bluuebunny/crossref_metadata_2025_split huggingface dataset:
Thoracic Epidural Anesthesia in Cardiac Surgery: A Systematic Review, Meta-Analysis, and Trial Sequential Analysis of Randomized Controlled Trials
Authors: Chiew John Keong , Low Christopher Jer Wei , Zeng Kieran , Goh Zhi Jie , Ling Ryan Ruiyang , Chen Ying , Ti Lian Kah , Ramanathan Kollengode 
Published: May 2023

BACKGROUND:
Research on fast-track recovery protocols postulates that thoracic epidural anesthesia (TEA) in cardiac surgery contributes to improved postoperative outcomes. However, concerns about TEA’s safety hinder its widespread usage. We conducted a systematic review and meta-analysis to assess the benefits and risks of TEA in cardiac surgery.

METHODS:
We searched 4 databases for randomized controlled trials (RCTs) assessing the use of TEA against only general anesthesia (GA) in adults undergoing cardiac surgery, up till June 4, 2022. We conducted random-effects meta-analyses, evaluated risk of bias using the Cochrane Risk-of-Bias 2 tool, and rated certainty of evidence via the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) approach. Primary outcomes were intensive care unit (ICU), hospital length of stay, extubation time (ET), and mortality. Other outcomes included postoperative complications. Trial sequential analysis (TSA) was conducted on all outcomes to elicit statistical and clinical benefit.

RESULTS:
Our meta-analysis included 51 RCTs (2112 TEA patients and 2220 GA patients). TEA significantly reduced ICU length of stay (−6.9 hours; 95% confidence interval [CI], −12.5 to −1.2; P = .018), hospital length of stay (−0.8 days; 95% CI, −1.1 to −0.4; P < .0001), and ET (−2.9 hours; 95% CI, −3.7 to −2.0; P < .0001). However, we found no significant change in mortality. TSA found that the cumulative Z-curve passed the TSA-adjusted boundary for ICU length of stay, hospital length of stay, and ET, suggesting a clinical benefit. TEA also significantly reduced pain scores, pooled pulmonary complications, transfusion requirements, delirium, and arrhythmia, without additional complications such as epidural hematomas, of which the risk was estimated to be <0.14%.

CONCLUSIONS:
TEA reduces ICU and hospital length of stay, and postoperative complications in patients undergoing cardiac surgery with minimal reported complications such as epidural hematomas. These findings favor the use of TEA in cardiac surgery and warrant consideration for use in cardiac surgeries worldwide.
Νυχτερινές μουσειακές δράσεις για ενήλικες: από την εκπαιδευτική στην κοινωνική διάσταση της επίσκεψης
Authors: Δοξανάκη Αναστασία , Παππά Βασιλική-Χαραλαμπία , Δερμιτζάκη Κατερίνα 
Published: May 2023

