bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effectiveness of Cultural Sensitivity Training on Undergraduate Students’ Knowledge, Self-Efficacy, and Ethnocultural Empathy
Authors: Butte Katie J. , Hristova Lena 
Published: April 2023

Abstract
Institutional racism and systemic bias must be addressed in health care education with embedded cultural sensitivity training. We report the results of remote training on culturally sensitive care to increase knowledge, self-efficacy, and empathy in undergraduate nursing students (n = 16). The training included four weekly remote sessions (~90 minutes). A pre-post survey indicated knowledge and self-efficacy increased (p < .01); empathy increased but not significantly, likely because of ceiling effects (p > .11). Compliance (94%) and satisfaction were excellent. This pilot study demonstrates a flexible, effective training model for nurse educators to implement within or alongside undergraduate nursing curricula.
The Translated Proximal Humerus Fracture: A Comparison of Operative and Nonoperative Management
Authors: Cosic Filip , Kirzner Nathan , Edwards Elton , Page Richard , Kimmel Lara , Gabbe Belinda 
Published: April 2023

Objectives:
To report on the long-term outcomes of the management of translated proximal humerus fractures.

Design:
A prospective cohort study was conducted from January 2010 to December 2018.

Setting:
Academic Level 1 trauma center.

Participants/Patients:
A total of 108 patients with a proximal humerus fracture with ≥100% translation, defined as no cortical bony contact between the shaft and humeral head fragments, were included.

Intervention:
Patients were managed nonoperatively with sling immobilization or with operative management as determined by the treating surgeon.

Main Outcome Measures:
Outcome measures were the Oxford Shoulder Score, EQ-5D-5L, return to work, and radiological outcomes. Complications recorded included further surgery, loss of position/fixation, nonunion/malunion, and avascular necrosis.

Results:
Of the 108 patients, 76 underwent operative intervention and 32 were managed nonoperatively. The mean (SD) age in the operative group was 54.3 (±20.2) years and in the nonoperative group was 73.3 (±15.3) years (P < 0.001). There was no association between Oxford Shoulder Score and management options (mean 38.5 [±9.5] operative versus mean 41.3 [±8.5] nonoperative, P = 0.48). Operative management was associated with improved health status outcomes; EQ-5D utility score adjusted mean difference was 0.16 (95% CI, 0.04–0.27; P = 0.008); EQ-5D VAS adjusted mean difference was 19.2 (95% CI, 5.2–33.2; P = 0.008). Operative management was associated with a lower odds of nonunion (adjusted OR 0.30; 95% CI, 0.09–0.97; P = 0.04), malunion (adjusted OR 0.14; 95% CI, 0.04–0.51; P = 0.003), and complications (adjusted OR 0.07; 95% CI, 0.02–0.32; P = 0.001).

Conclusion:
Translated proximal humerus fractures with ≥100% displacement demonstrate improved health status and radiological outcomes after surgical fixation.

Level of Evidence:
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
Dynamic Changes in Lumbar Spine Kinematics During Gait May Explain Improvement in Back Pain and Disability in Patients With Hip-Spine Syndrome
Authors: Chen Stephen R. , LeVasseur Clarissa M. , Como Christopher J. , Couch Brandon K. , Talentino Spencer E. , Klatt Brian A. , O’Malley Michael J. , Donaldson William F. , Lee Joon Y. , Shaw Jeremy D. , Anderst William J. 
Published: April 2023

Study Design.
Prospective cohort.

Objective.
Determine if total hip arthroplasty (THA) changes lumbar spine kinematics during gait in a manner that explains the improvements in back pain seen in patients with hip-spine syndrome.

Summary of Background Data.
For patients with hip-spine syndrome, improvements in both hip and back pain have been demonstrated after THA; however, the exact mechanism of improvement in back pain remains unknown, as no corresponding changes in lumbar spine static radiographic parameters have been identified.

