bluuebunny/crossref_metadata_2025_split huggingface dataset:
Tree growth is correlated with hydraulic efficiency and safety across 22 tree species in a subtropical karst forest
Authors: Aritsara Amy N A , Ni Ming-Yuan , Wang Yong-Qiang , Yan Chao-Long , Zeng Wen-Hao , Song Hui-Qing , Cao Kun-Fang , Zhu Shi-Dan 
Published: April 2023

Abstract
Karst forests are habitats in which access to soil water can be challenging for plants. Therefore, safe and efficient xylem water transport and large internal water storage may benefit tree growth. In this study, we selected 22 tree species from a primary subtropical karst forest in southern China and measured their xylem anatomical traits, saturated water content (SWC), hydraulic conductivity (Ks) and embolism resistance (P50). Additionally, we monitored growth of diameter at breast height (DBH) in 440 individual trees of various sizes over three consecutive years. Our objective was to analyze the relationships between xylem structure, hydraulic efficiency, safety, water storage and growth of karst tree species. The results showed significant differences in structure but not in hydraulic traits between deciduous and evergreen species. Larger vessel diameter, paratracheal parenchyma and higher SWC were correlated with higher Ks. Embolism resistance was not correlated with the studied anatomical traits, and no tradeoff with Ks was observed. In small trees (5–15 cm DBH), diameter growth rate (DGR) was independent of hydraulic traits. In large trees (&gt;15 cm DBH), higher Ks and more negative P50 accounted for higher DGR. From lower to greater embolism resistance, the size–growth relationship shifted from growth deceleration to acceleration with increasing tree size in eight of the 22 species. Our study highlights the vital contributions of xylem hydraulic efficiency and safety to growth rate and dynamics in karst tree species; therefore, we strongly recommend their integration into trait-based forest dynamic models.
Flipped Classroom Case Learning vs Traditional Lecture-Based Learning in Medical School Ophthalmology Education: A Randomized Trial
Authors: Chan Poemen P. , Lee Vivian W.Y. , Yam Jason C.S. , Brelén Marten E. , Chu Wai Kit , Wan Kelvin H. , Chen Li J. , Tham Clement C. , Pang Chi P. 
Published: April 2023

Purpose
To address the problem of teaching noncore specialties, for which there is often limited teaching time and low student engagement, a flipped classroom case learning (FCCL) module was designed and implemented in a compulsory 5-day ophthalmology rotation for undergraduate medical students. The module consisted of a flipped classroom, online gamified clinical cases, and case-based learning.

Method
Final-year medical students in a 5-day ophthalmology rotation were randomized to the FCCL or a traditional lecture-based (TLB) module. The outcomes of subjective assessments (student-rated anonymous Likert scale questionnaire, scale 1 to 5, and course and teaching evaluation, scale 1 to 6) and objective assessments (end-of-rotation and post-MBChB multiple-choice questions, scale 0 to 60) were compared between the 2 groups.

Results
Between May 2021 and June 2022, 216 students (108 in each group) completed the study. Compared with the TLB students, the students in the FCCL group rated various aspects of the course statistically significantly higher, including feeling more enthusiastic and engaged by the course and more encouraged to ask questions and participate in discussions (all P < .001). They also gave higher ratings for the instructional methods, course assignments, course outcomes, and course workload (P < .001). They gave higher course and teaching evaluation scores to the tutors (5.7 ± 0.6 vs 5.0 ± 1.0, P < .001). The FCCL group scored higher than the TLB group on the end-of-rotation multiple-choice questions (53.6 ± 3.1 vs 51.8 ± 2.8, P < .001). When 32 FCCL students and 36 TLB students were reassessed approximately 20 weeks after the rotation, the FCCL group scored higher (40.3 ± 9.1) than the TLB group (34.3 ± 10.9, P = .018).

