bluuebunny/crossref_metadata_2025_split huggingface dataset:
Defining Intensivists: A Retrospective Analysis of the Published Studies in the United States, 2010–2020*
Authors: Halpern Neil A. , Tan Kay See , Bothwell Lilly A. , Boyce Lindsay , Dulu Alina O. 
Published: January 2024

OBJECTIVES:
The Society of Critical Care Medicine last published an intensivist definition in 1992. Subsequently, there have been many publications relating to intensivists. Our purpose is to assess how contemporary studies define intensivist physicians.

DESIGN:
Systematic search of PubMed, Embase, and Web of Science (2010–2020) for publication titles with the terms intensivist, and critical care or intensive care physician, specialist, or consultant. We included studies focusing on adult U.S. intensivists and excluded non–data-driven reports, non-U.S. publications, and pediatric or neonatal ICU reports. We aggregated the study title intensivist nomenclatures and parsed Introduction and Method sections to discern the text used to define intensivists. Fourteen parameters were found and grouped into five definitional categories: A) No definition, B) Background training and certification, C) Works in ICU, D) Staffing, and E) Database related. Each study was re-evaluated against these parameters and grouped into three definitional classes (single, multiple, or no definition). The prevalence of each parameter is compared between groups using Fisher exact test.

SETTING:
U.S. adult ICUs and databases.

INTERVENTIONS:
None.

MEASUREMENTS AND MAIN RESULTS:
Of 657 studies, 105 (16%) met inclusion criteria. Within the study titles, 17 phrases were used to describe an intensivist; these were categorized as intensivist in 61 titles (58%), specialty intensivist in 30 titles (29%), and ICU/critical care physician in 14 titles (13%). Thirty-one studies (30%) used a single parameter (B–E) as their definition, 63 studies (60%) used more than one parameter (B–E) as their definition, and 11 studies (10%) had no definition (A). The most common parameter “Works in ICU” (C) in 52 studies (50%) was more likely to be used in conjunction with other parameters rather than as a standalone parameter (multiple parameters vs single-parameter studies; 73% vs 17%; p < 0.0001).

CONCLUSIONS:
There was no consistency of intensivist nomenclature or definitions in contemporary adult intensivist studies in the United States.
Executive Summary: Society of Critical Care Medicine Guidelines on Recognizing and Responding to Clinical Deterioration Outside the ICU
Authors: Honarmand Kimia , Wax Randy S. , Penoyer Daleen , Lighthall Geoffery , Danesh Valerie , Rochwerg Bram , Cheatham Michael L. , Davis Daniel P. , DeVita Michael , Downar James , Edelson Dana , Fox-Robichaud Alison , Fujitani Shigeki , Fuller Raeann M. , Haskell Helen , Inada-Kim Matthew , Jones Daryl , Kumar Anand , Olsen Keith M. , Rowley Daniel D. , Welch John , Baldisseri Marie R. , Kellett John , Knowles Heidi , Shipley Jonathan K. , Kolb Philipp , Wax Sophie P. , Hecht Jonathan D. , Sebat Frank 
Published: January 2024

RATIONALE:
Clinical deterioration of patients hospitalized outside the ICU is a source of potentially reversible morbidity and mortality. To address this, some acute care facilities have implemented systems aimed at detecting and responding to such patients.

OBJECTIVES:
To provide evidence-based recommendations for hospital clinicians and administrators to optimize recognition and response to clinical deterioration in non-ICU patients.

PANEL DESIGN:
The 25-member panel included representatives from medicine, nursing, respiratory therapy, pharmacy, patient/family partners, and clinician-methodologists with expertise in developing evidence-based clinical practice guidelines.

METHODS:
We generated actionable questions using the Population, Intervention, Control, and Outcomes format and performed a systematic review of the literature to identify and synthesize the best available evidence. We used the Grading of Recommendations Assessment, Development, and Evaluation approach to determine certainty in the evidence and to formulate recommendations and good practice statements (GPSs).

