bluuebunny/crossref_metadata_2025_split huggingface dataset:
Impact of Legal Guardian Absence on Research Enrollment in the PICU*
Authors: Armstrong Jennifer , Gibson Jess , O’Hearn Katie , Martin Dori-Ann , Assaf Maysaa , Menon Kusum 
Published: June 2024

OBJECTIVES:
To identify the frequency of which a legal guardian is at the bedside of children admitted to the PICU that are eligible for research studies.

DESIGN:
A prospective, observational study.

SETTING:
Three tertiary Canadian PICUs.

PATIENTS:
Two hundred one patients were admitted to the PICU between September 2021 and March 2023 (site 1), from March 2019 to March 2020 and March 2022 to March 2023 (site 2), and from March 2019 to March 2020 and July 2020 to November 2021 (site 3).

INTERVENTIONS:
None.

MEASUREMENTS AND MAIN RESULTS:
At each center, the duration of consent encounters was recorded for patients eligible for research by documenting the length of each attempt (min). The frequency of parental presence at bedside and the ability for a guardian to make a decision were also recorded. Thirty-five percent of patients eligible for research did not have a legal guardian at the bedside on the first attempted consent encounter. Twenty-three percent of approached patients were not enrolled due to an inability for a consent decision to be made by the child’s legal guardian or an inability to contact the guardian before discharge.

CONCLUSIONS:
The absence of legal guardians in the PICU poses a barrier to the enrollment of critically ill children in pertinent research studies and suggests that a model of deferred consent or implied consent would aid in the future of critical care research.
Brief Report: Subsequent Pregnancies in the IMPAACT 2010/VESTED Trial: High Rate of Adverse Outcomes in Women Living With HIV
Authors: Fairlie Lee , Brummel Sean , Ziemba Lauren , Coletti Anne , Chinula Lameck , Shapiro Roger , Stringer Jeffrey , Malonga Grace , Browning Renee , Chakhtoura Nahida , Mmbaga Blandina Theophil , Mhembere Tsungai P. , Omoz-Oarhe Ayotunde , Nagaddya Beatrice , Naidoo Megeshinee , Hoffman Risa M. , Lockman Shahin ,   for the IMPAACT 2010/VESTED Study Team
Published: June 2024

Introduction:
Women with HIV (WHIV) have higher risks of adverse pregnancy outcomes, particularly in the absence of antiretroviral treatment (ART), and timing of ART may impact risk.

Methods:
In the International Maternal Pediatric Adolescent AIDS Clinical Trials 2010/VESTED study, 643 pregnant WHIV in 9 countries were randomized in a 1:1:1 ratio to initiate ART: dolutegravir (DTG)+emtricitabine (FTC)/tenofovir alafenamide (TAF), DTG+FTC/tenofovir disoproxil fumarate (TDF), or efavirenz (EFV)/FTC/TDF. We describe adverse pregnancy outcomes in women with a subsequent pregnancy during 50 weeks of postpartum follow-up: spontaneous abortion (<20 weeks), stillbirth (≥20 weeks), preterm delivery (<37 weeks), and small for gestational age.

Results:
Of 643 women, 19 (3%) had 20 subsequent pregnancies while receiving ART at conception: DTG/FTC/TAF (3), DTG/FTC/TDF (2), EFV/FTC or lamivudine (3TC)/TDF (12), EFV/abacavir/3 TC (1), and no ART (1). Four spontaneous abortions, 3 stillbirths, and 1 induced abortion occurred. Three (25%) of 12 liveborn infants were preterm (24, 26, and 36 weeks of gestation). Only 12 subsequent pregnancies (60%) resulted in live birth, and at least 1 adverse pregnancy outcome occurred in 11 of 19 (58%) (induced abortion excluded). Of 7 women who experienced spontaneous abortion/stillbirth in the subsequent pregnancy, 4 experienced a stillbirth and 1 a neonatal death as outcomes of their earlier index pregnancy. No congenital anomalies were reported.

Conclusions:
Adverse pregnancy outcomes were common in this cohort of WHIV who conceived on ART shortly after an index pregnancy, 35% ended in stillbirth or spontaneous abortion. The majority of fetal losses occurred in women with recent prior pregnancy loss. Data from larger cohorts of WHIV conceiving on ART and surveillance are needed to elucidate rates and predictors of adverse pregnancy outcome.
Relationships Between Hepatic Steatosis and Frailty Differ by HIV Serostatus
Authors: Debroy Paula , Barrett Benjamin W. , Erlandson Kristine M. , Budoff Matthew , Brown Todd T. , Price Jennifer C. , Post Wendy S. , Stosor Valentina , Skavarca Carling , D'Souza Gypsyamber , Lake Jordan E. 
Published: June 2024

Background:
Frailty is associated with obesity-related comorbidities, but the relationship with nonalcoholic fatty liver disease (NAFLD) in people with HIV has been incompletely described. Our objective was to assess the associations between NAFLD and frailty.