Τα μουσεία στις ημέρες μας αντιμετωπίζουν πολλές προκλήσεις. Στόχος τους είναι να εκπαιδεύσουν και να ψυχαγωγήσουν τους επισκέπτες τους μέσα από δράσεις, που σταδιακά θα μετατρέψουν τον μουσειακό χώρο από στατικό σε ζωντανό και δημιουργικό περιβάλλον στα μάτια του κοινού. Οι νυχτερινές δράσεις -τις οποίες συναντάμε σε περισσότερα μουσεία τα τελευταία χρόνια- απαντούν σε αυτήν την ανάγκη, ανατρέποντας τη στερεοτυπική εικόνα του μουσείου ως αμιγώς εκπαιδευτικού περιβάλλοντος. Μέσα από αυτές τα μουσεία προσπαθούν να προβάλουν το περιεχόμενο και τις συλλογές τους με νέους και δημιουργικούς τρόπους, όπως νυχτερινές ξεναγήσεις, διανυκτερεύσεις, μουσική κ.ά.., ενισχύοντας την κοινωνική διάσταση της επίσκεψης. Το μουσείο, λοιπόν, μετατρέπεται σε έναν χώρο όπου οι άνθρωποι μπορούν να μάθουν, να κοινωνικοποιηθούν και να διασκεδάσουν ταυτόχρονα.
Η παρούσα μελέτη παρουσιάζει αρχικά τα αποτελέσματα έρευνας σε εκατόν έξι (106) ελληνικά μουσεία, ώστε να σκιαγραφηθεί το εγχώριο μουσειακό τοπίο σχετικά με τον χαρακτήρα των νυχτερινών δράσεων. Ποια είναι τα χαρακτηριστικά τους, σε ποιες ομάδες κοινού απευθύνονται; Έχουν καθαρά ψυχαγωγικό ή/και εκπαιδευτικό χαρακτήρα; Στον πυρήνα αυτού του προβληματισμού το άρθρο έπειτα εστιάζει στην αξιολόγηση της νυχτερινής δράσης Let’s Be Late! του Βιομηχανικού Μουσείου Φωταερίου της Αθήνας (Β.Μ.Φ.), που απευθυνόταν σε ενήλικο κοινό. Εξετάζει την εκπαιδευτική μεθοδολογία των δράσεων που πραγματοποιήθηκαν, τα δημογραφικά χαρακτηριστικά των συμμετεχόντων και τα μοτίβα συμπεριφοράς τους κατά τη δράση. Τα αποτελέσματά της είναι ενθαρρυντικά ως προς τη δυνατότητα των νυχτερινών μουσειακών δράσεων να προσελκύσουν μεγαλύτερο αριθμό επισκεπτών και να χτίσουν γέφυρες με ένα νέο ηλικιακά ενήλικο κοινό. Αναδεικνύουν, επίσης, την κοινωνική φύση των νυχτερινών μουσειακών εκδηλώσεων ενώ γίνεται φανερό ότι κατά τη διάρκεια αυτών προτάσσεται η ψυχαγωγική διάσταση της μουσειακής επίσκεψης, μέσα από την οποία προσπαθεί το Μουσείο να επιτύχει τους εκπαιδευτικούς του στόχους.
The effect of coronal pre-flaring and root canal irrigant on apex locators’ accuracy: an in-vitro study
Authors: Rifaat Shimaa , Aljami Abdullah , Alshehri Turki , T. Alameer Shahad , Aldossary Alhanoof , Almutairi Wejdan , N. Almaliki Mulham , A. Farooqi Faraz , Taymour Noha 
Published: May 2023

Background: Successful root canal treatment is influenced by the apical extent of root canal preparation and the eventual root canal filling. Achieving the full working length until the apical constriction, which is usually 0.5 – 1 mm shorter than the anatomical apex, is crucial. Electronic apex locators were used to detect the working length more accurately. There are six generations of electronic apex locators in the market. The selection of the appropriate irrigation with each apex locator for accurate working length determination is not fully investigated. Methods: The actual working lengths of 120 freshly extracted human single-rooted teeth were measured and compared with their working lengths using 3rd generation (Root ZX) followed by 6th generation (Raypex 6) apex locators in dry medium, presence of 5.25% sodium hypochlorite, and 2% chlorhexidine, without coronal pre-flaring and after coronal pre-flaring using the same irrigating media. Data were collected, tabulated, and afterward analyzed using one-way ANOVA with post-hoc to evaluate the significant difference in average working length between actual working length, Root ZX, and Raypex 6 apex locator working lengths accuracy. Results: The significant results were shown in roots that were coronally pre-flared and their working lengths were measured in a dry medium using Raypex 6 apex locator. While using the Root ZX apex locator, the most accurate results were shown in roots that were coronally pre-flared and their working lengths were measured while using a chlorhexidine irrigating solution. Conclusions: It is concluded that it is very important to know the specific irrigating medium to be used with each specific electronic apex locator to achieve the most accurate working length results.
Comparative evaluation of the effectiveness of Titanium platelet rich fibrin (T-PRF) membrane and collagen membrane combined with xenograft in the treatment of mandibular class II furcation defects – A study protocol of randomized controlled trial
Authors: Patil Ruchita , Dhadse Prasad V 
Published: May 2023

