bluuebunny/crossref_metadata_2025_split huggingface dataset:
Ischemic stroke with unknown onset of symptoms: current scenario and perspectives for the future
Authors: Lopes Rônney Pinto , Gagliardi Vivian Dias Baptista , Pacheco Felipe Torres , Gagliardi Rubens José 
Published: December 2022

Abstract
Background Stroke is a major cause of disability worldwide and a neurological emergency. Intravenous thrombolysis and mechanical thrombectomy are effective in the reperfusion of the parenchyma in distress, but the impossibility to determine the exact time of onset was an important cause of exclusion from treatment until a few years ago.
Objectives To review the clinical and radiological profile of patients with unknown-onset stroke, the imaging methods to guide the reperfusion treatment, and suggest a protocol for the therapeutic approach.
Methods The different imaging methods were grouped according to current evidence-based treatments.
Results Most studies found no difference between the clinical and imaging characteristics of patients with wake-up stroke and known-onset stroke, suggesting that the ictus, in the first group, occurs just prior to awakening. Regarding the treatment of patients with unknown-onset stroke, four main phase-three trials stand out: WAKE-UP and EXTEND for intravenous thrombolysis, and DAWN and DEFUSE-3 for mechanical thrombectomy. The length of the therapeutic window is based on the diffusion weighted imaging–fluid-attenuated inversion recovery (DWI-FLAIR) mismatch, core-penumbra mismatch, and clinical core mismatch paradigms. The challenges to approach unknown-onset stroke involve extending the length of the time window, the reproducibility of real-world imaging modalities, and the discovery of new methods and therapies for this condition.
Conclusion The advance in the possibilities for the treatment of ischemic stroke, while guided by imaging concepts, has become evident. New studies in this field are essential and needed to structure the health care services for this new scenario.
Current Postlaunch Implementation of State Mandates of Newborn Screening for Critical Congenital Heart Disease by Pulse Oximetry in U.S. States and Hospitals
Authors: Sakai-Bizmark Rie , Chang Ruey-Kang R. , Martin Gerard R. , Hom Lisa A. , Marr Emily H. , Ko Jamie , Goff Donna A. , Mena Laurie A. , von Kohler Connie , Bedel Lauren E. M. , Murillo Mary , Estevez Dennys , Hays Ron D. 
Published: December 2022

Objective Our objective was to gauge adherence to nationally endorsed protocols in implementation of pulse oximetry (POx) screening for critical congenital heart disease (CCHD) in infants after mandate by all states and to assess associated characteristics.
Study Design Between March and October 2019, an online questionnaire was administered to nurse supervisors who oversee personnel conducting POx screening. The questionnaire used eight questions regarding performance and interpretation of screening protocols to measure policy consistency, which is adherence to nationally endorsed protocols for POx screening developed by professional medical societies. Multilevel linear regression models evaluated associations between policy consistency and characteristics of hospitals and individuals, state of hospital location, early versus late mandate adopters, and state reporting requirements.
Results Responses from 189 nurse supervisors spanning 38 states were analyzed. Only 17% received maximum points indicating full policy consistency, and 24% selected all four options for potential hypoxia that require a repeat screen. Notably, 33% did not recognize ≤90% SpO2 as an immediate failed screen and 31% responded that an infant with SpO2 of 89% in one extremity will be rescreened by nurses in an hour rather than receiving an immediate physician referral. Lower policy consistency was associated with lack of state reporting mandates (beta = –1.23 p = 0.01) and early adoption by states (beta = –1.01, p < 0.01).
Conclusion When presented with SpO2 screening values on a questionnaire, a low percentage of nurse supervisors selected responses that demonstrated adherence to nationally endorsed protocols for CCHD screening. Most notably, almost one-third of respondents did not recognize ≤90% SpO2 as a failed screen that requires immediate physician follow-up. In addition, states without reporting mandates and early adopter states were associated with low policy consistency. Implementing state reporting requirements might increase policy consistency, but some inconsistency may be the result of unique protocols in early adopter states that differ from nationally endorsed protocols.
Key Points
Urinary Tract Infections in Low Birth Weight Neonates
Authors: Janardhan Shruthi , Kim Sharon , Cukovic Blerim , Demissie Seleshi , Roth Philip , Blau Jonathan 
Published: December 2022

