bluuebunny/crossref_metadata_2025_split huggingface dataset:
Paravertebral Nerve Block for Procedural Pain in Percutaneous Vertebroplasty
Authors: Kang Min-Seok , Son In-Seok , Kim Tae-Hoon , Lee Suk-Ha , You Ki-Han , Lee Woo-Myung , Hyun Jin-Tak , Park Hyun-Jin 
Published: November 2023

Objectives:This study aimed to unidimensionally measure procedural pain at each percutaneous vertebroplasty (PVP) stage and evaluate the effectiveness of paravertebral nerve block (PVNB) in reducing procedural pain.Methods:A retrospective study of prospectively collected data was conducted on 66 patients who underwent PVP for osteoporotic vertebral compression fractures. The subjects were divided into two groups: Group A (fluoroscopic-guided PVNB; 5 cm3of 0.75% ropivacaine on each side) and Group B (local anesthesia). To investigate procedural pain associated with PVP, the visual analog scale (VAS) score was assessed at each surgical stage: before the incision (stage 1), transpedicular approach (stage 2), and polymethylmethacrylate cement injection (stage 3). After the procedure, patients were asked about their surgical experience and satisfaction using the IOWA Satisfaction with Anesthesia Scale (ISAS). Periprocedural complications were also recorded.Results:A total of 63 patients (78.65 y of age) were finally enrolled: 30 from group A and 33 from group B. In both groups, a significant ≥2-point increase in procedural pain was observed during PVP compared to that during stage 1 (P<0.001). In stages 2 and 3, the pain intensity was significantly lower in Group A (P<0.001). Upon discharge, the VAS score improved in all groups; however, the ISAS score was significantly higher in Group A (P<0.001). There was no difference in periprocedural complications between the two groups (P=0.743).Discussion:PVP causes significant procedural pain, and PVNB is a potentially effective modality for enhancing patient satisfaction and reducing procedural pain.
A Unique Case of Intrauterine Pressure Injury
Authors: Burns Heather R. , Yim Nicolas H. , Dibbs Rami P. , Ferry Andrew M. , Belfort Michael A. , Buchanan Edward P. 
Published: November 2023

ABSTRACTThe authors present a review of the literature regarding pressure injuries (PIs) in neonates and a case of a newborn who developed a PI following a prolonged labor process and fetal malposition. A girl born at 35 weeks’ gestation to a 34-year-old gravida 7 para 6 mother with a medical history of untreated gestational diabetes, preeclampsia, and COVID-19 was delivered via cesarean section after failure to progress through labor. The premature infant was found to have a 3.2 × 2.3-cm PI at the nape of the posterior neck. Premature infants have a histologically proven, age-dependent decreased thickness of their stratum corneum, epidermis, and dermis, which places them at increased risk of developing PIs that can be painful and lead to infection. In the present case, the neonate’s congenital PI was successfully treated with medical-grade honey for approximately a month.
Nursing Students’ Knowledge on Pressure Injuries Following a Blended-Learning Unit: A Quasi-experimental Study
Authors: Bobbink Paul , Gschwind Géraldine , Charbonneau Lucie , Guex Carole , Chabal Laurent , Probst Sebastian 
Published: November 2023

ABSTRACT

OBJECTIVE
To assess first-year bachelor’s degree in nursing students’ knowledge about pressure injury (PI) etiology, classification, prevention, and management following blended learning and clinical practice.

METHODS
A quasi-experimental design was used. Nursing students’ PI knowledge was measured using the French version of the Pressure Ulcer Knowledge Assessment Tool (PUKAT) at three time points: baseline (before a blended-learning unit, consisting of 2 hours of e-learning and 3 hours of practical workshop), after the blended-learning unit, and after clinical practice.

RESULTS
A total of 21 students participated over the three time points. At baseline, the mean percentage of correct answers on the PUKAT was 45.8%. This score increased to 59.2% following the blended-learning unit and 65% after completing the clinical practice (F
2,58 = 19.08; P = .00). Over the three time points, students scored highest on knowledge of risk assessment and lowest on knowledge of prevention.

CONCLUSIONS
Blended-learning units combining e-learning and practical workshops are valuable tools to increase students’ knowledge about PIs. The PUKAT enables the evaluation of changes in students’ knowledge following a teaching unit on PIs. However, more research is needed to assess the long-term evolution of knowledge and the impact of this teaching on clinical practice.
Clinical Risk Factors of Perioperative Pressure Injury in Older Adult Patients with a Hip Fracture
Authors: Tzen Yi-Ting , Sambandam Senthil , Delmore Barbara , Wang Jijia , Chu Andy , Wukich Dane K. 
Published: November 2023

ABSTRACT

OBJECTIVE
To examine the clinical risk factors of perioperative pressure injury (PrI) in older adults with a hip fracture, including preoperative chronic comorbidities and postoperative complications.

