bluuebunny/crossref_metadata_2025_split huggingface dataset:
Bowel Management Protocol
Authors: Shanholtz Gayle , Vergara Franz Henryk , Amba Katheryne Tifuh , Ramos Mary Dioise 
Published: November 2023

Purpose of Study:
The project aimed to determine the impact of a standardized bowel regimen protocol for patients receiving opioids on the rate of stool softener prescription, occurrence of bowel movements of oncology patients, and improving the length of stay (LOS).

Primary Practice of Setting:
Oncology unit in a community hospital.

Methodology and Sample:
A posttest design was utilized, and a prospective medical record review of patients was completed after 8 weeks of the pilot study. The study sample (N = 164) included oncology patients admitted to a community hospital in the Southeast. The χ2 test was used to determine the impact of implementing a bowel panel order on the rate of stool softener prescriptions, the occurrence of bowel movements, and the LOS.

Results:
Only 43% (n = 40) of the patients from the comparison group were ordered laxatives, and more patients from the intervention group (68%; n = 49) received the bowel regimen protocol, whereas 26% (n = 19) of the patients used a laxative or stool softener using providers' preference and demonstrated statistical significance (p = .001). In the intervention group, 93% of the patients (n = 67) reported having bowel movements compared with the comparison group, whereas only 32% (n = 32) demonstrated statistical significance (p = .001). The average LOS in the intervention group is less than 9 days compared with the comparison group, which was at 9 days (p = .001).

Implications to Case Management Practice:
Case managers play a critical role in coordinating care, improving transitions of care, and reducing LOS. Case managers can have a significant impact by monitoring and reminding nurses to report the gastrointestinal movements of oncology patients and then escalate opioid-induced constipation with the providers immediately. Case managers can facilitate the implementation of bowel regimen protocols, which may reduce hospitalizations and enhance patient outcomes, by taking this action.
Experiences of Ambulatory Patients With Huntington's Disease With Case Management
Authors: Kruijthof Cindy , de Boer Marike E. , van Loon Anouk M. , Bredewold Jonieke , van Dusseldorp Loes 
Published: November 2023

Purpose/Objectives:
Huntington's disease (HD) requires high-quality care to reduce disruption of the patient system, prevent crisis situations, and prevent early admission in a nursing home. In the Netherlands, case management has been available for the last to 9 years for people with HD. However, there is a notable gap in understanding experiences and beliefs of HD patients regarding case managers' care, guidance, and support for quality of life. To improve the international quality of care for people with HD, insight in experiences of ambulatory HD patients with the care, guidance, and support received from a case manager HD (CMHD) is crucial.

Primary Practice Setting:
Ambulatory care.

Findings/Conclusions:
Ambulatory patients with HD highly appreciate and value the role and support of the CMHD. This was reflected in four themes: (1) the CMHD as a person, with commitment, sympathy, and reliability as central concepts; (2) the CMHD as a professional, with the key roles of coordinator, point of contact, expert, and supporter; (3) impact of the CMHD on quality of life, with support of coping with decline and monitoring the home situation as important subthemes; and (4) support of the CMHD for family members, with providing help and giving attention as subthemes. This insight into patients' experiences of the CMHD's role adds value to the improvement of the international quality of care for people with HD.

Implications for Case Management Practice:
Commitment, expertise, support for both family members and patients, and bond of trust from the CMHD are experienced as very valuable. These qualitative findings from a patient's perspective add significantly to the body of knowledge on CMHD's role and practices as “spider at the center of the web.”
Pulmonary Low Malignant Potential Adenocarcinoma
Authors: Pittaro Alessandra , Crivelli Filippo , Orlando Giulia , Napoli Francesca , Zambelli Vanessa , Guerrera Francesco , Sobrero Simona , Volante Marco , Righi Luisella , Papotti Mauro 
Published: November 2023

