bluuebunny/crossref_metadata_2025_split huggingface dataset:
Occurrence Rate and Outcomes of Weaning Groups According to a Refined Weaning Classification: A Retrospective Observational Study*
Authors: Van Hollebeke Marine , Ribeiro Campos Débora , Muller Jan , Gosselink Rik , Langer Daniel , Hermans Greet 
Published: February 2023

OBJECTIVES:
The weaning according to a new definition (WIND) classification groups mechanically ventilated (MV) patients into “short weaning,” “difficult weaning,” “prolonged weaning,” and “no weaning.” The aims of the study were: 1) to describe the weaning group distribution, 2) to evaluate if “short weaning” patients can be divided into groups with distinct characteristics and outcomes depending on the MV duration, and 3) to study 1-year outcomes related to weaning groups.

DESIGN:
Retrospective observational study.

SETTING:
Tertiary center with a mixed, mainly surgical ICU population.

PATIENTS:
MV patients admitted between April 11, 2018, and April 10, 2019.

INTERVENTIONS:
None.

MEASUREMENTS AND MAIN RESULTS:
A refined WIND classification was used, dividing “short weaning” patients into patients MV less than or equal to 24 hours, “short weaning a,” and those MV greater than 24 hours, “short weaning b.” Data were collected from electronic medical records. Of 1,801 MV patients, 65% were categorized as “short weaning a,” 13% “short weaning b,” 8% “difficult weaning,” 6% “prolonged weaning,” and 8% “no weaning.” “Short weaning a” patients were older, more frequently male, and had lower disease severity compared with “short weaning b.” Weaning duration (days: 0 [0–0] to 14 [10–21]), weaning success rate (99–69%), ICU length of stay (days: 2 [1–4] to 28 [19–48]), ICU mortality (1–37%), and hospital length of stay (days: 10 [7–18] to 48 [27–89]) and hospital mortality (4–42%; all p < 0.01) increasingly worsened from “short weaning a” to “prolonged weaning.” One-year mortality increased from “short weaning a” (9%) to “short weaning b” (27%), “difficult weaning” (39%), and “prolonged weaning” (49%). In adjusted analyses, weaning groups remained independently associated with 1-year mortality.

CONCLUSIONS:
The high proportion of “short weaning” patients in this mainly surgical ICU population could be divided into two groups with distinct characteristics. This refined WIND classification allowed to enhance prognostication, also beyond hospitalization, highlighting the need to further optimize the weaning process.
Transthoracic Salus Valve Feasibility Study: Short-Term Outcomes of a Transcatheter Self-Expandable Pulmonary Valve
Authors: Dong Jun , Su Junwu , Liu Aijun , Du Jing , Yang Jing , Li Qiangqiang , Li Bin , Yang Ming , Wang Zhijun , Bao Qian 
Published: February 2023

Objective:
The size and morphology of the right ventricular outflow tract (RVOT) in patients suffering from long-term pulmonary regurgitation (PR) after native RVOT (NRVOT) reconstruction are important factors affecting the feasibility, safety, and effectiveness of transcatheter pulmonary valve replacement. The purpose of this study was to evaluate the feasibility, safety, and effectiveness of a transthoracic Salus valve (Balance Medical Technology Co., Ltd, Beijing, China) in patients with moderate-to-severe PR after NRVOT reconstruction.

Methods:
Patients with moderate-to-severe PR after NRVOT reconstruction were selected between June 2021 and November 2021 at Beijing Anzhen Hospital. Demographic data as well as preoperative, intraoperative, and follow-up data were reviewed.

Results:
Ten patients with moderate-to-severe PR after NRVOT reconstruction underwent physical examination, transthoracic echocardiography, and cardiovascular magnetic resonance imaging. Seven patients were selected for transthoracic Salus valve replacement. Six patients underwent implantation of the Salus valve successfully. One valve migrated and was embolized during recovery of the delivery device; the Salus valve was surgically explanted and sutured to the inner wall of the main pulmonary artery. At a mean follow-up of (5.5 ± 1.1) months, dysfunction or migration of the Salus valve embolism was not observed.

