bluuebunny/crossref_metadata_2025 huggingface dataset:
Mitigating overtreatment of ductal carcinoma in situ
Authors: Chung Hannah L , Moseley Tanya W , Wolverton Dulcy E , Whitman Gary J
Published: February 2025

Ductal carcinoma in situ (DCIS) represents a pathologic continuum between a high-risk lesion of the breast and an invasive cancer. Because death from breast cancer is linked to its metastatic spread, the major significance of DCIS is its potential to progress to an invasive cancer and the risk of an occult invasive cancer unrecognized until surgical excision is performed. The standard of care management for DCIS is a minimum of surgical excision, often coupled with adjuvant treatments. For approximately half of the DCIS cases that are at low risk for progression, standard of care treatment represents a potential overtreatment and the source of one of the main criticisms against screening. To minimize overtreatment, the tumor biology of any individual’s DCIS should be considered in the context of the patient’s age, medical co-morbidities, tolerance for risk, to tailor personalized treatments. Just as the management of some high-risk lesions of the breast have evolved to include non-surgical options, it makes sense to personalize the management offered to patients with DCIS. This article reviews the epidemiology, imaging, pathology, ongoing trials, current and possible future treatments of DCIS, comparing and contrasting it with classic high-risk breast lesions and invasive breast cancers.
Sleep Timing, Sleep Timing Regularity, and Cognitive Performance in Women Entering Late Adulthood: The Study of Women's Health Across the Nation (SWAN)
Authors: Swanson Leslie M , Hood Michelle M , Thurston Rebecca C , Butters Meryl A , Kline Christopher E , Kravitz Howard M , Avis Nancy E , Neal-Perry Genevieve , Joffe Hadine , Harlow Siobán D , Derby Carol A
Published: February 2025

Study Objectives

This study examined whether sleep timing and its regularity are associated with cognitive performance in older women and whether associations vary based on cardiometabolic risk factors.

Methods

The cross-sectional analysis included 1,177 community-dwelling females (mean age 65 years) from the observational Study of Women’s Health Across the Nation (SWAN) annual visit 15. Sleep timing (mean midpoint from sleep onset to wake-up) and its regularity (standard deviation of midpoint ) were assessed using actigraphy. Cognitive measures included immediate and delayed verbal memory, working memory, and processing speed. Cardiometabolic risk measures included central obesity, hypertension, diabetes, and the Atherosclerotic Cardiovascular Disease (ASCVD) risk score. Linear regression models, adjusted for covariates, tested associations between sleep and cognitive measures.

Results

After covariate adjustment, early sleep timing was associated with worse delayed verbal memory (β = -0.37; p = 0.047) and late sleep timing was associated with worse processing speed (β = -1.80; p = 0.008). Irregular sleep timing was associated with worse immediate (β = -0.29; p = 0.020) and delayed verbal memory (β = -0.36; p= 0.006), and better working memory (β = 0.50; p = 0.004). Associations between early sleep timing and delayed verbal memory strengthened as ASCVD risk increased (interaction β=-8.83, p=.026), and tsleep timing irregularity’s effect on-working memory was stronger among women with hypertension (interaction β = -3.35, p = .039).

Conclusions

Sleep timing and its regularity are concurrently associated with cognitive performance in older women. Cardiovascular disease risk may modify some of these associations. Future longitudinal studies are needed to clarify these relationships.
Dynamic Impacts of Sleep Disruption on Ecologically Assessed Affective, Behavioral, and Cognitive Risk Factors for Suicide: A Study Protocol
Authors: Bozzay Melanie L , Armey Michael F , Brick Leslie , Nugent Nicole , Huang Jeff , Goldschmidt Andrea B , Schatten Heather T , Primack Jennifer M , Saletin Jared M
Published: February 2025

Diminished sleep health is a known warning sign for suicide. However, the contexts and time periods within which diminished sleep elevates suicide risk are unknown. Modeling the complex process by which diminished sleep health impacts daily functioning and established proximal suicide risk factors can aid in addressing these important knowledge gaps. This paper describes the methods and research protocol for a study that aims to elucidate the nature of the sleep-suicide relationship and develop an integrated model of proximal suicide risk. Participants will be 200 adults at high-risk for suicide recruited from a psychiatric inpatient unit. They will complete a baseline assessment including clinical interviews and self-reports, and laboratory tasks with concurrent electroencephalography to phenotype relevant risk processes. This baseline assessment will be followed by four weeks of ecological momentary assessment and digital phenotyping, coupled with assessments of sleep via a wearable used to generate a minute-by-minute metric of cognitive effectiveness using the Sleep Activity, Fatigue, and Task Effectiveness algorithm (SAFTE) index. Follow-up assessments will be conducted 1-, 3-, and 6-months post hospital discharge to determine how the developed proximal model of risk prospectively predicts suicidal ideation and behavior. The results of this study have the potential to greatly enhance understanding of how and why diminished sleep health is related to real-world fluctuations in suicide risk, knowledge that can inform efforts to better prevent, and intervene to reduce suicides.
biGMamAct: efficient CRISPR/Cas9-mediated docking of large functional DNA cargoes at the ACTB locus
Authors: Pelosse Martin , Marcia Marco
Published: February 2025

