bluuebunny/crossref_metadata_2025_split huggingface dataset:
European recommendations from healthcare professionals and people living with obesity on safe practice for bariatric and metabolic surgery medical tourism: a modified Delphi consensus statement from EASO, IFSO-EC, and ECPO
Authors: Dobbie Laurence J , Birney Susie , Breen Cathy , Bryant Sheree , Clare Ken , Ciudin Andreea , Felsenreich Daniel M , Halford Jason C G , Heneghan Helen , Lorenzo Nicola Di , Mooney Vicki , Parmar Chetan , O’Connell Jean , O’Malley Grace , Woodward Euan , Yumuk Volkan D , Peterli Ralph , McGowan Barbara 
Published: December 2024

Background:
Bariatric and metabolic surgery tourism (BMT) is becoming an increasingly popular route to treatment for patients living with obesity. Recent reports have highlighted that some patients travelling abroad for bariatric surgery have received inadequate care, fraudulent care, and, tragically, some cases have resulted in death. This study aimed to define consensus in Europe regarding safe practices concerning BMT.

Materials and methods:
IFSO-EC, EASO and ECPO initiated a task force to delineate safe practices in BMT. Two expert European panels were convened, one comprised of healthcare professionals (identified from EASO and IFSO-EC) and the other of patient representatives (identified from ECPO). The study utilized a modified Delphi consensus methodology, and 135 questions were administered. Surveys were conducted anonymously online, and consensus was defined as 70% agreement. Themes analyzed regarding BMT included regulation, pre-operative evaluation, operative care, post-operative care, advertising and online information.

Results:
One hundred and nineteen healthcare professionals and 88 patient representatives participated from 26 countries. The healthcare professional panel included 66 bariatric surgeons, 28 endocrinologists, 18 dietitians, three nurses, two psychologists, one general practitioner and one gastroenterologist. Three questionnaire rounds were conducted for the healthcare professional panel, and two were performed for the patient representative panel. Consensus recommendations were given across all themes relevant to BMT. These included evaluating and managing psychological health, sleep apnea, cardiovascular disease, liver health and dietetic assessment. The recommendations covered the requirements for regulatory standards, including surgeon accreditation and procedural volume. They also included recommendations regarding patient education, standardized operative care, online information provision, and follow-up.

Conclusions:
Through collaboration with healthcare professionals and patients living with obesity, we provide European recommendations regarding safe practices concerning BMT. Further evaluation is required regarding outcomes following BMT. These data, alongside the Delphi consensus recommendations, will inform BMT clinical guideline development.
Nomogram for predicting severe abdominal adhesions prior to definitive surgery in patients with anastomotic fistula post-small intestine resection: a cohort study
Authors: Yao Zheng , Shang Weiwei , Yang Fan , Tian Weiliang , Zhao Guoping , Xu Xin , MD Risheng Zhao , Tian Tao , Li Wuhan , Huang Ming , Zhao Yunzhao , Huang Qian 
Published: December 2024

Background:
This study aimed to develop and validate a nomogram for predicting the presence of severe intra-abdominal adhesions before definitive surgery (DS) for anastomotic fistula following small intestine resection (SIR).

Methods:
Patients were enrolled from January 2009 to October 2023 and were randomly divided (2:1) into development and validation cohorts. Predictors of severe adhesion were identified and integrated into a nomogram. The nomogram’s performance was evaluated through calibration, discrimination, and clinical utility. Results: A total of 414 patients were included, with 276 in the development cohort and 138 in the validation cohort. Severe adhesion was diagnosed in 54 (13%) patients, including 37 (13.4%) in the development cohort and 17 (12.3%) in the validation cohort (P = 0.76). Five predictors were identified: Sequential Organ Failure Assessment score, duration of early-stage abdominal infection, preoperative albumin (Alb) <35 g/L, visceral to subcutaneous fat area ratio, and preoperative C-reactive protein >10 mg/L. The nomogram demonstrated robust discrimination, with a concordance index (C-index) of 0.80 (95% CI, 0.76–0.90) in internal validation, and was well-calibrated. In the validation cohort, the model maintained good discrimination (C-index = 0.79; 95% CI, 0.67–0.94) and calibration. Decision curve analysis affirmed the nomogram’s clinical utility.

