bluuebunny/crossref_metadata_2025_split huggingface dataset:
Contained Giant Abdominal Aortic Aneurysm Rupture Secondary to Type I and III Endoleaks Requiring Open Repair With Endograft Explantation
Authors: Zamin Syed A. , Devalla Raviteja , Mitchell Marc E. 
Published: March 2023

Endovascular aneurysm repair (EVAR) is a minimally invasive treatment for abdominal aortic aneurysms (AAAs). Common complications include endoleaks, which are continued blood flow into the aneurysm sac external to the graft. Type I endoleaks occur proximally or distally, resulting from inadequate seals between the graft and artery. Type III endoleaks stem from defects between components in modular grafts or fabric tears. Re-intervention is indicated for type I and III endoleaks due to pressurization of the aneurysm sac resulting in a high risk of rupture. A 68 year-old man presented with an infrarenal AAA and underwent EVAR. He developed a late type I endoleak requiring reintervention with a stent graft cuff, and later presented with a recurrent type I endoleak and type IIIb endoleak. The AAA increased in size to 18 cm with contained rupture, requiring emergent endograft explantation and repair with a bifurcated Dacron graft. His postoperative course was uncomplicated.
Mechanical life support algorithm for emergency management of patient receiving extracorporeal membrane oxygenation
Authors: Akhtar Waqas , Pinto Sofia , Gerlando Emanuele , Pitt Timothy , Banya Winston , Dunning John , Bowles Christopher T , Rosenberg Alex 
Published: March 2023

Background There are limited practical advanced life support algorithms to aid teams in the management of cardiac arrest in patients on extracorporeal membrane oxygenation (ECMO). Methods In our specialist tertiary referral centre we developed, by iteration, a novel resuscitation algorithm for ECMO emergencies which we validated through simulation and assessment of our multi-disciplinary team. A Mechanical Life Support course was established to provide theoretical and practical education combined with simulation to consolidate knowledge and confidence in algorithm use. We assessed these measures using confidence scoring, a key performance indicator (the time taken to resolve gas line disconnection) and a multiple choice question (MCQ) examination. Results Following this intervention the median confidence scores increased from 2 (Interquartile range IQR 2, 3) to 4 (IQR 4, 4) out of maximum 5 ( n = 53, p < 0.0001). Theoretical knowledge assessed by median MCQ score increased from 8 (6, 9) to 9 (7, 10) out of maximum 11 ( n = 53, p0.0001). The use of the ECMO algorithm reduced the time taken by teams in a simulated emergency to identify a gas line disconnection and resolve the problem from median 128 s (65, 180) to 44 s (31, 59) ( n = 36, p 0.001) and by a mean of 81.5 s (CI 34, 116, p = 0.001). Conclusions We present an evidence based practical ECMO resuscitation algorithm that provides guidance to clinical teams responding to cardiac arrest in ECMO patients covering both patient and ECMO troubleshooting.
Clinical factors affecting the long-term survival of breast cancer patients
Authors: Li Yong-Hui , Wang Xiao-Ying , Shen Jun-Wei , Ma Lin-Lin , Wang Cui-Ping , He Kai , Liu Ding-Sheng , Li Yan-Fei 
Published: March 2023

Objective The average 5-year survival rate of breast cancer (BC) patients has been significantly prolonged with new therapeutic methods. However, their effects on BC patient long-term survival rates are unclear. Therefore, this study aimed to analyze the specific clinical factors that can affect BC long-term survival. Methods Here, we conducted a retrospective study and analyzed long-term survival using data of 3,240 BC patients from 1977 to 2005 from the Genotype-Tissue Expression (GTEx) database using the Kaplan–Meier method. Results Breast tumor size and stage were negatively correlated with long-term survival, but age showed no significant correlation. Estrogen receptor (ER) and progesterone receptor (PR) expression were each positively correlated with patient survival time, while ERBB2 receptor (HER2) expression was negatively correlated with survival time. Patients with high Nottingham prognostic index (NPI) values did not benefit from available therapies. Furthermore, breast-conserving surgery is more conducive to BC patient long-term survival than mastectomy. Conclusions Early detection and breast-conserving surgery may support long-term survival for BC patients. Elevated expression of ER and PR were both associated with longer patient survival time, while positive expression of HER2 showed the opposite trend. The long-term survival rates of patients with high NPI values can potentially be increased.
The Nurses’ Second Victim Syndrome and Moral Distress
Authors: Shomalinasab Esmat , Bagheri Zahra , Jahangirimehr Azam , Bahramnezhad Fatemeh 
Published: March 2023

