bluuebunny/crossref_metadata_2025 huggingface dataset:
Afro-Latinx Identity within Latin American Horror Cinema
Authors: Santiago Maillim
Published: February 2025

As a political, social, and cultural concept, Latin America was established for the benefit of Western Europe and the United States to refer to their colonies. From la gran familia puertorriqueña ideology in the Caribbean to President Domingo Sarmiento’s 1860s campaign of genocide against the Black population in Argentina, the prioritization of whiteness became evident in Latin American national cinemas. Horror cinema in Latin America has its roots in Mexico, Argentina, and Brazil, but the racial makeup of casts and directors as well as the anxieties addressed in their narratives deceive audiences into believing that a Black Latin American population does not exist. Despite comprising the majority of the population in some Latin American countries, Black citizens are continually neglected by national media industries. This chapter is an in-depth analysis of the absence and presence of Black filmmakers and stories in Latin American horror. It also functions as a critical intervention in the concept of Latinidad and Western constructions of identity.
Security Community
Authors: Gheciu Alexandra
Published: February 2025

NATO is widely considered to be the expression of a security community. Such a depiction sheds important light on key aspects of its evolution as a military alliance. The security community approach has made a significant contribution to the conceptualization of NATO. Yet, recent developments have shown that the logic of community has limited analytical and practical value vis-à-vis states that depart from, or explicitly reject, the core liberal-democratic norms around which NATO has defined itself. Further, the rise of illiberal forces in several member countries raises difficult questions concerning the relevance of the community logic within the Alliance. The analysis of its historical evolution and contemporary challenges leads to the conclusion that, while NATO still has the potential to adapt to a changing environment, its future as a security community cannot be taken for granted.
Conventional Force Posture
Authors: Ringsmose Jens
Published: February 2025

NATO’s conventional force posture has evolved in meaningful ways over the decades. This chapter explains the how and why of that evolution by reference to three distinct phases: the Cold War, the end of the Cold War up to Russia’s annexation of Ukrainian Crimea in 2014, and the period since of an increasingly adversarial relationship with Russia. The analysis is situated within a narrative of threats and strategic ideas. Taking its cue from neo-classical realism, the chapter suggests that NATO has adapted its conventional forces time and again in response to changing levels of threat and contemporaneous dominant beliefs about how to tailor and employ land, sea, and air forces. This approach offers a theory-informed historical narrative where levels of threat play the lead role and shifting strategic ideas a supporting one in explaining change in NATO.
The United Kingdom
Authors: Dorman Andrew M. , Uttley Matthew
Published: February 2025

The United Kingdom’s extensive engagement with NATO since 1949 sets it apart from many other European allies. The chapter is divided into two main sections. The first section examines the British role in the formation of NATO, explores its contribution to NATO’s Cold War evolution, and outlines how NATO became the focus of British post-World War II defence policy. The second section considers the United Kingdom’s engagement with an evolving NATO since the end of the Cold War. For the British, the preservation and strengthening of NATO has been a consistent priority and fundamental to how governments in London view European security. This section looks at the costs and benefits of membership for the United Kingdom, as well as the influence, impact, and inputs British membership has brought to bear on NATO. The conclusion notes that NATO has been a constant of policy for the United Kingdom amidst turbulence in other areas—most obviously the British relationship with the European Union.
France
Authors: Schmitt Olivier
Published: February 2025

France’s relationship with NATO has often been a difficult one. France was a founding member of NATO and has remained wedded to the Alliance ever since. However, for a fifty-year period stretching from the 1960s until the 2010s, France occupied a semi-detached position in the Alliance (notionally outside of integrated military structures). NATO is regularly an object of political debate in France. It is routinely perceived as the mechanism through which the United States maintains geopolitical dominance in Europe. Yet for all this, France is the third largest financial contributor to the Alliance, one of just three nuclear-armed allies, and regularly participates in its military operations. French leaders are keen to emphasize the Alliance’s importance for the country’s security and European security more broadly. The contradictory impulses of France’s relationship with NATO are explored in this chapter. It discusses prevailing narratives in France about NATO, as well as French preferences regarding NATO’s scope and level of ambitions, alongside calls for greater European strategic autonomy.
Performance Legitimacy and Coercion in the Authoritarian States of East and Southeast Asia
Authors: Martinez Kuhonta Erik
Published: February 2025

In defiance of the Third Wave of democratization, authoritarian regimes remain prevalent in East and Southeast Asia. This chapter argues that authoritarianism in East and Southeast Asia has persisted on the basis of performance legitimacy and coercion. Through comparative historical analysis, the chapter argues that there are, broadly speaking, two types of authoritarianism in Pacific Asia: a purely coercive type that uses state violence to maintain power; and a developmental type that combines performance legitimacy with the deployment of coercion, especially through institutional mechanisms. This chapter argues that it is this latter type—an “authoritarian developmental state”—that especially distinguishes East and Southeast Asia as world regions.
L’alphabétisation chez les enfants d’âge scolaire : une approche pédiatrique des prises de position et de l’évaluation
Authors: Kawamura Anne , Orsino Angela , McLeod Scott , Handley-Derry Mark , Siegel Linda , Vine Jocelyn , Jones-Stokreef Nicola
Published: February 2025