Conclusion:
This study introduces a practical nomogram for assessing the risk of severe abdominal adhesion prior to DS in patients undergoing surgery for anastomotic fistula after SIR.
Substitution of liposomal bupivacaine for lidocaine reduces incidence of injection-emergent adverse events after intraarticular therapies for knee osteoarthritis: a prospective cohort study
Authors: Lin Junqing , Gao Tao , Zhou Lenian , Liu Tiexin , Wang Qiuke , Lin Zixuan , Zhu Hongyi 
Published: December 2024

Background:
Local anesthetics as a part of intraarticular therapies (IATs) are widely used for treating knee osteoarthritis (KOA). Whether the substitution of liposomal bupivacaine (LB) for lidocaine is safe and effective in reducing the incidence of injection-emergent adverse events (AEs) after IATs remains unclear.

Methods:
We recruited outpatients who had a clinical diagnosis of KOA and decided to receive IATs from November 2023 to April 2024. The type of IATs (glucocorticoids, platelet-rich plasma, and hyaluronic acid) for each participant was decided by the preference of patients after consulting with his or her treating physicians. Using lidocaine or LB as local anesthetics was determined by enrollment timing due to considerations of safety. The primary outcome was injection-emergent AEs after IATs. Secondary outcome measures included the Visual Analog Scale (VAS) pain scores and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain subscale score.

Results:
In this study, 123 and 103 patients, respectively, received lidocaine and LB according to their enrollment date. Compared with lidocaine, using LB yielded a reduced incidence of AEs in the overall 2 weeks (LB vs. lidocaine, 30.1% vs. 45.5%, P = 0.018) and week 1 (LB vs. lidocaine, 23.3% vs. 39.8%, P = 0.008). After adjusting for sex, baseline body mass index, age, baseline WOMAC pain subscale score, and K–L grade, the substitution of LB for lidocaine was significantly associated with the reduced incidence of AEs in 2 weeks (OR, 0.484; 95% CI, 0.274–0.853; P = 0.012). In the initial 3 days, the LB groups reported better outcomes in terms of VAS pain score (change from baseline of VAS pain, LB vs. lidocaine, day 1 −8.3 ± 8.9 vs. −1.9 ± 9.3, P < 0.001; day 2 −20.6 ± 16.1 vs. −13.7 ± 19.4, P = 0.005; day 3 −22.3 ± 18.5 vs. −16.3 ± 19.3, P = 0.020). The changes from the baseline of the WOMAC pain subscale at day 14 were similar between the two groups (LB vs. lidocaine, −32.2 ± 11.7 vs. −29.4 ± 11.3, P = 0.073).

Conclusion:
With the substitution of LB for lidocaine, patients might have reported reduced incidence of AEs, mainly derived from the superiority in week 1. The substitution of LB for lidocaine was safe in different scenarios of IATs, and future randomized clinical trials were warranted by the current study.
Cerebral amyloid angiopathy-related inflammation (CAA-ri): A case report
Authors: Meng Yao , Xiao Yining , Sun Ruohan , Li Lingyu , Dong Yanhong 
Published: December 2024

Rationale:
Cerebral amyloid angiopathy-related inflammation (CAA-ri) is a treatable condition characterized by an acute or subacute onset, with its primary pathological hallmark being the deposition of amyloid, predominantly β-amyloid (Aβ), within intracranial microvessels. Despite its potential for treatment, CAA-ri is a rare disorder that is frequently underrecognized by clinicians in practice. This article provides a comprehensive overview of the clinical manifestations and therapeutic approaches associated with CAA-ri, aiming to enhance awareness among healthcare professionals.

Patient concerns:
A 67-year-old male patient who suffered from a sudden decline in cognitive functioning, intermittent headache, and dysphoria underwent brain magnetic resonance imaging, susceptibility weighted imaging, and cerebrospinal fluid analysis and was considered probable CAA-ri.

Diagnosis interventions:
During the course of disease development, the patient suffered from a sudden decline in cognitive functioning, mainly in the form of unresponsiveness, decreased comprehension, and increased repetitive language, accompanied by intermittent headaches and dysphoria. Brain magnetic resonance imaging showed numerous white matter in both hemispheres. Susceptibility weighted imaging showed multiple spots of hypointensity in the bilateral cerebral and cerebellar hemispheres, a hypointensity signal in the left occipital lobe, and extensive zones of hypointensity in bilateral sulci. Cerebrospinal fluid analysis was abnormal with elevated levels of protein and low levels of P-tau, Aβ42, and Aβ1-42/Aβ1-40. The use of glucocorticoids greatly reduced his symptoms. This lends credence to the probable CAA-ri diagnosis. The symptoms can be successfully alleviated by administering methylprednisolone sodium succinate.

