bluuebunny/crossref_metadata_2025_split huggingface dataset:
Breaking the Rules in Three Dimensions: What to Expect After a Thoracic-only Fusion With Structural Thoracic and Thoracolumbar Curves
Authors: Catanzano Anthony , Upasani Vidyadhar V. , Bryan Tracey P. , Yaszay Burt , Newton Peter O. ,   Harms Study Group
Published: December 2023

Objective:
Despite guidelines to fuse both thoracic and thoracolumbar/lumbar (TH/L) curves in patients with structural curves in both regions, a thoracic-only fusion allows preservation of lumbar motion segments. The purpose of this study was to assess the 2-year postoperative three-dimensional (3D) radiographic and clinical outcomes of patients with double or triple major (thoracic curves >TH/L curves) structural curves who underwent a thoracic-only fusion.

Methods:
A prospective adolescent idiopathic scoliosis registry was queried for double or triple major curves undergoing thoracic-only posterior fusion and a minimum 2-year follow-up. 3D reconstructions were generated from bi-planar radiographs. Paired sample t tests were used to assess differences in the coronal, sagittal, and axial planes pre and postoperatively, as well as Scoliosis Research Society Questionnaire–22 scores. Pearson correlations were utilized to identify variables related to spontaneous lumbar derotation.

Results:
Twenty-two patients met the inclusion criteria. Both thoracic [61 ± 10 degrees to 20 ± 9 degrees (P < 0.001)] and lumbar curves [41 ± 7 degrees to 22±7 degrees (P < 0.001)] had significant coronal improvement and T5 to T12 kyphosis improved from 7 ± 14 degrees to 23 ± 8 degrees (P < 0.001). The thoracic apical translation was significantly improved postoperatively (4.7 ± 1.5 to 0.5 ± 1 cm, P < 0.001), but the lumbar apical translation was unchanged (−1.7 ± 0.6 to −1.7±0.8 cm, P = 0.94). Scoliosis Research Society Questionnaire–22 scores significantly improved by 2 years postoperative.

Conclusions:
Unlike the 3D correction observed in nonstructural TH/L curves after thoracic-only fusion, patients with double or triple major curves demonstrated only spontaneous coronal correction of the lumbar curve, whereas the sagittal and axial planes were not significantly improved. These radiographic parameters did not negatively affect subjective or clinical outcomes at minimum 2-year follow-up.

Level of Evidence:
Level IV—therapeutic.
U-T Flap for Distal Symes Toe Amputation. A New Flap Adapted to Diabetic Ulcers of the Pulp of the Lesser Toes
Authors: Yammine Kaissar 
Published: December 2023

The surgical management of diabetic ulcers of the tip of the toes complicated with osteomyelitis of the distal phalanx usually consists of the excision of the bone and soft tissue using a distal Symes toe amputation. This surgery is usually conducted through 2 coronal flaps. When the ulcer is away from the nail or extends further on the plantar side of the pulp, wound closure could be difficult to achieve resulting in wound dehiscence. In addition, the remaining toe is often too short when compared with the neighboring digits. The objective of this surgical technique is to propose a new flap design that could be simple and easy to learn, mainly when dealing with small-to-moderate–sized wounds. The U-T flap is designed to reduce wound complications and yield better esthetics. We found the U-T flap to be a reproducible technique with better outcomes in terms of surgical wound healing and final toe length, after excision of distal infected toes.

Level of Evidence:
Diagnostic level 5—expert opinion. See Instructions for Authors for a complete description of levels of evidence.
Associations Between Inactivity and Cognitive Function in Older Intensive Care Unit Survivors
Authors: Elias Maya N. , Ahrens Emily A. , Schumacher Farah A. , Liang Zhan , Munro Cindy L. 
Published: December 2023

Background/Introduction
Critically ill older adults are profoundly inactive while in the intensive care unit (ICU), and this inactivity persists after discharge from the ICU. Older ICU survivors who were mechanically ventilated are at high risk for post-ICU cognitive impairment.

Objectives/Aims
The present study examined the relationship between the ratio of daytime to nighttime activity and executive function in older ICU survivors.

