bluuebunny/crossref_metadata_2025_split huggingface dataset:
Getting Tacrolimus Dosing Right
Authors: Marquet Pierre 
Published: October 2024

Abstract:
Tacrolimus (TAC) dosing is typically guided by the trough concentration (C0). Yet, significant relationships between TAC C0 and clinical outcomes have seldom been reported or only with adverse events. Large retrospective studies found a moderate correlation between TAC C0 and the area under the curve (AUC), where, for any given C0 value, the AUC varied 3- to 4-fold between patients (and vice versa). However, no randomized controlled trial evaluating the dose adjustment based on TAC AUC has been conducted yet. A few observational studies have shown that the AUC is associated with efficacy and, to a lesser extent, adverse effects. Other studies showed the feasibility of reaching predefined target ranges and reducing underexposure and overexposure. TAC AUC0–12 h is now most often assessed using Bayesian estimation, but machine learning is a promising approach. Microsampling devices are well accepted by patients and represent a valuable alternative to venous blood sample collection during hospital visits, especially when a limited sampling strategy is required. As AUC monitoring cannot be proposed very frequently, C0 monitoring has to be used in the interim, which has led to fluctuating doses in patients with an AUC/C0 ratio far from the population mean, because of different dose recommendations between the 2 biomarkers. We proposed estimating the individual AUC/C0 ratio and derived individual C0 targets to be used in between or as a replacement for AUC monitoring. Existing technology and evidence are now sufficient to propose AUC monitoring interspersed with individualized-C0 monitoring for all patients with kidney transplants while collecting real-world data to strengthen the evidence.
Implementing an Updated Alcohol Withdrawal Symptom Management Order Set Focused on Patient Safety
Authors: Lorbiecki Meghan , Gidal Alexander , Hagle Mary , Smith Tina , Ragen-Pease Kelly , Peterson Kyle , Matye Michael , Kowol Mary-Anne , Lampe Elise 
Published: October 2024

Abstract

Background
Patients experiencing alcohol withdrawal often receive care on inpatient mental health units. Registered nurses on one such unit had several concerns and questions about the existing alcohol withdrawal symptom management order set. To address these issues, a multidisciplinary team including nurses, psychiatrists, and pharmacists was formed.

Objectives
The aims for this project were to review and revise the existing order set, educate staff, implement the changes, and evaluate outcomes.

Methods
The Plan–Do–Study–Act quality improvement framework guided the project. Five phases were completed to revise the order set and implement: a survey of nurses on the unit, community practice evaluation, and order set revisions. A simulation escape room facilitated nursing education. Patient records were reviewed to identify adverse events.

Results
Diazepam replaced lorazepam as the primary medication choice, and a front-loading protocol was added. Order set clarity was improved, education increased nursing staff confidence to competently complete a patient assessment with the Clinical Institute Withdrawal Assessment Alcohol Scale Revised, and no adverse patient events occurred after implementation.

Conclusion
A revised order set for symptom management of patients experiencing alcohol withdrawal reflected up-to-date evidence while maintaining patient safety. All nurses agreed the revised order set was clear and easy to follow; pharmacists and physicians were satisfied with the revisions. Implications for leaders include having a multidisciplinary team, sufficient resources to answer clinical questions, and regular discussions by all involved disciplines to review any adverse events as well as newly published evidence. Close monitoring of patients early in implementation is recommended to detect adverse events.
Barriers and Facilitators to Recruitment of a Multifaceted Population of Opioid Use Disorder Community Stakeholders
Authors: Avery-Desmarais Shannon , Schuler Monika , Viveiros Jennifer , McCurry Mary , Tyo Mirinda , Kauranen Brianna 
Published: October 2024

Abstract

Background
Opioid use disorder (OUD) research is essential to inform evidence-based responses to the OUD crisis in the United States. Individuals with OUD, their caregivers, and support group leaders are historically difficult to recruit for research studies. The purpose of this study was to describe barriers and facilitators in recruitment during the implementation of a qualitative study that sought to explore stigma, barriers, and facilitators to healthcare.

Method
Researchers engaged in the original study completed a retrospective reflection of their experience recruiting members of the OUD community. Recruitment data were analyzed thematically, and facilitators and barriers for recruitment were identified.

Results
Three key barriers to recruitment were identified: choice of community partners, access to technology, and impractical incentives. One key facilitator to recruitment was identified: being patient yet persistent and flexible.

