bluuebunny/crossref_metadata_2025_split huggingface dataset:
Liposomal Bupivacaine for Peripheral Nerve Blockade: A Randomized, Controlled, Crossover, Triple-blinded Pharmacodynamic Study in Volunteers
Authors: Zadrazil Markus , Marhofer Peter , Opfermann Philipp , Schmid Werner , Marhofer Daniela , Zeilberger Mira , Pracher Lena , Zeitlinger Markus 
Published: April 2024

Background
Little is known about the pharmacodynamic characteristics of liposomal bupivacaine. Hypothesizing that they would not identify pharmacodynamic differences from plain bupivacaine during the initial period after administration, but would find better long-term pharmacodynamic characteristics, the authors designed a randomized, controlled, triple-blinded, single-center study in volunteers.

Methods
Volunteers aged 18 to 55 yr (body mass index, 18 to 35 kg/m2) received two ulnar nerve blocks under ultrasound guidance. Using a crossover design with a washout phase of 36 days or more, one block was performed with liposomal and one with plain bupivacaine. Which came first was determined by randomization. Sensory data were collected by pinprick testing and motor data by thumb adduction, either way in comparison with the contralateral arm. Endpoints included success, time to onset, and duration of blockade. Residual efficacy was assessed by the volunteers keeping a diary. Statistical analysis included Wilcoxon signed-rank and exact McNemar’s tests, as well as a generalized estimation equation model.

Results
Successful sensory blockade was noted in 8 of 25 volunteers (32%) after liposomal and in 25 of 25 (100%) after plain bupivacaine (P < 0.0001). Significant differences emerged for time to onset, defined as 0% response to pinpricking in four of five hypothenar supply areas (P < 0.0001), and for time from onset to 80% or 20% in one of five areas (P < 0.001; P < 0.001). Carryover effects due to the randomized sequencing were unlikely (estimate, −0.6286; sequence effect, 0.8772; P = 0.474). Self-assessment greater than 3.5 days did reveal, for liposomal bupivacaine only, intermittent but unpredictable episodes of residual sensory blockade.

Conclusions
The results show that liposomal bupivacaine is not a suitable “sole” drug for intraoperative regional anesthesia. Findings of its limited long-term efficacy add to existing evidence that a moderate effect, at best, should be expected on postoperative pain therapy.

Editor’s Perspective

What We Already Know about This Topic

What This Article Tells Us That Is New
Intensive Versus Standard Blood Pressure Management after Endovascular Therapy for Acute Ischemic Stroke: A Systematic Review and Meta-analysis
Authors: Zhang Kangda , Wang Xinyan , Wu Youxuan , Liang Fa , Hou Xuan , Zhang Zihui , Wang Anxin , Liu Liping , Han Ruquan 
Published: April 2024

Prospective clinical studies on blood pressure (BP) management targets after endovascular therapy (EVT) for acute ischemic stroke (AIS) have recently been published. Our objective was to assess the impact on clinical outcomes of BP management guided by established systolic BP (SBP) targets within the first 24 hours after successful EVT. Four randomized controlled trials (RCTs) including 1556 participants across 5 SBP target settings identified from 5 databases up to September 6, 2023 were included in this systematic review and meta-analysis. All the intensive SBP target groups in these RCTs were combined to facilitate head-to-head comparisons. Patients receiving intensive SBP management had lower risk of 90-day functional independence as assessed by the modified Rankin scale score (relative risk [RR], 0.81; 95% confidence interval [CI], 0.72 to 0.91; I
2, 12%), excellent outcomes (RR,0.86; 95% CI, 0.75 to 0.99; I
2, 7%), favorable outcomes (RR, 0.85; 95% CI, 0.78 to 0.92; I
2, 0%), and quality of life (standardized mean difference, -0.22; 95% CI, -0.35 to -0.10; I2,0%). There were no differences in the probability of any intracerebral hemorrhage (RR, 1.04; 95% CI, 0.92 to 1.19; I
2,0%), symptomatic intracerebral hemorrhage (RR, 1.10; 95% CI, 0.76 to 1.60; I
2, 0%), stroke-related death (RR, 1.16; 95% CI, 0.80 to 1.68; I
2, 0%), or parenchymal hematoma (RR, 1.71; 95% CI, 0.74 to 3.98; I
2, 47%) between SBP targets. This meta-analysis provides evidence from RCTs suggesting that intensive SBP control (target<160 mm Hg) may be detrimental to clinical outcomes in AIS patients with successful reperfusion after EVT.
Pulmonary Function at Minimum 10 Years After Segmental Pedicle Screw Instrumentation for Thoracic Adolescent Idiopathic Scoliosis
Authors: Helenius Linda , Ahonen Matti , Syvänen Johanna , Perokorpi Tanja , Helenius Ilkka 
Published: April 2024

Study design:
A prospective multi-center cohort study.

