bluuebunny/crossref_metadata_2025_split huggingface dataset:
Regional Analgesia Differential Sensory Block During Labor Epidural Analgesia: A Prospective Observational Study to Investigate the Relationship of Lower and Upper Sensory Block Levels to Cold, Pinprick, and Light Touch
Authors: Casellato JF , Balki M , Wang A , Ye XY , Downey K , Carvalho JCA 
Published: February 2025

(Can J Anesth. 2024;71(6):802–807. doi:10.1007/s12630-023-02638-5)
The prevailing choice for mothers requesting pain management during labor and delivery is epidural analgesia (EA). The use of a sensory block assessment is necessary to understand how the body is responding to the analgesia, both in an effort to ensure pain is effectively managed and the dose is not affecting the body adversely. Various assessment methods have been investigated, however, the use of a pragmatic bedside assessment by a clinician is the most favored. When anesthesia is used in preparation for a cesarean delivery, published data demonstrates that the use of either cold, pinprick, or light touch may be applied to accurately assess the sensory block. However, there is a lack of data firmly describing the use of these methods in anesthetics used during a vaginal birth. Thus, the authors sought clarification on whether cold, pinprick, and light touch are substrates equally attuned for such assessments.
The 90% Effective Dose of Intrathecal Hyperbaric Bupivacaine for Cesarean Delivery Under Combined Spinal-Epidural Anesthesia in Parturients With Super Obesity: An Up-Down Sequential Allocation Study
Authors: Tan HS , Fuller ME , Barney EZ , Diomede OI , Landreth RA , Pham T , Rubright SM , Ernst L , Habib AS 
Published: February 2025

(Can J Anesth. 2024;71(5):570–578. doi:10.1007/s12630-024-02705-5)
A greater number of obese parturients are giving birth through cesarean delivery (CD), in part due to rising rates of both obesity and CDs worldwide. To avoid various complications during a CD, the ideal option for anesthesia is a neuraxial technique, with either spinal or combined spinal-epidural (CSE) anesthesia. A sensory block at the T4 dermatome is achieved using intrathecal hyperbaric bupivacaine and opioids. Previous studies have reported the efficiency of intrathecal hyperbaric bupivacaine to be 95% when the dose is between 11 and 15 mg, however, these studies were performed mostly in patients who were not obese. In addition, magnetic resonance imaging has shown reduced levels of cerebrospinal fluid within the lumbar region, which has further been explained to cause excessive spread of the block cephalad. Thus, it has been suggested that reducing the dose of intrathecal bupivacaine within the obese population is essential to avoiding adverse effects across several systems of the body. However, various clinical trials contain data which suggest that this dosage reduction in obese woman is not necessary, although their data do not include individuals considered to be super obese (BMI ≥50 kg/m2). Importantly, the dose of intrathecal bupivacaine should be high enough to create adequate surgical anesthesia, otherwise the use of general anesthesia may be employed, increasing the risk of morbidity. Since the field lacks a consensus on intrathecal hyperbaric bupivacaine dosage for patients with super obesity undergoing a CD under CSE, the authors sought clarification with this study. The hypothesized 90% effective dose (ED90) was between 7.5 and 12 mg when administered with opioids.
Postoperative Analgesia A Personalized Protocol for Prescribing Opioids After Cesarean Delivery: Leveraging the Electronic Medical Record to Reduce Outpatient Opioid Prescriptions
Authors: Imo CS , Macias DA , McIntire DD , McGuire J , Nelson DB , Duryea EL 
Published: February 2025

(Am J Obstet Gynecol. 2024; 230:446.e1–446.e6. doi:10.1016/j.ajog.2023.09.092)
Cesarean deliveries (CD) are highly prevalent in the United States, with over 1.1 million performed in 2020. Despite this, standardized pain management at discharge is lacking. Many patients still receive excess opioids at discharge, often leading to unused medication that can contribute to misuse and addiction. Studies show similar opioid prescriptions for all patients regardless of varying pain levels and opioid requirements, highlighting the need to address overprescribing. In 2021, updated guidelines from the American College of Obstetricians and Gynecologists Committee on Clinical Consensus-Obstetrics recommended a multimodal approach, combining acetaminophen, nonsteroidal anti-inflammatory drugs (NSAIDs), and opioids, tailored to individual needs.
The Association Between Selective Serotonin Reuptake Inhibitors and the Incidence of Delirium in Critically Ill Patients: A Systematic Review
Authors: Schwab Hailey , Sines Benjamin , Moreton Elizabeth , Palanca Ben Julian , Austin C. Adrian 
Published: February 2025