Methods:
Cross-sectional and longitudinal analysis of men in the Multicenter AIDS Cohort Study. NAFLD was defined as a liver/spleen ratio <1.0 on abdominal computed tomography scans; frailty was defined by the frailty phenotype as having 3 of the following: weakness, slowness, weight loss, exhaustion, and low physical activity.

Results:
Men without (n = 200) and with HIV (n = 292) were included. NAFLD prevalence was 21% vs 16% and frailty 12% vs 17%, respectively. Among men with NAFLD, frailty was more prevalent in men without HIV (21% vs 11%). In multivariate analysis, NAFLD was significantly associated with frailty after controlling for significant variables. Men without HIV and NAFLD had 2.6 times higher probability [95% confidence interval (CI): 1.2– to 5.7] of frailty relative to men with neither HIV nor NAFLD. This association was not seen in men with HIV. The probability of frailty was higher among men without HIV with NAFLD (27% vs 10% in men without NAFLD) but lower among men with HIV with NAFLD (14% vs 19% in men without NAFLD). No significant relationships were found in longitudinal analyses.

Conclusions:
NAFLD was independently associated with frailty among men without HIV but not men with HIV, despite increased prevalence of frailty among men with HIV. The mechanisms of the muscle–liver–adipose tissue axis underlying NAFLD might differ by HIV serostatus.
Comparing Different Donor Sites After Vascularized Lymph Node Transfer to the Lymphedematous Upper Limb
Authors: Braizat Omar , Jarrar Salma , El-Debs Mohammed , Al-Adwan Mohammad Abu Orabi , Syaj Sebawe , Abuzanouneh Faris , Mohammed Mazin , Mohammedali Shiyas , Quazi Sohail Jamiluddin , Muneer Mohammed 
Published: June 2024

Background
Vascularized lymph node transfer (VLNT) involves the microvascular transplantation of functional lymph nodes from a donor site into a limb affected by lymphedema to restore the normal flow of lymphatic fluid. Despite the increasing clinical experience with VLNT, there remains insufficient data to support its routine use in clinical practice. Here, we aim to evaluate the effectiveness and safety of VLNTs for upper limb lymphedema and compare clinical outcomes when using different donor sites.

Methods
We carried out a systematic search of the literature through PubMed and Scopus databases for studies on VLNT for upper limb lymphedema. Primary and secondary outcomes included circumference reduction rate (CRR) and infection reduction rate by postoperative cellulitis episodes for the efficacy and safety of VLNT. Pooled analysis was performed using the inverse variance weighting meta-analysis of single means using the meta package in R software. Subgroup analyses were performed for donor and recipient sites, age groups, follow-ups, and symptom durations. Quality assessment was performed using the Newcastle-Ottawa Scale for nonrandomized studies.

Results
A total of 1089 studies were retrieved from the literature, and 15 studies with 448 upper limb lymphedema patients who underwent VLNT were included after eligibility assessment. The mean CRR was 34.6 (18.8) and the mean postoperative cellulitis episodes per year was 0.71 (0.7). The pooled analysis of CRR was 28.4% (95% confidence interval, 19.7–41.1) and postoperative cellulitis episodes showed a mean of 0.59 (95% confidence interval, 0.36–0.95) using the random-effect model. Subgroup analyses showed significant group differences in recipient site for CRR and postoperative cellulitis episodes with the wrist comprising the highest weights, and patients younger than 50 years showing a lower postoperative infection.

Conclusions
Vascularized lymph node transfer using gastroepiploic flaps at the wrists has shown a significant difference in reductions of limb circumference and cellulitis episodes in upper limb lymphedema patients when compared with other donor sites. However, further prospective studies are needed to consolidate this finding.
Patient-Reported Outcomes and Complication Profiles of Implant-Based Breast Reconstruction in Patients With Postmastectomy Radiation Therapy
Authors: Liu Jian , Chen Cong , Chen Honggang , Xiang Aizhai , Zheng Ruzhen , Hu Shufang , Guo Jufeng , Qu Li , Zhou Jun , Wu Jiong 
Published: June 2024

Objective
This study aims to investigate the patient-reported outcomes (PROs) and complications of distinct implant-based breast reconstruction modality for patients with postmastectomy radiation therapy (PMRT).

