bluuebunny/crossref_metadata_2025_split huggingface dataset:
ОСОБЛИВОСТІ ВИБОРУ МЕТОДУ РЕКОНСТРУКЦІЇ ДЕФЕКТІВ М’ЯКИХ ТКАНИН ПРИ ПОРАНЕННЯХ НИЖНІХ КІНЦІВОК
Authors: ШАПРИНСЬКИЙ Є. В. , МИРГОРОДСЬКИЙ Д. В. 
Published: September 2024

Мета роботи: розробити підхід до вибору способу реконструкції дефектів м’яких тканин нижніх кінцівок, що виникли внаслідок їх травматичних ушкоджень.
Матеріали і методи. Були досліджені результати лікування 52 хворих, які перебували на стаціонарному лікуванні у Клінічному високоспеціалізованому хірургічному Центрі з малоінвазивними технологіями КНП “ВОКЛ імені М. І. Пирогова” з дефектами м’яких тканин нижніх кінцівок, отриманими внаслідок бойової травми кінцівок за період 2022–2024 роки. Причинами їх були вибухова травма з осколковим пораненням у 47 хворих, кульове поранення – в 5 хворих. Ізольоване поранення кінцівок спостерігалось у 18 (34,62 %) випадках, у 34 (65,38 %) – поєднані ушкодження: з органами черевної та грудної порожнин – у 28 (53,84 %), голови – в 3 (5,77 %), пошкодженнями таза та органів порожнини малого таза – в 3 (5,77 %) хворих. Залежно від розмірів, об’єму дефектів м’яких тканин, локалізації, видів ушкоджень тканин та їх глибини хворі були поділені на чотири групи.
Результати. Хворим першої групи (18 осіб) з малими та середніми неглибокими дефектами м’яких тканин нижніх кінцівок їх закриття виконували власними тканинами, використовуючи шви дерматотензії. При підготовці дефектів м’яких тканин до їх закриття проводили етапні повторні (вторинні) хірургічні обробки з використанням фізичних методів та вакуумної терапії.
Хворим другої групи (15 осіб) з великими та обширними але неглибокими дефектами м’яких тканин проводили автодермо­пластику вільним розщепленим клаптем за методикою Тірша. У трьох (5,77 %) випадках спостерігали частковий некроз автодермотрансплантата.
У третій групі хворих (14 осіб) з великими та обширними глибокими дефектами м’яких тканин нижніх кінцівок нижче рівня глибокої фасції використовували різні варіанти пластики складними клаптями після відповідної їх підготовки. У 10 хворих виконана пластика з використанням ковзаючих клаптів (V та Y-пластики), у 2 – транспозиційних (Z-пластика) та у 2 – ротаційних (пропелерна пластика). У 2 (3,85 %) випадках у післяопераційному періоді спостерігався ішемічний крайовий некроз після проведеної V-подібної пластики.
Хворим четвертої групи (5 осіб) з великими і обширними дефектами м’яких тканин нижніх кінцівок з ушкодженнями глибоко розміщених структур лікування вимагало мультидисциплінарного підходу. Після відповідної підготовки дефекту до закриття було виконано 5 реконструкцій ротаційними “пропелерними” клаптями на судинній ніжці. В післяопераційному періоді спостерігався один випадок (1,92 %) крайового некрозу внаслідок ішемії автодермотрансплантата.
Отже, запропонований підхід з поділом хворих на групи залежно від розмірів дефектів, їх глибини, видів ушкоджень тканин дозволяє оптимізувати вибір способу закриття дефектів та отримати задовільні результати лікування у 88,46 % хворих.
Role of Cholesterol Metabolic Enzyme CYP46A1 and Its Metabolite 24S-Hydroxycholesterol in Ischemic Stroke
Authors: Sun Huawei , Yang Tao , Simon Roger P. , Xiong Zhi-gang , Leng Tiandong 
Published: September 2024

BACKGROUND:

For several decades, it has been recognized that overactivation of the glutamate-gated N-methyl-D-aspartate receptors (NMDARs) and subsequent Ca
2+
toxicity play a critical role in ischemic brain injury. 24S-hydroxycholesterol (24S-HC) is a major cholesterol metabolite in the brain, which has been identified as a potent positive allosteric modulator of NMDAR in rat hippocampal neurons. We hypothesize that 24S-HC worsens ischemic brain injury via its potentiation of the NMDAR, and reducing the production of 24S-HC by targeting its synthetic enzyme CYP46A1 provides neuroprotection.