RESULTS:
The panel issued 10 statements on recognizing and responding to non-ICU patients with critical illness. Healthcare personnel and institutions should ensure that all vital sign acquisition is timely and accurate (GPS). We make no recommendation on the use of continuous vital sign monitoring among “unselected” patients due to the absence of data regarding the benefit and the potential harms of false positive alarms, the risk of alarm fatigue, and cost. We suggest focused education for bedside clinicians in signs of clinical deterioration, and we also suggest that patient/family/care partners’ concerns be included in decisions to obtain additional opinions and help (both conditional recommendations). We recommend hospital-wide deployment of a rapid response team or medical emergency team (RRT/MET) with explicit activation criteria (strong recommendation). We make no recommendation about RRT/MET professional composition or inclusion of palliative care members on the responding team but suggest that the skill set of responders should include eliciting patients’ goals of care (conditional recommendation). Finally, quality improvement processes should be part of a rapid response system (GPS).

CONCLUSIONS:
The panel provided guidance to inform clinicians and administrators on effective processes to improve the care of patients at-risk for developing critical illness outside the ICU.
Off-label Use of Ceftazidime/Avibactam in Neonatal Intensive Care Unit: A Real-life Experience and Literature Review
Authors: Ftergioti Argyro , Degli Antoni Melania , Kontou Angeliki , Kourti Maria , Pantzartzi Kalliopi , Zarras Charalampos , Agakidou Eleni , Sarafidis Kosmas , Roilides Emmanuel , Iosifidis Elias 
Published: January 2024

Background:
Multi/extensively drug-resistant bacterial infections have recently increased and new antimicrobial options are needed for difficult-to-treat infections. Ceftazidime/avibactam (CZA) has been approved for patients 3 months to 18 years of age, but real-life data on its off-label use in neonates and young infants are still scarce.

Materials:
We report demographic, clinical and microbiologic data as well as outcome and safety of all cases of infants treated with CZA between January 1, 2021 and September 30, 2022 in a tertiary neonatal intensive care unit. We also review all neonatal cases previously reported.

Results:
Twenty-one patients [17 males, with median gestational age 29+2 (IQR 6+6) weeks] received 31 CZA courses at a dose of 20–50 mg/kg/dose of ceftazidime q8h for suspected or proved multi/extensively drug-resistant infections. Median postnatal age at the onset of treatment was 44 days (IQR: 94 days). Twelve bacteremias, 2 urinary tract infections and 1 ventilator-acquired pneumonia were recorded. Twelve (39%) treatments were targeted, while 19 (61%) were empirically started due to known colonization with Klebsiella pneumoniae carbapenemase-producing Gram-negative bacteria. All patients had received multiple antibiotics prior and concomitantly with CZA. The most common pathogen identified at targeted administrations was carbapenem-resistant Klebsiella pneumoniae (83%). No serious adverse events attributed to the drug were detected. Twenty-one courses of CZA administration to 20 neonates with a median gestational age of 28.5 (IQR 3.5) weeks were previously reported without significant related adverse events.

Conclusions:
Favorable clinical and microbiologic responses in neonatal intensive care unit patients treated with CZA off-label were observed without significant and unexpected adverse events in critically ill neonates.
Quantitative Assessment of Periocular Autologous Fat Transfer Survival Using 3D Stereophotogrammetric Imaging
Authors: Murta Fabiola , Guevara Gabriella F. , Hyer Jonathan N. , Ezra Daniel G. 
Published: January 2024

Purpose:
To assess periocular autologous fat transfer (AFT) survival by assessment of volume change with sequential 3D VECTRA imaging.

Objective:
Little is known about the patterns of graft survival of AFT in the periorbital region, especially in cases involving prior radiotherapy or trauma. The aim of this pilot study was to characterize fat survival following AFT in patients with a broad range of clinical indications, with and without a history of prior radiotherapy, for both periocular and orbital AFT, and in a subgroup of patients with an anophthalmic socket.

Method:
A single-institution, prospective cohort study involving 18 applications of AFT for volume augmentation in the periocular and orbital area. All patients had sequential 3D VECTRA photographs following a validated standardized protocol. Patient demographics, including gender, age, ethnicity, underlying diagnosis, and volume of fat injected, were also collected.

Results:
In total 13 patients were enrolled, 9 female (69.2%) and 4 male (31.0%). Mean age at the time of surgery was 47.8 years. Patients had volume deficiency secondary to a variety of causes; the most common cause was postenucleation socket syndrome following trauma in 6 patients (46.2%). The mean fat survival volume at the 1-month postoperative point was 70% and 55% by 6 months. AFT conducted with a multiport cannula for fat harvesting use had an initial higher rate of fat reabsorption with ANOVA p = 0.002, however, this was not observed at the later follow-up periods. There was no statistically significant difference in fat survival between abdominal or thigh donor fat sites. There was no statistically significant difference in residual injected volume at the early follow-up period between patients who had prior radiotherapy and those who did not p = 0.8496.

