bluuebunny/crossref_metadata_2025_split huggingface dataset:
COVID-19 mortality in 1984 Bhopal gas tragedy survivors: implications for chemically exposed populations
Authors: Dhingra Rachna , Sarangi Satinath , Chatterjee Pranab , Gun Arkaprabha , Sarkar Swarup 
Published: April 2024

Abstract
Leakage of methyl isocyanate from the Union Carbide plant in Bhopal, India, killed thousands and left deleterious trans-generational effects. Gas-exposed populations experience higher rates of lung and metabolic diseases, and immune dysregulation, all associated with adverse outcomes in coronavirus disease 2019 (COVID-19). We used publicly available, official data from government sources to estimate COVID-19–associated crude mortality in populations with and without a history of gas exposure. Overall, there were 1240 deaths among patients hospitalized with known COVID-19 in Bhopal, of which 453 (36.53%) were in gas-exposed individuals, 726 (58.55%) were in gas-unexposed individuals and the exposure status of 61 (4.92%) individuals could not be determined. There were 351 and 375 deaths in gas-unexposed people in the first (April 2020–February 2021) and second (March 2021–July 2021) waves, respectively; in the gas-exposed population, there were 300 and 153 deaths in the two respective waves. The overall annualized crude mortality of COVID-19 was 3.84 (95% CI 3.41 to 4.33) times higher in the gas-exposed population at 83.6 (95% CI 76.1 to 91.7) per 100 000 compared with the gas-unexposed population, at 21.8 (95% CI 20.2 to 23.4) per 100,000. When stratified by age, compared with unexposed people, the gas-exposed individuals experienced 1.88 (95% CI 1.61 to 2.21) and 1.24 (95% CI 1.02 to 1.50) times the mortality rates in the age groups of 35–65 and &gt;65 y, respectively. These findings indicate that gas-exposed individuals are likely to have a higher risk of severe COVID-19 and death and need to be specifically targeted and recognized for preventive and promotive efforts.
Exercise and osteoimmunology in bone remodeling
Authors: Zhao Zhonghan , Du Yuxiang , Yan Kai , Zhang Lingli , Guo Qiang 
Published: April 2024

AbstractBones can form the scaffolding of the body, support the organism, coordinate somatic movements, and control mineral homeostasis and hematopoiesis. The immune system plays immune supervisory, defensive, and regulatory roles in the organism, which mainly consists of immune organs (spleen, bone marrow, tonsils, lymph nodes, etc.), immune cells (granulocytes, platelets, lymphocytes, etc.), and immune molecules (immune factors, interferons, interleukins, tumor necrosis factors, etc.). Bone and the immune system have long been considered two distinct fields of study, and the bone marrow, as a shared microenvironment between the bone and the immune system, closely links the two. Osteoimmunology organically combines bone and the immune system, elucidates the role of the immune system in bone, and creatively emphasizes its interdisciplinary characteristics and the function of immune cells and factors in maintaining bone homeostasis, providing new perspectives for skeletal‐related field research. In recent years, bone immunology has gradually become a hot spot in the study of bone‐related diseases. As a new branch of immunology, bone immunology emphasizes that the immune system can directly or indirectly affect bones through the RANKL/RANK/OPG signaling pathway, IL family, TNF‐α, TGF‐β, and IFN‐γ. These effects are of great significance for understanding inflammatory bone loss caused by various autoimmune or infectious diseases. In addition, as an external environment that plays an important role in immunity and bone, this study pays attention to the role of exercise‐mediated bone immunity in bone reconstruction.
An Approach to Diversifying the Selection of a Guideline Panel—The Process Utilized for the Updated Adult Critical Care Ultrasound Guidelines
Authors: Nikravan Sara , Lanspa Michael J. , Ablordeppey Enyo , Gerlach Anthony T. , Shutter Lori , Patel Hariyali , Reuter-Rice Karin , Lewis Kim , Sharif Sameer , Díaz-Gómez José L. 
Published: April 2024

OBJECTIVES:
Clinical practice guidelines are essential for promoting evidence-based healthcare. While diversification of panel members can reduce disparities in care, processes for panel selection lack transparency. We aim to share our approach in forming a diverse expert panel for the updated Adult Critical Care Ultrasound Guidelines.

