bluuebunny/crossref_metadata_2025_split huggingface dataset:
Online Phylogenetics with matOptimize Produces Equivalent Trees and is Dramatically More Efficient for Large SARS-CoV-2 Phylogenies than de novo and Maximum-Likelihood Implementations
Authors: Kramer Alexander M , Thornlow Bryan , Ye Cheng , De Maio Nicola , McBroome Jakob , Hinrichs Angie S , Lanfear Robert , Turakhia Yatish , Corbett-Detig Russell 
Published: May 2023

Abstract
Phylogenetics has been foundational to SARS-CoV-2 research and public health policy, assisting in genomic surveillance, contact tracing, and assessing emergence and spread of new variants. However, phylogenetic analyses of SARS-CoV-2 have often relied on tools designed for de novo phylogenetic inference, in which all data are collected before any analysis is performed and the phylogeny is inferred once from scratch. SARS-CoV-2 data sets do not fit this mold. There are currently over 14 million sequenced SARS-CoV-2 genomes in online databases, with tens of thousands of new genomes added every day. Continuous data collection, combined with the public health relevance of SARS-CoV-2, invites an “online” approach to phylogenetics, in which new samples are added to existing phylogenetic trees every day. The extremely dense sampling of SARS-CoV-2 genomes also invites a comparison between likelihood and parsimony approaches to phylogenetic inference. Maximum likelihood (ML) and pseudo-ML methods may be more accurate when there are multiple changes at a single site on a single branch, but this accuracy comes at a large computational cost, and the dense sampling of SARS-CoV-2 genomes means that these instances will be extremely rare because each internal branch is expected to be extremely short. Therefore, it may be that approaches based on maximum parsimony (MP) are sufficiently accurate for reconstructing phylogenies of SARS-CoV-2, and their simplicity means that they can be applied to much larger data sets. Here, we evaluate the performance of de novo and online phylogenetic approaches, as well as ML, pseudo-ML, and MP frameworks for inferring large and dense SARS-CoV-2 phylogenies. Overall, we find that online phylogenetics produces similar phylogenetic trees to de novo analyses for SARS-CoV-2, and that MP optimization with UShER and matOptimize produces equivalent SARS-CoV-2 phylogenies to some of the most popular ML and pseudo-ML inference tools. MP optimization with UShER and matOptimize is thousands of times faster than presently available implementations of ML and online phylogenetics is faster than de novo inference. Our results therefore suggest that parsimony-based methods like UShER and matOptimize represent an accurate and more practical alternative to established ML implementations for large SARS-CoV-2 phylogenies and could be successfully applied to other similar data sets with particularly dense sampling and short branch lengths.
Telehealth Simulation: Effect on Nurse Learner Knowledge, Confidence, and Attitudes
Authors: Moore Jeanne , Jairath Nalini , Montejo Leigh , O’Brien Sandra , Want David 
Published: May 2023

Abstract
Limited research explores the effectiveness of educational interventions in meeting telehealth technology competencies. A combined didactic and simulation intervention was implemented with 66 prelicensure and 15 nurse practitioner students. Telehealth knowledge, confidence, and attitudes were evaluated using the Telemedicine Objective Structured Clinical Exam survey. Results were analyzed using descriptive and inferential strategies, and responses to an open-ended question were content analyzed. Survey scores significantly increased from pre- to post-intervention. Learners recognized the value of telehealth and the educational intervention. This effective and well-received intervention can be used by schools of nursing to facilitate student attainment of telehealth competencies.
Return to the Operating Room for Unplanned Pin Removal After Percutaneous Pinning of Supracondylar Humerus Fractures: A Retrospective Review
Authors: Lindsay Sarah E. , Crawford Lindsay , Holmes Stephanie , Kadado Allen A. , Memon Ramiz , Souder Christopher D. , Swarup Ishaan , Halsey Matthew 
Published: May 2023

Background:
Pin migration is a common complication associated with closed reduced and percutaneous pinning (CRPP) of supracondylar humerus fractures (SCHF) in children. Though this complication occurs frequently, little work has been done to elicit circumstances surrounding this complication. The purpose of this study was to evaluate patients with SCHF treated with percutaneous pins who needed to return to the operating room for pin removal.

Methods:
This was a multicenter study involving children treated at 6 pediatric tertiary care centers between 2010 and 2020. Retrospective chart review was performed to identify children aged 3 to 10 years of age with a diagnosis of a SCHF. Current Procedural Terminology (CPT) codes were used to identify patients who underwent CRPP of their injuries. CPT codes for deep hardware removal requiring procedural sedation or anesthesia were used to identify patients who needed to return to the operating room for hardware removal.

