bluuebunny/crossref_metadata_2025_split huggingface dataset:
Epidemiology of cardiogenic shock using the Shock Academic Research Consortium (SHARC) consensus definitions
Authors: Berg David D , Bohula Erin A , Patel Siddharth M , Alfonso Carlos E , Alviar Carlos L , Baird-Zars Vivian M , Barnett Christopher F , Barsness Gregory W , Bennett Courtney E , Chaudhry Sunit-Preet , Fordyce Christopher B , Ghafghazi Shahab , Gidwani Umesh K , Goldfarb Michael J , Katz Jason N , Menon Venu , Miller P Elliott , Newby L Kristin , Papolos Alexander I , Park Jeong-Gun , Pierce Matthew J , Proudfoot Alastair G , Sinha Shashank S , Sridharan Lakshmi , Thompson Andrea D , van Diepen Sean , Morrow David A 
Published: August 2024

Abstract

Aims
The Shock Academic Research Consortium (SHARC) recently proposed pragmatic consensus definitions to standardize classification of cardiogenic shock (CS) in registries and clinical trials. We aimed to describe contemporary CS epidemiology using the SHARC definitions in a cardiac intensive care unit (CICU) population.

Methods and results
The Critical Care Cardiology Trials Network (CCCTN) is a multinational research network of advanced CICUs coordinated by the TIMI Study Group (Boston, MA). Cardiogenic shock was defined as a cardiac disorder resulting in SBP &lt; 90 mmHg for ≥30 min [or the need for vasopressors, inotropes, or mechanical circulatory support (MCS) to maintain SBP ≥ 90 mmHg] with evidence of hypoperfusion. Primary aetiologic categories included acute myocardial infarction-related CS (AMI-CS), heart failure-related CS (HF-CS), and non-myocardial (secondary) CS. Post-cardiotomy CS was not included. Heart failure-related CS was further subcategorized as de novo vs. acute-on-chronic HF-CS. Patients with both cardiogenic and non-cardiogenic components of shock were classified separately as mixed CS. Of 8974 patients meeting shock criteria (2017–23), 65% had isolated CS and 17% had mixed shock. Among patients with CS (n = 5869), 27% had AMI-CS (65% STEMI), 59% HF-CS (72% acute-on-chronic, 28% de novo), and 14% secondary CS. Patients with AMI-CS and de novo HF-CS were most likely to have had concomitant cardiac arrest (P &lt; 0.001). Patients with AMI-CS and mixed CS were most likely to present in more severe shock stages (SCAI D or E; P &lt; 0.001). Temporary MCS use was highest in AMI-CS (59%). In-hospital mortality was highest in mixed CS (48%), followed by AMI-CS (41%), similar in de novo HF-CS (31%) and secondary CS (31%), and lowest in acute-on-chronic HF-CS (25%; P &lt; 0.001).

Conclusion
SHARC consensus definitions for CS classification can be pragmatically applied in contemporary registries and reveal discrete subpopulations of CS with distinct phenotypes and outcomes that may be relevant to clinical practice and future research.
A suitable and efficient optimization system for the culture of Chlamydia trachomatis in adult inclusion conjunctivitis
Authors: Wei Yuan , Xu Xizhan , Wang Leying , Chen Qiankun , Li Jinsong , Liu Xiafei , Wei Zhenyu , Pang Jinding , Peng Yan , Guo Xiaoyan , Cheng Zhen , Wang Zhiqun , Zhang Yang , Chen Kexin , Lu Xinxin , Liang Qingfeng 
Published: August 2024