METHODS:
We tested this hypothesis using electrophysiological, pharmacological, and transgenic approaches and in vitro and in vivo cerebral ischemia models.

RESULTS:

Our data show that 24S-HC potentiates NMDAR activation in primary cultured mouse cortical neurons in a concentration-dependent manner. At 10 µmol/L, it dramatically increases the steady-state currents by 51% and slightly increases the peak currents by 20%. Furthermore, 24S-HC increases NMDA and oxygen-glucose deprivation–induced cortical neuronal injury. The increased neuronal injury is largely abolished by NMDAR channel blocker MK-801, suggesting an NMDAR-dependent mechanism. Pharmacological inhibition of CYP46A1 by voriconazole or gene knockout of
Cyp46a1
dramatically reduces ischemic brain injury.

CONCLUSIONS:
These results identify a new mechanism and signaling cascade that critically impacts stroke outcome: CYP46A1 → 24S-HC → NMDAR → ischemic brain injury. They offer proof of principle for further development of new strategies for stroke intervention by targeting CYP46A1 or its metabolite 24S-HC.
Time-Dependent Potentiation of the PERK Branch of UPR by GPR68 Offers Protection in Brain Ischemia
Authors: Sun Wenyan , Tiwari Virendra , Davis Grace , Zhou Guokun , Jonchhe Sarun , Zha Xiangming 
Published: September 2024

BACKGROUND:
In ischemia, acidosis occurs in/around injured tissue and parallels disease progression. Therefore, targeting an acid-sensitive receptor offers unique advantages in achieving the spatial and temporal specificity required for therapeutic interventions. We previously demonstrated that increased expression of GPR68 (G protein-coupled receptor 68), a proton-sensitive G protein-coupled receptor, mitigates ischemic brain injury. Here, we investigated the mechanism underlying GPR68-dependent protection.

METHODS:
We performed biochemical and molecular analyses to examine poststroke signaling. We used in vitro brain slice cultures and in vivo mouse transient middle cerebral artery occlusion (tMCAO) models to investigate ischemia-induced injuries.

RESULTS:
GPR68 deletion reduced PERK (protein kinase R-like ER kinase) expression in mouse brain. Compared with the wild-type mice, the GPR68-/- (knockout) mice exhibited a faster decline in eIF2α (eukaryotic initiation factor-2α) phosphorylation after tMCAO. Ogerin, a positive modulator of GPR68, stimulated eIF2α phosphorylation at 3 to 6 hours after tMCAO, primarily in the ipsilateral brain tissue. Consistent with the changes in eIF2α phosphorylation, Ogerin enhanced tMCAO-induced reduction in protein synthesis in ipsilateral brain tissue. In organotypic cortical slices, Ogerin reduced pH 6 and oxygen-glucose deprivation–induced neurotoxicity. Following tMCAO, intravenous delivery of Ogerin reduced brain infarction in wild-type but not knockout mice. Coapplication of a PERK inhibitor abolished Ogerin-induced protection. Delayed Ogerin delivery at 5 hours after tMCAO remained protective, and Ogerin has a similar protective effect in females. Correlated with these findings, tMCAO induced GPR68 expression at 6 hours, and Ogerin alters post-tMCAO proinflammatory/anti-inflammatory cytokine/chemokine expression profile.

CONCLUSIONS:
These data demonstrate that GPR68 potentiation leads to neuroprotection, at least in part, through enhancing PERK-eIF2α activation in ischemic tissue but has little impact on healthy tissue.
Selective Access to Decision Support as a Function of Event Uncertainty
Authors: Ben Yaakov Yoav , McCarley Jason S. , Meyer Joachim 
Published: September 2024

