bluuebunny/crossref_metadata_2025_split huggingface dataset:
Twin pregnancy with sudden heart failure and pulmonary hypertension after atrial septal defect repair: A case report
Authors: Tong Chun-Xiao , Meng Tao 
Published: December 2023

BACKGROUND
Pulmonary arterial hypertension (PAH) in pregnancy is one of the major obstetric complications and is considered a contraindication to pregnancy as it is classified as a class IV risk in the revised risk classification of pregnancy by the World Health Organisation. Pregnancy, with its adaptive and expectant mechanical and hormonal changes, negatively affects the cardiopulmonary circulation in pregnant women. Do patients with repaired simple congenital heart disease (CHD) develop other pulmonary and cardiac complications during pregnancy? Can pregnant women with sudden pulmonary hypertension be treated and managed in time? In this paper, we present a case of a 39-year-old woman who underwent cesarean section at 33 wk' gestation and developed PAH secondary to repaired simple CHD. Our research began by a PubMed search for "pulmonary hypertension" and "pregnancy" and "CHD" case reports. Three cases were selected to review PAH in pregnancy after correction of CHD defects. These studies were reviewed, coupled with our own clinical experience.
CASE SUMMARY
Herein, a case involving a woman who underwent atrial septal defect repair at the age of 34, became pregnant five years later, and had a sudden onset of PAH and right heart failure secondary to symptoms of acute peripheral edema in the third trimester of her pregnancy. As a result, the patient underwent a cesarean section and gave birth to healthy twins. Within three days after cesarean delivery, her cardiac function deteriorated as the pulmonary artery pressure increased. Effective postpartum management, including diuresis, significant oxygen uptake, vasodilators, capacity and anticoagulants management, led to improvements in cardiac function and oxygenation. The patient was discharged from hospital with a stable recovery and transferred to local hospitals for further PAH treatment.
CONCLUSION
This case served as a reminder to obstetricians of the importance of pregnancy after repair of CHD. It is crucial for patients with CHD to receive early correction. It suggests doctors should not ignore edema of twin pregnancy. Also, it provides a reference for the further standardization of antenatal, intrapartum and postpartum management for patients with CHD worldwide.
Diffuse arterial atherosclerosis presenting with acute ischemic gastritis: A case report
Authors: Wei Rui-Yao , Zhu Jia-Hui , Li Xiang , Wu Jian-Yong , Liu Jun-Wei 
Published: December 2023

BACKGROUND
Ischemic gastritis is a clinically rare disease with high mortality that infrequently reported in the medical literature and under-recognized clinically and histopathologically. Early diagnosis and treatment can only be achieved through upper gastrointestinal endoscopy after symptoms appear.
CASE SUMMARY
A 68-year-old woman with a history of intracranial aneurysm developed dizziness, chest tightness and unconsciousness for 2 d. Computed tomography angiography showed diffuse coronary atherosclerosis, moderate to severe stenosis in the proximal end of the left anterior descending branch, multiple calcified plaques in the proximal end of the circumflex branch and right coronary artery, and mild to moderate stenosis. The patient also developed diffuse atherosclerosis in the splenic and mesenteric arteries, with mild lumen stenosis and atherosclerosis in the abdominal aorta and its branches. Endoscopy showed submucosal congestion and damage of the entire gastric mucosa, of which the fundus and body of the stomach were most seriously affected. The mucosa was swollen, with a deep purple color, surface erosion and dark red oozing blood. Pathological examination showed bleeding and necrosis of the gastric mucosa, with residual contours of the gastric glands, consistent with ischemic gastritis.
CONCLUSION
Ischemic gastritis is a rare disease that may be difficult to diagnose as its symptoms may be similar to those of other gastrointestinal diseases. Diagnosis is usually based on endoscopic and pathological examinations, which show insufficient blood supply to the gastric mucosa leading to mucosal damage and necrosis.
Applications of natural language processing at emergency department triage: A narrative review
Authors: Stewart Jonathon , Lu Juan , Goudie Adrian , Arendts Glenn , Meka Shiv Akarsh , Freeman Sam , Walker Katie , Sprivulis Peter , Sanfilippo Frank , Bennamoun Mohammed , Dwivedi Girish 
Published: December 2023

