bluuebunny/crossref_metadata_2025_split huggingface dataset:
Medicaid Expansion, Uninsurance Rates, and Catastrophic Costs at the Time of Emergency Gynecologic Surgery
Authors: Carrillo-Kappus Kristen , Albright Benjamin , Unnithan Shakthi , Erkanli Alaattin , Moss Haley 
Published: February 2025

OBJECTIVE:
To estimate the effect of Medicaid expansion on uninsurance rates and catastrophic charges from emergency surgical management of ectopic pregnancy and ovarian torsion using difference-in-difference analysis and to evaluate for racial and ethnic disparities.

METHODS:
We conducted a retrospective cohort analysis using 2012–2018 State Inpatient Data and State Ambulatory Surgery and Services Databases in four states: Kentucky and Maryland (expansion) and Florida and North Carolina (nonexpansion). Patients undergoing surgical management of ovarian torsion or ectopic pregnancy were included. Logistic regression models were used controlling for year and expansion type; a difference-in-difference treatment indicator was used to evaluate changes in uninsurance rates and catastrophic spending (hospital charges more than 10% of estimated annual median income) among those uninsured. We then examined race and ethnicity for those uninsured before and after expansion by state.

RESULTS:
A total of 594,116 patients were included. Before expansion, the percent of patients uninsured was higher in nonexpansion states (6.5%) compared with expansion states (5.1%). After expansion, the percent uninsured decreased from 5.1% to 2.4% in expansion states compared with 6.5% to 5.3% in nonexpansion states. The interaction between expansion year and Medicaid expansion status was significant (P<.001). Pre-expansion percent catastrophic charges among uninsured patients were higher in nonexpansion states compared with expansion states (96.7% vs 85.7%). After expansion, the percent catastrophic financial burden remained higher at 96.9% in nonexpansion states compared with 82.5% in expansion states. The interaction between expansion year and Medicaid expansion status was significant (P<.001). The uninsured gap between Black or African American and White patients in expansion states after expansion was 0.5%—relatively unchanged—compared with 11.6% for Hispanic and non-Hispanic patients, an increase from 8.3% before expansion.

CONCLUSION:
Medicaid expansion was associated with reductions in uninsured hospitalizations and catastrophic charges after gynecologic surgical emergencies and was associated with differences between Hispanic and non-Hispanic patients.
A Comprehensive Analysis Between Disk Geometry and Posterior Muscle Characteristics Among Degenerative Spine Patients
Authors: Jung Bongseok , Mathew Joshua , Sheikh Alshabab Basel , Elysee Jonathan , Duvvuri Priya , Fallon John , Abbas Anas , Katz Austen , Song Junho , Strigenz Adam , Zappia Luke , Lafage Renaud , Essig David , Lafage Virginie , Virk Sohrab 
Published: February 2025

Study Design:
A retrospective Cohort Study.

Objective:
The aim of this study is to investigate the associations between posterior muscle health characteristics and disk geometry parameters between L1 and S1.

Summary of Background Data:
Paralumbar muscle changes have been associated with clinical outcomes. However, the relationship between disk geometry and paralumbar muscle changes has not been defined.

Methods:
Axial T2 MRI was analyzed for paralumbar muscle measurements, and lateral radiographs were analyzed for disk geometry parameters in patients with disk degeneration. Associations between disk shape and muscle health at each individual lumbar level were evaluated using a partial correlation controlling for age and sex. Demographic data were compared between the listhesis groups, and an ANCOVA analysis controlling for significant demographic parameters was conducted to evaluate differences in muscle characteristics.

Results:
In all, 435 patients were included (age: 55.6±15, BMI: 29.5±6, 60.9% female, 41.3% White). Muscle health median characteristics were CSA/BMI=140, LIV=13, and Goutallier Classification of 1. Partial correlations between focal disk parameters and muscle health controlling for age and sex showed moderate significant positive associations between focal lordosis and lumbar indentation value (LIV) at every level L1-S1 (mean r=0.264 between L1 and L5, P<0.001), weak positive association between focal lordosis and CSA/BMI (mean r=0.113 at L2-L5, P <0.03), and weak negative associations between disk height and Goutallier Classification (mean r=0.158 at L1–L5, P<0.03). Listhesis at L4–S1 was stratified, and ANCOVA controlling for sex and age demonstrated no significant association between S and R groups and CSA/BMI, LIV, or Goutallier classification (P>0.1).