Results:
Between 2010 and 2020, 15 out of 7862 patients who were treated for SCHF at our 6 participating study centers experienced pin migration requiring a return to the operating room for pin removal, yielding a complication rate of 0.19%. Twelve (80%) of these injuries were Wilkins modification of the Gartland classification Type III, while the remaining injuries were Type II. 2-pin fixation constructs were used in nine (60%) children; 3-pin fixation constructs were used in 6 (40%) children. Pin migration was noted 23.2±7.0 days postoperatively at clinic follow-up. Four patients were noted to have multiple pins buried at follow-up. Four patients required 1-centimeter incisions for exposure of the buried pins, while surgeons were able to remove the buried pin with just a needle driver and blunt dissection in the remainder of patients.

Conclusions:
Pin migration is a common complication of closed reduction and percutaneous pinning of SCHF. There is variation in pin site management to prevent migration in the absence of underlying risk factors.

Level of Evidence:
Level III.
Patient-reported Outcome after Surgical Evacuation of Postoperative Spinal Epidural Hematomas at One-year Follow-up
Authors: Nerelius Fredrik , Sigmundsson Freyr G. , Karlén Niklas , Wretenberg Per , Joelson Anders 
Published: May 2023

Study Design.
Retrospective analysis of prospectively collected data from the National Swedish Spine Register (Swespine).

Objective.
To evaluate the effects of symptomatic spinal epidural hematoma (SSEH) requiring reoperation on one-year patient-reported outcome measures (PROMs) in a large cohort of patients treated surgically for lumbar spinal stenosis (LSS).

Summary of Background Data.
Studies exploring the outcomes of reoperations after SSEH are scarce and often lack validated outcome measures. As SSEH is considered a serious complication, understanding of the outcome following hematoma evacuation is important.

Materials and Methods.
After retrieving data from 2007 to 2017 from Swespine, we included all patients with LSS without concomitant spondylolisthesis who were treated surgically with decompression without fusion. Patients with evacuated SSEH were identified in the registry. Back/leg pain numerical rating scales (NRS), the Oswestry Disability Index (ODI), and EQ VAS were used for outcome assessment. PROMs before and one-year after decompression surgery were compared between evacuated patients and all other patients. Multivariate linear regression was performed to determine if hematoma evacuation predicted inferior one-year PROM scores.

Results.
A total of 113 patients with an evacuated SSEH were compared with 19527 patients with no evacuation. One-year after decompression surgery, both groups showed significant improvement in all PROMs. When comparing the two groups’ one-year improvement there were no significant differences in any PROM. The proportion of patients achieving the minimum important change was not significantly different for any PROM. Multivariate linear regression found that hematoma evacuation significantly predicted inferior one-year ODI (β=4.35, P=0.043), but it was not a significant predictor of inferior NRS Back (β=0.50, P=0.105), NRS Leg (β=0.41, P=0.221), or EQ VAS (β=−1.97, P=0.470).

Conclusions.

A surgically evacuated SSEH does not affect outcome in terms of back/leg pain or health-related quality of life. Commonly used PROM surveys may not capture neurologic deficits associated with SSEH.
Effect of Neuromuscular Electrical Stimulation in Patients With Critical Illness: An Updated Systematic Review and Meta-Analysis of Randomized Controlled Trials
Authors: Nakanishi Nobuto , Yoshihiro Shodai , Kawamura Yusuke , Aikawa Gen , Shida Haruka , Shimizu Motohiro , Fujinami Yoshihisa , Matsuoka Ayaka , Watanabe Shinichi , Taito Shunsuke , Inoue Shigeaki 
Published: May 2023

OBJECTIVES:
Neuromuscular electrical stimulation (NMES) is used in the rehabilitation of patients with critical illness. However, it is unclear whether NMES prevents ICU-acquired weakness (ICU-AW). For this purpose, we conducted an updated systematic review and meta-analysis.

DATA SOURCES:
We searched the MEDLINE, Cochrane Central Register of Controlled Trials, and Igaku Chuo Zasshi databases from April 2019 to November 2022 to identify new randomized controlled trials to the previous meta-analysis.

STUDY SELECTION:
We systematically searched the literature for all randomized controlled trials on the effect of NMES in patients with critical illness.

