bluuebunny/crossref_metadata_2025_split huggingface dataset:
Orthodontic Retainers and the Stability of the Maxillary Arch in Unilateral Cleft lip and Palate Patients: A Systematic Review
Authors: dos Santos Cibelle Cristina Oliveira , Bastos Renata Travassos da Rosa Moreira , Normando David 
Published: November 2022

Objective The aim of this systematic review was to elucidate the role of orthodontic retainers on the stability of compensatory orthodontic treatment in patients with unilateral cleft lip and palate. Methods Five electronic databases (PubMed, Scopus, Web of Science, LILACS, and LIVIVO) and the grey literature (OpenGrey and Google Scholar) were investigated, according to the population, exposure, comparator, outcomes and Study design eligibility criterion. The risk of bias assessment was determined based on the Risk of Bias In Nonrandomized Studies of Exposure (ROBINS-E) and the level of evidence with the GRADE tool. Results Three studies were included: two presented moderate risk of bias and one high. A moderate level of evidence revealed a mean value of 0.6 mm of intercanine relapse distance, and great variability between the data, regardless of the use or type of retention or rehabilitation. Relapse in the posterior region showed clinical significance, from −1 to −1.7 mm, especially in individuals who did not use retention, except in patients with symmetrical arches with Hawley retainer, where this value varies from −0.2 ± 0.63 mm. Conclusions Orthodontic retainers do not seem essential to prevent relapse at anterior maxillary dimensions after compensatory orthodontic treatment in patients with unilateral cleft lip and palate. Relapse in the posterior region can achieve greater clinical significance, which highlights the need for prolonged use of Hawley retainers and periodic evaluation of the stability of treatment results. Prospective studies with a longer follow-up can improve the certainty of the evidence.
Electrospun porous materials laden with tea tree oil and zinc nitrate exhibiting tailored physicochemical and in vitro apatite formation
Authors: Mani Mohan Prasath , Jaganathan Saravana Kumar , Md Khudzari Ahmad Zahran , bin Ismail Ahmad Fauzi , Faudzi Ahmad Athif Mohd , Tucker Nick 
Published: November 2022

Scaffold designs must accommodate the complex regeneration processes of damaged bone tissues. We attempt to achieve this goal by developing a composite electrospun scaffold mimicking the structural and functional requirements of extra cellular matrix This study investigates the use of a novel bone tissue regeneration formulation of tea tree oil (TT) and zinc nitrate Zinc2 incorporated into a polyurethane (PU) nanofibres scaffold fabricated via the well-known electrospinning technique.The diameter of these nanocomposites fibres was smaller (PU/TT-495 ± 184 nm and PU/TT/(ZnNO3)2–409 ± 155 nm) than polyurethane (1099 ± 118 nm) on its own. Fourier transform infrared spectroscopy analysis revealed that the PU and the additives interact through hydrogen-bond formation. Measuring the wettability of the PU/TT indicated a hydrophobic nature (115 ± 2) which was reversed by the addition of (ZnNO3)2 to PU/TT (69° ± 2). TT and the addition of (ZnNO3)2 increased the tensile strength. Atomic force microscopy showed that the fibres of PU/TT (633 ± 297 nm) and PU/TT/(ZnNO3)2 (345 ± 147 nm)were smoother than the PU (854 ± 32 nm). The developed nanocomposites showed delayed blood clot activation and reduced toxicity as determined by anticoagulant studies. Further, bone-forming abilities quantified by in vitro calcium deposition studies indicated enhanced calcium deposition (PU/TT-5.6% and PU/TT/(ZnNO3)2–10.8%) in comparison to PU (2.4%). We have demonstrated that the attributes of these nanocomposites maybe successfully exploited for bone reconstruction.
Exploring behaviour change in general practice consultations: A realist approach
Authors: Advocat Jenny , Sturgiss Elizabeth , Ball Lauren , Williams Lauren T , Prathivadi Pallavi , Clark Alexander M 
Published: November 2022

