bluuebunny/crossref_metadata_2025_split huggingface dataset:
Renal function in very old critically ill patients
Authors: Perschinka Fabian , Boyer Naomi , Forni Lui G. , Joannidis Michael 
Published: October 2023

Purpose of review
Current demographic change leads to higher number of elderly patients admitted to an ICU. Among other organs also the kidneys show age-related changes, which are associated with a decline in various aspects of renal function. The purpose of this review is to provide an overview of structural and functional changes in elderly and also to specifically address the increased risk of acute kidney injury (AKI) in this population.

Recent findings
Ageing in the kidneys is affected by many different factors, such as low grade chronic inflammation, called inflammageing, and various comorbidities. Nevertheless, a decrease of glomerular filtration rate (GFR) occurs independent of the presence of comorbidities and a steady decline of GFR has been reported in both healthy men and women. Pharmacodynamic of many drugs is altered by these changes. Additionally the rate of diuretic resistance appears to be increased. The cause of AKI occurrence in older age is, multifactorial and includes preventable triggers (hypovolemia, hypotension, nephrotoxins) as well as changes associated with aging.

Summary
Age-related alterations of the kidneys were found at microscopic and macroscopic levels of the cell. These changes lead to a reduced renal reserve and subsequently to an increased vulnerability of aged kidneys when an additional stressor is added. Age is an independent risk factor for developing AKI. Physicians should take into account the altered renal function in elderly patients and take renal protective measures at an early stage.
The role of renin-angiotensin system in sepsis-associated acute kidney injury: mechanisms and therapeutic implications
Authors: Garcia Bruno , Zarbock Alexander , Bellomo Rinaldo , Legrand Matthieu 
Published: October 2023

Purpose of review
This review aims to explore the relationship between the renin angiotensin system (RAS) and sepsis-associated acute kidney injury (SA-AKI), a common complication in critically ill patients associated with mortality, morbidity, and long-term cardiovascular complications. Additionally, this review aims to identify potential therapeutic approaches to intervene with the RAS and prevent the development of AKI.

Recent findings
Recent studies have provided increasing evidence of RAS alteration during sepsis, with systemic and local RAS disturbance, which can contribute to SA-AKI. Angiotensin II was recently approved for catecholamine resistant vasodilatory shock and has been associated with improved outcomes in selected patients.

Summary
SA-AKI is a common condition that can involve disturbances in the RAS, particularly the canonical angiotensin-converting enzyme (ACE) angiotensin-II (Ang II)/angiotensin II receptor 1 (AT-1R) axis. Increased renin levels, a key enzyme in the RAS, have been shown to be associated with AKI and may also guide vasopressor therapy in shock. In patients with high renin levels, angiotensin II administration may reduce renin concentration, improve intra-renal hemodynamics, and enhance signaling through the angiotensin II receptor 1. Further studies are needed to explore the role of the RAS in SA-AKI and the potential for targeted therapies.
Acute care for burn patients: fluids, surgery, and what else?
Authors: Palmieri Tina L. 
Published: October 2023

Purpose of review
Recently published initiatives spanning the burn care spectrum have substantially changed the standard of care in burn care. The purpose of this article is to describe new impactful concepts in burn first aid, triage, resuscitation, and treatment as well as their impact on future research.

Recent findings
First aid after burn injury traditionally consists of extinguishing the burn and applying dressings. Recent evidence suggests that applying 20 min of cool tap water to the burn wound in the first 3 h postburn mitigates burn injury extent. National burn center transfer criteria have been updated, impacting patient initial transfer and management. The adverse effects of hydroxocobalamin, a commonly used antidote for cyanide toxicity, have been delineated. Initial burn resuscitation recommendations for both volume and potentially fluid type are being reexamined. The emergence of innovative skin substitutes may improve burn survival by providing a physiologically stabilizing intermediate dressing. Finally, formal clinical practice guidelines for early mobility in the ICU after burn injury have been defined.

Summary
These changes in burn care, triage, resuscitation, and treatment have challenged traditional burn care standards, created new standards, and are the basis for future prospective randomized trials.
Damage control surgery: old concepts and new indications
Authors: Chung C. Yvonne , Scalea Thomas M. 
Published: October 2023

Purpose of review
While the principles of damage control surgery - rapid hemorrhage and contamination control with correction of physiologic derangements followed by delayed definitive reconstruction - have remained consistent, forms of damage control intervention have evolved and proliferated dramatically. This review aims to provide a historic perspective of the early trends of damage control surgery as well as an updated understanding of its current state and future trends.

