bluuebunny/crossref_metadata_2025_split huggingface dataset:
Treatment of Gestational Diabetes Mellitus Diagnosed Early in Pregnancy
Authors: Simmons D , Immanuel J. , Hague W. M. , Teede H. , Nolan C. J. , Peek M. J. , Flack J. R. , McLean M. , Wong V. , Hibbert E. , Kautzky-Willer A. , Harreiter J. , Backman H. , Gianatti E. , Sweeting A. , Mohan V. , Enticott J. , Cheung N. W. ,   for the TOBOGM Research Group*
Published: November 2023

(Abstracted from N Engl J Med 2023;388(23):2132–2144)
Gestational diabetes mellitus is a common pregnancy complication. It is associated with adverse outcomes, including preeclampsia, obstetrical intervention, large-for-gestational-age neonates, shoulder dystocia, birth trauma, and neonatal hypoglycemia. Cohort studies have found that women with hyperglycemia before 20 weeks of gestation are more likely to experience accelerated fetal growth by 24 to 28 weeks than those diagnosed with GDM later in pregnancy.
A Quality Improvement Initiative to Reduce Adverse Effects of Transitions of Anesthesia Care on Postoperative Outcomes: A Retrospective Cohort Study
Authors: Saha Amit K. , Segal Scott 
Published: November 2023

Background
An intraoperative transfer of care from one anesthesia provider to another, or handover, may result in information loss and contribute to adverse patient outcomes. In 2019 the authors undertook a quality improvement effort to increase the use of a structured intraoperative handover tool incorporated in the electronic medical record. The authors hypothesized that intraoperative handovers of anesthesia care would be associated with adverse patient outcomes, and that increased use of a structured tool would attenuate this effect.

Methods
This study included adult patients undergoing noncardiac surgery of at least 1 h duration performed during the period 2016 to 2021. Cases with a handover were identified if either there was a change of attending anesthesiologist or change of nurse anesthetist or resident for more than 35 min. The primary outcome was the occurrence of a composite of postoperative mortality and major postoperative morbidity. The effect of the intervention was analyzed by examining the quarterly change in odds ratio for the primary outcome for cases with and without a handover.

Results
A total of 121,077 cases, 40.4% of which had a handover, were included. After weighting, the composite outcome was statistically associated with handovers (3,517 of 48,986 [7.2%] in handover cases vs. 4,470 of 72,091 [6.2%] in nonhandover cases; odds ratio, 1.08; 95% CI, 1.04 to 1.12). Time series analysis showed a marked increase in usage of the structured tool after the initial intervention. The odds ratio for the composite outcome showed a significant decrease over time after the initial intervention (t = –3.97; P < 0.001), with the slope of the odds ratio versus time curve decreasing from 0.002 (95% CI, 0.001 to 0.004; P = 0.018) to –0.011 (95% CI, –0.01 to –0.018; P < 0.001).

Conclusions
Intraoperative handovers are significantly associated with adverse outcomes even after controlling for multiple confounding variables. Use of a structured handover tool during anesthesia care may attenuate the adverse effect.

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Hybrid Press-fit and Adjustable Button Femoral Fixation of Anterior Cruciate Ligament Semitendinosus and Bone-patellar Tendon-bone Autografts—A Technical Note
Authors: Aldawoudy Akram , Alajwani Mahmoud , Hirschmann Michael , Badr Ahmad , Waly Ahmed H. , Soliman Eiman 
Published: November 2023

Introduction:
Many fixation methods are available for anterior cruciate ligament (ACL) grafts. Adjustable buttons (ABs) are characterized by their high fixation strength but have the disadvantage of potential stretching of their linking suture material. Press-fit bone plugs provide fixation at the joint line and enhance biological graft healing. Using both is thought to result in a higher fixation strength, enhancing graft biology and transferring the fixation point to the joint line.

Materials and Methods:
It is the aim of this technical note to describe a certain technique of ACL graft hybrid fixation for hamstrings or bone-tendon-bone grafts, using AB combined with bone grafting of the femoral and tibial tunnels with press-fit bone plugs or bone chips.

Discussion:
ABs are commonly used fixation devices for ACL grafts. AB also allows the surgeon to tighten the ACL graft in full or near full extension. The ultimate load to failure of AB has the potential disadvantage of rendering the ACL graft progressively slack. AB augmented with press-fitting bone plugs enhances biological potentials, adds to fixation strength, and transfers the fixation level of the graft from the outer femoral cortex to the joint line.