Conclusion
Investigators must design research studies mindful of avoiding societal privilege and cognizant of the lens of the individual living with OUD.
Increased Uptake of 68Ga-DOTA-IBA in Multiple Subcutaneous Metastases of Prostate Cancer
Authors: Liu Huipan , Liu Yuhong , Wang Wei , Shang Xiaoyan , Chen Yue 
Published: October 2024

Abstract
Subcutaneous metastases are rare in prostate cancer. Herein, we present a case of a 66-year-old man with prostate cancer, who underwent 68Ga-labeled DOTA-ibandronic acid (68Ga-DOTA-IBA) PET/CT to explore the possibility of 177Lu-DOTA-IBA treatment. 68Ga-DOTA-IBA PET/CT demonstrated intensely increased uptake in the multiple osteoblastic bone metastases. Unexpectedly, 68Ga-DOTA-IBA uptake in multiple subcutaneous metastases was also noted.
Specifically Decreased Thalamic Blood Flow Following COVID-19 Infection
Authors: Matsubayashi Taiki , Yokoyama Kota , Tateishi Ukihide , Yokota Takanori , Sanjo Nobuo 
Published: October 2024

Abstract
Although long COVID refers to numerous COVID-19–related symptoms after infection, including depression, fatigue, anosmia, sleep disturbances, and brain fog, the etiology of long COVID remains largely unknown. A 41-year-old woman presented with a 3-week history of complete insomnia without drowsiness throughout the day after contracting COVID-19. SPECT using N-isopropyl-p-[123I] iodoamphetamine showed a significant regional cerebral blood flow reduction in the bilateral thalamus. We diagnosed her as having insomnia accompanied by thalamic hypoperfusion related to COVID-19 infection. To our knowledge, this is the first case of reduced regional cerebral blood flow specifically confined to the thalamus.
Lymphedema
Authors: Chaker Sara C. , James Andrew J. , King Daniella , Karagoz Huseyin 
Published: October 2024

Abstract
Lymphedema (LE) is characterized by the accumulation of lymph in the extremities, impairing functionality and quality of life. Despite its prevalence, accurate diagnoses and management remains complex because of inconsistencies in diagnostic criteria and limited epidemiological studies. This review aims to address this gap by providing a comprehensive overview of LE classifications, diagnostic approaches, and current management strategies. By synthesizing existing knowledge, this study seeks to contribute to a deeper understanding of LE for improvement of clinical consistency and education.
Choke Anastomosis
Authors: Cao Zilong , Jiao Hu , Gan Cheng , Zhang Tiran , Tian Jia , Li Rui , Yue Qiang , Yin Ningbei , Liu Liqiang 
Published: October 2024

Background
Choke anastomosis is commonly recognized as a resistance factor that detrimentally affects the hemodynamics of the skin flap; however, its additional potential physiological roles in normal skin function are currently not fully understood.

Methods
Ten cadaveric forehead flap specimens pedicled with unilateral STAs were perfused with lead oxide-gelatin mixture, and then dissected into 3 layers, including the super temporal fascia-frontalis-galea aponeurotica layer, the subcutaneous adipose tissue layer, and the “super-thin flap” layer. The forehead flap and stratified specimens underwent molybdenum target x-ray and subsequent transparent processing to effectively visualize the microscopic spatial architecture of arterial vessels across all levels.

Results
Based on the different anastomoses near the midline area of the flap, 2 types of arterial perfusion were identified: choke anastomosis type (8/10) and true anastomosis type (2/10). The former formed multiple choke anastomoses near the midline. In the “super-thin flap” layer, arterial perfusion density on the ipsilateral side was significantly higher compared to that on the contralateral side. The arterioles on the ipsilateral side exhibited a dense and uninterrupted distribution, whereas those on the contralateral side appeared sparse and dispersed. The latter exhibited an alternative perfusion pattern; the bilateral arterial vessels were connected with 3 to 5 true anastomoses near the midline. Furthermore, the microscopic architecture confirmed a uniform distribution of arterioles that remained continuous from ipsilateral to contralateral sides in the “super-thin flap” layer.