L’alphabétisation est un important déterminant social de la santé qui influe sur la vie socioaffective quotidienne des enfants et sur leurs perspectives économiques plus tard dans la vie. Il est essentiel de pouvoir lire, écrire et comprendre le texte écrit pour participer à la société, atteindre ses objectifs, acquérir des connaissances et réaliser son potentiel. Pourtant, une forte proportion d’adultes du Canada ne possède pas les compétences nécessaires en alphabétisation pour satisfaire aux exigences de plus en plus complexes du milieu du travail et les gérer. Les professionnels de la santé qui s’occupent d’enfants jouent un rôle essentiel pour détecter les enfants et les familles à risque de faible alphabétisation. Le présent document de principes propose des approches pour évaluer les enfants et conseiller les familles afin qu’elles améliorent leurs compétences en lecture, tout en préconisant leur droit à l’enseignement de la lecture fondé sur des données probantes.
Evaluating and caring for children with a suspected learning disorder in community practice
Authors: Cohen-Silver Justine , van den Heuvel Meta , Freeman Sloane , Ogilvie Jacqueline , Chobotuk Tara
Published: February 2025

Learning challenges are common in school-aged children, with 5% to 10% meeting the criteria for a specific learning disorder (SLD, previously termed a ‘learning disability’). Learning disorders can present in community practice settings as behaviour challenges, school avoidance, or as symptoms of a mental health problem. Concomitant issues may include a mental health disorder, a genetic, metabolic, or neurological condition, or developmental delay. This practice point offers guidance to paediatric health care professionals regarding the presentation and diagnosis of an SLD, including information on psychoeducational assessments, a medical workup for children with learning challenges, possible comorbid health issues, and points for improvement and advocacy in support of families and children with a range of learning issues.
Maternal smoking during pregnancy and blood lead levels in US children aged 1–15 years: associations modified by age and race
Authors: Sellars Ian Alexander , Zhang Jian , Rogers Gunnar Preston , Wei Yudan
Published: February 2025

Objectives

Tobacco smoke is an important source of lead exposure. Maternal smoking during pregnancy likely transfers lead from the mother to the child, contributing to increased lead exposure in developing children. The present study aims to examine the association between maternal smoking during pregnancy and blood lead levels (BLL) in children.

Methods

A total of 18,946 US children aged 1–15 years in the 1999–2016 National Health and Nutrition Examination Survey were included. We defined children with elevated BLL if BLL ≥ 3.5 µg/dL. We estimated odds ratios (ORs) of elevated BLL in children born to mothers who smoked versus nonsmoking mothers.

Results

A decreasing trend in the prevalence of elevated BLL occurred between 1999 and 2016. After adjustment for the trend and other covariates, children whose mothers smoked during pregnancy had significantly increased odds of having elevated BLL (OR = 1.60; 95% confidence interval [CI] 1.25–2.06) compared to children of nonsmoking mothers. The stratified analyses revealed a significant association existed in children aged 1–5 years (OR = 1.88 [95% CI 1.32–2.68]) and aged 6–10 years (OR = 1.79 [1.07–2.98]), but not in youths (11–15 years, OR = 0.72 [0.37–1.40]). Being born to smoking mothers was found to be associated with high odds of elevated BLL in White (1.93 [1.35–2.77]) and Black children (2.03 [1.43–2.87]), but with low odds in Hispanic children (0.46 [0.23–0.92]).

Conclusions

The study demonstrates age- and race-specific associations between maternal smoking during pregnancy and BLL among US children. Maternal smoking contributes to lead exposure in early life. Culturally appropriate interventions are needed to further reduce BLL in the pediatric population.
Interventions in primary care to increase uptake of adult vaccines: a systematic review
Authors: Wheeler Stephanie G , Beste Lauren A , Overland Maryann K , Wander Pandora L
Published: February 2025

Background

There is a significant gap in understanding which strategies effectively enhance vaccination rates for recommended adult vaccines in primary care settings. This review aimed to identify interventions in outpatient clinics that increase vaccination rates for commonly recommended adult vaccines and describe the change in vaccination rate associated with each intervention aimed at increasing vaccination rates in adults.

Methods

Systematic searches identified randomized, controlled trials aiming to increase the rate of vaccination in adults in outpatient clinics. Following PRISMA guidelines, PubMed, EMBASE, CINAHL, and the Cochrane Central Register of Controlled Trials (CENTRAL) were searched. Two reviewers independently extracted relevant data and assessed risk of bias. Meta-analysis was not done due to heterogeneity of data.

Results

Forty-four RCTs met inclusion criteria. Clinician reminders to order vaccine increased vaccination 4%–32%. Electronic health record (EHR) prompts to patients or physicians increased vaccination 1%–16%. Bundled interventions increased vaccination 4%–42%, with more intensive interventions associated with higher increases. RCT of interventions involving face-to-face contact with patients increased vaccinations 6%–17%. Group outpatient visits increased vaccination 13%–17%, home visits 6%–17%, and physician or nurse recommendation 15%.

Conclusions

Clinics may increase vaccination rates by reminding doctors to order vaccine, promoting face-to-face conversations about vaccination, and instituting bundled clinic process improvements. EHR prompts may be less effective.
Reliability and Validity of the Respect Factor in Student Evaluations of Clinical Educators
Authors: Wilson Anita M. , Douglas Aaron , Spandorfer John M.
Published: February 2025

Purpose

Medical student mistreatment has profound negative effects on student education. When medical students feel mistreated, they may also feel that they have been treated disrespectfully. This study examines the validity and reliability of a tool to measure students’ perception of educators’ level of respect.