DESIGN:
This process evaluation aims to understand whether the implementation of a transparent and intentional approach to guideline panel selection would result in the creation of a diverse expert guideline panel.

SETTING:
This study was conducted in the setting of creating a guideline panel for the updated Adult Critical Care Ultrasound Guidelines.

PATIENTS:
Understanding that family/patient advocacy in guideline creations can promote the impact of a clinical practice guideline, patient representation on the expert panel was prioritized.

INTERVENTIONS:
Interventions included creation of a clear definition of expertise, an open invitation to the Society of Critical Care Medicine membership to apply for the panel, additional panel nomination by guideline leadership, voluntary disclosure of pre-identified diversity criteria by potential candidates, and independent review of applications including diversity criteria. This resulted in an overall score per candidate per reviewer and an open forum for discussion and final consensus.

MEASUREMENTS AND MAIN RESULTS:
The variables of diversity were collected and analyzed after panel selection. These were compared with historical data on panel composition. The final guideline panel comprised of 33 panelists from six countries: 45% women and 79% historically excluded people and groups. The panel has representation from nonphysician professionals and patients advocates. Of the healthcare professionals, there is representation from early, mid, and late career stages.

CONCLUSIONS:
Our intentional and transparent approach resulted in a panel with improved gender parity and robust diversity along ethnic, racial, and professional lines. We hope it can serve as a starting point as we strive to become a more inclusive and diverse discipline that creates globally representative guidelines.
First-line Immunotherapy for Metastatic Merkel Cell Carcinoma
Authors: Kakish Hanna , Sun James , Ammori John B. , Hoehn Richard S. , Rothermel Luke D. 
Published: April 2024

Background:
Immune checkpoint inhibitors are a promising new therapy for advanced Merkel Cell Carcinoma (MCC). We investigated real-world utilization and survival outcomes of first-line immunotherapies in a contemporary cohort.

Methods:
Using the National Cancer Database (NCDB), we identified 759 patients with MCC between 2015 and 2020 with stage IV disease and known status of first-line systemic therapy. Univariable and multivariable analyses were used to determine predictors of immunotherapy usage. Overall survival (OS) was compared for patients receiving immunotherapy, chemotherapy, or no systemic therapies.

Results:
We identified 759 patients meeting our inclusion criteria: 329 patients received immunotherapy, 161 received chemotherapy, and 269 received no systemic therapy. Adjusting for demographic, clinical, and facility factors, high facility volume significantly predicted first-line immunotherapy use (OR 1.99; P=0.017). Median OS was 16.2, 12.3, and 8.7 months, among patients who received immunotherapy, chemotherapy, or no systemic therapy, respectively (P<0.001). On Cox multivariable survival analysis, first-line immunotherapy treatment (HR=0.79, P=0.041) and treatment at high-volume centers (HR=0.58, P=0.004) were associated with improved OS.

Conclusions:
Consistent with clinical trial results, first-line immunotherapy associated with improvement in median overall survival for patients with stage IV MCC, significantly outperforming chemotherapy in this real-world cohort. Treatment at high-volume centers associated with first-line immunotherapy utilization suggesting that familiarity with this rare disease is important to achieving optimal outcomes for metastatic MCC.
Plasmapheresis as therapeutic option in a 16-year-old with EVALI
Authors: Gaik Christine , Arndt Christian , Mand Nadine , Bauck Monika , Schwerk Nicolaus , Westhoff Christina , Bittmann Iris , Wulf Hinnerk 
Published: April 2024