OBJECTIVES:
To investigate the: 1) correlation between the maintenance or cessation of selective serotonin reuptake inhibitors (SSRIs) during hospitalization and the incidence of delirium among critically ill patients; 2) evaluate the effectiveness of utilizing SSRIs as a potential intervention for managing delirium in critically ill adults; and 3) evaluate the effects of continuing SSRIs in patients who were previously prescribed these medications on incidence of delirium or withdrawal symptoms manifesting as delirium.

DATA SOURCES:
PubMed, Scopus, Embase, PsycInfo, and ProQuest Central, and additional studies identified from reference lists and relevant systematic reviews.

STUDY SELECTION:
Studies included adults 18 years old and older with critical illness necessitating ICU care administered SSRIs during their hospital stay, where delirium and/or adverse effects were reported as outcomes.

DATA EXTRACTION:
Two team members extracted data from included studies into evidence tables, which were subsequently discussed to synthesize and align the extracted findings. Extraction criteria included study population and the type of control or comparison group, exposures, primary and secondary outcome measures, results, and implications. We used Study Quality Assessment Tools provided by the National Heart, Lung, and Blood Institute and National Institutes of Health public websites along with the TREND checklist to evaluate the quality of articles and analyze for bias.

DATA SYNTHESIS:
Two reviewers analyzed the studies’ risk for bias. Analysis followed the Grading of Recommendations Assessment, Development, and Evaluation criteria used in Cochrane systematic reviews. We used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist to design and report the study.

CONCLUSIONS:
The cessation of SSRIs in patients who were previously prescribed these medications is associated with an increased incidence of delirium or withdrawal symptoms manifesting as delirium. Continuing these medications in the setting of critical illness may mitigate the risk of delirium. Further investigation is warranted into the impact of SSRIs on delirium in patients not taking these medications prior to ICU admission.
How Long Should Patients Be Treated With Postcardiotomy Venoarterial Extracorporeal Membrane Oxygenation? Individual Patient Data Pooled Analysis
Authors: Biancari Fausto , Mäkikallio Timo , L’Acqua Camilla , Ruggieri Vito G. , Cho Sung-Min , Dalén Magnus , Welp Henryk , Jónsson Kristján , Ragnarsson Sigurdur , Hernández Pérez Francisco J. , Gatti Giuseppe , Alkhamees Khalid , Loforte Antonio , Lechiancole Andrea , D’Errigo Paola , Rosato Stefano , Spadaccio Cristiano , Pettinari Matteo , Fiore Antonio , Mariscalco Giovanni , Perrotti Andrea , Arafat Amr A. , Albabtain Monirah A. , AlBarak Mohammed M. , Laimoud Mohamed , Djordjevic Ilija , Samalavicius Robertas , Alonso-Fernandez-Gatta Marta , Wilhelm Markus J. , Kaserer Alexander , Bonalumi Giorgia , Juvonen Tatu , Polvani Gianluca 
Published: February 2025

Objectives:
To investigate the optimal duration of venoarterial extracorporeal membrane oxygenation (ECMO) for cardiogenic shock refractory to medical therapies after cardiac surgery and whether its prolonged use is justified.

Data Sources:
Previously published articles on postcardiotomy venoarterial ECMO.

Study Selection:
Articles reporting on the early outcome after postcardiotomy venoarterial ECMO in adult patients were identified through a systematic review of the literature.

Data Extraction:
Data on prespecified patients’ characteristics, operative variables, and outcomes were provided by the authors of previous studies on this topic.

Data Synthesis:
Individual data of 1267 patients treated at 25 hospitals from ten studies were included in this meta-analysis. In-hospital mortality rates were lowest among patients treated 3–6 days with venoarterial ECMO. Multilevel mixed-effects logistic regression considering the cluster effect of the participating hospitals adjusted for individual patient‘s risk profile and operative variables showed that the risk in-hospital mortality did not significantly increase in patients treated more than 6 days up to 20 days.