Method

Data from 516 student raters of 2,534 clinical educators (i.e., faculty and residents across 8 clinical departments) were used to investigate validity evidence based on Kane’s validity framework for an instrument that includes 2 items for measuring educator respect and 7 items for measuring teaching effectiveness. Exploratory and confirmatory factor analyses were conducted to investigate construct validity. Generalizability theory analysis was conducted to project estimates of the level of reliability of departmental-level respect scores for different data collection scenarios. The raters were third- and fourth-year students attending clinical rotations at Sidney Kimmel Medical College, Thomas Jefferson University, during the 2022 to 2023 academic year.

Results

Exploratory factor analysis revealed 2 correlated latent factors that represent respect and teaching effectiveness. The estimated confirmatory factor analysis model, with 2 first-order latent factors (i.e., respect and teaching effectiveness) and 1 second-order latent factor (i.e., teaching quality), resulted in a root mean square error of approximation index of 0.10 (indicating mediocre fit), a nonnormed fit index of 0.95 (indicating good fit), and a standardized root mean square residual of 0.03 (indicating good fit). Generalizability theory decision studies revealed plausible scenarios that would lead to reliability estimates between 0.71 and 0.81.

Conclusions

This study suggests that the respect rating scale yields sufficiently valid measures of students’ experiences and reliable department-level respect scores for plausible scenarios when ratings are obtained from 10 students nested in each of 35 educators per department. The results also suggest that the scale allows for valid decision-making about feedback to clinical educators and their departments.
Privacy, Care-seeking, and Stigma: A Qualitative Investigation of Patient Perspectives on Sharing Substance Use Disorder Treatment Records
Authors: Aluri James , Gurule Evelyn , Siddiqi Tulha Dobler , Upson Camryn R. , D’Sa Adam , Strain Eric C. , Antoine Denis G.
Published: February 2025

Objectives:

To examine, among persons with substance use disorders (SUDs), how their decision-making to seek care is influenced by concerns about the privacy of their treatment records, how they weigh the risks and benefits of record sharing, and their awareness of how records are shared and regulated.

Methods:

This qualitative study followed the Standards for Reporting Qualitative Research and analyzed semi-structured interviews of 13 men and 14 women recruited from inpatient and residential SUD treatment programs. Due to the onset of the COVID-19 pandemic, recruitment took place over an extended period (between May 2020 and July 2023). Interview transcripts were analyzed using qualitative thematic analysis. Saturation was checked using established quantitative methods.

Results:

Most participants reported that privacy concerns about their records were not a significant factor in the decision to seek treatment. Participants identified many benefits to record sharing, and stigma was viewed as a primary risk. Several women reported that health care professionals, particularly in emergency or perinatal care contexts, treated them differently or negatively after learning about their substance use history. Most participants were unaware of how their substance use treatment records were protected or who had access to their records.

Conclusions:

Sharing of SUD treatment records with health care professionals was generally viewed positively and privacy concerns did not appear to deter participants from seeking care. Stigma was a concern among participants, especially women. The unawareness of how records are shared highlights the need to better engage persons with SUDs in clinical conversations about their records.
Rotational Alignment in tibia diaphyseal fractures with the Suprapatellar Semi-extended Versus Standard Upper Entry Tibial Intramedullary Nailing: A Randomized Controlled Trial (RASPUTIN)
Authors: Varghese Viju Daniel , Jamshed Jubin , John Chandy Viruthipadavil , Kandagaddala Madhavi , Livingston Abel , Bliss Jeremy , Yadav Bijesh
Published: February 2025

OBJECTIVES:

To determine whether suprapatellar or infrapatellar approach makes a difference in the rate of rotational malalignment in tibial diaphyseal fractures treated with intramedullary nailing.

METHODS:

Design: Non inferiority, randomized controlled trial, with 2 arms (Suprapatellar and Infrapatellar approach)

Setting:

Single centre trial at a Level I trauma centre in South India.

Patient Selection Criteria:

Adults presenting with tibial diaphyseal fractures (OTA/AO 42A, B and C, 43A) planned for intramedullary nailing between September 2021 to July 2022.

Outcome Measures and Comparisons:

The primary outcome compared was the degree of rotational malignment in patients undergoing tibia nailing with Suprapatellar and Infrapatellar approaches. This was done using CT scan in the immediate post-operative period. Secondary outcomes included across the 2 groups were post-operative entry site pain, anterior knee pain (Kujala score), functional scores and union rates.

RESULTS:

50 patients, 25 in each arm were included and followed up to a period of 1 year. The mean age was 34 (16-67) years (68% male) in the suprapatellar group and 45 (16-72) years (72% male) in the infrapatellar group. The rate of rotational malalignment was 34% with 8 (32%) in the suprapatellar group and 9 (36%) in the infrapatellar group and was independent of approach (P=0.76). The rotational malalignment had no association with knee functional scores (P=0.24). Factors such as location of fracture (P=0.81), mechanism of injury (P=0.76), type of injury (P=0.24) and surgeon seniority (P=0.2) had no association with malrotation. Suprapatellar and infrapatellar groups were similar in terms of knee function (P=0.52), knee (P=0.31) and ankle P=0.23) range of movement and union rates (P=0.84). Entry site pain was found to be significantly less (P=0.021) in the suprapatellar group (6/25) as compared to the infrapatellar group (14/25).This difference persisted at 1 year.

CONCLUSIONS:

Rotational malalignment in tibial diaphyseal fractures treated by intramedullary nailing was independent of the approach used. Entry site pain was less common with suprapatellar approach.