BACKGROUND Class II furcation is a significant clinical problem in dentistry. Its presence indicates advanced periodontitis. Different xenografts are available for the treatment of furcation involvement. Platelet concentrates that have been assimilated have a high concentration of growth factors, which has the added benefit of improving and accelerating healing. This study aims to compare the evaluation of effectiveness of T-PRF with xenograft and collagen membrane with xenograft in class II furcation defects. METHODS A one-year timeframe is going to be utilized to carry out the planned protocol, which is a randomised clinical trial. According to the inclusion criteria, 26 systemically healthy patients with class II furcation defects in mandibular molars will be included in the study. In Group I, xenograft and T-PRF (test group) will be condensed and in Group II, xenograft and collagen membrane (control group) will be condensed after the complete debridement of the furcation defect. Plaque index (PI), papillary bleeding index (PBI), Periodontal pocket depth (PPD), relative attachment level (R-CAL) and relative gingival marginal level (R-GML) will be evaluated as the clinical parameters. Cone-beam computed tomography (CBCT) will be performed to measure furcation height (FH), furcation width (FW), and furcation depth (FD) defects of mandibular molars. Data from each group will be evaluated at the time of surgery (baseline), and three and six months after the surgery. EXPECTED OUTCOMES Using xenograft (FIX OSS) combined with T-PRF, the authors anticipate better outcomes for class II mandibular furcation defects (test group). Improved clinical and radiographic outcomes in terms of PPD, R-CAL, R-GML and FH, FW, FD, are anticipated. CONCLUSIONS Using xenograft in combination with the T-PRF procedure is anticipated to have a better combined effect on periodontal parameters, including hard tissues and soft tissue outcomes. Registration: CTRI REF/2023/03/064367.
Comparison of growth factors isolated from exosomes present in maternal blood of cleft and non-cleft infants for identification and quantification of growth factors involved in the growth and development of cartilage.
Authors: Soni Nikita , Niranjane Priyanka , Daigavane Pallavi , Pratim Biswa , Shinde Mrudula 
Published: May 2023

Background: Cleft lip and palate (C.L.P.) is a common congenital condition which affects the orofacial region. The aetiology of C.L.P. is multifaceted and involves genetic and environmental factors that impact the shape and position of the nasal cartilage, resulting in an asymmetrical appearance of the nose. Growth factors are crucial in regulating cartilage synthesis and repair. Exosomes have emerged as a promising cell-free drug delivery system that facilitates intercellular communication and maintains tissue homeostasis. This study identifies and quantifies the growth factors present in exosomes derived from lactating maternal blood of cleft and non-cleft infants and compares them to evaluate the differences. The study aims to assess the potential of these exosomes as a therapeutic approach for C.L.P. management. Methods: Blood samples were collected from lactating mothers at Sharad Pawar Dental College and isolating plasma using centrifugation. Exosome and total protein isolation will be conducted in the laboratory, and immunoblotting will evaluate growth factors. Quantitative and comparative protein and growth factor analysis will be conducted separately for maternal blood samples. Results: The growth factors responsible for cartilage growth and development will be present in maternal exosomes, potentially leading to novel therapies for C.L.P. management. The study aims to demonstrate the therapeutic potential of exosomes, as carriers of intra-cellular factors, in transporting growth factors to the required site for managing C.L.P. Conclusions: Overall, by understanding the roles played by growth factors, intercellular communication, and genetic and environmental factors in the aetiology of C.L.P., this research can contribute to creating effective treatment strategies for C.L.P. management. Finding growth factors in exosomes made from the blood of nursing mothers could be a cutting-edge therapeutic strategy for treating C.L.P.
Uncertainty evaluation of photoluminescence quantum yield measurement in an integrating hemisphere-based instrument
Authors: Yoo Jaekak , Gene Jinhwa , Kim Jaeseok , Park Seung-Nam , Lim Seong Chu , Jeong Mun Seok , Lee Tae Geol , Park Seongchong 
Published: May 2023

