bluuebunny/crossref_metadata_2025_split huggingface dataset:
Meeting complex multidimensional needs in older patients and their families during and beyond critical illness
Authors: Santangelo Erminio , Wozniak Hannah , Herridge Margaret S. 
Published: August 2024

Purpose of review
To highlight the emerging crisis of critically ill elderly patients and review the unique burden of multidimensional morbidity faced by these patients and caregivers and potential interventions.

Recent findings
Physical, psychological, and cognitive sequelae after critical illness are frequent, durable, and robust across the international ICU outcome literature. Elderly patients are more vulnerable to the multisystem sequelae of critical illness and its treatment and the resultant multidimensional morbidity may be profound, chronic, and significantly affect functional independence, transition to the community, and quality of life for patients and families. Recent data reinforce the importance of baseline functional status, health trajectory, and chronic illness as key determinants of long-term functional disability after ICU. These risks are even more pronounced in older patients.

Summary
The current article is an overview of the outcomes of older survivors of critical illness, putative interventions to mitigate the long-term morbidity of patients, and the consequences for families and caregivers. A multimodal longitudinal approach designed to follow patients for one or more years may foster a better understanding of multidimensional morbidity faced by vulnerable older patients and families and provides a detailed understanding of recovery trajectories in this unique population to optimize outcome, goals of care directives, and ongoing informed consent to ICU treatment.
Neuroprognostication, withdrawal of care and long-term outcomes after cardiopulmonary resuscitation
Authors: Bazbaz Adela , Varon Joseph 
Published: August 2024

Purpose of review
Survivors of cardiac arrest often have increased long-term risks of mortality and disability that are primarily associated with hypoxic-ischemic brain injury (HIBI). This review aims to examine health-related long-term outcomes after cardiac arrest.

Recent findings
A notable portion of cardiac arrest survivors face a decline in their quality of life, encountering persistent physical, cognitive, and mental health challenges emerging years after the initial event. Within the first-year postarrest, survivors are at elevated risk for stroke, epilepsy, and psychiatric conditions, along with a heightened susceptibility to developing dementia. Addressing these challenges necessitates establishing comprehensive, multidisciplinary care systems tailored to the needs of these individuals.

Summary
HIBI remains the leading cause of disability among cardiac arrest survivors. No single strategy is likely to improve long term outcomes after cardiac arrest. A multimodal neuroprognostication approach (clinical examination, imaging, neurophysiology, and biomarkers) is recommended by guidelines, but fails to predict long-term outcomes. Cardiac arrest survivors often experience long-term disabilities that negatively impact their quality of life. The likelihood of such outcomes implements a multidisciplinary care an integral part of long-term recovery.
Dietary protein in the ICU in relation to health outcomes
Authors: Bear Danielle E. , Summers Matthew J. , Chapple Lee-anne S. 
Published: August 2024

Purpose of review
Critical care nutrition guidelines recommend provision of higher protein doses than recommended in health. These recommendations have been predominately based on lower quality evidence and physiological rationale that greater protein doses may attenuate the significant muscle loss observed in critically ill patients. This review discusses the mechanistic action of protein in the critically ill, details results from recent trials on health outcomes, discusses considerations for interpretation of trial results, and provides an overview of future directions.

Recent findings
Two recent large clinical trials have investigated different protein doses and the effect on clinical outcome. Important findings revealed potential harm in certain sub-groups of patients. This harm must be balanced with the potential for beneficial effects on muscle mass and physical function given that two recent systematic reviews with meta-analyses demonstrated attenuation of muscle loss with higher protein doses. Utilizing biological markers such as urea: creatinine ratio or urea levels may prove useful in monitoring harm from higher protein doses.

Summary
Future research should focus on prospectively investigating biological signatures of harm as well as taking into the consideration elements that will likely enhance the effectiveness of protein dose.
Choanal atresia: a review of contemporary treatment strategies
Authors: De Jong Russell W. , Heydari Sahar , Fordham M. Taylor 
Published: August 2024

Purpose of review
Choanal atresia (CA) is a congenital nasal airway anomaly that, when present bilaterally, requires urgent surgical intervention. Surgical technique has evolved since its inception with most practices now favoring an endoscopic repair. Restenosis requiring revision surgery is a frequent complication, occurring in as many as 50% of cases. This review aims to highlight the most common surgical approaches, techniques used to prevent restenosis, and newer adjuncts to surgery that may improve outcomes.