Conclusion
This study demonstrated that choke anastomosis not only impairs blood perfusion in the adjacent angiosomes but also acts as a shunt converter to impact the blood supply of distal skin flaps at different levels through the “trans-territory diversion phenomenon.” This results in necrosis of the superficial dermis while preserving survival of the deep subcutaneous adipose tissue.
Relationship Between Dysbiotic Wound Microbiota and Critical Colonization
Authors: Kunimitsu Mao , Minematsu Takeo , Koudounas Sofoklis , Sanada Hiromi , Nakagami Gojiro 
Published: October 2024

Introduction
Detection of critical colonization is gaining importance in wound management, but its pathophysiology remains unclear. We previously clarified that a dysbiotic wound microbiota differing from skin commensal microbiota may be involved in critical colonization and that such wounds contain fewer Forkhead box protein P3 (FOXP3)–positive cells in the tissue. However, it is not clear whether FOXP3-positive cells contribute to the development of critical colonization. Here, we examined whether inhibition of FOXP3-positive cell could induce critical colonization when the commensal microbiota was present in the wounds.

Methods
Sprague-Dawley rats were administered FK506 or vehicle to inhibit differentiation into FOXP3-positive cells. Full-thickness wounds were made on the dorsal skin and inoculated with bacterial solution (dysbiosis group) or Luria-Bertani medium (commensal group). A bacterial solution was prepared by anaerobically culturing bacteria from the skin of donor rats on an artificial dermis in Luria-Bertani medium for 72 hours. Tissues were collected on day 4 postwounding for histological evaluation.

Results
After microbiota transplantation, excessive inflammation occurred in the FK506 + commensal group. In contrast, wounds with transplanted dysbiotic microbiota showed the same level of neutrophil infiltration, regardless of FK506 administration. Furthermore, the wound area was larger in the FK506 + commensal group than in the vehicle + commensal group on day 4 postwounding (P = 0.01). This area was also significantly larger in both the vehicle + dysbiosis (P = 0.01) and FK506 + dysbiosis groups (P = 0.03) than in the vehicle + commensal group.

Conclusions
This study has shown that dysbiosis may be at least related to developing critical colonization, and the results suggest that FOXP3-positive cells are involved in this process. Our study may contribute to establishing new interventions that prevent critical colonization by correcting wound microbiota.
Hypoxia and Normoxia Preconditioned Olfactory Stem Cells Against Noise-Induced Hearing Loss
Authors: Durna Yusuf M. , Yigit Ozgur , Edizer Deniz T. , Durna Daştan Sevgi , Gul Mehmet , Ovali Ercument 
Published: October 2024

Objective:
Noise-induced hearing loss is one of the leading causes of permanent hearing loss in the adult population. In this experimental study, the authors aimed to investigate the effectiveness of hypoxia and normoxia preconditioned olfactory stem cells against noise trauma.

Methods:
Twenty-seven female guinea pigs were enrolled. Two guinea pigs were sacrificed for harvesting olfactory tissue and 1 for examining the architecture of the normal cochlea. The remaining 24 guinea pigs were exposed to noise trauma for 1 day and then randomly divided into 3 groups: intracochlear injection of (i) normoxic olfactory stem cells, (ii) hypoxic olfactory stem cells, and (iii) physiological serum. Auditory brainstem response (ABR) measurement was performed before and 2 weeks after noise trauma and weekly for 3 weeks following intracochlear injection. Both click and 16 kHz tone-burst stimuli were used for detection of ABR.

Results:
No significant difference was noted between the groups before and 2 weeks after noise trauma. ABR thresholds detected after intracochlear injections were significantly higher in the control group compared with stem cell groups. However, no significant difference was detected between the stem cell groups. Fluourescence microscopy revealed better engraftment for hypoxic stem cells. Light and electron microscopy examinations were consistent with predominant degenerative findings in the control group, whereas normoxic group had more similar findings with normal cochlea compared with hypoxic group.

