bluuebunny/crossref_metadata_2025_split huggingface dataset:
Safety and Efficacy of Opioid-sparing Anesthesia Compared With Traditional Opioid Anesthesia
Authors: Lauretta Maria P. , Marino Luca , Bilotta Federico 
Published: November 2024

Objectives:
The rationale of adoption opioid-sparing anesthesia (OSA) is to achieve perioperative analgesia with a minimal amount of opioids combined with nonopioid adjuvants during and after surgery, namely multimodal anesthesia. The OSA approach was originally developed to overcome the known complications of opioid-based anesthesia (OA), and the present scoping review (ScR) aims at providing clinical evidence of the safety and efficacy of OSA with respect to OA.

Methods:
This ScR is mainly focused on studies presenting evidence on the safety and efficacy of OSA versus OA. PubMed and EMBASE databases were utilized to find relevant studies. The search strategy included the following keywords: “opioid sparing anesthesia complications, opioid sparing anesthesia efficacy, opioid sparing anesthesia safety.” The findings from the 25 included studies were categorized into the following subsections: article characteristics, goals of the studies, OSA protocols, and surgical settings analyzed.

Results:
In the 25 reviewed studies, evidence related to the impact of OSA versus OA was considered. Intraoperative safety and efficacy end points include hemodynamic stability and anesthetic/analgesic requirements. Postoperative end points include early cognitive dysfunction, opioid-induced bowel disorder, the physical status of mothers and newborns after labor and emergency cesarean, systemic immune and inflammation modifications, postoperative recovery, in-hospital and long-term opioid requirement, early postoperative pain, and chronic postsurgical pain. The studies reported lower intraoperative mean arterial pressure and heart rate fluctuations when α2 agonists were adopted, while no differences were recorded for other complication rates. Analysis of OSA approaches for the postoperative conditions includes α2 agonists, NMDA receptor blocking agents, gabapentinoids, nefopam hydrochloride, and locoregional anesthesia techniques with a positive impact on most of the end points considered.

Discussion:
The clinical implementation of OSA encompasses the perioperative use of nonopioid drugs and locoregional anesthesia techniques. The reviewed studies reported OSA as a feasible approach to reduce opioid-related complications with no impact on patient safety.
Nomograms Predicting Survival, Recurrence and Beneficiary Identification of Adjuvant Chemotherapy in Treatment-naïve Patients with Rectal Cancer who Underwent Upfront Curative Resection: A multi-institutional study
Authors: Kanemitsu Yukihide , Uotani Tomofumi , Tsukamoto Shunsuke , Ueno Hideki , Ishiguro Megumi , Ishihara Soichiro , Komori Koji , Sugihara Kenichi ,   Study Group for Nomogram of the Japanese Society for Cancer of the Colon and Rectum
Published: November 2024

Objective:
To create and validate nomograms predicting overall survival and recurrence in treatment-naïve rectal cancer (RC) patients who underwent upfront surgery.

Background:
Although multidisciplinary treatment is standard for locally advanced RC, understanding surgical efficacy is important for determining indications for perioperative adjuvant therapy.

Methods:
RC patients who underwent upfront surgery at the Japanese Society for Cancer of the Colon and Rectum institutions were analyzed. A training cohort (n = 1925) of treatment-naïve patients who underwent surgery between 2007 and 2008 was analyzed to construct prognostic models predicting postoperative survival and recurrence. Discrimination and calibration were performed using an external validation cohort (n = 2957; Japanese colorectal cancer registry, procedures in 2005–2006). Effects of adjuvant chemotherapy on survival were evaluated based on nomogram prediction and Surveillance, Epidemiology, and End Results (SEER) data (n = 10,482; upfront surgery for RC in 2010–2015).

Results:
In the training cohort, age predicted survival, venous invasion predicted recurrence, and sex, tumor location, histological type, preoperative carcinoembryonic antigen, invasion depth, lymphatic invasion, positive radial margin, and numbers of metastatic nodes and examined nodes predicted both. Internal and external validated Harrell’s C-index values were respectively 0.77 and 0.75 for survival and 0.75 and 0.74 for recurrence. RC patients who underwent upfront surgery in the SEER database were stratified into 3 risk levels by nomogram score. Adjuvant chemotherapy did not improve 5-year survival in low-risk patients, but did so for middle-risk (62.4% vs 76.8%) and high-risk (39.4% vs 63.5%) patients.