Conclusion:
AFT is an effective treatment for periorbital volume compromise with an acceptable survival rate in all categories of patients. Complex etiologies such as radiotherapy-related orbital and midface dysgenesis should not be a contraindication for AFT, with no difference in outcomes.
Long-Term Results of Oral Propranolol Treatment Protocol for Periocular Infantile Hemangioma: Should There Be Any Contraindication?
Authors: Ghahvehchian Hossein , Kashkouli Mohsen Bahmani , Ghanbari Shaghayegh , Karimi Nasser , Abdolalizadeh Parya , Abri Aghdam Kaveh 
Published: January 2024

Purpose:
The authors report long-term results of the oral propranolol treatment protocol for periocular infantile hemangioma regardless of conventional indications.

Methods:
This is a retrospective study (2008–2018) on children with propranolol treatment protocol for periocular infantile hemangioma and last follow-up (FU) of ≥4 months after treatment and age of >24 months. After systemic evaluation, it was started with 0.5 and increased by 0.5 every 3 days to reach 2 mg/kg/day. If there was no good response, it would be gradually increased up to 3 mg/kg/day. Tapering (0.5 mg/kg/day every 4 weeks) was started when patients were on treatment for ≥6 months and ≥12 months old and there was no change in the infantile hemangioma size for ≥3 months. Rebound growth was based on the parents’ report and would be treated by increasing the dose to at least 2 mg/kg/day for 3 months. FU was either in-person or via social media. Change in periocular infantile hemangioma size on the photos was scored by 3 masked observers (visual analog scale) and presented as excellent (≥50% reduction), good (1%–49%), fair (no change), and failure (enlarged).

Results:
Forty-three patients were included. Orbital involvement was in 49%, ptosis in 58%, and risk of amblyopia in 63%. Mean treatment, tapering, and FU duration were 37, 13, and 74 months, respectively. Mean age at presentation, start of propranolol treatment protocol, tapering, stop, and last FU were 1.5, 5, 29, 42, and 78 months, respectively. Twenty-seven patients received 2, seven 2.5, and nine 3 mg/kg/day. Mean visual analog scale significantly increased from 43% (FU1) to 92% (last FU) when 97.6% of patients showed an excellent response. The remaining skin lesions were observed in 35%. No side effect was reported.

Conclusions:
Long-term results of the propranolol treatment protocol for periocular infantile hemangioma showed an excellent response in 97.6% of patients with no side effects. A residual skin lesion was observed in 1/3 of the patient.
Precise and safe pulmonary segmentectomy enabled by visualizing cancer margins with dual-channel near-infrared fluorescence
Authors: Jeon Ok Hwa , Bao Kai , Kim Kyungsu , Wang Haoran , Yokomizo Shinya , Park G. Kate , Choi Byeong Hyeon , Rho Jiyun , Kim Chungyeul , Choi Hak Soo , Kim Hyun Koo 
Published: January 2024

Background:
Segmentectomy is a type of limited resection surgery indicated for patients with very early-stage lung cancer or compromised function because it can improve quality of life with minimal removal of normal tissue. For segmentectomy, an accurate detection of the tumor with simultaneous identification of the lung intersegment plane is critical. However, it is not easy to identify both during surgery. Here, the authors report dual-channel image-guided lung cancer surgery using renally clearable and physiochemically stable targeted fluorophores to visualize the tumor and intersegmental plane distinctly with different colors; cRGD-ZW800 (800 nm channel) targets tumors specifically, and ZW700 (700 nm channel) simultaneously helps discriminate segmental planes.

Methods:
The near-infrared (NIR) fluorophores with 700 nm and with 800 nm channels were developed and evaluated the feasibility of dual-channel fluorescence imaging of lung tumors and intersegmental lines simultaneously in mouse, rabbit, and canine animal models. Expression levels of integrin αvβ3, which is targeted by cRGD-ZW800-PEG, were retrospectively studied in the lung tissue of 61 patients who underwent lung cancer surgery.

Results:
cRGD-ZW800-PEG has clinically useful optical properties and outperforms the FDA-approved NIR fluorophore indocyanine green and serum unstable cRGD-ZW800-1 in multiple animal models of lung cancer. Combined with the blood-pooling agent ZW700-1C, cRGD-ZW800-PEG permits dual-channel NIR fluorescence imaging for intraoperative identification of lung segment lines and tumor margins with different colors simultaneously and accurately.