Recent advances in molecular and cell biology and imaging have unprecedentedly enabled multi-scale structure-functional studies of entire metabolic pathways from atomic to micrometer resolution, and the visualization of macromolecular complexes in situ, especially if these molecules are expressed with appropriately-engineered and easily-detectable tags. However, genome editing in eukaryotic cells is challenging when generating stable cell lines loaded with large DNA cargoes. To address this limitation, here, we have conceived biGMamAct, a system that allows the straightforward assembly of a multitude of genetic modules and their subsequent integration in the genome at the ACTB locus with high efficacy, through standardized cloning steps. Our system comprises a set of modular plasmids for mammalian expression, which can be efficiently docked into the genome in tandem with a validated Cas9/sgRNA pair through homologous-independent targeted insertion (HITI). As a proof of concept, we have generated a stable cell line loaded with an 18.3-kilobase-long DNA cargo to express 6 fluorescently-tagged proteins and simultaneously visualize 5 different subcellular compartments. Our protocol leads from the in-silico design to the genetic and functional characterization of single clones within 6 weeks and can be implemented by any researcher with familiarity with molecular biology and access to mammalian cell culturing infrastructure.
Foliar Fungicide Application Alters the Culturable Foliar Fungal Endophyte Community in Corn
Authors: Whitaker B. K. , Opoku J. , Kleczewski N. M.
Published: February 2025

Fungicides have been applied to crops for decades with the primary aim of managing fungal pathogens and diseases. However, as interest in the plant microbiome has grown, so to have questions about potential non-target effects of pest management on native microbiota. Corn is one of the most widely grown and economically important crops in the world, but little research has investigated the role of fungicide applications, particularly foliar fungicides, on the corn microbiome. Here, we used a culture-dependent approach to identify whether a systemic, multi-mode-of-action foliar fungicide would alter the foliar fungal endophyte (FFE) community in dent corn ear leaves at two midwestern US locations. The impact of the fungicide application on FFE community structure was highly dependent on spatial effects. Additionally, alpha diversity metrics that accounted for relative abundance of fungal taxa were most affected by fungicide treatment. By contrast, FFE isolation frequency from leaf fragments was not dependent on fungicide treatment, suggesting no net culturable fungal biomass changes. Ultimately, this work will serve as a resource for agronomists and pathologists seeking to understand the role of traditional crop management practices on the corn phytobiome.
Doxycycline: lights and shadows of a mysterious treatment for chronic rhinosinusitis
Authors: Hoang Minh P. , Seresirikachorn Kachorn , Snidvongs Kornkiat
Published: February 2025

Purpose of review

Chronic rhinosinusitis (CRS) is a diverse condition, including different underlying pathophysiologies. Tailoring the treatment for CRS depends on the individual's specific endotype and phenotype rather than using a universal approach. The emergence of biologics in recent years has raised questions about the role of antibiotics, particularly doxycycline, in CRS management. Insights from existing research on the mechanisms and appropriate use of doxycycline therapy may guide physicians in selecting the right treatment target.

Recent findings

CRS with nasal polyps (CRSwNP) is frequently associated with type 2 inflammation and characterized by tissue remodeling process that can result in recalcitrant condition. Doxycycline therapy (100 mg daily) improves CRSwNP by exerting antitissue remodeling effects through matrix metalloproteinase inhibition. Doxycycline seems to provide benefits when used alongside adequate medicine treatment.

Current evidence on the use of doxycycline therapy is limited to a small number of high-quality studies. Further research is needed to explore the duration and factors of success of doxycycline in treating CRS. Like other antibiotics, doxycycline has limitations related to side effects and the potential for antibiotic resistance. Therefore, treatment decisions should be made with caution, especially when doxycycline is used in combination with other pharmacologic therapies.
Managing a mass casualty, lessons learned
Authors: Næss Pål A. , Gaarder Christine
Published: February 2025

Purpose of review

Mass casualty incidents (MCIs) strain available healthcare resources requiring unusual actions. Within a trauma system, hospitals receiving patients from an MCI have a defined key role in the care of the casualties and their preparedness is critical for patient outcome. The aim of this review is to address recent relevant literature to highlight important elements necessary for an adequate hospital response to an MCI.

Recent findings

That disaster preparedness is a prerequisite for success during an MCI is undisputable. Key components in the hospital response to an MCI like triage, communication, leadership, security, and surge capacity are areas that still need attention. There has been an increased focus on optimal treatment of children and their families, and the psychosocial support for patients and staff involved.

The complexity and unpredictability of MCIs demands a predefined strategy within every hospital. This strategy should include increased attention to the specific needs for children, physical security and psychological support but not at the expense of frequent training of staff. Involvement of dedicated clinical leadership both during disaster preparedness planning, training and during actual MCIs is irreplaceable.
Integrating regional blocks into Enhanced Recovery After Surgery protocols for cesarean delivery: optimizing postoperative recovery
Authors: Lauretta Alessandra , Frkovic Vedran , Saporito Andrea
Published: February 2025

Purpose of review

This review aims to synthesize the current literature on the use of regional blocks to enhance and optimize postoperative recovery after cesarean delivery, highlighting key strategies, challenges, and emerging trends.

Recent findings

Recent developments in postoperative analgesia for cesarean delivery point toward more personalized treatment approaches. This involves identifying patients at high risk for severe postoperative pain and offering them tailored multimodal analgesic regimens.

