bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Evaluation of Serum Metal Ion Levels and Metallosis in Graduated Patients With Magnetically Controlled Growing Rods
Authors: Alberghina Flavia , McManus Robin , Keogh Cillian , Turner Henry , Moore David , Noël Jacques , Kennedy Jim , Kiely Patrick 
Published: October 2023

Background:
Magnetically controlled growing rods (MCGR) aim to control curve progression while limiting surgical burden in children with early-onset scoliosis. Systemic and local distribution of metal debris has been documented in children with spinal implants. The aim of the study was to assess serum metal ion levels and local metal debris-related changes at the conclusion of MCGR treatment.

Methods:
Between February 2019 and September 2022, all patients who had a conversion to definitive fusion at the completion of MCGR treatment in our institution were invited to participate in this study. Consenting patients had serum metal ion levels drawn (titanium, cobalt, and chromium) and histologic analyses of peri-implant tissue samples.

Results:
We enrolled 24 children who underwent definitive fusion post-MCGR treatment for early-onset scoliosis. The average age at definitive fusion was 13.3 years (range: 11 to 17 y). The average length of MCGR treatment was 4.8 years (range: 1.5 to 6.8 y). At the end of the MCGR treatment, 23 (96%) patients had elevated serum metal ion levels. Mean serum titanium levels were 165.4 nmol/L (range: 30 to 390 nmol/L), mean serum cobalt levels were 4.6 nmol/L (range: 1.2 to 14 nmol/L), and mean serum chromium levels were 14 nmol/L (range: 2.4 to 30 nmol/L). Peri-implant soft tissue histologic analysis demonstrated local metal debris and foreign body reactions in all patients.

Conclusions:
At the completion of MCGR treatment, the majority of patients demonstrate elevated serum metal ion levels and local metal debris-related peri-implant soft tissue changes. Although there is no current literature to suggest these findings are harmful, further research as to the clinical significance is required.

Level of Evidence:
Level IV.
Metaphyseal Fracture Displacement is Predictive of Intra-articular Diastasis in Adolescent Triplane Ankle Fractures
Authors: Greenhill Dustin A. , Mundluru Surya N. , Gomez Robert W. , Romero Joseph , Riccio Anthony I. 
Published: October 2023

Background:
Triplane fractures are rare enough that large homogeneous series to support management decisions are lacking. During initial evaluation, the addition of computed tomography (CT) to conventional X-rays (XR) does not always alter the patient’s clinical course. Therefore, routine use of CT is controversial. This study aims to: (1) clarify quantitative relationships between articular displacement measured on XR versus CT and (2) identify whether metaphyseal displacement on the lateral XR predicts clinically relevant articular displacement on a CT scan.

Methods:
A 10-year retrospective review of consecutive triplane fractures was performed at a level 1 pediatric trauma center. Maximum articular and metaphyseal displacement were recorded from XR and CT. Quantitative relationships between XR and CT measurements were compared among imaging modalities and radiographically operative versus nonoperative fractures.

Results:
Eighty-seven patients met the inclusion criteria. XR underestimated articular displacement by 229% in the sagittal plane (1 mm on XR vs 3.3 mm on CT; P < 0.05) and 17% in the coronal plane (2.3 mm on XR vs 2.7 mm on CT; P < 0.05). XR underestimated articular step-off by 184% in the coronal plane and 177% in the sagittal plane (P < 0.05). CT measurements more often differentiated patients who did or did not undergo surgery at our institution. Metaphyseal displacement was significantly higher in patients with traditionally operative articular displacement (≥2.5 mm on CT) versus those with articular displacement below traditionally operative thresholds (2.4 vs 0.9 mm, P = 0.001). Sixty patients had metaphyseal displacement >1 mm on the lateral XR, of whom 56 had surgical-magnitude articular displacement (≥2.5 mm) on CT (positive predictive value = 94%).

Conclusions:
Conventional radiographs underestimate the true articular displacement of triplane fractures. Surgical-magnitude articular step-off is rare, and the largest articular gap is usually visualized on the axial CT image. Metaphyseal displacement >1 mm, which is easily measured on a lateral XR, is strongly predictive of clinically relevant articular displacement on CT. This radiographic finding should prompt advanced imaging before proceeding with nonoperative management.