Methods.
Thirteen patients with severe, unilateral hip osteoarthritis scheduled to undergo THA with concomitant back pain and disability were tested at baseline and 6 months after THA. Harris Hip Score (HHS) and Oswestry Disability Index questionnaires were completed; the static orientation of the spine and pelvis were measured on standing radiographs, and lumbar spine kinematics were measured during treadmill walking using a validated measurement system that matched subject-specific bone models created from CT scans to dynamic biplane radiographs.

Results.
After THA, both the Oswestry Disability Index (36.3–11.3, P<0.001) and Harris Hip Score (55.7–77.9, P<0.001) improved; however, there were no changes in static intervertebral or pelvis orientation. During gait after THA, the overall lumbar spine (L1 to L5) was less lordotic from heel strike to contralateral toe off (P<0.001), the L4 and L5 vertebra were less anteriorly tilted by 3.9° (P=0.038) from midstance to contralateral heel strike and by 3.9° (P=0.001) during stance, respectively.

Conclusion:
The decreased anterior tilt of the 2 lowest lumbar vertebrae and the corresponding loss of lumbar lordosis may reduce facet loading during the stance phase of gait after THA. This change in lumbar spine kinematics during gait is a potential mechanism to explain the observed improvements in back pain and disability after THA.

Level of Evidence.
4.
Individualized red-cell transfusion strategy for non-cardiac surgery in adults: a randomized controlled trial
Authors: Liao Ren , Liu Jin , Zhang Wei , Zheng Hong , Zhu Zhaoqiong , Sun Haorui , Yu Zhangsheng , Jia Huiqun , Sun Yanyuan , Qin Li , Yu Wenli , Luo Zhen , Chen Yanqing , Zhang Kexian , Ma Lulu , Yang Hui , Wu Hong , Liu Limin , Yuan Fang , Xu Hongwei , Zhang Jianwen , Zhang Lei , Liu Dexing , Huang Han 
Published: April 2023

Abstract

Background:
Red-cell transfusion is critical for surgery during the peri-operative period; however, the transfusion threshold remains controversial mainly owing to the diversity among patients. The patient's medical status should be evaluated before making a transfusion decision. Herein, we developed an individualized transfusion strategy using the West-China-Liu's Score based on the physiology of oxygen delivery/consumption balance and designed an open-label, multicenter, randomized clinical trial to verify whether it reduced red cell requirement as compared with that associated with restrictive and liberal strategies safely and effectively, providing valid evidence for peri-operative transfusion.

Methods:
Patients aged >14 years undergoing elective non-cardiac surgery with estimated blood loss > 1000 mL or 20% blood volume and hemoglobin concentration <10 g/dL were randomly assigned to an individualized strategy, a restrictive strategy following China's guideline or a liberal strategy with a transfusion threshold of hemoglobin concentration <9.5 g/dL. We evaluated two primary outcomes: the proportion of patients who received red blood cells (superiority test) and a composite of in-hospital complications and all-cause mortality by day 30 (non-inferiority test).

Results:
We enrolled 1182 patients: 379, 419, and 384 received individualized, restrictive, and liberal strategies, respectively. Approximately 30.6% (116/379) of patients in the individualized strategy received a red-cell transfusion, less than 62.5% (262/419) in the restrictive strategy (absolute risk difference, 31.92%; 97.5% confidence interval [CI]: 24.42–39.42%; odds ratio, 3.78%; 97.5% CI: 2.70–5.30%; P<0.001), and 89.8% (345/384) in the liberal strategy (absolute risk difference, 59.24%; 97.5% CI: 52.91–65.57%; odds ratio, 20.06; 97.5% CI: 12.74–31.57; P<0.001). No statistical differences were found in the composite of in-hospital complications and mortality by day 30 among the three strategies.

Conclusion:
The individualized red-cell transfusion strategy using the West-China-Liu's Score reduced red-cell transfusion without increasing in-hospital complications and mortality by day 30 when compared with restrictive and liberal strategies in elective non-cardiac surgeries.

