bluuebunny/crossref_metadata_2025_split huggingface dataset:
Risk Factors Associated With Acute Kidney Injury in Traumatic Brain Injury Patients Treated With Hypertonic Saline: A Retrospective Study
Authors: Briscoe Jessica , Van Berkel Patel Megan , Hicks R. Chace , Froehling Nadia , Hunt Darren , Parker Jessica , Carter Breanna 
Published: August 2024

Background: Hypertonic saline (HTS) is essential pharmacologic treatment for traumatic brain injury (TBI). Previous studies associate HTS with acute kidney injury (AKI), however evidence in TBIs is limited. Objective: This study examines factors associated with AKI in patients requiring HTS for TBI. Methods: This retrospective study was performed at a Level-1 Trauma, Academic Medical Center. Inclusion criteria were TBI, age ≥12 years, ICU length of stay ≥72 hours, and administration of ≥24 hours of continuous HTS or 500 mL of HTS boluses. The primary outcome was identifying factors associated with AKI. Secondary outcomes included correlation between chloride load and level with development of AKI. Chloride load was calculated from HTS and non-HTS sources. Results: Of 129 patients included, 18 (14%) developed AKI. Maximum sodium level was higher in the AKI group ( P < 0.0001). Hyperchloremia (Cl ≥ 115 mEq/L) was more common in the AKI group (100% vs 81%, P = 0.0428). Maximum and change in serum chloride were higher in the AKI group (median 128 vs 123 mEq/L, P = 0.0026 and +24 mEq/L vs +17 mEq/L, P = 0.0084, respectively). Logistic regression analysis indicated an OR 1.095 times higher [95% CI (1.022, 1.172)] for developing AKI for every one mEq/L increase in maximum chloride level and an OR 1.032 [95% CI (1.006, 1.058)] for developing AKI for every 1-year increase in age. There was no difference in total chloride load between groups ( P = 0.2143). Non-HTS sources provided more than 40% of total chloride load in both groups. Conclusion: Chloride level, and age may be associated with AKI in TBI patients treated with HTS.
Thorn-induced Injury of the Knee Mimicking Pigmented Villonodular Synovitis (PVNS): A Case Report
Authors: Kumar Nishith , Singh Dharmendra Kumar , Hassan MS , Rustagi Ashish , Batta Nafisa Shakir , Botchu Rajesh 
Published: August 2024

Background and Aims: Plain film radiography is the first imaging modality in the detection of most foreign bodies. However, it is not sensitive for detection of radiolucent objects such as organic material including plant thorns. Case report: Herein, we present the case of a 19-year-old male patient, presenting with an 8-month history of right knee pain and laxity, whose radiographic appearance mimicked that of pigmented villonodular synovitis (PVNS) but was found to have a retained neglected plant thorn in his knee. Upon ultrasound evaluation for image-guided biopsy to confirm the provisional diagnosis of PVNS, he was found to have a retained neglected plant thorn in his knee. Discussion: Plant thorn injuries can present as knee synovitis, as in our case, and should be kept in the differential diagnosis. An ultrasound-guided removal is possible and is a useful minimally invasive procedure.
Renal Neoplasms with Concurrent Castleman-Like Regional Lymphadenopathy
Authors: Gama Alcino , Zhou Ruoji , De La Riva-Morales Ivan , Sosman Jeffrey , Isaila Bogdan , Chen Qing C , Lin Xiaoqi , Choy Bonnie , Chen Yi-Hua , Yang Ximing J. 
Published: August 2024

