bluuebunny/crossref_metadata_2025_split huggingface dataset:
Management and treatment of perioperative hypersensitivity
Authors: Littlejohns Anna , Savic Louise 
Published: May 2024

Purpose of review
Perioperative hypersensitivity reactions are rare but potentially catastrophic events. This review acts to summarize recent recommendations for both immediate and poststabilization management of suspected reactions, alongside practical advice for anaesthetists who may be faced with these events.

Recent findings
Prompt treatment is essential but may be hampered by delay in recognition. This can occur because there are multiple differential diagnoses for the observed clinical signs as well as variations in clinical presentation. Resuscitation is dependent on the use of adrenaline and fluids. Adrenaline should be administered in small, titrated intravenous boluses. Low-dose infusions should be commenced early if the response to boluses is poor. Large volume fluid resuscitation may be required to maintain adequate circulating volume. Chest compressions are recommended when there is evidence of inadequate perfusion, rather than waiting until cardiac arrest is confirmed. Antihistamines and corticosteroids are no longer recommended in the immediate management phase. Once the patient has been stabilized, it is important to obtain serial tryptase concentrations to aid the subsequent clinic investigation. The decision to proceed or abandon surgery will be based on an individual risk-benefit analysis. All cases of suspected perioperative hypersensitivity, including fatal cases, must be referred for formal investigation.

Summary
There have been recent updates to management guidelines in perioperative hypersensitivity. Treatment algorithms, treatment packs and referral packs can all help the anaesthetist manage these complex cases, aid the subsequent investigation and ensure patient safety in the future.
Integration of Clinical Trial Development in Hematology-Oncology Fellowship Training
Authors: Auberle Christine , Wu Ningying , Dipersio John F. , Waqar Saiama N. , Ratner Lee 
Published: May 2024

Abstract

Problem
Several barriers to physicians becoming clinical investigators exist, including inexperience, lack of available mentors, and inconsistent instructive approaches with varying degrees of participation during training. These barriers cause fewer hematology-oncology fellows to pursue academic careers. A consensus is needed on structuring education in clinical investigation paired with active participation in development of a clinical trial guided by a mentor with the goal of increasing fellow interest in clinical research and pursuit of careers in academic medicine.

Approach
The clinical trial development (CTD) program was initiated at Washington University School of Medicine in St. Louis in 2002 as a hands-on learning experience for hematology and oncology fellows in the design, implementation, and publication of clinical trials. Each fellow was required to identify a mentor and propose at least 1 prospective investigator-initiated clinical trial.

Outcomes
At the time of data abstraction in July 2023, 118 fellows had participated in the CTD program and initiated protocols in a variety of areas according to their interests. Fellows were included in data abstraction if their fellowship began in 2002 through 2021; the program is ongoing, and the most recent class will graduate in 2024. Disease types were evenly distributed between solid tumor oncology (60 [51%]) or classic and malignant hematology (58 [49%]). Ninety-three fellows (79%) obtained institutional review board approval, and 60 (65%) published their results. Among graduating fellows, 67 (66%) secured an academic faculty appointment. Fellows with institutional review board–approved projects had significantly higher odds of obtaining an academic faculty appointment (odds ratio, 4.96; 95% confidence interval, 1.54–15.98; P = .007).

Next Steps
Next steps will be to further evaluate the effect of the mentorship network on early career productivity of trainees that graduate and the feasibility of extending the program to another institution.
Effects of White Noise on Pain Scores and Salivary Cortisol Levels in Surgical Neonates
Authors: Lin Siya , Li Li , Ren Xuyan , Zhong Chunxia , Wu Kai , Fang Xiaoling , Liang Shaocong , Chen Xuedong , Chen Jingxia , Yang Liucheng , Wang Xiaowu , Wang Bin 
Published: May 2024

Background:
Neonates experience varying intensities of pain after surgery. While white noise has been used for postoperative pain relief in infants, its effects on neonates after surgery need further exploration.

Purpose:
This study aimed to evaluate the effects of white noise on pain scores and salivary cortisol levels in surgical neonates.

Methods:
In this randomized controlled trial, 64 neonates scheduled for surgery were recruited and assigned by block randomization into 2 groups. The intervention group listened to white noise at 50 dB, while the control group listened to white noise at 0 dB, for 30 minutes 6 times for 48 hours postoperatively. Pain scores, measured by the COMFORTneo Scale, and salivary cortisol levels were compared.

