bluuebunny/crossref_metadata_2025_split huggingface dataset:
Fluoroscopy-assisted epidural catheter placement: the effect of dye distribution in preoperative epidurograms on postoperative analgesia
Authors: Abdel-Moneem Mohamed Sobhy , Seam Elham Abdel Latif Hussein , Eskander Fahmy Saad Latif , Hamza Amr Hosny , El-Fawal Sanaa M. 
Published: October 2022

Abstract
Background
Postoperative epidural analgesia provides superior postoperative analgesia at rest and with activity, compared with systemic opioids. However, the impact of postoperative epidural analgesia on postoperative morbidity and/or mortality remains controversial, because of the sub-optimal reliability of epidural catheters that are placed preoperatively and used for postoperative pain control. The present study used the technique of lumbar epidurography. The study aims to better understand the possible correlation between the fluoroscopic characteristics of epidural catheters following injection of contrast medium and the postoperative functional characteristics regarding analgesia. In this single-arm clinical trial, 70 patients, aged 50 to 75 years old, underwent surgical urological procedures, involving incisions up to T8 dermatome, under combined general and epidural anesthesia. At the L2-L3 level, the epidural space was reached using the loss of resistance technique before general anesthesia was induced. The catheters were threaded upwards for 4–6 cm. Preoperative epidurograms were then done by injecting a 3-ml contrast medium OmnipaqueTM (240 mg I/ml) in the epidural catheters. The epidurograms were investigated for the location of the catheter tip in relation to the vertebral body, the extent of dye spread, laterality of dye spread (midline, right, or left), and the presence or absence of dye spread anterior to the spinal cord on the lateral image. The patients were followed postoperatively while epidural analgesia was infused.

Results
Both the postoperative epidural infusion and postoperative visual analog scale (VAS) scores were lower when catheter tips ended at L1 than when they ended at L2. As the contrast’s vertical spread increases in preoperative epidurograms, the analgesic infusion rate and VAS score decrease, and the number of dermatomes insensitive to cold increases. Epidurographically right-sided catheters showed more dermatomes deficient to cold sensations on the right side, compared with mid-line and left-sided catheters. Restriction of contrast to the posterior epidural space was associated with lower VAS scores and wider anesthesia to cold.

Conclusions
The use of epidurography to study epidural catheters may have the potential advantage of predicting the functionality of catheters and improving the reliability of postoperative epidural analgesia.
In silico detection of Cucurbitacin-E on antioxidant enzymes of model organism Galleria mellonella L. (Lepidoptera: Pyralidae) and variation of antioxidant enzyme activities and lipid peroxidation in treated larvae
Authors: Ercan Fahriye Sümer , Baş Hatice , Azarkan Serap Yalçın 
Published: October 2022

AbstractBackgroundIn silico studies further provided predictive binding properties of selected ligands for inhibition of target protein. In the study, molecular binding poses of Cucurbitacin-E and antioxidant enzymes (glutathione-S-transferase (GST), superoxide dismutase (SOD), catalase (CAT), glutathione reductase (GR), glutathione peroxidase (GPx) and acetylcholinesterase (AChE) ofGalleria mellonellawere determined in silico. Cucurbitacins are the most important components ofEcballium elaterium. The first cucurbitacin isolated from the plant was Cucurbitacin-E. In this study, the toxic effect ofE. elaterium(L.) A. Rich. (Cucurbitaceae) fruit juice onG. mellonella(Lepidoptera: Pyralidae) larvae, which is known as a good model insect, was also detected, and its effect on antioxidant enzyme activities and lipid peroxidation was revealed.ResultsThe plant fruit juice was tested on the target larvae ofG. mellonellawith different doses for 24 h. After the application, mortality rate, LC50, LC90and LC99values, the malondialdehyde (MDA) level and the activity changes of antioxidant enzymes were determined. Mortality increased with the increasing concentration of fruit juice. Also, increasing doses of essential oil caused decreasing in SOD, CAT, GST GPx, GR and AChE activities and increasing in MDA levels. As a result of in silico studies, maximum binding energy was obtained fromG. mellonellaCAT enzyme with Cucurbitacin E as a ligand.ConclusionsThis is the first study to demonstrate the in silico binding potential of Cucurbitacin E onG. mellonellaenzymes. The results indicate thatE. elateriumcan be used againstG. mellonellain a pest control program.Graphical Abstract
Pharmacognostic evaluation of Eranthemum indicum extracts for its in-vitro antioxidant activity, acute toxicology, and investigation of potent bioactive phytocompounds using HPTLC and GCMS
Authors: Nonglang Flavius Phrangsngi , Khale Abhijeet , Wankhar Wankupar , Bhan Surya 
Published: October 2022

