bluuebunny/crossref_metadata_2025_split huggingface dataset:
The incidence and outcomes of hyperacute cardiovascular dysfunction following isolated traumatic brain injury: an observational cohort study
Authors: Bird Flora L. , Wilson Mark , Aziz Shadman , Shebl Moustafa , Pickard Alexander , Sims David , Grier Gareth , Lockey David , Davenport Ross 
Published: February 2025

Background:
The relationship between early cardiovascular dysfunction (CVD) in isolated traumatic brain injury (iTBI) and outcome has not been fully described. We aimed to (1) determine the prevalence and phenotype of CVD after iTBI in the hyper-acute phase and (2) compare treatment and outcomes in those with CVD vs non-CVD.

Methods:
An observational cohort database study of severe iTBI patients (Head AIS 3+) at a level 1 trauma centre (2008–2019) and physician-led air ambulance service (2019–2020). CV dysfunction was defined as tachycardia or bradycardia, with hypotension. Physiology, laboratory results, 24-hour transfusion, and computer-topography (CT) findings were recorded. Outcomes were 28-day mortality and Glasgow Outcome Score (GOS).

Results:
A total of 168 patients met inclusion criteria, average age 46 years (IQR 30–61), 77% male, median ISS 25 (IQR 17–29) with 51% Head AIS 5. Time from injury to pre-hospital assessment was 31 minutes (IQR 20–42) with 20% demonstrating CVD on initial observations. The CVD group were more shocked (lactate 6.1 (1.7–10.9) vs. 2.4 (1.4–3.3), P < 0.001) and coagulopathic (43% vs. 15%, P = 0.001). There was no difference in Head AIS or CT findings between groups, except frequency of hypoxic ischemic encephalopathy (HIE) (CVD: 21% vs. non-CVD: 1%, P < 0.001). A 24-hour transfusion was higher in CVD patients: 3 (0–8) vs. 0 (0–0) units, P < 0.001. Mortality was greater in CVD vs non-CVD iTBI (61% vs. 31%, P = 0.002), but in patients with AIS 5, there was no difference (P = 0.262). One-third of CVD survivors (13/33) were discharged home, and 4/18 patients with recorded GOS had good neurological outcome.

Conclusion:
One in five patients with severe iTBI develop early CVD, associated with increased mortality, coagulopathy, and HIE. However, mortality and neurological outcome is highly variable in those with CVD across the iTBI severity spectrum. Further research is needed to define the pathophysiology and optimal treatment to improve outcomes for this subgroup of iTBI.
Development, validation, and clinical evaluation of a machine-learning based model for diagnosing early infection after cardiovascular surgery (DEICS): a multi-center cohort study
Authors: Pan Tuo , Zhang Haitao , Wang Chuangshi , Wang Hanghang , Matniyaz Yusanjian , Lv Zhi-Kang , Zhu Tong Tong , Wang Ya-Peng , Song Zhi-Zhao , Tang Yu-Xian , Zhang He , Pan Hao-Dong , Li Chen , Yang Lin-Shan , Guan Shi-Yu , Bian Wen , Hafu Xiateke , Li Xiang , Li Yang , Wu Xiao-Ting , Fan Zhi-Wei , Luo Yuan-Xi , Jiang Yi , Gao Ya-Xuan , Wang Wen-Zhe , Xue Yun-Xing , Fan Fu-Dong , Pan Jun , Zhou Qing , Zhang Bo-Min , Wang Wei , Wang Qiang , Fan Guo-Liang , Wang Dong-Jin 
Published: February 2025

Background:
This study addresses the critical need for timely and accurate diagnosis of early postoperative infection (EPI) following cardiac surgery. EPI significantly impacts patient outcomes and healthcare costs, making its early detection vital.

Objectives:
To develop, validate, and clinically implement a machine-learning-based model for diagnosing EPI post-cardiac surgery, enhancing postoperative care.

Methods:
In this multi-center cohort study spanning 2020 to 2022, data from four medical centers involved 2001 participants. Of these, 1400 were used for trainingand 601 for validation. Several machines-learning algorithms, including XGBoost, random forest, support vector machines, least absolute shrinkage and selection operator, and single-layer neural networks, were applied to develop predictive models. These were compared against a traditional logistic regression model. The model with the highest area under the receiver operating characteristic curve (AUROC) was deemed optimal. Implemented across four centers since 1 January 2023, a retrospective real-world study assessed its clinical applicability. Among 400 patients with an estimated EPI risk above 10%, identified by the optimal model, 55 followed its antibiotic upgrade recommendations (DEICS group). The remaining 345 patients upgraded antibiotics empirically, with 55 in the control group, matched 1:1 with the DEICS group. Clinical utility was evaluated through antibiotic use density (AUD), hospital costs, and ICU stay duration.