Level of Evidence:
Level III.
Clinical Research With Large Language Models Generated Writing—Clinical Research with AI-assisted Writing (CRAW) Study
Authors: Huespe Ivan A. , Echeverri Jorge , Khalid Aisha , Carboni Bisso Indalecio , Musso Carlos G. , Surani Salim , Bansal Vikas , Kashyap Rahul 
Published: October 2023

IMPORTANCE:
The scientific community debates Generative Pre-trained Transformer (GPT)-3.5’s article quality, authorship merit, originality, and ethical use in scientific writing.

OBJECTIVES:
Assess GPT-3.5’s ability to craft the background section of critical care clinical research questions compared to medical researchers with H-indices of 22 and 13.

DESIGN:
Observational cross-sectional study.

SETTING:
Researchers from 20 countries from six continents evaluated the backgrounds.

PARTICIPANTS:
Researchers with a Scopus index greater than 1 were included.

MAIN OUTCOMES AND MEASURES:
In this study, we generated a background section of a critical care clinical research question on “acute kidney injury in sepsis” using three different methods: researcher with H-index greater than 20, researcher with H-index greater than 10, and GPT-3.5. The three background sections were presented in a blinded survey to researchers with an H-index range between 1 and 96. First, the researchers evaluated the main components of the background using a 5-point Likert scale. Second, they were asked to identify which background was written by humans only or with large language model-generated tools.

RESULTS:
A total of 80 researchers completed the survey. The median H-index was 3 (interquartile range, 1–7.25) and most (36%) researchers were from the Critical Care specialty. When compared with researchers with an H-index of 22 and 13, GPT-3.5 was marked high on the Likert scale ranking on main background components (median 4.5 vs. 3.82 vs. 3.6 vs. 4.5, respectively; p < 0.001). The sensitivity and specificity to detect researchers writing versus GPT-3.5 writing were poor, 22.4% and 57.6%, respectively.

CONCLUSIONS AND RELEVANCE:
GPT-3.5 could create background research content indistinguishable from the writing of a medical researcher. It was marked higher compared with medical researchers with an H-index of 22 and 13 in writing the background section of a critical care clinical research question.
Choroidal Vascularity and Visual Outcomes in Macula-Off Rhegmatogenous Retinal Detachment
Authors: Lim Gyeongsoo , Kim Kyung Tae , Jo Kwon Hui , Lee Seungheon , Kim Dong Yoon , Chae Ju Byung , Seo Eoi Jong 
Published: October 2023

Abstract

Purpose:
To investigate the association between visual outcomes and choroidal changes in patients with macula-off rhegmatogenous retinal detachment (RRD).

Methods:
This study reviewed retrospectively 63 eyes with macula-off RRD who underwent vitrectomy. Their fellow eyes were analyzed as a control group. The choroidal vascularity index (CVI), ellipsoid zone/external limiting membrane integrity, central foveal thickness (CFT), and subfoveal choroidal thickness were documented and analyzed. Linear regression analyses were performed to identify factors affecting the final best-corrected visual acuity (BCVA).

Results:
Eyes with RRD showed increased CVI (68.8±4.1) compared to the control group (66.1±8.8, p=0.028). Multivariate linear regression analysis revealed that patients with a poor final BCVA had a longer detachment duration (p=0.002), worse baseline BCVA (p=0.034), thinner CFT (p=0.005), and greater CVI (p=0.001) and were more likely to be tamponated with silicone oil (p=0.001). CVI was particularly increased in eyes with poor ellipsoid zone/external limiting membrane integrity, prolonged detachment duration, thin CFT, and worse BCVA.

Conclusion:
Increased CVI could indicate poor visual outcomes in macula-off RRD patients. Choroidal remodeling could be associated with the disruption of the ellipsoid zone/external limiting membrane integrity.
Response of Locally Advanced Pancreatic Cancer to Intratumoral Injection of Large Surface Area Microparticle Paclitaxel
Authors: Sharma Neil R. , Lo Simon K. , Hendifar Andrew , Othman Mohamed O. , Patel Kalpesh , Mendoza-Ladd Antonio , Verco Shelagh , Maulhardt Holly A. , Verco James , Wendt Alison , Marin Alyson , Schmidt Christian Max , diZerega Gere 
Published: October 2023

Objectives
Large surface area microparticle paclitaxel (LSAM-PTX) provides an intratumoral (IT) chemotherapeutic depot. Safety, tolerability, and tumor response to IT LSAM-PTX delivered by endoscopic ultrasound–fine needle injection were evaluated in subjects with unresectable locally advanced pancreatic cancer (LAPC).