AbstractBackgroundNortheast India has a rich resource of herbal plants, and it is essential to validate their therapeutic activity with proper scientific evidence. This study aims to identify active phytocompounds found in the extracts ofEranthemum indicum(E. indicum) and to determine its antioxidative activities and toxicity.ResultsIn vitrofree radical scavenging activity of the aqueous extract (AE) and methanol extract (ME) ofE. indicum(leaves) was determined using 2,2-diphenyl-1-picrylhydrazyl (DPPH), 2,2′-azino-bis-3-ethylbenzothiazoline-6-sulfonic-acid (ABTS), ferric reducing antioxidant power (FRAP), and total antioxidant activity (TAC). ME depicted better inhibitory concentration when compared to AE. This indicates the effective extraction capacity of methanol, which is consistent with the fact that ME had a higher polyphenol and flavonoid, resulting in their antioxidative activity. HPTLC analysis using the solvent system of ethyl acetate/methanol/ammonia 28–30% (40:10:10) showed better fingerprinting separation, especially in the ME. Furthermore, DPPH radical solution, when used as a derivatizing agent in HPTLC analysis, confirmed that ME has betterin vitroantioxidant activities than AE. GCMS analysis of AE identified 3-beta-hydroxy-5-cholen-24-oic-acid as active compound, while in ME Beta.-l-arabinopyranoside and 2-methyl-3-(3-methyl-but-2-enyl)-2-(4-methyl-pent-3-enyl)-oxetane were identified as the major bioactive compound. Acute toxicological investigations have shown that bothE. indicumextracts have a high L.D. 50 value of 1533 mg/kg b.w for AE and 1567 mg/kg b.w for ME making them safe and non-toxic.ConclusionsExtraction and identification of these phytocompounds in the extracts ofE. indicumcan help us scientifically document its medicinal importance, and its benefit in pharmaceutical industries. Since it showed promising free radical scavenging activity, it can also be a potent antioxidant source.
Graded Cardiac Response Criteria for Patients With Systemic Light Chain Amyloidosis
Authors: Muchtar Eli , Dispenzieri Angela , Wisniowski Brendan , Palladini Giovanni , Milani Paolo , Merlini Giampaolo , Schönland Stefan , Veelken Kaya , Hegenbart Ute , Geyer Susan M. , Kumar Shaji K. , Kastritis Efstathios , Dimopoulos Meletios A. , Liedtke Michaela , Witteles Ronald , Sanchorawala Vaishali , Szalat Raphael , Landau Heather , Petrlik Erica , Lentzsch Suzanne , Coltoff Alexander , Bladé Joan , Cibeira Maria Teresa , Cohen Oliver , Foard Darren , Wechalekar Ashutosh , Gertz Morie A. 
Published: October 2022

PURPOSE Binary cardiac response assessment using cardiac biomarkers is prognostic in light chain amyloidosis. Previous studies suggested four-level cardiac responses using N-terminal prohormone of brain natiuretic peptide improves prognostic prediction. This study was designed to validate graded cardiac response criteria using N-terminal prohormone of brain natiuretic peptide/brain natiuretic peptide. PATIENTS AND METHODS This retrospective, multicenter study included patients with light chain amyloidosis who achieved at least a hematologic partial response (PR) and were evaluable for cardiac response. Four response criteria were tested on the basis of natriuretic peptide response depth: cardiac complete response (CarCR), cardiac very good partial response (CarVGPR), cardiac PR (CarPR), and cardiac no response (CarNR). Response was classified as best response and at fixed time points (6, 12, and 24 months from therapy initiation). The study primary outcome was overall survival. RESULTS 651 patients were included. Best CarCR, CarVGPR, CarPR, and CarNR were achieved in 16%, 26.4%, 22.9%, and 34.7% of patients, respectively. Patients in cardiac stage II were more likely to achieve CarCR than patients in cardiac stage IIIA and IIIB (22% v 13.5% v 3.2%; P < .001). A deeper cardiac response was associated with a longer survival (5-year overall survival 93%, 79%, 65%, and 33% for CarCR, CarVGPR, CarPR, and CarNR, respectively; P < .001). Fixed time-point analyses and time-varying covariates Cox regression analysis, to minimize survivorship bias, affirmed the independent survival advantage of deeper cardiac responses. Four-level response performed better than two-level response as early as 12 months from therapy initiation. CONCLUSION Graded cardiac response criteria allow better assessment of cardiac improvement compared with the traditional binary response system. The study re-emphasizes the importance of early diagnosis, which increases the likelihood of deep cardiac responses.
Case Report: Visualization for treatment of insomnia, anxiety, and depression caused by PTSD
Authors: Aldahadha Basim , Bani Mustafa Manar 
Published: October 2022