Methods
A retrospective review was conducted on breast cancer patients with stage II-III disease who performed implant-based breast reconstruction following with PMRT between September 2016 and April 2022. The patients were categorized into two matched groups: (1) patients receiving prepectoral breast reconstruction (PBR) or (2) subpectoral breast reconstruction (SBR) followed by PMRT. Following reconstruction, the patients were further compared for PMRT with the tissue expander (PMRT-TE) versus PMRT with permanent implant (PMRT-PI). PROs were measured with BREAST-Q questionnaire. Early and late complications were recorded and analyzed.

Results
A total of 55 eligible patients were recruited. Patients who underwent PBR reported significantly higher satisfaction with breasts scores (P = 0.003) compared with the SBR group. The PMRT-TE group had higher satisfaction with breasts (P = 0.001) but lower physical well-being (P = 0.029) scores compared with PMRT-PI group. Moreover, patients in SBR cohort had a higher risk of capsular contracture (Baker grade III or IV) (20.5% vs 6.3%) and implant dislocation (48.7% vs 12.5%) than patients in PBR cohort. Patients in PMRT-PI group had a slightly higher rate of capsular contracture (Baker grade III or IV) than PMRT-TE group (20.8% vs 12.9%).

Conclusions
PBR was associated with lower rates of late complications, especially for implant dislocation, and higher satisfaction with breasts scores compared to SBR. In addition, compared to PMRT-TE with PMRT-PI, patients in PMRT-TE cohort reported superior PROs of satisfaction with breasts.
A World Update of Progress in Lower Extremity Transplantation
Authors: Kodali Naga Anvesh , Janarthanan Ramu , Sazoglu Bedreddin , Demir Zeynep , Dirican Omer , Zor Fatih , Kulahci Yalcin , Gorantla Vijay S. 
Published: June 2024

Abstract
The field of vascularized composite allotransplantation (VCA) is the new frontier of solid organ transplantation (SOT). VCA spans life-enhancing/life-changing procedures such as upper extremity, craniofacial (including eye), laryngeal, tracheal, abdominal wall, penis, and lower extremity transplants. VCAs such as uterus transplants are life giving unlike any other SOT. Of all VCAs that have shown successful intermediate- to long-term graft survival with functional and immunologic outcomes, lower extremity VCAs have remained largely underexplored. Lower extremity transplantation (LET) can offer patients with improved function compared to the use of conventional prostheses, reducing concerns of phantom limb pain and stump complications, and offer an option for eligible amputees that either fail prosthetic rehabilitation or do not adapt to prosthetics. Nevertheless, these benefits must be carefully weighed against the risks of VCA, which are not trivial, including the adverse effects of lifelong immunosuppression, extremely challenging perioperative care, and delayed nerve regeneration. There have been 5 lower extremity transplants to date, ranging from unilateral or bilateral to quadrimembral, progressively increasing in risk that resulted in fatalities in 3 of the 5 cases, emphasizing the inherent risks. The advantages of LET over prosthetics must be carefully weighed, demanding rigorous candidate selection for optimal outcomes.
Local Management for Diabetic Foot Ulcers
Authors: Qian Hu , Jian Yang , Chu Xiangyuan , Wang Yuanliang , Liu Zhu , Zhang Neng , Deng Chenliang , Shi Xiuquan , Wei Zairong 
Published: June 2024

Objective:
This study evaluated the efficacy of various local management strategies for diabetic foot ulcers (DFUs).

Background:
Several surgical and nonsurgical local interventional approaches are available for the treatment of DFUs. The comparative effectiveness of different treatments is unknown, and it remains unclear which approach is the optimal choice for DFU treatment due to limited direct comparisons.

Methods:
We did a systematic review and meta-analysis to select the optimal approach to DFU's local management. We searched Medline, Embase, Web of Science, and ClinicalTrials.gov from inception to September 1, 2023, to identify relevant randomized controlled trials. We analyzed data by pairwise meta-analyses with a random-effects model. A network meta-analysis using the surface under the cumulative ranking curve was performed to evaluate the comparative efficacy of different interventional approaches in the early (within 12 wk) and late stages (over 12 wk).

