bluuebunny/crossref_metadata_2025_split huggingface dataset:
Changes in endothelial cell density after conventional phacoemulsification and FLACS in eyes with dense cataracts
Authors: Ganesh Sri , Brar Sheetal , Wadhokar Sanjali 
Published: January 2024

Purpose:
To compare the safety, effectiveness, and changes in endothelial cell density (ECD) after standard phacoemulsification and femtosecond laser-assisted cataract surgery (FLACS) in dense cataracts (Lens Opacities Classification System III grade 3.0 NO and above).

Setting:
Nethradhama Superspeciality Eye Hospital, Bangalore, India.

Design:
Prospective, randomized, comparative study.

Method:
100 eyes of 100 patients were randomly assigned to either conventional phacoemulsification surgery (CPS) or FLACS (LENSAR Laser System) using predefined patterns of nuclear fragmentations. Measured outcomes included intraoperative phacoemulsification time, irrigation fluid volume, surgical time, and complication rates. ECD was evaluated at baseline, 2 weeks, and 6 months postoperatively.

Results:
The CPS group had significantly higher mean total phacoemulsification time (11.17 ± 6.5 seconds vs 8.03 ± 3.77 seconds), effective phacoemulsification time (6.14 ± 3.62 seconds vs 4.42 ± 2.07 seconds), and total surgical time (8.18 ± 2.36 minutes vs 7.11 ± 1.55 minutes) than the FLACS group (P < .001). Volume of irrigation fluid was comparable between the 2 groups (CPS, 36.7 ± 12.18 mL; FLACS, 38.64 ± 13.73 mL (P = .45). Mean corneal edema score and central corneal thickness values on postoperative day 1 were significantly higher for the CPS group. At 6 months, % ECD loss was significantly higher in the CPS group (16.08%) vs the FLACS group (12.8%) (P < .001). 3 eyes in the CPS group had wound burns of varying severity.

Conclusions:
FLACS with customized nuclear fragmentation patterns resulted in significantly less intraoperative phacoemulsification time, surgical time, and endothelial cell loss compared with conventional phacoemulsification when treating dense cataracts.

Trial Registration Number:
CTRI/2021/12/038887.
Confronting mental health stigma in Haitian Americans suffering from mental health challenges
Authors: Moreau Marie M. , Love Rene A. , Fanfan Dany 
Published: January 2024

ABSTRACT

Background:
Haitian Americans have been disproportionately exposed to risk factors known to play a significant role in the development of mental illness. Yet despite the documented effectiveness of mental health treatment, a high proportion of Haitian Americans with mental health disorders have not received care.

Local problem:
Internalized stigma of mental illness (ISMI) was reported as one of the primary reasons Haitian Americans do not seek help for mental illnesses, resulting in poor long-term outcomes for individuals and families in this community. This quality improvement project characterized ISMI among Haitian Americans, examined associated demographic factors, and tested the impact of a culturally relevant ISMI educational video intervention on willingness to seek mental health treatment.

Methods:
Haitian Americans who self-reported mental illness (N = 20) were recruited from a South Florida clinic. Descriptive statistics, correlations, and thematic analyses were completed to analyze the data.

Interventions:
Participants completed the nine-item ISMI scale, watched an educational video about ISMI, completed a post-intervention survey, and engaged in conversations about mental health and ISMI.

Results:
Sixty-five percent of participants reported mild levels of ISMI. Sex was significantly correlated with ISMI (r = −0.458, p = .042); male participants experienced higher levels of ISMI. The educational video improved participants' knowledge of ISMI, and 85% indicated increased willingness to seek treatment.

Conclusions:
When caring for Haitian Americans with mental illnesses, nurse practitioners should initiate conversations about ISMI, consider gender differences in mental illness beliefs and attitudes, and provide culturally responsive psychoeducational interventions to promote more mental health treatment utilization.
Estimation of Cochlear Implant Insertion Depth Using 2D-3D Registration of Postoperative X-Ray and Preoperative CT Images
Authors: Liu George S. , Cooperman Shayna P. , Neves Caio A. , Blevins Nikolas H. 
Published: January 2024

Objective
To improve estimation of cochlear implant (CI) insertion depth in postoperative skull x-rays using synthesized information from preoperative CT scans.

Study Design
Retrospective cohort.

Setting
Tertiary referral center.