Conclusion:
These nomograms could predict survival and recurrence after upfront curative resection of RC and identify cases expected to benefit more from adjuvant chemotherapy.
Executive Summary of the American Radium Society Appropriate Use Criteria
Authors:   Expert Panel on Breast Cancer, Choi J. Isabelle , Freedman Gary M. , Guttmann David M. , Ahmed Kamran , Gao Wendy , Walker Eleanor M. , Harris Eleanor E. , Gonzalez Victor , Ye Jason , Nead Kevin , Taunk Neil , Tadros Audree B. , Dang Chau T. , Daroui Parima , Novick Kristina 
Published: November 2024

Objectives:
Recent literature has provided additional data to further individualize treatment recommendations on regional nodal irradiation (RNI) patient selection and delivery techniques, but controversies surrounding optimal RNI utilization remain, including radiation technique, modality selection, and internal mammary lymph node (IMN) inclusion. The American Radium Society (ARS) Breast Appropriate Use Criteria (AUC) Committee performed a systematic review and developed a consensus guideline to summarize recent data and provide evidence-based recommendations.

Methods:
A multidisciplinary panel comprised of 15 members representing radiation oncologists, medical oncologists, and surgical oncologists specializing in the treatment of breast cancer conducted an analysis of the medical literature from January 1, 2011 to April 1, 2024. Modified Delphi methodology was used to rate the appropriateness of treatments for variants across 3 key questions.

Results:
Patients with intermediate-risk breast cancer, such as limited nodal involvement or large primary tumor size, are reasonable candidates for RNI, although a subset of patients with overall favorable clinicopathologic features may be considered for treatment de-escalation. Data on the use of advanced radiation techniques for RNI were limited in scope and strength, and the panel agreed that careful patient selection is needed when using these tools. Evidence suggests that the IMN should be included when delivering RNI given the absolute benefit demonstrated in multiple randomized trials.

Conclusion:
A systematic review and evidence-based summary of recommendations are provided in these consensus guidelines from the ARS Breast AUC Committee to provide current comprehensive guidance on the optimal management of non-metastatic breast cancer patients being considered for RNI.
A rare incidence of signet ring cell carcinoma of the rectosigmoid junction: a case report
Authors: Javed Hadiya , Tariq Hamna , Nasir Aleena , Amin Mohammed Hammad Jaber , Hasanain Muhammad 
Published: November 2024

Introduction and importance:
Signet ring cell carcinoma (SRCC) is a rare type of adenocarcinoma. SRCC comprises 1.0% of all colon cancer and 0.7% of all rectal cancer. The SRCC spreads both hematologically and through lymph nodes making it highly invasive. The pathophysiology of the colorectal SRCC involves an alteration in the function of the RNF43, CDH-1, and SMAD4 genes as well as TGF-B signaling pathways, which are responsible for epithelial-mesenchymal transitions and stem cell properties. This also shows a higher rate of BRAF mutation, microsatellite instability-high (MSI-H) and CpG island methylator phenotype positivity

Case presentation:
A 17-year-old female patient with no known comorbidities presented with copious, bright red colored per rectal bleeding along with painful defecation. Colonoscopy revealed an eccentric growth that led to luminal narrowing. Multiple biopsies confirmed a 4 cm × 6 cm neoplastic lesion with locoregional lymphadenopathy, but no metastasis. The patient underwent anterior resection of the rectum, colostomy, and rectal stump closure. The sigmoid colon was resected up to the middle up to the third mesorectum followed by multiple re-explorations.

Discussion:
SRCC presents at an advanced stage with a poor prognosis because signet ring cells infiltrate the mucosa without forming a significant mass, hindering early diagnosis of this carcinoma. Among the previously published large-scale studies, SRCC involves the proximal colon, i.e., the cecum, ascending, and transverse colon. However, our case presents a less common left-sided presentation in a less-commonly presented demographic, a 17-year-old girl. The patient’s non-specific symptoms contributed to a delayed diagnosis. Despite this, the absence of metastasis in our late-diagnosed case is atypical of SRCC.

Conclusion:
SRCC should be considered as a differential diagnosis for young adults presenting with per-rectal bleeding and other common symptoms often seen in frequently diagnosed conditions. Therefore, early diagnosis along with appropriate surgical intervention combined with supportive treatment are important for better patient outcomes.
Laparoscopic cholecystectomy in a patient with Kartagener syndrome having multiple cystic arteries: a case report
Authors: Sadek Anthony , Hojeij Moussa , Abou Sleiman Gaby 
Published: November 2024

Introduction and importance:
Situs inversus totalis (SIT) is a rare condition that involves transposition of thoracic and abdominal viscera. It is associated with Kartagener syndrome (KS) that comprises a triad of SIT, bronchiectasis, and chronic sinusitis. Considering this anatomical variation, it poses a technical challenge for right-handed surgeons performing laparoscopic cholecystectomy. This is the only case report for a patient having KS presenting for cholelithiasis found to have multiple cystic arteries during surgery.