LEVEL OF EVIDENCE:

Level I
Impact of Cervical Micro-Endoscopic Laminotomy on Postoperative Neck Pain and Range of Motion
Authors: Kobayashi Hiroshi , Nikaido Takuya , Watanabe Kazuyuki , Kato Kinshi , Kobayashi Yoshihiro , Nakamura Masataka , Sekiguchi Miho , Hakozaki Michiyuki , Kameda Takuya , Kaneuchi Yoichi , Otani Koji , Yabuki Shoji , Konno Shin-ichi , Matsumoto Yoshihiro
Published: February 2025

Study Design.

Retrospective case-control study.

Objective.

To evaluate clinical outcomes of cervical microendoscopic laminotomy (CMEL) and segmental partial laminectomy (SPL) in patients with cervical spondylotic myelopathy (CSM).

Summary of Background Data.

CSM often requires posterior decompression surgery. Conventional techniques such as laminoplasty and SPL are associated with significant challenges, including axial neck pain and reduced cervical range of motion (ROM). In contrast, CMEL, a minimally invasive approach, may offer superior outcomes. However, direct comparisons with SPL remain limited.

Methods.

We retrospectively analyzed 105 patients (58 with CMEL and 47 with SPL) who underwent posterior decompression surgery for CSM between 2003 and 2020. The evaluated outcomes included intraoperative parameters, postoperative clinical measures (e.g., Neck Disability Index (NDI), Japanese Orthopaedic Association (JOA) scores, including recovery rate and treatment satisfaction), radiographic assessments, and complication rates.

Results.

Compared to SPL, CMEL resulted in reduced blood loss, shorter hospital stay, less postoperative neck pain, ROM preservation, and fewer complications at 1 year postoperatively.

Conclusions.

CMEL is a minimally invasive alternative to SPL, providing reduced morbidity and improved outcomes. This is particularly true for aging populations that require functional preservation and quality of life improvement. By avoiding instruments such as interlaminar spacers and implants, CMEL can potentially reduce healthcare costs.
Medicare work-related injuries: Underutilization of workers' compensation leads to higher out-of-pocket costs for older adults
Authors: McFalls Matthew , Virnig Beth A. , Andrew Ryan M.S , Erickson Darin J. , Kim Hyun , Jarosek Stephanie , Alexander Bruce H. , Ramirez Marizen R.
Published: February 2025

Objective: Older adults may pay healthcare-related costs for work injuries if Medicare covers claims over workers' compensation (WC). We assessed Medicare enrollee costs after a work-related injury by WC status.

Methods: We longitudinally analyzed Medicare fee-for-service claims (2016-2019) for age 65+ Medicare enrollees with work-related injuries, estimating WC effects on healthcare use and enrollee costs using difference-in-differences and quantile regression models.

Results: WC covered at least one Medicare claim for 16% of the 13,039 enrollees with work-related injuries. Over 90 days, mean Medicare out-of-pocket costs were lower with WC ($447) than without ($778). With WC, enrollees owed $1,432 at the 90th percentile compared to $2,465 without, an adjusted difference of $600 (95% CL -767, -432).

Conclusions: While WC covers some costs, Medicare claim billing increases after a work-related injury, often leading to substantial patient expenses.
Magnetic Resonance Imaging of Inner Ear and Internal Auditory Canal Structures in the Presence of a Cochlear Implant
Authors: Dewey Rebecca Susan , Dineen Robert A. , Clemence Matthew , Menon Nitin , Bowtell Richard , Boyle Patrick , Hartley Douglas E. H.
Published: February 2025

Objective

To determine whether the internal auditory canal (IAC) can be visualized using magnetic resonance imaging (MRI) in users of a cochlear implant (CI) model that can safely undergo MRI at 3 T.

Patients

Four normally hearing controls and three individuals unilaterally implanted with a HiRes Ultra 3D (Advanced Bionics LLC, California, USA).

Interventions

Participants underwent 3 T MRI using sequences appropriate for the postoperative surveillance of the IAC. Images in normally hearing individuals were acquired after placing a fully functional, unpowered, CI underneath a swimming cap at each of eight candidate scalp positions, four on each side of the head. Images were compared to a control condition without a CI present. and CI users were imaged with similar sequences.

Main Outcome Measures

In normally hearing controls, the likely impact of the artifact on detection of pathology for multiple neuroradiological locations as rated by two independent radiologists. In CI users, a qualitative assessment of the diagnostic usability of images.

Results

Visibility of the ipsilateral IAC and cochlea varied among the three CI users, with images from one participant deemed largely usable, while those from the other two participants exhibited less diagnostic certainty, likely due to differences in implant locations and cranial/neuroanatomical variations. Ratings of images in normally hearing participants showed that more middle-to-anterior CI locations were associated with reduced likelihood of overlooking gross abnormalities.

Conclusion

Through meticulous surgical placement, bilateral IAC visualization may be achievable for monitoring chronic health conditions such as tumor surveillance in high-risk patients, and as a safety monitoring outcome measure in clinical trials.
Impact of cytochrome P-450 3A4 enzyme/P-glycoprotein inducing antiseizure medications on direct oral anticoagulant therapy
Authors: McNary Sean M. , Kuhlenberg Madalyn , Basilio Lucia F. , Clark Nathan P. , Hui Rita L. , Niu Fang , Delate Thomas
Published: February 2025

Objectives

Concomitant use of cytochrome P-450 and P-glycoprotein (CYP 3A4/P-gp) inducing antiseizure medications and direct oral anticoagulants (DOAC) may result in reduced DOAC effectiveness, but study results are inconsistent and of variable quality. The purpose of this study was to assess the safety of concomitant CYP 3A4/P-gp inducing antiseizure medications and DOAC use.