Trial registration:
ClinicalTrials.gov, NCT01597232.
SHED-derived exosomes ameliorate hyposalivation caused by Sjögren's syndrome via Akt/GSK-3β/Slug-mediated ZO-1 expression
Authors: Du Zhihao , Wei Pan , Jiang Nan , Wu Liling , Ding Chong , Yu Guangyan 
Published: April 2023

Abstract

Background:
Sjögren's syndrome (SS) is an autoimmune disorder characterized by sicca syndrome and/or systemic manifestations. The treatment is still challenging. This study aimed to explore the therapeutic role and mechanism of exosomes obtained from the supernatant of stem cells derived from human exfoliated deciduous teeth (SHED-exos) in sialadenitis caused by SS.

Methods:
SHED-exos were administered to the submandibular glands (SMGs) of 14-week-old non-obese diabetic (NOD) mice, an animal model of the clinical phase of SS, by local injection or intraductal infusion. The saliva flow rate was measured after pilocarpine intraperitoneal injection in 21-week-old NOD mice. Protein expression was examined by western blot analysis. Exosomal microRNA (miRNAs) were identified by microarray analysis. Paracellular permeability was evaluated by transepithelial electrical resistance measurement.

Results:
SHED-exos were injected into the SMG of NOD mice and increased saliva secretion. The injected SHED-exos were taken up by glandular epithelial cells, and further increased paracellular permeability mediated by zonula occluden-1 (ZO-1). A total of 180 exosomal miRNAs were identified from SHED-exos, and Kyoto Encyclopedia of Genes and Genomes analysis suggested that the phosphatidylinositol 3 kinase (PI3K)/protein kinase B (Akt) pathway might play an important role. SHED-exos treatment down-regulated phospho-Akt (p-Akt)/Akt, phospho-glycogen synthase kinase 3β (p-GSK-3β)/GSK-3β, and Slug expressions and up-regulated ZO-1 expression in SMGs and SMG-C6 cells. Both the increased ZO-1 expression and paracellular permeability induced by SHED-exos were abolished by insulin-like growth factor 1, a PI3K agonist. Slug bound to the ZO-1 promoter and suppressed its expression. For safer and more effective clinical application, SHED-exos were intraductally infused into the SMGs of NOD mice, and saliva secretion was increased and accompanied by decreased levels of p-Akt/Akt, p-GSK-3β/GSK-3β, and Slug and increased ZO-1 expression.

Conclusion:
Local application of SHED-exos in SMGs can ameliorate Sjögren syndrome-induced hyposalivation by increasing the paracellular permeability of glandular epithelial cells through Akt/GSK-3β/Slug pathway-mediated ZO-1 expression.
Right ventricular-arterial uncoupling as an independent prognostic factor in acute heart failure with preserved ejection fraction accompanied with coronary artery disease
Authors: Jia Hongdan , Liu Li , Bi Xile , Li Ximing , Cong Hongliang 
Published: April 2023

Abstract

Background:
Right ventricular (RV)-arterial uncoupling is a powerful independent predictor of prognosis in heart failure with preserved ejection fraction (HFpEF). Coronary artery disease (CAD) can contribute to the pathophysiological characteristics of HFpEF. This study aimed to evaluate the prognostic value of RV-arterial uncoupling in acute HFpEF patients with CAD.

Methods:
This prospective study included 250 consecutive acute HFpEF patients with CAD. Patients were divided into RV-arterial uncoupling and coupling groups by the optimal cutoff value, based on a receiver operating characteristic curve of tricuspid annular plane systolic excursion to pulmonary artery systolic pressure (TAPSE/PASP). The primary endpoint was a composite of all-cause death, recurrent ischemic events, and HF hospitalizations.