Since 2019 when a cluster of cases with acute respiratory distress syndrome (ARDS) associated with e-cigarettes in the United States was reported, there have been increasing numbers of reports. Electronic-cigarette or Vaping Use-associated Lung Injury (EVALI) represents a recent entity of respiratory clinical syndromes, primarily in young adults. We report a previously healthy 16-year-old boy who developed severe ARDS following a brief nonspecific prodromal phase after excessive consumption of e-cigarettes. Despite maximum intensive care therapy, including several weeks of venovenous extracorporeal membrane oxygenation, plasmapheresis and repeated administration of immunoglobulins seemed the only way to achieve therapeutic success. Although many case reports have been published, to our knowledge, there are none to date on the therapeutic use of plasmaphoresis in severe EVALI. This case highlights the clinical features of EVALI and the diagnostic dilemma that can arise with EVALI occurring against the background of an expired SARS-CoV-2 infection, with a paediatric inflammatory syndrome (PIMS) as differential diagnosis. EVALI is a diagnosis of exclusion, and the medical history of vaping and e-cigarette use can provide valuable clues.
Ethical approval for this case report (protocol number 23–145 RS) was provided by the Ethical Committee of the Department of Medicine, Philipps-Universität Marburg, Germany on 13th of June 2023. Written informed consent to publish this case and the associated images was obtained from the patient and his mother.
Reconstruction of a Large Composite Hemicraniofacial Defect with Bipedicled DIEP/TRAM Flaps
Authors: Chia Jake , Soliman Bishoy , Hsieh Frank 
Published: April 2024

Summary:
Head and neck reconstructions are often challenging due to the mix of functional and aesthetic goals. It can be tricky when different tissue types are required to reconstruct each subunit. Craniofacial reconstructions require a large volume of tissue to cover defects that span across a large convex area. The latissimus dorsi muscle flap is a workhorse free flap used frequently by surgeons due to its ability to cover over a large surface area. However, there are unique situations when even the latissimus dorsi muscle is not enough to provide the bulk cover for the craniofacial defect. We present a complex case of a hemicraniofacial reconstruction after a hemifacial orbital exenteration and cranial resection of a large neglected basal cell carcinoma.
Ulnar Ray Deficiency: A New Classification and a Unique Case Report
Authors: Al-Qattan Mohammad M. , Al-Abidien Nowar Zain , Al-Mohrij Saad A. , Al-Qattan Ahmed M. 
Published: April 2024

Summary:
Ulnar ray deficiency is a rare congenital upper limb defect. We report on a unique case with hand-on-flank deformity on the one side and limb truncation on the contralateral side. The standard of care for the hand-on-flank deformity is to do humerus osteotomy to reposition the hand anteriorly. However, the right limb truncation in our patient made the senior author decide not to do the osteotomy. Final assessment showed that the posterior hand position enabled the patient to reach the ano-genital areas, the pocket, and the mouth. It was concluded that in case of hand-on-flank deformity in one limb and limb truncation of the contralateral limb, osteotomies to bring the hand anteriorly are not advised.
Morphological Differentiation of Corneal Inflammatory Cells
Authors: Schmitz Fynn , Klimas Rafael , Spenner Marie , Schumacher Aurelian , Hieke Alina , Greiner Tineke , Enax-Krumova Elena , Sgodzai Melissa , Fels Miriam , Brünger Jil , Huckemann Sophie , Stude Philipp , Tegenthoff Martin , Gold Ralf , Philipps Jörg , Fisse Anna Lena , Grüter Thomas , Pitarokoili Kalliopi , Motte Jeremias , Sturm Dietrich 
Published: April 2024

Purpose:
Corneal confocal microscopy is a noninvasive imaging technique to analyze corneal nerve fibers and corneal inflammatory cells (CICs). The amount of CICs is a potential biomarker of disease activity in chronic autoinflammatory diseases. To date, there are no standardized criteria for the morphological characterization of CICs. The aim was to establish a protocol for a standardized morphological classification of CICs based on a literature search and to test this protocol for applicability and reliability.