Patients
Ten adult cochlear implant recipients with preoperative and postoperative temporal bone computed tomography (CT)scans and postoperative skull x-ray imaging.

Interventions
Postoperative x-rays and digitally reconstructed radiographs (DRR) from preoperative CTs were registered using 3D Slicer and MATLAB to enhance localization of the round window and modiolus. Angular insertion depth (AID) was estimated in unmodified and registration-enhanced x-rays and DRRs in the cochlear view. Linear insertion depth (LID) was estimated in registered images by two methods that localized the proximal CI electrode or segmented the cochlea. Ground truth assessments were made in postoperative CTs.

Main Outcome Measure(s)
Errors of insertion depth estimates were calculated relative to ground truth measurements and compared with paired t tests. Pearson correlation coefficient was used to assess inter-rater reliability of two reviewer’s measurements of AID in unmodified x-rays.

Results
In postoperative x-rays, AID estimation errors were similar with and without registration enhancement (−1.3 ± 20.7° and −4.8 ± 24.9°, respectively; mean ± SD; p = 0.6). AID estimation in unmodified x-rays demonstrated strong interrater agreement (ρ = 0.79, p < 0.05) and interrater differences (−15.0 ± 35.3°) comparable to estimate errors. Registering images allowed measurement of AID in the cochlear view with estimation errors of 14.6 ± 30.6° and measurement of LID, with estimate errors that were similar between proximal electrode localization and cochlear segmentation methods (−0.9 ± 2.2 mm and −2.1 ± 2.7 mm, respectively; p = 0.3).

Conclusions
2D-3D image registration allows measurement of AID in the cochlear view and LID using postoperative x-rays and preoperative CT imaging. The use of this technique may reduce the need for postimplantation CT studies to assess these metrics of CI electrode position. Further work is needed to improve the accuracy of AID assessment in the postoperative x-ray view with registered images compared with established methods.
Intracochlear Trauma and Local Ossification Patterns Differ Between Straight and Precurved Cochlear Implant Electrodes
Authors: Geerardyn Alexander , Zhu MengYu , Verhaert Nicolas , Quesnel Alicia M. 
Published: January 2024

HypothesisTrauma to the osseous spiral lamina (OSL) or spiral ligament (SL) during cochlear implant (CI) insertion segregates with electrode type and induces localized intracochlear ossification and fibrosis.BackgroundThe goal of atraumatic CI insertion is to preserve intracochlear structures, limit reactive intracochlear tissue formation, and preserve residual hearing. Previous qualitative studies hypothesized a localized effect of trauma on intracochlear tissue formation; however, quantitative studies failed to confirm this.MethodsInsertional trauma beyond the immediate insertion site was histologically assessed in 21 human temporal bones with a CI. Three-dimensional reconstructions were generated and virtually resectioned perpendicular to the cochlear spiral at high resolution. The cochlear volume occupied by ossification or fibrosis was determined at the midpoint of the trauma and compared with regions proximal and distal to this point.ResultsSeven cases, all implanted with precurved electrodes, showed an OSL fracture beyond the immediate insertion site. Significantly more intracochlear ossification was observed at the midpoint of the OSL fracture, compared with the −26 to −18 degrees proximal and 28 to 56 degrees distal to the center. No such pattern was observed for fibrosis. In the 12 cases with a perforation of the SL (9 straight and 3 precurved electrodes), no localized pattern of ossification or fibrosis was observed around these perforations.ConclusionOSL fractures were observed exclusively with precurved electrodes in this study and may serve as a nidus for localized intracochlear ossification. Perforation of the SL, in contrast, predominantly occurred with straight electrodes and was not associated with localized ossification.
Foreign body in lung: a case report
Authors: Tolba Mohamed A. , Farhat Youssef Z. , Mohamad Anwar , Sedkey John A. 
Published: January 2024

Introduction:
The presence of a metal foreign body (FB) in the lungs can be a major contributor to pulmonary embolism. FB pulmonary embolism is a rare condition and difficult to diagnose due to its variable clinical presentations.

Case Presentation:
This article presents a case of a 34-year-old male presented to our emergency department after getting injured with a FB fragment entering the upper right thigh. Plain X-ray proved the presence of the FB and patient was admitted to surgical extraction. However, the FB disappeared with the first attempt to reposition the patient. Then, the patient underwent a chest computed tomography (CT) without contrast that revealed the presence of the FB in the heart with a characteristic finding of a starburst appearance. Then the patient was transferred to the Catheter lab. But cardiologists did not find the FB inside the heart. Another chest CT scan was done that showed the FB in the right lower pulmonary artery. Then patient was transferred to the cardio-thoracic surgery department that decided not to remove the FB and just follow-up.

