maurizio 
Published: January 2024

Background:
Severe mental disorders that require hospitalization are disabling conditions that contribute to the burden of mental diseases. They pose increased clinical challenges and highlight the need to thoroughly explore variables emerging from daily clinical practice. In this study, we assessed to what extent gender differences may characterize a large population of psychiatric inpatients.

Methods:
We conducted a cross-sectional study in 2 Italian teaching medical centers, which included 2358 patients who were consecutively admitted to the psychiatric emergency units. We explored and characterized gender differences for variables such as prevalence of psychiatric diagnosis, presence of suicidal ideation, suicide attempts, age at onset of psychiatric illness, presence of substance or alcohol abuse, length of stay, number of hospitalizations, presence of involuntary admission, type of discharge from the hospital, and pharmacological treatment at discharge.

Results:
Female patients were primarily diagnosed with bipolar disorder or personality disorders. Female patients had a significantly higher prevalence of lifetime suicide attempts (23.1% vs. 16.5%, P<0.001) and a longer length of hospitalization (11.43±10.73 d vs. 10.52±10.37 d, t=–2.099, gl=2356, P=0.036) compared with male patients. Male patients had more involuntary admissions (25.1% vs. 19.7%, χ2=9.616, gl=1, P=0.002), more use of illicit substances (34.1% vs. 20.9%, χ2=51.084, gl=1, P<0.001), and higher rates of alcohol abuse (21.3% vs. 14.7%, χ2=17.182, gl=1, P<0.001) compared with female patients. Finally, antidepressants and lithium were prescribed more frequently to the female patients, whereas other mood stabilizers were more often prescribed to the male patients.

Conclusions:
Our real-world results highlighted gender differences among patients with severe mental disorders admitted to psychiatric units, and suggest further investigations that may help in understanding trajectories accompanying disabling clinical conditions.
Different effects of the companion antiretroviral drugs on dolutegravir trough concentrations
Authors: Cattaneo Dario , Pagano Simone , Colombo Martina Laura , Giacomelli Andrea , Gori Andrea , Gervasoni Cristina 
Published: January 2024

Background:Dolutegravir is widely used in different dual and triple antiretroviral regimens. Here, we sought to investigate the effect of the companion antiretroviral drug(s) on dolutegravir plasma trough concentrations in persons with HIV, with a focus on dual regimens.Methods:Dolutegravir concentrations collected from October 2015 to March 2023 (n = 900) were stratified according to the main antiretroviral classes (NRTIs, NNRTIs, protease inhibitors) and according to single drugs. Dolutegravir concentrations measured in persons with HIV concomitantly treated with lamivudine were considered as the reference group.Results:Dolutegravir trough concentrations were significantly higher in persons with HIV given protease inhibitors compared with the reference [1886 (1036–2940) versus 1575 (1026–2226) ng/ml;P = 0.004]. The highest dolutegravir concentrations were measured in persons with HIV concomitantly treated with unboosted atazanavir [2908 (2130–4135) ng/ml]. Conversely, co-administration of darunavir/ritonavir resulted in significantly lower dolutegravir exposure [909 (496–1397) ng/ml;P = 0.002 versus reference]. Among NNRTIs, the higher dolutegravir concentrations were measured in presence of rilpivirine [2252 (1489–2686);P < 0.001 versus reference].Conclusion:Dolutegravir trough concentrations are differently affected by individual antiretroviral drugs, with some drug combinations (i.e. dolutegravir/darunavir/cobicistat, or dolutegravir/rilpivirine) providing significantly higher than expected dolutegravir exposure. Such combinations might be advantageous when there are concerns about dolutegravir plasma exposure or resistance.
HIV-1 gp120 amplifies astrocyte elevated gene-1 activity to compromise the integrity of the outer blood–retinal barrier
Authors: Jiang Jing , Wang Luoziyi , Li Qingjian , Wang Yucen , Wang Zhiliang 
Published: January 2024

Objective:
This study aims to investigate the functions and mechanistic pathways of Astrocyte Elevated Gene-1 (AEG-1) in the disruption of the blood–retinal barrier (BRB) caused by the HIV-1 envelope glycoprotein gp120.

Design:
We utilized ARPE-19 cells challenged with gp120 as our model system.

Methods:
Several analytical techniques were employed to decipher the intricate interactions at play. These included PCR, Western blot, and immunofluorescence assays for the molecular characterization, and transendothelial electrical resistance (TEER) measurements to evaluate barrier integrity.

Results:
We observed that AEG-1 expression was elevated, whereas the expression levels of tight junction proteins ZO-1, Occludin, and Claudin5 were downregulated in gp120-challenged cells. TEER measurements corroborated these findings, indicating barrier dysfunction. Additional mechanistic studies revealed that the activation of NFκB and MMP2/9 pathways mediated the AEG-1-induced barrier destabilization. Through the use of lentiviral vectors, we engineered cell lines with modulated AEG-1 expression levels. Silencing AEG-1 alleviated gp120-induced downregulation of tight junction proteins and barrier impairment while concurrently inhibiting the NFκB and MMP2/9 pathways. Conversely, overexpression of AEG-1 exacerbated these pathological changes, further compromising the integrity of the BRB.