Conclusions:
Posterior muscle health was significantly associated with disk shape, especially disk height and disk lordosis, with larger and more lordotic disks being associated with better muscle health. Disk listhesis was not significantly associated with muscle quality when controlling for demographic characteristics, and no differences in muscle health parameters were observed in patients with spondylolisthesis versus retrolisthesis. Overall, the results highlight important associations between lumbar compensation, disk geometry, and posterior muscle health.
Cystatin C-Guided Dosing Nomogram Improves Target Attainment for Cefepime in the Critically Ill
Authors: Barreto Erin F. , Scheetz Marc H. , Chang Jack , Cole Kristin C. , Fogelson Lindsay A. , Paul Johar , Jannetto Paul J. , Gajic Ognjen , Rule Andrew D. ,   for the Beta Lactam Optimization and Outcomes Management (BLOOM) Study Group
Published: February 2025

Objectives:
Estimated glomerular filtration rate is more accurate with combined creatinine and cystatin C equations (eGFRcr-cys) than creatinine alone. This study created and evaluated a cefepime dosing nomogram based on eGFRcr-cys for initial dosing in the critically ill.

Design:
Pharmacokinetic modeling and simulation study.

Setting:
Academic medical center.

Patients:
Critically ill adults treated with cefepime.

Interventions:
None.

Measurements and Main Results:
Data from 120 patients with baseline cystatin C and follow-up cefepime levels were used to develop a nomogram based on eGFRcr-cys and weight for initial cefepime dosing. The predicted proportion of patients who achieved a free cefepime concentration above the minimum inhibitory concentration of the organism for 100% of the dosing interval in the first 24 hours (100% ƒT > MIC at 24 hr) was compared between administered doses and those predicted by the nomogram doses. Overall drug exposure was estimated with the free area under the concentration time curve from 0 to 24 hours (ƒAUC0–24) and compared between administered and nomogram doses. Achievement of 100% ƒT > MIC at 24 hours was predicted to be significantly better with the nomogram compared with the administered dose (76% vs. 38%; p < 0.001). The median ƒAUC0–24 as predicted by the nomogram (666 mg·hr/L) was slightly higher than the actual ƒAUC0–24 with administered doses (612 mg·hr/L; p = 0.01), but the nomogram led to fewer ƒAUC0–24 values which were either too high (> 900) or too low (< 300) (7% vs. 20%; p = 0.004).

Conclusions:
Use of a cystatin C-inclusive dosing nomogram for cefepime could improve target attainment without increasing the risk of potentially toxic levels in the critically ill.
Elevated C-reactive protein and cardiovascular risk
Authors: Chia Jia Ee , Ang Song Peng 
Published: February 2025

Purpose of review
This review critically examines the evolving role of C-reactive protein (CRP) in cardiovascular disease (CVD), addressing its pathogenesis and relationship with various CVDs including coronary artery disease (CAD), heart failure, and atrial fibrillation.

Recent findings
CRP is mechanistically implicated in endothelial dysfunction, oxidative stress, and plaque destabilization. Recent studies demonstrate that lipid-lowering agents (statins, bempedoic acid) and anti-inflammatory therapies (canakinumab, colchicine) reduce CRP levels and improve outcomes in CAD. In heart failure, elevated CRP predicts adverse events, though evidence on phenotypes varies, and novel therapies (glucagon-like peptide-1 agonists, sodium-glucose cotransporter-2 inhibitors) lower CRP independently of weight loss. For atrial fibrillation, CRP correlates with postoperative incidence and recurrence postablation, though data remain inconsistent. Guidelines offer differing opinion with the American College of Cardiology and the American Heart Association (ACC/AHA) guidelines cautiously endorsing CRP for risk stratification in intermediate-risk individuals, while European guidelines advise against its routine use for primary prevention, reflecting unresolved questions about CRP's additive value.

