bluuebunny/crossref_metadata_2025_split huggingface dataset:
Panniculus Retractor Use for Visualization of Fetal Anatomy
Authors: Wise Melissa L. , Okon Marvin , Pratt Katelyn N. , Lane Andrew S. , Carlson Laura M. , Eichelberger Kacey Y. , Crockett Amy H. , Zhang Lu , Pasko Daniel N. 
Published: July 2024

OBJECTIVE:
To evaluate whether use of a panniculus retractor device for pregnant patients with body mass index (BMI) 40 or higher and a panniculus improves the completion rate of the fetal anatomic examination.

METHODS:
This was a randomized trial in which eligible patients with BMI 40 or higher and a panniculus were randomized to undergo their detailed fetal anatomic examination with a panniculus retractor device in place compared with usual care. The primary outcome was the completion rate of 16 prespecified views from the anatomic examination. Secondary outcomes included completion rate of all 64 views from our institution's detailed anatomic examination, duration of examination, major fetal anomaly detection rate, depth from the skin to amniotic cavity before and after retractor placement, patient and ultrasonographer satisfaction, and prespecified adverse events. We assumed a baseline completion rate of 23% for the primary outcome and targeted a twofold improvement with 80% power and two-sided α of 0.05, which resulted in a sample size of 132 participants. The goal enrollment was increased to 150 participants to account for potential dropout. Statistical tests included the Student’s t test, χ2, and relative risks (RRs) as appropriate.

RESULTS:
From March to July of 2023, 150 participants completed the study: 74 in the retractor group and 76 in the usual care group. Baseline characteristics were similar between groups except for panniculus grade. The completion rate of 16 prespecified views was 25.7% (19/74) in the retractor group and 31.6% (24/76) in the control group (RR 0.81, 95% CI, 0.49–1.35). There were no significant differences between groups for any of the secondary outcomes. Patient satisfaction and ultrasonographer satisfaction were similar between groups.

CONCLUSION:
Use of a panniculus retractor device during the fetal anatomic examination for patients with BMI 40 or higher and a panniculus was well tolerated by patients and ultrasonographers but did not improve the completion rate of 16 prespecified fetal anatomic views.

CLINICAL TRIAL REGISTRATION:

ClinicalTrials.gov, NCT05764408.
Efficacy and Safety of Extended-Release Dinalbuphine Sebacate for Postoperative Analgesia: A Systematic Review and Meta-analysis
Authors: Hsieh Yu-Lien , Wang Chi-Fei , Lin Chung-Ren 
Published: July 2024

Abstract

Background
Multimodal analgesia, which combines multiple medications with different analgesic mechanisms, is recommended for optimizing postoperative pain control and minimizing opioid-related side effects. Dinalbuphine sebacate (DNS), a prodrug of nalbuphine, has a 7-day long-acting analgesic effect on moderate to severe postoperative pain. We conducted a systematic review and meta-analysis to analyze the efficacy and safety of dinalbuphine sebacate for postoperative pain management.

Materials and Methods
We systematically searched PubMed, Embase, and the Cochrane Central Register of Controlled Trials to identify randomized controlled trials (RCTs) of DNS for postoperative analgesia. We assessed the quality of all included studies using the risk-of-bias tool. The primary outcome was postoperative pain score, and the secondary outcomes included analgesic consumption, need for rescue analgesics, adverse events, and length of hospital stay. A meta-analysis was performed for the pooled data, and the level of evidence was rated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system.

Results
We included five RCTs with 497 patients who underwent surgery. Compared with the control group, DNS significantly reduced the visual analog scale (VAS) through postoperative 48 hours {mean difference (MD) -37.54 (95% confidence interval [CI]: -70.47, -4.62)} to 7 days [MD -165.99 (95% CI: -231.44)], and decreased the requirement for rescue analgesics [RR 0.89 (95% CI: 0.81, 0.97)]. No significant difference was noted in VAS scores within postoperative 24 hours [MD -10.13 (95% CI: -30.11, 9.85)] or in total analgesic consumption. Patients receiving DNS had a higher risk of dizziness and injection site reactions, without an increased occurrence of other adverse events.