Conclusion:
Gp120 upregulates the expression of AEG-1 and activates the NFκB and MMP2/9 pathways. This in turn leads to the downregulation of tight junction proteins, resulting in the disruption of barrier function.
Biomechanical Property and Biocompatibility of a New Silicone Rubber Nasal Retainer (Nostriloo)
Authors: Bangun Kristaninta , Wicaksono Dwi , Kreshanti Prasetyanugraheni , Syarif Akhmad N. , Whulanza Yudan , Menna Clara 
Published: January 2024

Nasal retainers have been utilized to maintain the position of the nose after primary rhinoplasty in cleft lip patients. However, commercial nasal retainers made from silicone are quite expensive. To address this issue, the authors designed an alternative nasal retainer that is affordable, safe, and has similar biomechanical and biocompatibility properties to other commercial nasal retainers. Three types of nasal retainers were tested: our own (Nostriloo), a commercial nasal retainer from Turkey, and another one from Taiwan. There were 3 samples on each group, with a total sample of 9 retainers. Each sample was tested for biomechanical property and biocompatibility. Elasticity modulus, tensile strength, and direct and indirect toxicity were analyzed. Nostriloo had the least durable tensile strength but showed similar elastic modulus (2.76 ± 0.41 MPa) compared with human lower lateral cartilage (2.09 ± 0.81 MPa). On the basis of direct and indirect toxicity tests, Nostriloo is considered nontoxic. Nostriloo can be utilized for small-scale production and use. Further experiment is needed to produce higher-quality nasal retainers.
Ergonomics in Craniofacial Surgery: Can We Do Better? A Quality Improvement Study
Authors: Jaszkul Katrina M. , AlGhanim Khalifa , Fan Stacy , Diaz-Abele Julian 
Published: January 2024

Objective:
Many plastic surgeons experience musculoskeletal strain and injury from poor ergonomics during surgery. This is associated with reduced performance, shortened careers, and decreased quality of life. This study compared the ergonomics of the conventional operating table headrest and the Mayfield headrest in craniofacial surgery.

Methods:
A prospective cohort study of patients undergoing craniofacial operations between November 20, 2022 and April 26, 2023, within a single craniofacial surgeon’s practice. The authors obtained data on the total duration of the operation and Rapid Entire Body Assessment (REBA) scores for the primary surgeon and assistant.

Results:
Four operations (mean: 147 ± 60.9 min) were included in the regular headrest group, and 8 in the Mayfield headrest group (mean: 61±53.4 min). Four hundred fifty-five regular headrest time points and 851 Mayfield time points were recorded. Eight hundred thirty-five regular headrest time points and 538 Mayfield time points were recorded. The mean REBA score for the regular headrest was 5.79 ± 1.9, which was higher than the Mayfield (5.01 ± 2.0; P < 0.0001). Subgroup analysis showed the mean REBA score for the primary surgeon (5.89 ± 2.0) was higher than the assist (5.48 ± 1.6) in the regular headrest group (P < 0.0001), whereas the converse was true for the Mayfield headrest (primary surgeon: 4.67 ± 1.8, assist: 5.65 ± 2.15, P < 0.0001).

Conclusions:
Ergonomic scores were better using the Mayfield headrest than the regular headrest. The primary surgeon scored better with the Mayfield headrest, whereas the assists had better scores with the regular headrest.
Nasal Tip Vascularization and Its Application for Columellar Reconstruction
Authors: Rossell-Perry Percy 
Published: January 2024

Objective:
Many studies have been published about the vascular anatomy of the nose and its utility for nasal reconstruction. Anatomic variations of the main arteries and their perforators are well described in the literature. A nasal tip perforator, not well described in the published studies, is analyzed in the present study and its utility for columellar reconstruction. This paper presents an anatomic study of the nasal tip artery and its clinical applications for columellar repair.

Methods:
This study investigated the nasal tip perforator artery during nasal tip flap surgery for columellar repair in patients with sequels after nasal continuous positive airway pressure use. A descriptive anatomic study was conducted using intraoperative vascular dissection of patients operated on for nasal columellar defects by the author between 2013 and 2018. An observational study of a group of patients operated on for columellar repair using the axial nasal tip flap is presented here.

Results:
The nasal tip artery was found in all the intraoperative dissections. Location and trajectory are described. Observed columellar length and width in operated patients have been nonstatistical and significantly different than controls in this study.

Conclusions:
The presence and trajectory of the nasal tip artery have been consistent in all the studied cases. The nasal tip flap based on this perforator has been a useful method for columellar repair in the studied group of patients. The presence of this vessel may augment blood supply to the nasal tip skin. By confirming the preservation of this artery, the surgeon may elevate the nasal tip flap safely.
Extensive Temporomandibular Joint Herniation Into the External Auditory Canal
Authors: Mokhatrish Mohammad , Cho Sung Il 
Published: January 2024

Spontaneous herniation of the temporomandibular joint (TMJ) into the external auditory canal (EAC) is a rare occurrence. Typically, TMJ herniations are small and involve a focal defect in the EAC. In this report, we present an unusual case of extensive TMJ herniation measuring 17 mm, originating from a bony defect in the EAC. The patient underwent a successful treatment, which involved the surgical excision of the herniated mass and the subsequent reconstruction of the EAC using conchal cartilage. In this article, we will discuss the surgical techniques employed for repairing TMJ herniation in the EAC.
Damage-control orthopedics or early total care: What you need to know
Authors: Stevens Nicole M. , Tejwani Nirmal C. 
Published: January 2024

ABSTRACT
Patients with multisystem injuries are defined as multiply injured patients and may need multiple surgical procedures from more than one specialty. The importance of evaluating and understanding the resuscitation status of a multiple-injury patient is critical. Orthopedic strategies when caring for these patients include temporary stabilization or definitive early fixation of fractures while preventing further insult to other organ systems. This article will define multiple injuries and discuss specific markers used in assessing patients' hemodynamic and resuscitation status. The decision to use damage-control orthopedics or early total care for treatment of the patient are based on these factors, and an algorithm is presented to guide treatment. We will also discuss principles of external fixation and the management of pelvic trauma in a multiple-injury patient.