Methods

This was a retrospective cohort study of adult patients who were newly, concomitantly receiving a DOAC (apixaban, dabigatran, or rivaroxaban) and either a CYP 3A4/P-gp inducer (carbamazepine, phenytoin, phenobarbital, or primidone) or noninducer (gabapentin). The primary outcome was the occurrence of a thromboembolic complication, defined as the composite of ischemic stroke and systemic embolism (S/SE) and venous thromboembolism (VTE). Secondary outcomes included the components of the primary composite as well as all-cause mortality and clinically relevant bleeding. Adjusted multivariate proportional hazards modeling was used to compare outcomes for each DOAC individually in the inducer and noninducer groups.

Results

There were 1843 and 14 647 patients who received a DOAC plus a CYP3A4/P-gp inducer and noninducer, respectively. Overall, patients were primarily older, white, had atrial fibrillation, and were dispensed dabigatran. After adjustment, there were no statistically significant differences in the primary outcome between the groups (P > 0.05); however, concomitant inducer and DOAC use was associated with an increased risk of all-cause mortality (P < 0.05).

Conclusions

No excess risk of thrombosis during concomitant use of DOACs with CYP3A4/P-gp inducing antiseizure medications compared to use with gabapentin was identified. Further research is needed to confirm an association with excess all-cause mortality.
Clinical outcomes of rotational atherectomy followed by cutting balloon for calcified coronary lesions
Authors: Zhou Tingquan , Jin Xian , Ma Shixin , Han Jiming , Shen Chengxing
Published: February 2025

Objective

Rotational atherectomy is an effective method for treating severe coronary artery calcification; however, several challenges in its clinical application persist. This study aimed to compare the safety and effectiveness of rotational atherectomy combined with cutting balloon (RACB) versus rotational atherectomy with plain balloon (RAPB) in patients with heavily calcified coronary lesions.

Methods

This retrospective observational cohort study included 326 patients who underwent rotational atherectomy at Shanghai Sixth People’s Hospital from January 2016 to December 2022. Patients were divided into two groups (RACB and RAPB) on the basis of the type of balloon used. The primary outcome was the incidence of major adverse cardiovascular events (MACE) 1 year after percutaneous coronary intervention. Propensity score matching (PSM) was applied to minimize bias, and survival analyses were performed with the Cox proportional hazards model.

Results

The procedural complication rates of the patients in the RACB and RAPB groups were comparable. Baseline covariates were balanced between groups after adjustment via PSM. Patients receiving RACB during their procedures had a lower MACE rate during the first postprocedural year in the unadjusted analysis (6.7% vs 16.2%, P < 0.05) and after adjustment with PSM (5.6% vs 16.1%, P < 0.01). The Kaplan–Meier survival curves revealed hazard ratios of 0.44 (95% CI: 0.23–0.82; P < 0.05) for the unadjusted model and 0.36 (95% CI: 0.17–0.76; P < 0.01) for the PSM-adjusted model.

Conclusion

Performing RACB before stent implantation was demonstrated to be a safe and effective strategy for managing severely calcified coronary lesions.
Electrical impedance tomography to set positive end-expiratory pressure
Authors: Francovich Juliette E. , Katira Bhushan H. , Jonkman Annemijn H.
Published: February 2025

Purpose of review

To summarize the rationale and concepts for positive end-expiratory pressure (PEEP) setting with electrical impedance tomography (EIT) and the effects of EIT-based PEEP setting on cardiopulmonary function.

Recent findings

EIT allows patient-specific and regional assessment of PEEP effects on recruitability and overdistension, including its impact on ventilation-perfusion (V̇/Q) mismatch. The overdistension and collapse (OD-CL) method is the most used EIT-based approach for PEEP setting. In the RECRUIT study of 108 COVID-19 ARDS patients, the PEEP level corresponding to the OD-CL crossing point showed low overdistension and collapse (below 10% and 5%, respectively) regardless of recruitability. In a porcine model of acute respiratory distress syndrome (ARDS), it was shown that at this crossing point, respiratory mechanics (compliance, ΔP) were consistent, with adequate preload, lower right ventricular afterload, normal cardiac output, and sufficient gas exchange. A recent meta-analysis found that EIT based PEEP setting improved lung mechanics and potentially outcomes in ARDS patients. EIT thus provides critical insights beyond respiratory mechanics and oxygenation for individualized PEEP optimization. EIT-based methods for PEEP setting during assisted ventilation have also been proposed.

EIT is a valuable technique to guide individualized PEEP setting utilizing cardiopulmonary information that is not captured by respiratory mechanics and oxygenation response alone.
A review of potential mechanisms and treatments of gastric intestinal metaplasia
Authors: Wu Yueyao , Zhang Kehan , Zheng Yichao , Jin Haifeng
Published: February 2025

Gastric intestinal metaplasia (GIM) is a pathological process where gastric mucosal epithelial cells are replaced by intestinal-type cells, serving as a precursor lesion for gastric cancer. This transformation involves various genetic and environmental factors, affecting key genes and signaling pathways. Recent research has revealed complex mechanisms, including changes in gene expression, abnormal signaling pathway activation, and altered cell behavior. This review summarizes the latest research on GIM, discussing its pathogenesis, current treatment strategies, and potential efficacy of emerging approaches like gene editing, microbiome interventions, and integrative medicine. By exploring these strategies, we aim to provide more effective treatments for GIM and reduce gastric cancer incidence. The review also highlights the importance of interdisciplinary studies in understanding GIM mechanisms and improving treatment strategies.
Prediction of risk of blood transfusion in patients with cirrhosis
Authors: Li Ying , Zhu Wenwen , Song Zhiqun , Liang Wenbiao , Zhou Xiaoyu
Published: February 2025

Background

Blood transfusion is usually required for cirrhotic patients with bleeding which is related to high risk of mortality. Identifying cirrhotic patients at high risk of bleeding and needing blood transfusions would benefit these patients, yet this remains an unmet need.