Conclusions
With a low-to-moderate level of evidence, intramuscular DNS provides long-lasting analgesia from postoperative 48 hours to 7 days and may reduce the requirement for postoperative rescue analgesics. However, DNS does not offer additional pain relief within the first 24 hours postoperatively. Further high-quality studies are warranted.
International Prospective Register of Systematic Reviews (PROSPERO) registry: identifier: CRD42023494130
Pressurized intraperitoneal aerosol chemotherapy (PIPAC): Why it will transform cancer surgery
Authors: Reymond Marc Andre , Sautkin Yaroslv , Schönfelder Hans , Solass Wiebke 
Published: July 2024

Abstract
Pressurized intraperitoneal aerosol chemotherapy (PIPAC) represents an innovative method for delivering chemotherapy directly into the abdominal cavity, offering a targeted, effective, and less toxic treatment option for patients with nonresectable peritoneal metastasis (PM). PIPAC is increasingly adopted due to its benefits over traditional therapies, including enhanced drug penetration, reduced systemic toxicity, and improved efficacy in chemoresistant PM. Performed laparoscopically, PIPAC is minimally invasive, often outpatient, and well-tolerated, preserving patients’ quality of life. So far, PIPAC has been mainly used in advanced PM from ovarian, gastric, and colorectal cancers, where it can be effective even after other treatments have failed. The repeatable nature of PIPAC offers opportunities for maintenance therapy and long-term disease control. A recent meta-analysis of PIPAC studies reported a 4% nonaccess rate and 39% of patients completing three or more cycles, with only 4% experiencing severe toxicities. Pathological responses were observed in 68% of cases, indicating reliable efficacy. A first randomized trial showed PIPAC’s superiority in objective response rates and quality of life compared with intravenous chemotherapy for platinum-resistant ovarian cancer. Research in PIPAC is dynamic and multidisciplinary, aiming to refine the technique, minimize side effects, and expand its applicability to various cancers. Studies focus on the efficacy of aerosolized drug delivery, including nanoparticles and RNA-based therapies, which offer targeted treatment options with promising therapeutic potential. Innovations such as electrostatic precipitation PIPAC (ePIPAC) combine enhanced drug distribution with increased tissue penetration, representing significant advancements in PM treatment. Future developments will focus on optimizing aerosol characteristics, drug formulations, and personalized medicine approaches.
Uranium Mine Proposed Experimental Design for Natural Background Gross Gamma Exposure Rates, Post Remediation Final Status Survey Sampling Density, and Radiological Water Quality Modeling for a Worst-case Catastrophic Failure, Coles Hill, Virginia
Authors: Weyant David B. , Yoon Jaewan 
Published: July 2024

Abstract
Completely randomized experimental design statistical modeling techniques were employed to analyze exposure rate measurements for evaluating hypothetical natural background post uranium mill operations at Coles Hill, Virginia uranium milling processes. The proposed Coles Hill Uranium Mine is situated upstream of the Banister River. This River is nearly homogenous throughout the reach length used in analysis and feeds into the mouth of Kerr Reservoir, Lake Gaston, which serves as the main drinking water source for cities in the Hampton Roads area including Norfolk, Virginia Beach, and Chesapeake. A critical scan value (=DCGLscan) was developed to flag anomalies of surface contamination during simulated post remediation final status surveys. The natural background was critical for meeting the Multi-Agency Radiation Survey and Site Investigation Manual guidance for post remediation final status surveys. The overarching null hypothesis suggested that the selected mean natural background is equal to the survey unit’s mean natural background. Using SAS Procedures Shapiro-Wilk Test, ANOVA, and CR, it was decided the exposure rate data was normal, had no extreme outliers, and no collinearity between the number of samples (=treatment) and the areas (=block). Using the q-hyper (hypergeometric) distribution, the soil sampling density was decided for a final status survey unit. The most likely worst-case catastrophic failure analysis, 500-year event, such as the1969 Hurricane Camille of 69 centimeters of rain in Nelson County, Virginia was included in the model. The model showed impact was minimal at most to the Banister River’s drinking water and likely less than the Virginia’s Drinking Water Standards for gross alpha, 226Ra and 228Ra, and total uranium.
Association between bariatric surgery and outcomes of total joint arthroplasty: a meta-analysis
Authors: Liu Pan , Meng Jiahao , Tang Hang , Xiao Yifan , Li Xi , Wu Yumei , Liu Weijie , Xiong Yilin , Gao Shuguang 
Published: July 2024

Background:
Total joint arthroplasty (TJA) alongside bariatric surgery (BS) is frequently operated on in obese arthritis patients. The controversy persists regarding BS before TJA, and the extent of its impact on the prognosis of TJA patients remains uncertain. To explore this, we conducted a meta-analysis.