Managing pain after cesarean delivery continues to pose a significant challenge. The overall prevalence of acute postoperative pain remains high (58%) and, even when strict adherence to established guidelines is ensured, approximately 25% of patients report inadequate pain control. Within a multimodal analgesic framework, when neuraxial morphine – still considered the gold standard – is not an option, the use of peripheral nerve and fascial plane blocks has demonstrated clear benefits. Recent literature suggests that quadratus lumborum block may serve as a promising alternative to intrathecal morphine for women who cannot tolerate opioids. Additionally, incorporating certain regional techniques alongside neuraxial morphine may further improve postoperative analgesia, especially for patients at high risk of severe postoperative pain and those who have contraindications to other analgesic modalities.
Parents’ Experiences With Couplet Care Following Caesarean Section in an Integrated Neonatal and Maternity Unit
Authors: Mortensen Marianne Karstensen , Holm Kristina Garne , Mose Louise Schlosser
Published: February 2025

Background:

Couplet Care, which allows mothers and newborns to receive treatment together, has gained prominence in neonatal and maternity care settings. This model supports early bonding, skin-to-skin contact, and breastfeeding, benefiting both preterm and sick newborns.

Purpose:

The study aims to explore parents’ experiences with Couplet Care after a caesarean section in an integrated neonatal and maternity unit, where both mother and newborn required treatment.

Methods:

A qualitative, semi-structured interview approach was employed. Eight mothers and 6 fathers participated, sharing their perspectives on Couplet Care through interviews conducted at a Danish hospital setting providing Couplet Care in 6 family rooms in a level II neonatal intensive care unit. Data were analyzed using content analysis inspired by Graneheim and Lundman.

Results:

Parents initially relied heavily on nurses, gradually gaining autonomy as their hospital stay progressed. Fathers played an essential role in caregiving, especially when mothers were immobile post-surgery. The study highlighted the importance of clear communication from nurses, which fostered parental confidence.

Implications for Practice and Research:

Couplet Care offers a supportive environment that promotes parental autonomy and emphasizes the critical role fathers play in caregiving. Future research should investigate the long-term effects on family dynamics and the mental health of both mothers and fathers following caesarean sections in similar settings.
Hydroxyurea for Malignant Pertussis in Critically Ill Children
Authors: Blanc Matthieu , Marais Clémence , Debs Alexandre , Cousin Vladimir L. , Tissières Pierre ,   on behalf of the Paris Saclay Neonatal and Pediatric ICU Research Alliance (PANDORA) Study Group
Published: February 2025

OBJECTIVES:

Malignant pertussis, the most severe manifestation of Bordetella pertussis infection, is characterized by multiple organ failure and a high mortality rate despite advanced intensive care measures. Hyperleukocytosis is the hallmark of malignant pertussis and necessitates urgent and aggressive interventions. Among the therapeutic options, leukoreduction via whole blood exchange (BE) transfusion has been associated with significant procedural risks and potential clinical deterioration. Hydroxyurea was recently proposed as a pharmacological alternative for leukoreduction. This study reports our clinical experience with hydroxyurea as an alternative to BE in managing infants with malignant pertussis admitted to a PICU.

DESIGN:

Prospective case series.

SETTING:

A referral PICU in France.

PATIENTS:

Critically ill infants (n = 27) with severe pertussis infection.

INTERVENTIONS:

Hydroxyurea therapy or BE transfusion.

MEASUREMENTS AND MAIN RESULTS:

We reviewed all critically ill infants admitted to our unit for severe pertussis between January 2017 and July 2024. The primary outcome was 28-day survival, and the secondary outcome was the efficacy of hydroxyurea on blood leukocyte count reduction. Among the 27 infants admitted for severe pertussis, 12 exhibited features of malignant pertussis. Of these, seven were treated with hydroxyurea and five with BE. The majority of infants were term and under 3 months old. All patients required ventilatory support, with eight on invasive mechanical ventilation and three receiving extracorporeal membrane oxygenation therapy. Overall mortality was three of 12 (25%). Hydroxyurea was administered at a dose of 20 mg/kg/d for a median duration of 12 days. Hyperleukocytosis was successfully reduced within 7 days.

CONCLUSIONS:

Hydroxyurea is an alternative therapy for malignant pertussis infection that can efficiently address hyperleukocytosis with limited mortality.
Performance Evaluation of Prehospital Sepsis Prediction Models
Authors: Peltan Ithan D. , Rahmati Kasra , Bledsoe Joseph R. , Yoneoka Yukiko , Alvarez Felicia , Plendl Matthew , Taillac Peter P. , Youngquist Scott T. , Samore Matthew M. , Hough Catherine L. , Brown Samuel M.
Published: February 2025

Objectives:

Evaluate prediction models designed or used to identify patients with sepsis in the prehospital setting.

Design:

Nested case-control study.

Setting:

Four emergency departments (EDs) in Utah.

Patients:

Adult nontrauma patient with available prehospital care records who received ED treatment during 2018 after arrival via ambulance.

Interventions:

None.

Measurements and Main Results:

Of 16,620 patients arriving to a study ED via ambulance, 1,037 (6.2%) met Sepsis-3 criteria in the ED. Complete prehospital care data was available for 434 case patients with sepsis and 434 control patients without sepsis. Model discrimination for the outcome of meeting Sepsis-3 criteria in the ED was quantified using the area under the precision-recall curve (AUPRC), which yields a value equal to outcome prevalence for a noninformative model. Of 21 evaluated prediction models, only the Prehospital Early Sepsis Detection (PRESEP) model (AUPRC, 0.33 [95% CI, 0.27–0.41) outperformed unaided infection assessment by emergency medical services (EMS) personnel (AUPRC, 0.17 [95% CI, 0.13–0.23]) for prehospital prediction of patients who would meet Sepsis-3 criteria in the ED (p < 0.001). PRESEP also outperformed the quick Sequential Organ Failure Assessment score (AUPRC, 0.13 [95% CI, 0.11–0.16]; p < 0.001). Among 28 evaluated dichotomous predictors of ED sepsis, sensitivity ranged from 6% to 91% and positive predictive value 8–100%. PRESEP exhibited modest sensitivity (60%) and positive predictive value (20%).