DATA EXTRACTION:
Two authors independently selected the studies and extracted data. They calculated the pooled effect estimates associated with the occurrence of ICU-AW and adverse events as primary outcomes and muscle mass change, muscle strength, length of ICU stay, mortality, and quality of life as secondary outcomes. The certainty of evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation approach.

DATA SYNTHESIS:
Overall, eight studies were added to the previous 10 studies. Evidence suggests that the use of NMES reduces the occurrence of ICU-AW (six trials; risk ratio [RR], 0.48; 95% CI, 0.32–0.72); however, NMES may have little to no effect on pricking sensation in patients (eight trials; RR, 6.87; 95% CI, 0.84–56.50). NMES is likely to reduce the change in muscle mass (four trials; mean difference, –10.01; 95% CI, –15.54 to –4.48) and may increase muscle strength (six trials; standardized mean difference, 0.43; 95% CI, 0.19–0.68). Further, NMES may result in little to no difference in the length of ICU stay, and the evidence is uncertain about the effect on mortality and quality of life.

CONCLUSIONS:
This updated meta-analysis revealed that the use of NMES may result in a lower occurrence of ICU-AW in patients with critical illness, but its use may have little to no effect on pricking sensation in patients.
Reduced Risk of Lymphedema With Intensity-modulated Radiation Therapy Compared With 3-dimensional Conformal Radiation Therapy in Patients With Cervical Cancer Who Received Postoperative Pelvic Radiation Therapy
Authors: Uezono Haruka , Tsujino Kayoko , Miyazaki Shuichiro , Marudai Mitsuru , Bessyo Ryosuke , Takabayashi Hatamei , Yamaguchi Satoshi , Ota Yosuke 
Published: May 2023

Objectives:
To compare the long-term adverse events of intensity-modulated radiation therapy (IMRT) with those of 3-dimensional conformal radiation therapy (3D-CRT) in patients with intermediate-risk and high-risk uterine cervical cancer who underwent postoperative pelvic radiation therapy (PORT).

Methods:
We reviewed the medical records of 177 patients with cervical cancer who underwent radical surgery and PORT. IMRT and 3D-CRT were administered to 93 and 84 patients, respectively. Follow-up and toxicity assessments were then carried out.

Results:
The median follow-up period was 63 months (range: 3 to 177). There was a significant difference in the follow-up period between the IMRT and 3D-CRT cohorts (median: 59 vs. 112 mo, P<0.0001). The crude incidences of acute grade 2+ and grade 3+ gastrointestinal toxicities were significantly lower with IMRT than with 3D-CRT (22.6% vs. 48.1%, P=0.002, and 3.2% vs. 11.1%, P=0.04, respectively). The Kaplan-Meier estimates of late toxicities revealed that IMRT significantly reduced grade 2+ genitourinary (GU) toxicity and lower-extremity lymphedema ([LEL] requiring intervention) compared with 3D-CRT ([6.8% vs. 15.2% at 5-year, P=0.048] and [3.1% vs. 14.6% at 5-year, P=0.0029], respectively). IMRT was the only significant predictor of reducing LEL risk.

Conclusions:
The risks of acute gastrointestinal toxicity, late GU toxicity, and LEL from PORT for cervical cancer were reduced by IMRT. Lower inguinal doses may have contributed to a lower risk of developing LEL, which should be validated in future studies.
Tip orientation under real-time point-of-care neck ultrasonic monitoring is advantageous in peripherally inserted central catheter procedures: a retrospective cohort study
Authors: Liu Shuiqing , Jiang Shaowei , Ma Jing , Qian Feng , Gao Chengjin 
Published: May 2023

Abstract

Background
We analyzed the success and catheter tip malposition rates of peripherally inserted central catheter (PICC) placement using ultrasonic monitoring.

Methods
A total of 564 patients were recruited and assigned to either the intervention or control group. In the intervention group, 282 patients underwent ultrasound-guided PICC insertion, which helped to identify the position and depth of the catheter tip. From a total of 9000 patients, 282 were selectively chosen to receive the traditional method using body surface measurements (control group). The primary endpoint was the success rate; the secondary endpoint was the catheter tip malposition rate as detected by postprocedure chest radiography.