Methods:
As of 1 October 2023, the latest search on PubMed, Cochrane Library, Embase, and Web of Science was conducted to compare outcomes between patients who underwent preoperative BS and those who did not. The analysis focused on parameters such as length of stay (LOS), infection risk, venous thromboembolism, revision, transfusions, dislocations, periprosthetic fractures, knee stiffness, medical complications, and all-cause mortality in the eligible studies.

Results:
This meta-analysis included 18 trials with a total of 292 196 patients. Pooled findings indicated that preoperative BS significantly shortened the LOS (MD, −0.16; 95% CI, −0.25 to 0.07; I
2=58%; P=0.0004) and increased the risk of dislocation within 90 days (OR, 1.70; 95% CI, 1.20–
2
.42; I
2=21%; P=0.003) and all-cause mortality within 30 days (OR, 3.69; 95% CI, 1.81–7.49; I
2= 0%; P =0.0003) for TJA, in comparison with patients without BS. In the total hip arthroplasty (THA) subgroup, BS was more favorable, exhibiting significantly reduced risk of short-term revision (OR, 0.77; 95% CI, 0.61–0.99; I
2=0%; P=0.04) and long-term infection (OR, 0.72; 95% CI, 0.61–0.85; I
2=0%; P≤0.0001). For total knee arthroplasty (TKA) patients, no significant benefit was identified. In addition, there was no statistically significant correlation between preoperative or postoperative BS and the occurrence of complications in TJA patients.

Conclusions and Relevance:
Compared with the control group without BS, preoperative BS can shorten the LOS, increase the risk of dislocation within 90 days and all-cause mortality within 30 days in TJA, and reduce the risk of specific surgical complications in the THA subgroup but shows no significant difference in the TKA subgroup. There are no differences in clinical outcomes whether BS is performed before or after TJA. More high-quality trials are needed to further clarify the impact of BS on obese patients undergoing TJA.
Complex actions of sodium glucose transporter-2 inhibitors on lipids, calcific atherosclerosis, and bone density
Authors: Pradhan Stuti , Kalanski Sophia , Tintut Yin , Demer Linda L. 
Published: July 2024

Purpose of review
Inhibitors of sodium-glucose cotransporter-2 (SGLT2) lower renal glucose reabsorption and, thus, are used to treat patients with type 2 diabetes mellitus. Clinical trials coincidentally showed that SGLT2 inhibitors also benefitted patients with heart failure. This review explores the impact of SGLT2 inhibitors on other aspects of cardiovascular disease and skeletal health.

Recent findings
In some, but not all, clinical and preclinical studies, SGLT2 inhibitors are found to reduce serum levels of free fatty acids and triglycerides. Their effects on total and low-density lipoprotein cholesterol and cardiac function also vary. However, SGLT2 inhibitors reduce lipid accumulation in the liver, kidney, and heart, and alter expression of lipid metabolism genes. Effects on free fatty acid uptake in abdominal fat depots depend on the location of adipose tissue. In male, but not female, mice, SGLT2 inhibitors reduce the atherosclerotic lesions and aortic calcium deposition. With respect to skeletal health, recent literature has reported conflicting associations with the risks of fracture and amputation.

Summary
Studies suggest that SGLT2 inhibitors reduce tissue lipid accumulation, and in a sex-dependent manner, atherosclerosis and vascular calcification. However, their effects on lipid levels and bone health are complex and remain to be established.
Clonal Hematopoiesis Without Malignant Transformation Lasting Over 2 Years in a 9-Year-old Boy, Following Treatment for Acute Lymphocytic Leukemia
Authors: Yagasaki Hiroshi , Shimozawa Katsuyoshi , Kanezawa Koji , Tamura Takeaki , Kamiyama Makoto , Yamamoto Toshiyuki , Morioka Ichiro 
Published: July 2024