Background: Depression and anxiety are disorders related to insomnia that generally affect quality of life, especially if they are related to traumatic events. One of the therapeutic methods that has shown effectiveness in treating depression, anxiety and insomnia associated with posttraumatic stress disorder (PTSD) is the visualization method, which is a cognitive behavioral method. The aim of this case study is to investigate the effectiveness of visualization in treating symptoms of depression, anxiety and insomnia associated with posttraumatic experiences. Methods: Sulaiman is a university student who suffered with his family a painful traffic accident, and he has become unable to slee p. This affected his general life, so he became anxious and depressed and had nightmares when sleeping, which lasted for more than a year. He was trained on visualization exercises, including laughter, music, directed visualization, receptive visualization, programmed visualization, and others, which lasted for 17 sessions. Results: The results showed an average improvement of 77.8% for each of the symptoms of anxiety, depression, insomnia, and the number of minutes it takes to fall asleep. The results of the nonparametric test also showed that there were statistically significant differences in the ranks of measures, as it showed z-values for each of insomnia (z= -2.32, p=0.008), depression (z= -2.54, p=0.04), anxiety (z= -3.08, p=0.03), the time taken to enter sleep (z= -2.64, p=0.04), and the time spent asleep (z= -2.44, p=0.02). Conclusions: Sulaiman reported that he became more effective and said that depression, rumination, symptoms of anxiety and stressful thoughts had been reduced to a minimum due to learning more positive alternatives and effective and healthy fantasies.
Adjusting growth standards for fetal sex improves correlation of small babies with stillbirth and adverse perinatal outcomes: A state-wide population study
Authors: Pritchard Natasha L. , Walker Susan P. , Mitchell Alexandra R. , Tong Stephen , Lindquist Anthea C. 
Published: October 2022

Objectives
Sex impacts birthweight, with male babies heavier on average. Birthweight charts are thus sex specific, but ultrasound fetal weights are often reported by sex neutral standards. We aimed to identify what proportion of infants would be re-classified as SGA if sex-specific charts were used, and if this had a measurable impact on perinatal outcomes.

Methods
Retrospective cohort study including all infants born in Victoria, Australia, from 2005–2015 (529,261 cases). We applied GROW centiles, either adjusted or not adjusted for fetal sex. We compared overall SGA populations, and the populations of males considered small by sex-specific charts only (SGAsex-only), and females considered small by sex-neutral charts only (SGAunadjust-only).

Results
Of those <10th centile by sex-neutral charts, 39.6% were male and 60.5% female, but using sex-specific charts, 50.3% were male and 49.7% female. 19.2% of SGA females were reclassified as average for gestational age (AGA) using sex-specific charts. These female newborns were not at increased risk of stillbirth, combined perinatal mortality, NICU admissions, low Apgars or emergency CS compared with an AGA infant, but were at greater risk of being iatrogenically delivered on suspicion of growth restriction. 25.0% male infants were reclassified as SGA by sex-specific charts. These male newborns, compared to the AGAall infant, were at greater risk of stillbirth (RR 1.94, 95%CI 1.30–2.90), combined perinatal mortality (RR 1.80, 95%CI 1.26–2.57), NICU admissions (RR 1.38, 95%CI 1.12–1.71), Apgars <7 at 5 minutes (RR 1.40, 95%CI 1.25–1.56) and emergency CS (RR 1.12, 95%CI 1.06–1.18).