Results
In the intervention group, a total of 94 catheters were in a suboptimal position; 26 were too deep, 68 were too shallow, and 1 was inserted into the subclavian vein, with success and malposition rates of 66.3% and 0.4%, respectively. In the control group, 139 catheters were in a suboptimal position; 88 were too deep, 51 were too shallow, 9 were inserted into the jugular vein, and 2 were inserted into the subclavian vein, with success and malposition rates of 46.8% (P < 0.001) and 3.9% (P = 0.004), respectively. Significant differences were observed in success and malposition rates between the 2 groups.

Conclusion
Ultrasound-guided PICC procedures achieved higher success rates and lower malposition rates.
Cardiopulmonary haemodynamic effects and gas exchange during apnoeic oxygenation with high-flow and low-flow nasal oxygen
Authors: Forsberg Ida-Maria , Al-Saadi Jonathan , Sjöblom Albin , Grape Lisa , Petersson Johan , Lundberg Johan , Lodenius Ase , Eriksson Lars I. , Fagerlund Malin Jonsson 
Published: May 2023

BACKGROUND
Apnoeic oxygenation with high-flow nasal oxygen prolongs the safe apnoeic period during induction of general anaesthesia. However, central haemodynamic effects and the characteristics of central gaseous exchange remain unexplored.

OBJECTIVE
To describe mean pulmonary arterial pressure along with arterial and mixed venous blood gases and central haemodynamic parameters during apnoeic oxygenation with low-flow and high-flow nasal oxygen in pigs.

DESIGN
Experimental crossover study.

SETTING
Animal study of 10 healthy Swedish landrace pigs at Karolinska Institutet, Sweden, April–May 2021.

INTERVENTION
The pigs were anaesthetised, their tracheas intubated and their pulmonary arteries catheterised. The animals were preoxygenated and paralysed before apnoea. Apnoeic periods between 45 and 60 min were implemented with either 70 or 10 l min−1 100% O2 delivered via nasal catheters. In addition, seven animals underwent an apnoea without fresh gas flow. Cardiopulmonary parameters and blood gases were measured repeatedly.

MAIN OUTCOME MEASURES
Mean pulmonary arterial pressure during apnoeic oxygenation with high-flow and low-flow oxygen.

RESULTS
Nine pigs completed two apnoeic periods of at least 45 min with a P
aO2 not lower than 13 kPa. The mean pulmonary arterial pressure increased during 45 min of apnoea, from 18 ± 1 to 33 ± 2 mmHg and 18 ± 1 to 35 ± 2 mmHg, at 70 and 10 l min−1 O2, respectively (P < 0.001); there was no difference between the groups (P = 0.87). The P
aCO2 increased by 0.48 ± 0.07 and 0.52 ± 0.04 kPa min−1, at 70 and 10 l min−1 O2, respectively; there was no difference between the groups (P = 0.22). During apnoea without fresh gas flow, the SpO2 declined to less than 85% after 155 ± 11 s.

CONCLUSION
During apnoeic oxygenation in pigs, the mean pulmonary arterial pressure increased two-fold and P
aCO2 five-fold after 45 min, while the arterial oxygen levels were maintained over 13 kPa, irrespective of high-flow or low-flow oxygen.
Overexpression of microRNA-93-5p and microRNA-374a-5p Suppresses the Osteogenic Differentiation and Mineralization of Human Aortic Valvular Interstitial Cells Through the BMP2/Smad1/5/RUNX2 Signaling Pathway
Authors: Liu Cuiying , Zhang Yajie , Guo Jing , Sun Wei , Ji Yue , Wang Yaqing , Liu Jing , Kong Xiangqing 
Published: May 2023