IntroductionNatural language processing (NLP) uses various computational methods to analyse and understand human language, and has been applied to data acquired at Emergency Department (ED) triage to predict various outcomes. The objective of this scoping review is to evaluate how NLP has been applied to data acquired at ED triage, assess if NLP based models outperform humans or current risk stratification techniques when predicting outcomes, and assess if incorporating free-text improve predictive performance of models when compared to predictive models that use only structured data.MethodsAll English language peer-reviewed research that applied an NLP technique to free-text obtained at ED triage was eligible for inclusion. We excluded studies focusing solely on disease surveillance, and studies that used information obtained after triage. We searched the electronic databases MEDLINE, Embase, Cochrane Database of Systematic Reviews, Web of Science, and Scopus for medical subject headings and text keywords related to NLP and triage. Databases were last searched on 01/01/2022. Risk of bias in studies was assessed using the Prediction model Risk of Bias Assessment Tool (PROBAST). Due to the high level of heterogeneity between studies and high risk of bias, a metanalysis was not conducted. Instead, a narrative synthesis is provided.ResultsIn total, 3730 studies were screened, and 20 studies were included. The population size varied greatly between studies ranging from 1.8 million patients to 598 triage notes. The most common outcomes assessed were prediction of triage score, prediction of admission, and prediction of critical illness. NLP models achieved high accuracy in predicting need for admission, triage score, critical illness, and mapping free-text chief complaints to structured fields. Incorporating both structured data and free-text data improved results when compared to models that used only structured data. However, the majority of studies (80%) were assessed to have a high risk of bias, and only one study reported the deployment of an NLP model into clinical practice.ConclusionUnstructured free-text triage notes have been used by NLP models to predict clinically relevant outcomes. However, the majority of studies have a high risk of bias, most research is retrospective, and there are few examples of implementation into clinical practice. Future work is needed to prospectively assess if applying NLP to data acquired at ED triage improves ED outcomes when compared to usual clinical practice.
Do participants in a physical activity program from a Care Sport Connector become healthier? An explorative study from the Netherlands
Authors: Smit E. , Leenaars K. E. F. , Wagemakers M. A. E. , Bakker E. J. , Velden J. van der , Molleman G. R. M. 
Published: December 2023

Introduction
Care Sport Connectors (CSCs) have been appointed to create a connection between the primary care and physical activity (PA) sectors to stimulate residents who are inactive to become more physically active to gain health benefits. The objective of this explorative study was to find out whether CSCs achieve these goals by testing the hypothesis that more residents become physically active, and score higher for health-related fitness and health-related quality of life.

Method
We conducted a longitudinal study design whereby participants (n = 402) were measured at three time points: at the start of their PA program (T0); after 6 months (T1); and after 1 year (T2). Participants conducted a fitness test to measure their health-related physical fitness and filled in questionnaires to assess PA level (PA-, Fit-, Combi-, and sport norm), health-related quality of life, motivation for PA, and personal information. We used a multi-level analysis to test whether outcomes of participants differ over time. Participants who dropped out and maintainers were compared with a chi-square test and a one-way ANOVA.

Results
This study showed that one-third of the participants dropped out (n = 139). Participants who dropped out were, compared with maintainers, less physically active (P = 0.004) and were more often reached in bigger municipalities, by an integral approach. More participants meet the PA norm (P = 0.007) and sport norm (P<0.001) at T2 then at T0. Scores in health-related physical fitness and quality of life were significant but not a meaningful gain in health-related fitness.