We present an integrating hemisphere-based (i.e., a variant of integrating spheres) implementation of the indirect illumination method for absolute photoluminescence quantum yield measurements, which is a recommended method in the international standard IEC 62607-3-1:2014. We rigorously formulated a mathematical model and a measurement procedure for the absolute photoluminescence quantum yield measurement in the integrating hemisphere-based system. The measurement system was calibrated using an Hg-Ar discharge lamp and spectral irradiance standard lamps for wavelength and relative spectral radiant flux scales, respectively. Furthermore, we identified and evaluated uncertainty components involved in the photoluminescence quantum yield (PLQY) measurement. To validate our measurement system, we applied it to the two de facto standard dyes: quinine bisulfate (QBS) and fluorescein (FLS). Consequently, their PLQY values were determined to be 0.563±0.024 (k=2) and 0.876±0.032 (k=2) for, respectively, QBS and FLS, which are consistent with previous reports.
Ultrawide-band optically transparent antidiffraction metamaterial absorber with a Thiessen-polygon metal-mesh shielding layer
Authors: Song Naitao , Sun Qiao , Xu Su , Shan Dongzhi , Tang Yang , Tian Xiaoxi , Xu Nianxi , Gao Jingsong 
Published: May 2023

Transparent absorbers, with a functional integration of broadband electromagnetic shielding, microwave camouflage, and optical transparency, have attracted increasing attention in the past decades. Metal mesh, an artificial, optically transparent, conducting material composed of periodic metallic gratings, is the optimal choice for the microwave shielding layer of transparent absorbers because of its excellent compatibility between high transparency and low resistance. However, the micrometer-level periodicity of metallic grating concentrates the diffraction of light, which degrades the imaging quality of cameras and sensors in common. In this study, we report on a generalized Thiessen-polygon-randomization method that prevents the concentration of the diffraction of light in periodic metallic grating and demonstrate an ultrawide-band optically transparent diffraction-immune metamaterial absorber. The absorber is constructed with a multilayer indium-tin-oxide-based metasurface and a Thiessen-polygon-randomized metal-mesh reflector. The lossy metasurface provides multimode absorption, whereas the Thiessen-polygon randomization prevents the concentration of the diffraction of light. The practical sample achieves a 10 dB absorptivity and shielding effectiveness over a range of 8–26.5 GHz, and the optical transparency is also preserved over the entire visible and near-infrared regions. The point spread function and field of view are both improved by using the antidiffraction absorber. Our study paves the way for the application of optically transparent electromagnetic devices, display, and optoelectronic integration in a more practical stage.
Patient perspectives of antiretroviral pharmacy services: A cross-sectional cohort study
Authors: Liu Yadi , Lyden Elizabeth , Furl Renae , Havens Joshua P. 
Published: May 2023

Background
Adherence to antiretroviral therapy (ART) remains the main predictor of sustained HIV virologic suppression for people with HIV (PWH). Mail-order pharmacy services are often offered to patients as an alternative option to traditional pharmacy services. Some payers mandate ART to be dispensed from specific mail-order pharmacies regardless of patient choice complicating ART adherence for patients affected by social disparities. Yet, little is known about patient perspectives regarding mail-order mandates.

Methods
Eligible patients of the HIV program at University of Nebraska Medical Center with experience receiving ART from both a local and mail-order pharmacy were invited to complete a 20-question survey with three core sections: experiences/perspectives on local and mail-order pharmacy settings; pharmacy attributes rankings; and pharmacy preference. Paired t-tests and Mann-Whitney tests were used to compare the agreement scores of pharmacy attributes.