Conclusions:

PRESEP was the only evaluated prediction model that demonstrated better discrimination than unaided EMS infection assessment for the identification of ambulance-transported adult patients who met Sepsis-3 criteria in the ED.
Effects of a Modified Nurse Training Program on Completion Rate of Forms and Assessments in the Electronic Medical Record
Authors: Ware Andon M. , Murray Donal , Gill Norman W.
Published: February 2025

This retrospective study of an electronic medical record database evaluated a modified training program aimed at improving documentation completion percentages in eight skilled nursing facilities across Tennessee, Ohio, Florida, and Wisconsin. The program involved a weeklong curriculum tailored to increase proficiency with the electronic medical record system, focusing on five key documentation forms: Admission Assessment, Morse Fall Risk Assessment, Braden Risk Assessment, Elopement Risk Assessment, and Weekly Skin Check. Data were collected between February 2023 and July 2023. A 3-month preimplementation phase served as the baseline control, representing the period prior to the nurses undergoing the modified training program. Data from the 3-month period after implementation was used for comparison. The sample included 47 nurses. Data analysis consisted of descriptive and inferential statistics, with two-tailed paired t tests showing significant mean improvements (P < .001) in documentation completion percentages ranging from 42% to 70% across all five forms. Although causality could not be inferred, significant improvements were observed following the training program.
Aldosterone Synthase Inhibitor BI 690517: Specificity for Mineralocorticoid Receptor
Authors: Treihaft Andrew M. , Parikh Manish A. , Jackson Kaedrea A. , Frishman William H. , Peterson Stephen J.
Published: February 2025

Aldosterone plays a critical role in maintaining volume and blood pressure control. It also plays a highly negative role in vascular diseases such as systemic hypertension, congestive heart failure, and cardiorenal syndrome due to the critical role that the renin-angiotensin-aldosterone system plays in these diseases from oxidative stress, vasoconstriction, and vascular remodeling caused by angiotensin II. Controlling aldosterone involves drugs such as angiotensin-converting enzyme inhibitor/angiotensin receptor blockers and mineralocorticoid receptor antagonists (MRAs). Recent guidelines suggest that the MRAs were more beneficial than angiotensin-converting enzyme inhibitor/angiotensin receptor blockers and diuretics in resistant hypertension. It is also essential to understand the role of both mineralocorticoid receptors (MRs) and glucocorticoid receptors (GRs) because they are present in many of the same tissues, and the balance of these 2 receptors is critical for homeostasis. Glucocorticoids activate MRs at basal levels and GRs at stress levels. During oxidative stress, MR activation can negatively affect the balance of MRs/GRs interactions, cognition, and memory. The older drugs in this category were less effective than MRAs in controlling blood pressure. A new class of drugs to consider are the aldosterone synthase inhibitors, which inhibit salt and water reabsorption and decrease sympathetic stimulation. The ideal candidate drug must be capable of inhibiting the MR while sparing the glucocorticoid receptor, a challenge given the 95% homology of these receptors.
Literature Review: Effects of Environmental Noise on the Cardiovascular Health
Authors: Wang Andrew Jun , Frishman William Howard
Published: February 2025

The adverse effects of environmental noise on human health have been recognized for more than a century. In particular, during the last decades, the vast majority of studies have focused on the detrimental role of noise in the induction of cardiovascular diseases. In this study, we aim to conduct a literature review on chronic stress responses induced by environmental noise, the risk of cardiovascular disease, and the underlying pathophysiological mechanisms. We retrieved the publications from the PubMed database by searching for “noise AND cardiovascular.” By reviewing these publications in this study, we will first describe the epidemiologic research on cardiovascular risk factors and diseases induced by environmental noise, then discuss the mechanism(s) underlying these noise-induced cardiovascular impairments based on clinical and experimental studies, and finally evaluate the strategies to mitigate the effects of noise on cardiovascular health. We also evaluate the studies that describe the effects of noise level and noise intermittency, such as train noise, on cardiovascular health. We discuss whether environmental noise should be part of a risk factor profile for cardiovascular disease and how we should manage it, and assess the strategy that can be used to mitigate the noise-induced physiopathological changes. Furthermore, we briefly describe the effects of air pollution and heavy metals on cardiovascular health and discuss the relevance of these environmental stressors in the noise-induced cardiovascular disease. Our studies suggest that future studies are warranted to investigate new strategies that can mitigate the adverse effects of environmental noise on cardiovascular health.
Chelation Therapy in Coronary Artery Disease: Fact or Fiction?
Authors: Hasan Sara , Parikh Manish A. , Trivedi Dhaval B. , Frishman William H. , Peterson Stephen J.
Published: February 2025