Discussion:
There are many cases of metal FB lodged in the vascular system. In this case, CT scan had been performed to the FB helped to take the appropriate decision before the FB causes damage to any vital organ.

Conclusion:
FB traveling through the vascular system can cause a pulmonary embolism. In our case, the time the FB took to reach the pulmonary arteries was merely few hours. However, appropriate management could help steer the patient away from danger.
Combination of Mifepristone and Misoprostol for First-Trimester Medical Abortion: A Comprehensive Review of the Literature
Authors: Kelesidou Vera , Tsakiridis Ioannis , Virgiliou Andriana , Dagklis Themistoklis , Mamopoulos Apostolos , Athanasiadis Apostolos , Kalogiannidis Ioannis 
Published: January 2024

ABSTRACT

Importance
Several medications have been used to achieve medical abortion in the first trimester of pregnancy. The most commonly used is the combination of mifepristone and misoprostol; however, different doses and routes of administration have been proposed.

Objective
The aim of this study was to summarize published data on the effectiveness, adverse effects, and acceptability of the various combinations of mifepristone and misoprostol in medical abortion protocols in the first trimester of pregnancy.

Evidence Acquisition
This was a comprehensive review, synthesizing the findings of the literature on the current use of mifepristone and misoprostol for first-trimester abortion.

Results
The combination of mifepristone and misoprostol seems to be more effective than misoprostol alone. Regarding the dosages and routes, mifepristone is administered orally, and the optimal dose is 200 mg. The route of administration of misoprostol varies; the sublingual and buccal routes are more effective; however, the vaginal route (800 μg) is associated with fewer adverse effects. Finally, the acceptability rates did not differ significantly.

Conclusions
Different schemes for first-trimester medical abortion have been described so far. Future research needs to focus on identifying the method that offers the best trade-off between efficacy and safety in first-trimester medical abortion.

Target Audience
Obstetricians and gynecologists, family physicians

Learning Objectives
After participating in this activity, the learner should be better able to discuss available combinations of mifepristone and misoprostol for first-trimester medical abortion; describe the recommended doses of misoprostol for first-trimester medical abortion; and assess the adverse effects caused by misoprostol when administered by different routes.
Low-Grade Serous Ovarian Cancer: Expert Consensus Report on the State of the Science
Authors: Grisham Rachel N. , Slomovitz Brian M. , Andrews Nicole , Banerjee Susana , Brown Jubilee , Carey Mark S. , Chui Herman , Coleman Robert L. , Fader Amanda N. , Gaillard Stephanie , Gourley Charlie , Sood Anil K. , Monk Bradley J. , Moore Kathleen N. , Ray-Coquard Isabelle , Shih Le-Ming , Westin Shannon N. , Wong Kwang-Kwok , Gershenson David M. 
Published: January 2024

(Abstracted from Int J Gynecol Cancer 2023;0:1–14)
Low-grade serous carcinoma represents less than 10% of epithelial ovarian cancers, is often diagnosed in younger women, and is associated with prolonged survival relative to high-grade serous carcinoma. In 2019, a panel of experts gathered to address the unique needs of low-grade serous carcinoma management and published a consensus paper.
Surgical Anatomy of the Clitoris and Surrounding Vulvar Structures
Authors: Tappy Erryn , Corton Marlene 
Published: January 2024

(Abstracted from Am J Obstet Gynecol 2023;229(4):460–462)
During periurethral and vulvar procedures, thorough knowledge of clitoral anatomy is imperative to ensure the preservation of the autonomic and somatic nerves. This reduces chances of postoperative clitoral pain, sexual dysfunction, and decreased sensation, as entrapment and compression of these nerves during surgical procedures have been observed to likely cause such dysfunction.
Fetal Heart Rate Responses in Chronic Hypoxaemia With Superimposed Repeated Hypoxaemia Consistent With Early Labour: A Controlled Study in Fetal Sheep
Authors: Lear C. A. , Georgieva A. , Beacom M. J. , Wassink G. , Dhillon S. K. , Lear B. A. , Mills O. J. , Westgate J. A. , Bennet L. , Gunn A. J. 
Published: January 2024