Conclusion:
Hybrid AB and bone plug fixation of ACL autografts, whether hamstrings or bone-tendon bone, optimizes ACL graft fixation by gaining advantages and omitting the disadvantages of both techniques.
Duration of analgesia after forefoot surgery compared between an ankle and a sciatic nerve block at the popliteal crease
Authors: Olofsson Magnus , Nguyen Alexandre , Rossel Jean-Benoit , Albrecht Eric 
Published: November 2023

BACKGROUND
Forefoot surgery is associated with severe postoperative pain. Ankle and sciatic nerve blocks provide satisfactory postoperative analgesia after forefoot surgery, but little is known on their respective duration of analgesia.

OBJECTIVE
This randomised controlled, single-blinded trial tested the hypothesis that after forefoot surgery in the setting of multimodal analgesia, an ankle block provides analgesia superior to that of a sciatic nerve block at the popliteal crease.

DESIGN
A randomised controlled study.

SETTING
A single centre study in a university hospital in Switzerland, from September 2018 to November 2022.

PATIENTS
From 91 patients scheduled for forefoot surgery, 60 met the inclusion criteria of which 56 completed the protocol and their data were available for analysis. Exclusion criteria were existing sciatic nerve deficit, pre-existing peripheral neuropathy, chronic pain diagnosis, pregnancy, or identified contraindications to peripheral nerve block.

INTERVENTION
Patients undergoing forefoot surgery were randomly allocated to either a multi-injection ankle block (partly under ultrasound guidance) or a sciatic nerve block at the popliteal crease (under ultrasound guidance) combined with a saphenous nerve block at the ankle. Patients in each group received a total of 30 ml of ropivacaine 0.5% and a multimodal analgesic regimen inclusive of dexamethasone, paracetamol, ketorolac then ibuprofen.

MAIN OUTCOME MEASURE
The primary outcome was duration of analgesia, defined as time to first morphine request.

RESULTS
Mean ± SD duration of analgesia was 15.4 ± 8.0 h in the ankle block group and 20.0 ± 10.3 h in the sciatic nerve block group (P = 0.32). Of note, 15 of 26 (58%) and 24 of 30 (80%) patients of the ankle and sciatic nerve block groups did not request any morphine (P = 0.09). Other secondary outcomes were similar between groups.

CONCLUSION
Compared with the ankle block, the sciatic nerve block at the popliteal crease does not provide a longer duration of analgesia in patients undergoing forefoot surgery in the setting of multimodal analgesia.

TRIAL REGISTRATION
Clinicaltrials.com identifier: NCT03683342.
Peri-operative night-time work of anaesthesiologists
Authors: Ippolito Mariachiara , Noto Alberto , Lakbar Ines , Chalkias Athanasios , Afshari Arash , Kranke Peter , Garcia Carolina Soledad Romero , Myatra Sheila Nainan , Schultz Marcus J. , Giarratano Antonino , Bilotta Federico , De Robertis Edoardo , Einav Sharon , Cortegiani Andrea 
Published: November 2023

BACKGROUND
Qualitative data on the opinions of anaesthesiologists regarding the impact of peri-operative night-time working conditions on patient safety are lacking.

OBJECTIVE(S)
This study aimed to achieve in-depth understanding of anaesthesiologists’ perceptions regarding the impact of night-time working conditions on peri-operative patient safety and actions that may be undertaken to mitigate perceived risks.

DESIGN
Qualitative analysis of responses to two open-ended questions.

SETTING
Online platform questionnaire promoted by the European Society of Anaesthesiology and Intensive Care (ESAIC).

PARTICIPANTS
The survey sample consisted of an international cohort of anaesthesiologists.

MAIN OUTCOME MEASURES
We identified and classified recurrent themes in the responses to questions addressing perceptions regarding (Q1) peri-operative night-time working conditions, which may affect patient safety and (Q2) potential solutions.

RESULTS
We analysed 2112 and 2113 responses to Q1 and Q2, respectively. The most frequently reported themes in relation to Q1 were a perceived reduction in professional performance accompanied by concerns regarding the possible consequences of work with fatigue (27%), and poor working conditions at night-time (35%). The most frequently proposed solutions in response to Q2 were a reduction of working hours and avoidance of 24-h shifts (21%), an increase in human resources (14%) and performance of only urgent or emergency surgeries at night (14%).