Adenocarcinoma (ADC) is the most common histologic type of lung cancer, including in situ (lepidic), minimally invasive, and invasive forms. While the former 2 types are associated with a favorable outcome, the latter includes tumors with variable behavior, often tumor stage–related. A recent study proposed strict morphologic criteria defining a new subgroup of resected stage I invasive ADC (16% of cases) with favorable outcomes (100% disease-specific survival), named “ADC of low malignant potential (LMP-ADC).” The following criteria were met: ≤3 cm size, nonmucinous histotype, ≥15% lepidic growth, and the absence of the following: high-grade patterns, >1 mitosis/2 mm2, necrosis, and vascular/pleural invasion. The aim of the present study was to validate the performance of such criteria to identify LMP-ADC in a series of 274 stage IA resected lung ADCs from a single institution. Thirty-four tumors (12.4%) met the proposed criteria for LMP-ADC, as confirmed by additional stains for mitotic figures, Ki67 index, and elastic fibers (helpful to assess alveolar wall invasion). Minor differences between the lepidic and invasive components were observed regarding cell atypia and proliferation. p53 was normally expressed by invasive tumor cells. Mutations occurred in known lung cancer genes (mostly KRAS and EGFR). Five patients (14.7%) developed disease progression and 2 of them (5.9%) died of the disease. In our series, the disease-specific survival was 94.1%. In conclusion, in resected invasive lung ADC, a subgroup presenting low-grade morphologic features and associated with favorable prognosis does exist. Morphologic criteria for LMP-ADC supported by ancillary techniques represent a valid tool to better define this novel subgroup and to refine the stratification of invasive lung ADC, possibly suggesting modified follow-up protocols, based on the observed indolent behavior in most cases.
Extranodal NK/T-Cell Lymphoma Predominantly Composed of Anaplastic Cells
Authors: Zhong Yujia , Xie Jianlan , Chen Jierong , Ping Liqin , Zang Shengbing , Zhang Yingchun , Feng Yanfen , Huang Yuhua 
Published: November 2023

Extranodal NK/T-cell lymphoma (ENKTL) is a non-Hodgkin lymphoma associated with the Epstein-Barr virus that primarily affects individuals in East Asia and indigenous populations in Central and South America. Morphologically, ENKTL typically consists of medium-sized cells or a combination of small and large cells. This report presents 10 cases characterized by predominantly anaplastic cells with diffuse expression of CD30, resembling anaplastic lymphoma kinase-negative anaplastic large cell lymphoma (ALK-negative ALCL) and demonstrating highly aggressive behavior. The cohort included 9 males and 1 female, ranging in age from 29 to 65 years (median age: 47 y). Eight patients presented with nasal disease, while 2 had non-nasal disease. Five patients had stage I/II disease, and the remaining 5 had stage III/IV disease. Morphologically, necrosis was observed in 9 cases, angiocentric-angiodestructive growth in 3 cases, and pseudoepitheliomatous hyperplasia in 2 cases. Anaplastic cells predominated in all cases, with some displaying eccentric, horseshoe-shaped, or kidney-shaped nuclei (referred to as “Hallmark” cells). The morphology profile was monomorphic in 3 cases and polymorphic in 7 cases. Immunohistochemically, all cases tested positive for cytotoxic granule markers (TIA1 and granzymeB) and Epstein-Barr virus-encoded RNA. Cytoplasmic expression of CD3ε and CD56 was observed in 9 of 10 cases. Interestingly, most cases (7 of 8) exhibited variable expression of MuM1, ranging from 10% to 90%. All cases showed diffuse positivity for CD30 but were negative for ALK, resulting in 3 cases being initially misdiagnosed as ALK-negative ALCL. Compared with nonanaplastic cases, anaplastic cells predominant ENKTL had a significantly higher frequency of “B” symptoms, bone marrow involvement, hemophagocytic lymphohistiocytosis, and higher Ki67 proliferative index. These findings provide valuable information for pathologists, expanding their understanding of the cytologic spectrum of ENKTL. This rare variant of ENKTL, characterized by the predominance of anaplastic cells and diffuse CD30 expression, exhibits high aggressiveness and should be differentiated from ALK-negative ALCL. Awareness of this uncommon variant is crucial in preventing misdiagnosis and ensuring the timely initiation of therapy.
Frontalis Suspension through Infrabrow Skin Excision for Blepharoptosis in Asian Patients
Authors: Tomioka Yoko , Okazaki Mutsumi , Matsutani Hitomi 
Published: November 2023

