bluuebunny/crossref_metadata_2025_split huggingface dataset:
Ibuprofen Oral Administration Protocols for Analgesia After Cesarean Delivery: A Prospective Randomized Controlled Study
Authors: Li Shuang , Bao Ju , Qu Yuan , Zhang Bo , Cao Xinni , Huang Yanping , Liu Zhe 
Published: February 2025

Abstract

Objective:
To compare the analgesic effects of ibuprofen administered orally via two modes combined with a conventional, patient-controlled intravenous analgesia pump on maternal pain after cesarean section (CS).

Methods:
This prospective, randomized, controlled study enrolled females who underwent CS from August 2022 to August 2023 at Peking University First Hospital, Beijing, China. The participants were randomly assigned to the as-needed group (ibuprofen administered orally if demanded) or the scheduled group (ibuprofen administered orally 6 hours postpartum at 12-hour intervals for 48 hours). The post-delivery pain scores, oxycodone consumption at different time points, time to exhaust, ambulation, and lactation initiation, analgesia satisfaction level, and depression scores were compared between the two groups using relevant statistical methods with IBM SPSS version 26. The level of significance was 0.05.

Results:
The scheduled group showed significantly better pain control at 12 hours (4.00 (2.00–5.50) vs. 4.00 (4.00–6.00), P < 0.001), 24 hours (4.00 (2.00–4.00) vs. 4.00 (2.00–6.00), P < 0.001), and 36 hours (2.00 (2.00–4.00) vs. 4.00 (2.00–4.00), P < 0.001), and 48 hours (2.00 (2.00–4.00) vs. 2.00 (2.00–4.00), P = 0.004) post-delivery and lower levels of oxycodone consumption at 36 hours (10.20 (8.20–13.35) vs. 11.00 (8.80–14.40), P = 0.042) and 48 hours (12.40 (10.40–15.95) vs. 13.80 (11.00–16.00), P = 0.020) postpartum compared with those in the as-needed group. Additionally, the time to the return of bowel movements was shorter in the scheduled group than in the as-needed group (23.50 (16.94, 31.47) vs. 27.00 (19.88, 35.97), P = 0.004). Differences in post-delivery ambulation, lactation initiation, satisfaction levels, and depression scores were not significantly different between the two groups.

Conclusion:
The results of this study promote the use of ibuprofen (scheduled oral administration) combined with a conventional, patient-controlled intravenous analgesia pump for achieving better post-CS pain control than an as-needed dosage regimen.

Registration:
Chinese Clinical Trial Registry, ChiCTR2400082474.
Recurrence Following Operative vs. Non-Operative Management of Adhesive Small Bowel Obstruction in Children
Authors: Patwardhan Utsav M. , Ignacio Romeo C. , Pickett-Nairne Kaci , Russell Katie W. , Lee Justin , Padilla Ben , Melhado Caroline , Kelley-Quon Lorraine I. , Rothstein David H. , Thangarajah Hariharan , Ibarra-Meraz Ana , Barq Rabab M. , Larsen Kezlyn E. , Fowler Kathryn L , Hunteman Zebediah , Valencia-Bradd Maria , Lofberg Katrine , Jensen Aaron , Pandya Samir , Acker Shannon N. ,   on behalf of the Western Pediatric Surgery Research Consortium
Published: February 2025

Objective:
Data on the incidence of recurrent adhesive small bowel obstruction (ASBO) following index admission for ASBO in children are limited. We sought to determine if operative management was associated with a lower rate of recurrence compared to non-operative management (NOM).

Methods:
We conducted a prospective observational study of children with ASBO admitted to nine hospitals from 10/2020 to 12/2022 who underwent a trial of NOM. Children were followed for a year after admission. The primary outcome was readmission for recurrent ASBO. Adjusted comparisons were made between children successfully managed nonoperatively at the index admission and those who underwent surgery.

Results:
Among 136 children, 87 (63.9%) had successful NOM at the index admission. Within 1 year, twenty patients (14.7%; 17/87 NOM group; 3/49 operative group) had recurrent ASBO. On unadjusted analysis, there was a higher risk of recurrent ASBO in the NOM group (19.5 vs. 6.1%, P=0.04). However, after adjusting for age (HR 0.35, CI 0.10-1.23), there was no significant difference. Among patients with recurrent ASBO, 7/20 (35%) underwent an urgent or emergent operation at readmission; this rate was similar between initial management groups.