Results:
The XGBoost model achieved the highest performance with an AUROC of 0.96 (95% CI: 0.93–0.98). The calibration curve exhibited strong agreement with Brier scores of 0.02. According to the XGBoost model, the DEICS group significantly demonstrated reduced AUD (P < 0.01) in the matched cohort, along with decreased ICU stay time (median: 5 vs. 6 days, P = 0.01) and hospital costs (median: ¥150 000 vs. median: ¥200 000, P = 0.01) in the EPI cohort.

Conclusion:
The successful implementation of the XGBoost model facilitates accurate EPI diagnosis, improves postoperative recovery, and lowers hospital costs.
Metabolic myopathies series part 1: What we need to know
Authors: Edmund Sara J. , Heuer Beth Ann 
Published: February 2025

ABSTRACT
Metabolic myopathies, a group of genetic disorders characterized by disruptions in muscle cell pathways, often lead to significant muscle fatigue. The potential underdiagnosis of these conditions is a concern because it can lead to long-term complications. Nurse practitioners are in a prime position to identify and refer these patients, thereby preventing such sequelae. Three genetic disorders affecting muscle metabolism include McArdle disease, Tarui disease, and carnitine palmitoyltransferase II deficiency. McArdle disease is a glycogen storage disease caused by a flaw in the production of a critical muscle enzyme called phosphorylase, leading to the inability to break down glycogen within muscle cells. Muscle pain, fatigue, and sometimes rhabdomyolysis can result. Tarui disease results from insufficient phosphofructokinase, which disrupts glycolysis, leading to exercise intolerance. Carnitine palmitoyltransferase II deficiency affects lipid metabolism, disturbing long-chain fatty acid (LCFA) transport into the mitochondria. The mitochondria use these LCFAs to produce energy. Disruption can lead to exertional muscle pain and myoglobinuria.
Bilateral carotid body tumor management: tips, tricks, strategies, and problems
Authors: Piazza Cesare , Montenegro Claudia , Rampinelli Vittorio 
Published: February 2025

Purpose of review
Carotid body tumors (CBTs) are rare neuroendocrine tumors with an annual incidence of 1 : 30 000. Bilateral carotid body tumors (BCBTs) account for 3–5% of all CBTs and are more frequently linked to familial syndromes and potential malignancy. BCBT management is still not universally standardized and depends on multiple factors, including patient's age, risk of malignancy, location, growth rate, size, and related Shamblin and Mehanna classifications.

Recent findings
Options of treatment include active surveillance, external beam radiation, and surgery. Surgery is the first-choice treatment, but it may not always be performed especially in elderly patients. Simultaneous BCBT resection is not suggested due to high intra-operative and postoperative risks. The decision to operate on the larger or smaller tumor first is still debated. Whenever feasible, treatment of the larger tumor first to reduce the tumor burden should be preferred but with higher risks of neurovascular injury. Conversely, starting with the smaller tumor first offers a lower risk at initial surgery but may complicate the management of the larger tumor later.

Summary
Surgery for BCBTs, whenever feasible, remains the most indicated treatment but poses a significant risk of neurovascular complications. Resection of the larger, often more symptomatic, and potentially problematic or malignant tumor, reduces the overall disease burden and mitigates risks of rapid progression but involves a higher immediate complication hazard. Multidisciplinary evaluation is essential for balancing surgical risks and long-term outcomes, prioritizing neurovascular preservation and reducing morbidity.
Clinical Outcomes of Gender-Affirming Surgery in Individuals With Connective Tissue Disorders
Authors: Shah Jennifer K. , Camacho Justin M. , Eble Danielle , Hinson Chandler , Najafali Daniel , Patel Heli S. , Shih Pin-Keng , Nazerali Rahim , Morrison Shane D. 
Published: February 2025

Introduction
Gender-affirming surgery (GAS) is a complex process that often requires multiple surgical operations and carries a complication risk that could be exacerbated by connective tissue disorders (CTDs). This study aims to investigate the association between CTD diagnosis and GAS outcomes.