Abstract
The prevalence of Chlamydia trachomatis infection in the genitourinary tract is increasing, with an annual rise of 9 million cases. Individuals afflicted with these infections are at a heightened risk of developing adult inclusive conjunctivitis (AIC), which is commonly recognized as the ocular manifestation of this sexually transmitted infection. Despite its significant clinical implications, the lack of distinctive symptoms and the overlap with other ocular conditions often lead to underdiagnosis or misdiagnosis of AIC associated with C. trachomatis infection. Here, we established six distinct C. trachomatis culture cell lines, specifically highlighting the MA104 N*V cell line that exhibited diminished expression of interferon regulatory factor 3 (IRF3) and signal transducer and activator of transcription 1 (STAT1), resulting in reduced interferons. Infected MA104 N*V cells displayed the highest count of intracytoplasmic inclusions detected through immunofluorescence staining, peaking at 48 h postinfection. Subsequently, MA104 N*V cells were employed for clinical screening in adult patients diagnosed with AIC. Among the evaluated cohort of 20 patients, quantitative PCR (qPCR) testing revealed positive results in seven individuals, indicating the presence of C. trachomatis infection. Furthermore, the MA104 N*V cell cultures derived from these infected patients demonstrated successful cultivation and replication of the pathogen, confirming its viability and infectivity. Molecular genotyping identified four distinct urogenital serovars, with serovar D being the most prevalent (4/7), followed by E (1/7), F (1/7), and Ia (1/7). This novel cellular model contributes to studies on C. trachomatis pathogenesis, molecular mechanisms, and host–pathogen interactions both in vitro and in vivo. It also aids in acquiring clinically relevant strains critical for advancing diagnostics, treatments, and vaccines against C. trachomatis.
Black soldier fly (Diptera: Stratiomyidae) larvae reduce cyathostomin (Nematoda: Strongylidae) eggs but develop poorly on horse manure
Authors: Mann Destiny N , Hobert Kasey T , Biddle Amy S , Crossley Michael S 
Published: August 2024

Abstract
Cyathostomins are common digestive tract parasites of grazing horses that spread through contact with horse feces. Horse feces are colonized by a variety of organisms, some of which could serve to reduce parasite loads in horse pastures. Black soldier fly (Hermetia illucens L.; Diptera: Stratiomyidae) larvae (BSFL) could be an ideal candidate for biological control of cyathostomins, due to their near-global distribution, low risk of pathogen transmission, ability to develop on a variety of nutrient-poor substrates (including horse manure), and dramatic effect on microbial communities that cyathostomins depend on. Here, using controlled feeding bioassays, we evaluated the effect of BSFL on cyathostomin egg densities in horse manure while also tracking BSFL performance on manure relative to standard grain-based diets. We found that BSFL consumed less substrate, were slower to reach the prepupal stage, and ultimately yielded less biomass when reared on horse manure compared to grain-based diets. However, BSFL reduced average cyathostomin egg densities in horse manure by over 3-fold. Overall, our results suggest that despite horse manure being a poor substrate for BSFL growth, BSFL effectively reduce cyathostomin egg loads in infected horse manure, though the mechanisms by which they do this are uncertain. While BSFL are known to transform the microbial communities within a diversity of rearing substrates, their effect on larger, parasitic organisms in animal manures may be underappreciated. Promoting the decomposition of infected horse manure with BSFL might be a promising approach to managing parasite populations among grazing horses.
Cyclical drought and herbivore threats are potential causes of leaf variegation dimorphism in Cypripedium forrestii
Authors: Lin Lie-Wen , Huang Hua , Liu Wei-Wei , Sun Wei-Bang 
Published: August 2024

Abstract
Leaf variegation, the mosaic of colors on the leaf surface, can be developed by certain plant species without external influence. Although it may be associated with a variety of functions, the stable existence of different leaf color morphs within a plant species has not been fully explained by previous studies. This study focuses on the two leaf morphs of Cypripedium forrestii, an endangered lady slipper orchid, and compares their micromorphological structure, photosynthetic potential, differentially expressed genes (DEGs), and ecological features to gain a comprehensive understanding of the underlying leaf variegation polymorphism. Our findings demonstrate that leaf variegation is not pathological and does not affect photosynthetic potential. Additionally, it significantly reduces herbivory damage. We found that the probability of herbivory and leaf area loss for variegated leaves was notably higher under drought conditions. Therefore, variegated individuals may be more adaptive under such conditions, while non-variegated ones may be more cost-effective in normal years. These results suggest that different leaf color morphs may be favored by varying environmental conditions, and leaf polymorphism may be a legacy of ancient climate and herbivore fluctuations.
The intra-abdominal zebra, paraduodenal hernias resulting in small bowel obstructions: a case series
Authors: Anklowitz Andrew , Livezey Jonathan , Hoppe Samuel W , Mangieri Christopher W , Faler Byron 
Published: August 2024