Recent findings
Physiologically depleted patients in shock due to both traumatic and nontraumatic causes are often treated with damage control laparotomy and surgical principles. Damage control surgery has also been shown to be safe and effective in thoracic and orthopedic injuries. Damage control resuscitation is used in conjunction with surgical source control to restore patient physiology and prevent further collapse. The overuse of damage control laparotomy, however, is associated with increased morbidity and complications. With advancing technology, catheter- and stent-based endovascular modalities are playing a larger role in the resuscitation and definitive care of patients.

Summary
Optimal outcome in the care of the most severely injured patients requires judicious use of damage control surgery supplemented by advancements in resuscitation and surgical adjuncts.
Management of the kidney transplant recipient in the intensive care unit
Authors: Voora Santhi , Shah Sapna , Nadim Mitra K. 
Published: October 2023

Purpose of review
Kidney transplantation is the ideal treatment for patients with chronic kidney disease and end stage renal disease. While centers are performing more transplants every year, the need for organ transplantation outpaces the supply of organ donors. Due to a growing population of patients with advanced kidney disease and a scarcity of kidneys from deceased donors, patients face extended wait times. By the time patients approach transplantation they have multiple comorbidities, in particular cardiovascular complications. Their risk of complications is further compounded by exposure to immunosuppression post kidney transplantation. Kidney transplant recipients (KTRs) are medically complex and may require acute management in the intensive care unit (ICU), as a result of cardiovascular complications, infections, and/or respiratory compromise from lung infections and/or acute pulmonary edema. Acute complication of immunosuppression, such as thrombotic microangiopathy and posterior reversible encephalopathy syndrome may also warrant ICU admission. This review will cover assessment of high-risk complications and management strategies following kidney transplantation.

Recent findings
For intensivists caring for KTRs, it is imperative to understand anatomical considerations of the transplanted kidney, unique infectious risks faced by this population, and appropriate modulation of immunosuppression.

Summary
Recognizing potential complications and implementing appropriate management strategies for KTRs admitted to the ICU will improve kidney allograft and patient survival outcomes.
Telephone cardiopulmonary resuscitation, first responder systems, cardiac arrest centers, and global campaigns to save lives
Authors: Müller Michael P. , Jonsson Martin , Böttiger Bernd W. , Rott Nadine 
Published: October 2023

Purpose of review
The latest resuscitation guidelines contain a new chapter, which focuses on systems improving care for patients with out-of-hospital cardiac arrest (OHCA). In this article, we describe recent developments regarding telephone cardiopulmonary resuscitation (CPR), first responder systems, cardiac arrest centers, and global campaigns.

Recent findings
Telephone CPR has been implemented in many countries, and recent developments include artificial intelligence and video calls to improve dispatch assisted CPR. However, the degree of implementation is not yet satisfying. Smartphone alerting systems are effective in reducing the resuscitation-free interval, but many regions do not yet use this technology. Further improvements are needed to reduce response times. Cardiac arrest centers increase the survival chance after OHCA. Specific criteria need to be defined and professional societies should establish a certification process. Global campaigns are effective in reaching people around the world. However, we need to evaluate the effects of the campaigns.

Summary
Telephone CPR, first responder systems, cardiac arrest centers, and global campaigns are highlighted in the recent resuscitation guidelines. However, the degree of implementation is not yet sufficient. We do not only need to implement these measures, but we should also aim to monitor the systems regarding their performance and further improve them.
Remimazolam sedation with regional anesthesia in difficult airway due to huge thyroid goiter: A case report
Authors: Kim Gwanbeom , Kim Yu Yil , Heo Hyun Joo , Park Junyoung 
Published: October 2023

Rationale:
Remimazolam, a novel benzodiazepine, is known to have less respiratory depression compared to other anesthetic agents, and it also has a reversal agent that can be used in emergency situations. Remimazolam with these characteristics can be usefully utilized in the anesthetic management of patients with difficult airway.