Introduction Renal cell neoplasms are known to be associated with paraneoplastic syndromes, and the association with Castleman-like regional lymphadenopathy has been rarely reported. We aim to characterize the association between renal neoplasms and Castleman-like lymphadenopathy. Methods A search for renal neoplasms with concurrent Castleman-like lymphadenopathy in one single medical institution from 2000 to 2023 resulted in 4 specimens. A literature search for “Castleman” and “renal neoplasm” resulted in 8 reports. Patients’ demographics, clinical presentation, gross and histologic features, results of ancillary studies, treatment, and follow-up were evaluated. Results Our patients included 3 men and 1 woman, with a mean age of 60 years. Four different subtypes of renal neoplasms were diagnosed, including clear cell renal cell carcinoma (RCC), papillary RCC, chromophobe RCC, and mucinous cystadenoma of the renal pelvis. For Castleman-like regional lymphadenopathy, 2 were plasma-cell predominant, and 2 were hyaline-vascular. After a median follow-up of 84 months, all patients were alive with no recurrence or progression of Castleman-like features following nephrectomies. Conclusion Castleman-like regional lymphadenopathy should be considered in patients with renal tumors and lymphadenopathy. Although more prevalent in clear cell RCC, it can be also associated with other renal neoplasms. The concurrent lymphadenopathy was remitted following the renal tumor resections.
Prolonged in-use physicochemical and biological stability of nivolumab and pembrolizumab diluted in saline infusion bags and in partially used medication vials
Authors: Arnamo A Hedvig , Pluim Dick , Huitema Alwin DR , Jacobs Bart AW , Beijnen Jos H , Nuijen Bastiaan 
Published: August 2024

Aim/Background The aim of this study was to determine long-term physicochemical and biological stability of nivolumab and pembrolizumab diluted in saline infusion bags and partially used medication vials. This may enable the prolonged clinical use of these expensive monoclonal antibodies (mAbs) to minimize the economic loss. Methods Sterile nivolumab and pembrolizumab concentrates in partially used medication vials and compounded nivolumab and pembrolizumab infusion solutions were stored for two and four weeks, respectively, at 2–8°C in the dark. Subsequently, concentrates and compounded solutions were stored for an additional two weeks under ambient temperature and light conditions. A panel of validated and complementary methods, consisting of enzyme-linked immunosorbent assay, size exclusion chromatography, and dynamic light scattering, were used to assess the biological and physiochemical stability of these mAbs. Results All samples showed that purity and concentration had remained within the criteria of <5% as stated in the European Pharmacopoeia. Diluted in infusion bags, nivolumab and pembrolizumab remained biologically and physiochemically stable for up to four weeks when stored at 2–8°C in the dark with an additional two weeks of ambient temperature and light. Stability in partially used medication vials was demonstrated for at least two weeks when stored at 2–8°C in the dark with an additional two weeks of ambient temperature and light. Conclusion The findings of this study justify the storage and clinical re-use of sterile nivolumab and pembrolizumab in partially used medication vials and compounded IV infusion bags for up to six weeks. This minimizes the risk of economic loss due to waste. Moreover, these findings support the batch-wise compounding of fixed-dose and dose-banded nivolumab and pembrolizumab infusion bags.
An in-vitro method for comparative analysis of aspiration catheter tracking performance
Authors: Wodarg Fritz , Brouwer Patrick , Power Sarah , Gilvarry Michael , Mirza Mahmood , Conlon Richard , Johnson Sarah , McCarthy Ray 
Published: August 2024

Background and purpose Mechanical thrombectomy (MT) for acute ischemic stroke (AIS) relies on efficient tracking of aspiration catheters through complex vascular anatomies. Differences in catheter design lead to variation in tracking performance which may only become apparent after use in patients. We developed an in-vitro methodology for evaluating aspiration catheter performance under a variety of pre-defined circumstances, that can be used during catheter development for design optimization. Methods Validation of the in-vitro methodology involved testing four large bore aspiration catheters on recreated challenging vascular access routes derived from patient angiograms. Two experienced neurointerventionalists conducted the tests under controlled physiological and procedural conditions. Each catheter design was evaluated across 30 unique anatomy-procedural set-up combinations. A fifth, prototype large bore catheter was evaluated by trained engineers to assess the applicability of the in-vitro test. Results Results from statistical analysis using a general linear model demonstrated the methodology's effectiveness in detecting significant tracking differences among catheter designs ( p < 0.01). Minimal inter-operator variability was observed ( p = 0.304), while procedural techniques significantly influenced tracking performance ( p < 0.01). The tortuosity of the arterial access route notably impacted catheter performance ( p < 0.01), with anatomical features revealing varying degrees of influence on desirable and undesirable catheter design aspects. Conclusion We successfully developed a test methodology for evaluating the trackability of large bore aspiration catheters intended for treating acute ischemic stroke with large vessel occlusions. This methodology offers a robust approach to pre-clinical design assessment, utilizing anatomical models that simulate real-world vascular challenges to enhance catheter optimization.
Axillary compared to brachial access for endovascular procedures
Authors: Altaha Mustafa A , Bailey Shawn , Mafeld Sebastian , Jaberi Arash , Tan Kong Teng 
Published: August 2024

