bluuebunny/crossref_metadata_2025_split huggingface dataset:
Remimazolam for procedural sedation
Authors: Pingel Lasse , Maagaard Mathias , Tvarnø Casper D. , Sorenson Sandra , Bukhari Shaheer , Andersen Lars Peter Kloster , Andersen Jakob Hessel , Mathiesen Ole 
Published: February 2025

BACKGROUND
Midazolam and propofol are frequently used for procedural sedation. Remimazolam may provide a more controllable sedation with fewer adverse effects.

OBJECTIVE
To assess the sedation success rate and respiratory and cardiovascular complications of remimazolam versus placebo and other sedatives in adults undergoing procedural sedation.

DESIGN
A systematic review of randomised controlled trials (RCTs) with meta-analyses, trial sequential analyses (TSA), and GRADE evaluations of the certainty of evidence.

DATA SOURCES
We searched Medline, Embase, CENTRAL, BIOSIS, CINAHL, and Web of Science Core Collection from their inception to 22 June 2024.

ELIGIBILITY CRITERIA
RCTs allocating participants undergoing procedural sedation to remimazolam versus placebo or any active comparator.

RESULTS
We included 63 trials randomising 13 953 participants. All included trial results were judged to be at high risk of bias. The sedation success rate was similar with remimazolam versus active comparators, relative risk (RR) 1.04, [97.5% confidence interval (CI), 0.96 to 1.14; TSA-adjusted CI, 0.95 to 1.18], P
= 0.26, GRADE: very low. Subgroup analyses indicated that remimazolam versus midazolam increased sedation success rate, while the risks were similar with remimazolam versus comparators. Remimazolam versus active comparators decreased the risk of respiratory complications, RR 0.47, (97.5% CI, 0.36 to 0.61; TSA-adjusted CI, 0.35 to 0.61), P < 0.01; and cardiovascular complications, RR 0.46, (97.5% CI, 0.37 to 0.56; TSA-adjusted CI, 0.38 to 0.57), P < 0.01. Subgroup analyses indicated that remimazolam versus propofol reduced respiratory and cardiovascular complications, while the risks were similar versus midazolam.

CONCLUSION
Remimazolam seems to provide a similar sedation success rate as other active comparators (propofol, ciprofol, midazolam, dexmedetomidine, etomidate), although subgroup analyses indicated that remimazolam increased sedation success rate compared to midazolam. Remimazolam compared to propofol may decrease the risk of respiratory and cardiovascular complications. The certainty of the evidence was very low to low, and firm conclusions could not be drawn.
Eltrombopag-Induced Falsely Elevated Bilirubin Concentrations in Enzymatic and Vanadate Oxidation Assays: Involvement of High Serum Eltrombopag Concentrations
Authors: Oda Shun , Doki Kosuke , Obara Naoshi , Suzuki Yoshiharu , Chiba Shigeru , Homma Masato 
Published: February 2025

Background:
The administration of eltrombopag, used to restore low blood count, demonstrates a positive interference of blood bilirubin levels when analyzed through the diazo assay. However, research on bilirubin measurements using other methods is limited. Therefore, using an enzymatic assay, this study aimed to investigate the effect of serum eltrombopag on bilirubin measurements in patients with aplastic anemia. It further assessed the concentration-dependent effect of eltrombopag on bilirubin measurements using enzymatic and vanadate oxidation assays.

Methods:
Total and conjugated bilirubin concentrations measured using an enzymatic assay and serum eltrombopag concentrations were examined in 227 serum samples collected from 30 patients with aplastic anemia receiving eltrombopag. Eltrombopag-spiked samples were analyzed using the enzymatic and vanadate oxidation assays for total and conjugated bilirubin to determine its concentration-dependent effects.