Results:
In all, 141 randomized controlled trials involving 14076 patients and exploring 14 interventional strategies were eligible for inclusion. Most studies (102/141) had at least 1 risk-of-bias dimension. Good consistency was observed during the analysis. Local pairwise comparisons demonstrated obvious differences in the early-stage healing rate and early-stage and late-stage healing times, while no significant difference in the late-stage healing rate or adverse events were noted. surface under the cumulative ranking curves identified the standard of care (SOC) + decellularized dressing (DD), off-loading (OL), and autogenous graft (AG) as the 3 most effective interventions within 12 weeks for both healing rate (97%, mean rank: 1.4; 90%, mean rank: 2.3; 80.8%, mean rank: 3.5, respectively) and healing time (96.7%, mean rank: 1.4; 83.0%, mean rank: 3.0; 76.8%, mean rank: 3.8, respectively). After 12 weeks, local drug therapy (LDT) (89.5%, mean rank: 2.4) and OL (82.4%, mean rank: 3.3) ranked the highest for healing rate, and OL (100.0%, mean rank: 1.0) for healing time. With respect to adverse events, moderate and high risks were detected in the SOC + DD (53.7%, mean rank: 7.0) and OL (24.4%, mean rank: 10.8) groups, respectively.

Conclusion:
The findings suggest that OL provided considerable benefits for DFU healing in both the early and late stages, but the high risk of adverse events warrants caution. SOC+DD may be the preferred option in the early stages, with an acceptable risk of adverse events.
Decoding the Clavien-Dindo Classification
Authors: Staubli Sebastian Manuel , Walker Harriet Louise , Saner Fuat , Salinas Camila Hidalgo , Broering Dieter Clemens , Malagò Massimo , Spiro Michael , Raptis Dimitri Aristotle ,   the HeALgroup.AI
Published: June 2024

Objective:
To assess ChatGPT’s capability of grading postoperative complications using the Clavien-Dindo classification (CDC) via artificial intelligence (AI) with natural language processing.

Background:
The CDC standardizes the grading of postoperative complications. However, consistent and precise application in dynamic clinical settings is challenging. AI offers a potential solution for efficient automated grading.

Methods:
ChatGPT’s accuracy in defining the CDC, generating clinical examples, grading complications from existing scenarios, and interpreting complications from fictional as well as real world clinical summaries were tested.

Results:
ChatGPT 4 precisely mirrored the CDC, outperforming version 3.5. In generating clinical examples, ChatGPT 4 showcased 99% agreement with minor errors in urinary catheterization. For single complications, it achieved 97% accuracy. ChatGPT was able to accurately extract, grade, and analyze complications from free-text fictional discharge summaries. It demonstrated near-perfect performance when confronted with real-world discharge summaries: comparison between the human and ChatGPT4 grading showed a κ value of 0.92 (95% CI: 0.82–1) (P<0.001).

Conclusions:
ChatGPT 4 demonstrates promising proficiency and accuracy in applying the CDC. In the future, AI has the potential to become the mainstay tool to accurately capture, extract, and analyze CDC data from clinical data sets.
Examining the Burden of Non-Communicable Diseases among Elderly Individuals Aged 70 and Older in Jordan over Three Decades
Authors: Abdelhaq Aya , Barakat Duaa , Zghoul Renad , Sultan Iyad 
Published: June 2024

AbstractBackgroundThis study investigates the trends in non-communicable diseases (NCDs) among the elderly population aged 70 and above in Jordan from 1991 to 2022. The elderly Jordanian population was targeted as it has vastly increased over the years, being approximately 6 times higher in 2021 than in 1991. The aim of this study is to provide a comprehensive insight on the burden of NCDs among Jordan’s elderly population .MethodsUsing data extracted from the Global Burden of Disease (GBD), incidence rates, disability-adjusted life years (DALYs), and mortality rates associated with NCDs were analyzed.ResultsThe findings of this study reveal a significant increase in the total burden of NCDs over the three decades reaching an absolute DALYs number of above 262,000 by 2021. Elderly females appear to have a slightly higher burden of NCDs when compared to males over the specified time period of 1991 to 2021. Cardiovascular diseases and diabetes were identified as the primary contributors to this increase and seem to have the highest two death rate ranks. However, when compared to global rates Jordan appears to have a 34% lower NCDs burden. The incidence rates appear to be stable with minimal change suggesting that the NCDs incidence has remained relatively constant in Jordan over the past three decades.ConclusionThis upward trend underscores the escalating public health challenge posed by NCDs in Jordan’s aging population. This study provides a comprehensive overview of the changes in NCD burden and aims to inform healthcare policy and strategic planning to mitigate the impact of NCDs on the elderly in Jordan.
Prediction of future cognitive decline among cognitively unimpaired individuals using measures of soluble phosphorylated tau or tau tangle pathology
Authors: Ossenkoppele Rik , Salvadó Gemma , Janelidze Shorena , Binette Alexa Pichet , Bali Divya , Karlsson Linda , Palmqvist Sebastian , Mattsson-Carlgren Niklas , Stomrud Erik , Therriault Joseph , Rahmouni Nesrine , Rosa-Neto Pedro , Coomans Emma M. , van de Giessen Elsmarieke , van der Flier Wiesje M. , Teunissen Charlotte E. , Jonaitis Erin M. , Johnson Sterling C. ,   PREVENT-AD Research Group, Villeneuve Sylvia , Benzinger Tammie L.S. , Schindler Suzanne E. , Bateman Randall J. , Doecke James D. , Doré Vincent , Feizpour Azadeh , Masters Colin L. , Rowe Christopher , Wiste Heather J. , Petersen Ronald C. , Jack Clifford R. , Hansson Oskar 
Published: June 2024