Objectives Limited knowledge exists regarding access site complication rates between trans-axillary and trans-brachial approaches with sheath sizes ≥6Fr. We retrospectively reviewed our institution experience with access site complications for percutaneous trans-axillary and trans-brachial arterial interventions using sheath sizes ranging from 6Fr to 10Fr. Methods We examined 67 endovascular interventions performed over 18 months, restricted to sheath sizes of 6Fr to 10Fr. Procedures utilizing trans-brachial (41 cases) and trans-axillary (26 cases) approaches under sonographic guidance were included. Cases involving hemodialysis accesses and those requiring surgical cut-down were excluded. The primary outcome measure was the occurrence of major access site complications (SIR grade-II/III) within 30 days, with data collected on hemostasis method, sheath size, and complications. Statistical analysis involved ANCOVA and Fisher’s exact tests, with significance set at p < .05. Results Successful percutaneous arterial access was achieved in all cases using either approach (trans-axillary or trans-brachial). Closure devices were employed in all axillary punctures and in 71% of brachial punctures. Major access site complications occurred in 7 out of 41 cases (17%) in the trans-brachial group and in 4 out of 26 cases (15%) in the trans-axillary group. However, there was no statistically significant difference in complication rates between the two groups, regardless of access site or sheath size. Conclusion Trans-axillary access serves as a safe and effective upper limb access method for percutaneous endovascular procedures requiring sheath size of 7Fr or larger when compared to trans-brachial approach.
Successful use of lithoplasty for re-expansion of covered iliac stents with unilateral occlusion
Authors: Damara Fachreza A , Wolfers Matthew , Kirksey Lee 
Published: August 2024

Background: Vessel wall calcification is associated with stent under-expansion and in-stent restenosis. The traditional approaches to treat peripheral artery calcification are percutaneous transluminal angioplasty (PTA) and atherectomy. Shockwave intravascular lithotripsy (IVL) uses sonic wave pressure to disrupt calcium of the severely calcified lesions. Published reports of IVL to treat in-stent restenosis are limited to coronary interventions and bare metal platforms. Methods We describe the case of a 55-year-old male with extremely compressed under-expanded covered stents associated with severe wall calcification that resulted in stent occlusion. Results The IVL system balloon was deployed uneventfully, in a phased manner. Bilateral bare metal stents were also placed in a kissing fashion to further re-expand the arterial segments. Reintervention with IVL facilitated successful revascularization and the stent remained patent at 24 months. Conclusion Our case highlights the use of IVL as an effective tool in the management of vessel wall calcification both for primary and secondary interventions.
Exploring patient perception of decision-making in carpal tunnel release surgery: A systematic review and thematic synthesis of qualitative studies
Authors: Lui Bing Chun , Jerosch-Herold Christina 
Published: August 2024

Background Carpal tunnel syndrome is a common condition, but some controversies remain regarding diagnostics and the most effective treatments. As a result, patients often experience decisional conflicts, especially when considering carpal tunnel release surgery. Understanding factors that influence decision-making in surgery can help clinicians better grasp patient treatment preferences and priorities, reducing decisional conflicts, and enabling patients to make informed, value-aligned choices through shared decision-making. This qualitative evidence synthesis aims to explore patient perceptions of carpal tunnel release, examine the decision-making factors, and critically appraise and synthesise the existing evidence. Methods A systematic search was conducted across four electronic databases (MEDLINE, EMBASE, CINAHL Ultimate, PsycINFO) from inception to August 2023, supplemented by referencing and citation searching to identify eligible qualitative studies. Thematic synthesis was adopted as synthesis methodology, involving a line-by-line coding of the primary study findings, and the development of descriptive and analytical themes. Quality appraisal was conducted using the modified Critical Appraisal Skills Programme checklist, supplemented with the COnsolidated criteria for REporting Qualitative research checklist. Results Synthesis of six qualitative studies encompassing 66 participants generated five analytical themes: (1) Journey to normalcy, (2) Patient-centred care, (3) Work and life considerations, (4) Weighing up alternatives, and (5) Shaping the expectations, highlighting the complexity of patient decision-making in carpal tunnel release. Discussion In the management of carpal tunnel syndrome, therapists should consider various decision-making factors, prioritising communication and shared decision-making. This, along with personalised interactions, achieves patient-centred care and enhances patient care quality and therapeutic alliance.
Exploration of the Therapeutic Potential of Salvianolic Acid B Against senile Cataracts Based on Network Pharmacology and Experimental Validation
Authors: Dong Yongxiao , Zhao Jin , Zheng Xueli , Xue Tao , Ma Wenting , Cao Panpan , Wang Ling , Yuan Xiaoyong 
Published: August 2024

