bluuebunny/crossref_metadata_2025_split huggingface dataset:
Depth of anesthesia, temperature, and postoperative delirium in children and adolescents undergoing cardiac surgery
Authors: Köditz H. , Drouche A. , Dennhardt N. , Schmidt M. , Schultz M. , Schultz Barbara 
Published: May 2023

Abstract
Background
After pediatric cardiosurgical interventions, postoperative delirium can occur, which can be associated with undesirable consequences during and after the hospital stay. It is therefore important to avoid any factors causing delirium as far as possible. Electroencephalogram (EEG) monitoring can be used during anesthesia to individually adjust dosages of hypnotically acting drugs. It is necessary to gain knowledge about the relationship between intraoperative EEG and postoperative delirium in children.

Methods
In a dataset comprising 89 children (53 male, 36 female; median age: 0.99 (interquartile range: 0.51, 4.89) years) undergoing cardiac surgery involving use of a heart–lung machine, relationships between depth of anesthesia as measured by EEG (EEG index: Narcotrend Index (NI)), sevoflurane dosage, and body temperature were analyzed. A Cornell Assessment of Pediatric Delirium (CAP-D) score ≥ 9 indicated delirium.

Results
The EEG could be used in patients of all age groups for patient monitoring during anesthesia. In the context of induced hypothermia, EEG monitoring supported individually adjusted sevoflurane dosing. The NI was significantly correlated with the body temperature; decreasing temperature was accompanied by a decreasing NI.

A CAP-D score ≥ 9 was documented in 61 patients (68.5%); 28 patients (31.5%) had a CAP-D < 9. Delirious patients with an intubation time ≤ 24 h showed a moderate negative correlation between minimum NI (NImin) and CAP-D (rho = -0.41, 95% CI: -0.70 – -0.01, p = 0.046), i.e., CAP-D decreased with increasing NImin. In the analysis of all patients’ data, NImin and CAP-D showed a weak negative correlation (rho = -0.21, 95% CI: -0.40 – 0.01, p = 0.064). On average, the youngest patients had the highest CAP-D scores (p = 0.002). Patients with burst suppression / suppression EEG had a longer median intubation time in the intensive care unit than patients without such EEG (p = 0.023).

There was no relationship between minimum temperature and CAP-D score.

Conclusions
The EEG can be used to individually adjust sevoflurane dosing during hypothermia. Of the patients extubated within 24 h and classified as delirious, patients with deeper levels of anesthesia had more severe delirium symptoms than patients with lighter levels of anesthesia.
Acute airway obstruction requiring nasotracheal intubation following hypoglossal neuromonitoring: a case report
Authors: Bassi Jaspal Singh , Hsu Frank , Mnatsakanyan Lilit , Rajan Govind R. 
Published: May 2023

Abstract
Background
Intraoperative neurophysiological monitoring (IONM) is utilized for both the localization of critical structures and for real time detection and prevention of intraoperative neurological injury. Use of IONM to monitor the hypoglossal nerve is performed during neurosurgical, otolaryngological, and vascular procedures to improve surgical outcomes. There is a paucity of literature describing potential complications of IONM of the hypoglossal nerve, especially with respect to airway compromise. Here we present our findings regarding a case of acute airway obstruction following hypoglossal nerve monitoring.

Case Presentation
A 54-year-old male was admitted for left far-lateral craniotomy and microsurgical clipping of a left posterior inferior cerebellar artery (PICA) aneurysm. Following induction and intubation but prior to the procedure start, the patient was placed in the ¾ prone position with the left side up and his neck was flexed approximately 10 degrees. He then underwent placement of subdermal needle electrodes into the facial muscles, trapezius muscles, soft palate, and tongue for IONM. The procedure lasted 523 minutes and was completed without complication. However, approximately one hour after emergence from general anesthesia, the patient experienced progressive difficulty breathing secondary to severe lingual swelling. He required emergent placement of a nasotracheal tube guided by a fiberoptic bronchoscope. He remained intubated for 3 days and was treated with dexamethasone, after which the swelling resolved, and the patient was successfully extubated.