METHODS
In this retrospective study, the authors queried the PearlDiver Patient Records database between January 2011 and January 2020. Data from 54,194 patients without preexisting PrI were included for analyses. Patients were separated into two groups: (1) one or more perioperative PrI and (2) no PrI. Clinical factors as outcome variables include 21 comorbidities and 10 complications.

RESULTS
Univariate analyses were computed to compare the variables between groups, and two logistic regression models were developed to find comorbidity predictors and complication predictors. Of all patients, 1,362 (2.5%) developed one or more perioperative PrI. Patients with perioperative PrIs were more likely to be older men. One-year mortality for patients with perioperative PrI was 2.5 times that of patients without PrI. The regression models showed that predictors of perioperative PrI are malnutrition, hypoalbuminemia, frailty, peripheral vascular disease, dementia, urinary tract infection, perioperative red blood cell transfusion, and atrial fibrillation.

CONCLUSIONS
Screening for these comorbidities and complications may assist in determining the risk of PrI in older adults undergoing hip fracture surgery. Determining PrI risk enables the appropriate prevention strategies to be applied perioperatively.
Incidence of Pressure Injury Among Older Adults Transitioning from Long-term Care to the ED
Authors: Tate Kaitlyn , Palfreyman Simon , Reid R. Colin , McLane Patrick , Cummings Greta G. 
Published: November 2023

ABSTRACT

OBJECTIVE
To identify sociodemographic, health condition, and organizational/process factors associated with pressure injury (PI) incidence during older adults’ emergency transitions from long-term care (LTC) to the ED.

METHODS
Emergency transitions were tracked for older adults within included LTC facilities to participating EDs in two urban centers located in provinces in Canada. Binary logistic regression was used to examine the influence of sociodemographic, service use, and client health and function factors on the incidence of PIs during transitions from LTC facilities to EDs.

RESULTS
Having a mobility issue (odds ratio [OR], 4.318; 95% CI, 1.344–13.870), transitioning from a publicly owned versus a nonprofit volunteer LTC facility (OR, 4.886; 95% CI, 1.157–20.634), and time from ED arrival to return to LTC being 7 to 9 days (OR, 41.327; 95% CI, 2.691–634.574) or greater than 9 days (OR, 77.639; 95% CI, 5.727–1,052.485) significantly increased the odds of experiencing a new skin injury upon return to LTC. A higher number of reported reasons for emergency transition (up to 4) significantly decreased the odds of a new PI upon return to LTC (OR, 0.315; 95% CI, 0.113-0.880).

CONCLUSIONS
The study findings can be used to identify LTC residents at increased risk for developing new skin injuries during an emergency transition, namely, those with mobility impairment, those requiring inpatient care for 6 or more days, and those transitioning from publicly owned LTC facilities. Evaluating the uptake and effectiveness of single-pronged and multipronged interventions such as visual cues for patient turning through online monitoring, consistent risk assessments, and improved nutrition in all care settings are vital next steps in preventing skin injuries in this population.
Risk Factors for Suboptimal Outcome of FAI Surgery in the Adolescent Patient
Authors: Yen Yi-Meng , Kim Young-Jo , Ellis Henry B. , Sink Ernest L. , Millis Michael B. , Zaltz Ira , Sankar Wudbhav N. , Clohisy John C. ,   ANCHOR Group, Nepple Jeffrey J. 
Published: November 2023

Background:
Surgical treatment for adolescent patients with femoroacetabular impingement (FAI) is increasing. The purpose of this study was to determine the clinical outcomes of FAI surgery in a multicenter cohort of adolescent patients and to identify predictors of suboptimal outcomes.

Methods:
One hundred twenty-six adolescent hips (114 patients < 18 years of age) undergoing surgery for symptomatic FAI were studied from a larger multicenter cohort. The group included 74 (58.7%) female and 52 male hips (41.3%) with a mean age of 16.1 (range 11.3 to 17.8). Clinical outcomes included the modified Harris Hip Score (mHHS), Hip disability and Osteoarthritis Outcome Score (5 domains), and University of California Los Angeles activity score. Failure was defined as revision surgery or clinical failure (inability to reach minimally clinical important differences or patient acceptable symptoms state for the mHHS). Statistical analysis was used to identify factors significantly associated with failure.