Recent findings
Bioabsorbable, steroid-eluting stents were first developed for the adult chronic rhinosinusitis population but have been adapted for use in choanal atresia since 2017. The existing literature consists of multiple case series and one case-control study comparing these stents to traditional stents. To date, there have been no reports of restenosis or stent-related complications with these newer products.

Summary
Choanal atresia remains a difficult surgical pathology for which sustainable surgical results can be challenging. There is reason for optimism in bioabsorbable, steroid-eluting stents as an adjunct to CA repair if future studies expound upon their safety and efficacy.
The use of digital health interventions to deliver prehabilitation in solid organ transplant recipients: are we there yet?
Authors: Briggs Juliet , Chilcot Joseph , Greenwood Sharlene A. 
Published: August 2024

Purpose of reviewPrehabilitation, defined as preparing the body physically and psychologically for upcoming surgery is of increasing prominence in presurgical care. The aim of this review is to discuss the evidence base around prehabilitation in solid organ transplantation, the use of digital health as a tool to deliver these interventions, and consider future directions.Recent findingsPrehabilitation is of increasing interest as an adjunct to pretransplant care for individuals working up for solid organ transplantation. To date, research has shown that prehabilitation is acceptable and feasible; however, the literature base remains small. The majority of research has been delivered using in-person rehabilitation programmes, and the evidence base utilizing digital health as a means to deliver prehabilitation is limited.SummaryTo date, the research evidence base in prehabilitation for solid organ transplantation is limited. Evidence in other surgical populations has demonstrated promising results, particularly in aerobic capacity, physical function and postoperative complications. Further high-quality randomized controlled clinical trials are required to strengthen the evidence base, understand how digital health can be harnessed and utilized to deliver multimodal prehabilitation with an aim to see how this may form part of routine care in the solid organ transplantation pathway.
Operation STICK Improves Vascular Access Outcomes in a Specialty Team
Authors: Gibson Steven Matthew , Sarlabous Jessica , Adair Lauren , Bahl Amit 
Published: August 2024

Background:
Education and training may improve outcomes within an experienced vascular access team.

Purpose:
The purpose of this study was to measure the impact of a standardized peripheral intravenous catheter insertion educational program (Operation STICK) on vascular access outcomes.

Methods:
A quasi-experimental study design was used. Adult inpatients with difficult intravenous access (DIVA) requiring ultrasound-guided insertion by a vascular access specialty team were eligible. Data were collected before and 7 months after the educational training program.

Results:
A total of 54 subjects were included (24 pre- and 30 post-implementation). Significant improvements were found for mean peripheral intravenous catheter dwell time (3.62 to 14.97 days, P < .001), completion of therapy (58.3% to 96.7%, P = .001), and first-stick success rate (79.2% to 100%, P = .013). Catheter-to-vein ratio significantly decreased (P = .007).

Conclusions:
Standardized education/training in vascular access focusing on best practices yields favorable outcomes for DIVA patients within an established specialty team.
Dorsal Carpal Artery Perforator Flaps
Authors: Singh Apoorva Pratap , Dixit Pawan Kumar , Kala Prakash Chandra , Agrawal Dushyant , Katrolia Deepti , Karmakar Shilpi , Singla Priyanka , Humnekar Akhilesh 
Published: August 2024

Background
Hand injuries pose challenges due to complexity and aesthetic–functional concerns. Dorsum of hand injuries are difficult to treat due to thin skin cover and increased propensity to exposure of underlying structures. Perforator-based flaps can provide better outcomes with minimal donor site morbidity. This study aims to bridge the gap in anatomical knowledge and explore the potential benefits of dorsal carpal artery perforator flap.

Materials and Methods
A prospective study was done from July 2021 to June 2023, focused on study of dorsal carpal artery perforators on 12 fresh frozen cadaveric hands. Anatomical study involved injection of red latex into arteries at the wrist, followed by dissection and measurements. During the clinical phase, we used the inferences gained from the anatomical study to identify and mark perforator of dorsal carpal arteries. We performed V-Y advancement flap based on the DCPs in 5 patients who had dorsum of hand defects due to trauma.