Objective:
This study evaluates the 10-year pulmonary function outcomes for patients with structural thoracic adolescent idiopathic scoliosis (Lenke curve types 1-4, 6) after segmental pedicle screw instrumentation.

Summary of Background Data:
Adolescent idiopathic scoliosis with thoracic curves is associated with reduced pulmonary function preoperatively. It remains unclear how much pulmonary improvement can be obtained using pedicle screw instrumentation at long-term follow-up.

Methods:
Out of 64 consecutively surgically treated patients with thoracic AIS (Lenke 1-4, 6) using pedicle screw instrumentation, 50 (mean age at final FU 14.7 ± 1.9, 44 females) participated in a prospective 10-year follow-up study. They were evaluated using clinical examination, spinal radiographs, and spirometry preoperatively and at 10-year follow-up. The preoperative percentage predicted values were adjusted for the height loss caused by the scoliosis according to curve size.

Results:
Preoperatively 49% (20/41) had forced vital capacity (FVC) or forced expiratory volume in one second (FEV1) below 80% of the predicted normal values representing pulmonary function impairment. Major curve correction averaged 76% (SD 9%). FVC improved from preoperative 3.29 L (SD 0.78L) to 3.87 L (0.79L) at 10-year follow-up (P<0.001). This improvement averaged 510 mL (SD 560 mL) in patients having both preoperative and 10-year follow-up measurements available. The percentage predicted values for FVC showed an improvement from 83% preoperatively to 86% at 10-year follow-up (P=0.048). At 10-year follow-up 38% (19/50) of the patients had FVC or FEV1 below 80% of the predicted values.

Conclusions:
FVC improved by a mean of 510 ml from preoperative to 10-year follow-up in patients undergoing pedicle screw instrumentation for thoracic AIS. Despite 76% scoliosis correction and significant improvement of absolute lung volume values, more than one-third of these surgically treated otherwise healthy young adults fulfilled the criteria for pulmonary function impairment at 10-year follow-up.

Level of Evidence:
II.
Adverse Effects Related to Corticosteroid Use in Sepsis, Acute Respiratory Distress Syndrome, and Community-Acquired Pneumonia: A Systematic Review and Meta-Analysis
Authors: Chaudhuri Dipayan , Israelian Lori , Putowski Zbigniew , Prakash Jay , Pitre Tyler , Nei Andrea M. , Spencer-Segal Joanna L. , Gershengorn Hayley B. , Annane Djillali , Pastores Stephen M. , Rochwerg Bram 
Published: April 2024

OBJECTIVES:
We postulate that corticosteroid-related side effects in critically ill patients are similar across sepsis, acute respiratory distress syndrome (ARDS), and community-acquired pneumonia (CAP). By pooling data across all trials that have examined corticosteroids in these three acute conditions, we aim to examine the side effects of corticosteroid use in critical illness.

DATA SOURCES:
We performed a comprehensive search of MEDLINE, Embase, Centers for Disease Control and Prevention library of COVID research, CINAHL, and Cochrane center for trials.

STUDY SELECTION:
We included randomized controlled trials (RCTs) that compared corticosteroids to no corticosteroids or placebo in patients with sepsis, ARDS, and CAP.

DATA EXTRACTION:
We summarized data addressing the most described side effects of corticosteroid use in critical care: gastrointestinal bleeding, hyperglycemia, hypernatremia, superinfections/secondary infections, neuropsychiatric effects, and neuromuscular weakness.

DATA SYNTHESIS:
We included 47 RCTs (n = 13,893 patients). Corticosteroids probably have no effect on gastrointestinal bleeding (relative risk [RR], 1.08; 95% CI, 0.87–1.34; absolute risk increase [ARI], 0.3%; moderate certainty) or secondary infections (RR, 0.97; 95% CI, 0.89–1.05; absolute risk reduction, 0.5%; moderate certainty) and may have no effect on neuromuscular weakness (RR, 1.22; 95% CI, 1.03–1.45; ARI, 1.4%; low certainty) or neuropsychiatric events (RR, 1.19; 95% CI, 0.82–1.74; ARI, 0.5%; low certainty). Conversely, they increase the risk of hyperglycemia (RR, 1.21; 95% CI, 1.11–1.31; ARI, 5.4%; high certainty) and probably increase the risk of hypernatremia (RR, 1.59; 95% CI, 1.29–1.96; ARI, 2.3%; moderate certainty).

