bluuebunny/crossref_metadata_2025_split huggingface dataset:
Intraoperative 3D Fluoroscopy During Open Reduction for DDH: An Effective Alternative to Postoperative CT/MRI
Authors: Baljoun Amna , Bradley Catharine S. , Verma Yashvi , Wedge John H. , Gargan Martin F. , Kelley Simon P. 
Published: May 2024

Background:
Computed tomography CT or magnetic resonance imaging (MRI) has been the most used imaging modality to assess hip reduction in developmental dysplasia of the hip (DDH) after open reduction (OR). In 2015, intraoperative 3D fluoroscopy (3D) was introduced at our center as an alternative to CT/MRI. 3D offers the advantage that if hip reduction is insufficient, it can be addressed at the time of surgery. The purpose of this study was to assess the efficacy of 3D in comparison to CT/MRI.

Methods:
This was a single-centre, retrospective comparative study of two consecutive cohorts: those with OR and 3D between 2015 and 2017 and those with OR and CT/MRI between 2012 and 2014. Time to imaging, re-imaging, length of stay (LOS), re-operation, and redislocation or subluxation after cast removal were evaluated.

Results:
Forty-two patients (46 hips) had 3D, and 30 patients (32 hips) had CT/MRI. Significant differences were found between groups in time to imaging, cast changes, and LOS. All 3D was intraoperative (46 hips), and only 69% (22 hips) of CT/MRI was on the day of surgery (P<0.01). In the 3D group, 1 hip (2%) had a cast change under the same anesthetic, and 4 hips (13%) from CT/MRI had cast changes in subsequent surgery (P=0.03). The mean LOS in days for 3D was 1.72 and 2.20 for CT/MRI (P=0.03). There were no statistically significant differences between groups in further imaging and subluxations or re-dislocations at cast removal. Two hips (4%) in the 3D group had MRI, but with no further intervention (P=0.51), and at cast removal, there were 3 subluxations in each group (P=0.69) and 1 redislocation in the 3D group (P=1.00).

Conclusions:
Intraoperative 3D improved time to imaging, allowed for cast changes at surgery and had a shorter LOS. Moreover, there were no significant differences found in adverse outcomes between those who underwent 3D versus CT/MRI. 3D should thus be considered an effective alternative to CT/MRI for assessing hip reduction during OR for DDH.

Level of Evidence:
Diagnostic Study, level II.
Utilization and Outcomes in U.S. ICU Hospitalizations*
Authors: Kannan Sneha , Giuriato Mia , Song Zirui 
Published: May 2024

OBJECTIVES:
Despite its importance, detailed national estimates of ICU utilization and outcomes remain lacking. We aimed to characterize trends in ICU utilization and outcomes over a recent 12-year period in the United States.

DESIGN/SETTING:
In this longitudinal study, we examined hospitalizations involving ICU care (“ICU hospitalizations”) alongside hospitalizations not involving ICU care (“non-ICU hospitalizations”) among traditional Medicare beneficiaries using 100% Medicare part A claims data and commercial claims data for the under 65 adult population from 2008 to 2019.

PATIENTS/INTERVENTIONS:
There were 18,313,637 ICU hospitalizations and 78,501,532 non-ICU hospitalizations in Medicare, and 1,989,222 ICU hospitalizations and 16,732,960 non-ICU hospitalizations in the commercially insured population.

MEASUREMENTS AND MAIN RESULTS:
From 2008 to 2019, about 20% of Medicare hospitalizations and 10% of commercial hospitalizations involved ICU care. Among these ICU hospitalizations, length of stay and ICU length of stay decreased on average. Mortality and hospital readmissions on average also decreased, and they decreased more among ICU hospitalizations than among non-ICU hospitalizations, for both Medicare and commercially insured patients. Both Medicare and commercial populations experienced a growth in shorter ICU hospitalizations (between 2 and 7 d in length), which were characterized by shorter ICU stays and lower mortality. Among these short hospitalizations in the Medicare population, for common clinical diagnoses cared for in both ICU and non-ICU settings, patients were increasingly triaged into an ICU during the study period, despite being younger and having shorter hospital stays.