Objective We investigate the impact of event uncertainty, decision support (DS) display format, and DS sensitivity on participants’ behavior, performance, subjective workload, and perception of DS usefulness and performance in a classification task. Background DS systems can positively and negatively affect decision accuracy, performance time, and workload. The ability to access DS selectively, based on informational needs, might improve DS effectiveness. Method Participants performed a sensory classification task in which they were allowed to request DS on a trial-by-trial basis. DS was presented in separated-binary (SB), separated-likelihood (SL), or integrated-likelihood (IL) formats. Access preferences, task performance, performance time, subjective workload, and perceived DS usefulness and performance were recorded. Results Participants accessed DS more often when it was highly sensitive, stimulus information was highly uncertain, or the DS cue and stimulus information were perceptually integrated. Effective sensitivity was highest with the integrated likelihood DS. Although the separated likelihood DS provided more information than the binary likelihood DS, it was accessed less often, leading to lower sensitivity. Conclusion Participants are most likely to access DS when raw stimulus information is highly uncertain and appear to make effective use of likelihood DS only when DS cues are integrated with raw stimulus information within a display. Application Results suggest that DS use will be most effective when likelihood DS cues and raw stimulus information are perceptually integrated. When DS cues and raw stimuli cannot be perceptually integrated, binary cues from the DS will be more effective than likelihood cues.
Impact of Pharmacist Intervention on Inappropriate Continuations of Antipsychotics upon ICU Discharge
Authors: Dickman Lauren T. , Bauman Kelsey , Carter Christopher K. , Buchanan Paula M. 
Published: September 2024

Background: Transitions of care (TOC) are important to best practices as they are at times prone to medication errors. The intensive care unit (ICU) is an essential location needing effective TOC due to many reasons, but an important one being that certain medications are only indicated there. One example is antipsychotics used for agitation, delirium, and sedation. Objective: To design, implement, and analyze the benefit of a pharmacist intervention on inappropriate antipsychotic continuation from the ICU to another point in care at a small community hospital. Secondary outcomes include patients discharged from the hospital on antipsychotics inappropriately and accepted pharmacist interventions. Methods: This standard of care, prospective with historical control study included adult patients who were ordered a formulary antipsychotic for delirium, agitation, or sedation during their ICU-level of care admission at SSM Health: St. Clare Hospital- Fenton. Results: There were 33 patients in the historical period and 24 in the intervention period. Those in the intervention period were less likely to have a continuation of antipsychotics beyond 72 hours compared to patients in the historical period (16.7% vs 57.6%, P = 0.002). In addition, patients in the intervention period were less likely to have continuation of antipsychotics when discharged to home (12.5% vs 36.4%, P = 0.04). Conclusions: A pharmacist-driven intervention led to a significant decrease in patients continuing antipsychotics upon ICU discharge. This decrease was seen at both 72 hours from patients leaving the ICU and at hospital discharge.
Assessment of Changes in Vascular Density in the Layers of the Eye in Patients With Parkinson’s Disease
Authors: Bilgin Şule , Uysal Hasan Armağan , Bilgin Sinan , Yaka Emiş Cansu , Küsbeci Özge Yılmaz , Şener Ufuk 
Published: September 2024

Background The retina is affected by Parkinson’s disease (PD). Purpose We aimed to assess the anatomical and vascular deterioration of the retina in PD. Methods Sixty-six patients with PD and 66 healthy volunteers were evaluated in this study. Choriocapillaris vessel density (CCVD), superficial vascular density (SVD), deep vascular densities (DVD), central macular thickness (CMT), retinal nerve fibre layer (RNFL), ganglionic cell layer (GCL), and choroidal thickness (CT) were assessed. Results RNFL, GCL, CMT, and CT were thinner than in HC, and also the differences between the groups were statistically significant ( P < .05). SVD and DVD were not statistically different between the groups ( P > .05). There was a decrease in vascular density in all quadrants of the choriocapillary layer. The decrease in vascular density was statistically significant in the nasal, inferior and central quadrants ( P < .05). Conclusion These results supported vascular thinning in the choroidal layer. Also showed that vascular and neural layers were affected together. It could help clinicians in the follow-up of Parkinson’s patients.
A Multi-Institutional Natural Language Processing Pipeline to Extract Performance Status From Electronic Health Records
Authors: Maghsoudi Arash , Sada Yvonne H. , Nowakowski Sara , Guffey Danielle , Zhu Huili , Yarlagadda Sudha R. , Li Ang , Razjouyan Javad 
Published: September 2024