Methods
Ten subjects treated in a dose escalation phase and 22 additional subjects receiving 2 injections, 4 weeks apart, of 15 mg/mL LSAM-PTX were followed for 12 months. Paclitaxel pharmacokinetics were evaluated, imaging at 3 and 6 months determined tumor response, and multiplex immunofluorescence was conducted to characterize local immune response.

Results
Most treatment-emergent adverse events were attributed to LAPC. Plasma paclitaxel levels were negligible. Eight subjects' tumors became resectable after IT LSAM-PTX, and 5 of 6 (83%) were resected with R0. Multiplex immunofluorescence of resected tumors demonstrated increased T cells, natural killer cells, and macrophages and decreased myeloid-derived suppressor cells. Six-month disease control rate was 94%, and median overall survival was 19.7 months in the 2-injection subjects. For nonresected and resected groups, overall survival times were 18.9 and 35.2 months, respectively.

Conclusions
Neoadjuvant IT LSAM-PTX, in combination with SOC, was well tolerated and may provide benefits to LAPC patients, evidenced by enhanced immune response, improved disease control rate, restaging leading to surgery, and extended survival.
Cardiac papillary fibroelastoma: a rare cause of ST-segment elevation myocardial infarction: a case report
Authors: Raheela Fnu , Talpur Abdul S. , Rasmussen Michaela , Farooq Muhammad Jawad , Khalid Saad , Bhat Sadaf , Gilani Syed M. , Shrestha Sunita 
Published: October 2023

Introduction and importance:
Primary tumors of the heart are extremely rare occurrences. Among them, cardiac papillary fibroelastoma (CPF) is the second most common type. Although these tumors are usually benign, they can pose a risk of embolization, which may lead to severe complications like sudden death or embolization affecting the neurological, systemic, or coronary vasculature. Such complications can be life-threatening.

Case presentation:
In this report, the authors present the case of a 68-year-old woman who experienced ST-segment elevation myocardial infarction due to embolization from a large papillary fibroelastoma. To address the issue, the authors performed a minimally invasive surgical removal and resection of the aortic valve, followed by a histological examination to confirm the diagnosis.

Clinical discussion:
This case report discusses a rare occurrence of myocardial infarction caused by tumor embolization from a CPF. The patient presented with complete blockage of a coronary artery in the absence of atherosclerotic disease. Through a comprehensive workup, including transesophageal echocardiography, the CPF was identified as the source of embolization. Surgical resection of CPFs is curative, and recurrence has not been documented. Clinicians should consider CPFs in cases of coronary artery occlusion without atherosclerotic disease and employ transesophageal echocardiography for diagnosis. Prompt surgical intervention leads to an excellent prognosis and prevents recurrent embolization.

Conclusion:
This report emphasizes the importance of recognizing the potential complications associated with papillary fibroelastoma-induced embolization to the coronary arteries and highlights the need to mitigate the risk of such complications occurring.
Improving Hypertension Control in the Black Patient Population
Authors: Duckie Charmaine L. , Boston Karen A. , Champagne Brittney , Thompson Julie , Halpern David J. , Granger Bradi B. 
Published: October 2023

Background:
Nearly half of American adults have hypertension (HTN), and non-Hispanic Black patients are diagnosed at a higher rate than others.

Local Problem:
Our local clinic population reflected disproportionate rates of uncontrolled HTN among Black patients.

Methods:
A quality improvement pre-/postintervention design was used to evaluate an educational intervention to reduce blood pressure (BP) and improve self-monitoring of BP in Black patients using the Chronic Care Model.

Interventions:
A team-based approach was used to redesign clinic workflows and patient education, prescribe self-paced videos from an electronic health record (EHR) patient portal, and provide home BP cuffs.

Results:
Black participants (n = 79) improved viewing of prescribed videos (7.9% to 68.5%), knowledge scores (67.9 to 75.2), and mean systolic BP (−20.3 mm Hg; P > .001).