Coronary artery disease (CAD) is responsible for 690,000 deaths a year, a leading cause of mortality worldwide. CAD results from cholesterol plaque buildup in arteries. Chelation therapy, which uses ethylenediaminetetraacetic acid to remove toxic metals from the bloodstream, has been explored as an alternative treatment for atherosclerotic CAD. While the 2013 Trial to Assess Chelation Therapy (TACT) trial showed modest cardiovascular benefits, particularly in patients with diabetes, subsequent studies such as TACT2 did not confirm its efficacy in reducing cardiovascular events in patients with diabetes. Adverse effects of chelation therapy could include renal dysfunction, electrolyte imbalances, and potential complications from heavy metal mobilization that could be fatal. Still, none of these were seen in TACT or TACT2.
Jejunal Lymphatic and Vascular Anatomy Defines Surgical Principles for Treatment of Jejunal Tumors
Authors: Vasic Teodor , Stimec Milena B. , Stimec Bojan V. , Kjæstad Erik , Ignjatovic Dejan
Published: February 2025

BACKGROUND:

The jejunum has a wide lymphatic drainage field, making radical surgery difficult.

OBJECTIVE:

Extrapolate results from 2 methodologies to define jejunal artery lymphatic clearances and lymphovascular bundle shapes for radical bowel-sparing surgery.

DESIGN:

Two cohort studies.

SETTINGS:

The first dataset comprised dissections of cadavers at the University of Geneva. The second dataset incorporated preoperative 3D-computed tomography vascular reconstructions of patients included in the “Surgery with Extended (D3) Mesenterectomy for Small Bowel Tumors” clinical trial.

PATIENTS:

Eight cadavers were dissected. The 3D-computed tomography dataset included 101 patients.

MAIN OUTCOME MEASURES:

Lymph vessels ran parallel and interlaced with jejunal arteries. Lymphatic clearance was minimal at the jejunal artery’s origin, radially spreading thereafter. Jejunal arteries were categorized into 3 groups based on position to the middle colic artery origin on 3D-computed tomography. Group A: jejunal artery origins lie cranially and caudally to the middle colic artery. Group B: jejunal artery origins lie caudal to the middle colic artery. Group C: jejunal artery origins lie cranial to the middle colic artery. Jejunal veins were classified into 3 groups based on their trajectories to the superior mesenteric artery (dorsally/ventrally/combined).

RESULTS:

Lymph vessel clearances were 1.5 ± 1.0 mm at jejunal artery origins. Group A was present in 81 (80.2%), group B in 13 (12.9%), group C in 7 (6.9%) cases. Jejunal artery median was 4. A 57 (56.4%) of jejunal veins ran dorsally to the superior mesenteric artery, 16 (15.8%) ran ventrally, and 28 (27.8%) had combined course.

LIMITATIONS:

Lymph nodes weren’t counted during dissection because the main observation was the position of lymph vessels.

CONCLUSION:

Minimal jejunal artery lymphatic clearance implies ligating tumor-feeding vessels at origin. The intermingled jejunal artery lymphatics imply lymph node dissection along the proximal and distal vessels to the level of the first arcade. Classifying jejunal arteries and veins could simplify the anatomy for surgeons. See Video Abstract

Clinical trial registration number:

NCT05670574.
Urban greenspace under a changing climate: Benefit or harm for allergies and respiratory health?
Authors: Zhao Tianyu , Heinrich Joachim , Brauer Michael , Fulman Nir , Idrose Nur Sabrina , Baumbach Clemens , Buters Jeroen , Markevych Iana , Ritz Beate , Tham Rachel , Yang Bo-Yi , Zeng Xiao-Wen , Alashhab Samer , Gui Zhao-Huan , Lin Li-Zi , Nowak Dennis , Sadeh Maya , Singh Nitika , Dong Guang-Hui , Fuertes Elaine
Published: February 2025

An increasing proportion of the world’s population lives in urban settings that have limited greenspace. Urbanization puts pressure on existing greenspace and reduces its access. Climate impacts, including increased temperature and extreme weather events, challenge the maintenance of urban vegetation, reducing its ecosystem services and benefits for human health. Although urban greenspace has been positively associated with numerous health indicators, the evidence for allergies and respiratory health is much less clear and mixed. To address these uncertainties, a workshop with 20 global participants was held in Munich, Germany, in May 2024, focusing on the impact of greenspace-related co-exposures on allergies and respiratory health. This narrative review captures key insights from the workshop, including the roles of urban greenspace in (1) climate change mitigation, (2) interactions with pollen, and (3) emissions of biogenic volatile organic compounds and their byproducts, such as ozone. Additionally, it presents research and stakeholder recommendations from the workshop. Future studies that integrate advanced greenspace exposure assessments and consider the interplay of greenspace with pollen and biogenic volatile organic compounds, along with their relevant byproducts are needed. Increased public awareness and policy actions will also be essential for developing urban greenspace that maximizes health benefits, minimizes risks, and ensures resilience amid a changing climate and rapid urbanization.
Paravertebral block is not superior to the interpectoral and pectoserratus plane block for patients undergoing breast surgery
Authors: Dost Burhan , Bugada Dario , Karapinar Yunus Emre , Balzani Eleonora , Beldagli Muzeyyen , Aviani Fulvio Giulia , Yalin Mirac Selcen Ozkal , Turunc Esra , Sella Nicolò , De Cassai Alessandro
Published: February 2025

BACKGROUND

Breast surgery is frequently associated with significant acute postoperative pain, necessitating effective pain management strategies. Both thoracic paravertebral block (PVB) and interpectoral plane and pectoserratus plane (IP+PS) blocks have been used to relieve pain after breast surgery.