CONCLUSIONS:
ICUs are used in a sizeable share of hospitalizations. From 2008 to 2019, ICU length of stay and mortality have declined, while short ICU hospitalizations have increased. In particular, for clinical conditions often managed both within and outside of an ICU, shorter ICU hospitalizations involving younger patients have increased. Our findings motivate opportunities to better understand ICU utilization and to improve the value of ICU care for patients and payers.
Unique bile acid profiles in the bile ducts of patients with primary sclerosing cholangitis
Authors: Kayashima Atsuto , Sujino Tomohisa , Fukuhara Seiichiro , Miyamoto Kentaro , Kubosawa Yoko , Ichikawa Masataka , Kawasaki Shintaro , Takabayashi Kaoru , Iwasaki Eisuke , Kato Motohiko , Honda Akira , Kanai Takanori , Nakamoto Nobuhiro 
Published: May 2024

Background:
The relationship between primary sclerosing cholangitis (PSC) and biliary bile acids (BAs) remains unclear. Although a few studies have compared PSC biliary BAs with other diseases, they did not exclude the influence of cholestasis, which affects the composition of BAs. We compared biliary BAs and microbiota among patients with PSC, controls without cholestasis, and controls with cholestasis, based on the hypothesis that alterations in BAs underlie the pathophysiology of PSC.

Methods:
Bile samples were obtained using endoscopic retrograde cholangiopancreatography from patients with PSC (n = 14), non-hepato-pancreato-biliary patients without cholestasis (n = 15), and patients with cholestasis (n = 13).

Results:
The BA profiles showed that patients with PSC and cholestasis controls had significantly lower secondary BAs than non-cholestasis controls, as expected, whereas the ratio of cholic acid/chenodeoxycholic acid in patients with PSC was significantly lower despite cholestasis, and the ratio of (cholic acid + deoxycholic acid)/(chenodeoxycholic acid + lithocholic acid) in patients with PSC was significantly lower than that in the controls with or without cholestasis. The BA ratio in the bile of patients with PSC showed a similar trend in the serum. Moreover, there were correlations between the alteration of BAs and clinical data that differed from those of the cholestasis controls. Biliary microbiota did not differ among the groups.

Conclusions:
Patients with PSC showed characteristic biliary and serum BA compositions that were different from those in other groups. These findings suggest that the BA synthesis system in patients with PSC differs from that in controls and patients with other cholestatic diseases. Our approach to assessing BAs provides insights into the pathophysiology of PSC.
Left ventricular systolic dysfunction in obesity: a meta-analysis of speckle tracking echocardiographic studies
Authors: Gherbesi Elisa , Faggiano Andrea , Sala Carla , Carugo Stefano , Grassi Guido , Tadic Marijana , Cuspidi Cesare 
Published: May 2024

Background:
Obesity is a risk factor for left ventricular hypertrophy (LVH) and diastolic dysfunction. Available evidence on impaired myocardial deformation in obese patients without apparent systolic dysfunction assessed by LV ejection fraction (LVEF) is based on single studies. The aim of the present meta-analysis was to provide a comprehensive and updated information on this issue.

Methods:
The PubMed, OVID-MEDLINE, and Cochrane library databases were analysed to search English-language articles published from the inception up to 31 December 2023. Studies were identified by using MeSH terms and crossing the following search items: ‘myocardial strain’, ‘left ventricular mechanics’, ‘longitudinal global strain’, ‘speckle tracking echocardiography’, ‘systolic dysfunction’, ‘left ventricular ejection fraction’, and ‘obesity’.

Results:
Twenty-four studies including 5792 obese and 5518 nonobese individuals from different clinical settings were considered for the analysis. LV global longitudinal strain (GLS) was significantly impaired in the obese group [standard means difference (SMD): −0.86 ± 0.08; confidence interval (CI) −1.02 to −0.69, P < 0.0001] and this was paralleled by a significant difference in pooled LVEF between obese and controls (SMD −0.27 ± 0.06; CI −0.40 to −0.15, P < 0.0001). Unlike GLS, however, the majority of the selected studies failed to show statistically significant differences in LVEF. Furthermore, in patients with advanced obesity (BMI > 35 kg/m2, data from six studies), LV systolic dysfunction was more significantly detected by GLS (SMD −1.24 ± 0.19, CI −1.61/-0.87, P < 0.0001) than by LVEF (SMD −0.54 ± 0.27, CI −1.07 to −0.01, P = 0.046).