Conclusions
Use of growth centiles not adjusted for fetal sex disproportionately classifies female infants as SGA, increasing their risk of unnecessary intervention, and fails to identify a cohort of male infants at increased risk of adverse outcomes, including stillbirth. Sex-specific charts may help inform decisions and improve outcomes.
Negative and positive experiences of caregiving among family caregivers of older blunt trauma patients
Authors: Wong Ting-Hway , Tan Timothy Xin Zhong , Loo Lynette Ma , Chua Wei Chong , Iau Philip Tsau Choong , Ang Arron Seng Hock , Goo Jerry Tiong Thye , Chan Kim Chai , Nguyen Hai V. , Nadkarni Nivedita V. , Matchar David Bruce , Seow Dennis Chuen Chai , Ng Yee Sien , Chan Angelique , Fook-Chong Stephanie , Tang Tjun Yip , Ong Marcus Eng Hock , Malhotra Rahul 
Published: October 2022

ObjectivesFamily caregivers play a fundamental role in the care of the older blunt trauma patient. We aim to identify risk factors for negative and positive experiences of caregiving among family caregivers.DesignProspective, nationwide, multi-center cohort study.Setting and participants110 family caregivers of Singaporeans aged≥55 admitted for unintentional blunt trauma with an Injury Severity Score (ISS) or New Injury Severity Score (NISS)≥10 were assessed for caregiving-related negative (disturbed schedule and poor health, lack of family support, lack of finances) and positive (esteem) experiences using the modified-Caregiver Reaction Assessment (m-CRA) three months post-injury.MethodsThe association between caregiver and patient factors, and the four m-CRA domains were evaluated via linear regression.ResultsCaregivers of retired patients and caregivers of functionally dependent patients (post-injury Barthel score <80) reported a worse experience in terms of disturbed schedule and poor health (β-coefficient 0.42 [95% Confidence Interval 0.10, 0.75], p = .01; 0.77 [0.33, 1.21], p = .001), while male caregivers and caregivers who had more people in the household reported a better experience (-0.39 [-0.73, -0.06], p = .02; -0.16 [-0.25, -0.07], p = .001). Caregivers of male patients, retired patients, and patients living in lower socioeconomic housing were more likely to experience lack of family support (0.28, [0.03, -0.53], p = .03; 0.26, [0.01, 0.52], p = .05; 0.34, [0.05, -0.66], p = .02). In the context of lack of finances, caregivers of male patients and caregivers of functionally dependent patients reported higher financial strain (0.74 [0.31, 1.17], p = .001; 0.84 [0.26, 1.43], p = .01). Finally, caregivers of male patients reported higher caregiver esteem (0.36 [0.15, 0.57], p = .001).Conclusions and implicationsNegative and positive experiences of caregiving among caregivers of older blunt trauma patients are associated with pre-injury disability and certain patient and caregiver demographics. These factors should be considered when planning the post-discharge support of older blunt trauma patients.
Persistent COVID-19 symptoms 1 year after hospital discharge: A prospective multicenter study
Authors: Aranda Judit , Oriol Isabel , Feria Lucía , Abelenda Gabriela , Rombauts Alexander , Simonetti Antonella Francesca , Catalano Clarisa , Pallarès Natàlia , Martín Miguel , Vàzquez Núria , Vall-Llosera Estel , Rhyman Nicolás , Suárez Romina Concepción , Nogué Marta , Loureiro-Amigo Jose , Coloma Ana , Ceresuela Luis , Carratalà Jordi 
Published: October 2022

Objective
To determine the health status and exercise capacity of COVID-19 survivors one year after hospital discharge.

Methods
This multicenter prospective study included COVID-19 survivors 12 months after hospital discharge. Participants were randomly selected from a large cohort of COVID-19 patients who had been hospitalized until 15th April 2020. They were interviewed about persistent symptoms, underwent a physical examination, chest X-ray, and a 6-minute walk test (6MWT). A multivariate analysis was performed to determine the risk factors for persistent dyspnea.

Results
Of the 150 patients included, 58% were male and the median age was 63 (IQR 54–72) years. About 82% reported ≥1 symptoms and 45% had not recovered their physical health. The multivariate regression analysis revealed that the female sex, chronic obstructive pulmonary disease, and smoking were independent risk factors for persistent dyspnea. Approximately 50% completed less than 80% of the theoretical distance on the 6MWT. Only 14% had an abnormal X-ray, showing mainly interstitial infiltrates. A third of them had been followed up in outpatient clinics and 6% had undergone physical rehabilitation.