Abstract
Paraduodenal hernias are a rare but important clinical entity, as their presentation can be life-threatening if not properly diagnosed and managed appropriately. Additionally, this entity is defined by a unique and complex congenital anatomical abnormality which dictates a specific treatment algorithm. Here we present the cases of three patients from our clinical experience who all presented with either acute or chronic small bowel obstructions secondary to paraduodenal hernias. Two were left-sided paraduoenal hernias and one was right-sided. All three patients were successfully managed with surgical intervention. An appreciation of paraduodenal hernias, including the defining anatomy and methods of surgical management, is important for the general surgeon.
Placing two inferior vena cava filters for the bail-out management of opening failure of an inferior vena cava filter
Authors: Kawatani Yohei , Yoshiyama Azusa , Hori Takaki 
Published: August 2024

Abstract
A 93-year-old man with a femoral fracture was admitted to the emergency department. The patient presented with severe hypoxemia and shock. Enhanced computed tomography confirmed deep venous thrombosis in the left leg and pulmonary embolism. Subsequently, an inferior vena cava filter (IVCF) was implanted. Although the IVCF was completely unsheathed for deployment, it remained fully folded and did not open; it was not deployed or retrieved. A new IVCF was successfully placed in the same position. Acute treatment for the deep venous thrombosis and further pulmonary embolism was achieved.
Hepatic artery aneurysm post remote pancreaticoduodenectomy
Authors: Djalal Fakim , Landau John , Dubois Luc 
Published: August 2024

Abstract
We present a case of a 4.2-cm hepatic artery aneurysm following remote pancreaticoduodenectomy, which extended to the first division of the right hepatic artery. Given the absence of collateral flow from the superior mesenteric artery (SMA) and the inability to place a covered stent, we treated the patient with a saphenous vein graft to the right hepatic artery bifurcation. A CT scan at 1-year demonstrated a patent bypass to the right hepatic artery. We would advise caution when considering hepatic embolization following pancreaticoduodenectomy due to loss of SMA-based collaterals. Techniques that preserve arterial flow should be favored in this situation.
Pigmented basal cell carcinoma of the anus: a rare entity with diagnostic challenges
Authors: Fuentes-Calvo Kevin Joseph , Silva-Ramos Cielo Scarlet , Arechavala-López Sara Fernanda , Aguilar-Ruiz Fernando , Arias-Ruiz Luis Felipe , Trejo-Ávila Mario 
Published: August 2024

Abstract
Anal cancer is uncommon, comprising 2.2% of gastrointestinal cancers. Squamous cell carcinoma (SCC) is the most common; while perianal basal cell carcinoma (BCC) is rare, representing only 0.2% of anorectal malignancies. BCC, associated with sun exposure and immunosuppression, often resembles benign conditions and manifests as perianal ulcers or masses. Histologically, BCC exhibits basaloid tumor cells with distinct patterns. Despite its rarity, accurate diagnosis is crucial. We expose a case study of a 59-year-old male, previously healthy, that presented with hematochezia and perianal pain, leading to a diagnosis of lower gastrointestinal bleeding. Colonoscopy was needed, and a biopsy revealed an ulcerated, indurated lesion involving the left lateral hemorrhoidal bundle, diagnosed as pigmented basaloid carcinoma. Microscopic examination showed malignant nests of cells with peripheral nuclear palisading, melanocytes, and melanin pigment. Immunohistochemistry confirmed positivity for p63, CK5/6, and BCL2. Respect the treatment, due to the involvement of the anal sphincteric muscle, radiotherapy was chosen.
Abdominal endovascular aneurysm repair using an aorto-uni-iliac device resulting in resting lower extremity pain: a case report and discussion on patient selection
Authors: Ekblad John R , Hupp Colleen 
Published: August 2024

Abstract
Abdominal aortic aneurysms that meet criteria for repair are often managed with endovascular aneurysm repair using a bifurcated two-piece or bifurcated single-body stent. Patients with difficult anatomy, extensive calcifications, complete occlusion of common or external iliac artery, tortuous vessels, or small vessels may require placement of an Aorto-Uni-Iliac (AUI) stent graft. Placement of an AUI stent graft is typically combined with a femorofemoral crossover bypass to ensure adequate perfusion to the contralateral limb. In the elective setting, some literature now supports that select patients with unilateral occlusive common or external iliac disease may be treated with an AUI stent graft alone without femorofemoral crossover bypass. Here, we present a case of a 79-year-old female with an abdominal aortic aneurysms with unilateral occlusive iliac disease managed with an AUI stent graft who subsequently developed rest pain requiring a femorofemoral crossover bypass.
Patient Best Interest
Authors: Veatch Robert M. 
Published: August 2024