Background The increasing prevalence of moral distress in the stressful environment of the intensive care unit (ICU) provides grounds for nursing error and endangers patients’ health, safety, and even life. One of the most important reasons for this distress is the treatment team’s second victim syndrome (SVS), especially nurses, following errors in the treatment system. Objectives The present study aimed to determine the relationship between moral distress and SVS in ICUs. Research design This cross-sectional study involved a sample size of 96 ICU nurses working in hospitals affiliated with Tehran University of Medical Sciences, Iran, in the 2021–2022 period, who were selected via a simple random sampling method. Data were collected using the Demographic Questionnaire, the second victim experience and support tool (SVEST) and Moral Distress Scale-Revised (MDS-R). Descriptive statistics (percentage, frequency, mean, and SD) and analytical tests (Spearman correlation coefficient test, independent t-test, and ANOVA) were employed for data analysis. Participants and research context This study used a sample size of 96 intensive care unit nurses working in hospitals affiliated to Tehran University of Medical Sciences selected by simple random sampling. Ethical considerations The study obtained research ethics approval, and all participants were informed of the voluntary and anonymous nature of their participation. Findings The results showed that 59.4% of nurses suffered a low level of moral distress, and 40.6% suffered from a moderate level of moral distress. The SVS score of 86.5% of the nurses was moderate. There was no significant and direct correlation between moral distress and SVS in nurses; however, there was a significant and inverse correlation between the moral distress intensity and SVS ( p = 0.011). Conclusion Despite no significant correlation between moral distress and SVS, these variables were at moderate levels. Accordingly, it is suggested to provide a proper ground for expressing morally stressful situations, counseling and training strategies to deal with moral distress, creating support resources for those suffering from SVS, and implementing empowerment programs.
Healthcare students’ moral concerns and distress during the pandemic
Authors: Sala Defilippis Tiziana ML , Prati Annia , Scascighini Luca 
Published: March 2023

Background During the first wave of the new coronavirus (COVID-19) pandemic, the sudden increase in hospitalised patients put medical facilities in southern Switzerland under severe pressure. During this time, bachelor’s degree programs in nursing, physiotherapy and occupational therapy were disrupted, and students in their second year were displaced. Students experienced the continuous reorganisation of their traineeship as healthcare facilities adapted to a climate of uncertainty. Purpose The aim of this study was to investigate the degree of moral distress and the ethical issues most often encountered by physiotherapy, nursing and occupational therapy students enrolled in a traineeship during the first wave of the COVID-19 pandemic in southern Switzerland. Participants and research context The sample consisted of 102 participants, and the response rate was 81.6%. Research design Based on a pragmatic approach, a mixed-method with a convergent design was adopted. Data were collected between 30 April 2020 and 14 May 2020, via a survey administered to all occupational therapy, physiotherapy and nursing students in their fourth semester. Ethical considerations Given that no vulnerable persons were involved, the Ethics Committee of Southern Switzerland waived authorisation. However, all measures were put into place to protect participants by guaranteeing their anonymity and confidentiality. Results and discussion The data analysis showed that the main source for moral distress was ‘poor teamwork’ and that the moral issues encountered most often by students were related to the appropriateness of care and working conditions, with a clear reference to students’ own safety and that of their loved ones; the other concerns reported included the loss of learning opportunities and the perceived lack of technical knowledge and skills. Conclusions This survey offers a faithful overview of physiotherapy, nursing and occupational therapy students’ experience during the first pandemic wave. This study also identifies some key recommendations for healthcare professions’ education.
Assessment of Nomophobia and Loneliness in Rural Turkish Adolescents: A Cross-Sectional Study
Authors: Kılınç Ali , Çam Cüneyt , Ünsal Alaettin , Arslantas¸ Didem 
Published: March 2023