Conclusions:
The present study demonstrated that prolonged venoarterial ECMO support after adult cardiac surgery may be justified. However, the analysis was limited by the knowledge of only those circumstances known at the start of ECMO.
Burden and risk factors of colorectal cancer in Europe from 1990 to 2021
Authors: Zhang Tao , Wang Shuai , Li Dongming , Wang Yifei , Cao Xueyuan 
Published: February 2025

Background
Colorectal cancer (CRC) poses a significant health burden in Europe, but comprehensive studies on this region are limited.

Methods
Using data from the Global Burden of Diseases (GBD), Injuries, and Risk Factors Study 2021, we analyzed the regional distribution and temporal trends of the CRC and early-onset CRC burden in Europe from 1990 to 2021. Decomposition analysis was applied to quantify the contributions of population growth, aging, and epidemiological changes. The research also evaluated major risk factors associated with CRC and early-onset CRC.

Results
The burden of CRC in Europe was found to be higher than the global average. While the age-standardized incidence rate (ASIR) increased, both the age-standardized mortality rate (ASMR) and age-standardized disability-adjusted life years rate (ASDR) decreased. Early-onset CRC exhibits similar distribution characteristics and patterns of change. Males had a significantly higher CRC burden than females. Population aging was the primary driver of increased burden in Europe. Risk factor analysis revealed that low whole grain intake and high red meat consumption were the primary contributors to the elevated ASMR and ASDR of CRC and early-onset CRC. Additionally, the CRC and early-onset CRC burden associated with high BMI and high fasting plasma glucose showed an increasing trend.

Conclusion
The overall burden of CRC and early-onset CRC in Europe remains higher than the global level, with increasing ASIR and decreasing ASMR and ASDR. Targeted prevention and control strategies should be developed based on the major risk factors for CRC. Older adults and men should be prioritized for interventions.
Effect of Continuous Nutritionist-led Guidance on Bowel Preparation in Patients Undergoing Prostate Stereotactic Body Radiation Treatment With Endorectal Spacing
Authors: Carmeli Yonatan , Shpatz Yael , Oren-Ivry Iris , Mansano Anat , Lewin Ron , BarOrian Idan , Mattout Jacob , Weiss Ilana , Haisraely Ory , Lawrence Yaacov Richard , Symon Zvi 
Published: February 2025

Objective:
To evaluate the effect of a daily nutritionist consultation on rectal volume, gas, and prostate displacement during Stereotactic Body Radiation Treatment (SBRT) with an endorectal spacer.

Methods:
Twenty-six consecutive patients receiving 5 fraction SBRT with endorectal spacing were prospectively enrolled for an intensive daily nutritionist intervention utilizing biofeedback based on image guidance from each fraction. A retrospective control cohort receiving a standard bowel preparation was compared. Rectal volume, rectal gas, and prostate displacement were assessed by analysis of cone beam computed tomography. Data was analyzed using the SPSS statistics software.

Results:
Intense dietary intervention with biofeedback led to a consistently lower rectal gas score over 5 fractions (P<0.001) and less variability in rectal volume during prostate SBRT indicating a nonsignificant trend for superior preparation in the intervention group compared with controls, particularly for the first 2 fractions. However, there was no significant impact on prostate displacement as measured by couch correction.

Conclusions:
Intense dietary consultations effectively reduce rectal gas and variation of rectal volume during prostate SBRT with endorectal spacing. However, there was no advantage in reducing prostate displacement. Thus, labor-intensive daily nutritionist intervention with biofeedback is not cost-effective in reducing organ motion in patients with endorectal spacers compared with standard pretreatment dietary advice and is not recommended.
HIV diagnosis during acute infection: implications of long-acting preexposure prophylaxis and other evolving challenges
Authors: Elliott Tamara , Bradshaw Daniel , Fidler Sarah 
Published: February 2025

Purpose of review
Tests for HIV may perform differently in some circumstances such as with preexposure prophylaxis (PrEP) or other HIV prevention agents. Testing algorithms may not account for this, with a risk of false negative or positive HIV results. In this review we have explored the challenges of HIV testing in these special circumstances.