Objectives While general practice involves supporting patients to modify their behaviour, General Practitioners (GPs) vary in their approach to behaviour change during consultations. We aimed to identify mechanisms supporting GPs to undertake successful behaviour change in consultations for people with T2DM by exploring (a) the role of GPs in behaviour change, (b) what happens in GP consultations that supports or impedes behaviour change and (c) how context moderates the behaviour change consultation. Methods Semi-structured interviews with academic clinicians ( n = 13), GPs ( n = 7) and patients with T2DM ( n = 16) across Australia. Data were analysed thematically using a realist evaluation approach. Results Perspectives about the role of GPs were highly variable, ranging from the provision of test results and information to a relational approach towards shared goals. A GP–patient relationship that includes collaboration, continuity and patient-driven care may contribute to a sense of successful change. Different patient and GP characteristics were perceived to moderate the effectiveness and experience of behaviour change consultations. Discussion When patient factors are recognised in consultations, a relational approach becomes possible and priorities around behaviour change, that might be missed in a transactional approach, can be identified. Therefore, GP skills for engaging patients are linked to a person-centred approach.
Perioperative Management of Obstructive Sleep Apnea in Patients With Syndromic Craniosynostosis Undergoing LeFort III Osteotomy With Distraction: A Case Series
Authors: Brown Kathryn W. , Edwards Shelley R. , Hoppe Ian C. 
Published: November 2022

Study Design Retrospective observational study. Objective The purpose of this publication is to address the absence of literature detailing respiratory management in patients with syndromic craniosynostosis and obstructive sleep apnea during the immediate postoperative interval following LeFort III advancement with placement of distraction hardware but prior to sufficient midface advancement. Methods After IRB approval, the investigators retrospectively selected candidates for inclusion in this case series. The sample was composed of four patients ranging from 10 to 19 years of age undergoing LeFort III midface advancement during a one-year span at a single tertiary care center. All operations were performed by a single surgeon. Three of the selected patients suffered significant obstructive sleep apnea necessitating the operation, as determined by polysomnography. One patient experienced persistent apnea postoperatively requiring prolonged ICU level care. Results Three of the four patients had severe OSA diagnosed by polysomnography with a median AHI of 28.3. Two of the three patients with preoperative OSA experienced no untoward respiratory compromise in the immediate postoperative period; one required nightly oxygen tent and the other required no supplemental oxygen. Patient 1 experienced significant postoperative respiratory distress with nightly apneic episodes and desaturations requiring supplemental oxygen and frequent stimulation. Conclusions The present study suggests that early involvement of sleep medicine and management of patient expectations is vital. Extremely close postoperative monitoring in the ICU is necessary. Future studies are needed to protocolize perioperative management of obstructive sleep apnea in patients undergoing LeFort III osteotomy prior to initiation and completion of midface advancement.
Association of Thoracic MRI Findings With Specialty and Training
Authors: Linna Nathaniel B. , Zhang Steven , Farooqi Ali S. , Jia Lori , Huffman William , Casper David S. , Khalsa Amrit S. 
Published: November 2022

Study Design Retrospective Objective To compare the rate of positive pathology on thoracic MRI ordered by surgical spine specialists to those ordered by nonsurgical spine specialists. Methods Outpatient thoracic MRIs from January–March 2019 were evaluated from a single academic health care system. Studies without a known ordering provider, imaging report, or patients with known presence of malignancy, multiple sclerosis, recent trauma, or surgery were excluded (n = 320). Imaging studies were categorized by type of provider placing the order (resident, attending, or advanced practice practitioner) and department. MRIs were deemed positive if they showed relevant pathology that correlated with indication for exam as determined by a radiologist. One-sided chi-squared analysis was performed to determine statistical significance. Results Overall, our data demonstrated 17.2% of studies with positive pathology. Compared to nonspecialty clinicians, subspecialists showed 35/184 (19.0%) positivity rate versus the non-specialist with 20/136 (14.7%) positivity rate (P = .156). Posthoc analysis demonstrated that surgical specialists who order thoracic MRIs yield significantly higher positivity rates at 19/79 (24.0%) compared to nonsurgical specialists at 36/241 (14.9%) (P < .05). Overall, neurosurgery demonstrated the highest rate of positive thoracic MRIs at 14/40 (35.0%). Comparison between the rate of positivity between physicians and advanced practitioners was insignificant (P > .05). Conclusions Clinical diagnosis of symptomatic thoracic spine degenerative disease requires an expert physical exam combined with careful attention to radiology findings. Although the percent of relevant pathology on thoracic MRI is low, our data suggests evaluation by a surgical specialist should precede ordering a thoracic spine MRI.
Factors influencing the use of herbal medications during pregnancy at Public Health Center, Indonesia
Authors: Elba Fardila , Hilmanto Dani , Poddar Sandeep 
Published: November 2022