Abstract
Classical healthcare ethics generated by the health professions centers on the maxim that the health professional should do what will benefit the patient according to the professional’s ability and judgment. In the modern healthcare ethics of the 20th century, this faced four problems: basing patient benefit on the individual clinician’s judgment; excluding the interests of others; giving benefits and harms priority over moral rights; and assuming that the health professional can be expected to know the patient’s interests. Late in the 20th century, this maxim was first challenged by the occasional ethically exotic case such as abortion in which the patient’s moral perspective was recognized. By the end of the century, however, a more radical challenge had emerged: the realization that literally every clinical decision requires that some value perspective be superimposed on the basic medical and nursing facts and that there is no reason to assume that the clinician is an expert on which value perspective is relevant. This presents new challenges in nursing ethics.
Conceptions of Vulnerability Within the Context of Clinical Research
Authors: Deem Michael J. , Erlen Judith A. 
Published: August 2024

Abstract
Clinical research aims to produce new knowledge, understanding, and therapeutics to advance the care and treatment of patients. Sometimes achieving these goals involves recruitment of patients who are labeled as “vulnerable” by researchers, clinicians, and international ethics bodies. Despite the near ubiquity of the term vulnerable populations in discourse about nursing education, care, and research, it is not clear that such discourse consistently picks out the same referent when using the term. This chapter aims to clarify the term vulnerable as it is utilized in the context of clinical research. After mapping some of the conceptual terrain of vulnerability in clinical research contexts, the chapter provides a narrative ethical account of one author’s own research experience with two different study populations. Finally, the chapter examines the ethical and practical insights gained from combining these conceptual and narrative approaches to vulnerability and argues that while vulnerability is more appropriately recognized in individuals rather than populations, the label “vulnerable population” can be useful when researchers bear in mind certain qualifications regarding to what and to whom the term vulnerable refers.
Empowering Parents for Better Decision-Making
Authors: Salter Erica K. 
Published: August 2024

Abstract
Being a parent of an ill child, especially an acutely ill child, is a disorienting and bewildering experience. Studies examining parental coping during a child’s hospitalization demonstrate that a primary contributor to a parental stress response was the “loss of parenting role” experienced by parents. Pediatric clinical ethics tends to focus on conflicts in isolated treatment decisions, but in so doing can neglect the important reality that because of the disorienting nature of parenting an ill child, parents often engage (or disengage) in the decision-making process from a position of disempowerment, insecurity, and fear because their role as parent has been disrupted. The result can be disastrous: communication deteriorates, parents withdraw or become “difficult,” clinicians become frustrated, and nurses, in particular, are left feeling like surrogate parents. This chapter argues that pediatric clinical ethics should recognize the centrality of the parenting role and the practices of parenting to good clinical decision-making and invest in the empowerment of parents in reclaiming and reformulating their role as parent. The chapter argues that by returning attention to the practices and goods of parenting, parents of ill children are better equipped to engage in treatment decision-making. The chapter concludes with practical suggestions for how to engage, empower, and equip the parents of ill children as they reclaim their role as parents in the wilderness of significant childhood illness. Special attention is paid to the role nurses play in this process as they are uniquely positioned to help parents reimagine and reclaim their role.
Consent and My Chronically Ill Child
Authors: Largent Emily A. 
Published: August 2024

Abstract
Informed consent has roots in both ethical theory and in law. The underpinning for consent is respect for autonomy, which is typically understood as independence and self-rule or self-determination. A challenge arises in pediatrics because children generally lack the ability to act independently, either because they are minors and not considered legally capable of medical decision-making, or because developmentally they have limited or no decision-making capacity. Therefore, modifications to the informed consent framework are necessary in pediatrics: a child’s parents or guardians provide informed permission, while the child gives assent, or affirmative agreement, if appropriate. In this chapter, the author considers consent—not for care but for a child’s involvement in research and clinician training activities—through a personal lens. Such decisions are difficult because, whereas care is intended solely for the child’s benefit, research and training are intended to benefit future patients—by producing generalizable knowledge or better doctors.
Relational Autonomy
Authors: Larkin Philip J. 
Published: August 2024

