bluuebunny/crossref_metadata_2025_split huggingface dataset:
Intraoperative lung protection: strategies and their impact on outcomes
Authors: Simonte Rachele , Cammarota Gianmaria , De Robertis Edoardo 
Published: February 2024

Purpose of review
The present review summarizes the current knowledge and the barriers encountered when implementing tailoring lung-protective ventilation strategies to individual patients based on advanced monitoring systems.

Recent findings
Lung-protective ventilation has become a pivotal component of perioperative care, aiming to enhance patient outcomes and reduce the incidence of postoperative pulmonary complications (PPCs). High-quality research has established the benefits of strategies such as low tidal volume ventilation and low driving pressures. Debate is still ongoing on the most suitable levels of positive end-expiratory pressure (PEEP) and the role of recruitment maneuvers. Adapting PEEP according to patient-specific factors offers potential benefits in maintaining ventilation distribution uniformity, especially in challenging scenarios like pneumoperitoneum and steep Trendelenburg positions. Advanced monitoring systems, which continuously assess patient responses and enable the fine-tuning of ventilation parameters, offer real-time data analytics to predict and prevent impending lung complications. However, their impact on postoperative outcomes, particularly PPCs, is an ongoing area of research.

Summary
Refining protective lung ventilation is crucial to provide patients with the best possible care during surgery, reduce the incidence of PPCs, and improve their overall surgical journey.
Unexpected intensive care unit admission after surgery: impact on clinical outcome
Authors: Cammarota Gianmaria , De Robertis Edoardo , Simonte Rachele 
Published: February 2024

Purpose of review
This review is focused on providing insights into unplanned admission to the intensive care unit (ICU) after surgery, including its causes, effects on clinical outcome, and potential strategies to mitigate the strain on healthcare systems.

Recent findings
Postoperative unplanned ICU admission results from a combination of several factors including patient's clinical status, the type of surgical procedure, the level of supportive care and clinical monitoring outside the ICU, and the unexpected occurrence of major perioperative and postoperative complications. The actual impact of unplanned admission to ICU after surgery on clinical outcome remains uncertain, given the conflicting results from several observational studies and recent randomized clinical trials. Nonetheless, unplanned ICU admission after surgery results a significant strain on hospital resources. Consequently, this issue should be addressed in hospital policy with the aim of implementing preoperative risk assessment and patient evaluation, effective communication, vigilant supervision, and the promotion of cooperative healthcare.

Summary
Unplanned ICU admission after surgery is a multifactorial phenomenon that imposes a significant burden on healthcare systems without a clear impact on clinical outcome. Thus, the early identification of patient necessitating ICU interventions is imperative.
Perioperative management of patients on glucagon-like peptide-1 receptor agonists
Authors: Mizubuti Glenio B. , Ho Anthony M.-H. , Silva Leopoldo Muniz da , Phelan Rachel 
Published: February 2024

Purpose of review
To summarize the mechanism of action, clinical outcomes, and perioperative implications of glucagon-like peptide-1 receptor agonists (GLP-1-RAs). Specifically, this review focuses on the available literature surrounding complications (primarily, bronchoaspiration) and current recommendations, as well as knowledge gaps and future research directions on the perioperative management of GLP-1-RAs.

Recent findings
GLP-1-RAs are known to delay gastric emptying. Accordingly, recent case reports and retrospective observational studies, while anecdotal, suggest that the perioperative use of GLP-1-RAs may increase the risk of bronchoaspiration despite fasting intervals that comply with (and often exceed) current guidelines. As a result, guidelines and safety bulletins have been published by several Anesthesiology Societies.

Summary
While rapidly emerging evidence suggests that perioperative GLP-1-RAs use is associated with delayed gastric emptying and increased risk of bronchoaspiration (particularly in patients undergoing general anesthesia and/or deep sedation), high-quality studies are needed to provide definitive answers with respect to the safety and duration of preoperative drug cessation, and optimal fasting intervals according to the specific GLP-1-RA agent, the dose/duration of administration, and patient-specific factors. Meanwhile, clinicians must be aware of the potential risks associated with the perioperative use of GLP-1-RAs and follow the recommendations put forth by their respective Anesthesiology Societies.
Stress hyperglycaemia following trauma – a survival benefit or an outcome detriment?
Authors: Rugg Christopher , Schmid Stefan , Zipperle Johannes , Kreutziger Janett 
Published: February 2024

Purpose of review
Stress hyperglycaemia occur often in critically injured patients. To gain new consideration about it, this review compile current as well as known immunological and biochemical findings about causes and emergence.