Results
The study was carried out on 6 fresh frozen cadavers (12 hands). Anatomical findings revealed the anatomical location, caliber, and consistent number of dorsal carpal artery perforators supplying the dorsum of the hand arranged in 2 rows. Clinically, we applied this insight to create V-Y flaps in 5 patients with successful outcomes, thus, offering DCP-based flap as an alternative to distant flaps.

Conclusion
DCP-based flaps offer an efficient solution for reconstructing proximal hand defects over the dorsum, with minimal complications, enhancing our understanding of hand reconstruction options. The study's comprehensive anatomical insights and clinical outcomes contribute to improving hand defect management and surgical techniques
Quality of Video Content Related to Deep Inferior Epigastric Perforator Flap Breast Reconstruction
Authors: Viñuela Florido Manuel , Suárez Aguilar Javier , Maldonado Andrés A. , Cristóbal Velasco Lara 
Published: August 2024

Introduction
The deep inferior epigastric perforator (DIEP) flap is currently one of the main options in breast reconstruction. The information about this surgery is critical for the patient, in order to choose the breast reconstruction method. Our study aims to analyze and compare the quality and accuracy of the information related to the DIEP flap reconstruction method provided by social media platforms (SMPs) and the new large language models (LLMs).

Materials and Methods
A total of 50 videos in English and Spanish were selected from the main SMPs (YouTube, Instagram, and Facebook) using the keywords “DIEP flap” and “colgajo DIEP.” The duration, number of likes, dislikes, number of visits, upload date, author, and the video category (institutional video, media, patient experience, academic, and surgery) were analyzed. 3 specific questions were asked to 2 new LLMs (ChatGPT and Google Bard). The quality of information in SMPs and LLMs was analyzed and compared by 2 independent board-certified plastic surgeons using the Journal of American Medical Association and DISCERN scales.

Results
LLMs showed a statistically significant higher quality of information when compared with SMPs based on the DISCERN scores. The average DISCERN scores for answers given by ChatGPT and Google Bard were 54 ± 6.841 and 61.17 ± 6.306, respectively (good quality). In SMPs, the average scores were 2.31 ± 0.67 (insufficient quality) and 32.87 ± 9.62 (low quality) for the Journal of American Medical Association and DISCERN scales respectively. Thirty-eight percent of the videos in SMPs were performed by nonmedical authors.

Conclusions
The quality of information for breast reconstruction using DIEP flaps from LLMs was considered good and significantly better than in SMPs. The information found in SMPs was insufficient and of low quality. Academic plastic surgeons have an opportunity to provide quality content on this type of reconstruction in LLM and SMPs.
Predicting the Timing and Cause of Microvascular Free Flap Failure
Authors: Gupta Yash , Moisidis Elias , Clarke Fred , Haddad Roger , Illie Vlad , Southwell-Keely James 
Published: August 2024

Background
The aim of the study is to assess the possible predictors of microvascular free flap failure and determine the critical postoperative timing of flap failure, thereby minimizing this adverse outcome.

Methods
This is a retrospective single-institutional review of 1569 free flap operations. All free flaps with outcome status recorded were analyzed for possible predictors in the development of microvascular compromise. Compromised cases were then analyzed for differences in time to compromise and time to theater takeback between salvaged versus failed free flaps.

Results
Of the assessable 1569 free flaps, 31 developed microvascular compromise (2.0%); the salvage rate was 20.0%, and overall failure rate was 1.5%. Osteocutaneous free flaps in head and neck had increased risk of developing free flap failure compared to other flaps (odds ratio = 3.8, 95% confidence interval: 1.2–12.7). Among breast patients, previous radiotherapy had a significant association with flap failure (P < 0.001). Free flap salvage rates dropped from 38.5% to 7.7% for compromises detected after 24 hours (P = 0.160), and from 57.1% to 11.1% for free flaps taken back to theater greater than 3 hours after compromise detection (P = 0.032).