Children with acute lymphocytic leukemia rarely develop secondary hematological neoplasms. A 5-year-old boy was diagnosed with standard-risk precursor B-cell acute lymphocytic leukemia. The patient exhibited aberrant chromosomal changes in the bone marrow at 6 months postchemotherapy: 46,XY,der(6) t(1;6)(q12;p22) dup(6)(p22p12)[15]. Clinically, the patient has sustained complete remission and has not developed myeloid malignancy over the subsequent period (27 mo). The cytogenetic aberration was observed in 11% of CD34+ cells isolated from the bone marrow. We infer that the abnormal clone acquires self-renewal potency, differentiation, and growth advantage. Further long-term observation is needed to determine the nature of this cytogenetic aberration.
Operator syndrome
Authors: Ivory Rebecca Ann , Graber Jennifer S. , Frueh B. Christopher , Cady Harrison 
Published: July 2024

Abstract:
Operator syndrome is a common and predictable constellation of interrelated medical and psychiatric conditions and social and functional impairments experienced by special operations forces. Nurses in all settings should be aware of this emerging trend among veterans they encounter in practice so they may identify and intervene using evidence-based approaches and effect a positive outcome.
Brain death
Authors: Hills Teresa E. 
Published: July 2024

Abstract:
The incidence of brain death/death by neurologic criteria (BD/DNC) among all hospital deaths in the US is approximately 2.06% or 15,000-20,000 cases annually. This article reviews the latest guidelines for adult and pediatric BD/DNC. Although there have not been many changes to the guidelines over the years, BD/DNC guideline updates maintain consistency in determining BD/DNC.
A survey of nurses' experiences with patient visitation restrictions during the COVID-19 pandemic
Authors: Cliff Barbara , Keiser Elina , Malinowski Stacey , Wilson Meagan 
Published: July 2024

Abstract

Purpose:
To characterize nurses' experiences of restrictive visitation during the COVID-19 pandemic.

Methods:
In early 2023, an exploratory study investigated professional RNs' perceptions of restrictive visitation policies and end-of-life care during the COVID-19 pandemic, focusing on experiences between March and September 2020. An 11-question online survey containing qualitative and quantitative elements was sent to postlicensure nursing students and alumni of American Public University System (American Military University/American Public University).

Results:
Among the 41 survey respondents (response rate of 4%), 75.6% observed patients dying alone due to visitation restrictions during March-September 2020, with 87.8% noting strict no-visitation policies, yet only 10% found it effective. A majority (68.3%) supported allowing some family presence, reflecting negative sentiments toward strict policies; suggestions for enhancing family involvement included technology (78%) and employing volunteers or liaisons (34.1%) to improve patient/family well-being and alleviate nurse burden.

Conclusion:
The findings revealed insights into nurses' experiences and perspectives on end-of-life care and visitation limitations during the pandemic. While the isolation of patients during times of strict visitation restrictions has some merit, exploring options for modified family visitation at the end of life is critical.
Impact of the MOVE (Mobility Optimizes Virtually Everything) Program
Authors: Knight Tara , Bruzzi Bethany , Wright Angela , Bohnenkamp Susan K. 
Published: July 2024

Abstract:
Early mobility of hospitalized patients has been associated with improved postoperative results and psychological outcomes, decreased length of stay, and other benefits. This article discusses Mobility Optimizes Virtually Everything (MOVE), an interactive bingo-like activity for patients, and its impact on patient satisfaction, mobility documentation, and decompensation rates.
Pearls and pitfalls of OTC medications for seasonal allergies
Authors: Lewis Paige , Hong Eunhee , Sheridan Dan 
Published: July 2024

Abstract:
Seasonal allergies have a negative impact on patients' quality of life. Nurses must be aware of the different treatment options and lifestyle modifications to help patients manage their symptoms. This article discusses the benefits and risks of over-the-counter medications for seasonal allergies and other implications for nurses.
Video Versus Nonvideo in a Rabbit Training Model for Establishing an Emergency Front of Neck Airway in Children
Authors: Amato Francesca , Both Christian P. , Alonso Elena , Wendel-Garcia Pedro D. , Diem Birgit , Schneider Celine , Schmidt Anna , Kemper Michael , Schmitz Achim , Thomas Jörg 
Published: July 2024

Objectives
Simulating a realistic “cannot intubate, cannot oxygenate” (CICO) situation to train an “emergency front of neck airway” is difficult. It further remains unclear if provision of regular technical refreshers improves performance in the setting of a real CICO situation. The purpose of this prospective study on an established surgical rabbit cadaver tracheostomy model was to evaluate the benefit of viewing training material shortly before performing “emergency front of neck airway.”