Methods
Using the Merative MarketScan Research Databases, patients with gender dysphoria diagnoses who underwent GAS between 2007 and 2022 were identified. Among these, patients with diagnosed CTDs were identified. Demographics, comorbidities, and postoperative complications were recorded. Chi-squared, Shapiro-Wilk, Wilcoxon-Mann-Whitney, and multivariate logistic regression testing was used for statistical analysis.

Results
Of 7575 patients meeting criteria (mean age 29 ±10 years), 300 (4%) had CTD diagnoses. One or more postoperative complications were recorded in 9.8% of patients, without statistically significant difference between CTD and non-CTD patients. Additional simultaneous GAS procedures [odds ratio (OR) 2.02; P < 0.01], Elixhauser index scores of 3+ (OR 1.36; P = 0.010), and age >45 years (OR 1.47; P = 0.02) increased odds of experiencing complications following the index GAS procedure, while CTD diagnoses (P = 0.52) did not affect odds of experiencing complications. However, CTD diagnoses did elevate odds of readmission (OR 1.47; P = 0.046), as did multiple simultaneous GAS procedures (OR 2.66), Elixhauser index scores of 3+ (OR 3.72), and smoking (OR 2.18) (P < 0.01).

Conclusions
These findings suggest CTDs may impact some gender-affirming surgical outcomes, and careful preoperative evaluation and management of comorbidities is necessary to reduce the risk of complications and readmission in this population. Surgeons should continue to exercise caution when performing elective surgery on patients taking immunomodulatory medications.
Endoscopic Versus Open In situ Decompression of Cubital Tunnel Syndrome
Authors: Alghamdi Abdulaziz M. , Alkulli Osama A. , Faidah Dania E. , Alqazenli Mohamed K. , Fathi Abdulaziz B. , Allarakia Yousof F. , Alghamdi Arwa , Baaqeel Rasha 
Published: February 2025

Introduction
Cubital tunnel syndrome (CuTS) is the second most common compressive neuropathy of the upper extremity. Several surgical approaches are available for a definitive treatment. This systematic review and meta-analysis aimed to comprehensively assess and compare the efficacy and safety of endoscopic in situ decompression (EISD) and open in situ decompression for CuTS.

Methods
A systematic search was conducted using online databases (PubMed/MEDLINE, Embase, and Cochrane) on the 14th of April 2024. All human RCTs and observational studies in English were included in this review.

Results
Eleven studies, involving 686 patients, met the inclusion criteria. Pairwise meta-analyses showed that EISD had significantly increased surgery time [MD = 9.32 minutes, 95% confidence interval (CI) (3.54, 15.11), P = 0.002], higher risk of postoperative hematoma [RR = 4.44, 95% CI (1.30, 15.20), P = 0.02], higher risk of postoperative surgical-site pain [RR = 1.50, 95% CI (1.09, 2.05), P = 0.01], lower risk of postoperative elbow numbness [RR = 0.06, 95% CI (0.01, 0.48), P = 0.007], and better postoperative grip and pinch strength [MD = 6.29, 95% CI (1.35, 11.24), P = 0.01]. In addition, it trended insignificantly toward lower rates of chronic painful scarring recurrence rates. Other measured variables did not show significant differences between the 2 surgical techniques, including the functional outcomes assessed by Bishop's score, disabilities of the arm, shoulder, and hand score, and neurophysiologic data, in addition to the postoperative infection rate, subluxation of the ulnar nerve, and reoperation rates.

Conclusions
This meta-analysis demonstrated that both surgical techniques were effective in treating CuTS. Although it was inferior in some of the measured short-term outcomes, EISD showed better results in some of the long-term measured outcomes with questionable clinical significance. The choice of the surgical approach should be tailored for each case to optimize the quality of care and overall outcomes.
Challenging Legacy Burn Resuscitation Paradigms with Fluid Restriction and Early Plasma
Authors: Kahn Steven A , Huff Mallorie L , Taylor Justin , O’Neill Keisha , Hink Ashley B , Mittal Rohit , Bright Andrew , Baliga Prabhakar 
Published: February 2025

Background:
Fresh frozen plasma (FFP) as an adjunct in burn resuscitation to decrease endothelial cell permeability by restoring the glycocalyx is not yet standard of care, despite increasing evidence showing tis benefits. We hypothesize that utilizing an adjusted body weight index and starting resuscitation at a low rate of 2cc/kg/%TBSA with early plasma results in less fluid administration and superior clinical outcomes compared to traditional resuscitation methods such as Parkland formula.

