bluuebunny/crossref_metadata_2025_split huggingface dataset:
Managing a mass casualty, lessons learned
Authors: Næss Pål A. , Gaarder Christine 
Published: February 2025

Purpose of review
Mass casualty incidents (MCIs) strain available healthcare resources requiring unusual actions. Within a trauma system, hospitals receiving patients from an MCI have a defined key role in the care of the casualties and their preparedness is critical for patient outcome. The aim of this review is to address recent relevant literature to highlight important elements necessary for an adequate hospital response to an MCI.

Recent findings
That disaster preparedness is a prerequisite for success during an MCI is undisputable. Key components in the hospital response to an MCI like triage, communication, leadership, security, and surge capacity are areas that still need attention. There has been an increased focus on optimal treatment of children and their families, and the psychosocial support for patients and staff involved.

Summary
The complexity and unpredictability of MCIs demands a predefined strategy within every hospital. This strategy should include increased attention to the specific needs for children, physical security and psychological support but not at the expense of frequent training of staff. Involvement of dedicated clinical leadership both during disaster preparedness planning, training and during actual MCIs is irreplaceable.
Integrating regional blocks into Enhanced Recovery After Surgery protocols for cesarean delivery: optimizing postoperative recovery
Authors: Lauretta Alessandra , Frkovic Vedran , Saporito Andrea 
Published: February 2025

Purpose of review
This review aims to synthesize the current literature on the use of regional blocks to enhance and optimize postoperative recovery after cesarean delivery, highlighting key strategies, challenges, and emerging trends.

Recent findings
Recent developments in postoperative analgesia for cesarean delivery point toward more personalized treatment approaches. This involves identifying patients at high risk for severe postoperative pain and offering them tailored multimodal analgesic regimens.

Summary
Managing pain after cesarean delivery continues to pose a significant challenge. The overall prevalence of acute postoperative pain remains high (58%) and, even when strict adherence to established guidelines is ensured, approximately 25% of patients report inadequate pain control. Within a multimodal analgesic framework, when neuraxial morphine – still considered the gold standard – is not an option, the use of peripheral nerve and fascial plane blocks has demonstrated clear benefits. Recent literature suggests that quadratus lumborum block may serve as a promising alternative to intrathecal morphine for women who cannot tolerate opioids. Additionally, incorporating certain regional techniques alongside neuraxial morphine may further improve postoperative analgesia, especially for patients at high risk of severe postoperative pain and those who have contraindications to other analgesic modalities.
Parents’ Experiences With Couplet Care Following Caesarean Section in an Integrated Neonatal and Maternity Unit
Authors: Mortensen Marianne Karstensen , Holm Kristina Garne , Mose Louise Schlosser 
Published: February 2025

Background:
Couplet Care, which allows mothers and newborns to receive treatment together, has gained prominence in neonatal and maternity care settings. This model supports early bonding, skin-to-skin contact, and breastfeeding, benefiting both preterm and sick newborns.

Purpose:
The study aims to explore parents’ experiences with Couplet Care after a caesarean section in an integrated neonatal and maternity unit, where both mother and newborn required treatment.

Methods:
A qualitative, semi-structured interview approach was employed. Eight mothers and 6 fathers participated, sharing their perspectives on Couplet Care through interviews conducted at a Danish hospital setting providing Couplet Care in 6 family rooms in a level II neonatal intensive care unit. Data were analyzed using content analysis inspired by Graneheim and Lundman.

Results:
Parents initially relied heavily on nurses, gradually gaining autonomy as their hospital stay progressed. Fathers played an essential role in caregiving, especially when mothers were immobile post-surgery. The study highlighted the importance of clear communication from nurses, which fostered parental confidence.

Implications for Practice and Research:
Couplet Care offers a supportive environment that promotes parental autonomy and emphasizes the critical role fathers play in caregiving. Future research should investigate the long-term effects on family dynamics and the mental health of both mothers and fathers following caesarean sections in similar settings.
Hydroxyurea for Malignant Pertussis in Critically Ill Children
Authors: Blanc Matthieu , Marais Clémence , Debs Alexandre , Cousin Vladimir L. , Tissières Pierre ,   on behalf of the Paris Saclay Neonatal and Pediatric ICU Research Alliance (PANDORA) Study Group
Published: February 2025

OBJECTIVES:
Malignant pertussis, the most severe manifestation of Bordetella pertussis infection, is characterized by multiple organ failure and a high mortality rate despite advanced intensive care measures. Hyperleukocytosis is the hallmark of malignant pertussis and necessitates urgent and aggressive interventions. Among the therapeutic options, leukoreduction via whole blood exchange (BE) transfusion has been associated with significant procedural risks and potential clinical deterioration. Hydroxyurea was recently proposed as a pharmacological alternative for leukoreduction. This study reports our clinical experience with hydroxyurea as an alternative to BE in managing infants with malignant pertussis admitted to a PICU.