Conclusions
Delays in compromise detection and flap takeback to theater resulted in reduced salvage rates, with the critical timing of takeback being under 3 hours. Standardized flap monitoring protocols and incorporation of newer technologies could see faster detection and improved salvage rates. Additional care is required when reconstructing: osteocutaneous head and neck free flaps and previously irradiated breast patients.
Impact of Collagenase Injection on Dupuytren Disease Treatment in Japan
Authors: Yoneda Hidemasa , Curley James , Yamamoto Michiro , Hirata Hitoshi 
Published: August 2024

Background
Collagenase Clostridium histolyticum (CCH) injection, an effective enzymatic fasciotomy treatment for Dupuytren disease (DD), was abruptly withdrawn from the healthcare market outside the United States in 2020. The impact on patients, physicians and hospitals of this helpful surgical alternative no longer being available has been little studied.

Methods
To investigate the impact of the withdrawal of CCH in Japan, we used the National Database Open Data Japan from 2014 to 2020. Published by the government, it contains summary data of the National Database of Health Insurance Claims and Specific Health Checkups of Japan. We extracted the numbers of CCH injections with Xiaflex, the product name in Japan, and surgeries identified by “Dupuytren contracture surgery codes.” Each treatment was further parsed into one of 12 predefined regions in which it had taken place and by whether it had been delivered on an inpatient or outpatient basis.

Results
From its introduction in 2015, the number of DD patients treated with CCH increased in each successive year, reaching a peak in 2019, while the number of surgeries decreased with time. After the withdrawal in 2020, the number of surgeries increased to 1.5 times the 2019 number notwithstanding the impact of COVID-19, but the total number of patients treated decreased by 43%. In the initial regional analysis, CCH accounted for approximately 40% of all DD treatments in the less populous areas, with the exception of the Tohoku region, and more than 50% in the other regions. By 2019, the share of CCH treatment had increased in all regions. There was no significant correlation between the number of hand surgeons authorized to use CCH and the number of CCH cases within each region.

Conclusions
CCH increased treatment options for patients and surgeons. The withdrawal of this valuable pharmaceutical resulted in an increase in the number of surgeries amidst a decrease in the total number of treatments and lost opportunities for patients.
Association of Visual Impairment With Neuropsychiatric Symptoms of Dementia
Authors: Li Melissa , Hamedani Ali G. 
Published: August 2024

Background:
Visual impairment is a risk factor for cognitive impairment and hallucinations in older adults, but associations with other neuropsychiatric symptoms (NPS) of dementia have not been examined.

Methods:
We analyzed cross-sectional data from the Aging, Demographics, and Memory Study (ADAMS), a nationally representative sample of the US population aged 70+ years. Vision was measured by self-report and using a near card. Dementia was ascertained through cognitive testing with expert consensus, and NPS were screened using the Neuropsychiatric Inventory. We used logistic regression to measure the association between visual impairment and prevalent NPS adjusting for sociodemographic factors and comorbidities. Analyses incorporated sample weights to account for the complex survey design of ADAMS.

Results:
Of 624 participants with dementia, 332 (53%) had self-reported visual impairment and 193 (31%) had best-corrected acuity of 20/40 or worse. In unadjusted models, self-reported visual impairment was significantly associated with hallucinations (OR 2.88; 95% CI 1.12–7.44), depression (OR 2.79; 95% CI 1.7–4.57), and agitation (OR 1.61; 95% CI 1.05–2.48). Reduced visual acuity was associated with hallucinations (OR 10.13; 95% CI 2.93–34.98), psychosis (OR 6.69, 95% CI 2.53–17.7), and mania (OR 5.92, 95% CI 1.77–19.82). However, these associations did not remain significant after covariate adjustment.

Conclusions:
Visual impairment was associated with hallucinations, depression, agitation, psychosis, and mania in patients with dementia, but at least some of this relationship is explained by age, comorbidities, and other factors.
Circulating extracellular microRNAs in the blood promote sociability in mice
Authors: Dohi Eisuke , Matoba Ken , Garcia Phoebe A. , Francis-Oliveira Jose , Anguiano Frida , Kochi Takahiro , Badrani Jana , See Julia , Ito Norimichi , Mitani Rei , Rose Indigo V.L. , Choi Eric Y. , Imai Takashi , Crossman David K. , Pletnikov Mikhail V. , Witwer Kenneth W. , Niwa Minae , Kano Shin-ichi 
Published: August 2024