Outcomes:
During the patient’s hospitalization, immunosuppressive therapy, primarily consisting of methylprednisolone sodium succinate and methylprednisolone, was administered, resulting in a significant improvement in symptoms. Post-discharge, the patient was monitored regularly, revealing a gradual enhancement in cognitive function without recurrence. Consequently, immunosuppressive therapy was discontinued 1 year following the patient’s discharge.

Lessons:
CAA-ri is a rare clinical condition, and timely diagnosis and early treatment are very critical for patient prognosis.
Treatment of sudden sensorineural hearing loss with tinnitus with Fu subcutaneous needling: A case report
Authors: Zhang Jiarui , Lu Jin , Wang Yue , Ding Xinghao 
Published: December 2024

Rationale:
Fu’s subcutaneous needling (FSN) is a special acupuncture method that uses FSN to sweep the subcutaneous tissue around or adjacent to the limbs to disperse the pain. Sudden sensorineural hearing loss (SSHL) is a kind of otological emergency with sudden onset within 72 hours, with unilateral hearing loss, and hearing loss of ≥20 dB in 2 connected frequencies, and most of the patients have no obvious triggers. Most patients with SSHL are accompanied by tinnitus, vertigo, and nausea and vomiting.

Patient concerns:
The patient suffered from hearing loss with tinnitus. Although received relevant treatment, the hearing loss and tinnitus did not improve significantly.

Diagnoses:
SSHL with tinnitus.

Interventions:
FSN treatment. A point 5 cm lateral to the point of tension and stiffness of the left trapezius muscle was selected on the affected back as the needle insertion point, and the condition of the neck muscles was improved through the FSN sweeping movement with neck reperfusion activities. The patient received treatment twice a week, and 4 weeks of treatment as a phase. At the end of each phase, a pure tone threshold audiometry, tinnitus evaluation scale Tinnitus Handicap Inventory assessment, and neck muscle palpation were performed.

Outcomes:
The patient’s hearing improved and the Tinnitus Handicap Inventory score decreased.

Lessons:
FSN has a good therapeutic effect on SSHL with tinnitus.
Acute Effects of Slow-Paced Breathing on Measures of HRV in Hospitalized Patients With Bilateral COVID-19 Pneumonia: A Secondary Analysis of a Randomized Clinical Trial
Authors: Balint Elisabeth Maria , Grüner Beate , Gündel Harald , Haase Sophia , Kaw-Geppert Mandakini , Thayer Julian , Weimer Katja , Jarczok Marc N. 
Published: December 2024

Objective
Slow-paced breathing (SPB) with prolonged exhalation is assumed to stimulate vagal reflexes, which is represented by increased heart rate variability (HRV) values. However, most trials were conducted in healthy participants. We sought to evaluate the feasibility of SPB in hospitalized patients with confirmed bilateral COVID-19 pneumonia with major respiratory impairment and to investigate if SPB shows acute increasing effects on HRV measures in these severely ill patients with distinctly reduced vagal tone.

Methods
This single-center randomized controlled clinical trial enrolled 23 patients in the intervention (4-second inhalation, 6-second exhalation for 20 minutes 3× daily) and 23 patients in the control group (IG/CG). The effects of SPB on HRV were calculated using post-hoc likelihood ratio tests. Baseline HRV measures between the groups over time were compared using multilevel mixed-effect linear regression models with random slope including the covariates relevant comorbidities, COVID-19 medication, and age.

Results
HRV values at baseline were significantly decreased in all patients. During SPB, HRV parameters increased significantly (ln(SDNN), ln(LF), ln(TP); all p < .001). Higher breathing rate at baseline correlated with lower LF during SPB (p < .045). IL-6 morning levels were associated with lower HRV measures (p < .001). Resting HRV measures as well as subjective health increased over hospitalization time with no differences between IG and CG (comparing random slope with random slope interaction models: all LR χ
2(5) < 4.5; p > .48).