Background The aim of this study was to explore the preventive and therapeutic potential of salvianolic acid B in inhibiting senile cataracts through network pharmacology and experimental validation. Methods Disease-related genes were obtained from the DisGeNET and GeneCards databases. Drug targets were identified from the Swiss Target Prediction and PharmMapper databases, shared genes were identified via the Venny website, links between genes were identified via a protein–protein interaction (PPI) network, and GO and KEGG analyses were subsequently performed via R software. The key genes were identified via Cytoscape software, and their binding with Sal-B was demonstrated by molecular docking. Then, the results were verified by cell experiments. A CCK-8 assay was used to assess the activity of human LECs with or without H2O2 or Sal-B treatment, and the cell apoptosis rate of each group was determined by flow cytometry. The gene expression levels of caspase 3, TNF-α and MMP-9 in human LECs treated with or without H2O2 or Sal-B were determined by qPCR. Results A total of 705 and 152 cataract-related genes and salvianolic acid B-related genes, respectively, were identified, with 37 shared genes. The PPI results showed that MMP9, IL-2, JUN, TNF-α and caspase 3 were the core genes. GO data analysis revealed that the biological process, cell component and molecular function terms were most enriched in the categories “apoptosis progress”, “cytosol” and “protein binding”. Through KEGG enrichment analysis, we found that the core genes were related to the IL-17 and TNF signalling pathways. Cytoscape results showed that MMP9, TNF-α and caspase 3 were the key genes, and molecular docking showed that the drugs interacted well with the target molecules. The experimental results showed that salvianolic acid B inhibited H2O2-induced decreases in LEC activity and apoptosis and inhibited the gene expression of MMP9, TNF-α and caspase 3. Conclusion Network pharmacology and molecular docking results showed that salvianolic acid B has the potential to prevent and treat senile cataracts. The experimental results verified the finding that salvianolic acid B can inhibit the decrease in LEC activity and apoptosis induced by H2O2 and verified the expression of the key molecules MMP9, TNF-α and caspase 3.
Unilateral Spinal Anesthesia in Hip Fracture Surgery for Geriatric Patients With High Cardiovascular Risk due to Aortic Stenosis is Safe and Effective
Authors: Çağıran Zeynep , Vahabi Arman , Özgül Kazım Koray , Aljasim Omar , Karaman Semra , Özkayın Nadir , Aktuğlu Kemal , Sertöz Nezih 
Published: August 2024

Introduction Aortic stenosis is a cause of mortality or morbidity. It complicates the selection and management of anesthetic procedures. The aim of this study was to evaluate the efficacy, hemodynamic effects and postoperative outcome of unilateral spinal anesthesia in geriatric patients with hip fractures with moderate or severe aortic stenosis. Material and Method A retrospective observational study was conducted on geriatric high-risk patients with cardiac conditions who underwent surgery for hip fractures under unilateral spinal anesthesia with low-dose hyperbaric bupivacaine. The study period spanned from January 2018 to December 2021. The inclusion criteria were individuals with moderate to severe aortic stenosis, as defined by the American Heart Association Criteria. Data on demographic information, cardiac pathologies, hemodynamic data, data on motor and sensory block, perioperative complications, and mortality rates at 30th and 180th days were collected. Results Mortality rates at the 30th day and 180th day were 8.9% (n:4) and 24.4% (n:11), respectively. T6 level was predominantly obtained level of anesthesia (44.4%). Motor and sensory block formation times averaged 7.6 and 4.8 minutes, respectively. Surgical procedures were performed mostly within 1 hour (66.7%), and complications were rare (11.1% hypotension). Initial analgesic effect showed a rapid resolution, with 64.4% of patients requiring analgesic within the first hour postoperatively. Conclusion In elderly patients with moderate to severe aortic stenosis scheduled for hip fracture surgery, we posit that unilateral spinal anesthesia with ultra-low dose is safe and effective option.
Atrial cardiopathy biomarkers and atrial fibrillation in the ARCADIA trial
Authors: Kamel Hooman , Elkind Mitchell SV , Kronmal Richard A , Longstreth WT , Plummer Pamela , Aragon Garcia Rebeca , Broderick Joseph P , Pauls Qi , Elm Jordan J , Nahab Fadi , Janis L Scott , Di Tullio Marco R , Soliman Elsayed Z , Healey Jeff S , Tirschwell David L 
Published: August 2024

