bluuebunny/crossref_metadata_2025_split huggingface dataset:
Sleep–wake behavioral characteristics associated with depression symptoms: findings from the Multi-Ethnic Study of Atherosclerosis
Authors: Lau Stephen C L , Zhang Gehui , Rueschman Michael , Li Xiaoyu , Irwin Michael R , Krafty Robert T , McCall William V , Skidmore Elizabeth , Patel Sanjay R , Redline Susan , Smagula Stephen F 
Published: February 2024

AbstractStudy ObjectivesTo help prioritize target/groups for experimental intervention studies, we characterized cross-sectional associations between 24-hour sleep–wake measures and depression symptoms, and evaluated if similar sleep–wake–depression relationships existed in people with and without higher insomnia severity.MethodsParticipants had ≥3 days of actigraphy data (n = 1884; mean age = 68.6/SD = 9.1; 54.1% female). We extracted 18 sleep, activity, timing, rhythmicity, and fragmentation measures from actigraphy. We used individual and multivariable regressions with the outcome of clinically significant depression symptoms (Center for Epidemiologic Studies Depression Scale ≥ 16). We conducted sensitivity analyses in people with higher insomnia severity (top quartile of the Women’s Health Initiative Insomnia Rating Scale total score).ResultsFrom separate models in the overall sample, the odds of having depression symptoms were higher with: later timing (e.g. activity onset time odds ratio [OR]/1 SD = 1.32; 95% confidence interval [CI]: 1.16 to 1.50), lower rhythmicity (e.g. pseudo-F OR/1 SD = 0.75; 95% CI: 0.66 to 0.85), less activity (e.g. amplitude OR/1 SD = 0.83; 95% CI: 0.72 to 0.95), and worse insomnia (OR/1 SD = 1.48, 95% CI: 1.31 to 1.68). In multivariable models conducted among people with lower insomnia severity, later timing, lower rhythmicity, and higher insomnia severity were independent correlates of depression. In people with higher insomnia symptom severity, measures of later timing were most strongly associated with depression symptoms.ConclusionsThese correlative observations suggest that experimental studies are warranted to test if: broadly promoting 24-hour sleep–wake functioning reduces depression even in people without severe insomnia, and if advancing timing leads to depression symptom reductions in people with insomnia.
Current concepts in the use of cell salvage in obstetrics
Authors: Neef Vanessa , Meybohm Patrick , Zacharowski Kai , Kranke Peter 
Published: February 2024

Purpose of review
The worldwide leading cause of maternal death is severe maternal hemorrhage. Maternal hemorrhage can be profound leading to an entire loss of blood volume. In the past two decades, Patient Blood Management has evolved to improve patient's care and safety. In surgeries with increased blood loss exceeding 500 ml, the use of cell salvage is strongly recommended in order to preserve the patient‘s own blood volume and to minimize the need for allogeneic red blood cell (RBC) transfusion. In this review, recent evidence and controversies of the use of cell salvage in obstetrics are discussed.

Recent findings
Numerous medical societies as well as national and international guidelines recommend the use of cell salvage during maternal hemorrhage.

Summary
Intraoperative cell salvage is a strategy to maintain the patient‘s own blood volume and decrease the need for allogeneic RBC transfusion. Historically, cell salvage has been avoided in the obstetric population due to concerns of iatrogenic amniotic fluid embolism (AFE) or induction of maternal alloimmunization. However, no definite case of AFE has been reported so far. Cell salvage is strongly recommended and cost-effective in patients with predictably high rates of blood loss and RBC transfusion, such as women with placenta accreta spectrum disorder. However, in order to ensure sufficient practical experience in a multiprofessional obstetric setting, liberal use of cell salvage appears advisable.
Implementation of guidelines in clinical practice; barriers and strategies
Authors: De Hert Stefan , Paula–Garcia Waynice Neiva de 
Published: February 2024

Purpose of review
Published clinical practice guidelines frequently have difficulties for implementation of the recommendations and adherence in daily clinical practice. The present review summarizes the current knowledge on the barriers encountered when implementing clinical practice guideline and the strategies proposed to address these barriers.

Recent findings
Studies on strategies for implementation of clinical guidelines are scarce. Evidence indicates that a multidisciplinary policy is necessary in order to address the barriers at various levels. Continuous education and motivation of the stakeholders, together with structural adaptations are key elements in the process.