Introduction: There has been an increase in the usage of herbal remedies, particularly among pregnant women, across the globe. The prevalence of herbal medicine use during pregnancy ranged from 54.3% to 96.6% in the region studied, indicating a rising trend in the use of herbal medicine during pregnancy. Cold and flu symptoms and stomach problems were the most prevalent reasons people turned to this drug. Materials and methods: This study’s samples were pregnant women in the working area of Ciwaruga Public Health Center, which has eight villages. The samples were taken using a proportional simple random sampling technique until 96 respondents were obtained. The percentage of moms who took herbal medication was the primary outcome variable, and participants were chosen for the research using a systematic sampling procedure. A digital database was used to store quantitative data that had been coded. Results: The factors significantly associated with the use of herbal medicines during pregnancy were perception (OR 2.18; CI 1.02–4.66), having ever used herbal medicines during a previous pregnancy (OR 3.87; CI 1.46–10.25), and healthy reproductive is other reasons (OR 7.98; CI 4.45–14.30). Conclusion: Pregnant women in the Ciwaruga Public Health Center area often turn to herbal remedies, which may indicate a lack of access to mainstream medical treatment. They believe that herbal medications are useful and that using them during a prior pregnancy is linked.
SLAP Repair Versus Biceps Tenodesis in Patients Younger Than 40 Years: A Cost-Effectiveness Analysis
Authors: Sandler Alexis B. , Childs Benjamin R. , Scanaliato John P. , Dunn John C. , Parnes Nata 
Published: November 2022

Background: The surgical management of type II superior labrum anterior and posterior (SLAP) tears in patients younger than 40 years is controversial, but growing evidence suggests comparable outcomes between primary SLAP repair and primary biceps tenodesis, with lower rates of reoperations after primary biceps tenodesis. Given the relatively similar patient-reported outcomes, cost-effectiveness analyses of direct and indirect costs associated with the two procedures propound a valuable comparative technique. Hypothesis: In this value-based comparison of SLAP repair versus biceps tenodesis, we hypothesized that biceps tenodesis would be more cost-effective than SLAP repair in patients younger than 40 years. Study Design: Economic and decision analysis; Level of evidence, 4. Methods: A 1-month Markov cycle was simulated to reflect 10 years of health outcomes. Health states were selected based on outcomes that are especially important in assessing indirect costs for a younger, active patient population: return-to-sport rates, which demonstrate a return to baseline function, and reoperation rates. Transition state probabilities were obtained through an index systematic review and meta-analysis comparing labral repair and biceps tenodesis for the treatment of type II SLAP lesions in patients younger than 40 years. Health state utility and cost values were obtained from accepted values denoted in existing literature. Results: Both primary SLAP repair and primary biceps tenodesis yielded an average expected 8.1 quality-adjusted life years over the 10-year period. The average cost (in 2021 US$) was $16,619 for biceps tenodesis and $19,388 for SLAP repair. Conclusion: In a younger patient population, SLAP repair and biceps tenodesis had comparable quality-adjusted life years and utility in the treatment of type II SLAP tears; however, SLAP repair cost $19,388, while biceps tenodesis cost $16,619, reflecting a 14% cost savings with biceps tenodesis. These findings can be extrapolated to further establish the role for these procedures in treating SLAP tears.
Icaritin inhibits neuroinflammation in a rat cerebral ischemia model by regulating microglial polarization through the GPER–ERK–NF-κB signaling pathway
Authors: Yu Zining , Su Guangjun , Zhang Limei , Liu Gaigai , Zhou Yonggang , Fang Shicai , Zhang Qian , Wang Tianyun , Huang Cheng , Huang Zhihua , Li Liangdong 
Published: November 2022

Abstract
Background
Activated microglia play a key role in initiating the inflammatory cascade following ischemic stroke and exert proinflammatory or anti-inflammatory effects, depending on whether they are polarized toward the M1 or M2 phenotype. The present study investigated the regulatory effect of icaritin (ICT) on microglial polarization in rats after cerebral ischemia/reperfusion injury (CI/RI) and explored the possible anti-inflammatory mechanisms of ICT.