Objective Our objective was to evaluate the incidence of urinary tract infections (UTIs) in low birth weight (LBW) neonates and to evaluate the compliance of neonatal intensive care unit (NICU) providers in performing urine cultures as a part of late-onset sepsis (LOS) evaluations following an educational intervention.
Study Design A retrospective chart review for all LBW infants undergoing LOS evaluations was performed. An educational intervention was conducted to encourage NICU providers to perform urine cultures in LOS evaluations. Prospective chart reviews were conducted following the intervention to assess compliance with the urine culture directive and the incidence of UTIs before and after the intervention.
Results Rate of UTIs among LBW neonates was 1.3% for the entire study period and typical uropathogens were the cause. UTIs were found concurrently with bacteremia in only 33.3% of cases and showed a predilection for male infants when analyzing based on the number of infections. Urine cultures were performed in 20% of LOS evaluations prior to our educational intervention and increased to 57% (p < 0.0001) postintervention.
Conclusion An educational intervention is effective at increasing the rate of obtaining urine cultures with LOS evaluations. Performing these cultures reveals that UTIs in LBW neonates are common without bacteremia and can be missed if they are omitted from LOS evaluations.
Key Points
A Comprehensive Review on Phytochemistry and Pharmacology of Homoeopathic Medicine Rhus Toxicodendron
Authors: Goswami Abanti , Saka Vara Prasad , GV Narasimha Kumar , Biswas Bibaswan 
Published: December 2022

Abstract
Background Rhus toxicodendron is a homoeopathic medicine introduced into the homoeopathic system by Hahnemann in 1816, and ever since, it has been used to relieve arthritis, rheumatism and skin disorders.
Aim This review aimed to search the literature for the phytochemical and pharmacological investigations of homeopathic medicine Rhus tox. The assembled data of Rhus tox could be beneficial in helping researchers concentrate on the most pivotal aspects that still need to be examined.
Discussion In the Homoeopathic Pharmacopoeia of India, Toxicodendron pubescens P. Mill (Atlantic poison oak) and Toxicodendron radicans (poison ivy) have been mentioned as synonyms of Rhus toxicodendron Linn. The allergic contact dermatitis caused by touching the leaves of the Toxicodendron plants is believed to give the plant its specific name. Available literature illustrated the medicinal and pharmacological potential against various inflammatory diseases, including arthritis, showing immunomodulatory and anti-neoplastic activity.
Conclusion There is a need to establish evidence for the activities mentioned in the literature. The detailed knowledge regarding the mechanism of Rhus toxicodendron Linn. would help the scientific community understand the field of homeopathic medicine more closely.
Chronic inflammatory demyelinating polyneurophaty: assessment of the cognitive function and quality of life
Authors: Kozow Larissa , Pupe Camila , Nascimento Osvaldo J. M. 
Published: December 2022

Abstract
Background Studies were carried out with the objective of evaluating the quality of life (QoL) of patients affected by chronic inflammatory demyelinating polyradiculopathy (CIDP). However, the cognitive issue is still little addressed.
Objectives To assess the QoL and cognitive impairment of patients with CIDP and to analyze whether there is a correlation between these parameters.
Methods Seven patients with CIDP and seven paired controls were subjected to: mini-mental state examination (MMSE); Montreal cognitive assessment (MoCA); digit symbol replacement/symbol copy test (DSST); fatigue severity scale (FSS); Beck depressive inventory-I (BDI-I), and a short-form of health survey (SF-36).
Results The mean age of the participants was 50 years (71.4% male). The MMSE and MoCA had no statistical difference between the groups. Patients showed superior results in the memory domain in the MoCA (5 vs. 2, p = 0.013). In the DSST, we observed a tendency for patients to be slower. There was a strong negative correlation between fatigue levels and vitality domain (SF-36). There was no significant correlation between depression levels and QoL, and there was no correlation between depression and the results obtained in the cognitive tests. The patients presented higher levels of depression (15.28 vs. 3.42, p < 0.001). A total of 57% had severe fatigue, 28.8% self-reported pain, and 57.1% complained of cramps.
Conclusion There was no cognitive impairment in these patients. However, there was a tendency of slower processing speed. To better evaluate the alterations found, a study with a larger number of individuals would be necessary. Chronic inflammatory demyelinating polyradiculopathy affects the QoL of patients in different ways.
Risk of perioperative stroke and cerebral autoregulation monitoring: a systematic review
Authors: Santos Daniel Paes de Almeida dos , Thirumala Parthasarathy Deenadayalan , Reddy Gautama , Barros Daniel Ferreira de , Faria Vinicius Naves Rezende , Shandal Varun , Kurtz Pedro 
Published: December 2022