Summary
The barriers for implementation of guidelines involve different levels, including the healthcare system, organizational, societal and cultural specificities, and individual attitudes. All of these should be addressed with policy-driven strategies. Such strategies could include optimization of resources allocations, and establishing well coordinated multidisciplinary networks, finally, future studies should also evaluate the effectiveness of the potential strategies.
Prehospital transfusion of allogeneic blood products
Authors: Alomar-Dominguez Cristina , Bösch Johannes , Fries Dietmar 
Published: February 2024

Purpose of review
The purpose of this article is to provide a structural and practical analysis of the currently available data concerning prehospital transfusion of allogeneic blood products in cases of trauma and severe bleeding.

Recent findings
Prehospital transfusion of allogeneic blood products is a very early intervention, which may offer the potential to improve outcome, but that also comes with challenges including resource allocation, blood product storage, logistics, patient selection, legal and ethical considerations, adverse effects, and costs. Potential benefits including improved stability and reduction in coagulopathy and blood loss have not yet been clearly demonstrated.

Summary
The questionable efficacy and challenges in clinical practice may outweigh the potential benefits of prehospital allogeneic transfusion.
Dosing of tranexamic acid in trauma
Authors: Faraoni David , Fenger-Eriksen Christian 
Published: February 2024

Purpose of review
Tranexamic acid is routinely used as part of the management of traumatic bleeding. The dose recommendation in trauma was extrapolated from other clinical settings and the results of pragmatic randomized trials rather than pharmaco-kinetic and -dynamic evaluations. The review addresses current evidence on dosing of tranexamic acid in traumatized patients with a focus on efficacy, safety and risk-benefit profile.

Recent findings
A majority, but not all, of existing randomized clinical trials reports a reduction in mortality and/or blood loss with tranexamic acid administration. Increasing dose above the general recommendation (1 g bolus + 1 g infusion/8 h intravenously) has not been shown to further increase efficacy and could potentially increase side effects.

Summary
The benefit of tranexamic acid as adjuvant therapy in the management of bleeding trauma patients on mortality and transfusion requirements is clear and well documented, being most effective if given early and to patients with clinical signs of hemorrhagic shock. Recent reports suggest that in some patients presenting with a shutdown of their fibrinolytic pathway the administration of tranexamic acid could be associated with an increased risk of thromboembolic events and poor outcomes. A more personalized approach based on bedside assessment of fibrinolytic activation and pharmacokinetic-based dose regimen should be developed moving forward.
Broadening the scope and rising to the occasion, an opportunity for anaesthesiologists to take the lead in healthcare quality & patient safety (again)
Authors: Buhre Wolfgang , Maas Linde 
Published: February 2024

Purpose of review
The landscape of healthcare is characterized by high demands and scarce human and financial resources. This calls for action in improving healthcare quality. This review shows how anaesthesiologists are the designated medical specialist to share their affinity and knowledge in quality and safety, throughout the hospital and across the care continuum.

Recent findings
Recent studies show excellent frameworks and examples of anaesthesiologist leading the way in patient safety and quality of care.

Summary
Anaesthesiologist are early adapters of patient safety. In the last decades anaesthesia has become linked with patient safety and the quality of care. With the recent transition from peroperative to perioperative care; new opportunities are emerging, expanding our professional scope. Unfortunately, the anaesthesiologist is not often positioned in a leading role in quality of care and patient safety. After a brief rise during the COVID-19 pandemic, in which anaesthesiologists were visible in the frontline in many countries, we have unfortunately disappeared from the spotlight. This review shows numerous ideas, examples, and a framework how a leading position can be realized.
Refinements in the Treatment of Volkmann Ischemic Contracture of the Forearm: A Thematic Review
Authors: Stevanovic Milan , Sharpe Frances E. 
Published: February 2024

Summary:
Volkmann contracture of the forearm is a devastating complication of muscle ischemia. It is most commonly associated with trauma and a sequela of compartment syndrome. In the last few decades, much has improved in our ability to treat these patients. Our preferred treatments are presented along with representative case studies that illustrate the functional gains that can be achieved with a focus on moderate and severe contractures. Refinements in care that have evolved over the past 40 years of experience in treating these patients are presented.
Secondary Trigger Point Deactivation Surgery for Nerve Compression Headaches: A Scoping Review
Authors: Saffari Sara , Saffari Tiam M. , Janis Jeffrey E. 
Published: February 2024

Background:
Primary trigger point deactivation surgery has been successful in reducing or eliminating nerve compression headaches between 79% and 90% of the time. The aim of this review article was to discuss the factors that contribute to index trigger point deactivation surgery failure, the importance of reevaluating trigger points following failure, and the options for secondary surgery.