Objectives

This study aims to enhance blood transfusion management for patients with cirrhosis by developing a predictive model to assess the risk of transfusion.

Methods

We enrolled a cohort of 711 patients diagnosed with cirrhosis at The First Affiliated Hospital of Nanjing Medical University and divided into training set (n = 537) and validation set (n = 174). Each participant underwent a comprehensive clinical assessment. Data on prothrombin time (PT), platelet counts, and inflammatory markers were collected. Univariate and multivariate logistic regression analyses were performed to identify independent predictors. The nomogram was constructed. Model performance was evaluated through receiver operating characteristic curve analysis.

Results

The study successfully identified PT, platelet counts, and the mentioned inflammatory markers as significant predictors of the need for transfusion. The resulting nomogram demonstrated high predictive accuracy, with area under the curve values of 0.85 in the training set and 0.83 in the validation set.

Conclusion

The developed nomogram for predicting the need for blood transfusion in patients with cirrhosis shows promising effectiveness for clinical application. This tool can significantly contribute to optimizing transfusion practices, potentially improving patient care and outcomes through more personalized and efficient transfusion strategies.
Comparative efficacy and safety of SpyGlass percutaneous transhepatic cholangioscopy versus conventional cholangioscopy in challenging biliary access: a systematic review and meta-analysis
Authors: Mohamed Islam , Naeem Ahmed , Hassan Noor , Jung Daniel , Bader Abbas , Gaur Rishabh , Yousaf Abdulrehman , Abosheaishaa Hazem , Salem Ahmed E. , Mohamed Wael T. , Telbany Ahmed , Dahiya Dushyant Singh , Yusuke Hashimoto
Published: February 2025

Percutaneous transhepatic cholangioscopy (PTCS) is essential for managing patients with altered biliary anatomy when endoscopic retrograde cholangiopancreatography fails. This study aimed to compare the safety and efficacy of conventional PTCS (C-PTCS) with the SpyGlass PTCS (S-PTCS) system in cases of challenging biliary access. A systematic review and meta-analysis included 12 studies with 998 patients. Results indicated that S-PTCS had a significantly higher clinical success rate of 99% [confidence interval (CI): 96–100%] compared to 84% (CI: 73–95%) for C-PTCS (P < 0.01). Both techniques showed high technical success rates of 99% (CI: 96–100%) for S-PTCS and 98% (CI: 97–100%) for C-PTCS, with no significant difference (P = 0.61). Safety outcomes, such as pain, liver ischemia, hemobilia, cholangitis, and bleeding, were low and similar across both techniques. These findings highlight the superior clinical success of S-PTCS in challenging biliary access cases while maintaining comparable safety profiles with C-PTCS.
Metabolic dysfunction-associated steatotic liver disease correlates with higher lower graft survival in liver transplant recipients with hepatocellular carcinoma
Authors: Alsaqa Marwan , Sierra Leandro , Marenco-Flores Ana , Parraga Ximena , Barba Romelia , Goyes Daniela , Ozturk N. Begum , Curry Michael P. , Bonder Alan , Saberi Behnam
Published: February 2025

Background

Direct-acting antivirals (DAAs) have revolutionized hepatitis C virus (HCV) treatment. The changing landscape of hepatocellular carcinoma (HCC) in liver transplant (LT) recipients lacks a thorough description of the outcomes of HCC based on etiology.

Objective

To assess the waitlist (WL) dropout and graft survival in HCC LT candidates based on the etiology of HCC in the post-DAA era.

Methods

This retrospective cohort study analyzed United Network Organ Sharing/Organ Procurement Transplant Network data from 2015 to 2022. Graft survival was analyzed using Kaplan–Meier curves, and predictors of WL dropout and graft failure were assessed using multivariate analysis.

Results

Among LT recipients, etiologies were HCV (53.6%), alcohol-associated liver disease (ALD) (12.0%), metabolic dysfunction-associated steatotic liver disease (MASLD) (16.6%), hepatitis B virus (HBV) (5.6%), and other (12.1%). MASLD and ALD had the highest dropout rates (1-year: 20.4%, 21.7%; 3-year: 58.2%, 51.1%; P < 0.001). Dropout was linked to diabetes, low albumin, high Model of End-Stage Liver Disease, high alpha-fetoprotein, tumor number, and size. MASLD had the worst 1-, 3-, and 5-year graft survival (89.8%, 81.8%, and 74.1%) and higher failure risk than HCV (hazard ratio: 1.143, 95% CI: 1.021–1.281). Diabetes negated MASLD’s impact on graft failure but worsened survival for MASLD-HCC compared with HBV and ALD, matching HCV.