CONCLUSIONS:
In ARDS, sepsis, and CAP, corticosteroids are associated with hyperglycemia and probably with hypernatremia but likely have no effect on gastrointestinal bleeding or secondary infections. More data examining effects of corticosteroids, particularly on neuropsychiatric outcomes and neuromuscular weakness, would clarify the safety of this class of drugs in critical illness.
Evaluating the Sum of Eye and Motor Components of the Glasgow Coma Score As a Predictor of Extubation Failure in Patients With Acute Brain Injury
Authors: Taran Shaurya , Perrot Bastien , Angriman Federico , Cinotti Raphael ,   for the Extubation strategies in Neuro-Intensive care unit patients and associations with Outcomes (ENIO) Study Group,   on behalf of the PROtective VENTilation network,   the European Society of Intensive Care Medicine,   the Colegio Mexicano de Medicina Critica,   the Atlanréa group, and the Société Française d’Anesthésie et de Réanimation (SFAR) research network
Published: April 2024

OBJECTIVES:
To evaluate the association between the pre-extubation sum of eye and motor components of the Glasgow Coma Score (GCS-EM) and odds of extubation failure in patients with acute brain injury being liberated from mechanical ventilation.

DESIGN:
Secondary analysis of a prospective, multicenter observational study (ClinicalTrials.gov identifier NCT03400904).

SETTING:
Sixty-three hospital sites worldwide, with patient recruitment from January 2018 to November 2020.

PATIENTS:
One thousand one hundred fifty-two critically ill patients with acute brain injury, with a median age of 54 years, of whom 783 (68.0%) were male, 559 (48.5%) had traumatic brain injury, and 905 (78.6%) had a GCS-EM greater than 8 before extubation (scores range from 2 to 10).

INTERVENTIONS:
None.

MEASUREMENTS AND MAIN RESULTS:
GCS-EM was computed in intubated patients on the day of extubation. The main outcome was extubation failure, defined as unplanned reintubation within 5 days of extubation. Analyses used multilevel logistic regression with adjustment for patient characteristics and a random intercept for hospital site. In the primary analysis, GCS-EM was not associated with extubation failure (odds ratio, 1.07 per additional point; 95% CI, 0.87–1.31). Findings were consistent in sensitivity analyses that: 1) used different adjustment covariates, 2) included a verbal estimate to derive an overall GCS, 3) accounted for missing data, 4) considered a 2-day time interval to define extubation failure, 5) accounted for competing risks, and 6) used a propensity score-based model. There was no association between GCS-EM and extubation outcome in subgroups defined by brain injury diagnosis or age.

CONCLUSIONS:
In this large, contemporary, multicenter cohort of patients with acute brain injury, we found no association between the GCS-EM and odds of extubation failure. However, few patients had a pre-extubation GCS-EM less than or equal to 8, and the possibility of a true prognostic association in patients with low scores is not excluded.
Quantifying the Impact of Alternative Definitions of Sepsis-Associated Acute Kidney Injury on its Incidence and Outcomes: A Systematic Review and Meta-Analysis
Authors: Donaldson Lachlan H. , Vlok Ruan , Sakurai Ken , Burrows Morgan , McDonald Gabrielle , Venkatesh Karthik , Bagshaw Sean M. , Bellomo Rinaldo , Delaney Anthony , Myburgh John , Hammond Naomi E. , Venkatesh Balasubramanian 
Published: April 2024

OBJECTIVES:
To derive a pooled estimate of the incidence and outcomes of sepsis-associated acute kidney injury (SA-AKI) in ICU patients and to explore the impact of differing definitions of SA-AKI on these estimates.

DATA SOURCES:
Medline, Medline Epub, EMBASE, and Cochrane CENTRAL between 1990 and 2023.

STUDY SELECTION:
Randomized clinical trials and prospective cohort studies of adults admitted to the ICU with either sepsis and/or SA-AKI.

DATA EXTRACTION:
Data were extracted in duplicate. Risk of bias was assessed using adapted standard tools. Data were pooled using a random-effects model. Heterogeneity was assessed by using a single covariate logistic regression model. The primary outcome was the proportion of participants in ICU with sepsis who developed AKI.