CONCLUSION
Overall, the surveyed anaesthesiologists believe that workload-to-staff imbalance and excessive working hours were potential bases for increased peri-operative risk for their patients, partly because of fatigue-related medical errors during night-time work. The performance of nonemergency elective surgical cases at night and lack of facilities were among the reported issues and potential targets for improvement measures. Further studies should investigate whether countermeasures can improve patient safety as well as the quality of life of anaesthesia professionals. Regulations to improve homogeneity, safety, and quality of anaesthesia practice at night seem to be urgently needed.
LRH-1 agonist DLPC through STAT6 promotes macrophage polarization and prevents parenteral nutrition-associated cholestasis in mice
Authors: Ghosh Swati , Devereaux Michael W. , Liu Cuining , Sokol Ronald J. 
Published: November 2023

Background and Aims:
Parenteral nutrition-associated cholestasis (PNAC) is an important complication in patients with intestinal failure with reduced LRH-1 expression. Here, we hypothesized that LRH-1 activation by its agonist, dilauroylphosphatidylcholine (DLPC), would trigger signal transducer and activator of transcription 6 (STAT6) signaling and hepatic macrophage polarization that would mediate hepatic protection in PNAC.

Approach and Results:
PNAC mouse model (oral DSSx4d followed by PNx14d; DSS-PN) was treated with LRH-1 agonist DLPC (30 mg/kg/day) intravenously. DLPC treatment prevented liver injury and cholestasis while inducing hepatic mRNA expression of Nr5a2 (nuclear receptor subfamily 5 group A member 2), Abcb11 (ATP binding cassette subfamily B member 11), Abcg5 (ATP-binding cassette [ABC] transporters subfamily G member 5), Abcg8 (ATP-binding cassette [ABC] transporters subfamily G member 8), nuclear receptor subfamily 0, and ATP-binding cassette subfamily C member 2 (Abcc2) mRNA, all of which were reduced in PNAC mice. To determine the mechanism of the DLPC effect, we performed RNA-sequencing analysis of the liver from Chow, DSS-PN, and DSS-PN/DLPC mice, which revealed DLPC upregulation of the anti-inflammatory STAT6 pathway. In intrahepatic mononuclear cells or bone-marrow derived macrophages (BMDM) from PNAC mice, DLPC treatment prevented upregulation of pro-inflammatory (M1) genes, suppressed activation of NFκB and induced phosphorylation of STAT6 and its target genes, indicating M2 macrophage polarization. In vitro, incubation of DLPC with cultured macrophages showed that the increased Il-1b and Tnf induced by exposure to lipopolysaccharides or phytosterols was reduced significantly, which was associated with increased STAT6 binding to promoters of its target genes. Suppression of STAT6 expression by siRNA in THP-1 cells exposed to lipopolysaccharides, phytosterols, or both resulted in enhanced elevation of IL-1B mRNA expression. Furthermore, the protective effect of DLPC in THP-1 cells was abrogated by STAT6 siRNA.

Conclusions:
These results indicate that activation of LRH-1 by DLPC may protect from PNAC liver injury through STAT6-mediated macrophage polarization.
Longitudinal Changes of Posterior Vortex Veins in Highly Myopic Eyes determined by Retrospective Analyses of Indocyanine Green Angiograms
Authors: Lu Hongshuang , Chen Changyu , Xiong Jianping , Wang Yining , Wang Ziye , Moriyama Muka , Kamoi Koju , Uramoto Kengo , Takahashi Tomonari , Yoshida Takeshi , Ohno-Matsui Kyoko 
Published: November 2023

Abstract

Purpose:
To assess the longitudinal changes of the posterior vortex veins (VVs) in highly myopic (HM) eyes.

Methods:
The medical records of 1730 consecutive HM eyes that had undergone indocyanine green angiography (ICGA) were studied. Eyes that had posterior VVs and had undergone at least two ICGA examinations with a minimum interval of three years were selected from this group.

Results:
Ninety-one eyes of 78 patients met the inclusion criteria. A total of 124 posterior VVs were identified. Over an average interval of 7.8 ± 5.0 years, 41 (33.1%) of the 124 posterior VVs had marked changes consisting mainly of an attenuation of vessels in 36 posterior VVs (87.8%) and alterations in the drainage course in 16 PVVs (39.0%). Fifteen posterior VVs had both types of changes. Most of the attenuations of the vessels occurred for smaller branches, but a complete loss of the entire trunk was seen in 3 eyes. Additionally, 4 eyes had posterior VV changes in association with changes of peripheral VVs.