Conclusion:
Although the rate of recurrent ASBO in children is nearly 15% within one year, this rate does not differ based on the initial management strategy. Among children with recurrent ASBO, one-third underwent an urgent or emergent operation at readmission. NOM appears to be as effective in preventing recurrent ASBO as surgery.
Temporary Portal Vein Bypass for Resection of Pancreatic Neoplasms
Authors: Heckler Max , Abdallah Souhaylah , Kinny-Köster Benedict , Berchtold Christoph , Al-Saeedi Mohammed , Mehrabi Arianeb , Hackert Thilo , Hinz Ulf , Hank Thomas , Michalski Christoph W. , Büchler Markus W. , Loos Martin 
Published: February 2025

Objective:
We analyzed perioperative outcomes of patients undergoing pancreatectomy with portal vein resection for pancreatic cancer using temporary intraoperative mesoportal or mesocaval bypass.

Summary Background Data:
Pancreatectomy for advanced pancreatic cancer with long-segment involvement or complete occlusion of the mesoportal venous axis and cavernous transformation represents a major technical challenge. To avoid major bleeding as well as to overcome severe bowel congestion or ischemia due to long portal venous clamping, a mesoportal or mesocaval venous bypass graft first approach has been proposed. If an additional hepatic arterial resection needs to be considered, the mesoportal bypass seems preferable to ensure portal venous flow avoiding complete temporary vascular exclusion of the liver. However, the mesocaval approach appears to be a technically easier alternative.

Methods:
All consecutive patients who underwent pancreatectomy with venous bypass were identified from a prospectively maintained database. Patient characteristics, perioperative data, and postoperative short-term outcomes were analyzed.

Results:
Between 2011 and 2024, 63 patients were operated with temporary construction of an alloplastic venous bypass, including 34 patients with mesoportal and 29 patients with mesocaval bypass. Severe complications (Clavien-Dindo >3a) occurred in 16 of 63 patients (25.4%). No postoperative liver failure was observed. The median length of ICU and hospital stays were 2 and 21 days, respectively. The 90-day mortality rate was 6.3%. There were no differences in complication rates, median length of stays, and 90-day mortality rates between mesoportal and mesocaval shunts.

Conclusions:
Temporary intraoperative venous bypass graft first techniques are important surgical approaches for safe resection of advanced pancreatic tumors. Mesoportal and mesocaval shunts are both safe with comparable postoperative morbidity and mortality rates. The decision for mesoportal versus mesocaval bypass should be made according to the anatomy, particularly taking into account the extent of arterial involvement and the potential need for concomitant arterial resection.
Cost-analysis of Implementing robot-assisted Versus Open Pancreatoduodenectomy
Authors: Menso Julia E. , Francken Michiel F.G. , de Graaf Nine , Bonomi Alessandro M. , Guastella Riccardo , Balaban Dylan , Ali Mahsoem , Bonjer H. Jaap , van Dieren Susan , Dijkgraaf Marcel G.W. , van Hilst Jony , Pilz da Cunha Gabriela , Erdmann Joris , Kazemier Geert , Swijnenburg Rutger-Jan , Zonderhuis Barbara M. , Daams Freek , Festen Sebastiaan , Busch Olivier R. , Besselink Marc G. ,   for HPB-Amsterdam
Published: February 2025

Objective:
To perform a cost-analysis during the implementation of robot-assisted pancreatoduodenectomy (RPD) in a high-volume center.

Background:
Many high-volume centers are implementing RPD as alternative to open pancreatoduodenectomy (OPD) but the persevering concerns about increased costs of RPD versus OPD have not been addressed by large studies.

Methods:
Post-hoc cost-analysis of consecutive RPD versus OPD in a singly high-volume center (Jan 2015–May 2024). The eligibility criteria for RPD (i.e. no vascular contact, no chronic and necrotizing pancreatitis, and BMI<35 kg/m2) were used to select patients undergoing OPD, to minimize selection bias. Primary outcomes were total hospital costs and total hospital stay. Sensitivity analyses excluded the first half of the RPD experience.