Study design:
This was a retrospective comparative study of burn patients (>20%TBSA) resuscitated with 2cc/kg/%TBSA LR using their ABWI, early FFP, plus rescue FFP PRN oliguria. ABWI=ideal weight+0.3 [actual weight–ideal weight]. Patients with >30% TBSA were given 1-2UFFP at admission. Fluids were titrated 10-20%/hr. based on UOP. If oliguric for 2-hours, patients received 1-2U “rescue” FFP. Legacy groups were resuscitated with Parkland Formula (“4cc/kg” Group) or a less restrictive 3cc/kg ABWI Group w/rescue FFP only. Demographics, injury characteristics, fluids administered during resuscitation, UOP, outcomes, and death were recorded. Legacy groups were compared to the “2cc/kg+FFP” ABWI group.

Results:
Patients given 2cc/kg+FFP received significantly less fluid than the 3 and 4cc groups (1.7 vs 3.3 (p<0.05) vs 4.15 cc/kg/%TBSA (p<0.0001). Urine output was significantly reduced from 1.4 to 1 to 0.7 cc/kg/hr (p<0.0001), approaching goal of 0.5cc/kg/hr. Mortality, mechanical ventilation, tracheostomy, and hemodialysis was significantly less in the 2cc/kg+FFP group (p<0.05).

Conclusion:
Patients treated with the restrictive 2cc/kg+FFP formula received less fluid than the 3cc/kg and Parkland formula controls. With reduced fluids, patients had less mechanical ventilation, less dialysis, fewer tracheostomies, and better survival. AKI was minimal despite fluid restriction. Early experience suggests the new protocol is safe and feasible for further study.
Idiopathic Subglottic Stenosis and the Epithelial Interface of Host and Environment
Authors: Gelbard Alexander , Shilts Meghan H , Hoke Austin , Strickland Britton , Motz Kevin , Tsai Hsiu-Wen , Boone Helen , Drake Wonder P , Wanjalla Celestine , Smith Paula Marincola , Brown Hunter , Powell Jason , Ramirez-Solano Marisol , Atkinson James B , Simpson John , V Rajagopala Seesandra , Mallal Simon , Sheng Quanhu , Hillel Alexander T , Das Suman R 
Published: February 2025

Background:
Idiopathic subglottic stenosis (iSGS) is a rare fibrotic disease of the proximal airway affecting adult Caucasian women nearly exclusively. Life-threatening ventilatory obstruction occurs secondary to pernicious subglottic mucosal scar. Disease rarity and wide geographic patient distribution has previously limited substantive mechanistic investigation into iSGS pathogenesis.

Study Design:
Harnessing pathogenic mucosa from an international iSGS patient cohort and single cell RNA sequencing we provide an unbiased characterization of the cell subsets present in the proximal airway scar and detail their molecular phenotypes.

Results:
Airway epithelium in iSGS patients is depleted of basal progenitor cells and the residual epithelial cells acquire a mesenchymal phenotype. Observed displacement of bacteria beneath the lamina propria provides functional support for the molecular evidence of epithelial dysfunction. Matched superficial and deep tissue microbiomes support displacement of the native microbiome into the lamina propria of iSGS patients rather than disrupted bacterial community structure. However, animal models confirm bacteria are necessary for pathologic proximal airway fibrosis and suggest an equally essential role for host adaptive immunity. Human samples from iSGS airway scar demonstrate adaptive immune activation in response to the proximal airway microbiome of both matched iSGS patients and healthy controls. Clinical outcome data from iSGS patients suggests surgical extirpation of airway scar and reconstitution with unaffected tracheal mucosa halts the progressive fibrosis

Conclusion:
Our novel data support an iSGS disease model where epithelial alterations facilitate microbiome displacement, dysregulated immune activation, and localized fibrosis. Overall, these results refine our understanding of iSGS and implicate shared pathogenic mechanisms with distal airway fibrotic diseases.
Public Funding for AI in Canada 2011-2022: An equity-focused environmental scan
Authors: Attema G. , Mertz M. , Anawati A. , Austin A. , Bertrand J. , Jewett R. , Cameron E. 
Published: February 2025