Results:
There was clinically important improvement in all patient-reported outcomes for the overall group, but an 18.3% failure rate. This included a revision rate of 8.7%. Females were significantly more likely than males to be classified as a failure (25.7 vs. 7.7%, P=0.01), in part because of lower preoperative mHHS (59.1 vs. 67.0, P< 0.001). Mild cam deformity (alpha angle <55 degrees) was present in 42.5% of female hips compared with 17.3% male hips. Higher alpha angles were inversely correlated with failure. Alpha angles >63 have a failure rate of 8.3%, between 55 and 63 degrees, 12.0% failure rate, and <55 degrees (mild cam) failure rate of 37.5%. Patients who participated in athletics had a 10.3% failure rate compared with nonathletes at 25.0% (P=0.03, RR (relative risk) 2.4).

Conclusions:
Adolescent patients undergoing surgical treatment for FAI generally demonstrate significant improvement. However, female sex, mild cam deformities, and lack of sports participation are independently associated with higher failure rates. These factors should be considered in surgical decision-making and during patient counseling.

Level of Evidence:
Level III—retrospective comparative study.
Management of Nonunion of Distal Tibial Periarticular Fractures Using Ilizarov External Fixator
Authors: Zayda Ahmed , Badr Ismail Tawfeek 
Published: November 2023

Nonunion of the periarticular distal tibial fractures is a challenging issue with limited options for treatment. The study aims to evaluate the outcomes of treatment of non-united periarticular distal tibial fractures using Ilizarov external fixation. A retrospective study included 16 patients with distal tibial fracture nonunion treated with Ilizarov fixator from 2014 to 2019 with a minimum 1-year follow-up after frame removal. Fibular plating was done in 8 cases and supplementary interfragmentary screws at the nonunion site in 5 cases. Primary or delayed bone graft was used in 11 patients. The ASAMI protocol was used to assess the bone and functional results. The American Orthopaedic Foot and Ankle Society (AOFAS) scale was used to assess the functional outcomes. Study included 9 males and 7 females, mean age of 47.4±14.1 years. 15 cases had previous surgeries for nonunion. 7 had active infection. duration of nonunion was 24.1±13.2 months. Mean duration of fixation was 5.7±1.0 months. Mean follow-up was 21.8±8.5 months. Mean AOFAS score improved from 52.4±3.7 preoperatively to 85.4±9.8 at the latest follow-up (P<0.001). Finally, the infection was resolved, and union was achieved in all patients. Bone results were excellent in 3 cases and good in 13, whereas functional results were excellent in 6 cases, good in 8, fair in 1, and poor in 1. Ilizarov fixator is a reliable option for treating nonunion in the periarticular distal tibial fractures. It provides secure fixation for short distal fragments, especially with history of infection, those with bad skin conditions, previous failed internal fixation, and osteopenic bone.

Level of Evidence:
Level IV.
Treatment of Hallux Valgus with Metatarsus Adductus
Authors: Tung Wei Shao , Eftekhari Mani , Miller Christopher P. 
Published: November 2023

Abstract:Metatarsus adductus is a common congenital foot deformity with an inward deviation of the forefoot occurring in the transverse plane of the foot. This article describes a minimally invasive approach using proximal metatarsal metaphyseal osteotomies to address the adduction of metatarsals at the tarsometatarsal joint complex. This approach offers possible advantages of minimally invasive surgery over open procedures in terms of outcomes, including lowered incidences of sagittal malunion, nonunion of the arthrodesis or metatarsal osteotomy, wound healing complications, and joint stiffness. Further research is warranted for the long-term outcomes of the procedure and how much of the deformity can be corrected.Level of Evidence:Level IV.
Antibiotics, Sedatives, and Catecholamines Further Compromise Sepsis-Induced Immune Suppression in Peripheral Blood Mononuclear Cells
Authors: Miller Muska , Melis Miranda J. , Miller James R.C. , Kleyman Anna , Shankar-Hari Manu , Singer Mervyn 
Published: November 2023

OBJECTIVES:
We hypothesized that the immunosuppressive effects associated with antibiotics, sedatives, and catecholamines amplify sepsis-associated immune suppression through mitochondrial dysfunction, and there is a cumulative effect when used in combination. We thus sought to determine the impact of the exemplar drugs ciprofloxacin, propofol, and norepinephrine, used alone and in combination, at clinically relevant concentrations, on the ex vivo functionality of peripheral blood mononuclear cells (PBMCs) drawn from healthy, infected, and septic individuals.