Conclusions
Acute lingual edema is a potentially life-threatening phenomenon that can lead to rapid airway compromise. Generally, causes of acute lingual swelling include hemorrhage, edema, infarction, and infection. In the case described above, we suspect traumatic injury to the tongue’s vascular supply caused a deep tissue hematoma leading to postoperative acute lingual swelling and airway obstruction. With the widespread use of IONM, it becomes essential for providers to be aware that perioperative airway compromise is a potentially life-threatening complication, especially with respect to monitoring of the hypoglossal nerve. Awake fiberoptic nasotracheal intubation can successfully be employed to establish an emergency airway in such situations.
Neighborhood deprivation, built environment, and overweight in adolescents in the city of Oslo
Authors: Coutinho Sílvia R. , Andersen Oddbjørn Klomsten , Lien Nanna , Gebremariam Mekdes K. 
Published: May 2023

Abstract
Background
Even though the social and built environment characteristics of neighborhoods have been studied as potential determinants of social inequalities in obesity among adults, fewer studies have focused on children. Our first aim was to investigate whether there were differences in the food and physical activity environments between different neighborhood deprivation levels in the city of Oslo. We also explored whether there was an association between the prevalence of overweight (including obesity) among adolescents and (i) neighborhood deprivation levels and (ii) food and physical activity environments of the neighborhoods they live in.

Methods
We conducted a food and physical activity environment mapping (using ArcGIS Pro) in all neighborhoods of Oslo, which were defined by administrative boundaries (sub-districts). The neighborhood deprivation score was calculated based on the percentage of households living in poverty, unemployment in the neighborhood, and residents with low education. A cross-sectional study including 802 seventh graders from 28 primary schools in Oslo residing in 75 out of 97 sub-districts in Oslo was also performed. MANCOVA and partial correlations were ran to compare the built environment distribution between different neighborhood deprivation levels, and multilevel logistic regression analyses were used to explore the effect of neighborhood deprivation and the food and physical activity environments on childhood overweight.

Results
We found that deprived neighborhoods had greater availability of fast food restaurants and fewer indoor recreational facilities compared to low-deprived neighborhoods. Additionally, we observed that the residential neighborhoods of the adolescents with overweight had greater availability of grocery and convenience stores when compared to the residential neighborhoods of the adolescents without overweight. Adolescents living in neighborhoods with high deprivation had a two-fold higher odds (95% CI = 1.1–3.8) to have overweight compared to adolescents living in neighborhoods with low deprivation, regardless of participants’ ethnicity and parental education. However, the built environment did not determine the relationship between neighborhood deprivation and overweight in adolescents.

Conclusion
The neighborhoods in Oslo with higher deprivation levels had more obesogenic characteristics than the low-deprived neighborhoods. Adolescents living in high-deprived neighborhoods were more likely to have overweight than their counterparts from low-deprived neighborhoods. Thus, preventive measures targeting adolescents from high-deprived neighborhoods should be put in place in order to reduce incidence of overweight.
Reassessing the level and implications of male involvement in family planning in Indonesia
Authors: Rahayu Sukma , Romadlona Nohan Arum , Utomo Budi , Aryanty Riznawaty Imma , Liyanto Elvira , Hidayat Melania , Magnani Robert J. 
Published: May 2023

Abstract
Background
Although there is global recognition of the importance of involving men in family planning and reproductive health matters, this issue has received insufficient attention in many countries. The present study sought to characterize married Indonesian males as to their level of involvement in family planning, identify the correlates thereof and assess the implications of male involvement for unmet need for family planning.

Methods
A mixed methods research design was used. The main source of quantitative data was 2017 Indonesian Demographic Health Survey (IDHS) data from 8,380 married couples. The underlying “dimensions” of male involvement were identified via factor analysis. The correlates of male involvement were assessed via comparisons across the four dimensions of male involvement identified in the factor analysis. Outcomes were assessed by comparing women’s and couple’s unmet need for family planning for the four underlying dimensions of male involvement. Qualitative data were collected via focus group discussions with four groups of key informants.