Abstract:
Aortic valve calcification commonly occurs in patients with chronic kidney disease (CKD). However, the regulatory functions of microRNAs (miRNAs/miRs) in the osteogenic differentiation of human aortic valvular interstitial cells (hAVICs) in patients with CKD remain largely unknown. This study aimed to explore the functional role and underlying mechanisms of miR-93-5p and miR-374a-5p in the osteogenic differentiation of hAVICs. For this purpose, hAVICs calcification was induced with high-calcium/high-phosphate medium and the expression levels of miR-93-5p and miR-374a-5p were determined using bioinformatics assay. Alizarin red staining, intracellular calcium content, and alkaline phosphatase activity were used to evaluate calcification. The expression levels of bone morphogenetic protein-2 (BMP2), runt-related transcription factor 2 (Runx2), and phosphorylated (p)-Smad1/5 were detected by luciferase reporter assay, reverse transcription-quantitative polymerase chain reaction (RT-qPCR), and western blot analysis. The results revealed that the expression levels of miR-93-5p and miR-374a-5p were significantly decreased in hAVICs in response to high-calcium/high-phosphate medium. The overexpression of miR-93-5p and miR-374a-5p effectively suppressed the high-calcium/high-phosphate–induced calcification and osteogenic differentiation makers. Mechanistically, the overexpression of miR-93-5p and miR-374a-5p inhibits osteogenic differentiation by regulating the BMP2/Smad1/5/Runx2 signaling pathway. Taken together, this study indicates that miR-93-5p and miR-374a-5p suppress the osteogenic differentiation of hAVICs associated with calcium–phosphate metabolic dyshomeostasis through the inhibition of the BMP2/Smad1/5/Runx2 signaling pathway.
Closed Incision Negative Pressure Therapy in Oncoplastic Surgery Prevents Delays to Adjuvant Therapy
Authors: Ockerman Kyle M. , Bryan Jaimie , Wiesemann Gayle , Neal Dan , Marji Fady P. , Heath Frederik , Kanchwala Suhail , Oladeru Oluwadamilola , Spiguel Lisa , Sorice-Virk Sarah 
Published: May 2023

Background:
Breast reductions, including oncoplastic breast surgery (OBS), have high postoperative wound healing complication (WHC) rates, ranging from 17% to 63%, thus posing a potential delay in the onset of adjuvant therapy. Incision management with closed incision negative pressure therapy (ciNPT) effectively reduces postoperative complications in other indications. This retrospective analysis compares postoperative outcomes and delays in adjuvant therapy in patients who received ciNPT on the cancer breast versus standard of care (SOC) after oncoplastic breast reduction and mastopexy post lumpectomy.

Methods:
Patient demographics, ciNPT use, postoperative complication rates, and time to adjuvant therapy were analyzed from the records of 150 patients (ciNPT = 29, SOC = 121). Propensity score matching was used to match patients based on age, body mass index, diabetes, tobacco use, and prior breast surgery.

Results:
In the matched cohort, the overall complication rate of ciNPT-treated cancerous breasts was 10.3% (3/29) compared with 31% (9/29) in SOC-treated cancerous breasts (P = 0.096). Compared with the SOC-treated cancerous breasts, the ciNPT breasts had lower skin necrosis rates [1/29 (3.4%) versus 6/29 (20.7%); P = 0.091] and dehiscence rates [0/29 (0%) versus 8/29 (27.6%); P = 0.004]. In the unmatched cohort, the total number of ciNPT patients who had a delay in adjuvant therapy was lower compared to the SOC group (0% versus 22.5%, respectively; P = 0.007).

Conclusion:
Use of ciNPT following oncoplastic breast reduction effectively lowered postoperative wound healing complication rates and, most importantly, decreased delays to adjuvant therapy.
Treatment Protocol on Using Microfocused Ultrasound with Visualization for Skin Quality Improvement: The Korean Experience
Authors: Park Je-Young , Youn Seongjae , Hong Wonkyu , Lee Kyou Chae , Kim Inyong 
Published: May 2023

Summary:
Facial skin quality profoundly influences an individual’s perceived appearance and is an important aspect of facial rejuvenation. Facial pore enlargement is one of the most common concerns among Asian individuals that adversely impacts perceived skin surface evenness and affects overall skin quality. One of the major causes of enlarged pores is facial skin laxity. Microfocused ultrasound with visualization (MFU-V; Ultherapy; Merz North America, Inc., Raleigh, N.C.) is indicated for lifting and tightening of the face and neck, and improving the appearance of wrinkles on the décolletage. In addition, it is useful for addressing several aspects of facial rejuvenation, including facial pores, skin laxity, skin unevenness, etc., but there is limited literature on these applications. Thus, we present our proposed MFU-V treatment protocol for achieving a harmonious outcome for attractive skin, along with practical strategies for its application, illustrated in patients presenting with enlarged pores as their main concern. Drawing on our collective experience in using MFU-V for facial rejuvenation and the recently published skin quality framework that advocates addressing interrelated attributes of skin quality for optimal outcomes, we developed a treatment protocol for improving skin quality using MFU-V. This MFU-V treatment protocol reliably improves overall skin quality in patients presenting with enlarged pores, through MFU-V’s effects on skin lifting and tightening, and consequent improvement in facial pores and skin texture. This treatment protocol can be readily used as part of a multimodal layering approach to yield successful outcomes in patients with various facial skin concerns.