Conclusions:
This early feasibility study demonstrates the feasibility, safety, and effectiveness of transthoracic implantation of a Salus valve in patients with moderate-to-severe PR after NRVOT reconstruction. The short-term effectiveness is clear, medium and long-term effectiveness requires longer follow-up.
Burden of epilepsy in China and its provinces, 1990 to 2019: findings from the Global Burden of Disease Study 2019
Authors: Liu Wei , Xu Yangyang , Lin Yicong , Wang Lijun , Zhou Maigeng , Yin Peng , Zhao Guoguang 
Published: February 2023

Abstract

Background:
Epilepsy accounts for a significant portion of the global disease burden. However, little is known about the disease burden of epilepsy in China and its provinces.

Methods:
We assessed the burden of epilepsy in China and its provinces, municipalities, and autonomous regions from 1990 to 2019. Burden was measured as incidence, prevalence, deaths, years lived with disability, years of life lost, and disability-adjusted life years (DALYs), by age, sex, year, and province. We used the Socio-Demographic Index (SDI) to determine the association between the provincial development level and age-standardized DALY rates of epilepsy from 1990 to 2019.

Results:
In 2019, epilepsy caused 1367.51 thousand (95% uncertainty interval [UI]: 979.92–1837.61 thousand) DALYs, and the age-standardized DALY rate was 99.77 (95%UI: 71.33–133.52)/100,000. The age-standardized incidence and prevalence rates for epilepsy in China were 24.65/100,000 and 219.69/100,000, increased by 45.00% (95%UI: 8.03–98.74%) and 35.72% (95%UI: 0.47–86.19%) compared with that in 1990, respectively. From 1990 to 2019, the proportion of DALY caused by epilepsy in the age group under 25 years steadily decreased. The proportion of DALYs caused by epilepsy in people aged 50 years and over increased from 9.45% and 10.22% in 1990 to 29.01% and 32.72% for male and female individuals in 2019, respectively. The highest age-standardized mortality rates were seen in Tibet (4.26 [95%UI: 1.43–5.66]/100,000), Qinghai (1.80 [95%UI: 1.15–2.36]/100,000), and Yunnan (1.30 [95%UI: 0.88–1.62]/100,000), and the lowest mortality rates were in Guangdong (0.48 [95%UI: 0.39–0.64]/100,000), Zhejiang (0.56 [95%UI: 0.44–0.70]/100,000), and Shanghai (0.57 [95%UI: 0.41–0.73]/100,000). The age-standardized DALY rates across the country and in provinces, municipalities, and autonomous regions generally decreased as their SDI increased.

Conclusions:
The disease burden of epilepsy is still heavy in China, especially in the western provinces. The incidence and prevalence of epilepsy increased between 1990 and 2019, and the burden of epilepsy in the elderly increases gradually. This study provides evidence on epilepsy prevention and care of different regions in China.
Feasibility and Acceptability of an Online Family Literacy Program in an Under-Resourced Community During the COVID-19 Pandemic
Authors: Choi Yewoon , Uthirasamy Nila , Córdoba David , Morrow Lesley Mandel , Perez-Cortes Silvia , Ramachandran Usha , Pai Shilpa , Lima Daniel , Shelton Patricia A. , Jimenez Manuel E. 
Published: February 2023

Abstract:

Objective:
The objective of this study was to examine the feasibility and acceptability of an online family literacy program (FLP) among low-income Latino families during the COVID-19 pandemic.

Methods:
We conducted a mixed methods pilot study. Latino parent-child dyads participated in an 8-week online FLP conducted on video conferencing software, developed through a cross-sector health care-education partnership. We conducted surveys and structured observation to assess feasibility and acceptability and in-depth interviews to gain insight into the context of participants' experiences during the pandemic.

Results:
The 35 participating parent-child dyads all identified as Latino, 83% reported limited English proficiency, and 60% of parents did not achieve a high school diploma. Nearly two-thirds of families participated in at least half of the sessions. On average, parents welcomed, liked, approved, and found the program appealing. While 86% experienced a technology problem at least once during sessions, all were resolved with minimal assistance. During qualitative interviews, we identified 3 themes that provide insight into their experiences with the FLP within the broader context of the pandemic: (1) disruption in family routine and financial strain caused by COVID-19 intensified family stress, (2) the forced transition to remote learning highlighted the inequities experienced by Latino preschool children, and (3) the FLP empowered parents and enhanced health and education experiences.