Results:
Overall, 588 patients undergoing pancreatoduodenectomy were included (214 RPD, 374 OPD). Total hospital stay was shorter after RPD (10 [6–17] vs. 12 [8–21] days, P=0.001). Mean total hospital costs were €4,804 higher for RPD (€27,307 vs. €22,503, P=0.010). Outcomes improved in the second half of the RPD experience (n=107): total hospital stay (12 [7–23] to 9 [6–15] days, P<0.001), pancreatic fistula (48.6% to 31.8%, P=0.012), delayed gastric emptying (33.6% to 15.0%, P=0.001), and operative time (373 [341–411] to 310 [272–352] minutes, P<0.001). Consequently, costs per RPD procedure decreased with €11,058 (€32,836 to €21,778, P=0.001). Costs in the second half of the OPD experience remained stable (€24,025 to €21,013, P=0.210). Hence, total costs for RPD and OPD became comparable in the second half (€21,778 vs. €21,013, P=0.644).

Conclusion:
Implementing RPD is associated with considerable additional costs compared to OPD. With growing experience, both the outcomes and cost-efficiency of RPD improve, with costs decreasing by approximately a third, leading to similar costs as OPD. Large scale randomized trials will have to confirm these findings.
Rectus Sheath and Transversus Abdominis Plane Blocks for Preaponeurotic Endoscopic Repair: Is the Double Block the Solution for Postoperative Pain Management?
Authors: Toscano Antonio , Bonomo Luca Domenico , Capuano Paolo , Cremascoli Luca , Castelli Filippo , Puppo Mattia , Aprà Fabrizio , Jannaci Alberto , Cuccomarino Salvatore 
Published: February 2025

Background:
Diastasis recti abdominis (DRA) is a prevalent postpartum condition characterized by the separation of the rectus abdominis muscles with an interrectal distance >2.5 cm, often leading to symptoms like back pain, constipation, and urinary incontinence. Preaponeurotic endoscopic repair (REPA) is a novel, minimally invasive surgical approach for DRA, offering an alternative to traditional abdominoplasty. Despite its minimally invasive nature, REPA surgery poses significant postoperative pain challenges, typically managed with opioids, which carry numerous side effects.

Materials and Methods:
This retrospective study evaluates the efficacy of combining 2 ultrasound-guided abdominal wall blocks, rectus sheath block (RSB) and transversus abdominis plane block (TAPB), to manage postoperative pain in 55 DRA patients who underwent REPA surgery. We performed lateral TAPB in 28 cases, whereas 27 received an association of TAPB and RSB.

Results:
At 6 hours postsurgery, 61% of patients in the TAPB group reported significant pain (Numeric Rating Scale >3), compared with 19% in the TAPB-RSB group (P = 0.001). The TAPB-RSB group also required fewer analgesic rescue doses (P = 0.042) and showed earlier recovery, with faster initiation of oral intake and mobility.

Conclusion:
The combination of TAPB and RSB significantly reduces opioid consumption, postoperative pain, and the need for rescue analgesia compared with TAPB alone. The dual-block approach, providing a multi-dermatomal sensory block, suggests a promising strategy for improving postoperative pain management in REPA surgery.
Longer time to surgery for pelvic ring injuries is associated with increased systemic complications
Authors: Patel Mihir , McGwin Gerald , Spitler Clay 
Published: February 2025

BACKGROUND
Increased time to surgery is a well-established risk factor for complication and mortality among patients undergoing hip fracture fixation. However, few studies have been completed evaluating the association between time to surgery and complication rates in patients undergoing operative fixation of pelvic ring injuries.

METHODS
A retrospective cohort study was performed at a Level I trauma center including all patients with operative pelvic ring injuries from 2015 to 2022. Time from hospital admission to surgery, basic demographics, and comorbidities were determined for all patients. Systemic complications including acute respiratory distress syndrome, pneumonia, sepsis, deep venous thrombosis, pulmonary embolus, ileus, acute kidney injury, myocardial infarction, and mortality were recorded. The association between time to surgery and overall complications and each complication individually was estimated using multivariable statistical models.

RESULTS
A total of 1,056 patients were included in the final cohort. Patients who underwent surgery within 48 hours (n = 724) had an overall lower complication rate (17.8%) compared with those patients (n = 332) who underwent surgery greater than 48 hours after admission (34.9%). Each additional hour delay to surgery from admission was associated with a 0.4% increased odds of any complication. With respect to specific complications, each additional hour also increased the odds of sepsis (0.7%), deep venous thrombosis (0.3%), acute kidney injury (0.3%), myocardial infarction (0.5%), and pneumonia (0.4%). The odds of overall complication was 2.10 when patients underwent surgery within 42 hours after admission and increased at every time point afterwards.

CONCLUSION
Among patients with pelvic ring injuries, increased time to surgery was associated with an increased odds of systemic complication. This underscores the importance of aggressive resuscitation and prompt surgical intervention to reduce morbidity and improve overall patient outcomes.