DATA SYNTHESIS:
A total of 189 studies met inclusion criteria. One hundred fifty-four reported an incidence of SA-AKI, including 150,978 participants. The pooled proportion of patients who developed SA-AKI across all definitions was 0.40 (95% CI, 0.37–0.42) and 0.52 (95% CI, 0.48–0.56) when only the Risk Injury Failure Loss End-Stage, Acute Kidney Injury Network, and Improving Global Outcomes definitions were used to define SA-AKI. There was significant variation in the incidence of SA-AKI depending on the definition of AKI used and whether AKI defined by urine output criteria was included; the incidence was lowest when receipt of renal replacement therapy was used to define AKI (0.26; 95% CI, 0.24–0.28), and highest when the Acute Kidney Injury Network score was used (0.57; 95% CI, 0.45–0.69; p < 0.01). Sixty-seven studies including 29,455 participants reported at least one SA-AKI outcome. At final follow-up, the proportion of patients with SA-AKI who had died was 0.48 (95% CI, 0.43–0.53), and the proportion of surviving patients who remained on dialysis was 0.10 (95% CI, 0.04–0.17).

CONCLUSIONS:
SA-AKI is common in ICU patients with sepsis and carries a high risk of death and persisting kidney impairment. The incidence and outcomes of SA-AKI vary significantly depending on the definition of AKI used.
Targeted axillary dissection after neoadjuvant chemotherapy for highly selective patients with initial cN1 breast cancer: A single-center prospective trial
Authors: Chen Xiuchun , Lu Zhenduo , Wang Chengzheng , Lyu Minhao , Qiao Jianghua , Sun Xianfu , Li Lianfang , Zhang Chongjian , Liu Zhenzhen 
Published: April 2024

Abstract

Background:
Sentinel lymph node (SLN) biopsy is gradually accepted as the standard of care in breast cancer patients with down-staged axillary disease after neoadjuvant chemotherapy (NAC). However, it is still difficult to precisely define pre-NAC clinical node-positive (cN1) and post-NAC clinical node-negative (ycN0). This prospective single-center trial was designed to evaluate the feasibility and accuracy of standard targeted axillary dissection (TAD) after NAC in highly selective pre-NAC cN1 patients (not considering ultrasound-based axillary ycN staging).

Methods:
This prospective trial included patients with initial pre-NAC cT1–3N1M0 invasive breast cancer but with a rigorous definition of cN1 from the Affiliated Cancer Hospital of Zhengzhou University. When NAC was effective (including complete and partial responses) and preoperative axillary palpation was negative, preoperative ultrasound-based axillary staging was not considered, and all patients underwent TAD followed by axillary lymph node (LN) dissection. The detection rate (DR) and false-negative rate (FNR) of TAD were calculated.

Results:
A total of 82 patients were included, and 77 of them were eligible for data analysis. The DR for TAD was 94.8% (73/77). There were 26 patients with one abnormal LN at the time of diagnosis based on ultrasound, 45 patients with two, and 2 patients with three. One patient had one TAD LN, four patients had two TAD LNs, and 68 patients had three or more TAD LNs. Preoperative axillary palpation yielded negative results for all 73 patients who successfully underwent TAD. Preoperative ultrasound-based ycN0 and ycN+ conditions were detected for 52 and 21 cases, respectively. The FNR was 7.4% (2/27) for standard TAD (≥3 SLNs), which was lower than that of all successful TAD (≥1 SLN; 10.0%, 3/30).

Conclusions:
In rigorously defined pre-NAC cN1 breast cancer patients, standard TAD is feasible for those with negative axillary palpation after NAC, and FNR is also less than 10%.

Registration:

chictr.org.cn, ChiCTR2100049093
Long non-coding RNA MALAT1 in hematological malignancies and its clinical applications
Authors: Zhang Chunlan , Qin Yun , Wu Yu , Xu Heng , Shu Yang 
Published: April 2024

Abstract
Metastasis-associated lung adenocarcinoma transcript 1 (MALAT1) is a well-established oncogenic long non-coding RNA, the higher expression of which is strongly correlated with cancer events such as tumorigenesis, progression, metastasis, drug resistance, and treatment outcome in solid cancers. Recently, a series of studies has highlighted its potential role in hematological malignancies in terms of these events. Similar to solid cancers, MALAT1 can regulate various target genes via sponging and epigenetic mechanisms, but the miRNAs sponged by MALAT1 differ from those identified in solid cancers. In this review, we systematically describe the role and underlying mechanisms of MALAT1 in multiple types of hematological malignancies, including regulation of cell proliferation, metastasis, stress response, and glycolysis. Clinically, MALAT1 expression is related to poor treatment outcome and drug resistance, therefore exhibiting potential prognostic value in multiple myeloma, lymphoma, and leukemia. Finally, we discuss the evaluation of MALAT1 as a novel therapeutic target against cancer in preclinical studies.
Family Members' Engagement in Symptom Communication, Assessment, and Management in the Intensive Care Unit
Authors: Nyhagen Ragnhild , Egerod Ingrid , Rustøen Tone , Lerdal Anners , Kirkevold Marit 
Published: April 2024

Background
Opportunities for communication and participation in decision making are limited for critically ill patients, but family members serving as surrogates enable empowerment of these patients.