Conclusion
More residents become physically active and participate in sport because they took part in a PA programs or activity organized by a CSC. Lifestyle interventions should be offered with a higher frequency, intensity, and focus on behavior change. It is necessary to invest in combined lifestyle interventions offered by a collaboration of primary care, welfare, and PA professionals.
Estimating the number of required nurses in different types of hospitals: An application of the workload indicators of staffing needs (WISNS) method
Authors: Najafpour Zhila , Zare Nasiri Mohsen , Nozarian Mohammad-Hussein , Keliddar Iman , Shayanfard Kamran 
Published: December 2023

Background
Health system performance depends on the availability, accessibility, acceptability, and quality of health workforces. Policymakers seek whether the number of nurses is optimally matched based on patients’ needs. This study aimed to assess the workforce stock, workload activities, activity standards, and workload pressure to determine the number of required nurses in different types of hospitals in Iran.

Methods
This study applied the workload indicators of staffing needs (WISNs) method and was conducted in 22 surgical and internal medicine wards at five hospitals in the southwest of Iran during six months. A time-motion study, and several group discussions, interviews were used to extract the required data. Descriptive statistics were used for data analysis.

Results
All selected hospitals faced nursing shortages. The highest shortage (-47) and workload pressure (WISN ratio 0.45) were observed in the general-educational hospitals. In the specialized hospitals, the workload pressure was high (WISN ratio 0.49). The lowest shortage belonged to the private hospital. Based on our assessment, in all of the hospitals, nurses typically worked overtime due to high workload. The studied hospitals covered an average of 25% of their shortage with nursing overtime working. We noted that nurses were predominantly occupied with health service and supportive activities (≈90% of their time).

Conclusions
Based on the WISN method, all of the hospitals faced nursing shortages from moderate to high. However, it would be essential to consider current labor market analysis based on accurate data to adopt appropriate policies in HRH planning.
Understanding challenges to medical and dental student research practices. An insight from a cross-sectional study of the public sector in Pakistan
Authors: Qamar Wajiha 
Published: December 2023

Objective
The objective of the study is to identify and comprehend the challenges experienced by the undergraduate medical and dental students in enrolled in public sector in Pakistan while conducting research.

Methodology
A cross-sectional study was carried out from April to June of 2023 among undergraduate students at public sector medical and dental schools in Khyber Pakhtunkhwa, Pakistan. A customized questionnaire was developed to gather information on the challenges faced by students when undertaking research. The survey was circulated online using Google Forms, and participation was entirely optional. Descriptive statistics were used to analyse the responses.

Results
Participants in the study were 58 male and 139 female students who were enrolled in the Bachelor of Medicine & Bachelor of Surgery (MBBS) and Bachelor of Dental Surgery (BDS) programs. The analysis found that 47% of students cited a lack of knowledge and research skills as a major barrier, while 40% cited time restrictions as a major issue. Mentorship and training issues were cited as major barriers by 51% of students, while a lack of institutional support was cited as a significant issue by 53% of students. Language issues made it difficult to produce research papers for 14% of students, while finding research opportunities was challenging for 38% of students.

Conclusion
According to the research, undergraduate medical and dentistry students in the public sector encountered a number of challenges when conducting research. It was suggested that these issues be resolved by include research projects in the curriculum, providing specific interventions for enhancing research skills, establishing mentorship programs, and allocating funds for research activities.
Advancing minimally invasive surgery: A cutting-edge cable-actuated conveying mechanism for reliable tissue transportation
Authors: Kortman Vera Gesina , Verberne Yinte , Jovanova Jovana , Sakes Aimée 
Published: December 2023

Introduction
Tissue extraction plays a crucial role in various medical disciplines, with aspiration catheters serving as the prevailing method. Unfortunately, these catheters face limitations such as clogging and dependence on tissue properties and device dimensions. Therefore, there is a pressing need for an improved tissue extraction device that enables efficient and reliable tissue removal during Minimally Invasive Surgery (MIS).

Methods
In this study, we present a novel tissue transport system that utilizes a cylindrical conveyor belt mechanism for reliable tissue transportation. We conducted experiments using a proof-of-principle prototype to explore the influence of tissue elasticity, rotational velocity, instrument orientation, and tissue shape on the transportation rate, efficiency, and reliability. Tissue phantoms with gelatine concentrations of 3, 9, and 12 wt% were employed to simulate a range of Young’s moduli from 1 to 110 kPa.