Conclusion:
The present meta-analysis suggests that GLS may unmask systolic dysfunction often undetected by conventional LVEF in the obese setting; thus, this parameter should be incorporated into routine work-up aimed to identify obesity-mediated subclinical cardiac damage.
Effects of potassium supplementation on plasma aldosterone: a systematic review and meta-analysis in humans
Authors: McNally Ryan J. , Farukh Bushra , Chowienczyk Philip J. , Faconti Luca 
Published: May 2024

Objectives:
Effects of potassium supplementation on blood pressure (BP) may be offset by an increase in plasma aldosterone. The magnitude of potassium-dependent regulation of aldosterone secretion in humans is not fully characterized; it is not clear whether this is mediated by activation of the renin–angiotensin–aldosterone system (RAAS), as a result of a reduction in BP or other mechanisms. We performed a systematic review and meta-analysis of clinical trials assessing effects of potassium on plasma aldosterone and renin in adult individuals.

Methods:
This was carried out in accordance with PRISMA guidelines. Three databases were searched: MEDLINE, EMBASE and CENTRAL. Titles were firstly screened by title and abstract for relevance before full-text articles were assessed for eligibility. The keywords used included “aldosterone”, “potassium” and “RAAS”.

Results:
6395 articles were retrieved and after title/abstract screening, 123 full-text articles were assessed for eligibility. Thirty-six met the prespecified inclusion/exclusion criteria (of which 18/36 also reported systolic BP). Potassium supplementation caused a significant decrease in systolic BP (mean difference [95% CI] −3.69 mmHg [−4.91, −2.46], P < 0.001) and increase in serum potassium (+0.37 [0.23, 0.52] mmol/l, P < 0.001). There was an increase in plasma aldosterone (standardized difference 0.426 [0.299, 0.553], P < 0.001) but not in plasma renin activity. Meta-regression showed a significant positive correlation between change in plasma aldosterone and change in serum potassium (P < 0.001).

Conclusions:
Potassium supplementation increases plasma aldosterone concentrations, which correlates with the increase in serum potassium concentration which does not appear to be mediated by an increase in plasma renin activity.
Association of sleep traits with risk of hypertensive disorders of pregnancy: a mendelian randomization study
Authors: Zhao Huanqiang , Wen Ping , Xiong Yu , Xu Qixin , Zi Yang , Zheng Xiujie , Chen Shiguo , Qin Yueyuan , Shao Shuyi , Tu Xinzhi , Zheng Zheng , Li Xiaotian 
Published: May 2024

Background:
Unhealthy sleep patterns are common during pregnancy and have been associated with an increased risk of developing hypertensive disorders of pregnancy (HDPs) in observational studies. However, the causality underlying these associations remains uncertain. This study aimed to evaluate the potential causal association between seven sleep traits and the risk of HDPs using a two-sample Mendelian randomization study.

Methods:
Genome-wide association study (GWAS) summary statistics were obtained from the FinnGen consortium, UK Biobank, and other prominent consortia, with a focus on individuals of European ancestry. The primary analysis utilized an inverse-variance-weighted MR approach supplemented by sensitivity analyses to mitigate potential biases introduced by pleiotropy. Furthermore, a two-step MR framework was employed for mediation analyses.

Results:
The data analyzed included 200 000–500 000 individuals for each sleep trait, along with approximately 15 000 cases of HDPs. Genetically predicted excessive daytime sleepiness (EDS) exhibited a significant association with an increased risk of HDPs [odds ratio (OR) 2.96, 95% confidence interval (95% CI) 1.40–6.26], and the specific subtype of preeclampsia/eclampsia (OR 2.97, 95% CI 1.06–8.3). Similarly, genetically predicted obstructive sleep apnea (OSA) was associated with a higher risk of HDPs (OR 1.27, 95% CI 1.09–1.47). Sensitivity analysis validated the robustness of these associations. Mediation analysis showed that BMI mediated approximately 25% of the association between EDS and HDPs, while mediating up to approximately 60% of the association between OSA and the outcomes. No statistically significant associations were observed between other genetically predicted sleep traits, such as chronotype, daytime napping, sleep duration, insomnia, snoring, and the risk of HDPs.

Conclusion:
Our findings suggest a causal association between two sleep disorders, EDS and OSA, and the risk of HDPs, with BMI acting as a crucial mediator. EDS and OSA demonstrate promise as potentially preventable risk factors for HDPs, and targeting BMI may represent an alternative treatment strategy to mitigate the adverse impact of sleep disorders.
Recognition vs resolution charts for defocus curve determination in trifocal intraocular lenses
Authors: Tañá-Rivero Pedro , Tañá-Sanz Pedro , Tañá-Sanz Santiago , Montés-Micó Robert , Cerviño Alejandro 
Published: May 2024

Purpose:
To determine the impact of optotype choice on the determination of defocus curve in patients with cataract implanted with presbyopia-correcting intraocular lens (IOL).