Abstract
Background Perioperative stroke, delirium, and cognitive impairment could be related to management and to variations in blood pressure control, cerebral hypoperfusion and raised blood volume. Cerebral autoregulation (CAR) is a mechanism to maintain cerebral perfusion through the control of the vascular tone and hemodynamic reactions in the circulation.
Objective The present systematic review addresses the relationship between impaired CAR and perioperative stroke by evaluating the rate of neurological complications after surgery in studies in which perioperative CAR was tested or monitored.
Methods We included randomized clinical trials and prospective observational studies. All studies had adjusted the relative risk, hazard ratio or 95% confidence interval (95%CI) values. These estimation effects were tested using random-effects models. Heterogeneity among the selected studies was assessed using the Higgins and Thompson I2 statistics.
Results The Web of Science, PubMed and EMBASE electronic databases were searched to retrieve articles. A total of 4,476 studies published between 1983 and 2019 were analyzed, but only 5 qualified for the data extraction and were included in the final analysis. The combined study cohort comprised 941 patients who underwent CAR monitoring during surgical procedures. All studies provided information about perioperative stroke, which equated to 16% (158 of 941) of the overall patient population.
Conclusion The present meta-analysis showed evidence of the impact of CAR impairment in the risk of perioperative stroke. On the pooled analysis, blood fluctuations or other brain insults large enough to compromise CAR were associated with the outcome of stroke (odds ratio [OR]: 2.26; 95%CI: 1.54–2.98; p < 0.0001).
Patient Satisfaction with Pisiform Excision for Pisotriquetral Instability or Arthritis: A Prospective Review
Authors: Peters Mikaela J. , Mazor Avi , Glaris Zafeiria , Goetz Thomas Joseph 
Published: December 2022

Abstract
Background Pisotriquetral pain and instability is an elusive cause of ulnar-sided wrist pain. Initial treatment of chronic pisotriquetral pathology should involve a trial of nonoperative therapy such as neutral wrist splint, anti-inflammatories, and intra-articular steroid injections. The mainstay of surgical management of pisotriquetral pain is pisiform excision.
Purpose This prospective study seeks to understand patient satisfaction after pisiform excision in patients with isolated pisotriquetral pathology.
Patients and Methods A consecutive series of nine cases of pisiform excision was performed by the senior surgeon. The primary outcome measure was determined a priori to be the Patient-Rated Wrist Evaluation (PRWE) score. Wrist range of motion, grip strength, and QuickDASH (shortened version of Disabilities of the Arm, Shoulder and Hand) scores were also collected preoperatively and at 3 and 12 months postoperatively as secondary outcome measures.
Results There was a very rapid improvement in the PRWE by 3 months, which was maintained at 12 months. The QuickDASH score was slower to improve, with a significant improvement by 12 months. There was no change in grip strength or wrist range of motion at any time point.
Conclusion Pisiform excision results in a very rapid improvement of symptoms and should be considered in cases of pisotriquetral instability or arthritis that fail conservative management.
Level of Evidence Level IV, case series.
Storage and purification adaptations for the isolation of total RNA from the dura mater
Authors: Ferreira Maria Rosana de Souza , Galvão André Pukey Oliveira , Valença Marcelo Moraes , Martins Danyelly Bruneska Gondim 
Published: December 2022