Results:
TAPSE/PASP ≤0.43 provided good accuracy in identifying patients with RV-arterial uncoupling (area under the curve, 0.731; sensitivity, 61.4%; and specificity, 76.6%). Of the 250 patients, 150 and 100 patients could be grouped into the RV-arterial coupling (TAPSE/PASP >0.43) and uncoupling (TAPSE/PASP ≤0.43) groups, respectively. Revascularization strategies were slightly different between groups; the RV-arterial uncoupling group had a lower rate of complete revascularization (37.0% [37/100] vs. 52.7% [79/150], P <0.001) and a higher rate of no revascularization (18.0% [18/100] vs. 4.7% [7/150], P <0.001) compared to the RV-arterial coupling group. The cohort with TAPSE/PASP ≤0.43 had a significantly worse prognosis than the cohort with TAPSE/PASP >0.43. Multivariate Cox analysis showed TAPSE/PASP ≤0.43 as an independent associated factor for the primary endpoint, all-cause death, and recurrent HF hospitalization (hazard ratios [HR]: 2.21, 95% confidence interval [CI]: 1.44–3.39, P <0.001; HR: 3.32, 95% CI: 1.30–8.47, P = 0.012; and HR: 1.93, 95% CI: 1.10–3.37, P = 0.021, respectively), but not for recurrent ischemic events (HR: 1.48, 95% CI: 0.75–2.90, P = 0.257).

Conclusion:
RV-arterial uncoupling, based on TAPSE/PASP, is independently associated with adverse outcomes in acute HFpEF patients with CAD.
Alveolar target ventilation and dead space in children under anaesthesia
Authors: Gardon Aurelien , De Queiroz Siqueira Mathilde , Cerceuil Eloise , Bouhamri Noureddine , Chassard Dominique , Baudin Florent 
Published: April 2023

INTRODUCTION
Ventilator settings in children under anaesthesia remain difficult because of the changes in the physiology and the high dead space.

OBJECTIVE
To determine the alveolar minute-volume to sustain normocapnia in children under mechanical ventilation.

DESIGN
A prospective observational study.

SETTINGS
This study was performed between May and October 2019 in a tertiary care children's hospital.

PATIENTS
Children between 2 months and 12 years, weighing between 5 and 40 kg, admitted for general anaesthesia.

INTERVENTION
Volumetric capnography was used to estimate the alveolar and dead space volume (Vd).

MAIN OUTCOME MEASURES
Total and alveolar minute ventilation in (ml kg-1 min−1) over 100 breaths.

RESULTS
Sixty patients were included comprising 20 per group: 5 to 10 kg (group 1), 10 to 20 kg (group 2), 20 to 40 kg (group 3). Seven patients were excluded for aberrant capnographic curves. After normalisation to weight, the median [IQR] tidal volume per kilogram was similar between the three groups: 6.5 ml kg−1 [6.0 to 7.5 ml kg−1], 6.4  ml kg−1 [5.7 to 7.3  ml kg−1], 6.4  ml kg−1 [5.3 to 6.8  ml kg−1]; P = 0.3. Total Vd (in ml kg−1) was negatively correlated to weight (r = -0.62, 95% confidence interval -0.41 to -0.76, P < 0.001). The total normalised minute ventilation (ml kg−1 min−1) to obtain normocapnia was higher in group 1 than in group 2 and in group 3; 203  ml kg−1 min−1 [175 to 219 ml kg−1 min−1], 150  ml kg−1 min−1 [139 to 181  ml kg−1 min−1] and 128  ml kg−1 min−1 [107 to 157  ml kg−1 min−1]; P < 0.001 (mean ± SD), but (mean ± SD) alveolar minute ventilation was similar between the three groups; 68 ± 21  ml kg−1 min−1.

CONCLUSION
Total dead space volume (including apparatus dead space) represents a major component of tidal volume in children less than 30 kg, when using large heat and moisture exchanger filters. The total minute ventilation necessary to achieve normocapnia decreased with increasing weight, while the alveolar minute ventilation remained constant.

TRIAL REGISTRATION
ClinicalTrials.gov, identifier: NCT03901599
Microbiologic Epidemiology of Early-onset Sepsis in Neonates Born at ≥35 0/7 Weeks’ Gestation in Korea During 2009–2018
Authors: Yoon Yoonsun , So Hyejin , Lee Joon Kee , Kim Dongsub , Jo Kyo Jin , Kim Hyun Ho , Kim Yoo-Jin , Lee Jina , Jo Dae Sun , Kim Yun-Kyung , Park Su Eun , Chang Yun Sil , Kim Yae-Jean 
Published: April 2023

Background:
Sepsis within the first 3 days of life remains a leading cause of neonatal mortality and morbidity. However, few studies have addressed the epidemiology of sepsis in late preterm and term neonates, particularly in Asia. We aimed to estimate the epidemiology of early-onset sepsis (EOS) in neonates born at ≥35 0/7 weeks’ gestation in Korea.