Summary:
Frontalis suspension is the preferred approach for blepharoptosis with compromised levator function. Various studies have explored the use of different materials or material shapes for performing this procedure; however, a limited number discuss the specifics of skin incisions. Given that blepharoplasty demands not only functional but also aesthetic results, the authors applied an infrabrow incision, a technique commonly used in cosmetic surgery. This study, the first report involving a series of blepharoptosis cases treated using this technique, explores its viability as a promising alternative to traditional frontalis suspension. This technique was used in 7 consecutive patients exhibiting poor levator function who were treated at the University of Tokyo between September of 2019 and February of 2022. A retrospective analysis was conducted on clinical photographs and charts. In 1 representative case, visual field angle and frontal muscle tone were also measured. The average duration of postoperative follow-up was 9 months. In all cases, the frontalis muscle was adequately exposed to allow suspension through the infrabrow approach. Significant improvements were observed in the marginal reflex distances without effort from −1.9 to 2.1 mm (P = 0.0027) and marginal reflex distances with effort from 0.0 to 5.4 mm (P < 0.0001). Complications included a hematoma (n = 1), eyelash entropion (n = 1), transient sensory loss of the forehead (n = 1), and transient dry eye (n = 3). The infrabrow incision is a good alternative for frontalis suspension owing to its capacity to offer a broad surgical field, provide effective access to the frontalis muscle, and facilitate excess skin excisions without resulting in conspicuous scarring.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, IV.
Treatment Effects on Psychophysiological Stress Responses in Youth With Obesity
Authors: Van Royen Annelies , Verbiest Ine , Goemaere Heleen , Debeuf Taaike , Michels Nathalie , Verbeken Sandra , Braet Caroline 
Published: November 2023

ABSTRACT

Objective
Stress plays a central role in obesity development, but research on treatment options to tackle elevated stress levels in youth with obesity is scarce. The present study examined the impact of the Multidisciplinary Obesity Treatment (MOT; lifestyle intervention including physical exercise, healthy meals, and cognitive behavioral techniques) on physiological stress parameters in youth with obesity and assessed whether adding emotion regulation (ER) training on top of MOT is beneficial.

Methods
From an inpatient treatment center for obesity, 92 youngsters (mean [standard deviation] age = 12.50 [1.66] years, 43.5% boys) were randomly assigned to a control group (MOT) or experimental group (MOT + ER training). Before (T1) and after 12 weeks of treatment (T2), high-frequency heart rate variability (HF-HRV) and heart rate were measured at rest and during a stress induction (= psychophysiological reactivity).

Results
At T2, after MOT only, participants displayed a lower resting heart rate (M
T2/T1 = 74.7/78.6) and a reduced stress response (i.e., less decrease in HF-HRV [M
T2/T1 = −0.06/−0.01] and less increase in heart rate [M
T2/T1 = 0.03/0.06] after the stress induction). No further improvements were revealed after adding ER training. However, when considering the weight changes, the significant results in resting heart rate and HF-HRV and heart rate reactivity decreased in the control group, and additional improvements in psychophysiological parameters were discovered in the experimental group.

Conclusions
The results suggest that MOT may effectively reduce physiological stress responses and also provide preliminary evidence for a potential additional effect of ER training. Further research in a larger sample with extended follow-up measurements is needed.
The Role of Artificial Intelligence in Coronary Calcium Scoring in Standard Cardiac Computed Tomography and Chest Computed Tomography With Different Reconstruction Kernels
Authors: Lin Yenpo , Lin Gigin , Peng Meng-Ting , Kuo Chi-Tai , Wan Yung-Liang , Cherng Wen-Jin 
Published: November 2023

Purpose:
To assess the correlation of coronary calcium score (CS) obtained by artificial intelligence (AI) with those obtained by electrocardiography gated standard cardiac computed tomography (CCT) and nongated chest computed tomography (ChCT) with different reconstruction kernels.

Patients and Methods:
Seventy-six patients received standard CCT and ChCT simultaneously. We compared CS obtained in 4 groups: CSCCT, by the traditional method from standard CCT, 25 cm field of view, 3 mm slice thickness, and kernel filter convolution 12 (FC12); CSAICCT, by AI from the standard CCT; CSChCTsoft, by AI from the non-gated CCT, 40 cm field of view, 3 mm slice thickness, and a soft kernel FC02; and CSChCTsharp, by AI from CCT image with same parameters for CSChCTsoft except for using a sharp kernel FC56. Statistical analyses included Spearman rank correlation coefficient (ρ), intraclass correlation (ICC), Bland–Altman plots, and weighted kappa analysis (κ).