Conclusions
Applying the FCCL module in ophthalmology teaching enhanced medical students’ satisfaction, examination performance, and knowledge retention. A similar model may be suitable for other specialties.
Comparison of a Modern Digital Mechanomyograph to a Mechanomyograph Utilizing an Archival Grass Force Transducer
Authors: Michaelsen Kelly E. , Jelacic Srdjan , Nguyen Sharon T. , Haththotuwegama Kishanee J. , Togashi Kei , Bowdle Andrew 
Published: April 2023

Background
Mechanomyography is the traditional gold standard research technique for quantitative assessment of neuromuscular blockade. Mechanomyography directly measures the isometric force generated by the thumb in response to ulnar nerve stimulation. Researchers must construct their own mechanomyographs since commercial instruments are no longer available. A mechanomyograph was constructed, and its performance was compared against an archival mechanomyography system from the 1970s that utilized an FT-10 Grass force transducer, hypothesizing that train-of-four ratios recorded on each device would be equivalent.

Methods
A mechanomyograph was constructed using 3D-printed components and modern electronics. An archival mechanomyography system was assembled from original components, including an FT-10 Grass force transducer. Signal digitization for computerized data collection was utilized instead of the original paper strip chart recorder. Both devices were calibrated with standard weights to demonstrate linear voltage response curves. The mechanomyographs were affixed to opposite arms of patients undergoing surgery, and the train-of-four ratio was measured during the onset and recovery from rocuronium neuromuscular blockade.

Results
Calibration measurements exhibited a positive linear association between voltage output and calibration weights with a linear correlation coefficient of 1.00 for both mechanomyography devices. The new mechanomyograph had better precision and measurement sensitivity than the archival system: 5.3 mV versus 15.5 mV and 1.6 mV versus 5.7 mV, respectively (P < 0.001 for both). A total of 767 pairs of train-of-four ratio measurements obtained from eight patients had positive linear association (R
2 = 0.94; P < 0.001). Bland–Altman analysis resulted in bias of 3.8% and limits of agreement of −13% and 21%.

Conclusions
The new mechanomyograph resulted in similar train-of-four ratio measurements compared to an archival mechanomyography system utilizing an FT-10 Grass force transducer. These results demonstrated continuity of gold standard measurement of neuromuscular blockade spanning nearly 50 yr, despite significant changes in the instrumentation technology.

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Near-infrared spectroscopy and processed electroencephalogram monitoring for predicting peri-operative stroke risk in cardiothoracic surgery
Authors: Pierik Ramon , Scheeren Thomas W.L. , Erasmus Michiel E. , van den Bergh Walter M. 
Published: April 2023

BACKGROUND
Stroke is a feared complication after cardiothoracic surgery, with an incidence of around 2 to 3%. Anaesthesia and postoperative sedation may obscure clinical symptoms of stroke and thus delay diagnosis and timely intervention.

OBJECTIVES
The objective was to assess the value of intra-operative neuromonitoring and blood pressure monitoring for predicting the occurrence of peri-operative stroke within 3 days after cardiothoracic surgery.

DESIGN
Single-centre retrospective observational cohort study.

SETTING
Academic tertiary care medical centre.

PATIENTS
All consecutive patients with cardiothoracic surgery and intra-operative neuromonitoring admitted postoperatively to the Intensive Care Unit (ICU) between 2008 and 2017.

MAIN OUTCOME MEASURES
The primary endpoint was the occurrence of any stroke confirmed by brain imaging within 3 days postcardiothoracic surgery. Areas under the curve (AUC) of intra-operative mean arterial pressure (MAP), cerebral oxygen saturation (ScO2) and bispectral index (BIS) below predefined thresholds were calculated, and the association with early stroke was tested using logistic regression analyses.

RESULTS
A total of 2454 patients admitted to the ICU after cardiothoracic surgery had complete intra-operative data for ScO2, BIS and MAP and were included in the analysis. In 58 patients (2.4%), a stroke was confirmed. In univariate analysis, a larger AUCMAP<60 mmHg [odds ratio (OR) 1.43; 95% confidence interval (CI), 1.21 to 1.68) and larger AUCBIS<25 (OR 1.51; 95% CI, 1.24 to 1.83) were associated with the occurrence of postoperative stroke while ScO2 less than 50% or greater than 20% reduction from individual baseline was not (OR 0.91; 95% CI, 0.50 to 1.67). After multivariable analysis, AUCBIS<25 (OR 1.45; 95% CI, 1.12 to 1.87) and longer duration of MAP less than 60 mmHg (OR 1.52; 95% CI, 1.02 to 2.27) remained independently associated with stroke occurrence.