Patient concerns:
A 78-year-old female patient was scheduled proximal humerus fracture surgery. The patient occasionally complained dyspnea and had multiple comorbidities including thyroid goiter, dementia, and delirium.

Diagnoses:
The patient had a large thyroid goiter compressing and deviating the trachea. A short neck with increased circumference was confirmed. A difficult airway was anticipated in the preanesthetic evaluation.

Interventions:
Sedation with remimazolam followed by regional anesthesia was performed for the surgery.

Outcomes:
The surgery was completed without complications. The patient recovered and was discharged on 15th postoperative days.

Lessons:
The use of remimazolam for sedation may be an appropriate option in the anesthetic management of patients with difficult airway.
The efficacy and safety of aspirin in preventing venous thrombosis in major orthopedic surgery: An updated meta-analysis of randomized controlled trials
Authors: Liu Heng-Zhi , Liang Jie , Hu Ai-Xin 
Published: October 2023

Background:
Major orthopedic surgery, including hip and knee replacement and lower extremity trauma fractures surgery, is associated with a high risk of venous thromboembolism (VTE), especially proximal deep vein thrombosis (DVT), and pulmonary embolism (PE), and is linked with high morbidity and mortality rates. Chemical anticoagulation is routinely used to prevent VTE, with previous meta-analyses reporting on the efficacy and safety of aspirin and other anticoagulants, however, opinions are divided. In the past 2 years, several large randomized controlled trials have been published, therefore, we reanalyzed aspirin efficacy and safety when compared with other anticoagulants in preventing VTE in major orthopedic surgery.

Methods:
Using PubMed, The Cochrane Library, Embase, and Web of Science databases, we conducted a RCT search in August 2023. The main outcomes included VTE, proximal DVT or PE. Additional outcomes included bleeding events, wound complications, wound infections, blood transfusions, and death events.

Results:
In total, 17 eligible articles, involving 29,522 patients (15,253 aspirin vs 14,269 other anticoagulant cases), were included. Primary outcomes showed that VTE incidence was more high in the aspirin group when compared with other anticoagulants (risk ratio [RR] = 1.45, 95% confidence interval [CI] = 1.18–1.77, P = .0004) and proximal in the aspirin group the DVT and/or PE incidence was significantly higher in the aspirin group when compared with other anticoagulants (RR = 1.19, 95% CI = 1.02–1.39, P = .03). No significant secondary outcome differences were identified in the aspirin group when compared with other anticoagulants (bleeding events [RR] = 0.83, 95% CI = 0.63–1.10, P = .20); wound complications (RR = 0.45, 95% CI = 0.20–1.04, P = .06); wound infection (RR = 1.08, 95% CI = 0.85–1.38, P = .53); blood transfusion events (RR = 1.00, 95% CI = 0.84–1.19, P = 1.00) and death events (RR = 1.11, 95% CI = 0.78–1.57, P = .55).

Conclusions:
Our updated meta-analysis showed that aspirin was inferior to when compared with other anticoagulants in VTE-related orthopedic major surgery, including proximal DVT and/or PE, and was more likely to form VTE. No differences between groups were identified for bleeding, wound complications, wound infections, transfusion, or death events.
Spontaneous hemorrhage of spinal epidural capillary hemangioma resulting in hyperacute neurologic deficit: A case report
Authors: Kliea Marwa , Alsultan Mohammad , Chatty Eyad , Qatleesh Safaa , Hamzeh Ghassan 
Published: October 2023

Introduction:
Spinal epidural capillary hemangioma is a very rare variety of tumors, usually with a predilection for the thoracic spine.

Case presentation:
A 16-year-old female complained of hyperacute neurologic deficit progressed within hour, which presented by acute paraplegia, and loss of all sensations from her lower limbs up to her breasts. Neurologic exam revealed paralysis of lower limbs (0/5 on both legs) with a flaccid tone, absence of reflexes, weakness of the trunk with sensory level T4, bilateral flexion of plantar reflexes, and loss of sphincters’ controls. Emergent magnetic resonance imaging showed a dumbbell-shaped epidural mass in the posterior aspect of the spinal canal at the T1–T2 level, measuring approximately 1.1 × 4.5 × 1.5 cm in size. The lesion was isointense on T1-weighted, hyperintense on T2-weighted, and a little enhancement after gadolinium administration. The surgery was obtained nearly 16 hours after paralysis, which eradicated the lesion with good hemostasis. Histological examination showed a well-organized vascular tissue that haphazardly arranged and confirmed the diagnosis of capillary hemangioma. Neurological improvement was quickly observed within days after surgery and further complete recovery was achieved 2 months after discharge.