DESIGN:
Prospective case series.

SETTING:
A referral PICU in France.

PATIENTS:
Critically ill infants (n = 27) with severe pertussis infection.

INTERVENTIONS:
Hydroxyurea therapy or BE transfusion.

MEASUREMENTS AND MAIN RESULTS:
We reviewed all critically ill infants admitted to our unit for severe pertussis between January 2017 and July 2024. The primary outcome was 28-day survival, and the secondary outcome was the efficacy of hydroxyurea on blood leukocyte count reduction. Among the 27 infants admitted for severe pertussis, 12 exhibited features of malignant pertussis. Of these, seven were treated with hydroxyurea and five with BE. The majority of infants were term and under 3 months old. All patients required ventilatory support, with eight on invasive mechanical ventilation and three receiving extracorporeal membrane oxygenation therapy. Overall mortality was three of 12 (25%). Hydroxyurea was administered at a dose of 20 mg/kg/d for a median duration of 12 days. Hyperleukocytosis was successfully reduced within 7 days.

CONCLUSIONS:
Hydroxyurea is an alternative therapy for malignant pertussis infection that can efficiently address hyperleukocytosis with limited mortality.
Performance Evaluation of Prehospital Sepsis Prediction Models
Authors: Peltan Ithan D. , Rahmati Kasra , Bledsoe Joseph R. , Yoneoka Yukiko , Alvarez Felicia , Plendl Matthew , Taillac Peter P. , Youngquist Scott T. , Samore Matthew M. , Hough Catherine L. , Brown Samuel M. 
Published: February 2025

Objectives:
Evaluate prediction models designed or used to identify patients with sepsis in the prehospital setting.

Design:
Nested case-control study.

Setting:
Four emergency departments (EDs) in Utah.

Patients:
Adult nontrauma patient with available prehospital care records who received ED treatment during 2018 after arrival via ambulance.

Interventions:
None.

Measurements and Main Results:
Of 16,620 patients arriving to a study ED via ambulance, 1,037 (6.2%) met Sepsis-3 criteria in the ED. Complete prehospital care data was available for 434 case patients with sepsis and 434 control patients without sepsis. Model discrimination for the outcome of meeting Sepsis-3 criteria in the ED was quantified using the area under the precision-recall curve (AUPRC), which yields a value equal to outcome prevalence for a noninformative model. Of 21 evaluated prediction models, only the Prehospital Early Sepsis Detection (PRESEP) model (AUPRC, 0.33 [95% CI, 0.27–0.41) outperformed unaided infection assessment by emergency medical services (EMS) personnel (AUPRC, 0.17 [95% CI, 0.13–0.23]) for prehospital prediction of patients who would meet Sepsis-3 criteria in the ED (p < 0.001). PRESEP also outperformed the quick Sequential Organ Failure Assessment score (AUPRC, 0.13 [95% CI, 0.11–0.16]; p < 0.001). Among 28 evaluated dichotomous predictors of ED sepsis, sensitivity ranged from 6% to 91% and positive predictive value 8–100%. PRESEP exhibited modest sensitivity (60%) and positive predictive value (20%).

Conclusions:
PRESEP was the only evaluated prediction model that demonstrated better discrimination than unaided EMS infection assessment for the identification of ambulance-transported adult patients who met Sepsis-3 criteria in the ED.
Jejunal Lymphatic and Vascular Anatomy Defines Surgical Principles for Treatment of Jejunal Tumors
Authors: Vasic Teodor , Stimec Milena B. , Stimec Bojan V. , Kjæstad Erik , Ignjatovic Dejan 
Published: February 2025

BACKGROUND:
The jejunum has a wide lymphatic drainage field, making radical surgery difficult.