Methods:
A systematic review of the literature about definitions of CICs was conducted. Existing morphological descriptions were translated into a structured algorithm and applied by raters. Subsequently, the protocol was optimized by reducing and defining the criteria of the cell types. The optimized algorithm was applied by 4 raters. The interrater reliability was calculated using Fleiss kappa (K).

Results:
A systematic review of the literature revealed no uniform morphological criteria for the differentiation of the individual cell types in CICs. Our first protocol achieved only a low level of agreement between 3 raters (K = 0.09; 1062 rated cells). Our revised protocol was able to achieve a higher interrater reliability with 3 (K = 0.64; 471 rated cells) and 4 (K = 0.61; 628 rated cells) raters.

Conclusions:
The indirect use of criteria from the literature leads to a high error rate. By clearly defining the individual cell types and standardizing the protocol, reproducible results were obtained, allowing the introduction of this protocol for the future evaluation of CICs in the corneal confocal microscopy.
The Impact of Involvement in Whole Health System for Veterans or Participating in It for Oneself on Job Attitudes in VA Employees
Authors: Schult Tamara M. , Mohr David C. , Greenfield Russell H. , Reddy Kavitha P. 
Published: April 2024

ObjectiveThe aim of the study is to examine how involvement in the Whole Health System of care, clinically and personally (through employee-focused activities), would affect employee satisfaction, engagement, burnout, and turnover intent in the Veterans Health Administration.MethodsMultivariate logistic regression analysis of cross-sectional survey from Veterans Health Administration employees was used to determine the influence of Whole Health System involvement and Employee Whole Health participation on job attitudes.ResultsWhole Health System involvement was associated higher job satisfaction, higher levels of engagement, lower burnout, and lower turnover intent. A similar pattern of results was identified when looking specifically at Employee Whole Health participation and associated job attitudes.ConclusionsEmployees who are either directly involved in delivering Whole Health services to veterans or who have participated in Whole Health programming for their own benefit may experience a meaningful positive impact on their well-being and how they experience the workplace.
The Effects of Slope-Adaptive Prosthetic Ankle-Feet on Sloped Gait Performance and Quality in Unilateral Transtibial Prosthesis Users: A Scoping Review
Authors: Mueller Emily , Major Matthew J. 
Published: April 2024

ABSTRACT

Introduction
In nonimpaired human locomotion, sagittal-plane slope adaptation of the ankle-foot complex is a function driven by neuromotor control to support upright posture and forward ambulation. Loss of this adaptation due to transtibial amputation can lead to instability and compensatory motions as most commercially available prosthetic feet do not permit automatic slope adjustments. A selection of slope-adaptive ankle-feet (SAAF) has been developed to promote biomimetic ankle motion while ambulating over slopes. This review evaluated the current literature to assess the effects of SAAF prostheses on sloped gait performance in unilateral transtibial prosthesis users.

Methods
Four databases (PubMed, Embase, CINAHL, IEEE Xplore) were searched on April 28, 2022, for relevant articles. Search keywords covered the general terms “transtibial,” “amputation,” “slope,” “adaptive,” and “gait,” and included articles comparing an SAAF prosthesis to a non-SAAF prosthesis condition. Data were extracted for analysis, and results were grouped according to outcomes to identify trends and aid interpretation of slope adaptation effects on gait.

Results
Of the 672 articles screened, 24 met the selection criteria and were included in this review, published between 2009 and 2022. The non-SAAF condition included dynamic response feet and SAAF prostheses with the adaptability function inactive.
Outcomes included biomechanical variables (joint dynamics, gait symmetry, toe clearance), clinical outcome measures, and energy expenditure. All SAAF demonstrated some form of foot-ankle slope gradient adaptability, but effects on other joint dynamics were inconsistent. Minimum toe clearance during incline and decline walking was greater when using SAAF compared with non-SAAF in all reporting studies.

Conclusions
Results generally suggest improvements in gait quality, comfort, and safety with use of SAAF compared with non-SAAF during sloped walking. However, variations in tested SAAF and walking gradients across studies highlight the need for research to elucidate walking condition effects and advantages of specific designs.