Results
Indonesian male involvement as family planning clients remains limited, with only 8% of men using a contraceptive method at the time of the 2017 IDHS. However, factor analyses revealed three other independent “dimensions” of male involvement, two of which (along with male contraceptive use) were associated with significantly lower odds of female unmet need for family planning. Male involvement as clients and passive male approval of family planning, which in Indonesia empowers females take action to avoid unwanted pregnancies, were associated with 23% and 35% reductions in female unmet need, respectively. The analyses suggest that age, education, geographic residence, knowledge of contraceptive methods, and media exposure distinguish men with higher levels of involvement. Socially mandated gender roles concerning family planning and perceived limited programmatic attention to males highlight the quantitative findings.

Conclusions
Indonesian males are involved in family planning in several ways, although women continue to bear most of the responsibility for realizing couple reproductive aspirations. Gender transformative programming that addresses broader gender issues and targets priority sub-groups of men as well as health service providers, community and religious leaders would seem to be the way forward.
Prompt identification of struggling candidates in near peer-led basic life support training: piloting an online performance scoring system
Authors: Gillam Lawrence , Crawshaw Benjamin , Booker Matthew , Allsop Sarah 
Published: May 2023

Abstract
Background
Bristol Medical School has adopted a near peer-led teaching approach to deliver Basic Life Support training to first year undergraduate medical students. Challenges arose when trying to identify early in the course which candidates were struggling with their learning, in sessions delivered to large cohorts. We developed and piloted a novel, online performance scoring system to better track and highlight candidate progress.

Methods
During this pilot, a 10-point scale was used to evaluate candidate performance at six time-points during their training. The scores were collated and entered on an anonymised secure spreadsheet, which was conditionally formatted to provide a visual representation of the score. A One-Way ANOVA was performed on the scores and trends analysed during each course to review candidate trajectory. Descriptive statistics were assessed. Values are presented as mean scores with standard deviation (x̄±SD).

Results
A significant linear trend was demonstrated (P < 0.001) for the progression of candidates over the course. The average session score increased from 4.61 ± 1.78 at the start to 7.92 ± 1.22 at the end of the final session. A threshold of less than 1SD below the mean was used to identify struggling candidates at any of the six given timepoints. This threshold enabled efficient highlighting of struggling candidates in real time.

Conclusions
Although the system will be subject to further validation, our pilot has shown the use of a simple 10-point scoring system in combination with a visual representation of performance helps to identify struggling candidates earlier across large cohorts of students undertaking skills training such as Basic Life Support. This early identification enables effective and efficient remedial support.
Investigation of standardized training of radiation oncology residents for gynaecological tumours in China
Authors: Sun Shuai , Hu Ke , Zhang Fuquan , Hou Xiaorong 
Published: May 2023

Abstract
Background
Radiotherapy standardized training (ST) has been conducted for 7 years in China. This investigation evaluated the difficulties of and need for ST of radiation oncology residents (RORs) for gynaecological tumours (GYN) in China.

Methods
An anonymous online survey was conducted on the “Questionnaire Star” platform. The questionnaire contained 30 questions, including the basic information of the students, their knowledge of radiotherapy theory, training on GYN, the difficulties and needs they faced, and possible solutions.

Results
A total of 469 valid questionnaires were collected, resulting in a valid response rate of 85.3%. During the ST, only 58–60% of RORs received training in GYN, with a median clinical rotation time of 2–3 months. Among the RORs surveyed, 50.1% knew the physical characteristics of brachytherapy (BRT), and 49.2% could choose the appropriate BRT for patients. At the end of ST, 75.3% were able to complete the target delineation in GYN independently, and 56% were able to complete the BRT operation independently. The scarcity of GYN patients, insufficient teaching awareness of superior doctors, and lack of interest are the main reasons why ST cannot meet the standard.