Conclusions:
Posterior VV in highly myopic eyes can undergo changes with increasing time. The associated factors included the development and progression of myopic maculopathy lesions. In some cases, the blood drainage shifted from posterior VV to peripheral VV by forming anastomotic channels.
Association of tessellation density with progression of axial length and refraction in children: an AI-assisted 4-year study
Authors: Wei Ruoyan , Li Jun , Yang Weiming , Liu Chang , Wang Yunzhe , Wang Lin , Liu Shixue , Yu Yongfu , Huang Chen , Song Kaimin , Ju Lie , He Wanji , Zhong Hua , Pan Yanting , Fu Fayan , Wang Xiaoying , Chen Yuzhong , Ge Zongyuan , He Mingguang , Zhou Xingtao , Li Meiyan 
Published: November 2023

Abstract

Purpose:
To investigate fundus tessellation density (TD) and its association with axial length (AL) elongation and spherical equivalent (SE) progression in children.

Methods:
The school-based prospective cohort study enrolled 1997 individuals aged 7-9 in 11 elementary schools in Mojiang, China. Cycloplegic refraction and biometry were performed at baseline and 4-year visits. The baseline fundus photos were taken, and TD, defined as the percentage of exposed choroidal vessel area in the photos, was quantified using an artificial intelligence-assisted semi-automatic labeling approach. After the exclusion of 330 ineligible participants due to loss to follow-up or ineligible fundus photos, logistic models were employed to assess the association of TD with rapid AL elongation (>0.36mm/year) and SE progression (>1.00D/year).

Results:
The prevalence of tessellation was 477/1667 (28.6%) and mean TD was 0.008±0.019. The mean AL elongation and SE progression in 4 years were 0.90±0.58mm and -1.09±1.25D. Higher TD was associated with longer baseline AL (beta, 0.030; 95% confidence interval [CI]: 0.015,0.046; p<0.001) and more myopic baseline SE (beta, -0.017; 95%CI: -0.032,-0.002; p=0.029). Higher TD was associated with rapid AL elongation (odds ratio [OR], 1.128; 95%CI: 1.055,1.207; p<0.001) and SE progression (OR, 1.123; 95%CI: 1.020,1.237; p=0.018).

Conclusions:
TD is a potential indicator of rapid AL elongation and refractive progression in children. TD measurement could be a routine to monitor AL elongation.
Comparison of the Choroidal Vascularity Index Measurements of Images Acquired with Different Optical Coherence Tomography Scan Scale Types
Authors: Elbay Ahmet , Kırık Furkan , Ertürk Kamile Melis , Ozdemir Hakan 
Published: November 2023

ABSTRACT

Purpose:
To evaluate the differences in choroidal vascularity index (CVI) measurements between images acquired at the 1:1 pixel scale and at the 1:1 µm scale of the Heidelberg OCT device.

Methods:
Forty-five healthy eyes of 45 healthy subjects are included for this study. Fovea-centred scans were obtained with an enhanced-depth imaging mode with a high speed protocol scan. Each scan was exported in three different types: (a) 1:1 pixel scale type (PST) (b) 1:1 µm scale type (MST) and (c) 4x-magnified MST (4xMST; 400%-magnified 1:1 µm images exported via screenshot). A comparison between CVI measurements based on the different scale types of OCT images was conducted using the Bland–Altman analysis and intraclass correlation coefficient (ICC).

Results:
The image with the worst clarity was acquired via the MST, and the CVI was found to be higher in MST images (69.05±3.21) compared to the other groups. The ICC between the CVI values of the 4xMST and PST images was 0.92, between those of the 4xMST and MST images was 0.33 and between those of the PST and MST images was 0.44.

Conclusion:
The OCT scale and export method type significantly influence the image resolution, CVI and choroidal area measurements.
Early-onset of Familial Exudative Vitreoretinopathy: clinical characteristics, management and outcomes
Authors: Nicolas Kitic , Thibaut Chapron , Florence Metge-Galatoire , Ismael Chehaibou , Georges Caputo , Youssef Abdelmassih 
Published: November 2023

Abstract

Purpose:
To describe the clinical characteristics, management and outcomes of toddlers (under the age of 3) diagnosed with Familial exudative vitreoretinopathy (FEVR).

Methods:
In this retrospective study we included patients diagnosed with FEVR before the age of 3. Presenting characteristics, genetic testing, management and outcomes were collected.