Background: ARCADIA compared apixaban to aspirin for secondary stroke prevention in patients with cryptogenic stroke and atrial cardiopathy. One possible explanation for the neutral result is that biomarkers used did not optimally identify atrial cardiopathy. We examined the relationship between biomarker levels and subsequent detection of AF, the hallmark of atrial cardiopathy. Methods: Patients were randomized if they met criteria for atrial cardiopathy, defined as P-wave terminal force >5000 μV*ms in ECG lead V1 (PTFV1), NT-proBNP >250 pg/mL, or left atrial diameter index (LADI) ⩾3 cm/m2. For this analysis, the outcome was AF detected per routine care. Results: Of 3745 patients who consented to screening for atrial cardiopathy, 254 were subsequently diagnosed with AF; 96 before they could be randomized and 158 after randomization. In unadjusted analyses, ln(NT-proBNP) (RR per SD, 1.99; 95% CI, 1.85–2.13), PTFV1 (RR per SD, 1.15; 95% CI, 1.03–1.28) and LADI (RR per SD, 1.34; 95% CI, 1.20–1.50) were associated with AF. In a model containing all 3 biomarkers, demographics, and AF risk factors, age (RR per 10 years, 1.24; 95% CI, 1.09–1.41), ln(NT-proBNP) (RR per SD, 1.88; 95% CI, 1.67–2.11) and LADI (RR per SD, 1.25; 95% CI, 1.14–1.37) were associated with AF. These three variables together had a c-statistic of 0.82 (95% CI, 0.79–0.85) but only modest calibration. Discrimination was attenuated in sensitivity analyses of patients eligible for randomization who may have been more closely followed for AF. Conclusions: Biomarkers used to identify atrial cardiopathy in ARCADIA were moderately predictive of subsequent AF.
Trades-offs between pollinator attraction and florivore defense maximize reproductive success in the self-incompatible Rivea ornata (Convolvulaceae)
Authors: Chitchak Natthaphong , Stewart Alyssa B. , Traiperm Paweena 
Published: August 2024

Abstract
Background
Rivea ornata, a rare species from the morning glory family, exhibits uncommon characteristics compared to other typical morning glories, including nocturnal flowers that fit the classic moth pollination syndrome. However, the accuracy of its predicted pollination syndrome and its mating system have never been assessed. Additionally, R. ornata flowers attract not only pollinators but also florivores, potentially reducing plant reproductive success. Therefore, this study examined two populations of R. ornata in Thailand and assessed traits related to pollinator attraction and reward, determined its mating system, identified floral visitors and effective pollinators, and investigated the effect of florivory on reproductive success.

Results
Rivea ornata is highly fertile but self-incompatible and an obligate outcrosser, rendering it highly dependent on pollinators. Lepidopterans, particularly nocturnal hawk moths, were found to account for a significant proportion of all visits and were the sole effective pollinators of this plant species, in correspondence with its predicted pollination syndrome. Surprisingly, florivory did not significantly reduce reproductive success. This phenomenon may be explained by the strategies employed by R. ornata, which align with the optimal defense hypothesis and functional trade-offs. Specifically, R. ornata appears to invest resources in defending key floral structures while, simultaneously, guard ants are conspicuously absent from flowers, resulting in some florivore damage to non-vital floral organs but ensuring that pollinators are not deterred by ants and thus maintaining high pollinator visitation rates.

Conclusions
Our findings indicate that reproduction-related traits in R. ornata, including those involved in pollinator attraction and reward and florivore defense, are highly effective and work in concert to maximize plant reproductive success. Therefore, a main risk that R. ornata faces is the decline or disappearance of hawk moths and other lepidopterans given its extreme specialization and high dependence on pollinators, and conservation efforts should include habitat protection for both R. ornata and its pollinators.