Conclusion:
We report an extremely rare case of spinal epidural capillary hemangioma, where acute spontaneous hemorrhage in the lesion resulted in the hyperacute neurologic deficit within an hour. Since these are benign lesions, the immediate surgical intervention results in a very favorable prognosis and is considered the treatment of choice. Also, this case highlighted and rose the question of a better neurologic improvement in younger age patients with spinal cord injury.
Meta-analysis and time trend prediction of the prevalence of hypertension in Chinese college students
Authors: Zhang Zhaoqi , Li Minghui , Li Jiatong , Yu Ouyang , Jiang Baoyuan , Chen Yan , Guo Lianying 
Published: October 2023

Background:
To understand the prevalence of hypertension among Chinese college students over the past decade (2010–2020) and predict its future trend, we aim to provide a basis for preventing and controlling hypertension among college students.

Methods:
Databases such as Chinese National Knowledge Infrastructure, Wanfang database, PubMed, and Web of Science were searched, and publications on the prevalence of hypertension among Chinese college students from 2010 to 2020 were collected. Search for publications in both Chinese and English databases using keywords “hypertension,” “prevalence,” “disease status,” “cross-sectional survey,” “epidemiology,” “China,” “adolescents,” and “college students.” Publication screening, data extraction, and quality assessment were independently conducted by 2 researchers. Meta-analysis was performed using Stata 16, and trends in the prevalence of hypertension among college students were analyzed using R 4.2.0.

Results:
A total of 37 publications were included in this analysis, which involved 233,603 Chinese college students. The Meta-analysis results showed significant heterogeneity among the studies (I2 = 98.9%, P < .05). Using a random-effects model, the overall prevalence of hypertension among college students was estimated to be 3.3% (95% CI = 2.9%–3.6%), with a higher prevalence among male students (6.2%, 95% CI = 5.4%–7.1%) than female students (1.1%, 95% CI = 0.9%–1.3%). The prevalence of hypertension is notably higher in northern regions than in southern regions. The prevalence of hypertension among college students showed an increasing trend from 2010 to 2020. Trend analysis predicted that the prevalence of hypertension among college students will reach 10% and 14.6% by 2030 and 2040, respectively. The risk of hypertension in male students was 4.63 times higher than that of female students (95% CI = 2.97–7.23). Compared normal weight students, overweight and obese students had 3.08 times (95% CI = 2.48–3.82) and 6.69 times (95% CI = 2.25–19.90) higher risk of hypertension, respectively.

Conclusion:
The prevalence of hypertension in Chinese college students was about 3.3%. The prevalence of hypertension in male college students was higher than that in females, and the prevalence in northern regions was generally higher than that in southern regions. The prevalence of hypertension among Chinese college students will reach 10.0% in the next 10 years and 14.6% in the next 20 years. Male and BMI ≥ 24 were risk factors for hypertension among college students.
Hashimoto’s thyroiditis-related myopathy in a patient with SARS-CoV-2 infection: A case report and systematic literature review
Authors: Lee Zheng Cong , Wong Yu Jun Eugene , Ti Lian Lian , Shrikant Digambarrao Pande , Tay Tunn Lin , Santosa Anindita 
Published: October 2023

Rationale:
Hashimoto’s thyroiditis (HT) is a common autoimmune disease. However, its presentation and management in the context of COVID-19 are unclear, and COVID-19-triggered HT, along with myopathy and persistent creatine kinase (CK) levels, have not been previously reported. Moreover, no literature review is currently available on HT in the context of COVID-19. This study is a case report and systematic review of the literature.

Patient concerns:
A 33-year-old man was admitted with acute-onset myalgia, anosmia, loss of taste, fever, and upper respiratory tract symptoms.

Diagnoses:
He was diagnosed with coronavirus disease (COVID-19) during hospitalization and had abnormal CK levels. The elevated CK level persisted even after the resolution of COVID-19. After excluding myopathies and cardiac factors, HT was diagnosed.