Background: Nomophobia, short for “no mobile phone phobia,” is defined as having an involuntary and unreasonable fear when the mobile device is unreachable or uncommunicable. Aims: The study aimed to evaluate nomophobia and loneliness levels of high school (HS) students from a rural region. Methods: This cross-sectional study was conducted between November 5 and December 28, 2018, on 850 HS students in Sivrihisar, Eskis¸ehir, Turkey. Nomophobia Questionnaire (NMP-Q) and UCLA Loneliness Scale were used. Mann-Whitney U, Kruskal-Wallis, Spearman Correlation analysis, and Multiple Linear Regression were performed. Results: In the study group, 429 (50.5%) were female. Their ages ranged from 13 to 19, and their mean age (standard deviation [SD]) was 15.66 (1.18) years. The mean score (SD) from NMP-Q was 54.92 (14.87), while the mean score (SD) from the UCLA loneliness scale was 13.95 (4.60). Multivariate analysis showed that being a female, having first smartphone use before the age of 13, having high daily smartphone usage, having a high frequency of checking phones, and having more friends on social media than in real life were associated with higher nomophobia levels (F = 28.424, P < .001, R² = 0.213). There was a positive weak correlation between nomophobia and loneliness levels (r = 0.353, P = .001). Conclusions: Factors such as phone usage habits and loneliness, which can be changed by providing education and creating appropriate environments in schools, are important determinants of nomophobia among HS students in rural areas, suggesting that interventions to combat nomophobia are possible.
Hypophosphatemia related to the use of ibrutinib
Authors: Karadeniz Mine , Cinar Olgu Erkin , Erdogdu Batuhan , Malkan Umit Yavuz , Goker Hakan , Ozcebe Osman Ilhami 
Published: March 2023

Introduction Tyrosine kinase inhibitors (TKis) and Bruton's TKi (BTKis) constitute broadly used antitumor drug groups with almost completely tolerable and manageable side-effect profiles. Mainly side effects are cardiovascular and gastrointestinal for the TKi group. Hypophosphatemia is documented frequently in many studies with TKis but rarely mentioned with ibrutinib use up to the present. Case report A 61-year-old patient with the diagnosis of chronic lymphocytic leukemia had hypophosphatemia-related complaints and symptoms when ibrutinib use was preferred for his second relapse of the disease. After drug discontinuation, we started ibrutinib again with an alternating dose. We managed to control hypophosphatemia, and the patient has been following up for 2 years in remission status without any support or a second drug need. Management and outcome We have presented here a chronic lymphocytic leukemia case that developed mild–severe hypophosphatemia associated with ibrutinib use. By using an alternating dose of ibrutinib, we managed to control the disease and drug side effects. Discussion TKis and BTKis are widely in use for different indications. Hypophosphatemia is rare but it can cause drug discontinuation or change if it is not manageable. It is mentioned that hypophosphatemia can be seen due to a common group effect with the mechanism of causing secondary hyperparathyroidism and renal tubulopathy. In our case, we could explain the side effect of hypophosphatemia with secondary hyperparathyroidism and renal tubulopathy. Prospective, large-group studies are needed to explain the hypophosphatemia and other side effects of ibrutinib and new BTKis in detail.
Risk of Breast Cancer Progression after Treatment in the Western Region of Saudi Arabia
Authors: Ramadan Majed , Alsiary Rwiah , Alsaadoun Noor , Alhusseini Noara , Raihan Sajid Muhammad , Mohamed Hamed Noor , Ziad Arabi Tarek , Nedal Sabbah Belal 
Published: March 2023