Methods:
A literature search was performed using a combination of keywords involving “chronic headache” and “nerve deactivation surgery,” in databases until February 2023.

Results:
Data of 1071 patients were evaluated and included (11 articles). The failure rate after index trigger point deactivation surgery occurs is approximately 12%, primarily due to incomplete primary trigger point deactivation. Secondary trigger points may not appear until the primary trigger is eliminated, which occurs in 17.8% of patients. Reevaluation of previously diagnosed trigger points as well as uncovered trigger points and additional preoperative testing is indicated to help determine candidacy for further surgical deactivation. To address scarring that could contribute to failure, corticosteroid injection, acellular dermal matrix, adipofascial fat, or expanded polytetrafluoroethylene sleeves have been described with beneficial effects. For neuroma management, regenerative peripheral nerve interface, targeted muscle reinnervation, a combination of both, relocation nerve grafting, or nerve capping have also been described. Neurectomy can be performed when patients prefer anesthesia and/or paresthesia over current pain symptoms.

Conclusion:
Secondary trigger point deactivation surgery is indicated when there is suspicion of incomplete deactivation, internal scarring, neuroma, or newly-diagnosed trigger points.
Awareness and acceptability of embryo adoption among African women with fertility challenges in Umuahia, South East Nigeria
Authors: Agwu Felix Eke , Ekechi-Agwu Chinelo A 
Published: February 2024

Objective:
In African culture, a large premium is attached to procreation. An African woman who has not given birth to a child lacks fulfillment and marital security. Embryo adoption though an uncommon procedure is currently becoming an option for infertile African women.

Methods:
A study questionnaire was randomly administered to 220 infertile women at the fertility clinic. Data collated was analyzed using the EPI info version.

Results:
Most of the women were married (85.7%) and the majority were Pentecostals (71%). The most common source of awareness was social media (40.8%) and friends (34.7%). Most respondents were aware of embryo adoption (82.8%). All respondents most importantly, understand embryo adoption to mean fusion of male and female gametes (100%). For the majority of the respondents, their culture (94.4%) and religion (92.5%) do not prohibit embryo adoption.

Conclusion:
This study demonstrates that embryo adoption is widely accepted as a treatment for infertility among women in Umuahia, South-East Nigeria; a typical African society. Religion and culture in Africa are not barriers to the utilization of embryo adoption in Africa.
A deep dive into the percutaneous mitral valve data
Authors: Tagliari Ana Paula , Saadi Rodrigo Petersen , Tang Gilbert H.L. 
Published: February 2024

Purpose of review
This review offers insights into percutaneous mitral valve management, emphasizing pivotal trials that contributed to its evolution.

Recent findings
Mitral regurgitation (MR) is a highly prevalent heart valve disease, with surgical intervention being the gold standard for managing primary MR. However, a notable proportion of patients face ineligibility criteria or are at high surgical risk, particularly in the setting of secondary MR. To fill this gap, transcatheter therapies have emerged as less invasive alternatives. Initially guided by the EVEREST trial criteria, transcatheter leaflet repair techniques have shown impressive technological improvements, addressing nowadays a wide range of anatomical scenarios. Evidence supporting the safety and efficacy of transcatheter leaflet repair is derived from pivotal trials, including EVEREST II, COAPT, MITRA-FR, and CLASP IID, and large multicenter registries including EXPAND, EXPAND G4, and EuroSMR. However, not all patients meet the anatomical and clinical criteria for leaflet repair. For those patients, transcatheter mitral valve replacement may be a minimally invasive option and multiple clinical trials are current underway.