OBJECTIVE

In this systematic review and meta-analysis with trial sequential analysis, we aimed to identify the optimal analgesic technique for achieving effective pain relief in breast surgery. The primary outcome of this study was postoperative opioid consumption expressed as morphine milligram equivalent (MME) at 24 h. Secondary outcomes included resting and movement pain scores at 0, 6, 12 and 24 h, postoperative nausea and vomiting (PONV), and rescue analgesic requirements within the first 24 h.

DESIGN

A meta-analysis of randomised controlled trials (RCTs) with meta-regression and trial sequential analysis (TSA).

DATA SEARCH

We systematically searched Pubmed, Scopus, the Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science, Google Scholar, Medline (from inception to until 1 October 2024).

ELIGIBILITY CRITERIA

RCTs that include patients undergoing breast surgery with PVB or IP+PS block, with no language restriction.

RESULTS

Eighteen RCTs with 924 patients were included. No significant difference in MME consumption at 24 h was observed between the two techniques; mean difference (MD) −1.94 (95% confidence interval (CI) −4.27 to 0.38, P = 0.101). Subgroup analyses revealed a minor advantage for IP+PS in patients without axillary involvement; MD −2.42 (95% CI −3.56 to −1.29, P < 0.001), though below the threshold of clinical significance. Secondary outcomes, including pain scores, PONV incidence and rescue analgesic requirements were comparable. Trial sequential analysis (TSA) confirmed sufficient sample size, suggesting further studies may not alter conclusions.

CONCLUSION

PVB and IP+PS blocks offer comparable analgesic efficacy and opioid-sparing effects after breast surgery, with no meaningful differences in 24-h MME consumption, pain scores, or PONV incidence.
Development of a UHPLC-MS/MS Method for the Determination of Omadacycline in Human Plasma
Authors: Chen Chuang , Chen Yao-Jie , Fu Jing , Wang Yu-Zhen , Qin Sun-Ting , Kong Meng-Yu , Lin Guan-Yang , Zhang Xiu-Hua , Yu Xu-Ben
Published: February 2025

Omadacycline is a novel aminomethylcycline antibiotic that retains its antibacterial activity against strain-specific efflux pumps and ribosomal protective protein mechanisms of tetracycline resistance. To determine the concentration of omadacycline in human plasma, an ultra-high-performance liquid chromatography-tandem mass spectrometry method was developed to provide a basis for therapeutic monitoring of omadacycline in clinical settings. The experimental approach involves using an ACQUITY UPLC BEH C18 column (2.1 × 50 mm, 1.7 μm), with a mobile phase of 0.1% aqueous formic acid:acetonitrile (90:10, vol/vol), a flow rate of 0.3 mL·min−1, a column temperature of 40°C, and an injection volume of 0.1 μL. Protein precipitation was employed as pretreatment, using acetonitrile as the precipitant. Minocycline was used as an internal standard. Omadacycline and internal standard were monitored in positive ion mode with the following mass transition pairs: mass/charge (m/z) = 557.1→ 470.1 for omadacycline, and m/z = 458.3→ 440.9 for IS, respectively. The established method showed a good linearity in the range of 0.01–10 mcg/mL of omadacycline (Y = 0.4603X + 0.0452, r2 = 0.999), with the lower limit of quantification of 0.01 mcg/mL. Method validation included accuracy, precision, matrix effect, recovery, carryover, dilution integrity, and stability, all of which met the requirements of the US Food and Drug Administration for the validation of bioanalytical methods. This method has been successfully applied to therapeutic drug monitoring in patients.
Immediate Lymphatic Reconstruction May Decrease the Incidence of Lymphedema in Patients Undergoing Axillary Lymph Node Dissection
Authors: Yakaback Spencer , Fraulin Georgia , Lindell Jonsson Eva , Elmi Assadzadeh Golpira , Bains Ish , Temple-Oberle Claire
Published: February 2025

Background:

Approximately one-third of patients undergoing axillary lymph node dissection (ALND) for breast cancer will develop breast cancer–related lymphedema (BCRL). To prevent BCRL, immediate lymphatic reconstruction (ILR) has been proposed, whereby lymphatics cut during the ALND are anastomosed to adjacent veins to restore lymphatic drainage. As evidence for ILR grows, the aim of this study was to investigate its efficacy at our institution.

Methods:

This prospective single-center study included 17 women undergoing ALND with ILR. Our primary outcome was the incidence of BCRL, diagnosed using a greater than 10% relative difference in arm volume. Use of compression therapy was also followed. Our secondary outcome was patient-reported outcome measures, determined by the validated Lymphedema Quality of Life (LYMQOL-Arm) survey. Postoperatively, patients were followed up at regular intervals for a minimum of 18 months.

Results:

The median age of included patients was 49 (interquartile range [IQR] 46–58). The average follow-up time was 34.4 months (range 18–42 mo). Two patients met the criteria for BCRL. Patients with BCRL had a significantly higher median arm volume difference of 27.5% (IQR 21.8%–33.2%) versus 4.2% (IQR 1.6%–7%; P = 0.02). Three patients used compression to control symptoms. Patients without lymphedema scored better in several domains of the LYMQOL-Arm survey, including function, appearance, and overall quality of life; however, these results did not meet statistical significance.