CONCLUSION
Cumulative intra-operative BIS values below 25 and longer duration of MAP below 60 mmHg were associated with the occurrence of peri-operative stroke within 3 days after cardiothoracic surgery. Prospective studies are warranted to evaluate a causal relationship between low BIS and stroke to establish whether avoiding intra-operative BIS values below 25 might reduce the incidence of peri-operative stroke.
Dermoscopic Assessment of Pityriasis Versicolor: A Cross-Sectional Observational Study
Authors: Manickam Navakumar , Saminathan Praveen Vasanthi , Vazhavanthan Deepika , Gopalan Kannan 
Published: April 2023

Objective:
Pityriasis versicolor (PV) is usually a clinical diagnosis. In uncertain cases, PV is confirmed by microscopic examination with 10% potassium hydroxide (KOH). However, the KOH test is not 100% sensitive in diagnosing PV. Dermoscopy of PV is still an unexplored area with very little data reported. This study was planned to study the various dermoscopic features and their utility in the diagnosis of PV.

Methods:
This cross-sectional observational study was carried out over a 1-year period (September 2020–September 2021) among 57 patients with KOH-confirmed PV. All patients underwent dermoscopy using a handheld dermoscope (DermLite DL4; DermLite LLC, San Juan Capistrano, CA, USA). The chi-square test or Fisher’s exact test was used to analyze the data.

Results:
Of the 57 patients, most had the hypopigmented type (n = 43, 75.44%), followed by the hyperpigmented type (n = 12, 21.05%) and the perifollicular type (n = 2, 3.51%). Non-uniform pigmentation was the most common dermoscopic finding observed in both patients with hypopigmented PV (n = 42, 97.67%) and hyperpigmented PV (n = 12, 100%) (P = 0.001). Scaling was the next most commonly observed finding; patchy scaling (n = 25, 58.13%) and perifollicular scaling (n = 13, 30.23%) were commonly seen in hypopigmented PV, while hyperpigmented PV showed more diffuse scaling (n = 6, 50.00%) (P = 0.04) followed by patchy scaling (n = 5, 41.66%). Dermoscopy showed unique “double-edged scales” in all lesions with furrow scaling (n = 11, 19.30%) after eliciting a positive evoked scale sign. Other interesting features seen in hypopigmented PV were hypopigmentation around the hair follicle (n = 24, 55.48%) (P = 0.001) and perilesional hyperpigmentation (the halo sign) (n = 15, 34.88%) (P = 0.04).

Conclusion:
We observed several dermoscopic findings in PV that can serve as useful clues for differentiating PV from other similar disorders.
Against Authority: The Bioethics of Ivermectin Use for COVID-19 Infection
Authors: Astărăstoae Vasile , Rogozea Liliana M. 
Published: April 2023

Background:
The COVID-19 pandemic has brought new ethical challenges to both health care professionals and the general public. Among the ethical problems amplified during this period were the making of medical decisions to quickly introduce some drugs into therapeutic practice with unproven or insufficiently proven effects (such as ivermectin), the validity of drug testing, and the allocation of limited resources.

Fields of Uncertainty:
The COVID-19 pandemic brought to the attention of the entire scientific world a new problem, which exceeded the guidelines and rules known until then. Out of the desire to quickly solve this medical problem, a series of measures were taken, however not sufficiently validated in scientific terms; the recommendations regarding the use of drugs known for their properties to treat a greater number of conditions, such as ivermectin, was tried.

Data Sources:
A narrative review of the specialized literature was carried out using keywords such as COVID-19, ivermectin, ethics, and off-label medication from Scopus and Google Scholar but also of official documents developed at the international level (World Health Organization).

Ethics and Therapeutic Advances:
The off-label use of ivermectin alone or in combination with other medications during COVID pandemic raised problems related to the demonstration of its effectiveness, but also to ethics, starting from the expectations that both the medical staff and the population had of it. Ivermectin therapy was also evaluated by analyzing the behavior of ivermectin based on ethical principles (nonmaleficence, beneficence, and respect for one's autonomy) or on justice. Even in times of pandemic, exceptionalism must not triumph, and finding an effective treatment must be done through studies that respect ethical standard.