Methods:
A retrospective study was conducted in neonates with proven EOS born at ≥35 0/7 weeks’ gestation from 2009 to 2018 at seven university hospitals. EOS was defined as identifying bacteria from a blood culture within 72 hours after birth.

Results:
A total of 51 neonates (0.36/1,000 live births) with EOS were identified. The median duration from birth to the first positive blood culture collection was 17 hours (range, 0.2–63.9). Among the 51 neonates, 32 (63%) patients were born by vaginal delivery. The median Apgar score was 8 (range, 2–9) at 1 minute and 9 (range, 4–10) at 5 minutes. The most common pathogen was group B Streptococcus (n = 21; 41.2%), followed by coagulase-negative staphylococci (n = 7; 13.7%) and Staphylococcus aureus (n = 5, 9.8%). Forty-six (90.2%) neonates were treated with antibiotics on the first day of symptom onset, and 34 (73.9%) neonates received susceptible antibiotics. The overall 14-day case-fatality rate was 11.8%.

Conclusion:
This is the first multicenter study on the epidemiology of proven EOS in neonates born at ≥35 0/7 weeks’ gestation and found that group B Streptococcus was the most common pathogen in Korea.
Regulation of granulocyte colony-stimulating factor-induced hematopoietic stem cell mobilization by the sympathetic nervous system
Authors: Suzuki Tomohide , Ishii Shinichi , Katayama Yoshio 
Published: April 2023

Purpose of review
Granulocyte colony-stimulating factor (G-CSF) is now a standard agent to mobilize hematopoietic stem cells (HSCs) from the bone marrow to circulation. This review introduced mechanistic insights from the aspect of the sympathetic nervous system (SNS).

Recent findings
Mobilization efficiency is determined by the balance between promotion and suppression pathways critically regulated by the SNS. G-CSF-induced high catecholaminergic tone promotes mobilization by (1) the strong suppression of osteolineage cells as a hematopoietic microenvironment and (2) fibroblast growth factor 23 production from erythroblasts, which inhibits CXCR4 function in HSCs. Simultaneously, SNS signals inhibit mobilization by (1) prostaglandin E2 production from mature neutrophils to induce osteopontin in osteoblasts to anchor HSCs and (2) angiopoietin-like protein 4 production from immature neutrophils via peroxisome proliferator-activated receptor δ to inhibit BM vascular permeability.

Summary
We now know not only the regulatory mechanisms of G-CSF-induced mobilization but also the leads about unfavorable clinical phenomena, such as low-grade fever, bone pain, and poor mobilizers. Recent understanding of the mechanism will assist clinicians in the treatment for mobilization and researchers in the studies of the hidden potential of BM.
Historical Cohort of Severe Congenital Neutropenia in Iran: Clinical Course, Laboratory Evaluation, Treatment, and Survival
Authors: Spoor Jonathan , Farajifard Hamid , Keshavarz-Fathi Mahsa , Rezaei Nima 
Published: April 2023

Introduction:
Severe congenital neutropenia (SCN) is one of the primary immunodeficiency diseases developed by genetic alterations. Mutations in several genes including HAX-1, G6PC3, jagunal, and VPS45 account for autosomal recessive SCN.

Patients and Methods:
Patients with SCN registered in the Iranian Primary Immunodeficiency Registry and referred to our clinic at the Children’s Medical Center were reviewed.

Results:
Thirty-seven eligible patients with a mean age of 28.51 ± 24.38 months at the time of diagnosis were included. Nineteen cases had consanguineous parents and 10 cases had confirmed or unconfirmed positive family history. The most prevalent infectious symptoms were oral infections followed by respiratory infections. We identified HAX-1 mutation in 4, ELANE mutation in 4 cases, G6PC3 mutation in 1, and WHIM syndrome in 1 case. Other patients remained genetically unclassified. After the median follow-up of 36 months from the time of diagnosis, the overall survival was 88.88%. The mean event-free survival was 185.84 months (95% CI: 161.02, 210.66).