DESIGN:
In vitro/ex vivo investigation.

SETTING:
University laboratory.

SUBJECTS:
Healthy volunteers, infected (nonseptic) patients in the emergency department, and septic ICU patients.

INTERVENTIONS:
PBMCs were isolated from these subjects and treated with ciprofloxacin (100 µg/mL), propofol (50 µg/mL), norepinephrine (10 µg/mL), or all three drugs combined, with and without lipopolysaccharide (100 ng/mL) for 6 or 24 hours. Comparison was made between study groups and against untreated cells. Measurements were made of cell viability, cytokine production, phagocytosis, human leukocyte antigen-DR (HLA-DR) status, mitochondrial membrane potential, mitochondrial reactive oxygen species production, and oxygen consumption. Gene expression in immune and metabolic pathways was investigated in PBMCs sampled from healthy volunteers coincubated with septic serum.

MEASUREMENTS AND RESULTS:
Coincubation with each of the drugs reduced cytokine production and phagocytosis in PBMCs isolated from septic patients, and healthy volunteers coincubated with septic serum. No effect was seen on HLA-DR surface expression. No cumulative effects were seen with the drug combination. Sepsis-induced changes in gene expression and mitochondrial functionality were not further affected by addition of any of the drugs.

CONCLUSION:
Drugs commonly used in critical care lead to significant immune dysfunction ex vivo and enhance sepsis-associated immunosuppression. Further studies are required to identify underlying mechanisms and potential impact on patient outcomes.
The International Awareness of Breast Reconstruction
Authors: Alsubhi Fatema S. , Alothman Mohammed A. , Alhadlaq Abdulrahman I. 
Published: November 2023

Background:
To our knowledge, this is the first and largest study conducted to collect data among surgeons worldwide about breast reconstruction. We have aimed to collect data about breast reconstruction worldwide, the most popular breast reconstruction techniques, and the barriers behind the low rate of breast reconstruction according to surgeons.

Methodology:
A comparative cross-sectional design was used in this study. A prepared questionnaire, which was developed after reviewing the literature review conducted for this study, was used to collect data. The questionnaire is multiple choice. It was distributed among surgeons online.

Results:
The study includes 812 participants who live all over the world, representing 79 countries. More than a third of surgeons perform less than 10 breast reconstructions per year (33.38%), and 45.86% of them think that immediate surgery is the most frequent practice. A higher percentage of participants prefer implants over autologous reconstruction as a technique for breast reconstruction (54.9%). Moreover, 39.02% of participants shared that a lack of knowledge about the availability of breast reconstruction was a reason for refusing the surgery.

Conclusions:
This study demonstrates that the breast reconstruction rate is still low and that most surgeons prefer implants that are performed immediately. The lack of knowledge among patients about the availability of breast reconstruction is the most common reason for refusing reconstruction. Therefore, there is a need to increase patient awareness about the availability of this surgery.
The Use of Three Iliac Crest Muscles for Head and Neck Soft Tissue Reconstruction: Technical Note
Authors: Crêvecoeur Hervé , Nsimba-Bimwala Francis , Shimwa-Karengera Stéphane 
Published: November 2023

Summary:
This technical note describes a novel approach to reconstructing soft tissue in the head and neck region by diverting a flap originally intended for hard tissue reconstruction. We present a case of a 79-year-old woman with a large tumor on the left side of the mobile tongue, where the use of a radial free flap was challenging. Instead, we used the muscular portion of the iliac crest as a reliable alternative for reconstruction, offering a suitable oral lining. Using a muscular free flap, we achieved effective tongue reconstruction while minimizing donor site morbidity. The deep circumflex iliac artery muscular free flap demonstrates promising outcomes for large defects in the oral cavity and facial regions. However, a comprehensive case series with functional assessments and long-term follow-up is necessary to evaluate potential complications, such as hernia formation.
Extended Superior Dermoglandular Pedicle Approach: A Versatile Technique for a Variety of Breast Deformities
Authors: Aboul Wafa Ahmed Mabrouk 
Published: November 2023

Background:
Although the selected pedicle is important in how it maintains nipple viability and is of equal importance, it can be utilized with the remaining breast tissue to reshape the breast mound. It is ideally used as an extended pedicle, as it allows us to use the tissue in the lower pole of the breast. The purpose of this article was to evaluate additional indications and outcomes using the extended superior pedicle approach along with conventional techniques.

Methods:
This is a retrospective study over 5 years of using an extended superior dermoglandular pedicle approach for managing a variety of breast deformities. Postoperative complications, along with patient and surgeon satisfaction, were assessed.