Conclusions:
The failures or rather lack of success in decision making during the pandemic showed that alongside scientific knowledge and the development of health policies, it is necessary to constantly evaluate the measures and decisions from an ethical point of view, and the prevention of slippages and abuses is not only necessary but even mandatory.
Relative Pain Reduction and Duration of Nerve Block Response Predict Outcomes in Headache Surgery- A prospective cohort study
Authors: Knoedler Leonard , Chartier Christian , Casari Maria E. , Ortiz Ricardo , Odenthal Jan , Gfrerer Lisa , Austen William G. 
Published: April 2023

Background:
Experts agree that nerve block (NB) response is an important tool in headache surgery screening. However, the predictive value of NBs remains to be proven in a prospective fashion.

Methods:
Pre- and post- NB visual analogue pain scores (0- 10) as well as duration of NB response were recorded prospectively. Surgical outcomes were recorded prospectively by calculating the Migraine Headache Index (MHI) preoperatively and postoperatively at 3 months, 12 months, and every year thereafter.

Results:
The study population included 115 patients. The chance of achieving MHI percent improvement of ≥80% was significantly higher in subjects who reported relative pain reduction of >60% following NB versus ≤60% (63/92, 68.5% versus 10/23, 43.5%; p= 0.03). Patients were more likely to improve their MHI ≥50% with relative pain reduction of >40% versus ≤40% (82/104, 78.8% versus 5/11, 45.5%; p= 0.01). In subjects with NB response of >15 days, 10 of 13 patients (77.0%) experienced MHI improvement of ≥80%. Notably, all of these patients (100%) reported MHI improvement of ≥50% with mean MHI improvement of 88%. Subjects with a NB response of ≥24 hours achieved significantly better outcomes than patients with a shorter response (72.7± 37.0% vs. 46.1± 39.7%; p= 0.02). However, of 14 patients reporting NB response of <24 hours, 4 patients had MHI improvement of ≥80% and 7 of ≥50%.

Conclusions:
Relative pain reduction and duration of NB response are predictors of MHI improvement after headache surgery. NBs are a valuable tool to identify patients who will benefit from surgery.
Remote fit wrist braces through artificial intelligence
Authors: Sedigh Ashkan , Townsend Clay , Khawam Sultan M. , Vaccaro Alexander R. , Carreras Britani N. , Beredjiklian Pedro K. , Rivlin Michael 
Published: April 2023

Introduction:
Physical boundaries to access skilled orthotist or hand therapy care may be hindered by multiple factors, such as geography, or availability. This study evaluated the accuracy of fitting a prefabricated wrist splint using an app on a smart device. We hypothesize that remote brace fitting by artificial intelligence (AI) can accurately determine the brace size the patient needs without in-person fitting.

Methods:
Healthy volunteers were recruited to fit wrist braces. Using 2 standardized calibrated images captured by the smart device, each subject's image was loaded into the machine learning software (AI). Later, hand features were extracted, calibrated, and measured the application, calculated the correct splint size, and compared with the splint chosen by our subjects to improve its own accuracy. As a control (control 1), the subjects independently selected the best brace fit from an array of available splints. Subject selection was recorded and compared with the AI fit splint. As the second method of fitting (control 2), we compared the manufacturer recommended brace size (based on measured wrist circumference and provided sizing chart/insert brochure) with the AI fit splint.

Results:
A total of 54 volunteers were included. Thirty-two splints predicted by the algorithm matched the exact size chosen by each subject yielding 70% accuracy with a standard deviation of 10% (p < 0.001). The accuracy increased to 90% with 5% standard deviation if the splints were predicted within the next size category. Fit by manufacturer sizing chart was only 33% in agreement with participant selection.