Abstract
Background RNA extraction is a step that precedes several molecular techniques. The fibrous tissue, more specifically the dura mater, has several limitations in routine protocols, and lacks optimization protocols to overcome these problems.
Objective To test stock reagents and purification kits, optimizing commercial kit protocols for RNA extraction from the dura mater.
Methods Dura mater samples were obtained from eight Wistar rats and maintained in two different stabilizers. The samples were purified using four different protocols, and the RNA was evaluated for the yield and purity in NanoDrop 2000 (Thermo Scientific, Wilmington, DE, United States). Beta-actin gene was used for analyzing gene expression, since is one of the most used reference genes.
Results The RNA preservation was similar in both stabilizers. The addition of an incubation step prior the purification protocols allowed better tissue digestion and RNA recovery. The RNA purified using the protocols membrane-based showed higher quality than liquid-liquid purification. This impact was observed in the 3-week evaluation using RT-qPCR.
Conclusion Stabilizers are efficient for RNA preservation and membrane-based purification protocols are more suitable for RNA recovery from dura mater tissue, allowing the evaluation of gene expression in this type of tissue. Adaptations in the dura mater RNA extraction protocol differ from the pre-established protocols because it takes into account the peculiarity of fibrous tissue and low cellularity. In addition to providing a low-cost mechanism, based on techniques that are part of the laboratory routine, it is possible to improve the quality of the extracted material, ensuring greater efficiency in the use of subsequent techniques.
Newborn Weight Loss Tool and Readmission for Hyperbilirubinemia
Authors: Schutzman David L. , Kuter Nazli , Salvador Agnes , Wyatt Dorothy , Snijder Juan , Peregrino Manuel , Basu Rhea , Irigoyen Matilde 
Published: December 2022

Objective The aim of this study was to determine if the Newborn Weight Loss Tool (NEWT) can predict hospital readmission due to hyperbilirubinemia.
Study Design This is a case–control study of 93 newborns and 186 controls ≥35 weeks' gestation. All were discharged from the Mother–Baby unit of an urban academic center and subsequently readmitted for hyperbilirubinemia. Controls were matched for date of birth, gestational age, and Bhutani risk zone. All infants were screened for hyperbilirubinemia prior to discharge and managed according to American Academy of Pediatrics guidelines in place at the time. Chi-square, Fisher's exact test, and multivariate analysis were utilized as appropriate.
Results There was no significant difference between the groups for a NEWT < 50% at discharge. More cases than controls breastfed. A significantly greater percentage of cases had NEWT > 50% at readmission than discharge. NEWT > 90% was moderately associated with readmission for hyperbilirubinemia (p = 0.081).
Conclusion NEWT provides a more nuanced assessment of weight loss following birth and can aid in highlighting newborns at risk for readmission due to hyperbilirubinemia.
Key Points
How to Reach the Best Ultrasound Performance in the Delivery Room
Authors: Santana Eduardo Félix Martins , Castello Renata Gomes , Passos Maria Eduarda Tenório , Ribeiro Gabriela Carneiro Freitas , Araujo Júnior Edward 
Published: December 2022

AbstractUltrasonography is an instrument that is present in the maternal-fetal assessment throughout pregnancy and with widely documented benefits, but its use in intrapartum is becoming increasingly relevant. From the assessment of labor progression to the assessment of placental disorders, ultrasound can be used to correlate with physiological findings and physical examination, as its benefit in the delivery room cannot yet be proven. There are still few professionals with adequate training for its use in the delivery room and for the correct interpretation of data. Thus, this article aims to present a review of the entire applicability of ultrasound in the delivery room, considering the main stages of labor. There is still limited research in evidence-based medicine of its various possible uses in intrapartum, but it is expected that further studies can bring improvements in the quality of maternal and neonatal health during labor.
Association of Dual Venous Anastomosis with Reduced Risks for Flap Congestion in Microsurgical Lower Extremity Reconstruction: A Multicenter Study
Authors: Lee Sang-Hun , Lee Kyeong-Tae , Park Bo Young 
Published: December 2022