OBJECTIVE:
Extrapolate results from 2 methodologies to define jejunal artery lymphatic clearances and lymphovascular bundle shapes for radical bowel-sparing surgery.

DESIGN:
Two cohort studies.

SETTINGS:
The first dataset comprised dissections of cadavers at the University of Geneva. The second dataset incorporated preoperative 3D-computed tomography vascular reconstructions of patients included in the “Surgery with Extended (D3) Mesenterectomy for Small Bowel Tumors” clinical trial.

PATIENTS:
Eight cadavers were dissected. The 3D-computed tomography dataset included 101 patients.

MAIN OUTCOME MEASURES:
Lymph vessels ran parallel and interlaced with jejunal arteries. Lymphatic clearance was minimal at the jejunal artery’s origin, radially spreading thereafter. Jejunal arteries were categorized into 3 groups based on position to the middle colic artery origin on 3D-computed tomography. Group A: jejunal artery origins lie cranially and caudally to the middle colic artery. Group B: jejunal artery origins lie caudal to the middle colic artery. Group C: jejunal artery origins lie cranial to the middle colic artery. Jejunal veins were classified into 3 groups based on their trajectories to the superior mesenteric artery (dorsally/ventrally/combined).

RESULTS:
Lymph vessel clearances were 1.5 ± 1.0 mm at jejunal artery origins. Group A was present in 81 (80.2%), group B in 13 (12.9%), group C in 7 (6.9%) cases. Jejunal artery median was 4. A 57 (56.4%) of jejunal veins ran dorsally to the superior mesenteric artery, 16 (15.8%) ran ventrally, and 28 (27.8%) had combined course.

LIMITATIONS:
Lymph nodes weren’t counted during dissection because the main observation was the position of lymph vessels.

CONCLUSION:
Minimal jejunal artery lymphatic clearance implies ligating tumor-feeding vessels at origin. The intermingled jejunal artery lymphatics imply lymph node dissection along the proximal and distal vessels to the level of the first arcade. Classifying jejunal arteries and veins could simplify the anatomy for surgeons. See Video Abstract

Clinical trial registration number:
NCT05670574.
Paravertebral block is not superior to the interpectoral and pectoserratus plane block for patients undergoing breast surgery
Authors: Dost Burhan , Bugada Dario , Karapinar Yunus Emre , Balzani Eleonora , Beldagli Muzeyyen , Aviani Fulvio Giulia , Yalin Mirac Selcen Ozkal , Turunc Esra , Sella Nicolò , De Cassai Alessandro 
Published: February 2025

BACKGROUND
Breast surgery is frequently associated with significant acute postoperative pain, necessitating effective pain management strategies. Both thoracic paravertebral block (PVB) and interpectoral plane and pectoserratus plane (IP+PS) blocks have been used to relieve pain after breast surgery.

OBJECTIVE
In this systematic review and meta-analysis with trial sequential analysis, we aimed to identify the optimal analgesic technique for achieving effective pain relief in breast surgery. The primary outcome of this study was postoperative opioid consumption expressed as morphine milligram equivalent (MME) at 24 h. Secondary outcomes included resting and movement pain scores at 0, 6, 12 and 24 h, postoperative nausea and vomiting (PONV), and rescue analgesic requirements within the first 24 h.

DESIGN
A meta-analysis of randomised controlled trials (RCTs) with meta-regression and trial sequential analysis (TSA).

DATA SEARCH
We systematically searched Pubmed, Scopus, the Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science, Google Scholar, Medline (from inception to until 1 October 2024).

ELIGIBILITY CRITERIA
RCTs that include patients undergoing breast surgery with PVB or IP+PS block, with no language restriction.

RESULTS
Eighteen RCTs with 924 patients were included. No significant difference in MME consumption at 24 h was observed between the two techniques; mean difference (MD) −1.94 (95% confidence interval (CI) −4.27 to 0.38, P = 0.101). Subgroup analyses revealed a minor advantage for IP+PS in patients without axillary involvement; MD −2.42 (95% CI −3.56 to −1.29, P < 0.001), though below the threshold of clinical significance. Secondary outcomes, including pain scores, PONV incidence and rescue analgesic requirements were comparable. Trial sequential analysis (TSA) confirmed sufficient sample size, suggesting further studies may not alter conclusions.