Summary
From MitraClip to newer and more innovative technologies, the landscape of percutaneous mitral valve interventions continues to evolve, offering new hopes to patients who may not be ideal candidates for conventional surgery.
Double outlet right ventricle – the 50% rule has always been about the conus
Authors: Josowitz Rebecca , Rogers Lindsay S. 
Published: February 2024

Purpose of review
There has been much variability in the definition of double outlet right ventricle (DORV) spanning the last century. Historically, emphasis has been placed on the assignment of the great arteries to the right ventricle as a definition of DORV. In this review, we aim to underscore the importance of conal muscle, rather than rules surrounding assignment of great arteries to ventricles. We will be outlining the variability in patient anatomy that results from variations in conal muscle development in DORV, which may not fit perfectly into predefined constructs. This anatomic variability directly determines physiology and surgical repair options.

Recent findings
There is a growing appreciation of the utility of cross-sectional imaging in complex DORV, and the generation of patient-specific 3D models with virtual reality simulations for surgical planning. These models improve the prediction of candidacy for biventricular repair and allow the mapping of complex baffle pathways preoperatively.

Summary
DORV is not a disease entity in itself, but rather a vast spectrum of disorders associated with maldevelopment of conal muscle and often abnormal expansion of one the great vessels. Patient-specific 3D models will be crucial for improved surgical planning and patient outcomes.
The Resistance of Riboflavin/UV-A Corneal Cross-Linking to Enzymatic Digestion Is Oxygen-Independent
Authors: Hafezi Nikki L. , Aydemir M. Enes , Lu Nan-Ji , Torres-Netto Emilio A. , Hillen Mark , Koppen Carina 
Published: February 2024

Purpose:
Corneal cross-linking (CXL) with riboflavin and UV-A induces several effects in the cornea, including biomechanical stiffening, generation of reactive oxygen species, and increased resistance to enzymatic digestion. Whereas the biomechanical stiffening effect is oxygen-dependent, little is known about the effect of oxygen on the resistance to enzymatic digestion. Here, we examined CXL-induced enzymatic resistance in the absence of oxygen.

Methods:
Ex vivo porcine corneas (n = 160) were assigned to 5 groups. Group 1 was the control group (abrasion and riboflavin application). Groups 2 and 3 received accelerated 10 and 15 J/cm2 high-fluence CXL protocols in the presence of oxygen (9′15″ @ 18 mW/cm2 and 8′20″ @ 30 mW/cm2, respectively), whereas groups 4 and 5 received accelerated 10 and 15 J/cm2 high-fluence CXL protocols in the absence of oxygen (oxygen content less than 0.1%). After CXL, corneas were digested in 0.3% collagenase A solution. Mean time until complete dissolution was determined.

Results:
The mean times to digestion in groups 1 through 5 were 22.31 ± 1.97 hours, 30.78 ± 1.83 hours, 32.22 ± 2.22 hours, 31.38 ± 2.18 hours, and 31.69 ± 2.53 hours, respectively. Experimental CXL groups showed significantly higher (P < 0.001) resistance to digestion than nonirradiated controls. There was no significant difference in time to digestion across all experimental CXL groups, irrespective of fluence delivered or the absence of oxygen.

Conclusions:
The resistance to digestion in accelerated high-fluence riboflavin/UV-A CXL is oxygen-independent, which is of particular importance when developing future optimized CXL protocols for corneal ectasia and infectious keratitis.
Two-Year Progression of Dry Eye Disease in Dry Eye Assessment and Management Study
Authors: Lee Daniel Chein , Guo Michelle , Yu Yinxi , Bunya Vatinee Y. , Asbell Penny , Ying Gui-Shuang 
Published: February 2024

Purpose:
The purpose of this study was to evaluate the progression of dry eye disease (DED) symptoms and signs over 2 years through a secondary analysis of data collected from the Dry Eye Assessment and Management study.

Methods:
Participants who were assigned to omega-3 fatty acid in the first year were rerandomized in the second year to either continue with omega-3 fatty acid or switch to placebo. At baseline, 3, 6, 12, 18, and 24 months, DED symptoms were evaluated by using the Ocular Surface Disease Index and the Brief Ocular Discomfort Index (BODI). DED signs were assessed using conjunctival staining, corneal staining, tear break-up time, Schirmer testing, and keratography measures. Medication usage was documented at each visit. Because the treatment and placebo groups displayed no statistical differences in both signs and symptoms, data from the 43 participants were combined to assess longitudinal changes in symptoms and signs.