Discussion:
Autosomal recessive SCN is more common in countries with high rates of consanguinity like Iran. The genetic classification was possible only for a few patients in our study. This might suggest that there are other autosomal recessive genes causative of neutropenia that have yet to be described.
Improved Facial and Skull-base Symmetry Following Osteotomy and Distraction of Unilateral Coronal Synostosis
Authors: Mellgren Jonas , Säljö Karin , Tarnow Peter , Maltese Giovanni , Bhatti-Søfteland Madiha , Olsson Robert , Hallén Tobias , Kölby Lars 
Published: April 2023

Objectives:
Unilateral coronal synostosis (UCS) results in a surgically demanding deformation, as the deformity is asymmetric in the calvarium but also presents with facial scoliosis and orbital dystopia. Traditional cranioplasties correct the forehead but have little effect on the face and orbits. Here, we describe a consecutive series of patients operated for UCS with osteotomy of the fused suture combined with distraction osteogenesis (FOD).

Methods:
Fourteen patients [mean age: 8.0 months (range: 4.3–16.6 months)] were included in this study. We measured and compared the orbital dystopia angle (ODA), anterior cranial fossa deviation (ACFD), and anterior cranial fossa cant (ACFC) between results from preoperative computed tomography and those at distractor removal.

Results:
Blood loss was 6.1 mL/kg (range: 2.0–15.2 mL/kg), and length of stay was 4.4 days (range: 3.0–6.0 days). We observed significant improvements in the ODA from [median (95% confidence interval)] −9.8° (−12.6° to −7.0°) to −1.1° (−3.7° to −1.5°) (p<0.001), ACFD from 12.9° (9.2–16.6°) to 4.7° (1.5–7.9°) (p<0.001), and ACFC from 2.5° (1.5–3.5°) to 1.7° (0.0–3.4) (p=0.003).

Conclusions:
The results showed that osteotomy combined with a distractor for UCS straightened the face and relieved orbital dystopia by affecting the nose angle relative to the orbits, correcting the deviation of the cranial base in the anterior fossa, and lowering the orbit on the affected side. Furthermore, this technique demonstrated a favorable morbidity profile with low perioperative bleeding and a short inpatient period, suggesting its potential to improve the surgical treatment of UCS.
Do buccal flaps improve velopharyngeal insufficiency in conversion Furlow palatoplasty for patients with cleft palate?
Authors: Lignieres Austin , Anderson Brady , Alimi Oluwatofe , Cepeda Alfredo , Seitz Allison , Obinero Chioma G. , Teichgraeber John F. , Nguyen Phuong D. , Greives Matthew R. 
Published: April 2023

Background:
Velopharyngeal insufficiency (VPI) is a complication following primary palatoplasty that can lead to hypernasality of the voice and other speech problems. The conversion Furlow palatoplasty for VPI can be done with the addition of buccal flaps to provide additional tissue for palatal repair. In this study we aimed to determine the effectiveness of buccal flaps with conversion Furlow in secondary management of VPI.

Methods:
A retrospective review of patients undergoing surgical repair of VPI between 2016 and 2020 was performed. Patients underwent either conversion Furlow palatoplasty alone (FA) or conversion Furlow with buccal flaps (FB) for VPI after primary straight-line repair of the palate. We reviewed medical records to collect demographics, operative information, and preoperative and postoperative speech scores.

Results:
Of the 77 patients in the study, 16 (21%) had a revision that incorporated buccal flaps. The median age at cleft palate revision surgery was 8.97 years in the FA group and 7.96 years in the FB group (p = 0.337). In the FA group, 4 patients (7%) developed a postoperative fistula, compared to 0 patients in the FB group. The average time to follow-up after revision surgery was 3.4 years (7 months – 5.9 years). Both cohorts demonstrated a decrease in hypernasality and total parameter scores postoperatively.

Conclusions:
The use of buccal flaps in revision Furlow palatoplasty could decrease risk for postoperative complications. The use of data from a larger patient population from multiple institutions is warranted to determine true significance.