CONCLUSION
PVB and IP+PS blocks offer comparable analgesic efficacy and opioid-sparing effects after breast surgery, with no meaningful differences in 24-h MME consumption, pain scores, or PONV incidence.
Development of a UHPLC-MS/MS Method for the Determination of Omadacycline in Human Plasma
Authors: Chen Chuang , Chen Yao-Jie , Fu Jing , Wang Yu-Zhen , Qin Sun-Ting , Kong Meng-Yu , Lin Guan-Yang , Zhang Xiu-Hua , Yu Xu-Ben 
Published: February 2025

Abstract:
Omadacycline is a novel aminomethylcycline antibiotic that retains its antibacterial activity against strain-specific efflux pumps and ribosomal protective protein mechanisms of tetracycline resistance. To determine the concentration of omadacycline in human plasma, an ultra-high-performance liquid chromatography-tandem mass spectrometry method was developed to provide a basis for therapeutic monitoring of omadacycline in clinical settings. The experimental approach involves using an ACQUITY UPLC BEH C18 column (2.1 × 50 mm, 1.7 μm), with a mobile phase of 0.1% aqueous formic acid:acetonitrile (90:10, vol/vol), a flow rate of 0.3 mL·min−1, a column temperature of 40°C, and an injection volume of 0.1 μL. Protein precipitation was employed as pretreatment, using acetonitrile as the precipitant. Minocycline was used as an internal standard. Omadacycline and internal standard were monitored in positive ion mode with the following mass transition pairs: mass/charge (m/z) = 557.1→ 470.1 for omadacycline, and m/z = 458.3→ 440.9 for IS, respectively. The established method showed a good linearity in the range of 0.01–10 mcg/mL of omadacycline (Y = 0.4603X + 0.0452, r2 = 0.999), with the lower limit of quantification of 0.01 mcg/mL. Method validation included accuracy, precision, matrix effect, recovery, carryover, dilution integrity, and stability, all of which met the requirements of the US Food and Drug Administration for the validation of bioanalytical methods. This method has been successfully applied to therapeutic drug monitoring in patients.
Immediate Lymphatic Reconstruction May Decrease the Incidence of Lymphedema in Patients Undergoing Axillary Lymph Node Dissection
Authors: Yakaback Spencer , Fraulin Georgia , Lindell Jonsson Eva , Elmi Assadzadeh Golpira , Bains Ish , Temple-Oberle Claire 
Published: February 2025

Background:
Approximately one-third of patients undergoing axillary lymph node dissection (ALND) for breast cancer will develop breast cancer–related lymphedema (BCRL). To prevent BCRL, immediate lymphatic reconstruction (ILR) has been proposed, whereby lymphatics cut during the ALND are anastomosed to adjacent veins to restore lymphatic drainage. As evidence for ILR grows, the aim of this study was to investigate its efficacy at our institution.

Methods:
This prospective single-center study included 17 women undergoing ALND with ILR. Our primary outcome was the incidence of BCRL, diagnosed using a greater than 10% relative difference in arm volume. Use of compression therapy was also followed. Our secondary outcome was patient-reported outcome measures, determined by the validated Lymphedema Quality of Life (LYMQOL-Arm) survey. Postoperatively, patients were followed up at regular intervals for a minimum of 18 months.

Results:
The median age of included patients was 49 (interquartile range [IQR] 46–58). The average follow-up time was 34.4 months (range 18–42 mo). Two patients met the criteria for BCRL. Patients with BCRL had a significantly higher median arm volume difference of 27.5% (IQR 21.8%–33.2%) versus 4.2% (IQR 1.6%–7%; P = 0.02). Three patients used compression to control symptoms. Patients without lymphedema scored better in several domains of the LYMQOL-Arm survey, including function, appearance, and overall quality of life; however, these results did not meet statistical significance.

Conclusions:
ILR in patients undergoing ALND is associated with a low incidence of BCRL. Our study is one of the first to use patient-reported outcome measures to study ILR.
Total Breast Reconstruction With a Fat-augmented Latissimus Dorsi Flap Combined With a Breast Implant: Tribrid Breast Reconstruction
Authors: Sowa Yoshihiro , Nakayama Ichiro , Higai Shino , Toyohara Yoshihiro , Kurokawa Yasue , Sunaga Ataru , Inafuku Naoki 
Published: February 2025