Clinical Relevance
Slope-adaptive prosthetic ankle-feet may improve user gait quality and comfort and enhance gait safety by increasing minimum toe clearance. Patients who encounter slopes regularly should be considered as potential users of SAAF if indicated appropriately.
Improving care in lung cancer surgery: a review of quality measures and evolving standards
Authors: Lee Rachel M. , Rajaram Ravi 
Published: April 2024

Purpose of review
Lung cancer is the leading cause of cancer-related death in the United States. Pulmonary resection, in addition to perioperative systemic therapies, is a cornerstone of treatment for operable patients with early-stage and locoregional disease. In recent years, increased emphasis has been placed on surgical quality metrics: specific and evidence-based structural, process, and outcome measures that aim to decrease variation in lung cancer care and improve long term outcomes. These metrics can be divided into potential areas of intervention or improvement in the preoperative, intraoperative, and postoperative phases of care and form the basis of guidelines issued by organizations including the National Cancer Center Network (NCCN) and Society of Thoracic Surgeons (STS). This review focuses on established quality metrics associated with lung cancer surgery with an emphasis on the most recent research and guidelines.

Recent findings
Over the past 18 months, quality metrics across the peri-operative care period were explored, including optimal invasive mediastinal staging preoperatively, the extent of intraoperative lymphadenectomy, surgical approaches related to minimally invasive resection, and enhanced recovery pathways that facilitate early discharge following pulmonary resection.

Summary
Quality metrics in lung cancer surgery is an exciting and important area of research. Adherence to quality metrics has been shown to improve overall survival and guidelines supporting their use allows targeted quality improvement efforts at a local level to facilitate more consistent, less variable oncologic outcomes across centers.
Radioguided surgery for lymph node metastases in prostate cancer
Authors: Knipper Sophie , Falkenbach Fabian , Maurer Tobias 
Published: April 2024

Purpose of review
This review highlights recent advancements in radioguided surgery (RGS) for prostate cancer. Our objective is to provide expert insights into the state of research, as reflected in the selected articles, and to offer perspectives on the clinical implications and future directions that emerge from this rapidly evolving domain.

Recent findings
Key findings include the potential of PSMA-RGS surgery to improve the detection of lymph node invasion in primary prostate cancer, to guide successful removal of metastatic lesions in oligorecurrent patients with acceptable complications, and the feasibility of robot-assisted PSMA-RGS using a miniaturized gamma probe. Additionally, the development of novel PSMA ligands and the integration of fluorescence imaging offer promising improvements in imaging and surgical guidance.

Summary
PSMA-RGS is an emerging approach that shows promise for improving lymph node assessment and treatment outcomes in prostate cancer. However, its effect on cancer-specific as well as overall survival are still being investigated, and PSMA-targeted surgery remains an area of active research.
Positive allosteric modulation of a GPCR ternary complex
Authors: Burger Wessel A.C. , Draper-Joyce Christopher J. , Valant Celine , Christopoulos Arthur , Thal David M. 
Published: April 2024

AbstractThe activation of a G protein-coupled receptor (GPCR) leads to the formation of a ternary complex between agonist, receptor, and G protein that is characterised by high-affinity binding. Allosteric modulators bind to a distinct binding site from the orthosteric agonist and can modulate both the affinity and the efficacy of orthosteric agonists. The influence allosteric modulators have on the high-affinity active state of the GPCR-G protein ternary complex is unknown due to limitations on attempting to characterize this interaction in recombinant whole cell or membrane-based assays. Here, we use purified M2muscarinic acetylcholine receptor (mAChR) reconstituted into nanodiscs to show that once the agonist-bound high-affinity state is promoted by the G protein, positive allosteric modulators stabilise the ternary complex that, in the presence of nucleotides leads to an enhanced initial rate of signalling. Our results enhance our understanding of how allosteric modulators influence orthosteric ligand signalling and will aid the design of allosteric therapeutics.TeaserAllostery from top and bottom, the combined influence of positive allosteric modulators on receptor signalling.