Conclusion:
Olfactory stem cells were demonstrated to have the potential to have beneficial effects on noise trauma.
In-Person Healthcare Simulation
Authors: Palaganas Janice C. , Mosher Cynthia , Wawersik Dawn , Eller Susan , Kirkpatrick Amanda J. , Lazarovici Marc , Brown Kristen M. , Stapleton Stephanie , Hughes Patrick G. , Tarbet Amanda , Morton Alex , Duff Jonathan P. , Gross Isabel T. , Sanko Jill 
Published: October 2024

Summary Statement
Given the large accumulation of research focused on the effectiveness of in-person simulation-based education (SBE), this umbrella review—or systematic review of systematic reviews—was conducted using Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines to analyze collective findings and close identified literature gaps. This study presents a descriptive analysis of the most effective modalities, methods, and measurements of in-person SBE, as well as major themes that emerged during analysis as it relates to SBE outcomes.
The major patterns or themes that emerged confirm for the first time a longstanding sentiment in the literature, specifically the following: a need to produce higher-quality research with greater rigor, larger sample sizes, more randomized controlled trials, mixed methods, and longitudinal studies. These findings suggest a need to redirect scientific efforts in SBE. Despite the nearly ubiquitous issues noted across the systematic reviews' findings, results of this umbrella review seem to support the notion that in-person simulation-based education improves learning outcomes including technical and nontechnical skills and behavioral and attitudinal change. Analyses highlighted the need to improve overall research approaches and reduce redundancy, as well as the need to standardize terminology, broaden global diversity, and push for further research funding opportunities to support these efforts.
Classifying High-Frequency Oscillations by Morphologic Contrast to Background, With Surgical Outcome Correlates
Authors: Qing Kurt , Von Stein Erica , Yamada Lisa , Fogarty Adam , Nuyujukian Paul 
Published: October 2024

Purpose:
Ictal high-frequency oscillations (HFOs) are a reliable indicator of a seizure onset zone for intracranial EEG recordings. Interictal HFOs often are also observed and may be a useful biomarker to supplement ictal data, but distinguishing pathologic from physiologic HFOs continues to be a challenging task. We present a method of classifying HFOs based on morphologic contrast to the background.

Methods:
We retrospectively screened 31 consecutive patients who underwent intracranial recordings for epilepsy at Stanford Medical Center during a 2-year period, and 13 patients met the criteria for inclusion. Interictal EEG data were analyzed using an automated event detector followed by morphologic feature extraction and k-means clustering. Instead of only using event features, the algorithm also incorporated features of the background adjacent to the events. High-frequency oscillations with higher morphologic contrast to the background were labeled as pathologic, and “hotspots” with the most active pathologic HFOs were identified and compared with clinically determined seizure onset zones.

Results:
Clustering with contrast features produced groups with better separation and more consistent boundaries. Eleven of the 13 patients proceeded to surgery, and patients whose hotspots matched seizure onset zones had better outcomes, with 4 out of 5 “match” patients having no disabling seizures at 1+ year postoperatively (Engel I or International League Against Epilepsy Class 1–2), while all “mismatch” patients continued to have disabling seizures (Fisher exact test P-value = 0.015).

Conclusions:
High-frequency oscillations with higher contrast to background more likely represent paroxysmal bursts of pathologic activity. Patients with HFO hotspots outside of identified seizure onset zones may not respond as well to surgery.
Change in Social Participation of Adults with Spinal Cord Injury During the First Two Waves of the COVID-19 Pandemic in Canada
Authors: Fortin-Bédard Noémie , Nindorera Félix , Leblond Jean , Rahn Caroline , Best Krista L. , Borisoff Jaimie , Sweet Shane N. , Arbour-Nicitopoulos Kelly P. , Routhier François 
Published: October 2024

AbstractIntroductionThe change in environmental and social context measures during the COVID-19 pandemic affected daily activities of people with spinal cord injury (SCI), their interactions within the community, and consequently their social participation during the first wave of the pandemic. However, there is little information about the changes in social participation as the pandemic evolved in Canada. Objective: To describe the change in social participation of adults with SCI after the first two years of the COVID-19 pandemic in Canada.MethodsA follow-up from a previous study exploring the social participation of adults with SCI living during the first wave was conducted eight months later (second wave). Social participation was measured using the Assessment of Life Habits (LIFE-H 4.0) and Measure of Quality of the Environment (MQE) among 18 adults with SCI.ResultsParticipants reported increases between both waves of COVID-19 in life habits categories, including mobility, personal care and health, nutrition, and recreation. New environmental factors were identified as facilitators, including the increased availability of businesses in the community.ConclusionThese findings suggest that people with SCI increased fulfillment and satisfaction of certain life habits. Reduced environmental barriers and increased facilitators improved social participation as the pandemic evolved.
Motor network reorganization associated with rTMS-induced writing improvement in writer’s cramp dystonia
Authors: Bukhari-Parlakturk Noreen , Mulcahey Patrick J. , Lutz Michael W. , Ghazi Rabia , Huang Ziping , Dannhauer Moritz , Termsarasab Pichet , Scott Burton , Simsek Zeynep B. , Groves Skylar , Lipp Mikaela , Fei Michael , Tran Tiffany K. , Wood Eleanor , Beynel Lysianne , Petty Chris , Voyvodic James T. , Appelbaum Lawrence G. , Al-Khalidi Hussein R. , Davis Simon W. , Michael Andrew M. , Peterchev Angel V. , Calakos Nicole 
Published: October 2024