Results
Sixty patients (N = 146; 41.1%) responded to the survey. Mean age was 52 years. Most were male (93%) and White (83%). The majority of participants were on ART for HIV treatment (90%) and 60% were using mail-order pharmacies for their prescription services. Significant scoring differences (p<0.05) were observed for all pharmacy attributes favoring local pharmacies. Refilling ease was the most important attribute noted. More respondents (68%) preferred local pharmacies versus mail-order pharmacies. Payer associated mail-order pharmacy mandates were experienced by 78% with half believing the mandates impacted their medical care negatively.

Conclusions
In this cohort study, respondents preferred local pharmacies compared to mail-order pharmacy for ART prescription services and noted ease of refilling as the most important pharmacy attribute. Two-thirds of respondents believed mail-order pharmacy mandates negatively affected their health. Insurance payers should consider the removal of mail-order pharmacy mandates to allow patient choice of pharmacy, which may help remove barriers to ART adherence and improve long-term health outcomes.
Exploring the impact of COVID-19 on reported maternal and neonatal complications and access to maternal health care in five government health facilities in Blantyre, Malawi
Authors: Blair Alden , Haile Winta , Muller Anna , Simwinga Luseshelo , Malirakwenda Richard , Baltzell Kimberly 
Published: May 2023

Background
There is a dearth of studies assessing the effects of SARS-CoV-2 on the healthcare system and access to care, especially in lower- and middle-income countries such as Malawi. We aimed to assess the impacts of COVID-19 on reported maternal and neonatal complications as well as potential changes in maternal care access to care among five primary care health facilities in Blantyre, Malawi.

Methods
This retrospective cohort study assessed maternal and neonatal register data from five participating health centers in Blantyre, Malawi using the Malawi District Health Information Software 2 (DHIS2) to compare outcomes from 15 months before COVID-19 emerged, defined as the pre-Covid period (January 2019 –March 2020) with nine months after COVID-19 (April 2020 –December 2020).

Results
There was a significant decrease in reported use of vacuum extraction, which went from <0.01%in the pre-COVID period to 0% in the COVID period (p = 0.01). The proportion of births reporting fetal distress almost tripled from 0.46% to 1.36% (p = 0.001) during the COVID-19 period. Additionally, reported anticonvulsant use significantly increased from 0.01% to 1.2% (p<0.01), and antibiotic use significantly increased from 0.45% to 1.6% (p = 0.01). Asphyxia was the only significant neonatal complication variable reported, increasing from 2.80% to 3.45% (p = 0.01).

Conclusion
Our findings suggest that significant outcomes were mainly due to the indirect effects of COVID-19 rather than the virus itself. Based on our findings and the contextual qualitative interviews with two Malawian expert midwives, we concluded that mothers may have been affected more due to understaffing and shortage of skilled personnel in the study health facilities. Therefore, the development of highly skilled health workers may contribute to better outcomes, along with adequate staffing and a streamlined referral process.
Health, well-being, and burnout amongst Early Career Doctors in Nigeria
Authors: Bernard Ubom Akaninyene Eseme , Adebayo Oladimeji , Adeoye Philip Adewale , Kanmodi Kehinde K. , Salihu Mumeen Olaitan , Umar Shehu Salihu , Tolani Musliu Adetola , Ogunsuji Oluwaseyi Oyekunle , Monye Henreitta I. , Eze Ugochukwu A. , Ibrahim Yahya Abdulmajid , Nuhu James Teri , Selowo Temitope Toluse , Ibrahim Shuaibu Onoruoyiza , Alatishe Taiwo , Buowari Dabota Yvonne , Edadi Ukam Ekup , Williams Adedayo , Ojo Abayomi , Osasona Toba , Esievoadje Evo Olori , Sanni Taofeek Adedayo , Ishaya Dare Godiya , Suleiman Abiodun , Kabir Muhammad Sani , Enebeli Ugo Uwadiako 
Published: May 2023

Background
Early Career Doctors (ECDs) in Nigeria are faced with many individual and systemic problems, which consequently adversely affect their health, well-being, patient care and safety.