Conclusion
In China, the ST of RORs in GYN should be strengthened, the teaching awareness of specialist trainers should be increased, and the curriculum should be optimized, especially the curriculum for specialist operation and a strict assessment system.
A long-term outcome (up to 29 years) of bilateral iliac wings “bayonet osteotomies” for closure of bladder exstrophy
Authors: Wongcharoenwatana Jidapa , Adulkasem Nath , Ariyawatkul Thanase , Eamsobhana Perajit , Chotigavanichaya Chatupon , Chotivichit Areesak 
Published: May 2023

Abstract
Background
Several types of pelvic osteotomy techniques have been reported and employed by orthopedic surgeons to enhance the approximation of symphyseal diastasis in bladder exstrophy patients. However, there is limited evidence on a long-term follow-up to confirm which osteotomy techniques provide the most suitable and effective outcomes for correcting pelvic deformities. This study aimed to describe the surgical technique of bilateral iliac bayonet osteotomies for correcting pelvic bone without using fixation in bladder exstrophy and to report on the long-term clinical and radiographic outcomes following the bayonet osteotomies.

Methods
We retrospectively reviewed patients with bladder exstrophy who underwent bilateral iliac bayonet osteotomies with the closure of bladder exstrophy between 1993 and 2022. Clinical outcomes and radiographic pubic symphyseal diastasis measurements were evaluated. From a total of 28 operated cases, eleven were able to attend a special follow-up clinic or were interviewed by telephone by one of the authors with completed charts and recorded data.

Results
A total of 11 patients (9 female and 2 male) with an average age at operation of 9.14 ± 11.57 months. The average followed-up time was 14.67 ± 9.24 years (0.75–29), with the average modified Harris Hip score being 90.45 ± 1.21. All patients demonstrated decreased pubic symphyseal diastasis distance (2.05 ± 1.13 cm) compared to preoperative (4.58 ± 1.37 cm) without any evidence of nonunion. At the latest follow-up, the average foot progression angle was externally rotated 6.25° ± 4.79° with full hips ROM, and no patients reported abnormal gait, hip pain, limping, or leg length discrepancy.

Conclusions
Bilateral iliac wings bayonet osteotomies technique demonstrated a safe and successful pubic symphyseal diastasis closure with an improvement both clinically and radiographically. Moreover, it showed good long-term results and excellent patient’s reported outcome scores. Therefore, it would be another effective option for pelvic osteotomy in treating bladder exstrophy patients.
Membrane fusion, potential threats, and natural antiviral drugs of pseudorabies virus
Authors: Ye Ni , Feng Wei , Fu Tiantian , Tang Deyuan , Zeng Zhiyong , Wang Bin 
Published: May 2023

AbstractPseudorabies virus (PrV) can infect several animals and causes severe economic losses in the swine industry. Recently, human encephalitis or endophthalmitis caused by PrV infection has been frequently reported in China. Thus, PrV can infect animals and is becoming a potential threat to human health. Although vaccines and drugs are the main strategies to prevent and treat PrV outbreaks, there is no specific drug, and the emergence of new PrV variants has reduced the effectiveness of classical vaccines. Therefore, it is challenging to eradicate PrV. In the present review, the membrane fusion process of PrV entering target cells, which is conducive to revealing new therapeutic and vaccine strategies for PrV, is presented and discussed. The current and potential PrV pathways of infection in humans are analyzed, and it is hypothesized that PrV may become a zoonotic agent. The efficacy of chemically synthesized drugs for treating PrV infections in animals and humans is unsatisfactory. In contrast, multiple extracts of traditional Chinese medicine (TCM) have shown anti-PRV activity, exerting its effects in different phases of the PrV life-cycle and suggesting that TCM compounds may have great potential against PrV. Overall, this review provides insights into developing effective anti-PrV drugs and emphasizes that human PrV infection should receive more attention.
The effect gap of hypertension health management services in poverty and non-poverty counties on the hypertension control: evidence from China Chronic Diseases Risk Factors Surveillance
Authors: Jiang Bo , Wang Limin , Zhang Mei , Zhao Zhenping , Zhang Xiao , Li Chun , Zhou Maigeng 
Published: May 2023

Abstract
Background
The Chinese government implemented the health poverty alleviation project (HPAP) since 2016 in poverty counties (PCs). To evaluate the effect of the HPAP on hypertension health management and control in PCs is vital for the policy improvement.

Methods
China Chronic Disease and Risk Factors Surveillance programme were conducted from August 2018 to June 2019. A total of 95,414 participants aged 35 and above from 59 PCs and 129 non-poverty counties (NPCs) were involved in this study. Hypertension prevalence, hypertension control, treatment and health management prevalence, and physical examination proportion were calculated and compared by PCs and NPCs. Logistic regression was employed to explore the association between hypertension control and management services.