Objective
The aim of this study was to explore family members' engagement in symptom communication in the intensive care unit.

Methods
A qualitative descriptive design using fieldwork methodology with triangulation of participant observation and individual interviews was conducted. Nine mechanically ventilated patients were observed in interaction with family members and clinicians in the intensive care unit. Six of the observed patients, 6 family members, and 9 clinicians were interviewed after participant observation. Field notes and transcripts were analyzed using Braun and Clarke's method of thematic analysis.

Results
Family members engaged actively in symptom communication, assessment, and management, and there were barriers and facilitators to family engagement. Three main themes and 9 subthemes describing family engagement emerged: (1) intermediary role (recognize and report symptoms, provide patient information, and assist in communication), (2) independent role (provide familiarity, manage symptoms, and promote patient communication), and (3) conditions for family engagement (intensive care unit environment, relationship with the patient, and patient preferences).

Discussion
Family members have unique knowledge of the patient that differs from and complement the competence of the staff, and might contribute to improved symptom communication. Future research should examine how family members can contribute to symptom communication, assessment, and management.
Evidence-Based Investigation of Nurses' Nutrition Interventions in Intensive Care Patients Regarding Enteral Nutrition
Authors: Turan Mensure , Cengiz Zeliha , Olmaz Dilek 
Published: April 2024

Aim
The aim of this study was to examine the practices and knowledge levels of nurses regarding enteral nutrition interventions in intensive care unit patients in terms of evidence.

Method
This cross-sectional study was conducted in 2 hospitals between May and August 2021. A total of 136 nurses working in the intensive care units of the hospitals completed online questionnaires including demographic characteristics and questions about enteral nutrition.

Results
According to the nurses' knowledge level about the indication of enteral nutrition formulas, the following were incorrect or incomplete: their knowledge about transition to parenteral nutrition in case of nutritional contraindications, what to do when the amount of gastric residual volume in tolerance is >500 mL every 6 hours, the conditions for starting enteral nutrition, and which formulas are appropriate to use. Regarding their knowledge about enteral feeding tubes/sets, their knowledge about radiologic imaging after tube placement, measurement of gastric pH level, and marking the tube location was insufficient. Differently, the correct answer percentages of the nurses in 11 of the 13 questions regarding the principles of enteral nutrition practice were above 70%.

Conclusion
Nurses had adequate knowledge of the principles of enteral nutrition practice, but their knowledge of the indication of enteral nutrition formulas and the evidence for enteral feeding tubes/sets varied. The results showed that nurses need to gain information about the indication of enteral nutrition formulas and evidence related to enteral feeding tubes/sets.
Descemet Membrane Endothelial Keratoplasty With and Without Graft Deswelling: A Prospective Clinical Study
Authors: Menzel-Severing Johannes , Prues-Hölscher Jennifer , Jürgens Lukas , Geerling Gerd 
Published: April 2024

Purpose:
The purpose of this study was to assess whether omission of dextran from corneal organ culture medium alters the outcome of Descemet membrane endothelial keratoplasty.

Methods:
Participation in this single-center, multisurgeon, prospective, randomized, comparative clinical trial was offered to patients scheduled for Descemet membrane endothelial keratoplasty between April 2020 and May 2022. Patients received grafts from corneas deswollen in organ culture medium-containing 6% dextran T-500 or from corneas that were not deswollen. Corrected distance visual acuity (CDVA), graft detachment, central corneal thickness (CCT), and corneal endothelial cell counts were measured at different time points up to 12 months postoperatively.

Results:
Grafts stored with dextran were transplanted in 92 patients, and grafts stored without dextran were transplanted in 102 patients. Mean donor age and endothelial cell counts did not differ significantly between both groups. Mean (±SD) postmortem time in hours was 23.9 ± 11.8 in grafts that were deswollen and 28.2 ± 13.8 in grafts that were not deswollen (P = 0.02). The groups did not show any significant difference at baseline regarding sex, CDVA, or CCT. In the group with dextran, patients had a mean age of 72.5 ± 9.9 years versus 69.5 ± 8.7 in the group without dextran (P = 0.03). CDVA improved and CCT decreased significantly in both groups. No differences were detected between the groups regarding CDVA, CCT, endothelial cell counts, or rebubbling rates.

Conclusions:
This study did not detect any evidence that the omission of dextran from organ culture medium negatively affects the outcomes of Descemet membrane endothelial keratoplasty.