Case presentation:
A 55-year-old man with KS, known to have bronchiectasis, presented with nonspecific diffuse upper abdominal pain and positive murphy sign on the left. Biliary colic with cholelithiasis was diagnosed using ultrasound of the abdomen. The patient was admitted to the surgical floor for persistent biliary colic and was planned for laparoscopic cholecystectomy. The cholecystectomy was done by a single right-handed surgeon, and the patient was discharged on the next day.

Clinical discussion:
The American laparoscopic cholecystectomy technique with reversed mirror-image of routine laparoscopic cholecystectomy port sites was adopted. The operative team including the operating surgeon and camera operator were on the patient’s right side, and the laparoscopic devices with the technician nurse were located on the left side for safer dissection and easier access to the different structures. The procedure was complicated by the Calot triangle anatomy variation along with the presence of three cystic arteries and one cystic duct. The surgery was completed within 50 minutes, a shorter duration compared to other reported cases.

Conclusion:
Laparoscopic cholecystectomy in patients with SIT is a challenging, technically demanding procedure due to anatomical inversion and structural variations. The surgeon must modify various technical steps to perform this procedure successfully and dissect the gallbladder and its structures. A good knowledge of anatomy and a skillful dissection intraoperatively remain the gold standards for a successful outcome with minimal complications.
Role of Mast Cell in Hyperalgesic Priming and the Preventive Effect of Electroacupuncture on the Transition from Acute to Chronic Pain
Authors: Ren Junhui , Li Na , Danning Xi , Wei Naixuan , Shao Xiaomei , Liu Boyi , Liang Yi , Du Junying , Jin Xiaomin , Fang Jianqiao , Fang Junfan 
Published: November 2024

Objective:
Injury can lead to long-term changes that increase the sensitivity of afferent nerve endings to subsequent stimulation and pain can transition from acute to chronic. This phenomenon is known as hyperalgesic priming (HP). This study aimed to understand the mechanisms underlying the effect of Electroacupuncture (EA) on HP and optimize acupoint selection for EA to prevent pain transition.

Methods:
A rat HP model was established using sequential intraplantar injections of carrageenan (Cg) and prostaglandin E2 (PGE2). The pain thresholds were measured using von Frey filaments. EA on bilateral Zusanli(ST36) and Kunlun(BL60) was used to prevent pain transition. The number of mast cells in the ipsilateral hindpaw skin was determined using toluidine blue or fluorescence-labeled avidin staining. The protein expression levels of protein kinase C (PKCε) in the lumbar dorsal root ganglions (DRGs) were detected by western blotting 24 h after PGE2 injection. Serial pharmacological experiments were conducted to evaluate the relationship between mast cells and pain transition. Finally, EA on the bilateral ST36 and Chongyang(ST42) or a novel combination (ST36 and ST42 on the ipsilateral side, and ST36 and BL60 on the contralateral side) was used to prevent pain transition.

Results:
Although EA applied to ST36 and BL60 alleviated acute pain induced by Cg injection, it failed to prevent the pain transition caused by PGE2 injection. Mast cell accumulation in the ipsilateral hind paw was observed 7 days after Cg injection. Furthermore, mast cell degranulation may be responsible for PKCε activation in the DRG, a marker of pain transition. EA significantly decreased the number of mast cells in the skin of the ipsilateral hind paw when applied at ST36 and ST42, but not when applied at ST36 and BL60. Furthermore, EA employed to ST36 and ST42 significantly reversed long-term hyperalgesia induced by PGE2 injection, even when administered before injection. However, EA did not alleviate acute pain caused by Cg injection. By using a novel acupoint combination, EA simultaneously alleviated acute pain and prevented pain transition.

Conclusions:
Our study suggests that mast cells play a critical role in both HP and the transition from acute to chronic pain, whereas EA can prevent pain transition by decreasing the number of mast cells in the local tissue.
Graphical abstract: http://links.lww.com/AHM/A144.
Multimodal Imaging Of Vitelliform Lesion In Macular Telangiectasia Type 2.
Authors: Pradhan Amrita , Jain Mukesh , Baliarsingh Ankeeta , Chowdhury Ruchira , Mandal Soumava , Ansari Imran , Sen Ahana , Majumdar Bristi , Chattree Surabhi , Saurabh Kumar , Roy Rupak 
Published: November 2024

Purpose:
To evaluate multimodal imaging of vitelliform lesions in macular telangiectasia type 2.