Conclusion:
Remote brace fitting using AI prediction model may be an acceptable alternative to current standards because it can accurately predict wrist splint size. As more subjects were analyzed, the AI algorithm became more accurate predicting proper brace fit. In addition, AI fit braces are more than twice as accurate as relying on the manufacturer sizing chart.
Project Inspire pilot study: A hospital-led comprehensive intervention reduces gun violence among juveniles delinquent of gun crimes
Authors: Malone Kaleb , Hogue Antwan , Naman Edmond , Graves Curtis , Haiflich Andrew , Simmons Jon D. , Williams Ashley Y. 
Published: April 2023

BACKGROUND
Gun violence disproportionately affects young Black men, but the impact extends to families and communities. Those at highest risk are teens delinquent of gun crimes. While there is no nationally accepted juvenile rate of recidivism, previous literature reveals rearrest rates from 50% to 80% in high-risk youth, and some reports show that up to 40% of delinquent juveniles are incarcerated in adult prisons before the age of 25 years. We hypothesize that Project Inspire, a hospital-led comprehensive intervention, reduces recidivism among high-risk teens.

METHODS
Led by a level 1 trauma center, key community stakeholders including the juvenile court, city, and city police department joined forces to create a community-wide program aimed at curbing gun violence in high-risk individuals. Participants, aged 13 to 18 years, are selected by the juvenile gun court. They underwent a rigorous 3-week program with a curriculum incorporating the following: trauma-informed training and confidence building, educational/professional development, financial literacy, entrepreneurship, and career-specific job shadowing and mentorship. Rates of recidivism were measured annually.

RESULTS
Project Inspire has hosted two classes in 2018 and 2019, graduating nine participants aged 14 to 17 years. Sixty-seven percent were Black. All were males. At 1 year, none of the graduates reoffended. At 2 years, one participant reoffended. At 3 years, no additional participants reoffended. No graduate reoffended as a juvenile. Thus, the overall rate of recidivism for Project Inspire is 11% to date. Eighty-nine percent of graduates received a diploma, general educational development, or obtained employment.

CONCLUSION
Project Inspire is a hospital-led initiative that effectively reduces recidivism among juveniles delinquent of gun crimes. This sets the framework for trauma centers nationwide to lead in establishing impactful, comprehensive, gun-violence intervention strategies.

LEVEL OF EVIDENCE
Prognostic and Epidemiological; Level V.
Neoadjuvant Chemotherapy plus Surgery versus Direct Surgery in Senile Patients with Gastric Cancer: Single-Center Retrospective Cohort Study
Authors: Sah Birendra Kumar , Yu Zhenjia , Li Jian , Lu Sheng , Zheng Yanan , Zhu Zhenglun , Li Chen , Yan Min , Zhu Zhenggang 
Published: April 2023

AbstractBackgroundDespite the lack of decisive research advocating neoadjuvant chemotherapy there is a broad consensus that it is beneficial for gastric cancer in terms of survival. However, there is no comparative research on whether it is similarly helpful in senile patients with the age above 75 years old. Here we compared the survival rate between neoadjuvant plus surgery with Direct Surgery.MethodsWe analyzed 79 patients with locally advanced gastric cancer who were preoperatively suspicious of serosa positive or beyond (cT4a or cT4b); or extensive lymph node involvement (cN3). Postoperative complications and overall survival rate were compared between the patients who underwent neoadjuvant chemotherapy (NAC) plus surgery and the patients who had direct surgery.ResultsA total of 15 (19%) patients underwent neoadjuvant chemotherapy and 64 (81%) patients had direct surgery. The median follow-up time was 34 months (range of 24-60 months). While the median survival time was not reached in the direct surgery group, the median survival time for the NAC plus Surgery Group was 37 months. Two years of overall survival (OS) for the patients in the NAC plus Surgery group and direct surgery group were 53.3% and 70.3% respectively. There was no statistical difference between the two groups (p>0.05) in overall postoperative complication and length of postoperative stay.ConclusionsReduced does of neoadjuvant chemotherapy was feasible in senile patients. There was no difference in survival rate between the patients who had neoadjuvant plus surgery compared to those who had direct surgery. While this result contradicts the previous assumption that neoadjuvant chemotherapy is beneficial for late-stage gastric cancer patients, a well-controlled prospective study is mandatory for a better understanding of whether neoadjuvant chemotherapy is beneficial to senile patients too.