Conclusion:
Latino families had high participation levels in an online FLP and found it acceptable. Additional work is needed to understand how similar primary care programs can be leveraged to promote optimal development during a time of heightened need.
Designer Benzodiazepines: Effects, Toxicity, and Interactions
Authors: El Balkhi Souleiman , Abbara Chadi 
Published: February 2023

Purpose:
Although designer benzodiazepines (DBZDs) constitute a minor part of new psychoactive substances, they deserve the greatest attention because of their popularity among drug users and increasing number and availability. This review covers the effects of different DBZDs, available pharmacological evaluation tools, and their reported toxicity and potential pharmacodynamic and pharmacokinetic interactions with other drugs commonly co-abused with DBZDs.

Methods:
For this narrative review, a nonsystematic search was performed on PubMed, EMBASE, Google Scholar, and PubMed Central databases between June and July 2021.

Results:
The current consensus hypothesis suggests that DBZDs mediate their effects through interactions with the GABAA receptor, producing similar effects to benzodiazepines used in therapy, including sedation, hypnosis, anxiolysis, muscle relaxation, euphoria, amnesia, and addiction. Owing to the complexity of their action mechanism and the numerous GABAA subtype receptors, the pharmacodynamic metrics of DBZDs are very difficult to establish. The pharmacological effects of DBZD are related to their structure, influencing their binding to GABAA receptor subunits. Quantitative structure–activity relationship studies successfully predicted the biological activity and relative potency of DBZD but could not predict the main pharmacological effect of a given DBZD. Exploring the effects by netnographic studies is one of the available alternatives, despite its limitations. DBZDs are usually identified in the context of polysubstance use. Pharmacodynamic interactions between DBZDS and other CNS depressants, such as opioids, have been extensively reported. However, pharmacokinetic interactions between DBZDs and opioids are considered less important, and contradictory conclusions about their clinical significance have been reported.

Conclusions:
Understanding the mechanism of action and other pharmacological metrics is highly important in the clinical management of DBZDs.
Anteroinferior plating is an independent factor for decreasing symptomatic implant removal rates after plate fixation for midshaft clavicle fractures
Authors: Ariga Akane , Shimura Haruhiko , Fujita Koji , Nimura Akimoto 
Published: February 2023

Abstract

Objectives:
The factors that significantly influence the symptomatic implant removal rates after plate fixation for midshaft clavicle fractures remain controversial. The purpose of this study was to compare the symptomatic implant removal rates between 2 different types of plating technique and to evaluate independently associated factors.

Design:
Retrospective cohort study.

Setting:
Acute care center.

Patients/Participants:
A total of 71 patients 16 years or older who were diagnosed with displaced midshaft clavicle fractures from April 2016 to March 2020.

Intervention:
Thirty-nine patients were treated with superior plating (Group SP), and the remaining 32 patients were treated with anteroinferior plating (Group AIP).

Main Outcome Measurements:
Symptomatic implant removal rates after plate fixation for midshaft clavicle fractures.

Results:
Symptomatic implant removal rates were significantly lower in Group AIP (28.1%) than in Group SP (53.8%) (P = 0.033). Multivariate analyses showed that symptomatic implant removal rates were significantly decreased by three independent factors, namely AIP (odds ratio [OR] = 0.323) (P = 0.037), greater age (45 years or older) (OR = 0.312) (P = 0.029), and high body mass index (≥25 kg/m2) (OR = 0.117) (P = 0.034).

Conclusions:
AIP significantly and independently decreased the symptomatic implant removal rate. Among the three explanatory factors showing significant difference, plating technique is the only factor that can be altered by medical institutions. Therefore, we recommend this technique for displaced midshaft clavicle fractures to reduce a second surgery such as symptomatic implant removal.

Level of Evidence:
Level 3, retrospective cohort study
The differing effects of nociception and pain memory on isometric muscle strength in participants with and without a history of injury: A quasi-experimental study
Authors: Sueki Derrick G. , Dunleavy Kim , Puentedura Emilio J. , Heard Lindsey , Van der Heide Peter , Cheng Ming-Shun 
Published: February 2023

Abstract

OBJECTIVE
The goals of this study were to establish whether mechanical pressure pain, short-term memory recall of a painful stimulus, or long-term memory of a prior painful lower extremity injury alters isometric muscle strength and whether there was a difference in responses between participants with and without a previous history of injury.

DESIGN
59 pain-free participants (29 with previous injury and 30 without) participated in this study. Tibialis anterior isometric muscle strength was compared pre and post-noxious mechanical stimulus with instructions to recall pain (short-term and long-term).