Conclusions:

ILR in patients undergoing ALND is associated with a low incidence of BCRL. Our study is one of the first to use patient-reported outcome measures to study ILR.
Total Breast Reconstruction With a Fat-augmented Latissimus Dorsi Flap Combined With a Breast Implant: Tribrid Breast Reconstruction
Authors: Sowa Yoshihiro , Nakayama Ichiro , Higai Shino , Toyohara Yoshihiro , Kurokawa Yasue , Sunaga Ataru , Inafuku Naoki
Published: February 2025

Total breast reconstruction using only a latissimus dorsi flap (LDF) often has a problem of insufficient volume. Recently, a fat-augmented LDF has been introduced as a solution to this problem. However, there are still many cases in which augmentation with fat grafting alone is not enough to achieve symmetrical breasts. Here, we discuss a new approach for full breast reconstruction, which we refer to as tribrid reconstruction, that combines the fat-augmented LDF with a breast implant. Depending on the need for a skin island, the LDF or muscle flap is harvested and augmented with fat grafting, either to the flap itself or by injecting fat into the pectoral muscle or the subcutaneous tissue of the chest. In cases in which this does not correct asymmetry, an implant is added to enhance the breast volume. This 3-component reconstruction method was applied in 9 cases, and all achieved sufficient postoperative volume and satisfactory aesthetic results. This technique can be used in a single surgery to reconstruct both moderately sized and larger breasts.
Central pulse pressure, carotid artery remodeling and coronary artery calcifications
Authors: Kozakova Michaela , Morizzo Carmela , Jamagidze Giuli , Chiappino Sara , Chiappino Dante , Emdin Michele , Palombo Carlo
Published: February 2025

Objectives:

The aim of the study was to evaluate the role of central pulse pressure (PP) in carotid wall thickening and coronary artery calcification (CAC).

Methods:

In an asymptomatic general population (N = 396, 163 men, 47–89 years), central PP was measured by applanation tonometry, CAC by computed tomography, and common carotid artery intima–media thickness (cIMT), pulse wave velocity (cPWV) and the power of the signal reflected from carotid media (cMP) by radiofrequency-based carotid ultrasound. High cIMT was defined as cIMT equal to or greater than the 75th percentile for given sex and age, and CAC presence as a CAC score greater than 0.

Results:

In the entire population, luminal diameter and cMP increased with increasing central PP (r = 0.32 and 0.25; P < 0.0001). One hundred and ninety-seven individuals had high cIMT; individuals with high cIMT had higher central PP, luminal diameter, cMP and cPWV (P = or <0.0001), but comparable wall tensile stress (P = 0.23). In a logistic regression model, high cIMT was independently associated with luminal diameter and central PP. One hundred and fifty-two individuals had CAC score greater than 0; in a logistic regression model, CAC score greater than 0 was independently associated with sex, age, central PP, LDL-cholesterol, triglycerides and T2DM.

Conclusion:

Our findings indicate that high central PP contributes both to an increase in cIMT and the development of CAC. However, while central PP was the only risk factor linked to high cIMT, multiple atherosclerotic risk factors were associated with CAC. Therefore, both high cIMT and CAC reflect the adverse impact of high pulsatile load on the vascular system, yet only CAC can be considered a marker of atherosclerosis.
Large Language Models in Traditional Chinese Medicine: A Systematic Review
Authors: Chen Zhe , Wang Hui , Li Chengxian , Liu Chunxaing , Yang Fengwen , Zhang Dong , Fauci Alice Josephine , Zhang Junhua
Published: February 2025

Objective:

Generative artificial intelligence (AI) technology, represented by large language models (LLMs), has gradually been developed for traditional Chinese medicine (TCM); however, challenges remain in effectively enhancing AI applications for TCM. Therefore, this study is the first systematic review to analyze LLMs in TCM retrospectively, focusing on and summarizing the evidence of their performance in generative tasks.

Methods:

We extensively searched electronic databases for articles published until June 2024 to identify publicly available studies on LLMs in TCM. Two investigators independently selected and extracted the related information and evaluation metrics. Based on the available data, this study employed descriptive analysis for a comprehensive systematic review of LLM technology related to TCM.

Results:

Ten studies published between 2023 and 2024 met our eligibility criteria and were included in this review, including 40% LLMs in the TCM vertical domain, 40% containing TCM data, and 20% honoring the TCM contribution, with a foundational model parameter range from 1.8 to 33 billion. All included studies used manual or automatic evaluation metrics to evaluate model performance and fully discussed the challenges and contributions through an overview of LLMs in TCM.

Conclusions:

LLMs have achieved significant advantages in TCM applications and can effectively address intelligent TCM tasks. Further in-depth development of LLMs is needed in various vertical TCM fields, including clinical and fundamental research. Focusing on the functional segmentation development direction of generative AI technologies in TCM application scenarios to meet the practical needs-oriented demands of TCM digitalization is essential.