Conclusion
SPB is feasible and safe in patients with bilateral COVID-19 pneumonia and appears to be an effective self-performed intervention to acutely increase HRV measures. This observation was independent of comorbidities and comedication. Further trials should corroborate these findings and extend it to other severely ill populations.

Registration
German Clinical Trials Register under ID DRKS00023971 (https://drks.de/search/en/trial/DRKS00023971), with a Universal Trial Number (UTN) U1111-1263-8658
The Implementation of Perioperative Geriatric Management Could Decrease the Incidence of Postoperative Delirium in the Elderly Undergoing Major Orthopedic Surgeries
Authors: Zou Yan , Deng Tingzhi , Xu Yu , Zheng Qing , Wu Yuan , Hui Shan , Liu Cuizhong , Wei An 
Published: December 2024

Objectives:
This study aimed to explore the association of perioperative geriatric management (PGM) in major orthopedic surgeries.

Methods:
One hundred seventy-five participants aged 75 and older were in-hospital patients who underwent major orthopedic surgery from September 2020 to September 2021, and they received PGM and necessary treatment for indicators with abnormal value (the PGM group). Another 175 participants in the control group only received the evaluation part of the PGM, recruited by filtering in the electronic medical record system from March 2016 to March 2017. The treatment included joint intervention of psychiatrists and rehabilitation physicians. For example, for patients at risk for falling, evaluation of inadequate blood volume, delirium, abnormal gait, and visual impairment should be performed. The logistic regression analysis was adopted to determine the association of PGM and postoperative delirium.

Results:
The prevalence of postoperative delirium among participants was 13.71%. Compared with the empirical treatment group, the postoperative delirium was significantly decreased (7.43% versus 14.29%) (P<0.05). Compared with the control group, participants were in the PGM group were at lower risk of postoperative delirium, mainly attributed to these following factors: Charlson comorbidity index <5 [odds ratio (OR)=0.620; 95% CI: 0.010-0.623], mini cog >2 (OR=0.224; 95% CI: 0.061-0.824), Confusion Assessment Method score indicating low risk (OR=0.079; 95% CI: 0.010-0.623), nutritional risk screening scale <3 (OR=0.306; 95% CI: 0.095-0.989), and major adverse cardiovascular events <3 (OR=0.253; 95% CI: 0.073-0.720). After adjusting for the length of hospital stay and reason for hospitalization, the association between the parameters above and postoperative delirium is still significant (P<0.05).

Conclusions:
The implementation of the PGM could decrease the incidence of postoperative delirium significantly, which might contribute to improving the overall prognosis in elderly patients who underwent major orthopedic surgeries.
Automated Computerized-Based Intervention to Identify Hypomagnesemia in Primary Care Patients With Arrhythmia
Authors: López-Garrigós Maite , Ahumada Miguel , Leiva-Salinas María , Blasco Alvaro , Flores Emilio , Leiva-Salinas Carlos ,   On behalf of the PRIMary Care-LABoratory (PRIMLAB) working group
Published: December 2024

Objectives:
Hypomagnesemia early diagnosis and consequently early, timely magnesium supplementation is of utmost benefit, but it often goes underdiagnosed. The objective was to show and monitor an intervention to identify hypomagnesemia in patients with arrhythmia.

Methods:
A cross-sectional study was designed in the laboratory. In primary care patients, the Laboratory Information System would automatically add a serum magnesium test when sample availability is present in any request when a diagnosis of arrhythmia is made. We counted the number of detected patients with hypomagnesemia (serum magnesium <1.7 mg/dL, <0.7 mmol/L), and calculated the cost in reagent of each identified case.

Results:
In 430 patients with arrhythmia, serum magnesium was measured, and 41 (9.5%) had hypomagnesemia results. One patient showed severe hypomagnesemia values (<1.2 mg/dL and <0.49 mmol/L). Patients with a deficit were significantly (P<0.01) older than the total group of patients with normal magnesium values (66.3±13.2 versus 61.6±12.5). Each case represented a cost of 3.15€ in reagent.