Recent findings
Long-acting injectable PrEP using cabotegravir or lenacapavir has been studied in large randomized controlled trials (HPTN083/084 and PURPOSE1/2 respectively). Injectable PrEP was significantly more efficacious than oral PrEP, but infections still occurred risking the emergence of HIV drug-resistance. HIV diagnostic test results were atypical in those receiving injectable PrEP, with low or undetectable HIV viral loads, delayed or diminished antibody, and HIV detection assays reverting from reactive to unreactive; so-called long acting early viral inhibition (LEVI) syndrome. In these cases, missed or delayed HIV diagnoses could be reduced with the use of HIV nucleic acid amplification tests in addition to routine testing, but this remains unfeasible in many settings.

Summary
Finding HIV testing strategies that are affordable and practical in low- and middle-income countries that can accurately diagnose HIV in the context of HIV prevention is of high importance, but more research is needed in this area.
Anaesthesia as a risk factor for long-term cognitive decline
Authors: Pennings Christoph H. , Van Boxtel Martin , De Korte-De Boer Dianne , Buhre Wolfgang , Vossen Carine J. 
Published: February 2025

BACKGROUND
There are concerns whether (repeated) exposure to general anaesthesia is associated with long-term cognitive decline.

OBJECTIVE
We investigated the potential, negative relationship between total exposure to surgery under general anaesthesia and its impact on long-term cognitive development.

DESIGN
A prospective longitudinal cohort study.

SETTING
The Netherlands.

PARTICIPANTS
1823 Adults, aged 25–84 with normal cognitive functioning on inclusion with three serial cognitive assessments between 1995 and 2008, with comprehensive documentation on demographic, lifestyle, and health factors.

MAIN OUTCOME MEASURES
The primary outcomes were test scores in the cognitive domains of learning and memory, executive function, selective attention, mental speed, and information processing speed. Linear mixed models were used to analyse the effects of the estimated total time under general anaesthesia at baseline on cognitive development during a 12-year follow-up period.

RESULTS
When adjusting for demographic and systemic health-related factors, prolonged exposure to surgery under general anaesthesia (measured in total baseline minutes) negatively affected three cognitive domains. These included the CST (executive functioning, P < 0.05), Stroop (selective attention and mental speed, P < 0.001) and LDST (information processing speed, P < 0.005). Age and education were the primary factors impacting lifetime cognitive decline. Hypertension, diabetes, and smoking negatively affected various cognitive domains.

CONCLUSION
Increased exposure to surgery under general anaesthesia independently contributes to long-term cognitive decline. Demographic variables and health-related factors are key contributors to accelerated cognitive decline over an individual's lifetime.
Predictive Performance of Bayesian Dosing Software for Vancomycin in Intensive Care Unit Patients
Authors: Bai Gali , Qi Hui , Huang Yaqun , Zhang Jiao , Zhao Huiying , Wen Ruiting , Zhang Xiaohong 
Published: February 2025

Background:
According to the updated guidelines, Bayesian-derived area under the curve estimation is recommended to guide vancomycin dosing. However, the Bayesian dosing software that facilitates this procedure has not been adequately assessed in intensive care unit (ICU) patients. This study evaluated the performance of 3 commonly used Bayesian software programs in predicting vancomycin concentrations in ICU patients before they could be utilized for personalized dosing in this population.

Methods:
Retrospective data from adult ICU patients who were administered vancomycin intravenously were obtained to predict serum concentrations a priori (based solely on patient characteristics) or a posteriori (Bayesian forecasting using measured concentrations). The predictive performance was evaluated via bias and precision using relative bias (rBias) and relative root mean squared error, respectively.

Results:
Data from 139 patients with 284 vancomycin concentrations were evaluated using 3 software programs: SmartDose (He model), Pharmado (Yasuhara model), and PrecisePK (Rodvald and Goti model). All 3 programs showed clinically acceptable bias with the exception of the Goti model of PrecisePK in an a priori estimation (rBias, 27.44%). A relatively low level of precision in terms of relative root mean squared error was observed in all these programs, but with a marked improvement in the a posteriori estimation (27.69%–37.64%) compared with the a priori situation (45.12%–68.59%).