(Abstracted from BJOG 2023;130:881–890)
The fetal heart rate is a powerful indicator of overall fetal well-being. In recent years, there has been the development of evaluation approaches of the fetal heart rate tracing such as deceleration area (DA) and capacity (DC).
Immunohistochemical Expression of Epidermal Growth Factor Receptor (EGFR) in Oral Squamous Cell Carcinoma and Oral Potentially Malignant Disorders
Authors: Aamir Razia , Rauf Fozia , Iqbal Fatima , Yousuf Sarah , Rehman Asif , Sheikh Ahmareen K. , Muhammad Sardar 
Published: January 2024

Background:
Increased epidermal growth factor receptor (EGFR) expression has been implicated in several tumors and is associated with increased tumor advancement as well as a potential drug target. The objective of the study was to compare the immunohistochemical expression of EGFR in oral squamous cell carcinoma (OSCC) with oral potentially malignant disorders (OPMDs) and their demographic and pathologic parameters.

Methods:
This study was a comparative cross-sectional analytical study. It was conducted at the Department of Pathology, Peshawar Medical College, Riphah International University, Islamabad, Pakistan, from March 2021 to February 2022. The sample size was calculated through G Power. Thirty-eight cases of oral squamous cell carcinoma and 38 cases of oral potentially malignant disorders (OPMDs) were included in the study. Statistical analysis was performed using the Statistical Package for Social Sciences version 20.0. χ2 tests and Fisher exact tests were applied to compare categorical variables.

Results:
Mean age of OSCC was 61.6±13.9, with age range from 26 to 90 years. The male-to-female ratio for OSCC was 2.16:1. Buccal mucosa was the most common site involved (34.2%). The most common histologic type was well-differentiated OSCC (71.05%) followed by poorly differentiated (16%) and moderately differentiated (13.15%). The mean age of OPMDs cases was 59.16 ± 10.81 with a male-to-female ratio of 1:1.2. Buccal mucosa was the common site (55.3%), followed by the tongue (18.4%). The OPMDs with dysplasia were 55.2%, and without dysplasia were 44.8%. A total of 55.7% of cases of OSCC showed positive EGFR expression as compared with 36.9% OPMDs cases. A higher number of low-grade OSCC cases showed increased EGFR positivity (59.3%) as compared with high grade (45.45%). EGFR positivity in OPMD cases without dysplasia was 41.2% as compared with cases with dysplasia (33.3%). The EGFR expression in OPMD cases was higher in the ≤50 age group (P=0.001) and in females (P=0.032), which was statistically significant.

Conclusions:
EGFR expression by Immunohistochemistry may not be a helpful prognostic marker to determine the risk of OPMDs progressing to higher grades of dysplasia or invasive cancer. However, further studies relating this tumor marker to stage, lymph node metastasis, hematogenous metastasis, survival outcomes, and treatment response may give useful information regarding the utility of this marker.
Reliability and Accuracy of the Pediatric Swiss Emergency Triage Scale—the SETSped Study
Authors: Fehlmann Christophe A. , Garcin Sophie , Poncet Antoine , Marti Christophe , Rutschmann Olivier T. , Brandle Gabriel , Faundez Tamara , Simon Josette , Delieutraz Tatiana , Grosgurin Olivier 
Published: January 2024

Background and Importance
The Swiss Emergency Triage Scale (SETS) is an adult triage tool used in several emergency departments. It has been recently adapted to the pediatric population but, before advocating for its use, performance assessment of this tool is needed.

Objectives
The purpose of this study was to assess the reliability and the accuracy of the pediatric version of the SETS for the triage of pediatric patients.

Design, Setting, and Participants
This study was a cross-sectional study among a sample of emergency triage nurses (ETNs) exposed to 17 clinical scenarios using a computerized simulator.

Outcome Measures and Analysis
The primary outcome was the reliability of the triage level performed by the ETNs. It was assessed using an intraclass correlation coefficient.
Secondary outcomes included accuracy of triage compared with expert-based triage levels and factors associated with accurate triage.

Main Results
Eighteen ETNs participated in the study and completed the evaluation of all scenarios, for a total of 306 triage decisions. The intraclass correlation coefficient was 0.80 (95% confidence interval, 0.69–0.91), with an agreement by scenario ranging from 61.1% to 100%. The overall accuracy was 85.8%, and nurses were more likely to undertriage (16.0%) than to overtriage (4.3%). No factor for accurate triage was identified.