Interventions:
CK levels did not decrease appreciably until 14 d after levothyroxine administration.

Outcomes:
The patient was discharged from the hospital in good health. In the systematic literature review, 7 case reports on COVID-19-associated HT were observed, although no incidence of associated myopathy or persistent elevation of CK was noted.

Lessons:
This case report highlights the potential link between COVID-19 and autoimmune thyroid diseases. In particular, this study underscores the significance of recognizing new-onset autoimmune thyroid disease in COVID-19-positive patients with elevated CK levels that cannot be attributed to other factors. This systematic review offers additional perspectives for diagnosing and managing HT in COVID-19 settings. Overall, the findings of this study could have important clinical implications for the care of COVID-19 patients, as early identification and treatment of autoimmune thyroid disease could help prevent long-term complications. Additional research is essential to elucidate the fundamental correlations between COVID-19 and HT and assess the effectiveness of therapeutic approaches for autoimmune thyroid conditions related to COVID-19.
Effect of ultrasound-guided femoral nerve block with dexmedetomidine and ropivacaine on postoperative analgesia in patients undergoing total knee arthroplasty: a randomized controlled trial
Authors: Hao Conghui , Qian Haitao , Li Han , Zhu Pin , Zhang Xiaobao , Zhao Zhibin , Luan Hengfei 
Published: October 2023

Background:
Dexmedetomidine, a potent and highly selective α2-adrenoreceptor agonist, has become a popular adjuvant to local anesthetics. This study was designed to investigate the effect of dexmedetomidine with ropivacaine for femoral nerve block on postoperative analgesia after total knee arthroplasty.

Methods:
Forty-six patients after total knee arthroplasty received ultrasound-guided femoral nerve block with either 0.3% ropivacaine alone (group R) or 0.3% ropivacaine with 0.5 μg/kg dexmedetomidine (group RD). Total 24-h sufentanil consumption, visual analogue scale (VAS) pain scores, frequency of patient-controlled analgesia (PCA) pressed, Ramsay sedation score, the incidence of bradycardia and hypotension, and incidence of postoperative nausea and vomiting (PONV) were recorded.

Results:
Compared to group R, the total 24-h sufentanil consumption was significantly reduced (110.76 ± 11.56 vs. 99.09 ± 13.31; P<0.05), the VAS scores were lower at 10 and 12 h postoperatively [3(2–3) vs. 2(1–2) and 3(2–3) vs. 2(1–3), respectively; P<0.05], the frequency of PCA pressed was lower at 8–12 and 12–16-h time intervals [(5(3–6) vs. 2(1–3) and 4(3–4) vs. 2(1–3), respectively; P<0.05]. However, there were no differences in Ramsay’s sedation score and the incidence of PONV. Also, no patient experienced bradycardia and hypotension.

Conclusions:
0.5 μg/kg dexmedetomidine with 0.3% ropivacaine for femoral nerve block significantly decreased the total 24-h sufentanil consumption, prolonged and enhanced the analgesic efficacy of ropivacaine, without clinically relevant cardiovascular depression or over-sedation in patients undergoing total knee arthroplasty.
Increasing COVID-19 Immunization Awareness in Rural Communities Through a Multimedia Campaign
Authors: Skuras Alexis , Iseler Jackeline 
Published: October 2023

Purpose/ObjectivesThe purpose of this project was to implement a multimedia campaign to increase COVID-19 vaccine awareness and acceptance in rural communities.Description of ProjectThis project was created and implemented in partnership with a public university in Michigan and targeted to rural Michigan communities. The campaign consisted of digital advertisements and video interviews with nurses from rural areas. Interview questions were developed using knowledge of the health belief model and allowed the nurses to share their COVID-19 stories. Video interviews were published to social media, and digital advertisements were targeted to rural areas via geofencing. A viewer response survey was provided to measure likelihood of behavior change after viewing.OutcomeThe campaign advertisements and videos reached 602 980 people during the implementation period, and 239 surveys were completed. Of the 53 unvaccinated respondents, 87% stated an increased likelihood to vaccinate.ConclusionThis project supports the ability of the clinical nurse specialist to lead a multimedia campaign partnership that can reach thousands of people and increase the likelihood of vaccination. As the popularity of digital media continues to rise, clinical nurse specialists can embrace these channels to disseminate critical health information.