Methods
A rat model of transient middle cerebral artery occlusion (tMCAO) was established. Following treatment with ICT, a G protein-coupled estrogen receptor (GPER) inhibitor or an extracellular signal-regulated kinase (ERK) inhibitor, the Garcia scale and rotarod test were used to assess neurological and locomotor function. 2,3,5-Triphenyltetrazolium chloride (TTC) and Fluoro-Jade C (FJC) staining were used to evaluate the infarct volume and neuronal death. The levels of inflammatory factors in the ischemic penumbra were evaluated using enzyme-linked immunosorbent assays (ELISAs). In addition, western blotting, immunofluorescence staining and quantitative PCR (qPCR) were performed to measure the expression levels of markers of different microglial phenotypes and proteins related to the GPER–ERK–nuclear factor kappa B (NF-κB) signaling pathway.

Results
ICT treatment significantly decreased the cerebral infarct volume, brain water content and fluorescence intensity of FJC; improved the Garcia score; increased the latency to fall and rotation speed in the rotarod test; decreased the levels of interleukin-1 beta (IL-1β), tumor necrosis factor-alpha (TNF-α), Iba1, CD40, CD68 and p-P65-NF-κB; and increased the levels of CD206 and p-ERK. U0126 (an inhibitor of ERK) and G15 (a selective antagonist of GPER) antagonized these effects.

Conclusions
These findings indicate that ICT plays roles in inhibiting the inflammatory response and achieving neuroprotection by regulating GPER–ERK–NF-κB signaling and then inhibiting microglial activation and M1 polarization while promoting M2 polarization, which provides a new therapeutic for against cerebral ischemic stroke.

Graphical Abstract
Current utilization of interosseous access in pediatrics: a population-based analysis using an EHR database, TriNetX
Authors: Hoskins Meloria , Sefick Samantha , Zurca Adrian D. , Walter Vonn , Thomas Neal J. , Krawiec Conrad 
Published: November 2022

Abstract
Background
When central or peripheral intravenous access cannot be achieved in a timely manner, intraosseous (IO) access is recommended as a safe and equally effective alternative for pediatric resuscitation. IO usage and its complications in the pediatric population have been primarily studied in the setting of cardiac arrest. However, population-based studies identifying noncardiac indications and complications associated with different age groups are sparse.

Results
This was a retrospective observational cohort study utilizing the TriNetX® electronic health record data. Thirty-seven hospitals were included in the data set with 1012 patients where an IO procedure code was reported in the emergency department or inpatient setting. The cohort was split into two groups, pediatric subjects < 1 year of age and those ≥ 1 year of age. A total incidence of IO line placement of 18 per 100,000 pediatric encounters was reported. Total mortality was 31.8%, with a higher rate of mortality seen in subjects < 1 year of age (39.2% vs 29.0%; p = 0.0028). A diagnosis of cardiac arrest was more frequent in subjects < 1 year of age (51.5% vs 38.0%; p = 0.002), and a diagnosis of convulsions was more frequent in those ≥ 1 of age (28.0% vs 13.8%; p <0.01). Overall, 29 (2.9%) subjects had at least one complication.

Conclusions
More IOs were placed in subjects ≥ 1 year of age, and a higher rate of mortality was seen in subjects < 1 year of age. Lower frequencies of noncardiac diagnoses at the time of IO placement were found in both groups, highlighting IO may be underutilized in noncardiac settings such as convulsions, shock, and respiratory failure. Given the low rate of complications seen in both groups of our study, IO use should be considered early on for urgent vascular access, especially for children less than 1 year of age.
Cardiovascular risk management: the success of target level achievement in high- and very high-risk patients in Hungary
Authors: Jancsó Zoltán , Csenteri Orsolya , Szőllősi Gergő József , Vajer Péter , Andréka Péter 
Published: November 2022

Abstract
Background
The management of risk factors in patients with high cardiovascular risk and its effectiveness is of paramount importance. Over the last decade, several studies have examined the achievement of cardiovascular risk factors’ target levels in Europe. In the present Hungarian study, we assessed the cardiovascular risk level of participants aged 40–65 years and the success of achieving risk factors’ target levels in high- and very high-risk patients. We compared these results with the results of two similar European studies.