Results
The hypertension prevalence in NPCs was significantly higher than that in PCs (NPCs 46.1% vs. PCs 41.2%, P < 0.001). The NPCs participants had a higher hypertension control prevalence (NPCs 32.7% vs. PCs 27.3%, P < 0.001) and treatment prevalence (NPCs 86.0% vs. PCs 80.0%, P < 0.001) than that in PCs. The proportion of physical examination in one year in NPCs was significantly higher than that in PCs (NPCs 37.0% vs. PCs 29.5%, P < 0.001). The proportion of diagnosed hypertension patients without hypertension health management in NPCs was significantly higher than that in PCs (NPCs 35.7% vs. PCs 38.4%, P < 0.001). Multivariable logistic regression showed that standardized and non-standardized hypertension health management were positively correlated with hypertension control in NPCs, and standardized hypertension health management was positively correlated with hypertension control in PCs.

Conclusions
These findings show the equity and accessibility gap of health resources still existed between PCs and NPCs under the influence of the HPAP. Hypertensive health management was effective for hypertension control in both PCs and NPCs. However, the quality of management services still needs to be improved.
An autopsy case of a patient on maintenance hemodialysis with continuous idiopathic cholesterol crystal embolism for 7 years
Authors: Kawai Yumiko , Kinoshita Chiharu , Matsuda Koichi , Takeuchi Keiko , Inoue Yoshimoto , Fujita Yoko 
Published: May 2023

Abstract
Background
CCE is a systemic disease with poor prognosis with no established treatment. Approximately 23–32% of CCE cases progress to end-stage renal failure, and the 1-year mortality rate of CCE with organ failure is 60–90%. The dialysis method for the patients with CCE is still controversial.

Case report
The patient is 73 years old male who was diagnosed with idiopathic CCE. He had survived 7 years though he had been on maintenance HD. We used nafamostat for HD every time. He took prednisolone and statin. He died due to rupture of AAA and we autopsied him. CCs developed in five organs, including the right lung CCE was assumed to be continuously present since the diagnosis.

Discussion and conclusion
CCE was continuous until death, and CCs in the right lung were possibly due to HD. HD through AV shunt could worsen CCE, and HD should be recognized as the aggravating factor. The use of nafamostat while undergoing HD as well as use of steroids and statins until death may have prevented fatal events and contributed to the patient's long survival.
The use of cannabinoid compounds in therapy in children - future or threat?
Authors: Cieszkowska Joanna , Czerwik Julia , Czubala Marta , Dmochowska Joanna , Kamiński Jakub 
Published: May 2023

Introduction and objective:
Therapy with the use of "medical marijuana" is becoming more and more popular with patients, who often perceive it as a more natural and safe form of treatment. It is also more and more boldly considered by physicians in the pediatric population, especially when standard methods of pharmacotherapy prove insufficient. The following review focuses on the possibilities of using cannabis preparations in children with drug-resistant epilepsy, autism spectrum disorders and spasticity. It also draws attention to the possible side effects and risks of unjustified use of medical marijuana.
State of knowledge:
In the pediatric population, high efficacy and a favorable safety profile have been proven so far in the treatment of epileptic seizures associated with Lennox-Gastaut syndrome and Dravet syndrome, and for the treatment of epileptic seizures in tuberous sclerosis complex, (TSC) . Although the therapy has been approved only for the above-mentioned indications, high hopes are also placed on the use of cannabinoids to treat the symptoms of other diseases and disorders, including spasticity and autism spectrum disorders.
Conclusions:
The research carried out so far gives hope for the possibility of using medical marijuana in other indications as well, as its use correlates with the reduction of i.a. symptoms of spasticity or autism spectrum disorders. At the same time, further studies are needed to assess the balance of benefits and potential risks of the therapy. Since recreational cannabis use in youth is known to be associated with serious adverse events, and medical cannabis use has a relatively strong placebo effect, decisions about its use should always be made carefully and based on scientific evidence.