Abstract
As people make the complex transitions from living to dying, issues of autonomy become critical in how and why decisions are made, who makes them, and why. Western cultural thought would support the right of individual self-determination, a model prevalent in literature. However, taking a European lens, there are opposing arguments, rejecting individualism in favor of a family- or community-oriented decision-making system.
This chapter considers the debate on autonomy in the context of palliative and end-of-life care from the perspective of relational ethics. Using the framework proposed by Bergum and Dossetor (2005) around a series of clinical end-of-life care scenarios, the argument will be made that more compassionate, respectful, and clinically safe decisions can be made if taking a relational perspective that values how people can make decisions in “communitas” rather than only at an individual level.
Help Wanted
Authors: Chapple Helen Stanton , Gillen Megan 
Published: August 2024

Abstract
Being a nurse in the intensive care unit (ICU) is difficult work. It is physically, emotionally, intellectually, ethically, and spiritually taxing. This chapter explores the connection between the nurse and the machines used in the ICU as an unrecognized factor in the stress that ICU nurses undergo. The authors portray these machines and their management as part of the rescue project designed to alleviate society’s terror of human finitude. Using a case interview, they show that ICU nurses shoulder a burden that society disdains: negotiating the transition to dying while making it meaningful. Such an endeavor requires multilevel social support. But the solidarity that could enable success in this task on society’s behalf is intermittent, inconsistent, and inadequate. Without it, clinicians suffer, risk errors, and ultimately leave the bedside. Nurses use emotional labor to negotiate everyone’s detachment from the technology that is the lifeblood of the ICU environment. They need help.
Inhaled Nitric Oxide in Full-Term and Nearly Full-Term Infants With Hypoxic Respiratory Failure
Authors: Bassler Dirk 
Published: August 2024

Abstract
Inhaled nitric oxide was evaluated in several small studies with inconsistent results. The NINOS Trial investigated whether inhaled nitric oxide would reduce mortality or the need for extracorporeal membrane oxygenation (ECMO) in infants born at or near term who had hypoxic respiratory failure that was unresponsive to aggressive conventional therapy. Two hundred thirty-five infants were enrolled in this prospective randomized trial. Sixty-four percent of the control group and 46% of the nitric oxide group died within 120 days or were treated with ECMO (p = 0.006). The main benefit of nitric oxide was reduced use of ECMO, with little apparent effect on mortality.
Outcome at Two Years of Age of Infants From the DART Study
Authors: Onland Wes , van Kaam Anton H. 
Published: August 2024

Abstract
At the time of this trial, the various tradeoffs of dexamethasone—in particular that between ease of extubation and long-term neurodevelopmental outcomes—were quite uncertain. The DART study investigated the efficacy and safety of a low-dose dexamethasone regimen initiated after the first week of life. The study’s target sample size was 814, but enrollment had to be abandoned after 2 years of recruitment because of increasing lack of clinician equipoise and difficulty with recruitment following various professional and Academy statements. Ultimately, 70 ventilator-dependent extremely preterm infants were randomized to a dexamethasone regimen (0.89 mg/kg total, via a 10-day tapering course) or saline placebo, showing in the initial short-term publication that dexamethasone facilitates extubation. This follow-up study showed that there was no difference in the primary outcome of death or major disability at 2 years of age (45.7% versus 42.9%; RR 1.07, 95% CI 0.63 to 1.80).
Neurodevelopmental Outcome at 5 Years of Age After General Anesthesia or Awake-Regional Anesthesia in Infancy
Authors: DeMauro Sara B. 
Published: August 2024

Abstract
GAS was the first RCT to assess the effect of general anesthesia in infancy on childhood neurocognitive outcomes. This randomized, controlled, equivalence trial compared regional versus general anesthesia for infants undergoing inguinal hernia repair. The primary outcome was full-scale intelligence quotient (IQ) at 5 years. The investigators demonstrated equivalence of the 2 approaches—both IQ and multiple secondary neurodevelopmental and behavioral outcomes were similar in the 2 study arms at 5 years. Based on these results, clinicians and parents can be reassured that a single short exposure to general anesthesia during infancy should not have adverse developmental consequences during childhood.