Results:
All 68 patients expressed that the results were either excellent (85.3%) or very good (14.7%) according to the evaluation parameters. Among the 68 patients, there were 62 very good outcomes (91.2%) and six good outcomes (8.8%) according to surgeon evaluation. Only one reduction experienced a superficial partial loss, which was improved with no intervention. There was minor asymmetry in three patients (4.4%), which was not experienced by the patients, and poor scar quality in one dark-skinned patent.

Conclusions:
The author was able to expand the utility of extended superior pedicle for various breast deformities, such as reduction mammoplasty; mastopexy; augmentation mastopexy, either autoaugmentation or prosthetic; tuberous breast; after lumpectomy resection; and even in secondary breast deformities with reproducible and reliable outcomes across a wide patient population.
Immortalized Human Conjunctival Epithelial Cells Produce Functional Complement C3 and C4 Proteins
Authors: Ziemanski Jillian F. , Szalai Alexander J. 
Published: November 2023

Purpose:
The aim of this study was to assess whether complement proteins C3 and C4 are produced by immortalized human conjunctival epithelial (HCjE) cells.

Methods:
Supernatants and cell lysates from undifferentiated and differentiated HCjE cells were assayed for C3 and C4 by enzyme-linked immunosorbent assay. To measure complement protein function, supernatants and lysates were treated with heat-aggregated IgG, and soluble C5b-9 was measured.

Results:
C3 was upregulated in supernatants from differentiated HCjE cells compared with undifferentiated HCjE cells (556.55 ± 91.75 vs. 56.95 ± 12.09 ng/mL, P <0.001). C4 was also increased in supernatants but to a much lesser extent (0.599 ± 0.476 vs. 0.172 ± 0.0133 ng/mL, P = 0.03). From HCjE cell lysates, total C3 production was 9.03 times higher in differentiated HCjE cells (P <0.001), whereas total C4 remained relatively unchanged. After activation with heat-aggregated IgG, sC5b-9 could be detected from both undifferentiated and differentiated HCjE cell lysates, but not in the HCjE supernatants.

Conclusions:
HCjE cells produce C3 and C4 in sufficient quantities to support the formation of sC5b-9, confirming their biological activity and suggesting that HCjE cells likely produce all complement proteins C1 through C9.
Central Venous Catheter-related Bloodstream Infections Caused by Enterobacterales in Pediatric Oncology Patients: Catheter Salvage or Removal
Authors: van den Bosch Ceder H. , Kops Aranka L. , Loeffen Yvette G. T. , van der Steeg Alida F. W. , van de Wetering Marianne D. , Fiocco Marta F. , Ekkelenkamp Miquel B. , Wolfs Tom F. W. 
Published: November 2023

Background:
The aim was to determine whether salvage treatment with systemic antibiotics is a safe and effective strategy for Enterobacterales bloodstream infections (BSI) in pediatric oncology patients with a central venous catheter (CVC).

Methods:
A retrospective study was performed on oncology and stem cell recipient patients with a CVC and blood culture with Enterobacterales, at the Princess Máxima Centre for Pediatric Oncology, Utrecht, the Netherlands. Analyses were performed for all BSI and for episodes meeting central line-associated bloodstream infection (CLABSI) criteria. The cumulative incidence of an event (ie, removal, intensive care admission or death) was estimated after blood culture collection for episodes primarily treated with antibiotics. The effect of prognostic factors on the hazard of the event of interest was assessed by estimating a Cox proportional hazard regression model.

Results:
In total, 95 CVC-related Enterobacterales BSIs in 82 patients were included; 12 (13%) BSIs required immediate CVC removal and for 83 (87%) BSIs CVC salvage was attempted. The cumulative incidence of events at 60 days was 53.0% [95% confidence interval (CI): 41.7–63.1] for BSIs (n = 83), and 64.4% (95% CI: 48.3–76.7) for CLABSIs (n = 45). The events occurred after a median of 6 (Q1–Q3: 2–15) and 6 (Q1–Q3: 2–20) days for BSIs and CLABSIs, respectively. Intensive care admission after salvage treatment was required in 16% of the BSIs and CLABSIs, resulting in death in 5% and 2% of cases, respectively. No significant association between risk factors and events was found.

Conclusions:
The cumulative incidence of an event at 60 days after salvage treatment for Enterobacterales CLABSIs and BSIs in pediatric oncology patients is high. Immediate CVC removal appears recommendable for this patient group.