ABSTRACTExtracellular vesicles (EVs) are cell-derived membrane vesicles that circulate throughout the body. Accordingly, circulating EVs and their associated molecules, such as RNAs and proteins, are regarded as promising sources of molecular biomarkers for various disorders. Cell culture-derived EVs have also drawn substantial attention as possible delivery tools for therapeutic molecules. Nevertheless, the biological impact of circulating EVs onin vivophysiology and pathology remains elusive. Here we report that systemic exposure to blood circulating EVs from wild-type (WT) mice attenuates sociability deficits inRag1-/-mice. Intravenously injected WT mouse blood EVs reach the brain and restore postsynaptic inhibitory signals in theRag1-/-medial prefrontal cortex (PFC) pyramidal neurons. Mechanistically, WT EV-associated microRNAs, miR-23a-3p and miR-103-3p, reduce PKCε expression, increasing postsynaptic GABAA receptors in the mPFC pyramidal neurons. Our findings reveal a sociability-promoting effect of blood circulating EVs and associated miRNAs with therapeutic potential for sociability deficits.
Low-pass nanopore sequencing for measurement of global methylation levels in plants
Authors: Liau Yusmiati , Whibley Annabel , Hill Amy , Vanga Bhanupratap , Pither-Joyce Meeghan , Hilario Elena , Bailey Sarah , Thomson Susan J. , Lizamore Darrell 
Published: August 2024

AbstractNanopore sequencing enables detection of DNA methylation at the same time as identification of canonical sequence. A recent study validated low pass nanopore sequencing to accurately estimate global methylation levels in vertebrates with sequencing coverage as low as 0.01x. We investigated the applicability of this approach to plants by testing three plant species and analysed the effect of technical and biological parameters on estimate precision and accuracy. Our results indicate that a higher coverage (0.1x) is required to assess plant global methylation at an equivalent accuracy to vertebrates. Shorter read length and a closer sequence match between sample and reference genome improved measurement accuracy. Application of this method inVitis viniferashowed consistent global methylation levels across different leaf sizes, and different sample preservation and DNA extraction methods, whereas different varieties and tissue types did exhibit methylation differences. Similarly, distinct methylation patterns could be observed in different genomic features. Our findings suggest the suitability of this method as a low-cost screening tool for validation of experimental parameters, developmental time courses and to assess methylation status for different modification types and sequence contexts at the level of whole genome or for abundant genomic features such as transposable elements.
Spatial mapping of immunosuppressive CAF gene signatures in H&E-stained images using additive multiple instance learning
Authors: Markey Miles , Kim Juhyun , Goldstein Zvi , Gerardin Ylaine , Brosnan-Cashman Jacqueline , Javed Syed Ashar , Juyal Dinkar , Pagidela Harshith , Yu Limin , Rahsepar Bahar , Abel John , Hennek Stephanie , Khosla Archit , Taylor-Weiner Amaro , Parmar Chintan 
Published: August 2024

AbstractThe relative abundance of cancer-associated fibroblast (CAF) subtypes influences a tumor’s response to treatment, especially immunotherapy. However, the extent to which the underlying tumor composition associates with CAF subtype-specific gene expression is unclear. Here, we describe an interpretable machine learning (ML) approach, additive multiple instance learning (aMIL), to predict bulk gene expression signatures from H&E-stained whole slide images (WSI), focusing on an immunosuppressive LRRC15+ CAF-enriched TGFβ-CAF signature. aMIL models accurately predicted TGFβ-CAF across various cancer types. Tissue regions contributing most highly to slide-level predictions of TGFβ-CAF were evaluated by ML models characterizing spatial distributions of diverse cell and tissue types, stromal subtypes, and nuclear morphology. In breast cancer, regions contributing most to TGFβ-CAF-high predictions (“excitatory”) were localized to cancer stroma with high fibroblast density and mature collagen fibers. Regions contributing most to TGFβ-CAF-low predictions (“inhibitory”) were localized to cancer epithelium and densely inflamed stroma. Fibroblast and lymphocyte nuclear morphology also differed between excitatory and inhibitory regions. Thus, aMIL enables a data-driven link between tissue phenotype and transcription, offering biological interpretability beyond typical black-box models.