Summary
CRP remains a pivotal inflammation biomarker in CVD, yet its causal role and clinical applicability require clarification. While CRP-guided therapies show promise, discrepancies in guidelines highlight the need for robust trials to determine whether targeting CRP directly improves outcomes. Future research should focus on CRP's pathophysiological mechanisms and validate its utility in personalized CVD management.
The 2024 ILTS-ILCA consensus recommendations for liver transplantation for hepatocellular carcinoma and intrahepatic cholangiocarcinoma
Authors: Kodali Sudha , Kulik Laura , D’Allessio Antonio , De Martin Eleonora , Hakeem Abdul Rahman , Lewinska Monica , Lindsey Stacie , Liu Ken , Maravic Zorana , Patel Madhukar S. , Pinato David , Rammohan Ashwin , Rich Nicole , Sanduzzi Zamparelli Marco , Victor David W. , Vinaxia Carmen , Brombosz Elizabeth W. , Villanueva Augusto , Meyer Tim , Selzner Nazia , Ghobrial R. Mark , Rela Mohamed , Sapisochin Gonzalo 
Published: February 2025

Background:
Liver transplantation (LT) provides the best long-term survival outcomes for patients with liver cancer. As a result, the field of transplant oncology has grown greatly over the past few decades, and many centers have expanded their criteria to allow increased access to LT for liver malignancies. Center-level guidelines and practices in transplant oncology significantly vary across the world, leading to debate regarding the best course of treatment for this patient population.

Methods:
An international consensus conference was convened by the International Liver Transplantation Society and the International Liver Cancer Association on February 1-2, 2024, in Valencia, Spain to establish a more universal consensus regarding LT for oncologic indications. The conference followed the Delphi process, followed by external expert review.

Results:
Consensus statements were accepted regarding patient assessment and waitlisting criteria, pre-transplant treatment (including immunotherapy) and downstaging, living donor liver transplantation, post-LT patient management, and patient- and caregiver-related outcomes.

Conclusion:
The multidisciplinary participants in the consensus conference provided up-to-date recommendations regarding the selection and management of patients with liver cancer being considered for LT. Although participants deferred to center protocols in many cases, there was great interest in safely expanding access to LT for patients with larger tumor burden and biologically amenable lesions.
Noninvasive Targeted Temperature Management of the Inner Ear: Numerical Simulations and Experimental Measurements in a Human Cadaver Model
Authors: Yepes Maria Fernanda , Hoffer Michael E. , Chiossone Juan Armando , Soejima Nathaniel , King Curtis S. , Rajguru Suhrud M. 
Published: February 2025

Hypothesis
Mild therapeutic hypothermia (MTH) could be delivered to the human inner ear using a localized, noninvasive approach to achieve protective temperature reductions without systemic side effects.

Background
MTH has demonstrated protective effects in the cochlea following injuries such as device implantation, ototoxicity, and noise overexposure. It targets key cellular mechanisms, including proinflammatory pathways, oxidative stress, pyroptosis, and apoptosis. However, systemic and invasive methods for MTH carry risks and are less practical for broader clinical applications. Developing a localized, noninvasive approach could offer a safer, more accessible solution for hearing preservation after cochlear injury.

Methods
Cadaveric middle and inner ear structures, maintained near physiological conditions, were used to test a custom-designed cooling gel pack (ReBound) placed externally on the temporal bone. Temperature changes were recorded over 60 or 30 minutes. To complement experimental findings, three-dimensional geometrical models were created from imaging data, and finite element heat transfer analysis simulated temperature changes across inner ear structures.

Results
With external gel pack application, inner ear temperatures dropped by 2.9°C within 30 minutes and 4.6°C within 60 minutes. Cooling persisted for 10 minutes post-device removal. Numerical modeling corroborated these findings, indicating average temperature reductions of 2°C to 4°C. Biological sex differences were observed in cooling efficiency and overall temperature drop.

Conclusion
This study demonstrates that localized, noninvasive MTH can effectively reduce inner ear temperatures to therapeutically relevant levels. These findings support a promising, clinically translatable approach for protecting cochlear structure and function after injury, with minimal systemic risks.
Usefulness of a Digital Tool to Improve Methodology and Reporting of Breath Tests for Small Intestinal Bacterial Overgrowth
Authors: Pereyra Lisandro , Steinberg Leandro , Navar Sofia , Stefanolo Juan P. , Schlottmann Francisco 
Published: February 2025

Goals:
We aimed to determine if the use of a web-based digital tool could improve methodology and reporting of breath tests (BT).

Background:
Although BT represent a noninvasive and low-cost tool for the diagnosis of small intestinal bacterial overgrowth (SIBO), lack of standardization and poor test performance have been described.