RESULTS
Short-term and long-term pain recall produced a significant reduction in muscle strength (short-term: F(1,57) = 160.472, p < 0.001; long-term: F(1,57) = 128.899, p < 0.001). A greater decrease was experienced with short- and long-term pain memory than exposure to mechanical pain (mechanical pain: -14.8% or -32.98 kg, 95% CI (-41.57, -24.19); short-term: -24.1% or -52.70 kg, 95% CI (-60.98, -44.34); long-term: -20.3% or -44.63 kg, 95% CI (-52.77, -36.95)). There was no significant difference in responses associated with an injury history.

CONCLUSION
Findings suggest that recalled pain memory can impact motor responses and calls attention to the role of past injury history in the rehabilitation process.
The effect of a modified elastic band orthosis on gait and balance in stroke survivors
Authors: Thitithunwarat Nutkritta , Krityakiarana Warin , Kheowsri Suchittra , Jongkamonwiwat Nopporn , Richards Jim 
Published: February 2023

Background:
Gait is crucial for independent living for stroke survivors and assistive devices have been developed to support gait performance. Ankle foot orthosis (AFOs) are commonly provided to stroke survivors to prevent foot drop during walking. However, previous studies have reported limitations of AFOs including them being too heavy, creating skin irritation, and being a stigma of disability.

Objective:
The purpose was to compare the gait and balance improvement between elastic band orthosis (EBOs) and AFOs.

Study Design:
Experimental study design.

Methods:
The AFOs and EBOs were provided to 17 stroke survivors, and changes in gait and balance were assessed compared to barefoot (control). Gait spatiotemporal parameters were measured using the zebris-FDM-Rehawalk® system, and balance ability was evaluated using the time up and go test (TUG). Satisfaction with the EBOs was determined using the Quebec user evaluation of satisfaction with assistive technology (QUEST2.0) questionnaire.

Results:
The EBO showed significant differences in; gait speed, cadence, stride length, stride time, step length unaffected side, stance phase and swing phase on the affected side, and pre-swing on the unaffected side, and balance performance (TUG) (p<0.05) when compared to the AFO and control conditions. The participants were quite satisfied with the EBOs with QUEST2.0 scores greater than 4 out of 5.

Conclusions:
EBOs could be provided to stroke survivors given their acceptability and properties to improve gait and balance. The EBO used in this study offered clinically important improvements in gait and balance when compare to AFO and control conditions, and could mitigate against some of the limitations reported in the use of AFOs in stroke survivors.
Treatment of Challenging Extracranial Arteriovenous Malformations
Authors: Jia Hechen , Chen Yuxi , Yang Xi , Lee Yuanbo , Zou Yun , Zhou Jingwei , Jin Yunbo , Hua Chen , Lin Xiaoxi 
Published: February 2023

Abstract
Extracranial arteriovenous malformation (AVM) is a high-flow congenital vascular malformation, where direct communication between the arteries and veins impedes perfusion of capillary beds and causes disfigurement of the affected tissue. Surgery and endovascular therapy are currently the main treatment for extracranial AVMs. Nevertheless, management of complex cases is sometimes challenging because of severe complications such as refractory ulceration, life-threatening bleeding, and even cardiac insufficiency. Here, we reviewed the development and potential treatment for extracranial AVMs and shared our single-center experiences of diagnosis and treatment of this challenging disease.
Application of Dual “Kite” Myomucosal Flaps for the Repair of Medium Lip Defects
Authors: Gao Zhiquan , Yang Weiyuan , Sun Haiyang , Wang Xinyu , Tan Xiaoyan , Yao Ping , Tang Dongsheng 
Published: February 2023

Objective
To investigate the application of dual “kite” myomucosal flaps (subcutaneous pedicle advancement flap) for the repair of medium lip defects (one-third to one-half lip width).

Methods
Dual kite myomucosal flaps were designed in the adjacent area of the defect in 17 patients with medium lip defect with the principle of using homogenous tissue as far as possible without affecting local anatomical units.

Results
The follow-up time was 3 to 24 months; 16 patients showed primary wound healing, and 1 patient showed prolonged healing. The blood supply of the myomucosal flaps were reliable. The myomucosal flaps were smooth, with no proliferation of scars, and the local appearance was good.