Conclusions:
This team-based approach enhanced patient engagement, self-monitoring skills, EHR-reported BP, and overall BP control for a cohort of Black patients with uncontrolled BP.
Structural Equation Modeling of Associations Between Nursing Practice Environment And Missed Nursing Care
Authors: Rivaz Mozhgan , Abbasi Fereshteh , Pasyar Nilofar 
Published: October 2023

Background:
Missed nursing care (MNC) negatively impacts the quality of patient care. There may be a relationship between the nursing practice environment (NPE) and MNC; however, this relationship has not been examined in developing countries during the COVID-19 pandemic.

Purpose:
To determine the relationship between the NPE and MNC during the COVID-19 pandemic.

Methods:
A cross-sectional study of 300 participants was conducted in 4 teaching hospitals in Iran. Data were collected using a demographic and clinical form, the Nursing Professional Practice Environment Questionnaire, and MISSCARE survey and analyzed using structural equation modeling.

Results:
The hypothesized model was well fit, showing that 1 unit improvement of the NPE domains of patient-centered care, effective leadership, and policy transparency decreased MNC by 0.18, 0.12, and 0.05, respectively.

Conclusion:
The model confirmed the association between the dimensions of the NPE and MNC. These findings can assist health policymakers and nursing managers in improving the NPE.
Evaluating and Addressing the Diversity, Equity, Inclusion, and Belonging Climate in a School of Nursing
Authors: Rhoten Bethany Andrews , Steed Julia , Johnson Rolanda , Schorn Mavis N. 
Published: October 2023

Background:
There is a critical need to prepare a diverse nursing workforce and address issues of structural racism and health inequities.

Problem:
A shortage of underrepresented nurse faculty exacerbates the lack of diversity in nursing education. Microaggressions and discrimination experienced by underrepresented nursing students hinder their personal and professional growth. Evaluating diversity, equity, and inclusion (DEI) and belonging within a school of nursing is crucial for progress.

Approach:
An alumni survey and a faculty/staff survey were conducted to assess DEI perceptions, which informed the development of a strategic plan. Goals focused on monitoring the cultural climate, increasing diversity and inclusivity, and enhancing faculty competencies. Educational offerings and initiatives were implemented to support these goals.

Outcomes:
Ongoing evaluation is essential to sustain progress in this critical area.

Conclusion:
These efforts are necessary for sustainable progress and equitable care provision.
Reverse Mentoring in Nursing Education
Authors: Williams Cheryl 
Published: October 2023

Background:
Nurse educators are challenged to prepare an expanding number of diverse students with various sociocultural and generational differences. Whether diversity, sociocultural, and/or generational divides are contributory, a perennial decline exists of historically disenfranchised students finishing nursing programs. Reverse mentoring is an innovative adaption of traditional mentoring. Reverse mentoring is a practice that reverses traditional mentor and mentee roles, which may mitigate diverse and intergenerational misconceptions.

Purpose:
To prepare a diverse nursing workforce, educators should integrate strategies to embrace differences, reduce biases, remove learning barriers, and value learning new teaching methods.

Methods:
A literature review revealed few articles on reverse mentoring in nursing education.

Results:
Reverse mentoring is a successful strategy in many Fortune 500 companies. Therefore, reverse mentoring may demonstrate promise in nursing education.

Conclusion:
Exploring reverse mentoring in nursing education may reveal strategies to elucidate and mitigate biases and barriers in nursing education.
New Onset Geriatric Syndromes and One-year Outcomes Following Elective Gastrointestinal Cancer Surgery
Authors: Melucci Alexa D. , Loria Anthony , Aquina Christopher T. , McDonald Gabriela , Schymura Maria J. , Schiralli Matthew P. , Cupertino AnaPaula , Temple Larissa K. , Ramsdale Erika , Fleming Fergal J. 
Published: October 2023

Objective:
To assess whether older adults who develop geriatric syndromes following elective gastrointestinal surgery have poorer 1-year outcomes.

Summary Background Data:
Within ten years, 70% of all cancers will occur in older adults ≥65 years old. The rise in older adults requiring major surgery has brought attention to age-related complications termed geriatric syndromes. However, whether postoperative geriatric syndromes are associated with long-term outcomes is unclear.