Methods:
We performed a retrospective analysis of a consecutive series of BT reports from 8 different gastroenterology units during the period April 2024 to July 2024. Data from the BT reports was extracted, masked, and uploaded in a digital tool that supports the entire breath test process and creates a report. Three experts in SIBO who were blinded for the test interpretation determined a diagnosis for each patient and delineated a total of 12 quality items that considered relevant to be included in a BT report. The main outcomes of the study were accuracy (ie, proportion of correct diagnoses) and quality of BT reports.

Results:
A total of 210 BT were analyzed; the type of substrate was informed in 187 (89.0%) BT and lactulose was used in most of the studies (162/187, 86.6%). Most tests measured only hydrogen (89.5%) and 38 (18.1%) extended the BT for <90 minutes. SIBO was diagnosed in 92 (43.8%) and 79 (37.6%) patients in the original BT report and the digital tool report, respectively. As compared with the diagnosis by the expert gastroenterologists and current guidelines, the original report was accurate in 182 (86.6%) patients and the digital tool report in 210 (100%) patients (P<0.0001). Regarding quality of reporting, the original BT report had a median of 5 (3 to 8) items included and the digital tool report described a median of 9 (7 to 11) items (P<0.0001).

Conclusions:
Breath tests methodology and interpretation for the diagnosis of SIBO are heterogenous and do not comply with current guidelines. The use of a web-based digital tool specifically developed to assist the entire BT process appears to improve accuracy and quality of reports.
Effects of Acupoints-Based TENS at Different Frequencies + tDCS on Poststroke Spastic Hemiplegia: A Randomized Controlled Trial
Authors: Wang Xiu-Yan , Qian Xu , Ma Liang-Xiao , Xiu Jing-Yun , Ma Ling-Hui , Chen Meng-Yu , He Jia-Ling 
Published: February 2025

Background:
Acupoints-based transcutaneous electrical nerve stimulation (Acu-TENS) and transcranial direct current stimulation (tDCS) may contribute to the rehabilitation of poststroke spastic hemiplegia, but the evidence remains inadequate, particularly regarding the frequency selection of Acu-TENS.

Study Question:
Whether Acu-TENS + tDCS is effective for poststroke spastic hemiplegia and what is the optimal frequency of Acu-TENS?

Study Design:
Ninety patients were randomly allocated in a 1:1:1 ratio to 2 observation groups and a standard care control group. All participants received regular rehabilitation and standard care. In addition, 1 mA tDCS + Acu-TENS at 20 Hz or 100 Hz was applied in observation groups for 12 sessions for 4 weeks.

Measures and Outcomes:
The primary outcome was the Modified Ashworth Scale change from baseline to week 4. Secondary outcomes included the Fugl-Meyer Assessment, Modified Barthel Index, co-contraction ratio, and integrated electromyography. Outcomes were assessed at baseline, after 4-week treatment, with 4-week follow-up.

Results:
Both observation groups showed reductions in the change of Modified Ashworth Scale compared with the control group after 4-week treatment [Acu-TENS-20 Hz + tDCS vs. control, −0.48 (95% confidence interval, −0.64 to −0.33); P < 0.001; Acu-TENS-100 Hz + tDCS vs. control, −1.44 (95% confidence interval, −1.63 to −1.26); P < 0.001]. Acu-TENS-100 Hz + tDCS group provided a greater decrease in Modified Ashworth Scale than 20 Hz [−0.96 (95% confidence interval, −1.15 to −0.77); P < 0.001]. The observation groups increased Fugl-Meyer Assessment, Modified Barthel Index, and co-contraction ratio of limbs and declined integrated electromyography of spasmodic muscles of flexor carpi radialis and gastrocnemius (P < 0.05). No differences were observed among groups in integrated electromyography of antagonistic muscles.

Conclusions:
For poststroke spastic hemiplegia, Acu-TENS + tDCS might be an effective adjunctive modality, and 100 Hz Acu-TENS is recommended, which should be verified in larger trials.