ABSTRACTBackgroundWriter’s cramp (WC) dystonia is an involuntary movement disorder with distributed abnormalities in the brain’s motor network. Prior studies established the potential for repetitive transcranial magnetic stimulation (rTMS) to either premotor cortex (PMC) or primary somatosensory cortex (PSC) to modify symptoms. However, clinical effects have been modest with limited understanding of the neural mechanisms hindering therapeutic advancement of this promising approach.ObjectiveThis study aimed to understand the motor network effects of rTMS in WC that correspond with behavioral efficacy. We hypothesized that behavioral efficacy is associated with modulation of cortical and subcortical regions of the motor network.MethodsIn a double-blind, cross-over design, twelve WC participants underwent rTMS in one of three conditions (Sham-TMS, 10 Hz PSC-rTMS, 10 Hz PMC-rTMS) while engaged in a writing task to activate dystonic movements and measure writing fluency. Brain connectivity was evaluated using task-based fMRI after each TMS session.Results10 Hz rTMS to PSC, but not PMC, significantly improved writing dysfluency. PSC-TMS also significantly weakened cortico-basal ganglia, cortico-cerebellum, and intra-cerebellum functional connectivity (FC), and strengthened striatal FC relative to Sham. Changes in PSC and SPC BOLD activity were associated with reduced dysfluent writing behavior.Conclusions10 Hz rTMS to PSC improved writing dysfluency by redistributing motor network connectivity and strengthening somatosensory-parietal connectivity. A key signature for effective stimulation at PSC and improvement in writing dysfluency may be strengthening of intra-cortical connectivity between primary somatosensory and superior parietal cortices. These findings offer mechanistic hypotheses to advance the therapeutic application of TMS for dystonia.Highlights10 Hz repetitive TMS to somatosensory cortex reduces writing dysfluency in dystoniaIncreased somatosensory cortex activity correlates with reduced writing dysfluencyIn dystonia + sham-TMS, writing dysfluency correlates with cerebellar connectivity.10 Hz rTMS to somatosensory cortex induces reorganization of the motor network
Development, Testing, and Calibration of LINCS: A New Microsimulation Model of Maternal and Fetal Cytomegalovirus Infection
Authors: Wu Aaron S. , Coskun Elif , Prabhu Malavika , Santos Emily M. , Kakkar Fatima , Flanagan Clare F. , Dugdale Caitlin M. , Pesch Megan , Giardina John C. , Ciaranello Andrea L. 
Published: October 2024

ABSTRACTBackgroundCongenital cytomegalovirus (cCMV) is a leading cause of birth defects and the most common cause of non-genetic sensorineural hearing loss in children. There is a lack of decision modeling frameworks that can project cytomegalovirus (CMV)-related patient outcomes and inform health policy. We created, tested, and calibrated a model of CMV acquisition and transmission in pregnancy using linked mother-infant dyads.MethodsWe developed theLinkingINfants and Mothers inCytomegalovirusSimulation (LINCS) dyad-level Monte-Carlo microsimulation model of CMV infection among pregnant people and fetuses throughout pregnancy. We parameterized the model with data from the existing literature, implemented rigorous code testing procedures, and calibrated a key set of parameters to match model output to external data on cCMV prevalence and symptom risk.ResultsA fully parameterized model for CMV among pregnant people and fetuses was developed, and the model code was confirmed to perform as specified. The calibration procedure identified parameter sets that generated model output closely matching the target values from the available data on cCMV prevalence and symptom risk.ConclusionsThe LINCS model’s ability to simulate the natural history of CMV infection during pregnancy was described and demonstrated, and the model was tested and calibrated to ensure proper functioning. Base case parameters were derived for CMV infection natural history to be used in future decision analyses of CMV testing and treatment strategies.