Conclusion

MASLD has the highest WL dropout and post-LT graft failure among HCC LT candidates, surpassing HCV in the post-DAA era. The worst graft survival in MASLD-HCC is associated with pre-LT diabetes.
CD96: immunoregulation and its role and prospect in immunotherapy of primary hepatocellular carcinoma
Authors: Chai Jiaqi , Li Luyang , Wu Qimei , Zhang Shuhan
Published: February 2025

Recently, immune checkpoint inhibitors have been widely used in the treatment of advanced liver cancer. Immune checkpoints are a type of molecules that play an important role in the self-regulation of the immune system. In tumor immunity, their activation by immune checkpoints leads to the inhibition of effector lymphocyte activation or the mediation of cytotoxic T cell dysfunction, resulting in immune escape. These immune checkpoints include programmed death receptor 1 (PD-1) and its ligand PD-L1, as well as cytotoxic T lymphocyte-associated protein 4 (CTLA-4) and others. Immune checkpoint inhibitors block the interaction between immune checkpoint receptors and ligands, thereby relieving the immune suppression caused by immune checkpoints, and reactivating immune cells to exert antitumor effects. With the continuous progress of immunotherapy research, drugs targeting PDL-1, PD-1, and CTLA-4 have played an important role in clinical treatment. However, some patients still cannot benefit from immunotherapy; therefore, multitarget immunotherapy is an important way to improve the response rate of immunotherapy. CD96 is one of the members of the immunoglobulin superfamily receptors, which mainly functions by regulating natural killer cells and CD8+ T cells, and is expected to become a new generation of immune checkpoints. This article reviews the molecular structure of CD96, its role in tumor immunity, and its application in hepatocellular carcinoma, hoping to provide reference for related research.
Comparison of acute pancreatitis and acute on chronic pancreatitis: a retrospective cohort study
Authors: Bouça-Machado Tiago , Araújo Teixeira João Paulo , Rebelo Paula , Barbosa Elisabete , Pedersen Jan Bech , Drewes Asbjørn Mohr , Olesen Søren Schou
Published: February 2025

Background

Acute on chronic pancreatitis (ACP) shares a similar clinical presentation with acute pancreatitis (AP) and is often diagnosed and treated in the same way. However, these two conditions may have distinct clinical risk profiles and prognoses. There is currently limited evidence available regarding the specific characteristics of ACP.

Methods

This retrospective cohort study included all adult patients admitted with a diagnosis of AP or ACP between 2017 and 2019 at two tertiary referral centers. The primary outcome was disease severity as defined by the Atlanta classification. Secondary outcomes included the presence of local and systemic complications, organ failure, ICU admission, and mortality. Differences in outcomes between ACP and AP were compared using multivariate logistic regression models, with results presented as odds ratios (ORs).

Results

We included 1163 patients, 90% of whom had AP and 10% had ACP. ACP patients were predominantly male (81 vs. 46%; P < 0.001), whereas AP patients were older (mean age 62.6 vs. 56.5 years, P < 0.001). ACP patients had lower amylase and lipase levels (P < 0.001). Multivariate analysis showed no difference in the risk of moderate or severe pancreatitis (OR, 1.15; 95% CI, 0.66–1.98; P = 0.615). ACP patients had a higher risk of local complications (predominantly pseudocysts) (OR, 1.71; 95% CI, 1.00–2.92; P = 0.049) and a lower risk of organ failure (P = 0.019) and ICU admission (P = 0.005).

Conclusion

Our study confirms previous observations that ACP has a more favorable in-hospital prognosis than AP and extends these findings to a modern European setting.
Clinical outcomes of endoscopic mucosal resection for large superficial nonampullary duodenal epithelial tumor: a single-center study
Authors: Barbaro Federico , Papparella Luigi Giovanni , Chiappetta Michele Francesco , Schepis Tommaso , Maresca Rossella , Del Vecchio Livio Enrico , Ciuffini Cristina , Pecere Silvia , Petruzziello Lucio , Costamagna Guido , Spada Cristiano
Published: February 2025

Background and aim

Endoscopic mucosal resection (EMR) of superficial nonampullary duodenal epithelial tumors (SNADETs) is challenging, and to date, only a few studies assessed the clinical outcomes of EMR in the duodenum. The aim of this study was to evaluate the efficacy and safety of EMR for the treatment of SNADETs >10 mm.

Patients and methods

This is a single-center retrospective study reporting data from a cohort of consecutive patients undergoing EMR of large (>1 cm) SNADETs between January 2017 and December 2021.

Results

A total of 81 patients with 83 lesions underwent EMR (70 conventional EMR, 13 underwater EMR). The median size was 20 mm (range: 10–60 mm). The mean procedure time was 45 ± 30 min, and the en-bloc resection rate was 47%. In all patients, SNADETs were successfully removed (i.e. technical success). Delayed bleeding occurred in 5 (6%) of EMRs. One delayed perforation occurred, which was managed surgically. Recurrence rate was 20% with a median follow-up period of 20.5 months. Recurrence was detected at the first endoscopic follow-up in 88% of cases, and all recurrences were successfully treated endoscopically. Lesion size (P = 0.04), previous endoscopic resection (P = 0.05), and piecemeal resection (P = 0.05) were independent risk factors of local recurrence after EMR on multivariate-adjusted analysis.