Results:
A total of 54 patients (108 eyes) with a mean age at diagnosis of 10.9±2.6 months were included. Poor visual behavior (33%) and strabismus (26%) were the most common presenting symptoms while screening only represented 11%. About half of included patients had a severe disease (stage 4 and 5). Genetic testing was positive in 40.7% of patients with 24% having a family history of FEVR. LRP5 was the most prevalent mutation (54.5%).
Surgery was performed in 44.4% of eyes and was successful in 69.8% of cases. Failure exclusively occurred in eyes with severe stages. Among eyes evaluated for visual acuity (72 eyes), a majority (76.4%) had a vision of hand motion or better.

Conclusion:
FEVR tended to be worse with earlier age at diagnosis, subsequently affecting the prognosis. Surgical intervention was common and primarily included lens sparing vitrectomy and combined lensectomy and vitrectomy. Surgical success hinged on the stage of the disease.
Novel Methods of Identifying Individual and Neighborhood Risk Factors for Loss to Follow-Up After Ophthalmic Screening
Authors: Heilenbach Noah , Ogunsola Titilola , Elgin Ceyhun , Fry Dustin , Iskander Mina , Abazah Yara , Aboseria Ahmed , Alshamah Rahm , Alshamah Jad , Mooney Stephen J. , Maestre Gladys , Lovasi Gina S. , Patel Vipul , Al-Aswad Lama A. 
Published: November 2023

Précis:
Residence in a middle-class neighborhood correlated with lower follow-up compared with residence in more affluent neighborhoods. The most common explanations for not following up were the process of making an appointment and lack of symptoms.

Purpose:
To explore which individual-level and neighborhood-level factors influence follow-up as recommended after positive ophthalmic and primary care screening in a vulnerable population using novel methodologies.

Participants and Methods:
From 2017 to 2018, 957 participants were screened for ophthalmic disease and cardiovascular risk factors as part of the Real-Time Mobile Teleophthalmology study. Individuals who screened positive for either ophthalmic or cardiovascular risk factors were contacted to determine whether or not they followed up with a health care provider. Data from the Social Vulnerability Index, a novel virtual auditing system, and personal demographics were collected for each participant. A multivariate logistic regression was performed to determine which factors significantly differed between participants who followed up and those who did not.

Results:
As a whole, the study population was more socioeconomically vulnerable than the national average (mean summary Social Vulnerability Index score=0.81). Participants whose neighborhoods fell in the middle of the national per capita income distribution had a lower likelihood of follow-up compared with those who resided in the most affluent neighborhoods (relative risk ratio=0.21, P-value<0.01). Participants cited the complicated process of making an eye care appointment and lack of symptoms as the most common reasons for not following up as instructed within 4 months.

Conclusions:
Residence in a middle-class neighborhood, difficulty accessing eye care appointments, and low health literacy may influence follow-up among vulnerable populations.
Barriers to Care Among Glaucoma Patients With a Missed Appointment and Interest in a Navigator Program
Authors: Wasser Lauren M. , Bear Todd M. , Sommers Matthew , Cassidy Julie , Muir Kelly W. , Williams Andrew M. 
Published: November 2023

Précis:
Most glaucoma patients with missed appointments report barriers to care and social risk factors. One third expressed interest in engaging with a patient navigator program. Most expressed interest in rescheduling.

Purpose:
The purpose of this study was to identify barriers to care among glaucoma patients with missed appointments and to assess their interest in a patient navigator program.

Material and Methods:
A cross-sectional study involving adult glaucoma patients from an academic eye center who missed their scheduled appointment between April 18 and July 25, 2022. Participants were surveyed about reasons for missed appointments, barriers to care, social risk factors, and interest in consulting with our patient navigator program.

Results:
Of 172 patients with a missed glaucoma appointment, 73% (126/172) were contacted, and 40% (51/126) of those completed the survey. Participant age averaged 67±14 years, half were female (25/51, 49%), and most identified as Black (27/51, 53%) or White (21/51, 40%). Barriers to seeing a doctor including difficulty scheduling appointments (13/51, 26%), transportation (12/51, 24%), and cost or insurance barriers (8/51, 16%). Twenty-eight (55%) respondents reported at least one social risk factor. A positive association was found between having at least one risk factor and expressing interest in consulting our patient navigator (odds ratio=6.7, P=0.009). Overall, a third of respondents expressed interest in engaging with our patient navigator program (17/51, 33%). Two thirds of participants reported awareness of missed appointments (34/51, 67%), of whom 35% (12/34) reported having already rescheduled, 41% (14/34) expressed interest in rescheduling, and 24% (8/34) did not wish to return.

Conclusions:
Glaucoma patients with missed appointments report barriers to care and face social risk factors. Telephone outreach may help to re-engage them with care, and patients expressed interest in a patient navigator program to address social needs.