Graphical abstract: http://links.lww.com/AHM/A152.
A 10-Year Personal History of the Radiological Operations Support Specialist
Authors: Irwin William
Published: February 2025

The Radiological Operations Support Specialist Program accomplished one of the hardest outcomes—to build and sustain an all-volunteer organization from a few people to hundreds. Even more, the organization created a cadre of newly certified technical specialists able to help the local, state, and federal authorities respond better to a radiological or nuclear catastrophe so our nation can recover faster. The effort has had the endorsement of the United States Congress and the support of three important federal agencies and the national partnership for radiation protection, the Conference of Radiation Control Program Directors. The development of the Radiological Operations Support Specialist (ROSS) occurred over the same time when numerous other references, tools, trainings, and exercises were ushered in. A 10-year period that may be the most remarkable unified radiological emergency preparedness effort yet undertaken. This article describes the key motivators and many of the guidance documents and technical tools and capabilities that came together over the last 10 years that helped build not just an organization of radiological and nuclear emergency response and recovery subject matter experts that the nation needs, but also nearly everything to sustain them effectively for decades to come.
Shared Decision-Making in Severe Aortic Stenosis
Authors: van Beek-Peeters Judith J.A.M. , Habibovic Mirela , Faes Miriam C. , van der Meer Jop B.L. , Pel-Littel Ruth E. , van Geldorp Martijn W.A. , Van den Branden Ben J.L. , van der Meer Nardo J.M. , Minkman Mirella M.N.
Published: February 2025

Background

The experiences and preferences of older patients regarding shared decision-making (SDM) for managing severe aortic stenosis (AS) and its impact on health outcomes are not well known.

Objective

The purpose of this study was to provide insight into the experiences, preferences, and needs for SDM of older patients with severe AS and the associations between perceived SDM levels and patients' quality of life, depression, and anxiety.

Methods

A descriptive, exploratory multiple-methods study was conducted using a survey, focus groups, and individual interviews with patients 70 years and older with severe AS. Data were collected at baseline and at 3-month follow-up. Quantitative data were analyzed using multivariate linear regression and quantitative data using qualitative thematic analysis.

Results

Quantitative analysis (n = 120) showed that 29.6% of patients reported maximum scores for the perceived SDM level. In addition, the perceived SDM level was significantly associated with the quality of life category environment (B = 2.75; 95% confidence interval, 0.90–4.61; P = .004). Professionals' identification of discussion partners was reported by 41.3% of patients, and 52% of patients reported professionals' exploration of patients' daily lives. For future decision-making, 55.6% of patients preferred a collaborative role. Qualitative analysis of 2 focus groups (n = 10) and interviews (n = 7) revealed patients' preference for informal caregivers' support for decision-making. Patients expressed caution in sharing views on their daily lives and expectations and suggested better preparation and goal exploration for decision-making.

Conclusions

To align with SDM and personalize the decision-making process, healthcare professionals must foster patient input and engage informal caregivers. Patients must reflect on their daily activities to define their treatment goals.
The Importance of Fostering Trust in Service Delivery With Child and Youth Survivors of Commercial Sexual Exploitation
Authors: O’Brien Jennifer E. , Mitchell Kimberly J. , Jones Lisa M. , Chinwokwu-Njemanze Chioma
Published: February 2025

The commercial sexual exploitation (CSE) of children occurs when individuals under the age of 18 years exchange sex/sexual acts for goods, services, drugs, or money. Current research suggests that many survivors of CSE had contact with a variety of professionals during their victimization experiences; however, many child CSE survivors are wary of those working with them in professional roles, including those seeking to engage them in regular care. The current study used qualitative interviews with professionals working with children who have experienced CSE to explore their strategies for facilitating trust. Qualitative data were collected from 80 diverse professionals from 11 different cities across the United States. Grounded theory analysis revealed three main themes regarding the facilitation of trust building: (a) clear communication, (b) humanization of experience, and (c) boundaries/limits. Findings from the current study offer practical implications for professionals, such as nurses, who are interested in facilitating rapport with children who have experienced CSE victimization in the interest of primary and tertiary prevention. Future research should focus on survivor perspectives to explore how professional’s approaches are experienced by the populations they purport to serve.
Comparing Tenecteplase and Alteplase for Acute Ischemic Stroke
Authors: Tu Chen-Chen , Mao Hanqi Kelly , Wessol Jennifer L.
Published: February 2025

BACKGROUND: Acute ischemic stroke (AIS) is a leading cause of mortality and disability. Patients who receive thrombolytic therapy promptly tend to have better outcomes. Although alteplase (tPA) is the standard Food and Drug Administration–approved thrombolytic for AIS treatment, recent American Heart Association guidelines suggest that tenecteplase (TNK) can be used as an alternative. This project compares the cost-effectiveness and clinical outcomes of TNK versus tPA in AIS treatment. Key outcomes include door-to-needle time, length of stay, National Institutes of Health Stroke Scale scores, and the incidence of hemorrhagic conversion events. METHODS: The project involved retrospective analysis through medical chart reviews at a thrombectomy-capable stroke center in a Pacific Northwest community hospital. Data were collected from 175 AIS patients treated with either tPA (82) or TNK (93) between March 2022 and December 2023. Patients eligible for thrombolytic therapy received tPA before March 15, 2023, with TNK used thereafter. Selection criteria adhered to American Heart Association guidelines and clinicians' judgment. RESULTS: Although door-to-needle times were similar (P = .20), excluding outliers revealed a significant difference favoring TNK (P = .04). No significant group differences were observed for demographics, National Institutes of Health Stroke Scale scores, length of stay, or post–intracerebral hemorrhage rates. Tenecteplase use resulted in over $40 000 in medication savings during the project period. CONCLUSION: Tenecteplase offers comparable safety and efficacy to tPA for treating AIS, with the added benefit of cost savings. Although clinical outcomes did not significantly differ between the 2 drugs, TNK's reduced cost and ease of administration make it an attractive option, particularly in resource-limited settings. These results support the current organizational treatment protocol favoring TNK.