Results:
The CSAICCT was consistent with CSCCT (ρ = 0.994 and ICC of 1.00, P < 0.001) with excellent agreement with respect to cardiovascular (CV) risk categories of the Agatston score (κ = 1.000). The correlation between CSChCTsoft and CSChCTsharp was good (ρ = 0.912, 0.963 and ICC = 0.929, 0.948, respectively, P < 0.001) with a tendency of underestimation (Bland–Altman mean difference and 95% upper and lower limits of agreements were 329.1 [–798.9 to 1457] and 335.3 [–651.9 to 1322], respectively). The CV risk category agreement between CSChCTsoft and CSChCTsharp was moderate (κ = 0.556 and 0.537, respectively).

Conclusions:
There was an excellent correlation between CSCCT and CSAICCT, with excellent agreement between CV risk categories. There was also a good correlation between CSCCT and CS obtained by ChCT albeit with a tendency for underestimation and moderate accuracy in terms of CV risk assessment.
Identification of Mitral Valve Prolapse on Non–electrocardiography-gated Enhanced Chest Computed Tomography
Authors: Son Min Ji , Chun Eun Ju , Yoo Seung Min , Lee Soo Jeong , White Charles S. 
Published: November 2023

Purpose:
The primary imaging modality for the diagnosis of mitral valve prolapse (MVP) is echocardiography supplemented by electrocardiography (ECG)-gated cardiac computed tomography (CT) angiography. However, we have recently encountered patients with MVP who were initially identified on non–ECG-gated enhanced chest CT. The purpose of this study is to evaluate the diagnostic accuracy of non–ECG-gated enhanced chest CT to predict the presence of MVP.

Patients and Methods:
Of 92 patients (surgically confirmed MVP who underwent non–ECG-gated chest CT), 27 patients were excluded for motion artifact or insufficient surgical correlation, and 65 patients were ultimately included. As a control, 65 patients with dyspnea and without MVP (non–ECG-gated chest CT and echocardiography were performed within 1 month) were randomly selected. We retrospectively analyzed an asymmetric double line sign on axial CT images for the presence of MVP. The asymmetric double line sign was defined as the presence of a linear structure, not located in the plane traversing the mitral annulus.

Results:
Use of the asymmetric double line sign to predict MVP on non–ECG-gated CT showed modest sensitivity, high specificity, modest negative predictive value, and high positive predictive value of 59% (38/65), 99% (64/65), 70% (64/91), and 97% (38/39), respectively.

Conclusion:
The asymmetric double line sign on non–ECG-gated enhanced chest CT may be a valuable finding to predict the presence of MVP. Familiarity with this CT finding may lead to prompt diagnosis and proper management of MVP.
Cutaneous Layer and SMAS Suspension (CaSS) Lift as a Minimally Invasive Lateral Midface Lift
Authors: Byun Jin Suk , Kim Kenneth K. 
Published: November 2023

Background:
In our prior study, the authors determined that pulling on the superficial adipose layer is more effective in lifting the skin than pulling on the superficial musculoaponeurotic system (SMAS). Applying this concept of using the superficial adipose layer to transmit the lifting force to the skin, this study examined improvements in patients who underwent lateral midface lifting using our minimally invasive multilayer lifting technique and measured the duration of those improvements.

Methods:
Along the hairline in front of the sideburns, a W-shaped zigzag incision of 3 to 8 mm in width and 3 to 4 cm in length was made. On the temporal scalp, 3 to 4 cm away from the first incision, a second incision was made more lateral/posterior to the first incision, and an elliptical excision of 3 to 5 mm in width and 3 to 4 cm in length was made. From the medial cut margin of the anterior first incision, the superficial temporal fascia/SMAS (the deep layer), and the superficial adipose layer (the superficial layer) were purchased with 3-0 polyester sutures, tunneled under the soft tissue, and fixed to the deep temporal fascia of the second posterior temporal incision. Prior to the excised temporal scalp closure, the dermis in the medial cut margin of the second incision was pulled to the rear as much as possible and fixed to the deep temporal fascia.