Conclusion:
This dual-channel image-guided surgery enables complete tumor resection with adequate negative margins that can reduce the recurrence rate and increase the survival rate of lung cancer patients.
Real-time classification of tumour and non-tumour tissue in colorectal cancer using diffuse reflectance spectroscopy and neural networks to aid margin assessment
Authors: Nazarian Scarlet , Gkouzionis Ioannis , Murphy Jamie , Darzi Ara , Patel Nisha , Peters Christopher J. , Elson Daniel S. 
Published: January 2024

Background:
Colorectal cancer is the third most commonly diagnosed malignancy and the second leading cause of mortality worldwide. A positive resection margin following surgery for colorectal cancer is linked with higher rates of local recurrence and poorer survival. The authors investigated diffuse reflectance spectroscopy (DRS) to distinguish tumour and non-tumour tissue in ex-vivo colorectal specimens, to aid margin assessment and provide augmented visual maps to the surgeon in real-time.

Methods:
Patients undergoing elective colorectal cancer resection surgery at a London-based hospital were prospectively recruited. A hand-held DRS probe was used on the surface of freshly resected ex-vivo colorectal tissue. Spectral data were acquired for tumour and non-tumour tissue. Binary classification was achieved using conventional machine learning classifiers and a convolutional neural network (CNN), which were evaluated in terms of sensitivity, specificity, accuracy and the area under the curve.

Results:
A total of 7692 mean spectra were obtained for tumour and non-tumour colorectal tissue. The CNN-based classifier was the best performing machine learning algorithm, when compared to contrastive approaches, for differentiating tumour and non-tumour colorectal tissue, with an overall diagnostic accuracy of 90.8% and area under the curve of 96.8%. Live on-screen classification of tissue type was achieved using a graduated colourmap.

Conclusion:
A high diagnostic accuracy for a DRS probe and tracking system to differentiate ex-vivo tumour and non-tumour colorectal tissue in real-time with on-screen visual feedback was highlighted by this study. Further in-vivo studies are needed to ensure integration into a surgical workflow.
Zhishi Xiebai Guizhi Decoction for coronary heart disease: A systematic review and meta-analysis
Authors: Li Ming , Song Shengqiang , Rong Yuanhang , Wu Di , Yin Yongtian 
Published: January 2024

Background:
Coronary heart disease (CHD) is a type of cardiovascular disease (CVD) caused by coronary atherosclerosis. It is a main cause of medical burden and cardiovascular related death. Zhishi Xiebai Guizhi Decoction (ZXGD) is a representative prescription of traditional Chinese medicine (TCM) in the treatment of CHD, but there is poor systemically evidence-based appraisal.

Objective:
To evaluate the efficacy and safety of ZXGD for CHD.

Methods:
Eight databases were retrieved for randomized controlled trials (RCTs). Data was extracted independently by 2 reviewers. The quality of the included studies was assessed by Cochrane Collaboration risk of bias tool. Clinical efficacy, blood lipid, vascular endothelial function, inflammatory factor and homocysteine (Hcy) were prespecified outcome measures.

Results:
Twenty-four studies (2272 patients) were included. Meta-analysis showed that compared with conventional western medicine (WM) alone, ZXGD was associated with a greater symptom improvement rate with a relative risk (RR) of 1.21 [95% CI (1.16, 1.26), P < .00001] and a greater electrocardiogram (ECG) improvement rate with a RR of 1.27 [95% CI (1.16, 1.40), P < .00001]. In terms of blood lipid, ZXGD reduced total cholesterol (TC) with a mean difference (MD) of −1.15 [95%CI (−1.75, −0.55), P = .0002] and triglyceride (TG) [MD = −0.72, 95%CI (−0.99, −0.45), P < .00001], reduced low-density lipoprotein cholesterol (LDL-C) [MD = −0.93, 95% CI (−1.17, −0.69), P < .00001], and increased high-density lipoprotein cholesterol (HDL-C) [MD = 0.31, 95%CI (0.20, 0.42), P < .00001]. In terms of vascular endothelial function, ZXGD decreased the level of endothelin-1 (ET-1) [MD = −7.81, 95%CI (−9.51, −6.10), P < .00001], and increased nitric oxide (NO) [MD = 8.90, 95%CI (7.86, 9.93), P < .00001]. ZXGD also reduced high-sensitivity C-reactive protein (hs-CRP) [MD = −1.73, 95% CI (−2.63, −0.83), P < .00001] and Hcy [MD = −2.03, 95%CI (−2.78, −1.28), P < .00001]. No significant differences were found in adverse event rate between the 2 groups with a RR of 0.77 [95% CI (0.44, 1.34), P = .36].