Results
The mean transportation rates for these phantoms were 7.75±0.48, 8.43±1.50, and 8.90±0.56 g/min, respectively. Notably, all phantoms were transported successfully. The perfect reliability exhibited underscores the potential of our instrument as an alternative to aspiration catheters. CONCLUSION: This research presents a significant step forward in the field of tissue extraction, offering a promising approach for MIS with enhanced efficiency and reliability.
Physiological and clinical effects of low-intensity blood-flow restricted resistance exercise compared to standard rehabilitation in adults with knee osteoarthritis–Protocol for a randomized controlled trial
Authors: Sørensen Brian , Aagaard Per , Hjortshøj Mikkel H. , Hansen Sofie K. , Suetta Charlotte , Couppé Christian , Magnusson S. Peter , Johannsen Finn E. 
Published: December 2023

IntroductionOsteoarthritis (OA) is a common disease with high socioeconomical costs. In Denmark, standard rehabilitation (SR) consists of a combination of patient education and supervised physical exercise involving a standardized neuromuscular training program. As an evidence-based alternative, high–load (>70% 1RM) resistance training (HIRT) has shown positive rehabilitation effects in knee-OA but may not be tolerated in all patients (~25%) due to knee joint pain. However, low-load resistance training (20–40% 1RM) with concurrent partial blood-flow restriction (BFR) appears to produce effects similar to HIRT yet involving reduced joint pain during and after exercise.The aim is to examine the effect of low-load BFR training compared to SR on pain, thigh muscle mass and muscle function in adults with knee-OA. We hypothesize that 12 weeks of BFR will lead to superior improvements in pain, muscle mass and mechanical muscle function compared to SR.Methods and analysis90 participants diagnosed with radiographic knee-OA will be randomized to either BFR or SR twice a week for 12 weeks. BFR will consist of two selected lower limb strength exercises performed with an inflated pneumatic occlusion cuff. Intervention procedures in SR consist of a full 8 weeks GLA:D course followed by 4 weeks of team group training.Primary outcome variable is the change in KOOS-Pain subscale from baseline to 12 weeks. Secondary outcome variables are changes in pain sensitivity, functional performance, muscle mass and mechanical muscle function.Intention-to-treat and per-protocol analyses will be conducted. One-way analysis of variance will be performed to evaluate between-group changes. Pre-to-post intervention comparisons will be analyzed using a mixed linear model. Regression analysis will be performed to evaluate potential associations between selected outcome variables.
Contraceptive use by number of living children in Ghana: Evidence from the 2017 maternal health survey
Authors: Compton Sarah , Nakua Emmanuel , Moyer Cheryl , Dzomeku Veronica , Treleaven Emily , Otupiri Easmon , Lori Jody 
Published: December 2023

Background
There is a significant literature describing the link between parity and contraceptive use. However, there is limited knowledge about the disaggregation by parity of the type of contraceptives. In this study, we describe the use of contraceptives by parity among women of reproductive age in Ghana, focusing on use of highly effective methods (injection, pill, intrauterine device, implant, and sterilization).

Methods
Using the 2017 Ghana Maternal Health Survey, a nationally-representative cross-sectional household survey, we describe contraceptive method use by number of living children among sexually active women of reproductive age. We then estimated predictors of use of highly effective contraception in a multilevel logistic regression model.

Results
Most women in this survey are not using any method of contraception, although this varies by whether or not they have begun childbearing. Contraceptive method use varies by number of living children. Before having children, natural (periodic abstinence and withdrawal) and episodic (condoms) methods dominate. Once a woman has one living child, method preference changes to injectables and implants. Factors associated with using a highly effective method of contraception are: having >3 children, being in a relationship, having had an abortion, being younger than age 30, and having had sexual intercourse within days of answering the survey (p < .001 for all).