Results:
Although pain scores decreased after surgery in all subjects, no statistically significant difference was observed between the 2 groups (P = .937). There was a significant difference between pre- and postintervention pain scores in the intervention group only (P = .006). Salivary cortisol levels decreased after intervention in the intervention group, but there was no significant difference between pre- and postintervention levels in the 2 groups (P = .716).

Implications for Practice:
Given the reduction in pain scores and salivary cortisol concentrations after white noise intervention, white noise shows potential as an adjunctive soothing measure for neonates after surgery.

Implications for Research:
Future studies are needed to confirm the efficacy and utility of white noise intervention in clinical settings.
Hepatitis B Birth Dose Vaccination Improvement Initiative
Authors: Heidenreich Kaeli N. , Blair Shannon , Gillespie Hayley , Chang Amanda J. , Burns James L. , Shah Malika D. 
Published: May 2024

Background:
An estimated 25,000 infants are born to mothers diagnosed with hepatitis B virus (HBV) each year in the United States. Administration of the birth dose HBV vaccine prevents transmission during delivery. Despite national guidelines promoting vaccination within 24 hours of birth, fewer than 70% of infants receive the dose in their first 3 days of life. To improve compliance with national recommendations, Northwestern Medicine implemented a bundled care initiative in the well newborn nursery, entitled the 24-hour baby bundle (24-HBB).

Purpose:
Evaluate the 24-HBB’s effect on improving time to HBV vaccine administration.

Methods:
The 24-HBB was created by an interdisciplinary team and implemented on February 17, 2020. Bundled care begins at 23 hours of life, starting with the HBV vaccine, followed by bath, weight, and congenital heart disease screening, and ending with metabolic screening. We conducted a retrospective cohort study of 22,057 infants born at Northwestern Medicine Prentice Women’s Hospital in Chicago, Illinois. Our sample included preintervention birthdates between February 16, 2019, and January 16, 2020, and postintervention birthdates between March 17, 2020, and February 16, 2021, with a 2-month washout education period between January 17, 2020, and March 16, 2020.

Results:
Hepatitis B virus immunization within 24 hours increased significantly from 43.83% to 66.90% (P < .0001). In addition, overall hepatitis B immunization prior to discharge significantly increased after implementation of the 24-HBB (98.18% vs 98.82%, P < .0001).

Implications for Practice and Research:
The 24-HBB is effective at increasing rates of HBV immunization within 24 hours of birth. Newborn nurseries may benefit from similar initiatives to prevent hepatitis B infection, satisfy national recommendations, and promote childhood vaccination compliance.
Pharmacotherapy in patients with heart failure with reduced ejection fraction: A systematic review and meta-analysis
Authors: Tang Jia , Wang Ping , Liu Chenxi , Peng Jia , Liu Yubo , Ma Qilin 
Published: May 2024

Abstract

Background:
Angiotensin receptor neprilysin inhibitors (ARNIs), angiotensin-converting enzyme inhibitors (ACEIs), angiotensin receptor blockers (ARBs), β-blockers (BBs), and mineralocorticoid receptor antagonists (MRAs) are the cornerstones in treating heart failure with reduced ejection fraction (HFrEF). Sodium-glucose cotransporter 2 inhibitors (SGLT-2is) are included in HFrEF treatment guidelines. However, the effect of SGLT-2i and the five drugs on HFrEF have not yet been systematically evaluated.

Methods:
PubMed, Embase, and the Cochrane Library were searched for randomized controlled trials (RCTs) from inception dates to September 23, 2022. Additional trials from previous relevant reviews and references were also included. The primary outcomes were changes in left ventricular ejection fraction (LVEF), left ventricular end-diastolic diameter/dimension (LVEDD), left ventricular end-systolic diameter/dimension (LVESD), left ventricular end-diastolic volume (LVEDV), and left ventricular end-systolic volume (LVESV), left ventricular end-systolic volume index (LVESVI), and left ventricular end-diastolic volume index (LVEDVI). Secondary outcomes were New York Heart Association (NYHA) class, 6-min walking distance (6MWD), B-type natriuretic peptide (BNP) level, and N-terminal pro-BNP (NT-proBNP) level. The effect sizes were presented as the mean difference (MD) with 95% confidence interval (CI).