Purpose Performance status (PS), an essential indicator of patients’ functional abilities, is often documented in clinical notes of patients with cancer. The use of natural language processing (NLP) in extracting PS from electronic medical records (EMRs) has shown promise in enhancing clinical decision-making, patient monitoring, and research studies. We designed and validated a multi-institute NLP pipeline to automatically extract performance status from free-text patient notes. Patients and Methods We collected data from 19,481 patients in Harris Health System (HHS) and 333,862 patients from veteran affair’s corporate data warehouse (VA-CDW) and randomly selected 400 patients from each data source to train and validate (50%) and test (50%) the proposed pipeline. We designed an NLP pipeline using an expert-derived rule-based approach in conjunction with extensive post-processing to solidify its proficiency. To demonstrate the pipeline’s application, we tested the compliance of PS documentation suggested by the American Society of Clinical Oncology (ASCO) Quality Metric and investigated the potential disparity in PS reporting for stage IV non-small cell lung cancer (NSCLC). We used a logistic regression test, considering patients in terms of race/ethnicity, conversing language, marital status, and gender. Results The test results on the HHS cohort showed 92% accuracy, and on VA data demonstrated 98.5% accuracy. For stage IV NSCLC patients, the proposed pipeline achieved an accuracy of 98.5%. Furthermore, our analysis revealed a documentation rate of over 85% for PS among NSCLC patients, surpassing the ASCO Quality Metrics. No disparities were observed in the documentation of PS. Conclusion Our proposed NLP pipeline shows promising results in extracting PS from free-text notes from various health institutions. It may be used in longitudinal cancer data registries.
Successful desensitization to etoposide in a patient after cardiac arrest
Authors: Pérez-Codesido S. , Azzi Virgini V. , Fertani S. , Jandus P. 
Published: September 2024

Introduction Etoposide phosphate is a chemotherapeutic agent used to treat various malignant neoplasms. Hypersensitivity reactions may occur with its use, and in rare cases, an anaphylactic reaction can manifest. Available options for patients experiencing hypersensitivity reactions include premedication, changing treatment, or undergoing desensitization. Various pediatric desensitization protocols have been described, ranging from six to fifteen steps, while published adult cases are rare. Case Report We report the case of a 61-year-old woman with small-cell lung cancer and brain metastases. In November 2019, she underwent the second cycle of cisplatin and etoposide phosphate treatment. While receiving etoposide phosphate, she experienced dyspnea and suffered a cardiorespiratory arrest, leading to cardiopulmonary resuscitation and subsequent admission to the Intensive Care Unit. Her acute tryptase levels were notably elevated at 18 µg/L (compared to a baseline tryptase level of 6,6 µg/L) during the reaction. Case Management We implemented a 16-step desensitization protocol (without premedication) under close monitoring in an intermediate care unit. The protocol was successfully executed over three cycles until tumor progression mandated a modification in systemic treatment. Discussion To our knowledge, this is the first documented case of successful desensitization to etoposide phosphate in a patient who experienced cardiac arrest during a hypersensitivity reaction. Although protocols of varying lengths have been published, we emphasize the importance of individualizing each protocol to fit the severity of the reaction and the resources and experience of each unit.
Assessment of drug-drug interactions among patients with hematologic malignancy: A clinical pharmacist-led study
Authors: Zarrabi Sogol , Hosseini Elham , Sadeghi Kourosh , Vaezi Mohammad , Shahrami Bita 
Published: September 2024

Introduction Patients with hematologic malignancies often receive multiple medications, leading to potential drug-drug interactions (DDIs). Identifying and managing these DDIs is crucial for ensuring patient safety and effective care. This study aimed to identify and describe DDIs and associated factors in hematologic malignancy patients. Methods This prospective interventional study was conducted at a referral center and included hospitalized patients with hematologic malignancies who were receiving at least four concurrent medications. A pharmacist initially compiled a comprehensive list of all medications through patient interviews and medication reviews, and subsequently, identified and categorized potential DDIs using the Lexi-interact® and Micromedex® databases. The clinical pharmacist then evaluated the clinical impact of the identified DDIs in every individual patient and provided appropriate interventions to resolve them. Results A total of 200 patients met the inclusion criteria for the study, with 1281 DDIs identified across 337 distinct types. The majority of identified DDIs exhibited major severity (52.1%) and pharmacokinetic mechanisms (50.3%), with an unspecified onset (79.4%) and fair evidence (67%). Of the identified DDIs, 81.1% were considered clinically significant, prompting 1059 pharmacotherapy interventions by the clinical pharmacist. Additionally, a significant relationship was observed between the number of drugs used during hospitalization and the occurrence of DDIs (P < 0.001, r = 0.633). Conclusion DDIs are highly prevalent among hospitalized patients with hematologic malignancies, with their occurrence increasing alongside the number of medications administrated. The intervention of a clinical pharmacist is crucial to evaluate the clinical impact of these DDIs and implement effective interventions for their management.
Analyzing Risk Factors for Delayed Extubation Following Posterior Approach Surgery for Congenital Scoliosis: A Retrospective Cohort Study
Authors: Cui Jian , Zhang Jingjing , Li Wenzhe , Liu Wei , Wang Yixi , Xu Tao , Wang Yi , Yu Xiangyou 
Published: September 2024