Background: The risk of breast cancer progression is one of the most difficult factors to predict as it is studied in different populations, patient groups, or time frames, resulting in conflicting estimates of incidence rates reported in the literature. The purpose of this study is to identify predictive factors for breast cancer recurrences in a sample of the Middle Eastern population. Methodology: A cohort retrospective study included all eligible breast cancer patients at the National Guard Health Affairs (NGHA) Hospital in Jeddah, Western region, from 2015 to 2021. Our primary outcome was the progression status of the patients; we adjusted for demographic, clinical, and molecule characteristics of the population. From 2015 to 2021, there were 319 patients diagnosed with breast cancer. Multiple logistic regression analysis was used to estimate predictors of breast cancer progression. Results: One of five breast cancer patients had breast cancer progression (20.83%), while 66.15% of the progression patients were between the ages of 41–65. In multivariate analysis, age, progesterone receptor (PR), family history, and tumor size were significant predictors of breast cancer progression. The age group of 20–40 years was a protective predictor of breast cancer progression, patients in the young age group were less likely to be diagnosed with progression (OR = 0.35; CI = 0.15, 0.81). While negative PRs and tumor size greater than 2 cm were significant predictor factors of breast cancer progression (OR = 2.07; CI = 1.09, 3.91, OR = 2.02; CI = 1.9, 3.78). Conclusion: Although the effect of young age as a protective factor for the progression of breast cancer remains controversial, our study revealed that patients between 41 and 60 years of age had a higher rate of progression. Future larger prospective studies are needed to delineate the role of age and PR hormone receptors in determining the best treatment options for women with breast cancer in the Saudi population.
The effect of pre-microwave irradiation on the floatation of polystyrene, polyethylene terephthalate, and polyvinylchloride using numerous traditional depressants
Authors: Pakbar Hakimeh , Ostad Movahed Saeed , Jourabchi Shahab 
Published: March 2023

The absence of an effective technique for separation of an individual plastic from a mixture of plastics, is one of the most important concern in plastics waste management. The recently introduced floatation technique used to separate the selected engineering plastics including, polystyrene (PS), polyethylene terephthalate (PET), and polyvinylchloride (PVC) from each other. The floatation was assisted by using the traditional depressants (chemical agents). The effects of plastics surface pre-microwave irradiation at different microwave output powers, 20–100% studied on the floatation of each plastic. Also, the effect of depressant concentration, 400–2000 mg/L on the plastics floatation was evaluated. The results showed the pre-microwave irradiation of the plastics surface at different microwave output powers and depressant concentrations had important influence on the sink-float behavior of the studied plastics with the exception of PET. It seemed, the number and type of the active sites on the plastics surface changed after microwave irradiation. There was not any regular trend for the floatability of a plastic with increasing the microwave output power. The results reinforced by the traditional identification techniques including contact angle (θ) measurement, scanning electron microscope (SEM) images, and attenuated total reflectance Fourier transform infrared spectroscopy (ATR-FTIR) spectra analysis. The driven equations by a design of experiment software (Design-Expert ®) showed suitable conformity between the predicted and actual plastics flotation values.
ReRNet: A Deep Learning Network for Classifying Blood Cells
Authors: Zhu Ziquan , Wang Shui-Hua , Zhang Yu-Dong 
Published: March 2023

Aims Blood cell classification helps detect various diseases. However, the current classification model of blood cells cannot always get great results. A network that automatically classifies blood cells can provide doctors with data as one of the criteria for diagnosing patients’ disease types and severity. If doctors diagnose blood cells, doctors could spend lots of time on the diagnosis. The diagnosis progress is very tedious. Doctors can make some mistakes when they feel tired. On the other hand, different doctors may have different points on the same patient. Methods We propose a ResNet50-based ensemble of randomized neural networks (ReRNet) for blood cell classification. ResNet50 is used as the backbone model for feature extraction. The extracted features are fed to 3 randomized neural networks (RNNs): Schmidt neural network, extreme learning machine, and dRVFL. The outputs of the ReRNet are the ensemble of these 3 RNNs based on the majority voting mechanism. The 5 × 5-fold cross-validation is applied to validate the proposed network. Results The average-accuracy, average-sensitivity, average-precision, and average-F1-score are 99.97%, 99.96%, 99.98%, and 99.97%, respectively. Conclusions The ReRNet is compared with 4 state-of-the-art methods and achieves the best classification performance. The ReRNet is an effective method for blood cell classification based on these results.
Effects of Intensive Versus Distributed Constraint-Induced Movement Therapy for Children With Unilateral Cerebral Palsy: A Quasi-Randomized Trial
Authors: Wang Tien-Ni , Liang Kai-Jie , Liu Yi-Chia , Shieh Jeng-Yi , Chen Hao-Ling 
Published: March 2023