AbstractBackgroundIn this new equity-driven landscape, if there is to be system-wide transformation in research funding allocation, indicators of funding allocations need to be explored. This environmental scan aims to understand how research funding for artificial intelligence (AI) has been allocated and distributed in Canada from 2011-2022. Using geographical representations, we describe and map research funding for Canadian researchers by publicly funded granting agencies and provide analyses for AI research spending since 2011MethodologyWe developed a rapid environmental scan to create a database of all AI funded projects from the following agencies: CIHR, NSERC, SSHRC, CRC, AMS, NFRF and CFI. Using publicly available research funding reporting and agency websites, we identified through title, keyword and project summary screening, AI projects in English and French for the years 2011-2022.Principal FindingsA total of 4112 projects were identified, with the following information for each project recorded: title, year, institution, city, province, total funding, language, funding agency, funding program and primary investigator. A total of $384,933,265.74 million was allocated for publicly funded AI related projects in Canada from 2011-2022. Average funding per project was $93,612.18. The top three provinces with the most funding for all years are Ontario, Quebec, and British Columbia. The top three funding agencies by total amount for all years were NSERC at $155,267,817, CIHR at $136,594,644, and CFI at $58,317,627ConclusionThis information can assist in accountability and understanding of Canada’s publicly funded research allocations, and provide information related to the distribution of such funds, thus informing equity policy strategies.
Multi-omic data integration and analyses for biomarker discovery of spontaneous preterm birth phenotypes
Authors: Gupta Juhi K. , Care Angharad , Goodfellow Laura , Alfirevic Zarko , Alfirevic Ana , Müller-Myhsok Bertram 
Published: February 2025

ABSTRACTBackgroundPreterm birth, delivery <37 weeks of gestation, is a global health concern affecting 1.3 million infants annually. A higher morbidity burden is associated with infants born <34 weeks of gestation. A more robust biomarker of spontaneous preterm birth needs to be identified. To our knowledge, this study uniquely integrated three ‘ome-wide’ datasets prospectively collected from the same individuals within a single, defined UK cohort. The study aimed to integrate genomic, transcriptomic, and metabolomic data collected from the same cohort of women for biomarker discovery.MethodsPregnant women with a history of a previous spontaneous preterm birth (sPTB) <34 weeks were recruited in Liverpool in a subsequent pregnancy at 16 and/or 20 weeks of gestation. Pregnancy outcomes were followed up and categorised into the different clinical subgroups of SPTB <34 weeks, PPROM <34 weeks and term delivery >37 weeks (controls). Blood samples were profiled for genomics, transcriptomics and metabolomics. ANOVA analyses were performed at each gestational timepoint. Network enrichment analyses was performed on significant genes.ResultsAfter multi-omic data integration, 43 women at week 16 and 40 women at week 20 of gestation had all three genomics, transcriptomics and metabolomic profiling available. Multiple significant transcripts were detected (p<0.05) from the ANOVA analyses, though these were mostly in non-coding regions.ConclusionThree different omic data, genomics, transcriptomics and metabolomics, were integrated across the same individuals for biomarker analyses. Molecular signatures were detected that could lead to understanding the pathways involved in the different subgroups of preterm birth: SPTB and PPROM.
Discoloration of the Cephalothorax inPandalus borealisand its Correlation with Internal Cadmium Concentration
Authors: Joseph Nwanneka , Reilly Brandon , Wight Alex , Huang Xin Yu 
Published: February 2025

AbstractThis study investigates the correlation between discoloration of the cephalothorax inPandalus borealis(P. borealis) shrimp and cadmium concentration. The data, obtained through Atomic Absorption Spectroscopy (AAS), was converted into weight-based cadmium concentrations and analyzed using both parametric and non-parametric statistical tests. Despite assumptions of normal distribution not being met, a two-sample Student’s t-test and Mann-Whitney test were performed to examine the differences in cadmium concentrations between pink and discolored shrimp. Results indicated no statistically significant differences between the two groups. Experimental analysis revealed considerable overlap in cadmium concentration ranges for both groups, with high standard deviations. Factors such as the period of exposure to cadmium and potential influences from other contaminants or microorganisms were also considered. Previous studies have linked discoloration in shrimp to heavy metals and infections, but this study found no correlation between cadmium concentration and discoloration inP. borealis. The conclusion suggests that cadmium may not be a sole factor in shrimp discoloration, and other variables should be explored. Recommendations for future research include examining other trace metals, microbial infections, shrimp age, and extent of exposure to provide a comprehensive understanding of cephalothorax discoloration in shrimp.