Objective
This study, the second phase of the Challenges of Residency Training and Early Career Doctors in Nigeria (CHARTING II) Study, sought to examine the risk factors and contributors to the health, well-being and burnout amongst Nigerian ECDs.

Methods
This was a study of health, well-being and burnout amongst Nigerian ECDs. Outcome variables included burnout, depression, and anxiety, which were respectively assessed using the Copenhagen Burnout Inventory (CBI) and Oldenburg Burnout Inventory (OLBI), Patient Health Questionnaire (PHQ-9) depression scale, and Generalized Anxiety Disorder (GAD-7) scale. The quantitative data obtained was analysed using the IBM SPSS, version 24. Associations between categorical outcome and independent variables were assessed using chi square, with level of significance set at < 0.05.

Results
The mean body mass index (BMI), durations of smoking and alcohol consumption of the ECDs were 25.64 ± 4.43 kg/m2 (overweight range), 5.33 ± 5.65 years and 8.44 ± 6.43 years respectively. Less than a third (157, 26.9%) of the ECDs exercised regularly. The most common disease conditions affecting the ECDs were musculoskeletal (65/470, 13.8%) and cardiovascular diseases (39/548, 7.1%). Almost a third (192, 30.6%) of the ECDs reported experiencing anxiety. Male and lower cadre ECDs were more likely than female and higher cadre ECDs to report anxiety, burnout and depression.

Conclusion
There is an urgent need to prioritize the health and well-being of Nigerian ECDs, so as to optimize patient care and improve Nigeria’s healthcare indices.
Encefalitis por dengue
Authors: Diaz Angarita Thomas Felipe , Moreno Sánchez Alexandra , Cárdenas Parra Karen Lorena 
Published: May 2023

Antecedentes: se trata de un adolescente con enfermedad transmitida por A. aegypti con compromiso neurológico, diagnosticada en un hospital a 2600 metros sobre el nivel del mar. Entidad de difícil enfoque por baja frecuencia a esta altitud. Reporte de caso Paciente de 15 años sin antecedentes patológicos de importancia, quien realiza viaje a lugares endémicos de enfermedades transmitidas por vectores, posterior a su regreso presenta malestar general, fiebre y rash generalizado por lo que consulta en varias ocasiones a diferentes servicios de urgencias, donde se realiza enfoque equívoco; a los 6 días de sintomatología inicia con deterioro neurológico, por lo que consulta nuevamente; teniendo en cuenta antecedente exposicional y clínica se sospecha Dengue atípico, el cual se confirma con serología. Conclusiones: El Dengue atípico, aunque es una entidad poco diagnosticada en áreas no endémicas, se debe tener en cuenta en pacientes con antecedentes claros exposicionales, lo cual puede cambiar el manejo y pronóstico de la enfermedad.
A Bridge to Banding: Splenic Artery Embolization in Hepatosplenic Schistosomiasis
Authors: Hassan Noor , Mohamed Islam , Rajab Rawan , Campbell Jack , Zulqarnain Mir , Sadeddin Esmat , Ghoz Hassan 
Published: May 2023

ABSTRACT
Schistosomiasis is a parasitic infection endemic to sub-Saharan Africa. The severe form of disease, caused by deposition of Schistosoma eggs in the portal vein, is known as hepatosplenic schistosomiasis. We present a case of a 26-year-old woman with esophageal varices in the setting of hepatosplenic schistosomiasis. This patient underwent partial splenic artery embolization to treat thrombocytopenia secondary to splenic sequestration. After embolization and improvement of cell counts, the patient was successfully able to undergo variceal band ligation.