Recent findings
Glucose is the preferred energy substrate for fending immune cells, reparative tissue and the cardiovascular system following trauma. To fulfil these energy needs, the liver is metabolically reprogrammed to rebuild glucose from lactate and glucogenic amino acids (hepatic insulin resistance) at the expenses of muscles mass and – to a less extent – fat tissue (proteolysis, lipolysis, peripheral insulin resistance). This inevitably leads to stress hyperglycaemia, which is evolutionary preserved and seems to be an essential and beneficial survival response. It is initiated by damage-associated molecular patterns (DAMPs) and pathogen-associated molecular patterns (PAMPs), intensified by immune cells itself and mainly ruled by tumour necrosis factor (TNF)α and catecholamines with lactate and hypoxia inducible factor (HIF)-1α as intracellular signals and lactate as an energy shuttle. Important biochemical mechanisms involved in this response are the Warburg effect as an efficient metabolic shortcut and the extended Cori cycle.

Summary
Stress hyperglycaemia is beneficial in an acute life-threatening situation, but further research is necessary, to prevent trauma patients from the detrimental effects of persisting hyperglycaemia.
Improving morbidity and mortality in hip fragility fractures
Authors: Kelly Tara , Moore Brenden , George Renuka 
Published: February 2024

Purpose of review
Hip fragility fractures (HFF) carry high morbidity and mortality for patients and will increase in frequency and in proportion to the average patient age. Provision of effective, timely care for these patients can decrease their morbidity and mortality and reduce the large burden they place on the healthcare system.

Recent findings
There are associative relationships between prefracture frailty, postoperative delirium and increased morbidity and mortality. The use of a multidisciplinary approach to HFF care has shown improved outcomes in care with focus on modifiable factors including admission to specialty care floor, use of peripheral nerve blocks preoperatively and Anesthesia and Physical Therapy involvement in the care team. Peripheral nerve blocks including pericapsular nerve group (PENG) blocks have shown benefit in lowering morbidity and mortality.

Summary
HFF are associated with >40% chance of continued pain and inability to return to prefracture functional status at 1 year as well as >30% mortality at 2 years. In this opinion piece, we will discuss how a multidisciplinary approach that includes Anesthesia as well as utilization of peripheral nerve blocks can help to lessen postoperative issues and improve recovery.
Can the Lower Extremity Functional Scale Be Used in Children and Adolescents? A Validation Study
Authors: Chua Yi Ling , Sheri Sonia , Yeo Beatrice Shu Qing , Lee Nicole Kim Luan , Ng Shin Huey , Lim Kevin Boon Leong 
Published: February 2024

Background:
The lower extremity functional scale (LEFS) is a patient-reported outcome measure for assessment of lower extremity function. It has been validated in adults but not in children or adolescents.

Methods:
Patients 8 to 18 years of age who were treated for a lower limb fracture, injury, or other conditions were invited to join the study. LEFS and Pediatric Quality of Life Inventory 4.0 Generic Core Scales (PedsQL) were administered. Reliability and validity of the LEFS were determined for the entire cohort and for 2 age groups (children: 8 to 12 years; adolescents 13 to 18 years) using PedsQL as comparison.

Results:
A total of 178 patients were recruited into this study. In the entire cohort, internal consistency of LEFS was excellent (0. 972) with acceptable floor (0%) and ceiling (12%) effects. Correlation between LEFS and PedsQL physical functioning component was high (r=0.859). Construct validity was acceptable, with all 8 hypotheses demonstrating statistical significance. Factor analysis showed that item 15 (sitting for 1 hour) may contribute to measurement error in the pediatric population. Results remained similar when comparing the 2 age groups.

Conclusions:
The LEFS is overall an acceptable patient-reported outcome assessment of children and adolescents with various lower limbs disorders.

Level of Evidence:
Level II.
Cardiac rehabilitation for heart failure: progress and gaps in evidence and policy
Authors: Ngo-Hamilton Alfred , Agakishiev Dzhalal , Maharaj Valmiki 
Published: February 2024

Purpose of review
This review synthesizes recent research on the efficacy, optimal design, and delivery methods of cardiac rehabilitation tailored to heart failure patients. Despite established benefits, cardiac rehabilitation referral and access disparities persist, necessitating elucidation of limitations and solutions.