Study Design Retrospective cohort study. Objectives Investigate the risk factors for delayed extubation after posterior approach orthopedic surgery in patients with congenital scoliosis. Methods The clinical data of patients who received surgery for congenital scoliosis at the First Affiliated Hospital of Xinjiang Medical University between January 2021 and July 2023 have been gathered. Patients are categorized into the usual and the delayed extubation groups, depending on the duration of tracheal intubation after surgery. The study employs univariate and multivariate logistic regression models to examine the clinical characteristics of the two cohorts and discover potential risk factors linked to delayed extubation. In addition, a prediction model is created to visually depict the significance of each risk factor in terms of weight according to the nomogram. Results A total of 119 patients (74.8% females), with a median age of 15 years, are included. A total of 32 patients, accounting for 26.9% of the sample, encountered delayed extubation. Additionally, 13 patients (10.9%) suffered perioperative complications, with pneumonia being the most prevalent. The multivariate regression analysis revealed that the number of osteotomy segments, postoperative hematocrit, postoperative Interleukin-6 levels, and weight are predictive risk factors for delayed extubation. Conclusions Postoperative hematocrit and Interleukin-6 level, weight, and number of osteotomy segments can serve as independent risk factors for predicting delayed extubation, with combined value to assist clinicians in evaluating the risk of delayed extubation of postoperative congenital scoliosis patients, improving the success rate of extubation, and reducing postoperative treatment time in the intensive care unit.
Revision shoulder arthroplasty and proximal humeral bone loss: a comprehensive review and proposal of a new algorithm of management
Authors: Baldari Angelo , Saccone Luca , Caldaria Antonio , de Sanctis Edoardo Giovannetti , De Angelis D’Ossat Gian Mauro , La Verde Luca , Palumbo Alessio , Franceschi Francesco 
Published: September 2024

AbstractWith the rising prevalence of shoulder arthroplasty, the incidence of revision shoulder arthroplasty is also increasing. The complexity of these revision procedures poses significant challenges, with bone loss being a critical factor impacting treatment outcomes. Addressing substantial humeral bone defects is crucial for ensuring implant stability and functionality. A comprehensive literature review was conducted using PubMed, Medline, and Google Scholar to identify existing classification systems for proximal humeral bone loss in the context of revision shoulder arthroplasty. The study assessed the advantages and limitations of these classifications, using this information to propose a new diagnostic and therapeutic algorithm. Several classification systems for proximal humeral bone loss were identified. McLendon et al. classify proximal humeral bone loss based on a 5-cm bone loss threshold and suggest an allograft prosthesis composite for losses exceeding this limit. Boileau’s system stratifies bone loss into four types based on the extent of loss, with specific recommendations for each category. The PHAROS classification provides a detailed anatomical assessment but lacks quantitative precision. The proposed PHBL-SCORe system offers a novel algorithm incorporating preoperative radiographic measurements to determine the percentage of bone loss and guide treatment options. Proximal humeral bone loss presents significant challenges in revision shoulder arthroplasty, necessitating precise preoperative planning and classification to guide surgical intervention. Existing classification systems provide valuable frameworks but often rely on average population values, neglecting individual anatomical variations. The proposed PHBL-SCORe system offers a patient-specific approach, improving the accuracy of bone loss assessment and optimizing treatment strategies. Implementing this classification in clinical practice could enhance surgical outcomes and reduce complications associated with rRSA (revision Reverse Shoulder arthroplasty). Further studies are required to validate this algorithm and explore its long-term efficacy in diverse patient populations.