Methods:
A population-based retrospective cohort study using the New York State Cancer Registry and the Statewide Planning and Research Cooperative System was performed including patients >55 years with pathologic stage I-III esophageal, gastric, pancreatic, colon, or rectal cancer who underwent elective resection between 2004-2018. Those aged 55-64 served as the reference group. The exposure of interest was a geriatric syndrome (fracture, fall, delirium, pressure ulcer, depression, malnutrition, failure to thrive, dehydration, or incontinence [urinary/fecal]) during the surgical admission. Patients with any geriatric syndrome within 1 year of surgery were excluded. Outcomes included incident geriatric syndrome, 1-year days alive and out of the hospital, and 1-year all-cause mortality.

Results:
37,998 patients with a median age of 71 years without a prior geriatric syndrome were included. Of those 65 years or more, 6.4% developed a geriatric syndrome. Factors associated with an incident geriatric syndrome were age, alcohol/tobacco use, comorbidities, neoadjuvant therapy, ostomies, open surgery, and upper gastrointestinal cancers. An incident geriatric syndrome was associated with a 43% higher risk of 1-year mortality (hazard ratio, 1.43; 95% confidence interval, 1.27-1.60). For those aged 65+ discharged alive and not to hospice, a geriatric syndrome was associated with significantly fewer days alive and out of hospital (322 vs. 346 d, P<0.0001). There was an indirect relationship between the number of geriatric syndromes and 1-year mortality and days alive and out of the hospital after adjusting for surgical complications.

Conclusions:
Given the increase in older adults requiring major surgical intervention, and the establishment of geriatric surgery accreditation programs, these data suggest that morbidity and mortality metrics should be adjusted to accommodate the independent relationship between geriatric syndromes and long-term outcomes.
TandZ, Partial Seed Coat Patterning Genes in Common Bean, Provide Insight into the Structure and Protein Interactions of a Plant MBW Complex
Authors: McClean Phillip E. , Roy Jayanta , Colbert Christopher L. , Osborne Caroline , Lee Rian , Miklas Phillip N. , Osorno Juan M. 
Published: October 2023

AbstractFlavonoids are secondary metabolites associated with seed and flower color. A ternary MBW protein complex consisting of interfacingMYB,beta-helix-loop-helix (bHLH), andWD40 repeat (WDR) proteins controls the expression of late biosynthetic genes in the flavonoid pathway.P, the master regulator gene of flavonoid expression in common bean (Phaseolus vulgarisL.) was recently determined to encode a bHLH protein. Two other genes,TandZ, are also historically considered regulators since they determine the distribution of color in seeds and flowers. These two genes were cloned using reverse genetics based on genetic mapping, candidate gene selection, phylogenetic analysis, and mutant analysis. Domain and AlphaFold2 structure analyses determinedTencoded a seven-bladed β-propeller WDR protein, whileZencoded a R2R3 MYB protein. Modeling of the Z MYB/P bHLH/T WDR MBW complex identified interfacing sequence domains and motif in all three genes that are conserved in dicots. One Z MYB motif is a possible β-MoRF that only appears in a structured state when Z MYB is modeled in a MBW complex. Complexes containing mutant T and Z proteins changed the interaction of members of the complex in ways that would alter their role in regulating expression of genes in the flavonoid pathway.HighlightThe MBW complex of bean comprised of the classicZ,P, andTgenes associated with seed coat patterning defines critical proteins interactions for flavonoid gene expression.
PRCnet: An Efficient Model for Automatic Detection of Brain Tumor in MRI Images
Authors: Farhan Ahmeed Suliman , Khalid Muhammad , Manzoor Umar 
Published: October 2023

AbstractBrain tumors are the most prevalent and life-threatening cancer; an early and accurate diagnosis of brain tumors increases the chances of patient survival and treatment planning. However, manual tumor detection is a complex, cumbersome and time-consuming task and is prone to errors, which relies on the radiologist’s experience. As a result, the development of accurate and automatic system for tumor detection is critical. In this paper, we proposed a new model called Parallel Residual Convolutional Network (PRCnet) model to classify brain tumors from Magnetic Resonance Imaging. The PCRnet model uses several techniques (such as filters of different sizes with parallel layers, connections between layers, batch normalization layer, and ReLU) and dropout layer to overcome the over-fitting problem, for achieving accurate and automatic classification of brain tumors. The PRCnet model is trained and tested on two different datasets and obtained an accuracy of 94.77% and 97.1% for dataset A and dataset B, respectively which is way better as compared to the state-of-the-art models.