Results:
We included 68 RCTs involving 16,425 patients. Compared with placebo, ARNI + BB + MRA + SGLT-2i was the most effective combination to improve LVEF (15.63%, 95% CI: 9.91% to 21.68%). ARNI + BB + MRA + SGLT-2i (5.83%, 95% CI: 0.53% to 11.14%) and ARNI + BB + MRA (3.83%, 95% CI: 0.72% to 6.90%) were superior to the traditional golden triangle “ACEI + BB + MRA” in improving LVEF. ACEI + BB + MRA + SGLT-2i was better than ACEI + BB + MRA (–8.05 mL/m2, 95% CI: –14.88 to –1.23 mL/m2) and ACEI + BB + SGLT-2i (–18.94 mL/m2, 95% CI: –36.97 to –0.61 mL/m2) in improving LVEDVI. ACEI + BB + MRA + SGLT-2i (–3254.21 pg/mL, 95% CI: –6242.19 to –560.47 pg/mL) was superior to ARB + BB + MRA in reducing NT-proBNP.

Conclusions:
Adding SGLT-2i to ARNI/ACEI + BB + MRA is beneficial for reversing cardiac remodeling. The new quadruple drug “ARNI + BB + MRA + SGLT-2i” is superior to the golden triangle “ACEI + BB + MRA” in improving LVEF.

Registration:
PROSPERO; No. CRD42022354792.
Acute increases in physical activity and temperature are associated with hot flash experience in midlife women
Authors: Witkowski Sarah , White Quinn , Shreyer Sofiya , Garcia Randi L. , Brown Daniel E. , Sievert Lynnette Leidy 
Published: May 2024

AbstractObjectiveThis study determined the association between acute changes in physical activity, temperature, and humidity and 24-hour subjective and objective hot flash experience.MethodsData collection occurred during the cooler months of the year in Western Massachusetts (October-April). Women aged 45-55 across three menopause stages (n = 270) were instrumented with ambulatory monitors to continuously measure hot flashes, physical activity, temperature, and humidity for 24 hours. Objective hot flashes were assessed via sternal skin conductance, and subjective hot flashes were recorded by pressing an event marker and data logging. Physical activity was measured with wrist-worn accelerometers and used to define sleep and wake periods. Logistic multilevel modeling was used to examine the differences in physical activity, humidity, and temperature in the 10 minutes preceding a hot flash versus control windows when no hot flashes occurred. The odds of hot flashes were considered separately for objective and subjective hot flashes as well as for wake and sleep periods.ResultsData from 188 participants were included in the analyses. There was a significantly greater odds of a hot flash following acute increases in physical activity for objective waking hot flashes (odds ratio [OR], 1.31; 95% confidence interval [CI], 1.17-1.47;P< 0.001) and subjective waking hot flashes (OR, 1.16; 95% CI, 1.0-1.33;P= 0.03). Acute increases in the actigraphy signal were associated with significantly higher odds of having an objective (OR, 1.17; 95% CI, 1.03-1.35;P< 0.01) or subjective (OR, 1.72; 95% CI, 1.52-2.01;P< 0.001) sleeping hot flash. Increases in temperature were significantly related to the odds of subjective sleeping hot flashes only (OR, 1.38; 95% CI, 1.15-1.62;P< 0.001). There was no evidence for a relationship between humidity and odds of experiencing any hot flashes.ConclusionThese results indicate that acute increases in physical activity increase the odds of hot flashes that are objectively measured and subjectively reported during waking and sleeping periods. Temperature increases were only related to subjectively reported nighttime hot flashes.
Current trends in the management of corneal neovascularization
Authors: Rangu Neal , Dang Deanna H. , Riaz Kamran M. 
Published: May 2024

Purpose of review
The aim of this study was to highlight recent developments in the medical and surgical management of corneal neovascularization (NV).

Recent findings
Improved understanding and diagnostic criteria among clinicians have led to advancements in the characterization of corneal NV and objective assessment of treatment response through ancillary imaging devices. Developments in corneal NV treatments, such as antivascular endothelial growth factor, fine needle diathermy, and photodynamic therapy, have improved treatment success rates and visual outcomes. More recent surgical treatment advancements include corneal cross-linking, endothelial keratoplasty, and mitomycin intravascular chemoembolization. Finally, a greater appreciation of the molecular pathogenesis and angiogenic factors involved in corneal NV has identified numerous potential targeted therapies in the future.