Abstract
Background Flap congestion related with venous thrombosis is a major cause for microsurgical lower extremity reconstruction failure. Conducting dual venous anastomosis has been suggested to reduce risks for the adverse outcomes; however, its efficacy remains controversial. This study evaluated a potential association of dual venous anastomosis with the development of flap congestion in diverse clinical situations.
Methods This multicenter study included patients who underwent microsurgical lower extremity reconstruction at two institutions. They were divided into two groups based on the number of venous anastomoses—single and dual groups. Their perfusion-related complications (PRCs), including total/partial flap loss, arterial or venous insufficiency, and emergent reoperation, were compared. Independent association of the number of venous anastomoses with the outcomes was evaluated. Further analyses were conducted using propensity score matching.
Results In total, 225 cases were analyzed, of which 92 were included in the single group and the other 133 in the dual group. The two groups had generally similar baseline characteristics. The dual group presented significantly lower rates of PRC, including total/partial flap loss, flap congestion, and emergent reoperation. Multivariable analyses showed that conducting dual venous anastomoses was associated with reduced risks for the development of overall PRC and flap congestion. These associations were more prominent when restricting analyses for cases with chronic wound and trauma (vs. oncologic defects). Similar associations were observed in the propensity score matching analysis.
Conclusion Conducting dual venous anastomosis seems associated with reduced risks for flap congestion in microsurgical lower extremity reconstruction, especially for cases with unfavorable conditions.
The statistics of time varying cross-sectional information coefficients
Authors: Ding Zhuanxin , Sun Yixiao 
Published: December 2022

AbstractThe information coefficient (IC), defined as the correlation coefficient between a stock return and its factor exposures predictor variables, is one of the most commonly used statistics in quantitative financial analysis. In this paper, we establish consistency and asymptotic normality of the time series average of cross-sectional sample ICs when the true underlying ICs between the risk-adjusted residual return and the standardized factor exposures are time varying. We use those results to show that the time series average of the cross-sectional sample ICs divided by its sample standard deviation converges to the ex ante expected portfolio information ratio (IR) as derived in Ding and Martin (2017). A simulation study based on a true factor model shows that the finite sample results are strikingly close to what the theory suggests. We also conduct empirical simulations using actual stock returns and quantitative factor exposures, and we find that the logarithm of the estimated IR can be explained very well by a function of the IC mean, the IC standard deviation, and the sample size in exactly the same way as predicted by our theory built on a linear factor model with time varying ICs.
The effect of immediate environment on bond strength of different bond types—A valence bond study
Authors: Chourasia Mukesh , Cowen Todd , Friedman-Ezra Aviva , Rubanovich Eden , Shurki Avital 
Published: December 2022

The ability to design catalysis largely depends on our understanding of the electrostatic effect of the surrounding on the bonds participating in the reaction. Here, we used a simplistic model of point charges (PCs) to determine a set of rules guiding how to construct PC-bond arrangement that can strengthen or weaken different chemical bonds. Using valence bond theory to calculate the in situ bond energies, we show that the effect of the PC mainly depends on the bond’s dipole moment irrespective of its type (being covalent or charge shift). That is, polar bonds are getting stronger or weaker depending on the sign and location of the PC, whereas non- or weakly polar bonds become stronger or weaker depending only on the location of the PC and to a smaller extent compared with polar bonds. We also show that for polar bonds, the maximal bond strengthening and weakening effect can be achieved when the PC is placed along the bond axis, as close as possible to the more and less polarizable atom/fragment, respectively. Finally, due to the stabilizing effects of polarizability, we show that, overall, it is easier to cause bond strengthening compared with bond weakening. Particularly, for polar bonds, bond strengthening is larger than bond weakening obtained by an oppositely signed PC. These rules should be useful in the future design of catalysis in, e.g., enzyme active sites.