Method:
Color fundus picture (CFP), optical coherence tomography angiography (OCTA), fundus autofluorescence (FAF), and fundus fluorescein angiography (FFA).

Result:
Vitelliform lesions were found in two cases of macular telangiectasia type 2.

Conclusion:
Vitelliform deposits can be present in eyes with macular telangiectasia type 2. Fundus autofluorescence imaging is a highly sensitive modality for detecting vitelliform lesions.
Safety and efficacy of laser lithotripsy for treatment of bladder calculi: evidence from a systematic literature review
Authors: Akram Mahir , Cerrato Clara , Enikeev Dmitry , Tokas Theodoros , Somani Bhaskar K. 
Published: November 2024

Purpose of review
Bladder stones account for 5% of all urinary tract calculi. Contributing factors include bladder outflow obstruction, infections, foreign bodies, or neurogenic voiding dysfunction. This necessitates an effective treatment modality, and with advances in medical technology, minimally invasive techniques using lasers are being widely adopted. This systematic review aims to assess the efficacy and safety of laser lithotripsy for treating bladder stones.

Recent findings
A thorough literature review (PROSPERO: CRD 42024551910) was conducted using appropriate search terms up to March 2024. Only original studies written in English, with at least 10 patients with bladder stones treated with laser, were considered with inclusion. A total of 8 studies (411 patients) were identified on screening with a mean age of 59.6 ± 8.5 years and a male: female ratio of 326 : 14. These reviews covered a geographical area of Asia, Europe, and the USA. The mean stone size was 3.7 ± 0.7 cm, and an overall stone-free rate (SFR) postlaser lithotripsy was 96%. Mean operation time was calculated to be 76.36 ± 47.10 min and an overall complication rate of 16.5% (n = 68), with the most common being haematuria (n = 22), followed by UTI (n = 18), incontinence (n = 8), urosepsis (n = 6), clot retention (n = 4), mucosal injury (n = 3) and urinary retention (n = 3). All complications were minor and there were no Clavien >II complications.

Summary
Laser lithotripsy for bladder stone achieves an excellent success rate in the form of SFR, combined with a low risk of major complications, and allows concomitant treatment of enlarged prostate, and should be considered in all patients.
Recommendations for Specialty Palliative APRN Graduate Education
Authors: Dahlin Constance , Wholihan Dorothy , Wiencek Clareen , Acker Kristi A. , Breakwell Susan , Buschman Penelope , Cormack Carrie L. , DeSanto-Madaya Susan , Doherty Caroline , Edwards Rebecca , English Nancy , Fink Regina M. , Goodnough Ami K. , Lindell Kathleen , Mazanec Polly , McHugh Marlene E. , Moore Ellen P. , Obrecht Jennifer A. , Pawlow Patricia , Johnstone-Petty Marianne , Quinlin Linda , Tresgallo Mary E. 
Published: November 2024

Background:
Advanced practice registered nurses (APRNs) are essential to care for the growing number of individuals with advanced illness given the shortage of palliative care clinicians.

Problem:
Graduate education for specialty practice palliative APRNs lacks consistency in structure, content, and standardization of specialty palliative APRN education.

Approach:
A workgroup of expert palliative APRNs and graduate faculty conducted focused discussions and a literature review to develop consensus recommendations based on national palliative APRN competencies and aligned with the 8 core concepts of the AACN Essentials.

Outcome:
Recommendations include: (a) definition of core concepts; (b) associated skills; (c) andragogical approaches; (d) evaluation methods; and (e) references for curricular development.