Conclusion
The dual kite myomucosal flaps provide a reliable method for repairing medium lip defects, decreasing the need for additional excision of normal skin tissue, and reducing skin scar.
Management of Complex Forearm Injuries
Authors: Perruisseau-Carrier Anne , Tilhet Laura , Rouanet Marion , Henry Anne-Sophie , Hu Weiguo 
Published: February 2023

Abstract
The management of complex forearm injuries is challenging, not only because of the anatomical complexity of the region but also because of the dramatic functional consequences of these injuries. Preservation of the upper limb and restoration of hand function are the focus of the surgical management of these injuries. Decision making will consider several parameters such as the type of injury, the patient, the moment of reconstruction, the debridement, and the options available for reconstruction.
A multidisciplinary approach joining plastic surgeons and orthopedic surgeons in a team effort is essential to achieve the best outcomes. On the basis of their experience, the authors conclude that the keystone in complex forearm injuries management is represented by a careful assessment of the lesions, an aggressive and early debridement, the prevention of complications such as infection and compartment syndrome, and an “as early as possible” reconstruction.
Experience in Microsurgical Treatment of Complete Scalp Avulsion
Authors: Lin Jian , Wei Peng , Wang Yangjian , Song Qinghua , Yang Zhuan , Xu Yi 
Published: February 2023

Background
Avulsion of the scalp is a rare destructive event worldwide. Before the emergence of microsurgery, skin transplantation, flap transplantation, greater omentum transplantation, and other methods were once widely used. However, replantation offers the optimum reconstruction.

Methods
Six cases of complete avulsion injury of a large scalp treated from May 2017 to May 2020 were retrospectively analyzed. Under the microsurgery technology, the wound was cleaned and explored, and the appropriate arteriovenous anastomosis was selected. Preoperative blood preparation and skin preparation were actively performed. Postoperative strict nursing and observation of the blood supply of replanted scalp were performed. Regular outpatient follow-up after discharge was performed.

Results
Replantation was successful in 5 cases and failed in 1 case, and in 1 case the occipital scalp (approximately 10% of the scalp area) died and crusted 2 months after the operation. After 6 to 24 months of follow-up, all patients were satisfied with the reconstructed appearance.

Conclusions
Superb microsurgical technique and more detailed anatomical knowledge are the key conditions for successful complete scalp avulsion replantation. Compared with other methods, successful replantation can achieve the best aesthetic and functional results.
A Review of 559 Sternal Wound Reconstructions at a Single Institution
Authors: Kuonqui Kevin , Janhofer David E. , Takayama Hiroo , Ascherman Jeffrey A. 
Published: February 2023

Background
Sternal wound infection (SWI) and dehiscence after median sternotomy for cardiac surgery remain challenging clinical problems with high morbidity. Bilateral pectoralis major myocutaneous flaps are excellent for most sternal wounds but do not reach deeper mediastinal recesses. The omental flap may be a useful adjunct for addressing these deeper mediastinal infections.

Methods
Records of 598 sternal wound reconstructions performed by a single surgeon (J.A.A.) from 1996 to 2022 were reviewed. At the time of surgery, patients underwent sternal hardware removal, debridement, and closure with bilateral pectoralis major myocutaneous flaps. Pedicled omental flaps were also mobilized when additional vascularized tissue was required within the deeper mediastinum.

Results
Complete data were available for 559 sternal wound reconstructions performed by the senior author during this period. Bilateral pectoralis and omental flaps were mobilized in 17 of 559 (3.04%) patients. Common indications for initial cardiac surgery included repair or replacement of diseased aortic roots (9/17; 52.94%), aortic valves (8/17; 47.06%), and mitral valves (6/17; 35.29). Mean American Society of Anesthesiologists score was 3.56. Preoperative morbidity included culture-positive wound infection (12/17; 70.59%), dehiscence (15/17; 88.24%), wound drainage (11/17; 64.71%), and inability to close the chest after the original sternotomy because of hemodynamic instability (6/17; 35.29%). Intraoperative deep mediastinal or bone cultures were positive in 8 of 17 (47.06%) patients. Postoperative complications included partial dehiscence (2/17; 11.76%), skin edge necrosis (1/17; 5.88%), seroma (1/17; 5.88%), abdominal hernia (1/17; 5.88%), and recurrent infection (2/17; 11.76%). Three patients (17.65%) died within 30 days of the reconstruction surgery.

Conclusions
Patients undergoing combined pectoralis major and omental flap closure frequently had a history of aortic root and valve disease, and other significant preoperative morbidities. However, postoperative complication rates after combined flap closure were relatively low. Combined pectoralis major and omental flap reconstruction thus appears to be an effective intervention in patients with sternal wounds extending into the deep mediastinum.