Conclusions:
The automated computer-based intervention to identify patients with hypomagnesemia was useful and affordable, given the cost per detected case.
Modified Infrabrow Blepharoplasty for Periorbital Rejuvenation in Asia Women
Authors: Luo Mengmeng , Zhao Qingfang , Liu Wenjing , Xu Jinghong , He Zhigang 
Published: December 2024

Objective:
The infrabrow blepharoplasty is a common surgical operation indicated in Asians for periorbital rejuvenation. This operation alone is difficult to achieve the correction of crow’s feet. Therefore, the authors elucidate the authors' experiences of applying infrabrow blepharoplasty combined with the subcutaneous undermining of the lateral periorbital region to treat upper eyelid dermatochalasis with lateral hooding deformity and alleviate crow’s feet, including its indications, operative procedures, and postoperative outcomes.

Methods:
Retrospective review of patients undergoing infrabrow blepharoplasty incorporated with subcutaneous undermining of the lateral periorbital region between January 2019 and December 2023. Thirty-nine patients who were well followed up were retrospectively reviewed. The surgical procedure is described in depth. Frontal and lateral view photographs were obtained to evaluate the curative effect. The following data were collected preoperatively and at postoperative 6 months: distance between the pupil centre and the supratarsal fold, distance between the pupil centre and lower margin of eyebrow, distance between the lateral canthus and the supratarsal fold, distance between the lateral canthus and lower margin of eyebrow, the rating of Crow’s Feet Grading Scale (CFGS) at rest and at a maximum smile.

Results:
The study included 78 eyelids of 39 patients ranging in age from 37 to 56 years, with a mean age of 46.25 years. The mean follow-up for the patients was 6.7 months. Compared with the postoperation with the preoperation, distance between the pupil centre and the supratarsal fold increased from 5.45 ± 1.31 to 5.98 ± 1.62 mm, distance between the lateral canthus and the supratarsal fold increased from 3.93 ± 1.24 to 6.13 ± 1.87 mm, no evidence of significant changes in distance between the pupil centre and lower margin of eyebrow and distance between the lateral canthus and lower margin of eyebrow. The average change in the rating of CFGS was -0.62 ± 0.11 at maximum contraction and -0.24 ± 0.08 at rest. No significant complications occurred in any patient postoperatively.

Conclusion:
The combination of infrabrow blepharoplasty with the subcutaneous undermining of the lateral periorbital region was effective in addressing moderate dermatochalasis with lateral hooding and improve crow’s feet in middle-aged Chinese patients, resulting in a rejuvenated periorbital area and flattening of the eyebrow is not noted at the same time. The anthropometric measurement of the upper eyelid and CFGS facilitate operation outcome assessment.
ED Nurse-Led Code Sepsis to Reduce Time to Antibiotics
Authors: Gomez Leslie , LeClair Kelli , Jenkins Danisha , David Mary Ann , Downing Jillian , Graham Julie 
Published: December 2024

Background: Delays in sepsis recognition contribute to delays in antibiotic administration, which lead to increased morbidity and mortality in patients with sepsis. Our objective was to create an Emergency Department (ED) Code Sepsis Nurse-led team to reduce the time to antibiotics and mortality in patients with sepsis. Methods: This initiative was implemented at a community hospital in Southern California in response to previous undesirable sepsis outcomes. In fiscal year 2021, the ED Sepsis Nursing Team was launched with the goal of improving sepsis-related outcomes. The following interventions were implemented: First, a group of dedicated Sepsis Nurses with training specific to sepsis recognition was created, and an electronic ED-sepsis screening tool was developed and implemented. Next, the dedicated sepsis nurses designed and educated to a “Code Sepsis” activation process. The code triggered a multidisciplinary response and implementation of standing orders for blood cultures, lactate, complete blood count, complete metabolic panel, and chest x-ray or urinalysis if indicated. Finally, the Sepsis Team Registered Nurse (RN) Captain led house-wide monthly Sepsis Task Force meetings to improve unit-level engagement and to allow the team to have ownership over sharing wins and losses. Results: By Quarter 4 (Q4) of Fiscal Year 2021, door-to-antibiotic time for sepsis patients dropped from 196.7 min (Q1) to 144.7 (Q4). Additionally, mortality dropped below the health system average (10.4% vs. 13.5%), and Fiscal Year 2021 surpassed the readmissions benchmark of <1.0 at a rate of 0.5. Conclusion: An RN-led, interprofessional response to accepted sepsis identification criteria enhanced staff and physician engagement and improved sepsis outcomes for patient mortality and hospital reporting outcomes. The process was adopted with very few obstacles that were easily overcome as the understanding of the role and its significance was realized.