Setting:
Oftalvist Alicante, Alicante, Spain.

Design:
Observational case-control study.

Methods:
Patients implanted with Asqelio Trifocal IOL participated in this study. Uncorrected and corrected distance visual acuity (VA) and subjective refraction were determined. Monocular defocus curves were obtained 6 months postoperatively with the Clinical Trial Suite system using either Early Treatment Diabetic Retinopathy Study (ETDRS) or Landolt C charts under photopic conditions (85 cd/m2), and range of vergence from +2.00 to −5.00 diopters (D) in 0.50 D steps.

Results:
A total of 49 patients were enrolled in the study, 24 in the ETDRS group (7 male, 17 female) and 25 in the Landolt C group (5 male, 20 female). Nonsignificant differences were found between patients conforming both groups, except for preoperative intraocular pressure and white-to-white distance. All patients were within ±1.00 D from intended refraction after surgery. 75% of patients in the ETDRS group and 84% in the Landolt C group were within ±0.50 D. Average difference between the groups across vergences provided by the defocus curve was 0.12 ± 0.05 logMAR units, significant for all vergences (P < .05). Differences in VA were significant for distance, intermediate, and near between both groups, except for uncorrected distance VA.

Conclusions:
Defocus curves created using Landolt C charts yield significantly lower through-focus outcomes than those created with standard ETDRS charts. This should be taken into account when comparing the performance of presbyopia-correcting systems across studies where recognition charts might have been used because of patient characteristics.
Comparison of complications and visual outcomes of combined phacovitrectomy vs stand-alone phacoemulsification: multicenter database study
Authors: Bakr Mohammad , Elhusseiny Abdelrahman M. , Toma Joseph , Sallam Ahmed B. 
Published: May 2024

Purpose:
To compare the rates of intraoperative complications, cystoid macular edema (CME), and visual outcomes in eyes that underwent combined phacovitrectomy (Phaco-PPV) with those with stand-alone phacoemulsification.

Setting:
A multicenter database study across 8 ophthalmology departments in the United Kingdom.

Design:
Retrospective, nonrandomized, multicenter comparative study.

Methods:
We extracted data for patients who underwent Phaco-PPV and stand-alone phacoemulsification from January 2000 through May 2015. The primary study outcomes were the rates of intraoperative complications and CME postoperatively.

Results:
The study included 2222 eyes in the combined Phaco-PPV group and 112 689 in the stand-alone phacoemulsification group. The combined Phaco-PPV group had a higher incidence of posterior capsule rupture (2.7% vs 1.7%), dropped lens fragments (0.5% vs 0.2%), suprachoroidal hemorrhage (0.4% vs 0.1%), and CME (3.6 vs 1.1%) (P < .001). The mean preoperative visual acuity (VA) was lower in the combined Phaco-PPV group, with a mean VA of 0.98 vs 0.68 logMAR (Snellen ∼20/200 vs 20/100) in the stand-alone phacoemulsification group (P < .001). VA at 24 weeks was lower in the combined Phaco-PPV group (mean VA 0.67 vs 0.22 logMAR (Snellen ∼20/100 vs 20/32), P < .001).

Conclusions:
Combined Phaco-PPV had higher rates of intraoperative complications and CME, along with a lower postoperative VA, when compared with stand-alone phacoemulsification surgery.
Perioperative outcomes and safety of valveless insufflation system in minimally invasive urological surgery: a systematic review and meta-analysis
Authors: Lu Youyi , Zou Qingsong , Jiang Bo , Li Qi 
Published: May 2024

Background:
With the rapid development of laparoscopic and robot-assisted surgery, many technological innovations and improvements have emerged to optimize minimally invasive surgery and ensure minimal patient risk. Although AirSeal has been widely reported in the field of urology, its perioperative outcomes and safety in minimally invasive urological surgery remain unclear because of inconsistent levels of evidence.

Objectives:
The authors performed this meta-analysis to evaluate the perioperative outcomes and safety of the valveless insufflation system (VIS) in minimally invasive urological surgery compared with the conventional insufflation system (CIS).