Conclusions
This simulator-based study showed that the SETS is reliable and accurate among a pediatric population. Future research is needed to confirm these results, compare this triage scale head-to-head with other recognized international tools, and study the SETSped in real-life setting.
Development of a Pharmacy Point-of-Dispensing Toolkit for Anthrax Post-Exposure Prophylaxis for Allegheny County Postal Workers
Authors: Schneider Sarah N. , Nguyen Thai Q. , Hake Kelsey L. , Nightingale Barbara S. , Mangan Thomas P. , Rice Amanda N. , Carroll Joni C. 
Published: January 2024

Context:
The Centers for Disease Control and Prevention (CDC) and the US Postal Service (USPS) consider anthrax to be a potential threat to USPS workers. A county health department–owned pharmacy supports local USPS response in the event of an exposure. The pharmacy team identified the need to review and update the local anthrax response plan.

Program/Policy:
A Pharmacy Point-of-Dispensing Toolkit and response plan for initial 10-day post-exposure antibiotic prophylaxis was developed for use by a local health department in the event of a mass anthrax exposure at a US Post Office sorting facility. The pharmacist's role in medical countermeasures planning for anthrax exposure is also discussed to illustrate how pharmacists' medication expertise can be utilized.

Evaluation:
The CDC's Public Health Preparedness Capabilities: National Standards for State and Local Planning framework and inputs from an interprofessional stakeholder team were used to develop a Medical Countermeasures Response Plan and Implementation Toolkit for mass point-of-dispensing (POD) in the event of an anthrax exposure.

Implementation and Dissemination:
Stakeholders attended a USPS Community Partner Training event where additional revisions to the toolkit were made. The toolkit and standing order are now implemented at the local health department to be reviewed and updated on a yearly basis by health department leadership.

Discussion:
Pharmacists can use their medication expertise and experience with patient education to design emergency response plans focused on increasing patient safety and medication adherence. Pharmacists should be involved in emergency response and medical countermeasures planning that involve medications.
Mother-to-Child Transmission of HBV Infection by Preventive Interventions in Southern Vietnam's Hospitals
Authors: Hoang Quoc Cuong , Nguyen Minh Ngoc , Nguyen Thi Thu Huong , Nguyen Mong Hoai Thu , Ha Thi Bich Ngoc , Nguyen Viet Thinh , Nguyen Thuong Vu , Tran Ngoc Huu 
Published: January 2024

Introduction:
The World Health Organization (WHO) recommends tenofovir disoproxil fumarate (TDF) for pregnant women with hepatitis B virus (HBV) presenting with HBV DNA levels of 106 copies/mL or more to hinder mother-to-child transmission (MTCT). Moreover, it is suggested that neonates of HBV-infected mothers receive an HBV vaccine birth dose within 24 hours of birth to mitigate transmission risk.

Methodology:
The study included 661 HBV-infected pregnant women and 316 infants from 3 hospitals in Southern Vietnam between October 2019 and November 2020. Infants were classified on the basis of their mothers' TDF prophylaxis into I-TDF (+) group (107 infants) whose mothers received TDF; I-TDF (−) group (56 infants) whose mothers missed TDF; and I-NTDF group (153 infants) whose mothers did not necessitate TDF. Almost all infants received an HBV vaccine birth dose with HBIG administered on the basis of parents' financial standing.

Results:
MTCT was found in 2.2% of the cases. The respective MTCT rates for I-TDF (+), I-TDF (−), and I-NTDF groups were 2.8%, 5.4%, and 0.7%. Immune response rates to the HBV vaccination in the total cohort, I-TDF (+), I-TDF (−), and I-NTDF groups, were 88.6%, 87.9%, 85.7%, and 90.2%, respectively. Vaccinated infants exhibited a statistically lower risk of HBV infection postbirth (aRR = 0.1; 95% confidence interval, 0.0-0.6; P = .01).

Conclusion:
TDF can equate the MTCT risk in pregnant women with HBV DNA levels of 106 copies/mL or more to those with lower levels. Early administration of the HBV vaccine postbirth also effectively curtails MTCT. Thus, expanding TDF prophylaxis and vaccine coverage is pivotal to impede MTCT.