Trial Registration:

www.chictr.org ChiCTR2200067186.
Gene therapy for sickle cell disease and thalassemia
Authors: Scaramellini Natalia , Panzieri Daniele Lello , Cappellini Maria Domenica 
Published: February 2025

Purpose of review
Thalassemia and sickle cell disease are among the most frequent monogenic hereditary diseases. Access to transfusions, iron chelation therapies and drugs such as hydroxyurea have improved life expectancy and quality of life. However, these diseases still cause significant disability. The first available curative therapy, bone marrow transplantation, is unfortunately not feasible for all patients. Over the past decade, numerous studies have focused on finding new curative therapies, and many clinical trials have evaluated different gene therapy approaches.

Recent findings
The therapeutic targets focus on adding functional copies of the gene encoding β-globin in defective CD34+ cells, mainly using lentiviral vectors directed towards HSCs. More recently, the focus has shifted to inducing fetal hemoglobin production at therapeutic levels or repairing the underlying molecular defect, using novel gene editing techniques involving CRISPR-Cas9, transcription activation-like effector protein nucleases, zinc finger nucleases and base editing. Preclinical and clinical studies now focus on optimizing how gene therapy is performed and delivered to reduce or eliminate myeloablative treatment and its potential adverse events.

Summary
In this review, we explore the potential to induce fetal hemoglobin production at therapeutic levels or to repair the underlying molecular defect that causes the disease genetically. Here, we review recent gene editing studies that are opening a new era in curative treatment for hemoglobinopathies.
The promise of cerebral organoids for neonatology
Authors: Howard Clare E. , Cheenath Manju , Crouch Elizabeth E. 
Published: February 2025

Purpose of the review
Applying discoveries from basic research to patients in the neonatal intensive care unit (NICU) is challenging given the difficulty of modeling this population in animal models, lack of translational relevance from animal models to humans, and lack of primary human tissue. Human cell derived cerebral organoid models are an appealing way to address some of these gaps. In this review, we will touch on previous work to model neonatal conditions in cerebral organoids, some limitations of this approach, and recent strategies that have attempted to address these limitations.

Recent findings
While modeling of neurodevelopmental disorders has been an application of cerebral organoids since their initial description, recent studies have dramatically expanded the types of brain regions and disease models available. Additionally, work to increase the complexity of organoid models by including immune and vascular cells, as well as modeling human heterogeneity with mixed donor organoids will provide new opportunities to model complex neonatal pathologies.

Summary
Organoids are an attractive model to study human neurodevelopmental pathologies relevant to patients in the neonatal ICU. New technologies will broaden the applicability of these models to neonatal research and their usefulness as a drug screening platform.
Assessing basic life support awareness, and knowledge among university undergraduates: a cross-sectional study
Authors: Baklola Mohamed , Elnemr Mohammed , Ghazy Mohamed , Omar Yusof , Darwish Nour Edin , Ahmed Baher , Alkalla Eman , Reda Reem , Elmimy Hanaa , Mohamed Teeb , Sherif Aya , Al-Bawah Naji , Shaheena Dina Gamal 
Published: February 2025

Background:
Basic life support (BLS) is a critical skill for saving lives during emergencies. This study aims to assess BLS awareness and knowledge among undergraduates at University, examining the impact of gender, faculty, and prior correct cardiopulmonary resuscitation (CPR) training on students’ confidence and competence.

Methods:
A descriptive, cross-sectional study was conducted from August to December 2023 across six faculties: medicine, nursing, engineering, sciences, commerce, and law. Using convenience sampling, a total of 1165 students participated by completing a self-administered, bilingual questionnaire. Descriptive statistics, Pearson correlation tests, t-tests, ANOVA, and multivariate logistic regression analyses were performed using SPSS software version 26, with visual representations created using R software.

Results:
The majority of participants were female (64.8%), with a significant portion (70%) believing that CPR training should be mandatory. Only 29.6% had received CPR training. Females scored higher on BLS knowledge than males (4.9 vs. 4.5, P < 0.05). Students from medical faculties had greater BLS knowledge compared to their non-medical peers (6.3 vs. 3.5, P < 0.05). Trained students were more confident in performing CPR (35.1% vs. 10.2% among untrained, P < 0.05). Multivariate logistic regression identified prior CPR training and medical faculty enrollment as significant predictors of higher BLS knowledge and confidence.

Conclusion:
Significant gaps in BLS knowledge and training exist among University undergraduates, with disparities based on gender, faculty, and prior training. The findings underscore the need for mandatory CPR training across all faculties to enhance student preparedness and competence.