Conclusion:
ZXGD is effective and safe in the treatment of CHD. However, more rigorous and high-quality RCTs are needed to verify the conclusion.
Pure white cell aplasia before and after thymectomy in the rare conundrum of thymoma: A case report and review of the literature
Authors: Yang Yang , Chen Chunmei , Zheng Bingrong , Fan Liping , Chen Xiajun , Hu Meiwei 
Published: January 2024

Rationale:
Pure white cell aplasia (PWCA) is a rare paraneoplastic syndrome that occurs in patients with thymomas. Currently, the pathogenesis and treatment of this disease remain in the exploratory stage.

Patient concerns:
We report a 68-year-old woman with thymoma experienced PWCA involvement as her first presentation. The patient had high fever and agranulocytosis at the onset of the disease. The white blood cell count in the complete blood count was 1.9 × 109/L with a neutrophil of 0.1 × 109/L. The bone marrow aspirates showed decreased granulocyte proliferation. Computed tomography showed a large mass in the anterior mediastinum.

Diagnoses:
The final diagnosis of our patient was PWCA and thymoma.

Interventions:
She underwent a thymectomy and cyclosporine A administration during first remission.

Outcomes:
Long-term remission was achieved following the readministration of cyclosporine A after the disease recurrence.

Lessons:
PWCA or agranulocytosis with thymoma has been confirmed to be an extremely rare disease. Thymomas with PWCA correlate with autoimmunity. From this case study and the literature review, we concluded that the pathogenesis of thymomas in PWCA is mainly related to the activation of autoreactive T cells. Thymectomy and the immunosuppressive drug, cyclosporine A, were chosen for treatment. The patient’s granulocyte levels were unable to recover after surgery because of the inability to promptly clear activated T cells. After surgery, cyclosporine A continued to take for a long time. Thymectomy combined with prolonged cyclosporine A administration may be an effective method for treating this rare disease.
A deep learning approach using an ensemble model to autocreate an image-based hip fracture registry
Authors: Oosterhoff Jacobien H.F. , Jeon Soomin , Akhbari Bardiya , Shin David , Tobert Daniel G. , Do Synho , Ashkani-Esfahani Soheil , Ghaednia Hamid , Schwab Joseph H. 
Published: January 2024

Abstract

Objectives:
With more than 300,000 patients per year in the United States alone, hip fractures are one of the most common injuries occurring in the elderly. The incidence is predicted to rise to 6 million cases per annum worldwide by 2050. Many fracture registries have been established, serving as tools for quality surveillance and evaluating patient outcomes. Most registries are based on billing and procedural codes, prone to under-reporting of cases. Deep learning (DL) is able to interpret radiographic images and assist in fracture detection; we propose to conduct a DL-based approach intended to autocreate a fracture registry, specifically for the hip fracture population.

Methods:
Conventional radiographs (n = 18,834) from 2919 patients from Massachusetts General Brigham hospitals were extracted (images designated as hip radiographs within the medical record). We designed a cascade model consisting of 3 submodules for image view classification (MI), postoperative implant detection (MII), and proximal femoral fracture detection (MIII), including data augmentation and scaling, and convolutional neural networks for model development. An ensemble model of 10 models (based on ResNet, VGG, DenseNet, and EfficientNet architectures) was created to detect the presence of a fracture.

Results:
The accuracy of the developed submodules reached 92%–100%; visual explanations of model predictions were generated through gradient-based methods. Time for the automated model-based fracture–labeling was 0.03 seconds/image, compared with an average of 12 seconds/image for human annotation as calculated in our preprocessing stages.

Conclusion:
This semisupervised DL approach labeled hip fractures with high accuracy. This mitigates the burden of annotations in a large data set, which is time-consuming and prone to under-reporting. The DL approach may prove beneficial for future efforts to autocreate construct registries that outperform current diagnosis and procedural codes. Clinicians and researchers can use the developed DL approach for quality improvement, diagnostic and prognostic research purposes, and building clinical decision support tools.