Conclusion

Large duodenal adenomas can be effectively managed by EMR. However, duodenal EMR of large lesions carries a significant risk of early recurrence, with a nonnegligible risk of adverse events. Lesion dimension, piecemeal resection, and previous endoscopic resection were associated with a higher recurrence rate. Close endoscopic follow-up is recommended given the high incidence of early recurrence, which can be successfully treated endoscopically.
Predictive value of serum HBV RNA on HBeAg seroconversion in treated chronic hepatitis B patients
Authors: Liu Ting , Shi Yuru , Wu Jing , Qin Linghan , Qi Yingjie
Published: February 2025

Purpose

To investigate the predictive value of serum hepatitis B virus (HBV) RNA on HBeAg seroconversion in treated chronic hepatitis B (CHB) patients.

Methods

Sixty-four HBeAg-positive CHB patients were selected. They were divided into HBeAg seroconversion group including 11 cases and HBeAg non-seroconversion group including 53 cases. HBV RNA levels and other laboratory results were measured at baseline and week 12, 24, 48, 72 during treatment in both groups. The predictive value of HBV RNA level for the seroconversion of HBeAg in patients treated for hepatitis B was analyzed.

Results

Significant differences existed in serum HBV DNA and HBV RNA levels between the two groups at baseline while there was no significant difference in HBsAg. The correlation between HBV RNA and HBV DNA was significantly high (r = 0.707, P < 0.05), while the correlation between HBV DNA and HBsAg (r = 0.474, P < 0.05) or HBV RNA and HBsAg was poor (r = 0.372, P < 0.05). Patients with younger age and higher HBV RNA levels at baseline and week 24 were less likely to have HBeAg seroconversion. HBV RNA was better than HBV DNA and HBsAg in predicting HBeAg seroconversion whether at baseline or week 12 and week 24. The area under the curve of HBV RNA level at 24th week was the highest, which was 0.942, and the cutoff value was 4.145 log10 copies/ml.

Conclusion

HBV RNA level may be a suitable serum marker to predict whether HBeAg seroconversion can occur. CHB patients with serum HBV RNA level lower than 4.145 log10 copies/ml at week 24 were more likely to achieve HBeAg seroconversion.
Current clinical evidence in intrarenal temperature, pressure and suction during retrograde intrarenal surgery: a review of literature
Authors: Tokas Theodoros , Gauhar Vineet , Yuen Steffi Kar Kei , Somani Bhaskar Kumar
Published: February 2025

Purpose of review

Experimental evidence suggests that intrarenal temperatures (IRTs) and pressures (IRPs) during retrograde intrarenal surgery (RIRS) with laser lithotripsy are clinically significant. Suction devices aim to facilitate RIRS and improve procedure outcomes. We present an overview of new clinical studies regarding IRT, IRP, and suction developments.

Recent findings

High laser power, low irrigation, and restricted working space were directly correlated with increased IRTs. Increased irrigation flow rate and ureteral access sheath (UAS) maintained well tolerated IRTs. Baseline IRPs ranged from 16 to 17 mmHg. Intraoperative IRP monitoring maintained values below 22 mmHg. Hand-assisted pumps often increase IRPs above the safety threshold. Prolonged IRP increments were correlated to postoperative infections. Suction devices decreased operative time to less than 60 min and improved stone-free rates (SFRs) at 1 day to more than 80 and at 30 days to more than 90%.

Despite the limited clinical evidence, IRTs during RIRS correlate directly with laser power and reversely correlate with irrigation flow rate and UAS use. Intraoperative IRP monitoring prevents hazardous increments. Manual pump irrigation causes extremely high IRPs. There is a possible relation between prolonged IRP increments and infectious complication development. Using suction UAS or flexible and navigable sheaths (FANS) improves operative times and SFRs, while more studies regarding direct in-scope suction (DISS) efficiency and safety are needed.
Pre-endoscopy Anesthesiology Clinic Evaluation Does Not Reduce Adverse Event Rates for High-risk for Sedation Patients
Authors: Thurm Tamar , Zmora Niv , Bruck Rafael , Bar Nir , Philips Adam , Shibolet Oren , Deutsch Liat
Published: February 2025

Objectives:

Preoperative or preanesthesia evaluation is an established practice in patients undergoing surgery. The efficacy of a similar practice before endoscopic procedures has not yet been determined. At our medical center, patients with severe comorbidities, deemed at high risk for sedation, were assigned to an anesthesiologist-supervised endoscopic procedure (ASEP). Since late 2016 they are assessed at anesthesiology clinic pre-endoscopy. Our objective was to compare adverse events (AEs) between these 2 strategies.

Methods:

A retrospective review of all ambulatory upper and lower endoscopies between 2016 and 2017 was performed. Data on postprocedural (14 d) emergency department (ED) admissions, hospitalizations, operations, and mortality before and after policy change (BPC and APC) were compared.

Results:

During the study period 18,240 ambulatory upper and lower endoscopic procedures were performed in 14,906 patients, 7447 (49.96%) BPC, and 7459 (50.04%) APC; 580 were ASEP. The proportions of ASEP were comparable between the 2 time periods (BPC 295 versus APC 285; P=0.721); however, APC there was a 25-fold increase in pre-endoscopy anesthesiology clinic assessments [BPC-6 patients (2.03%) versus APC-146 patients (51.22%), P<0.001]. Postprocedural sedation-related AEs were comparable between the groups [0.07%-BPC (head injury, stroke, myocardial infarction, and aspiration) versus 0.03%-APC (aspiration and dyspnea), P=0.256]. None of these patients were sedated by an anesthesiologist.

Conclusions:

Policy change of pre-endoscopy evaluation for high-risk for sedation patients was not associated with a change in AE rates. Policy adherence was limited. The lack of AE rate reduction may indicate a marginal impact on an already low event rate with ASEP for high-risk patients.