Recent findings
Exercise-based cardiac rehabilitation improves long-term mortality and hospitalization rates but not short-term mortality. cardiac rehabilitation further enhances quality of life and medical therapy adherence. However, cardiac rehabilitation relies on in-person delivery, presenting access barriers exacerbated during COVID-19. Significant geographic disparities exist, with analyses indicating current capacity only serves 45% of eligible US adults even if fully utilized. Referral rates also lag, disproportionately affecting women and minority groups. Research increasingly focuses on home-based and digital therapeutics modalities to expand reach, with evidence demonstrating comparable improvements across settings. Protocols and research center on heart failure with reduced ejection fraction (HFrEF), despite growing heart failure with preserved ejection fraction (HFpEF) prevalence.

Summary
Increasing referrals through standardized procedures and addressing multifactorial geographic, economic, and capacity limitations are imperative to ensure equitable cardiac rehabilitation access. Broadening HFpEF rehabilitation research and care standards also constitutes a critical practice gap requiring alignment with projected epidemiologic shifts. Advancing patient-centered, evidence-based solutions can promote rehabilitation as essential secondary prevention for wider cardiac populations.

Video abstract:

http://links.lww.com/HCO/A97
Performance of ChatGPT in Diagnosis of Corneal Eye Diseases
Authors: Delsoz Mohammad , Madadi Yeganeh , Raja Hina , Munir Wuqaas M. , Tamm Brendan , Mehravaran Shiva , Soleimani Mohammad , Djalilian Ali , Yousefi Siamak 
Published: February 2024

Purpose:
The aim of this study was to assess the capabilities of ChatGPT-4.0 and ChatGPT-3.5 for diagnosing corneal eye diseases based on case reports and compare with human experts.

Methods:
We randomly selected 20 cases of corneal diseases including corneal infections, dystrophies, and degenerations from a publicly accessible online database from the University of Iowa. We then input the text of each case description into ChatGPT-4.0 and ChatGPT-3.5 and asked for a provisional diagnosis. We finally evaluated the responses based on the correct diagnoses, compared them with the diagnoses made by 3 corneal specialists (human experts), and evaluated interobserver agreements.

Results:
The provisional diagnosis accuracy based on ChatGPT-4.0 was 85% (17 correct of 20 cases), whereas the accuracy of ChatGPT-3.5 was 60% (12 correct cases of 20). The accuracy of 3 corneal specialists compared with ChatGPT-4.0 and ChatGPT-3.5 was 100% (20 cases, P = 0.23, P = 0.0033), 90% (18 cases, P = 0.99, P = 0.6), and 90% (18 cases, P = 0.99, P = 0.6), respectively. The interobserver agreement between ChatGPT-4.0 and ChatGPT-3.5 was 65% (13 cases), whereas the interobserver agreement between ChatGPT-4.0 and 3 corneal specialists was 85% (17 cases), 80% (16 cases), and 75% (15 cases), respectively. However, the interobserver agreement between ChatGPT-3.5 and each of 3 corneal specialists was 60% (12 cases).

Conclusions:
The accuracy of ChatGPT-4.0 in diagnosing patients with various corneal conditions was markedly improved than ChatGPT-3.5 and promising for potential clinical integration. A balanced approach that combines artificial intelligence–generated insights with clinical expertise holds a key role for unveiling its full potential in eye care.
Long-Term Outcomes of Keratoprosthesis With Biological Haptic: A Review of 25 Years of Single-Center Surgeries
Authors: Angerer Maximilian P. M. , Weller Julia M. , Kruse Friedrich E. , Hille Konrad 
Published: February 2024

Purpose:
To study the outcome of eyes that underwent surgery for keratoprosthesis with a biological haptic, osteo-odonto-keratoprosthesis (OOKP) or tibia keratoprosthesis, by a single surgeon over a time span of more than 25 years.

Methods:
One hundred thirty eyes that had received a keratoprosthesis with a biological haptic between 1994 and 2022 by a single surgeon were included in this retrospective analysis. Main outcome parameters were postoperative best corrected visual acuity, postoperative refractive error, postoperative complications, anatomical and functional survival of the prosthesis as well as comparison of subgroups of the 2 different types (OOKP n = 78; tibia keratoprosthesis n = 52) of keratoprostheses, and subgroup analysis of different indications for surgery. Patients were examined every 6 months.