Conclusion:

The Recommendations for Specialty Palliative APRN Education is a first step toward the standardization of quality advanced practice specialty palliative nursing education. These recommendations provide the foundation for a comprehensive curriculum for palliative APRNs.
Leveraging Virtual Containers for High-Powered, Collaborative AI Research in Radiology
Authors: Aronson Lucas , Garrett John , Wentland Andrew L. 
Published: November 2024

Abstract
Numerous obstacles confront radiologists interested in the use of artificial intelligence (AI) models within the field of radiology. For example, discrepancies between the radiologist's and an AI developer's hardware and software specifications pose a substantial hindrance to using AI models. Additionally, accessing and using GPU computers can lead to compatibility issues and add to these challenges. Finally, the dissemination of AI models and the ability to download preexisting AI models are not simple tasks due to the size and complexity of most programs. Virtual containers offer a solution to such compatibility issues and provide a simplified way for radiologists to use AI models. Virtual containers are software tools that bundle code, required programs, and necessary software packages to ensure that a program runs identically for all users, regardless of their computing environment. This article outlines the features of virtual containers (compatibility, versatility, and portability) and highlights an applied use case for virtual containers in the development of an AI model.
Risk Factors for Invasive Surgical Site Infections Among Adult Single Liver Transplant Recipients at Duke University Hospital in the Period 2015–2020
Authors: Carugati Manuela , Arif Sana , Yarrington Michael E. , King Lindsay Y. , Harris Matt , Evans Kyla , Barbas Andrew S. , Sudan Debra L. , Miller Rachel A. , Alexander Barbara D. 
Published: November 2024

Background.
Invasive primary surgical site infections (IP-SSI) are a severe complication of liver transplant surgery. Identification of risk factors for IP-SSI is critical to IP-SSI prevention.

Methods.
All adult single liver transplants performed at Duke University Hospital in the period 2015–2020 were reviewed for IP-SSI occurring within 90 d of transplant. Risks for IP-SSI were identified using least absolute shrinkage and selection operator variable selection procedure. A 2-sided P value of <0.05 was considered statistically significant.

Results.
IP-SSI were identified in 34/470 (7.2%) adult single liver transplants. Repeat transplantation, spilt liver, Roux-en-Y biliary anastomosis, anastomotic leak, and post-transplant renal replacement therapy were positively associated with IP-SSI. IP-SSI were associated with increased length of index transplant hospitalization (24.5 versus 10.0 d, P < 0.01) and 1-y all-cause mortality (14.7% versus 4.1%, P = 0.02). Gram positive bacteria were the main pathogens (51.7%), followed by Gram negative bacteria (24.1%) and Candida (24.1%). Multidrug resistance bacteria increased over time (27.3% in 2015 versus 66.7% in 2020, P = 0.17).

Conclusions.
In the setting of routine antimicrobial prophylaxis and an overall low rate of IP-SSI, surgical factors were the main determinants of IP-SSI among adult liver transplant recipients. IP-SSI had a negative impact on the length of index transplant hospitalization and 1-y mortality. While the surgical factors associated with an increased risk of IP-SSI are not easily modifiable, their impact may be best contained by close clinical monitoring and tailored antimicrobial therapy.
Dynamics of Ischemia/Reperfusion Injury Markers During Normothermic Liver Machine Perfusion
Authors: Caballero-Marcos Aránzazu , Rodríguez-Bachiller Luis , Baroja-Mazo Alberto , Morales Álvaro , Fernández-Cáceres Paloma , Fernández-Martínez María , DíazFontenla Fernando , Velasco Enrique , Fernández-Yunquera Ainhoa , Díaz-Zorita Benjamin , Cortese Sergio , Pérez-Peña José María , Colón-Rodríguez Arturo , Romero-Cristóbal Mario , Asencio José Manuel , Bañares Rafael , López-Baena José Ángel , Salcedo-Plaza Magdalena 
Published: November 2024

Background.
A comprehensive mechanistic assessment of normothermic machine perfusion (NMP) is an essential step toward identifying biomarkers to assess liver viability. Although some studies have evaluated the effect of NMP on inflammation markers, there are other key pathological mechanisms involved in ischemia/reperfusion injury (IRI) that have not yet been evaluated.

Methods.
Eight human donor livers preserved by NMP were included to analyze IRI during preservation. Concentrations of several biomarkers involved in different biological processes of IRI were measured in the perfusate.

Results.
Perfusate levels of intercellular adhesion molecule 1, P-selectin, vascular cell adhesion molecule 1, metalloproteinase with thrombospondin motif type 1, member 13, phospholipase A2 group VII, and syndecan-1 progressively increased during NMP. Noteworthy, perfusate lactate levels showed a strong correlation with C-X-C motif chemokine ligand 10 (P = 0.001), intercellular adhesion molecule 1 (P = 0.01), and urokinase plasminogen activator (P = 0.001).

Conclusions.
Perfusate lactate correlates with the main underlying biological mechanisms occurring in the NMP environment. Moreover, several IRI biomarkers accumulate during NMP, which may limit the extent of the benefits of this technology.