Results:
The effects of surgery were monitored for 6 to 42 months after surgery. The nasolabial folds were improved. Skin elasticity also showed significant improvements, which lasted throughout the follow-up period (up to 42 mo).

Conclusions:
Unlike traditional wide dissection SMAS facelift, our method requires minimal incisions and does not require skin undermining. Therefore, the operating time is shorter, and postoperative swelling is minimized. In our technique, the superficial adipose layer, the superficial temporal fascia/SMAS, and the dermis were pulled individually to lift all layers of the lateral midface soft tissues. This results in a significant and long-lasting lateral midface rejuvenation.
The Effect of Presurgical Nasoalveolar Molding on Oronasal Fistula Following Primary Palatoplasty
Authors: Siriwiroj Singto , Pisek Poonsak , Punyavong Pattama , Jenwitheesuk Kamonwan , Surakunprapha Palakorn , Winaikosol Kengkart 
Published: November 2023

Objective:
Presurgical nasoalveolar molding (PNAM) is widely used in cleft care protocol. This study investigated the correlation between PNAM and oronasal fistula after primary palatoplasty.

Methods:
A case-controlled study of 80 unilateral and bilateral complete cleft palate patients who underwent cleft palate repair were enrolled. Patients were divided into 2 groups: (1) no PNAM use and (2) PNAM use. The incidence of oronasal fistula and postoperative complications were compared between groups.

Results:
Forty patients in each group demonstrated the same baseline characteristics. The PNAM group showed a significantly lower postoperative oronasal fistula rate (15% versus 50%, P=0.003). Palatal cleft width wider than 12.5 mm increases the odds ratio of fistula formation by 1.19-fold (P=0.037), and the PNAM protected against postoperative palatal fistula formation (odds ratio 0.20, P=0.003).

Conclusion:
Presurgical nasoalveolar molding can reduce postoperative oronasal fistula in wide-gap Veau type III and IV cleft palate.
YiQiFuMai Injection Ameliorated Sepsis-induced Cardiomyopathy by Inhibition of Ferroptosis via xCT/GPX4 Axis
Authors: Guo Liying , Li Peng , Wang Yuming , Wang Jing , Lei Jinyan , Zhao Jie , Wu Xiliang , He Wenju , Jia Jianwei , Miao Jing , Wang Dongqiang , Cui Huantian 
Published: November 2023

Abstract
Sepsis-induced cardiomyopathy (SIC) is a distinct form of myocardial injury that disrupts tissue perfusion and stands as the significant cause of mortality among sepsis patients. Currently, effective preventive or treatment strategies for SIC are lacking. YiQiFuMai injection (YQFM), composed of Panax ginseng C.A. Mey., Ophiopogon japonicus (Thunb.) Ker Gawl., and Schisandra chinensis (Turcz.) Baill., is widely used in China to treat cardiovascular diseases, such as coronary heart disease, heart failure and SIC. Research has shown that YQFM can improve cardiac function and alleviate heart failure through multiple pathways. Nevertheless, the mechanisms through which YQFM exerts its effects on SIC remain to be fully elucidated. In this study, we firstly investigated the therapeutic effects of YQFM on a SIC rat model and explored its effects on myocardial ferroptosis in vivo. Then, LPS-induced myocardial cell death model was used to evaluate the effects of YQFM on ferroptosis and xCT/GPX4 axis in vitro. Furthermore, using GPX4 inhibitors, we aimed to verify whether YQFM improved cardiomyocyte ferroptosis through the xCT/GPX4 axis. The results showed that YQFM was effective in alleviating myocardial injury in septic model rats. Besides, the concentrations of iron and the levels of lipid peroxidation-related factors (ROS, MDA and 4-HNE) were significantly decreased and the expression of xCT/GPX4 axis was up-regulated in SIC rats after YQFM treatment. In vitro studies also showed that YQFM alleviated iron overload and lipid peroxidation and activated xCT/GPX4 axis in LPS-induced myocardial cell death model. Moreover, GPX4 inhibitor could abolish the effects above. In summary, the study highlights the regulatory effect of YQFM in mitigating myocardial injury. It probably achieves this ameliorative effect by enhancing xCT/GPX4 axis and further reducing ferroptosis.