Methods
Previously trained participants were randomized into 2 groups. The control group (video) was allowed to watch an instructional video before performing a tracheotomy on the training model, while the study group (nonvideo) was not. Queried outcomes included success rate, performance time, and severe secondary airway injuries between the 2 groups.

Results
In 29 tracheotomies performed by 29 participants, the overall success rate was 86% (92% video; 81% nonvideo, P = 0.4). Performance time was not different between the 2 groups (video: 80 s [IQR25–75: 53–86], nonvideo 64 s [IQR25–75: 47–102]; P = 0.93). Only in the nonvideo group, the performance time and the time between the workshops correlated positively (P = 0.048). Severe secondary injuries were noted in 4 of 29 rabbit cadavers, 2 in each group. Watching a refresher video before performing an emergency surgical tracheostomy in an infant training model did not influence the success rate and the performance time in previously trained anesthetists.

Conclusions
These results highlight the ease of learning, memorization, and recall of this emergency surgical tracheostomy technique and may demonstrate its applicability in a real infant CICO situation.
Deep mutational scanning of SARS-CoV-2 Omicron BA.2.86 and epistatic emergence of the KP.3 variant
Authors: Taylor Ashley L. , Starr Tyler N. 
Published: July 2024

AbstractDeep mutational scanning experiments aid in the surveillance and forecasting of viral evolution by providing prospective measurements of mutational effects on viral traits, but epistatic shifts in the impacts of mutations can hinder viral forecasting when measurements were made in outdated strain backgrounds. Here, we report measurements of the impact of all single amino acid mutations on ACE2-binding affinity and protein folding and expression in the SARS-CoV-2 Omicron BA.2.86 spike receptor-binding domain (RBD). As with other SARS-CoV-2 variants, we find a plastic and evolvable basis for receptor binding, with many mutations at the ACE2 interface maintaining or even improving ACE2-binding affinity. Despite its large genetic divergence, mutational effects in BA.2.86 have not diverged greatly from those measured in its Omicron BA.2 ancestor. However, we do identify strong positive epistasis among subsequent mutations that have accrued in BA.2.86 descendants. Specifically, the Q493E mutation that decreased ACE2-binding affinity in all previous SARS-CoV-2 backgrounds is reversed in sign to enhance human ACE2-binding affinity when coupled with L455S and F456L in the currently emerging KP.3 variant. Our results point to a modest degree of epistatic drift in mutational effects during recent SARS-CoV-2 evolution but highlight how these small epistatic shifts can have important consequences for the emergence of new SARS-CoV-2 variants.
High fat low carbohydrate diet is linked to protection against CNS autoimmunity
Authors: Ni Duan , Tan Jian , Reyes Julen , Senior Alistair M , Andrews Caitlin , Taitz Jemma , Potier Camille , Wishart Claire , Spiteri Alanna , Piccio Laura , King Nicholas Jonathan Cole , Barres Romain , Raubenheimer David , Simpson Stephen James , Nanan Ralph , Macia Laurence 
Published: July 2024

SummaryMultiple sclerosis (MS) is a common central nervous system (CNS) autoimmune disease, and diets and nutrients are emerging as critical contributing factors. However, a comprehensive understanding of their impacts and the underlying mechanisms involved is lacking. Harnessing state-of-the-art nutritional geometry analytical methods, we first revealed that globally, increased carbohydrate supply was associated with increased MS disease burden, while fat supply had an opposite effect. Furthermore, in a preclinical MS mouse model, experimental autoimmune encephalomyelitis (EAE), we found that an isocaloric diet high in carbohydrate aggravated EAE, while a diet enriched in fat was fully protective. This was reflected by reduced neuroinflammation and skewing towards anti-inflammatory phenotypes, which involved transcriptomic, epigenetic and immunometabolic changes. We showcased that manipulating diets is a potentially efficient and cost-effective approach to prevent and/or ameliorate EAE. This exhibits translational potentials for intervention/prevention of MS and possibly other autoimmune diseases.