Conclusion
In this analysis, the number of living children a woman has, her age, and timing of last intercourse are the most significant predictors of using a highly effective method of contraception. However, the majority of participants in this study report not using any method of contraception to avoid unwanted pregnancies. Future research that attempts to unpack the disconnect between not wanting to become pregnant and not using contraception is warranted.
Reconceptualizing a preclinical model for natural, adaptive surgical skills learning.
Authors: Thosar Dr. Sumedha , Mahale Dr. Swapna 
Published: December 2023

Title
Reconceptualizing a preclinical model for natural, adaptive surgical skills learning.
Introduction
Preclinical suture training on live-subjects are not always the optimal means of introducing the students to surgical skill. Suturing on foam, animal skin, waste meat, self-made suturing models are commercially available which may be cost ineffective. The efficacy of incision, suturing, and flap reflection technique using different models was evaluated.
Objective
To compare the effectiveness of incision, flap reflection and suturing technique on dragon fruit skin, banana peel and mackintosh sheet adapted to dental cast model using questionnaire for interns.
Methodology
80 interns were demonstrated and asked to perform incision, flap reflection and suturing technique on 3 casts adapted with mackintosh sheet, banana peel and dragon fruit skin each. Answers were evaluated from the questionnaire form given to the interns.
Results
85.36% students responded that dragon fruit was best replicating the gingiva and 56.09% experienced that flap reflection was easier with dragon fruit skin model. 65.8 % students experienced more gaping with banana peel model. Less time was required to perform incision, flap reflection and suturing with mackintosh sheet.
Conclusion
A dragon fruit skin model can be used for effecting learning of surgical skills.
Screening for subvisible particles in pharmaceutical formulations – a case study
Authors: Siddiqui Abdullah , Al Shareef Ahmed Jaber , Muzahem Salem , Jagadeesan Premanandh 
Published: December 2023

Particulate contamination arising from subvisible particles in pharmaceutical manufacturing is a major challenge affecting both product safety and manufacturer reputation. Hence, detection and quantification of subvisible particles play pivotal role in pharma industries and regulatory monitoring process.
Flow imaging microscopy has been widely used to characterize and count particulate matter having profound application in imaging analytics. The current study reports our preliminary findings on sub visible particles in pharmaceutical formulations. The particle size distribution and concentration are assessed using pre-defined image libraries and statistical pattern-recognition. A total of 32 samples were screened and found to contain a size range between 70 and 12239 particles belonging to glass, fiber, plastic, and unknown product category.
In conclusion, flow imaging is a simple and rapid complementary method for the detection and quantiﬁcation of subvisible particulate matter screening.
Antifungal activity of Punica granatum linn extracts against Malassezia pachydermatis
Authors: Chamilete Sophia Aparecida Morro , Matsumoto Leopoldo Sussumu , Delfino Fernanda , Pirajá Guilherme Villa , Silva Regildo Márcio Gonçalves da , Peixoto Erika Cosendey Toledo de Mello 
Published: December 2023

Malassezia pachydermatis causes external otitis, often affecting dogs, and control methods for this microorganism have been resistant to synthetic antifungals. Therefore, this study evaluated the antifungal activity of aqueous extracts of Punica granatum Linn (AEP) fruit peel dehydrated (AEPd) and in natura (AEPn) against Malassezia pachydermatis. The M. pachydermatis samples were from the Microbiology Laboratory of the State University of Northern Paraná (UENP), PR, Brazil. The strains were identified and replicated after inoculation in the Sabouraud dextrose medium. Subsequently, the P. granatum extract was obtained through different extraction methods: cold, water bath, decoction, and infusion. Each test was run fivefold at 10, 20, 30, 40, and 50% after 10, 20, and 30 minutes. The sensitivity of isolates was determined with the Kirby-Bauer disc diffusion method and indicated by an inhibition zone larger than 15 mm. The results were evaluated with a 2x3x6 factorial study design, ANOVA, and Tukey's test at 5% significance. AEPn showed antifungal activity on M. pachydermatis strains, and AEPd did not present an inhibitory influence at any concentration and time. Extraction by decoction was the most efficient, followed by water bath, cold, and infusion. The extracts at a 50% concentration showed the best results, but all other doses determined an inhibition zone larger than 15 mm. Thus, AEP showed a significant therapeutic potential for controlling M. pachydermatis.