LEVEL OF EVIDENCE
Prognostic and Epidemiological; Level III.
Single cell level analysis of ATP release kinetics and cell fate following ultrasound targeted microbubble cavitation using microscopy techniques
Authors: Amate Marie , Tan Ju Jing , Boudreault Francis , Grygorczyk Ryszard , Gervais Thomas , Yu François T. H. 
Published: February 2025

AbstractIt is known that ultrasound-targeted microbubble cavitation (UTMC) can induce vasodilation. This image guided spatially targeted approach is called provascular therapy when used as a radiotherapy sensitizer in radiation oncology. Extracellular adenosine-5’-triphosphate (eATP), which plays an important role in vascular tone regulation, is released by cells following UTMC, possibly through sonoporation (formation of temporary and non-deadly pores in the cell membrane) and/or cell death. Herein, we were interested in quantifying UTMC-mediated ATP releasedin vitrousing a microfluidics-based model and study its relationship with UTMC-mediated cell fate to better understand and improve UTMC mediated bioeffects.Lipid microbubbles (MB, Definity®), luciferin-luciferase (LL – for eATP quantification), and propidium iodide (PI – poration tracer) were flown over HUVEC cells cultured in a microfluidic device. Ultrasounds at 1 MHz, varying in pressure (300, 400 kPa) and length (10, 100, 1000 cycles) were applied to the chip. The LL chemiluminescent signal after the ultrasound pulse was acquired with an EMCCD camera to characterize ATP release kinetics. Then, a viability assay was performed with calcein-AM. An in-house MATLAB program pairing eATP kinetics with PI/calcein data was used to classify cells into three categories (sonoporated, dead, and untreated).Within the testing conditions, a single UTMC pulse caused between 4% and 55% PI-positive (PI+) cells in the ultrasound-treated area. Amongst PI+ cells, we generally found more dead cells than sonoporated cells, except for milder pulses (300 kPa; 10 and 100 cycles). The analysis of individual responses of ATP release demonstrated that dead cells released more ATP (up to 22.4 ± 12.2 fmol/cell) than sonoporated cells (6.8 ± 3.4 fmol/cell) and at a faster release rate which peaked at 4s.This study showed that sonoporation plays a significant role in UTMC-mediated ATP release, advancing our understanding of UTMC’s potential use as a radiosensitizer in solid tumors.
Dynamic fMRI networks of emotion
Authors: Janssen Niels , Elvira Uriel K.A. , Janssen Joost , van Erp Theo G.M. 
Published: February 2025

AbstractThe experience of emotions is that of dynamic, time changing processes. Yet, many fMRI studies of emotion average across time to focus on maps of static activations, overlooking the temporal dimension of emotional responses. In this study, we used time-resolved fMRI, group spatial independent component analysis (ICA), dual regression, and Gaussian curve fitting to examine both the spatial and temporal properties of whole-brain networks during a behavioral task. This task included trials that spanned over 25 seconds of watching short, emotionally evocative movie clips, making emotion-related decisions, and an intertrial rest period. We identified four whole-brain networks with unique spatial and temporal features that mapped onto different stages of the task. A network activated early in the course of the task included perceptual and affective evaluation regions, while two later networks supported semantic interpretation and decision-making, and a final network aligned with default mode activity. Both spatial and temporal properties of all four networks were modulated by the emotional content of the movie clips. Our findings extend current models of emotion by integrating temporal dynamics with large-scale network activity, offering a richer framework for understanding how emotions unfold across distributed circuits. Such temporal-spatial markers of emotional processing may prove valuable for identifying and tracking alterations in clinical populations.
Immune responses to human pathogens exposed to simulated Mars conditions
Authors: Zaccaria Tommaso , Bulut Özlem , Ferreira Anaisa V. , Dona Margo , Langereis Jeroen D. , Mesman Rob J. , Wesseling Joppe , van Niftrik Laura , Netea Mihai G. , Rettberg Petra , Beblo-Vranesevic Kristina , de Jonge Marien I. , Domínguez-Andrés Jorge 
Published: February 2025