Summary
The management of corneal NV has evolved to include several standalone and combination medical and surgical options. Additionally, improvements in quantifying corneal NV and understanding its molecular basis have contributed to new management strategies with improved outcomes.
Test-Retest Reliability of Intraocular Pressure Measurements With Office-Based Versus Home-Based Rebound Tonometers
Authors: Realini Tony , Halenda Kevin , Palko Joel , McMillan Brian , Balasubramani Goundappa K. 
Published: May 2024

Précis:
Intraocular pressure (IOP) measurements obtained with the HOME2 rebound tonometer are interchangeable with measurements obtained using the office-based IC100 and IC200 rebound tonometers, making characterization of circadian IOP achievable with no inter-device sources of variability.

Objective:
To evaluate test-retest reliability between IOP measurements obtained with a home rebound tonometer operated by patients and those obtained with office rebound tonometers operated by experienced clinical staff.

Methods:
After training and practice with a home rebound tonometer (iCare HOME2) in a randomly selected eye, patients with established or suspected open angle glaucoma underwent IOP measurement in the fellow eye as follows in randomized order: 3 good quality measurements with the iCare IC100 operated by experienced clinical staff, 3 good quality measurements with the iCare IC200 operated by experienced clinical staff, and 3 good quality measurements with the HOME2 operated by the patient. The Shrout-Fleisch intraclass correlation coefficient (ICC; 2,1) was the measure of reliability utilized based on the model using 2-way random effects, absolute agreement, and single measurement.

Results:
Thirty eyes of 30 patients were evaluated. The Pearson correlation coefficient (r) for IOP measurements taken with the IC100 and HOME2 was 0.97, with the IC200 and HOME2 was 0.96, and with the IC100 and IC200 was 0.97. Test-retest reliability between HOME2 and IC100 (ICC: 0.90), HOME2 and IC200 (ICC: 0.92), and IC100 and IC200 (ICC: 0.94) all reflected excellent test-retest reliability.

Conclusion:
The test-retest reliability of IOP measurements taken by patients using the iCare HOME2 self-tonometer compared with IOP measurements taken by trained operators using the iCare IC100 and IC200 tonometers was uniformly excellent (ICCs all ≥0.9). These findings indicate that these three devices should be considered interchangeable for the clinical assessment of circadian IOP.
Cystic plate approach combined with ICG fluorescence in laparoscopic anatomical hepatectomy
Authors: Chen Hao , Shen Kefeng , Shen Xiayong , Liu Wenbin , Ge Yongsheng , Yu Jihai , Jia Weidong , Ma Jinliang , Yuan Peng , Zhang Chuanhai 
Published: May 2024

Background:
The in-depth understanding of the fine anatomy of the liver has promoted the development of modern liver surgery. With the rapid popularity of laparoscopic hepatectomy, the membrane structure of the liver and its ability to dissect the intrahepatic and extrahepatic vascular system more conveniently and accurately has been gradually emphasized.

Objective:
Exploring the value of extrahepatic sheath dissection of the hepatic pedicle in minimally invasive anatomical hepatectomy with cystic plate approach. This study aims to assess the benefits of integrating the cystic plate approach with real-time guided laparoscopic anatomical hepatectomy, in comparison with conventional laparoscopic anatomical hepatectomy.

Materials and methods:
Based on the theory of cystic plate and hepatic portal plate, the authors have pioneered the fluorescence real-time guided cystic plate approach in hepatectomy. The article focuses on the anatomical knowledge and technical difficulties of anatomical hepatectomy with fluoroscopic laparoscopic cystic plate approach and explores the safety and practicality of the cystic plate approach in laparoscopic anatomical hepatectomy. Additionally, a retrospective cohort study was also conducted to compare the operation time, intraoperative blood loss, and postoperative complications between the cystic plate approach and the conventional approach during fluoroscopic laparoscopic hepatectomy.