Conclusion
Despite the high rate of survivors of the first wave of the COVID-19 pandemic with persistent symptomatology at 12 months, the follow-up and rehabilitation of these patients has been really poor. Studies focusing on the role of smoking in the persistence of COVID-19 symptoms are lacking.
Quality and content evaluation of websites with information about immune checkpoint inhibitors: An environmental scan
Authors: Ruiz Juan Ignacio , Singh Gagandeep , Erck McKenna , Geng Yimin , Suarez-Almazor Maria E. , Lopez-Olivo Maria A. 
Published: October 2022

Background
Trustworthy educational information for patients is critical for increasing their knowledge base and preparing them for shared decision making with clinicians. As the internet has become an important source of health information for many patients, the purpose of this study was to assess the quality and content of websites with educational content about immune checkpoint inhibitors.

Methods
We performed an environmental scan of the currently available websites providing educational information for patients about immune checkpoint inhibitors. We used three search engines: Google, Bing, and Yahoo! (9/20/2021). Two independent investigators selected relevant uniform resource locators (URLs), appraised the quality of the websites, and collected their characteristics. We evaluated the accuracy, completeness, technical elements, design and aesthetics, readability, usability, and accessibility of the websites. The user experience was also evaluated.

Results
We identified 37 websites for analysis. In 10 websites (27%), it was not possible to know the source of the information provided. Thirty-three (89%) provided a definition with a simple explanation of cancer and treatment and 30 (81%) on complications of immune checkpoint inhibitors; only seven (19%) provided information about the balance between risks and benefits. Thirty-five (95%) provided a statement of purpose. Regarding the design, all 37 (100%) had appropriate visual aspects, typography, and grammar. Thirty-six (97%) were well organized. For most of the websites (n = 35, 95%) the content was easy to find. Only two websites had a readability score of 6, while the others had higher scores. Regarding the user experience, the overall quality of websites was rated as excellent in 16 (43%), good in 14 (38%), and fair in 7 (19%).

Conclusions
Our findings reveal that websites with information about immune checkpoint inhibitors mostly have general information about cancer, the treatments, and adverse events. Few websites provide information about the balance between harms and benefits of treatment, costs, the source of the information, or the hierarchy of evidence. These findings identify the gap in the quality and content of websites for patients treated with immune checkpoint inhibitors and can help website creators and developers.
Levels and associated factors of the maternal healthcare continuum in Hadiya zone, Southern Ethiopia: A multilevel analysis
Authors: Ahmed Ritbano , Sultan Mohammed , Abose Selamu , Assefa Biruk , Nuramo Amanuel , Alemu Abebe , Demelash Minychil , Eanga Shamill , Mosa Hassen 
Published: October 2022

Background
The continuity of care throughout pregnancy, birth, and after delivery is an effective strategy to avert maternal and newborn deaths. A low proportion of mothers have achieved the continuum of maternal care in Ethiopia. This study aimed to assess the rate and factors associated with the completion of a continuum of maternal healthcare services in Hadiya Zone, Southern Ethiopia.

Methods
A community-based, cross-sectional study was conducted over two months (from September to October 2021) in 18 kebeles of the Hadiya zone, southern Ethiopia. Multistage cluster sampling was carried out to select the required study subjects, and data were collected using a structured, interviewer-administered questionnaire. A multilevel binary logistic regression model was used to examine the effects of individual and community-level factors on key elements of the care continuum. The measure of fixed effects was expressed as an odds ratio with a 95% confidence interval (CI).

Results
In this study, only 11.3% of women completed all components of the care continuum, which included four or more antenatal visits, skilled birth attendance, and postnatal care. The factors that are significantly associated with the completion of maternal care include higher maternal education [AOR = 4.1; 95%CI: 1.3–12.6], urban residence [AOR = 1.8; 95%CI: 1.1–3.0], time of first antenatal care follow-up [AOR = 2.7; 95% CI: 1.6–4.6], knowledgeability regarding postnatal danger signs [AOR = 1.9, 95% CI: 1.1–3.3], being in the highest wealth quintile [AOR = 2.8; 95%CI: 1.2–6.6] and primipara [AOR = 3.6; 95%CI: 1.4–9.4].

Conclusion
The rate of continuum of maternal healthcare services utilization was low in the study area. The findings indicated that higher maternal education, urban residence, time of first antenatal care follow-up, knowledgeability regarding postnatal danger signs, being in the highest wealth quintile and primipara were the factors associated with the completion of the continuum of maternal care. As a result of this study’s findings, program planners and ministry of health and non-governmental organizations working on maternal health should prioritize continued and strengthened health education in order to increase the completion level of the continuum of maternal healthcare services.