Methods:
The authors comprehensively searched PubMed, Web of Science, Cochrane Library, and Embase databases to identify eligible studies published up to January 2024. Review Manager software (version 5.3.0) was used for the statistical analysis. Eligible studies were randomized controlled trials (RCTs) or non-RCTs of minimally invasive urological surgery with VIS vs CIS. The study outcomes included perioperative outcomes and safety. The authors excluded publication types, including letters, reviews, case reports, and animal and pediatric studies.

Results:
The authors finally identified five RCTs and eight non-RCTs in this meta-analysis. The meta- analysis indicated that the operative time was comparable between the groups (P=0.57, I
2=91%). However, a VIS may increase blood loss (P=0.0004, I
2=45%) and shorten hospital stays (P<0.00001, I
2=90%). Due to the high heterogeneity of the results, the authors carefully evaluated all included studies and discovered that the studies by Bucur and Ferroni may be the sources of heterogeneity. When these two studies were excluded, heterogeneity was significantly reduced, and the operative time for VIS was significantly shorter than that for CIS (P=0.0002). Adjusted blood loss showed no difference between the VIS and CIS groups (P=0.10). In terms of safety, the pooled results revealed that the incidence of Clavien–Dindo III–IV complications in the VIS group was significantly lower than that in the CIS group (P=0.02, I
2=0%). Moreover, VIS significantly reduced general pain (P=0.02, I
2=15%) and shoulder pain (P=0.001, I
2=0%) 12–24 h postoperatively. No significant differences were observed in total complications (P=0.06, I
2=0%), blood transfusion (P=0.14, I
2=0%), and subcutaneous emphysema (P=0.96, I
2=63%) between the two groups.

Conclusions:
Our meta-analysis revealed additional perioperative advantages of the VIS in minimally invasive urological surgery. Moreover, VIS is superior to CIS owing to less severe complication rates, general pain, and shoulder pain.
Prediction of the pathological subtypes by intraoperative frozen section for patients with cT1N0M0 invasive lung adenocarcinoma (ECTOP-1015): a prospective multicenter study
Authors: Fu Zichen , Shen Xuxia , Deng Chaoqiang , Cao Hang , Jin Yan , Zheng Qiang , Yang Yongguo , Qian Bin , Yuan Chunyan , Wang Weihua , Zhang Lei , Song Qingping , Zuo Shuying , Ma Junjie , You Shuqing , Zheng Senzhong , Gao Qingli , Su Guangli , Zhang Yang , Fu Fangqiu , Chen Haiquan , Li Yuan 
Published: May 2024

Background:
This study aims to assess the diagnostic accuracy of the intraoperative frozen section (FS) in determining the pathological subtypes among patients diagnosed with cT1N0M0 invasive lung adenocarcinoma.

Materials and methods:
This was a prospective, multicenter (seven centers in China) clinical trial of Eastern Cooperative Thoracic Oncology Projects (ECTOP-1015). Patients with cT1N0M0 invasive lung adenocarcinoma were enrolled in the study. Pathological images obtained from FS and final pathology (FP) were reviewed by at least two pathologists. The primary endpoint was the concordance between FS and FP diagnoses. The interobserver agreement for identifying pathological subtypes on FS was evaluated among three pathologists.

Results:
A total of 935 patients were enrolled. The best sensitivity of diagnosing the predominant subtype was 78.2% in the evaluation of the acinar pattern. The presence of an acinar pattern diagnosed by FS was an independent factor for the concordance between FS and FP (P=0.007, 95% confidence interval: 2.332–4.736). Patients with tumor size >2 cm measured by pathology showed a better concordance rate for the predominant subtype (81.6% vs. 74.6%, P=0.023). The presence of radiological ground glass opacity component did not affect the diagnosis accuracy of FS for the predominant subtype (concordance rate: 76.4% vs. 75.2%, P=0.687). Patients with ground glass opacity component showed better accuracy of the identification in the presence of lepidic pattern-predominant adenocarcinoma (82.1% vs. 71.0%, P=0.026). Substantial agreement between the FS diagnosis from three pathologists for the predominant pathological pattern was revealed with κ=0.846.

Conclusions:
This is the largest prospective trial evaluating FS diagnosing pathological subtype in cT1N0M0 invasive lung adenocarcinoma. A favorable concordance in the assessment of the pathological subtypes between FS and FP was observed, indicating the feasibility of utilizing accurate intraoperative pathological diagnoses from FS in guiding surgical strategies. A combination of radiology could improve the precision of FS.