Results:
The longest follow-up was 25.8 years. Reasons for implantation were graft-vs-host disease (6.9%), vascularized corneas and dry eye (22.9%), physical or chemical burns (29.8%), Stevens–Johnson syndrome (9.9%), and ocular cicatricial pemphigoid (30.5%). The functional success rate with postoperative visual acuity of better than 0.7 log MAR was achieved by 56.9%. The OOKP subgroup showed a better mean visual outcome. 14 keratoprostheses (10.7%) had to be explanted over the whole time span. In the time leading to explantation, refraction showed a statistically significant myopic shift when compared with the non-explanted prosthesis. Anatomical survival rates were better for the OOKP in the first 12 years after implantation.

Conclusions:
The study shows that keratoprosthesis with a biological haptic has favorable long-term outcomes. The retention rate stayed very high with excellent functional outcomes.
Effect of dysnatremia and dysglycemia on outcomes among surgical intensive care unit patients
Authors: Abu Abeeleh Mahmoud , Hamouri Hanan , Bani Hani Amjad , Ahmad Fatima M. , Abu Halaweh Sami , Al-Warafi Wedad A. , Al Sahile Leen B. , Abu Amrieh Zain M. , Abu Abeeleh Farah , Battah Abdelkader H. , Bani Ismail Zuhair , Al Nassarwin Saif , Al Jaafreh Tala , Ribie Mohammad , Salameh Mohammad , Abu-Humaidan Anas H.A. 
Published: February 2024

Objectives:
The objectives of this study were to evaluate the relationships between serum sodium and glucose concentrations and outcomes among patients admitted to the surgical intensive care unit (SICU).

Materials and methods:
Patient records admitted to the SICU between July 2020 and December 2020 were used in the study. Data included in the analysis were patient age, sex, comorbidities, surgical intervention, diagnosis of sepsis, sequential organ system failure scores, serum sodium concentrations, serum glucose concentrations, and SICU outcomes (discharged vs. deceased). A univariate logistic regression analysis was used to determine significant risk factors for mortality during a SICU stay.

Results:
A total of 194 patients with a mean age of 60±16 years were admitted to the SICU during the study period. Twenty-three percent of the patients were found to have sepsis with 18% mortality. Serum sodium and glucose concentrations were significantly higher (P-value ≤0.05) at all-time points in deceased patients compared to those who were discharged from the SICU.

Conclusion:
The results of the study indicate that serum sodium and glucose concentrations could be used as independent predictors of mortality in SICU patients with sepsis. However, further clinical trials are warranted before this application could be recommended in SICU.
Impact of the starch-based anti-adhesive agent 4DryField PH on anastomotic healing after rectal surgery
Authors: Stoerzer Simon , Winny Markus , Beetz Oliver , Jacobi Severin , Klempnauer Juergen , Poehnert Daniel 
Published: February 2024

Aim:
Postoperative adhesions cause medical and socio-economic problems. 4DryField PH (4DF) is a starch-based medical product/agent with approved anti-adhesive and haemostatic effects. However, the influence on anastomotic healing has not yet been evaluated. The purpose of this study was, therefore, to characterize the effects of intraoperatively applied 4DF on the incidence of anastomotic leakage (AL) after rectal surgery.

Methods:
In this retrospective, monocentric cohort study, 157 patients after rectal surgery and primary anastomosis were divided into two groups. One group received 4DF (n=57), the other was treated without 4DF application (n=100). The groups were followed up for confirmed ALs.

Results:
The rate of ALs (P=0.850) proved to be comparable. Other additional outcome parameters like postoperative hospital stay (P=0.801), wound infection rate (P=0.627), re-admission rate (P=1.000), re-operation rate (P=0.533) and the 30-day mortality (P=0.463) also showed no statistically significant differences. A multivariable regression model for the complete cohort could not identify 4DF application as prognostically relevant for the development of AL, whereas rectal cancer (OR=2.660 [1.184–5.974]; P=0.018), smoking (OR=3.555 [1.326–9.533]; P=0.012), an ASA (American Society of Anaesthesiologists) score ≥3 (OR=2.894 [1.300–6.442]; P=0.009) and male sex (OR=2.411 [1.040–5.591]; P=0.040) were determined as independent risk factors.