Methods
This was a secondary analysis of pooled data from 2 primary studies of older adults who were functionally independent prior to hospitalization, mechanically ventilated while in ICU, and within 24 to 48 hours post-ICU discharge. Actigraphy recorded daytime activity (mean activity counts per minute, 6 am to 9:59 pm) and nighttime activity (mean activity counts per minute, 10 pm to 5:59 am). A daytime-to-nighttime activity ratio was calculated by dividing daytime activity by nighttime activity. The NIH Toolbox Dimensional Change Card Sort Test assessed cognitive flexibility (DCCST: fully corrected T score). Multivariate regression examined the association between the daytime-to-nighttime activity ratio and DCCST scores, adjusting for 2 covariates (age in years and NIH Toolbox Grip Strength fully corrected T score).

Results
The mean daytime-to-nighttime activity ratio was 2.10 ± 1.17 (interquartile range, 1.42). Ratios for 6 participants (13.6%) were less than 1, revealing higher activity during nighttime hours rather than daytime hours. Higher daytime-to-nighttime ratios were associated with better DCCST scores (β = .364, P = .005).

Conclusions
The proportion of daytime activity versus nighttime activity was considerably low, indicating severe alterations in the rest/activity cycle. Higher daytime-to-nighttime activity ratios were associated with better executive function scores, suggesting that assessment of daytime activity could identify at-risk older ICU survivors during the early post-ICU transition period. Promotion of daytime activity and nighttime sleep may accelerate recovery and improve cognitive function.
Impact of COVID-19 on Quality of Life After Hospital Discharge in Patients Treated With Noninvasive Ventilation/Continuous Positive Airway Pressure
Authors: Bolgeo Tatiana , Di Matteo Roberta , Gatti Denise , Cassinari Antonella , Damico Vincenzo , Ruta Federico , Gambalunga Francesca , Maconi Antonio 
Published: December 2023

Background
COVID-19 has caused a worldwide pandemic that has significantly affected people's health and daily lives. Patients hospitalized with COVID-19 have impaired physical and psychological conditions. Despite this, few studies have examined the physical and psychological health of COVID-19 patients after discharge from the hospital.

Aims
To assess the impact of COVID-19 pneumonia on quality of life and residual disability, anxiety, and insomnia at 4 and 8 months after hospital discharge in patients treated with continuous positive airway pressure and noninvasive ventilation.

Methods
This is a prospective, multicenter, longitudinal observational study. The STROBE checklist was observed. We administered the Post–COVID-19 Functional Status scale to identify and objectively quantify the degree of residual disability and the impact on the patient's functional status. Simultaneously, we used the EuroQOL-5D scale to measure the quality of life, the 7-item Generalized Anxiety Disorder Scale to monitor anxiety, and the Insomnia Severity Index to monitor insomnia.

Results
The study enrolled 199 patients 4 months after discharge; 145 completed the 8-month follow-up. The quality of life, insomnia, pain, and movement ability seem to worsen over time in our cohort of patients. The quality of life deteriorated significantly between 4 and 8 months after discharge especially in terms of mobility (27.6% of the patients interviewed) and pain (31% of the patients interviewed). There was a significant correlation between COVID-19 symptoms and comorbidities present at admission and inadequate quality-of-life perception.

Discussion
The recognition of early signs and symptoms in patients who have already experienced COVID-19 disease is essential for early detection and prevention of chronicity. Health care professionals need to pay more attention to the physical and psychological rehabilitation of COVID-19 patients after hospital discharge. To determine the long-term impacts of COVID-19, a long-term follow-up of COVID-19 patients after discharge is required.
Longitudinal Analysis of Local Recurrence and Survival After Transanal Abdominal Transanal Radical Proctosigmoidectomy for Low Rectal Cancer Treated With Neoadjuvant Chemoradiation
Authors: Marks John H. , Reif de Paula Thais , Saidi Hela , Ikner Taylor P , Schoonyoung Henry , Marks Gerald , Keller Deborah S 
Published: December 2023

BACKGROUND:
The transanal abdominal transanal radical proctosigmoidectomy was developed in 1984 as a sphincter preservation surgery in low rectal cancers after preoperative radiation. While serving as a catalyst for disruptive sphincter preservation surgery, it continues to be used and evolve. With the controversy over safety and local recurrence in other sphincter preserving surgery, review of transanal abdominal transanal radical proctosigmoidectomy long-term oncologic outcomes is warranted.

OBJECTIVE:
To assess local after transanal abdominal transanal radical proctosigmoidectomy after neoadjuvant chemoradiation.

DESIGN:
Retrospective cohort study of a prospectively maintained database.

SETTINGS:
Tertiary rectal cancer referral center.