Background Previous studies have compared the effectiveness of constraint-induced movement therapy (CIMT) by different training doses. However, whether the dosing schedule, that is, intensive or distributed, influences the effectiveness of CIMT in children with unilateral cerebral palsy (CP) is unknown. Objective To investigate the effectiveness of intensive and distributed CIMT for children with unilateral CP. Methods Fifty children with unilateral CP were assigned to intensive or distributed CIMT group with a total of 36 training hours. The intensive CIMT was delivered within 1 week, and the distributed CIMT was delivered twice a week for 8 weeks. The outcomes were the Melbourne Assessment 2, Box and Block Test, Pediatric Motor Activity Log-Revised (PMAL-R), Bruininks–Oseretsky test of motor proficiency 2, ABILHAND-Kids and Parenting Stress Index—Short Form. The intensive group was assessed at the initiation of treatment (week 0), at the end of 1 week treatment (week 1), and 8 weeks after the initiation of treatment (week 8). The distributed group was assessed at week 0 and week 8. Results The within-group analyses demonstrated significant differences on all motor outcomes. There were no significant between-group differences at post-treatment, while the intensive CIMT demonstrated larger improvements than the distributed CIMT did on quality of use of the more-affected hand, as rated by parents on the PMAL-R at week 8. Conclusions The 2 dosing schedules of CIMT had similar effectiveness for children with unilateral CP. The intensive CIMT yielded additional improvement on parent rated motor quality of the more-affected hand at 8 weeks after the initiation of treatment. Trial registration: ClinicalTrials.gov (ID: NCT03128385)
Under (back) pressure: Better collateral flow may facilitate clot removal in ischemic stroke: A systematic review and meta-analysis
Authors: Seymour Trey , Kobeissi Hassan , Ghozy Sherief , Gupta Rishabh , Kadirvel Ramanathan , Kallmes David F 
Published: March 2023

Background Collateral status may facilitate clot removal and affect rates of successful reperfusion following endovascular therapy (EVT) for acute ischemic stroke (AIS). Methods Following the PRISMA guidelines, a systematic literature review of the English language literature was conducted using PubMed, Scopus, Web of Science, and Embase. Papers which focused on collateral status and patients treated with EVT for AIS were included in our analysis. Outcomes of interest included collateral score grading, rates of successful reperfusion defined as thrombolysis in cerebral infarction (TICI) score 2b-3 and onset to revascularization time. We calculated pooled odds ratio (OR) or mean difference (MD) and their corresponding 95% confidence intervals (CI) based on collateral status. Results 16 studies, with 6073 patients, were included in our analysis. Among the included studies, there were six different collateral grading scales, which were dichotomized into “good to moderate” and “poor” collaterals. Odds of successful reperfusion were significantly higher among patients with good to moderate collateral circulation compared to those with poor collaterals (OR =  1.61; 95% CI = 1.24 to 2.09; P-value < 0.001); however, there was heterogeneity among included studies (I2 = 5 4%; P-value = 0.008). Onset to revascularization time was comparable between patients with good to moderate collateral circulation compared to those with poor collaterals (MD = 3.91 min; 95% CI = −8.71 to 16.53; P-value = 0.544); however, there was heterogeneity among included studies (I2= 60%; P-value = 0.014). Conclusions The presence of good collaterals may increase the odds of achieving successful reperfusion following EVT for AIS. Improved collateral flow was associated with improved angiographic outcomes, although future work is needed to determine if a causal relationship exists.