Summary:
Total breast reconstruction using only a latissimus dorsi flap (LDF) often has a problem of insufficient volume. Recently, a fat-augmented LDF has been introduced as a solution to this problem. However, there are still many cases in which augmentation with fat grafting alone is not enough to achieve symmetrical breasts. Here, we discuss a new approach for full breast reconstruction, which we refer to as tribrid reconstruction, that combines the fat-augmented LDF with a breast implant. Depending on the need for a skin island, the LDF or muscle flap is harvested and augmented with fat grafting, either to the flap itself or by injecting fat into the pectoral muscle or the subcutaneous tissue of the chest. In cases in which this does not correct asymmetry, an implant is added to enhance the breast volume. This 3-component reconstruction method was applied in 9 cases, and all achieved sufficient postoperative volume and satisfactory aesthetic results. This technique can be used in a single surgery to reconstruct both moderately sized and larger breasts.
Central pulse pressure, carotid artery remodeling and coronary artery calcifications
Authors: Kozakova Michaela , Morizzo Carmela , Jamagidze Giuli , Chiappino Sara , Chiappino Dante , Emdin Michele , Palombo Carlo 
Published: February 2025

Objectives:
The aim of the study was to evaluate the role of central pulse pressure (PP) in carotid wall thickening and coronary artery calcification (CAC).

Methods:
In an asymptomatic general population (N = 396, 163 men, 47–89 years), central PP was measured by applanation tonometry, CAC by computed tomography, and common carotid artery intima–media thickness (cIMT), pulse wave velocity (cPWV) and the power of the signal reflected from carotid media (cMP) by radiofrequency-based carotid ultrasound. High cIMT was defined as cIMT equal to or greater than the 75th percentile for given sex and age, and CAC presence as a CAC score greater than 0.

Results:
In the entire population, luminal diameter and cMP increased with increasing central PP (r = 0.32 and 0.25; P < 0.0001). One hundred and ninety-seven individuals had high cIMT; individuals with high cIMT had higher central PP, luminal diameter, cMP and cPWV (P = or <0.0001), but comparable wall tensile stress (P = 0.23). In a logistic regression model, high cIMT was independently associated with luminal diameter and central PP. One hundred and fifty-two individuals had CAC score greater than 0; in a logistic regression model, CAC score greater than 0 was independently associated with sex, age, central PP, LDL-cholesterol, triglycerides and T2DM.

Conclusion:
Our findings indicate that high central PP contributes both to an increase in cIMT and the development of CAC. However, while central PP was the only risk factor linked to high cIMT, multiple atherosclerotic risk factors were associated with CAC. Therefore, both high cIMT and CAC reflect the adverse impact of high pulsatile load on the vascular system, yet only CAC can be considered a marker of atherosclerosis.
Large Language Models in Traditional Chinese Medicine: A Systematic Review
Authors: Chen Zhe , Wang Hui , Li Chengxian , Liu Chunxaing , Yang Fengwen , Zhang Dong , Fauci Alice Josephine , Zhang Junhua 
Published: February 2025

Objective:
Generative artificial intelligence (AI) technology, represented by large language models (LLMs), has gradually been developed for traditional Chinese medicine (TCM); however, challenges remain in effectively enhancing AI applications for TCM. Therefore, this study is the first systematic review to analyze LLMs in TCM retrospectively, focusing on and summarizing the evidence of their performance in generative tasks.

Methods:
We extensively searched electronic databases for articles published until June 2024 to identify publicly available studies on LLMs in TCM. Two investigators independently selected and extracted the related information and evaluation metrics. Based on the available data, this study employed descriptive analysis for a comprehensive systematic review of LLM technology related to TCM.

Results:
Ten studies published between 2023 and 2024 met our eligibility criteria and were included in this review, including 40% LLMs in the TCM vertical domain, 40% containing TCM data, and 20% honoring the TCM contribution, with a foundational model parameter range from 1.8 to 33 billion. All included studies used manual or automatic evaluation metrics to evaluate model performance and fully discussed the challenges and contributions through an overview of LLMs in TCM.

Conclusions:
LLMs have achieved significant advantages in TCM applications and can effectively address intelligent TCM tasks. Further in-depth development of LLMs is needed in various vertical TCM fields, including clinical and fundamental research. Focusing on the functional segmentation development direction of generative AI technologies in TCM application scenarios to meet the practical needs-oriented demands of TCM digitalization is essential.
Graphical abstract: http://links.lww.com/AHM/A152.