PATIENTS:
Low adenocarcinoma (≤5 cm anorectal ring) receiving neoadjuvant chemoradiation then transanal abdominal transanal radical proctosigmoidectomy for curative resection between 1998-2021.

MAIN OUTCOME MEASURES:
Local recurrence rates and overall survival rates.

RESULTS:
Of 255 included, 67.8% were male (n = 173), mean 58.7 years old (standard deviation 11.5), with mean body mass index 27.1 kg/m2 (standard deviation, 5.4) and 50.2% (n = 128) American Society of Anesthesiology II. The mean tumor size was 4.8 cm (standard deviation 1.9), majority clinical T3 (81.8%, n = 184) and 52.1% had nodal disease (n = 100). The median radiation dose was 5400 cGy, with 73.7% (n = 149) achieving good response. 90.2% (n = 230) had minimally invasive surgery. Complete total mesorectal excision rate was 94.3% (n = 83/87) and 100% (n = 255) had negative distal margins. The mean examined lymph nodes were 13.9 (standard deviation, 10.7). After median follow-up of 55.4 months, 5.1% (n = 13) patients developed local recurrence, at median time of 29.6 months. The 5-year overall survival was 84.1% (95% CI 78.8-89.4).

LIMITATIONS:
Retrospective review with risk of bias and lack of generalizability.

CONCLUSIONS:
In this longitudinal study, the transanal abdominal transanal radical proctosigmoidectomy demonstrated excellent long-term locoregional control and survival in very low rectal cancers. The superior transanal abdominal transanal radical proctosigmoidectomy outcomes are durable over time, warranting expansion of the sphincter preserving surgery technique.
Localization of Central Breast Lymphatics and Predefined Separation of Lobes along the Horizontal Septum
Authors: Würinger Elisabeth 
Published: December 2023

Background:
The predictable localization of the neurovascular supply along the ligamentous suspension, composed of the horizontal septum, vertical ligaments, and superficial fascia, has increased safety in breast reduction. Lymphatic drainage of the breast has always been described as running close to vascular supply. However, the correlation between the lymphatic course and ligamentous suspension has not yet been considered. This study aimed to visualize the relationship, direction of lymphatic flow, and predefined separation of lobes along the horizontal septum.

Methods:
To investigate central drainage, methylene blue was injected subareolarly in five breasts of female cadavers before blunt preparation of the horizontal septum in anatomical studies. To visualize central and peripheral drainage, lymphographin was injected into one of the three different sites in 14 breasts; the dynamic flow of drainage was observed during subsequent septum-based breast reductions in clinical settings.

Results:
In all anatomical studies, a predefined section of the glandular layers allowed access to central clearance along the stained horizontal septum. Clinical investigations similarly showed clearance along the corresponding part of the ligamentous suspension, most reliably along the horizontal septum. The affected quadrant of the breast, its relation to the nipple-areola complex, and the anterior-posterior axis toward the thoracic wall mainly determine the direction of lymphatic flow. Interconnections along the ligaments may explain the unpredictability of final clearance directions.

Conclusions:
This study shows the horizontal septum as a guiding structure for central mammary drainage. This may encourage a septum-based approach for refinement of procedures such as oncoplastic, irradiation, and lymphedema treatments.
Quantifying Improvement in V˙o 2peak and Exercise Thresholds in Cardiovascular Disease Using Reliable Change Indices
Authors: Faricier Robin , Keltz Randi R. , Hartley Tim , McKelvie Robert S. , Suskin Neville G. , Prior Peter L. , Keir Daniel A. 
Published: December 2023

Purpose:
Improving aerobic fitness through exercise training is recommended for the treatment of cardiovascular disease (CVD). However, strong justifications for the criteria of assessing improvement in key parameters of aerobic function including estimated lactate threshold (θLT), respiratory compensation point (RCP), and peak oxygen uptake (V˙o
2peak) at the individual level are not established. We applied reliable change index (RCI) statistics to determine minimal meaningful change (MMCRCI) cutoffs of θLT, RCP, and V˙o
2peak for individual patients with CVD.

Methods:
Sixty-six stable patients post-cardiac event performed three exhaustive treadmill-based incremental exercise tests (modified Bruce) ∼1 wk apart (T1-T3). Breath-by-breath gas exchange and ventilatory variables were measured by metabolic cart and used to identify θLT, RCP, and V˙o
2peak. Using test-retest reliability and mean difference scores to estimate error and test practice/exposure, respectively, MMCRCI values were calculated for V˙o
2 (mL·min−1.kg−1) at θLT, RCP, and V˙o
2peak.