Methods
We conducted a cross-sectional study involving 37,778 patients aged 40–65 years from Hungary between 2019 and 2020. Cardiovascular risk levels and target values were set according to the 2016 European Guideline. Target achievement was evaluated for body mass index, waist circumference, blood pressure, total, LDL, and HDL cholesterol, triglyceride, and HbA1c (in diabetics).

Results
For 37,298 patients, all the data were available to determine their cardiovascular risk category. Of these, 23.1% had high and 31.4% had very high cardiovascular risk (men: 27.1 and 39.6%, women: 20.5 and 26.1%, respectively). Achievement of the LDL-C target of 1.8 mmol/l was only 8.0% among very high-risk patients, which was significantly lower than the European average (29%). Achievement of target blood pressure among high-risk patients was better than the European average (63.4% vs. 44.7%, respectively); however, achievement was slightly lower among very high-risk patients compared with the European average (49.4% vs. 58%, respectively). The proportion of patients with type 2 diabetes who achieved a HbA1c below 7% was 57.3% in the high-risk population and 53% in the very high-risk population, which was in line with the European average success rates (58.5 and 54%, respectively). Waist circumference (< 88 cm for women and < 102 cm for men) was achieved by 29.4% of patients in the very high-risk group in our survey, which was lower than the European average of 41%.

Conclusions
The success rate of cardiovascular risk management in Hungary is lower than the European average in several parameters. Furthermore, our data highlight the poor effectiveness of obesity management in Hungary. General practice partnerships may be important sites for positive change.
Fear of childbirth: validation of the Kiswahili version of Wijma delivery expectancy/experience questionnaire versions A and B in Tanzania
Authors: Massae Agnes F. , Larsson Margareta , Leshabari Sebalda , Mbekenga Columba , Pembe Andrea B. , Svanberg Agneta S. 
Published: November 2022

Abstract
Background
Fear of childbirth is common both before and after childbirth, often leading to complications in mother and new-born. The Wijma Delivery Expectancy/Experience Questionnaires (W-DEQ) are commonly used to measure fear of childbirth among women before (version A) and after childbirth (version B). The tools are not yet validated in the Tanzanian context. This study aimed to validate the reliability, validity, and factorial structure of their Kiswahili translations.

Methods
A longitudinal study was conducted in six public health facilities in the Pwani region, Tanzania. In all, 694 pregnant and 625 postnatal women were concurrently selected and responded to W-DEQ-A and W-DEQ-B. Validation involved: translating the English questionnaires into Kiswahili; expert rating of the relevancy of the Kiswahili versions’ items; computing content validity ratio; piloting the tools; data collection; statistical analysis with reliability evaluated using Cronbach’s alpha and the intraclass correlation coefficient. Tool validity was assessed using factor analysis, convergent and discriminant validity. Exploratory factor analysis and confirmatory factor analysis were conducted on data collected using W-DEQ-A and W-DEQ-B, respectively.

Results
Exploratory factor analysis revealed seven factors contributing to 50% of the total variation. Four items did not load to any factor and were deleted. The factors identified were: fear; lack of self-efficacy; lack of positive anticipation; isolation; concerns for the baby; negative emotions; lack of positive behaviour. The factors correlated differently with each other and with the total scores. Both Kiswahili versions with 33 items had good internal consistency, with Cronbach’s alphas of .83 and .85, respectively. The concerns for the baby factor showed both convergent and discriminant validity. The other six factors showed some problems with convergent validity. The final model from the confirmatory factor analysis yielded 29 items with good psychometric properties (χ2/df = 2.26, p =  < .001, RMSEA = .045, CFI = .90 and TLI = .81).

Conclusions
The Kiswahili W-DEQ-A-Revised and W-DEQ-B-Revised are reliable tools and measure fear of childbirth with a multifactorial structure, encompassing seven factors with 29 items. They are recommended for measuring fear of childbirth among pregnant and postnatal Tanzanian women. Further studies are needed to address the inconsistent convergent validity in the revised versions and assess the psychometric properties of W-DEQ-A among pregnant women across gestational ages.