Results:
A total of 38 patients who met the inclusion criteria underwent laparoscopic hepatectomy between January 2019 and November 2022. No significant disadvantages were found in terms of operation time and intraoperative blood loss during the surgeries. Furthermore, the postoperative indications, including liver function indexes on the first postoperative day, WBC, and the postoperative hospital stay, were also not affected, thus proving the safety of the cystic approach. Importantly, through the cystic plate approach, the target liver pedicle was fully freed, and then the segments to be resected were precisely marked by positive or negative staining, followed by hepatectomy under real-time fluoroscopic guidance. This approach is extremely advantageous in anatomical liver segment resections, especially in right posterior lobe or hemi-hepatectomy, without increasing intraoperative bleeding or postoperative complication rates.

Conclusion:
This technique allows for easy and safe freeing of the target liver pedicle using membrane structures, and also allows for precise anatomical hepatectomy in combination with real-time fluoroscopic laparoscopic navigation.
Risk factors for nephrolithiasis formation: an umbrella review
Authors: Ma Yucheng , Cheng Chao , Jian Zhongyu , Wen Jun , Xiang Liyuan , Li Hong , Wang Kunjie , Jin Xi 
Published: May 2024

Objective:
Nephrolithiasis is prevalent and burdensome worldwide. At present, evidence on the risk factors for nephrolithiasis is unconsolidated and the associations remain uncertain. The authors systematically evaluate the robustness of the meta-analytic evidence and aid more reliable interpretations of the epidemiological relationships.

Methods:
The authors conducted a comprehensive review of the meta-analyses, screened the included studies with the aid of the AMSTAR 2 evaluation tool, and then used R (4.1.1) software to perform data analysis to evaluate the association between candidate risk factors and kidney stones, and evaluated the credibility of the evidence of the association between risk factors and kidney stones according to the GRADE classification, and finally obtained the strength and effectiveness of the association.

Results:
The authors finally included 17 meta-analyses regarding 46 risk factors, 34 of which (73.9%) showed statistically significant association with nephrolithiasis. Among the significant associations, the authors found that waist circumference, BMI, dietary intake and fructose intake were positively correlated with the occurrence and development of nephrolithiasis. Caffeine, dietary fiber and DASH-diet showed a tendency to reduce kidney stones. Interestingly, calcium supplementation, dietary calcium, and vitamin D, which are widely believed to be responsible for stone formation, made no difference or even reduced the risk of nephrolithiasis.

Conclusions:
The authors’ study demonstrates the suggestive causal (central obesity, type 2 diabetes, gout, dietary sodium, fructose intake and higher temperatures) risk factors of nephrolithiasis. The authors also demonstrate the suggestive causal (coffee/alcohol/beer intake, dietary calcium and DASH-diet) protective factors of nephrolithiasis. To provide epidemiological basis for the treatment and prevention of nephrolithiasis.
Laparoscopic-assisted full-sized liver transplantation with magnetically fast portal vein anastomosis: an initial cohort study
Authors: Liu Xue-Min , Li Yu , Feng Zhe , Zhang Xiao-Gang , Wang Shan-Pei , Xiang Jun-Xi , Liu Si-Nan , Guo Kun , Hou Jing-Jing , Shi Ai-Hua , Zhang Xu-Feng , Lyu Yi 
Published: May 2024

Background:
Some cases of laparoscopic-assisted liver transplantation (LA-LT) with utilization of reduced-size grafts has been reported. The authors here introduced successful utilization of LA-LT with whole liver grafts and magnetic portal vein anastomosis.

Methods:
Eight patients with liver cirrhosis were included for LA-LT using donor organs after cardiac death. The surgical procedures included purely laparoscopic explant hepatectomy and whole-liver graft implantation via the midline incision. After explant removal, the whole-liver graft was then placed in situ, and a side-to-side cavo-caval anastomosis with 4–5 cm oval opening was performed. The magnetic rings were everted on the donor and recipient portal vein, respectively, and the instant attachment of the two magnets at the donor and recipient portal vein allowed fast blood reperfusion, followed by continuous suturing on the surface of the magnets.

Results:
The median operation time was 495 (range 420–630). The median time of explant hepatectomy and inferior vena cava anastomosis was 239 (range 150–300) min and 14.5 (range 10–19) min, respectively. Of note, the median anhepatic time was 25 (range 20–35) min. All the patients were discharged home with no major complications after more than 12 months follow-up.

Conclusion:
LA-LT with full-size graft is feasible and utilization of magnetic anastomosis would further simplify the procedure.