Results:
At 3 months after omega-3 fatty acid treatment, there were significant improvements from baseline in Ocular Surface Disease Index and Brief Ocular Discomfort Index scores (all P ≤ 0.002) and less use of artificial tears or gel (P = 0.02), but between 3 and 24 months, no significant changes in symptoms and treatments were observed (P ≥ 0.06). Except for a significant improvement in conjunctival staining score over 2 years (P = 0.001), there were no significant sign changes in corneal staining (P = 0.32), tear break-up time (P = 0.43), Schirmer test (P = 0.09), and additional measures (all P ≥ 0.07).

Conclusions:
We did not observe a progression of DED signs or symptoms over a 2-year period, except for a probable placebo response in symptoms in the first 3 months and an improvement in conjunctival staining score.
Differences in Guttae Ultramorphology in Relation to Visual Function in Fuchs Endothelial Corneal Dystrophy
Authors: Weller Julia M. , Bennemann Maximilian , Tourtas Theofilos , Kruse Friedrich E. , Schlötzer-Schrehardt Ursula 
Published: February 2024

Purpose:
The purpose of this study was to investigate the differences in guttae ultramorphology and their relation to visual function in eyes with Fuchs endothelial corneal dystrophy (FECD).

Methods:
Thirty FECD eyes without ocular comorbidities were included. Visual functional parameters (best-corrected visual acuity with high-contrast and low-contrast letters and contrast sensitivity/LogCS) and corneal morphology measured with Scheimpflug tomography (Pentacam) were assessed. The surgically removed Descemet membranes were examined by light and transmission electron microscopy.

Results:
Preoperative mean best-corrected visual acuity (logarithm of the minimum angle of resolution) was 0.52 ± 0.18, LogCS 0.96 ± 0.21 and central corneal thickness 640 ± 55 μm. All eyes had signs of subclinical corneal edema in Scheimpflug tomography; clinically visible corneal edema was present in 40% of eyes. Histological findings included a posterior fibrillar zone (PFZ) in 10 specimens (33%) and abnormal collagen depositions in Descemet membranes in 14 specimens (47%). Guttae buried within the PFZ were present only in eyes with clinically visible edema (n = 4, 13%). There was no difference in visual function results and tomography parameters between eyes with and without PFZ or between protruding guttae and guttae embedded in a PFZ, respectively.

Conclusions:
Guttae morphology and density were not correlated with visual functional parameters. Guttae buried in a PFZ occurred only in eyes with clinically manifest edema, and thereby, they are an ultramorphological sign for advanced FECD. Subclinical edema was present in all eyes and might be more relevant for quality of vision than guttae ultramorphology.
Corneal Endothelium Viability Assay Using Trypan Blue Dye After Preloaded Descemet Membrane Endothelial Keratoplasty Graft Preparation
Authors: Szkarlat Michael R. , Hicks Nicholas , Titus Michael S. , Sawant Onkar B. 
Published: February 2024

Purpose:
The purpose of this study was to establish a validated method, consistent with Eye Bank Association of America medical standards, for evaluating endothelial cell loss (ECL) from an entire Descemet membrane endothelial keratoplasty (DMEK) graft using trypan blue dye as an alternative to specular microscopy.

Method:
Twenty-nine corneas were prepared for preloaded DMEK by a single technician, and the endothelium was stained with trypan blue dye for 30 seconds. The technician estimated total cell loss as a percentage of the graft and captured an image. Images were evaluated by a blinded technician using ImageJ software to determine ECL and compared with endothelial cell density from specular microscopy. Tissue processing intervals were analyzed for 4 months before and after implementation of this method.

Results:
For the 29 grafts, there was no statistically significant difference (t test, P = 0.285) between ECL estimated by a processor (mean = 5.8%) and ECL calculated using an ImageJ software (mean = 5.1%). The processor tended to estimate greater ECL than the actual ECL determined by ImageJ (paired t test, P = 0.022). Comparatively, postprocessing endothelial cell density measured by specular microscopy were higher compared with the preprocessing endothelial cell density (mean = 4.5% P = 0.0006). After implementation of this evaluation method, DMEK graft processing time intervals were reduced by 47.9% compared with specular microscopy evaluation (P < 0.001).

Conclusions:
Our results show that visual ECL estimation using trypan blue staining by a DMEK graft processor is a reliable and efficient method for endothelial assessment. Unlike specular microscopy, this method achieves comprehensive visualization of the entire endothelium, reduces total time out of cold storage, and decreases total time required to prepare and evaluate DMEK grafts.