AbstractThe identification of health risks associated with long-term crewed missions to Mars is critical for mission planning and crew safety. Human-associated pathogens can be part of the microbiome and are likely to be transported during these missions. This study examines the immunological responses of human immune cells stimulated with non-fastidious bacterial species that cause opportunistic infections, i.e.Klebsiella pneumoniaeandSerratia marcescens, after exposure to simulated Martian conditions, including UV radiation, desiccation and atmospheric pressure. We observed that exposure of the bacteria to these conditions altered cytokine secretion, reactive oxygen species (ROS) production, and phagocytic activity in human peripheral blood mononuclear cells (PBMCs). Specifically, exposure to desiccation reduced cytokines and ROS production, indicating impaired innate immune recognition and stimulation. Notably, the altered immune response was partially restored when desiccated bacteria were regrown in standard media. Flow cytometry revealed decreased bacterial size and complexity of both species post-exposure. These findings indicate that Martian conditions induce bacterial morphological and physiological changes, which could impair immune recognition and response. Expanding these studies toin vivomodels and a broader range of potentially pathogenic microorganisms is essential to estimate infection risks during Mars missions, which is vital for developing strategies to mitigate infection risks and maintain astronaut health during long-term space travel.ImportanceSince Yuri Gagarin’s 1961 flight, human space exploration has expanded, unintentionally transporting microorganisms, including pathogens, into space environments. Our previous studies demonstrated that opportunistic pathogens likeKlebsiella pneumoniaeandSerratia marcescenscan survive simulated Mars conditions. With upcoming Mars missions, it is crucial to understand how such conditions influence these pathogens and their interaction with the human immune system. This research evaluates immune responses to bacteria pathogens exposed to Martian stressors such as UV radiation and desiccation, revealing significant changes of the immune responses to the exposed bacteria. These findings provide essential insights into the health risks that astronauts may face if infected with Mars-adapted pathogens. Understanding these interactions will help to develop preventive strategies and therapeutic measures, ensuring the safety and health of crew members during long-term missions. Ultimately, this work contributes to the broader objective of safe human exploration and colonization of Mars.
Phosphorylated CheV interacts with a subset of chemoreceptors
Authors: Matilla Miguel A. , Cano-Muñoz Mario , Monteagudo-Cascales Elizabet , Krell Tino 
Published: February 2025

AbstractChemotaxis pathways are among the most complex signaling systems in bacteria. A central feature of these pathways is the ternary complex formed by chemoreceptors, the autokinase CheA, and the coupling proteins CheW and CheV. Whereas CheW is present in all chemotaxis pathways, CheV is primarily found in bacteria that contain many chemoreceptors. CheV is a fusion of a CheW-like domain to a phosphorylatable receiver domain. The roles of CheV and its phosphorylation are currently uncertain.Pseudomonas aeruginosacontains many chemoreceptors for which the cognate signals have been identified. Quantitative capillary chemotaxis assays of acheVmutant revealed that responses to certain chemoeffectors, such as nitrate and α-ketoglutarate, were drastically reduced, while responses to others, such as amino acids and inorganic phosphate, were comparable to the wild type, indicating that CheV selectively acts on specific chemoreceptors. To study the mechanism of CheV action, we conducted protein-protein interaction experiments using isothermal titration calorimetry. These studies showed that unphosphorylated CheV fails to bind to cytosolic fragments of the McpN and PctA chemoreceptors, which mediate responses to nitrate and amino acids, respectively. In contrast, the phosphorylation-mimic CheV D238E bound with very high affinity (KD= 8 nM) to McpN but failed to interact with PctA. Thus, CheV inP. aeruginosabinds to some chemoreceptors but not to others in a phosphorylation-dependent manner. These results suggest that CheV is a regulatory protein that modulates signaling through specific chemoreceptors. CheV may thus facilitate the coordination of chemotaxis responses in complex, multi-chemoreceptor systems.ImportanceOf all chemosensory signaling proteins, CheV is perhaps the least understood. Our demonstration that CheV interacts only with certain chemoreceptors offers fundamental new insights. These findings, combined with the observation that CheV is present in bacteria with numerous chemoreceptors, suggest that CheV plays a role in coordinating chemotactic outputs in complex chemosensory systems. Understanding the mechanisms by which chemotactic responses are defined in bacteria with a high number of chemoreceptors is a major research priority in the field of chemotaxis. While previous studies, including this one, show that the ability to be phosphorylated is crucial for CheV function, the molecular consequences of CheV phosphorylation have remained unclear. Our discovery that phosphorylation is essential for CheV binding to certain chemoreceptors fills in this critical gap in understanding the molecular mechanism of CheV. This study is likely to inspire further research into CheV function in other bacteria using similar approaches.