ABSTRACTPlasma p-tau217 and Tau-PET are strong prognostic biomarkers in Alzheimer’s disease (AD), but their relative performance in predicting future cognitive decline among cognitively unimpaired (CU) individuals is unclear. In this head-to-head comparison study including 9 cohorts and 1534 individuals, we found that plasma p-tau217 and medial temporal lobe Tau-PET signal showed similar associations with cognitive decline on a global cognitive composite test (R2PET=0.32 vs R2PLASMA=0.32, pdifference=0.812) and with progression to mild cognitive impairment (Hazard ratio[HR]PET=1.56[1.43-1.70] vs HRPLASMA=1.63[1.50-1.77], pdifference=0.627). Combined plasma and PET models were superior to the single biomarker models (R2=0.36, p<0.01). Furthermore, sequential selection using plasma p-tau217 and then Tau-PET reduced the number of participants required for a clinical trial by 94%, compared to a 75% reduction when using plasma p-tau217 alone. We conclude that plasma p-tau217 and Tau-PET showed similar performance for predicting future cognitive decline in CU individuals, and their sequential use (i.e., plasma p-tau217 followed by Tau-PET in a subset with high plasma p-tau217) is useful for screening in clinical trials in preclinical AD.
Multidisciplinary clinical assessment and interventions for childhood listening difficulty and auditory processing disorder: Relation between research findings and clinical practice
Authors: Moore David R. , Lin Li , Bhalerao Ritu , Caldwell-Kurtzman Jody , Hunter Lisa L. 
Published: June 2024

AbstractPurposeListening difficulty (LiD), often classified as auditory processing disorder (APD), has been studied in both research and clinic settings. The aim of this study was to examine the predictive relation between these two settings. In our “SICLiD” research study, children with normal audiometry, but caregiver-reported LiD, performed poorly on both listening and cognitive tests. Here we examined results of clinical assessments and interventions for these children in relation to research performance.MethodsStudy setting was a tertiary pediatric hospital. Electronic medical records were reviewed for 64 children aged 6-13 years recruited into a SICLiD LiD group based on a caregiver report (ECLiPS). The review focused on clinical assessments and interventions provided by Audiology, Occupational Therapy, Psychology (Developmental and Behavioral Pediatrics), and Speech-Language Pathology services, prior to study participation. Descriptive statistics on clinical encounters, identified conditions, and interventions were compared with quantitative, standardized performance on research tests. Z-scores were compared for participants with and without each clinical condition using univariate and logistic prediction analyses.ResultsOverall, 24 clinical categories related to LiD, including APD, were identified. Common conditions were attention (32%), language (28%), hearing (18%), anxiety (16%), and autism spectrum (6%) disorders. Performance on research tests varied significantly between providers, conditions, and interventions. Quantitative research data combined with caregiver reports provided reliable predictions of all clinical conditions except APD. Individual test significant correlations were scarce, but included the SCAN composite score, which predicted clinical language and attention difficulties, but not APD diagnoses.ConclusionsThe variety of disciplines, assessments, conditions and interventions revealed here supports previous studies showing that LiD is a multifaceted problem of neurodevelopment. Comparisons between clinical- and research-based assessments suggest a path that prioritizes caregiver reports and selected psychometric tests for screening and diagnostic purposes.