Results:
There were no significant between-trial differences in V˙o
2 at θLT (P = .78), RCP (P = .08), or V˙o
2peak (P = .74) and each variable exhibited excellent test-retest variability (intraclass correlation: 0.97, 0.98, and 0.99; coefficient of variation: 6.5, 5.4, and 4.9% for θLT, RCP, and V˙o
2peak, respectively). Derived from comparing T1-T2, T1-T3, and T2-T3, the MMCRCI for θLT were 3.91, 3.56, and 2.64 mL·min−1.kg−1; 4.01, 2.80, and 2.79 mL·min−1.kg−1 for RCP; and 3.61, 3.83, and 2.81 mL·min−1.kg−1 for V˙o
2peak. For each variable, MMCRCI scores were lowest for T2-T3 comparisons.

Conclusion:
These MMCRCI scores may be used to establish cutoff criteria for determining meaningful changes for interventions designed to improve aerobic function in individuals with CVD.
Broad Vitreomacular Attachment Induced Macular Hole: Structural Changes and Surgical Outcome
Authors: Cheng Chia-Yi , Hsieh Yi-Ting , Yang Chung-May 
Published: December 2023

Purpose:This study aims to describe the structural changes and surgical outcomes of full-thickness macular holes (FTMHs) induced by vitreomacular traction (VMT) with broad vitreomacular attachment (VMA).Methods:A retrospective analysis of idiopathic FTMHs from October 2010 to May 2022 was conducted. Patients with FTMHs and no retinal detachment (RD) induced by broad VMA (the study group) were compared to a control group consisting of typical FTMHs with focal VMA.Results:31 eyes had broad VMA associated FTMH and among which 7 eyes (22%) were with concurrent RD. Among the total of 24 cases without RD, 8 (33%) exhibited schisis. The incidence of lamellar holes associated epithelial proliferation (LHEP) and multiple membrane traction was significantly higher in the study group. 100% FTMH closure was observed postoperatively in both groups. While the postoperative visual acuity was not significantly different, the study group showed greater ellipsoid zone disruption length.Conclusion:Broad VMA-induced FTMHs are characterized by diverse macular structural changes, including schisis and macular detachment. These FTMHs are associated with a higher incidence of LHEP and multiple membrane traction. Surgical outcomes for FTMHs induced by broad VMA are similar to those induced by typical focal VMA, with both groups demonstrating a 100% hole closure rate.
US nurse practitioner voluntary turnover: Development of a framework for analysis
Authors: Strobehn Patricia K. , Barnes Hilary , Bellury Lanell M. , Randolph Justus J. 
Published: December 2023

ABSTRACT

Background:
There is growing interest in nurse practitioner (NP) turnover with some reports indicating it is as high as 15% annually. However, there is a lack of generalizability and other conceptual weaknesses in the literature. These weaknesses support the development of a framework to operationalize NP turnover for administrators to develop workplace initiatives to reduce turnover.

Purpose:
To describe the demographic and job characteristics of four NP voluntary turnover groups (i.e., dynamic leavers, static leavers, dynamic stayers, and static stayers) representing voluntary turnover intention and actual turnover among US NPs.

Methodology:
A cross-sectional, descriptive secondary analysis of NPs (N = 86,632) from the 2018 National Sample Survey of Registered Nurses (NSSRN) was used to delineate and describe four NP voluntary turnover groups.

Results:
Nurse practitioners who left nursing (static leavers) were older and had the most work experience. Nurse practitioners who changed jobs and stayed in nursing (dynamic leavers) were younger, less experienced, and reported the least job satisfaction. Nurse practitioners who remained in their positions (stayers) regardless of whether they reported turnover intentions or not earned the most and reported the most job satisfaction.

Conclusions:
Four NP voluntary turnover groups were defined and described to distinguish voluntary turnover intentions from actual turnover.