Conclusion:
The application of 4DF in proximity to the anastomotic region after rectal surgery did not increase the risk of AL and showed no impact on other investigated outcome parameters.
Is 3 weeks a proper time point for the diagnosis of grade B POPF after pancreaticoduodenectomy?
Authors: Shen Yuhang , Gao Yuan , Wu Siyuan , Ma Le , Zhu Chunfu 
Published: February 2024

Background:
In 2016, the International Study Group of Pancreatic Fistula (ISGPF) improved the definition of postoperative pancreatic fistula, which defines one of diagnostic criteria for progression of biochemical leak (BL) to grade B fistula as drain for more than 3 weeks. However, the authors found patients with BL after pancreaticoduodenectomy (PD) or laparoscopic pancreatoduodenectomy (LPD) in our medical center usually progressed to grade B fistula within 3 weeks, which is inconsistent with diagnostic criteria (more than 3 weeks) described in the guidelines. The objective of this study was to investigate the time point at which patients with BL progressed to grade B fistula after PD or LPD.

Methods:
The authors selected patients from June 2013 to October 2022 as the research subjects. The authors used a receiver operating characteristic curve to calculate the cutoff value of the time point when BL progressed to grade B fistula.

Results:
The cutoff value of the time point at which BL progresses to grade B fistula was postoperative day (POD) 9.5. The sensitivity and specificity were 63.6 and 81.4%, respectively.

Conclusion:
The cutoff value of time point of BL progression to grade B fistula was 9.5, which indicated that we do not need to define grade B fistula as drain for more than 3 weeks. The authors considered that a too-late time point might delay the timely diagnosis and treatment of grade B fistula and further optimization of the definition of grade B fistula was necessary.
The emerging role of cell-free DNA as a molecular marker for duodenal adenocarcinoma
Authors: Lai Hon-Fan , Wang Shin-E , Chen Shih-Chin , Shyr Bor-Shiuan , Shyr Yi-Ming , Shyr Bor-Uei 
Published: February 2024

Background:
Duodenal adenocarcinoma is rare and its prognostic factors remain controversial. In our study, the role of cell-free deoxyribonucleic acid (cfDNA) as prognostic factor in duodenal adenocarcinoma was evaluated.

Methods:
From June 2003 to July 2021, plasma samples were collected from 41 patients with duodenal adenocarcinoma. Plasma cfDNA was assessed in combination with clinicopathological and biochemical characteristics. Univariate and multivariate analyses were conducted to identify independent prognostic factors for overall survival with a Cox proportional hazards regression model.

Results:
The 1- and 5-year survival rates of the patients with high plasma cfDNA level (>9288 copies/mL) group were 58.7% and 17.6%, respectively, which were much lower than patients with low cfDNA level (≤9288 copies/mL), with 95.2% and 64.6%. In univariate analysis, high cfDNA level, lymph node involvement, lymphovascular invasion, and tumor stage were associated with decreased survival. When subjected to multivariate analysis, only high cfDNA level showed significance in influencing the overall survival of duodenal cancer.

Conclusion:
cfDNA analysis is simple and noninvasive. High cfDNA level is a strong independent prognostic factor for decreased overall survival and it should be integrated into clinical care.
Sugammadex shortens operation time and improves operation turnover efficacy in video-assisted thoracoscopic surgery
Authors: Lin Yu-Tsen , Ting Chien-Kun , Hsu Han-Shui 
Published: February 2024

Background:
This study compared sugammadex and neostigmine as agents for routine neuromuscular blockade reversal in video-assisted thoracoscopic surgery (VATS) to determine the optimal choice that achieves a shorter operation time and improved turnover efficiency while enhancing postoperative outcomes and ensuring patient safety during thoracic surgery.

Methods:
This prospective study, conducted from July 2022 to March 2023, compared the effect of sugammadex and neostigmine on operation time and turnover efficiency in VATS, involving 60 participants randomly assigned to either group, with the primary objective of identifying the optimal anesthesia reversal choice for improved outcomes and patient safety during thoracic surgery.

Results:
In the study, the sugammadex group showed a significantly shorter total operation room occupancy time (130 ± 7 vs 157 ± 7 minutes; p = 0.009) than the neostigmine group. Patients in the neostigmine group had higher mean pulse rates when leaving the operation room (85 ± 3 vs 73 ± 3 beats/min; p = 0.002) and 120 minutes later in the postanesthesia care unit (76 ± 2 vs 68 ± 2; p = 0.016).

Conclusion:
This study’s findings suggest that sugammadex may enhance total operating room occupancy time, operation turnover efficacy, and respiratory recovery outcomes in VATS, potentially improving patient care and anesthesia management.