Conclusions:
Bayesian dosing software is a potential tool for vancomycin dose optimization in ICU patients. Patients with different physiological and pathological features may be referred to specific Bayesian programs.
A Sensitive Ultrafiltration Plus RP-HPLC-FLD Method to Quantify Total and Free Perampanel Concentrations in the Plasma of Patients With Epilepsy: A Fully Validated Assay With Clinical Application
Authors: Dong Zhonghua , Wang Peng , Cui Xueyan , Liu Jinjuan , Shi Haiyan , Yang Yilei , Xu Jingya , Yi Qiaoyan 
Published: February 2025

Background:
Perampanel (PER), a novel antiepileptic drug, exhibits high protein binding. Given the drug's susceptibility to various factors, including drug interactions, and the considerable variability in blood concentrations among individuals, solely measuring the total plasma concentration of PER may not provide comprehensive insights. This study aimed to establish an HPLC-FLD method to quantify both total and free PER in clinical samples.

Methods:
Analysis of total PER involved a straightforward sample preparation process involving plasma protein precipitation. Plasma samples were ultrafiltered to isolate the free portion of PER. Chromatographic separation was achieved on an InertSustain C18 column at a 1-mL/min flow rate using a gradient of acetonitrile and aqueous sodium acetate buffer at pH 4.4.

Results:
Calibration curves for total and free PER in plasma exhibited excellent linearity over the concentration ranges of 10–3000 and 0.5–100 ng/mL, respectively. The method was applied to analyze blood samples from patients with epilepsy quantitatively; the total concentration of perampanel in the plasma of the patients was in the range of 90.45–563.39 ng/mL, whereas the free concentration was in the range of 1.82–15.29 ng/mL. The plasma protein binding ratio of perampanel was normally between 97.09% and 99.29% and decreased in cases of hypoproteinemia.

Conclusions:
The method was rigorously validated for selectivity, accuracy, precision, and stability in accordance with established FDA and EMA guidelines. The developed method enables the rapid and accurate quantification of both total and free PER concentrations in the plasma of patients with epilepsy, offering technical support for its subsequent clinical application.
Outcomes of 32,019 Deep Inferior Epigastric Perforator Flap Reconstructions: Insights from the Largest National Readmission Data
Authors: Araya Sthefano , Peluso Heather , Doremus Nathan , Lane Jaina , Patel Heli , Talemal Lindsay , Najafali Daniel , Chang Alexander H. , Patel Sameer A. 
Published: February 2025

Background:
We analyzed patient outcomes after deep inferior epigastric perforator (DIEP) flap reconstruction using a national database to assess readmission, mortality, morbidity, and length of stay (LOS).

Methods:
This retrospective cohort study utilized the 2017–2020 Nationwide Readmissions Database. Patients had an International Classification of Diseases, Tenth Revision procedure code for DIEP flap reconstruction from January to November each year. The primary outcome was the 30-day readmission rate, with secondary outcomes including in-hospital and 30-day mortality, reasons for admission and readmission, and complication rates. Multivariate regression adjusted for confounders.

Results:
A total of 32,019 DIEP flap reconstructions were identified, with a median patient age of 51 years. The most common indication was breast reconstruction after mastectomy. In-hospital, 30-day, and calendar-year mortality rates were all under 1% (95% confidence interval [CI]: 1.29–3.99). The 30-day readmission rate was 5.8% (95% CI: 5.4%–6.3%), with infection being the leading cause of readmission (2.0%), a previously unreported finding. Other causes included wound dehiscence (0.19%), pulmonary embolism (0.19%), sepsis (0.18%), and hematoma (0.18%). Reoperation rates were 7% during the index hospitalization and 11% during readmission. The average LOS was 3.7 days (95% CI: 3.65–3.82), consistent with current literature.

Conclusions:
This study provides valuable insights into DIEP flap reconstruction outcomes, revealing a 2.0% infection readmission rate. It shows a higher overall readmission rate (7% versus 5.6%) and a lower dehiscence rate (0.2% versus 2.8%) compared with previous data. These findings, derived from the largest nationally representative readmission database in the United States, also demonstrate comparable reoperation rates and LOS.