Implications:
Characterizing NP voluntary turnover can help administrators mitigate losses and project organizational needs associated with NP turnover. A framework developed from the 2018 NSSRN can be used to research and develop key initiatives to strengthen the NP workforce.
Diversity, Equity, and Inclusion Curriculum Embedded in a Physical Medicine and Rehabilitation Residency Program
Authors: Nnoromele Chinenye C. , Chen Ya-Ting , Olezene Cameron S. , Blauwet Cheri A. , Brady Wagner Lynne C. , Katz Nicole B. , Hunter Tracey , Silver Julie K. 
Published: December 2023

ABSTRACT
Diversity, Equity, and Inclusion (DEI) initiatives are continuing to have increased importance in medical training, including rehabilitation medicine. Although resident-led curricula have been integrated into medical education in other training programs, to our knowledge, this the first report focusing on integrating these topics into resident education for a Physical Medicine and Rehabilitation (PM&R) program. We created a didactic curriculum for our rehabilitation residents that included: quarterly lectures on DEI topics followed by small group discussions. Each session also included an article that was included in the discussion. The sessions utilized both anonymous pre and post-survey data to assess the efficacy of our initiative. Our initial data showed that our quarterly sessions created a safe and comfortable environment for discussing DEI topics. In addition, our session specific data supported that increased awareness of DEI disparities with rehabilitation and medicine was achieved. Our committee used the data and feedback to create further iterations of this initiative within our program, and we believe that this is a model that can be adopted by other PM&R residencies.
Post-ERCP Pancreatitis Risk Factors: Is Post-Sphincterotomy Bleeding Another Risk Factor?
Authors: Altunpak Burak , Aydin Husnu , Cebi Fevzi , Seyit Hakan , Kones Osman , Akarsu Cevher , Kabuli Hamit , Gumusoglu Alpen , Karabulut Mehmet 
Published: December 2023

Background:
Despite advancements in technology and expertise, ERCP carries risks of significant complications, such as pancreatitis, bleeding, and perforation. Post-ERCP pancreatitis is the most common and important complication following ERCP. In our study, we aimed to examine the relationship between patient and procedure-related parameters and the development of pancreatitis.

Methods:
Four hundred patients who underwent ERCP between January 1, 2019 and December 31, 2020, at the General Surgery Clinic of the Bakirköy Dr. Sadi Konuk Health Application and Research Center of the University of Health Sciences Faculty of Medicine were retrospectively evaluated. Patient and procedure-related factors were analyzed statistically through univariate and multivariate analyses.

Results:
Age, urgent indication, ERCP history, cholangitis, precut sphincterotomy, common bile duct diameter, pancreatic cannulation, pancreatic stent, and bleeding were statistically significant risk factors for post-ERCP pancreatitis (+). In multivariate analysis, the effects of urgent indication, ERCP history, cholangitis, precut sphincterotomy, common bile duct diameter, and pancreatic cannulation on post-ERCP pancreatitis were statistically significant risk factors (P<0.05).

Discussion:
This study demonstrates that emergency indication, ERCP history, cholangitis, precut sphincterotomy, and pancreatic cannulation are significant risk factors for the development of post- ERCP pancreatitis. One notable contribution of our study to the existing literature is the unique analysis of post-sphincterotomy bleeding as an independent factor.
Comprehensive Genomic Features indicative for Notch Responsiveness
Authors: Giaimo Benedetto Daniele , Friedrich Tobias , Ferrante Francesca , Bartkuhn Marek , Borggrefe Tilman 
Published: December 2023

ABSTRACTTranscriptional specificity is often determined by transcription factor levels and/or chromatin context. In the Notch signal transduction pathway, transcription factor RBPJ is the central component and directly forms a coactivator complex together with the Notch intracellular domain (NICD). While the RBPJ protein levels remain constant in most tissues, dynamic expression of Notch target genes varies depending on the given cell-type and the Notch activity state. To elucidate dynamic RBPJ binding genome-wide, we investigated RBPJ occupancy by ChIP-Seq making use of Notch-dependent T cells. Surprisingly, only a small set of the total RBPJ sites show a dynamic binding behavior in response to Notch signaling. Compared to static RBPJ sites, dynamic sites differ in regard to their chromatin state, binding strength and enhancer positioning. Dynamic RBPJ sites are predominantly located distal to transcriptional start sites (TSS), while most static sites are found in promoter-proximal regions. Importantly, gene responsiveness is preferentially associated with dynamic RBPJ binding sites and this static and dynamic binding behavior is repeatedly observed in different cell types and species. Based on the above findings we used a machine-learning algorithm to predict Notch responsiveness with high confidence in different cellular contexts. This approach is potentially applicable to other transcription factors regulating signal-induced gene sets. Our results strongly support the notion that the combination of binding strength and enhancer positioning are indicative of Notch responsiveness.