Results:
A strong positive correlation was observed between total bilirubin and serum eltrombopag concentrations in patients receiving eltrombopag (r = 0.820). However, the correlation between conjugated bilirubin and serum eltrombopag concentrations was weaker (r = 0.413). In eltrombopag-spiked serum samples, the enzymatic assay showed significant false elevation of total bilirubin concentrations at ≥6.0 mcg/mL; no interference with conjugated bilirubin measurements was observed. The vanadate oxidation assay showed mild positive biases of 0.2 and 0.1 mg/dL for total and conjugated bilirubin concentrations, respectively, at a high eltrombopag concentration (50 mcg/mL).

Conclusions:
Eltrombopag causes clinically significant concentration-dependent interference in total blood bilirubin, but not in conjugated bilirubin measurements through the enzymatic assay in patients with aplastic anemia. The vanadate oxidation assay may be used as an alternative to measure total blood bilirubin when the eltrombopag concentration is below 50 mcg/mL.
Ethical Dilemmas in Plastic Surgery: Insights From a Survey Study in Saudi Arabia
Authors: Arkoubi Amr Youssef , Jefri Zainalabden E. , Aldaghri Faris A. , Obeid Faisal M. , Almodumeegh Abdulaziz Saleh , Alhadlaq Abdulmajeed , Daghistani Waiel A , Mortada Hatan 
Published: February 2025

Background:
Plastic surgery often presents complex ethical dilemmas involving patient autonomy, informed consent, and resource allocation. This study aimed to explore these challenges and their impact on surgeons’ decision-making processes.

Methods:
A survey study was conducted among plastic surgeons in Saudi Arabia between May and June 2024. An online-validated questionnaire was distributed to consultants, residents, and registrars. The survey covered demographic information and ethical dilemma scenarios. Data were analyzed using SPSS, with chi-square tests used to assess associations.

Results:
Among the 75 participants, 53.3% were consultants, 82.7% were male, and the majority (38.7%) were between 30 and 39 years of age. Most surgeons (41.3%) reported rarely encountering ethical dilemmas, with managing patient expectations being the most common issue, cited by 48.0% of respondents. Professional guidelines influenced decision-making for 56.0% of the participants. Consultants and residents had differing experiences; consultants were more concerned about advertising practices (75.0% compared with 12.5%) and complications (70.0% compared with 30.0%), whereas residents focused primarily on resource allocation (100.0% versus none of the consultants).

Conclusions:
Plastic surgeons in Saudi Arabia face various ethical challenges, with differences noted between consultants and residents. The findings highlight the importance of addressing these challenges to enhance decision-making and patient care.
Spanish Translation and Validation of the LIMB-Q: A Patient-reported Outcome Measure for Lower Extremity Trauma
Authors: Alahmadi Sami , Barata Herrera Daniela M. , Heron Matthew J. , Gomez-Rexrode Amalia E. , Rivera Perla Krissia M. , Soto Edgar , Ghanem Diane , Shafiq Babar , Mundy Lily R. 
Published: February 2025

Background:
Hispanic patients represent a notable portion of the adult trauma population in the United States, yet their participation in studies collecting patient-reported outcome measure data following lower extremity injuries is limited. This study aims to translate and linguistically validate the LIMB-Q in Spanish for use in this population.

Methods:
We followed guidelines from the World Health Organization and the Professional Society for Health Economics and Outcomes Research to conduct this translation. Two independent translators conducted a blind forward translation of the LIMB-Q from English to Spanish, followed by a back translation to confirm the conceptual preservation of each LIMB-Q item. Five patients then participated in cognitive debriefing interviews to collect feedback on comprehension, interpretation, and language.

Results:
Translators occasionally differed in the vocabulary they used in their forward translations. All conflicts were resolved by discussion and selection of the option with the greatest colloquial recognition and medical relevance. Back translation identified 25 differences, including items that did not fully convey semantics (n = 12), were missing parts (n = 9), or were listed out of order (n = 4). All items with inadequate semantics were revised to ensure full retention of their original meaning. Five patients participated in cognitive debriefing interviews, resulting in 5 revisions for diction and syntax.

Conclusions:
The Spanish (US) translation of LIMB-Q is now available. This instrument may be used in both clinical and research settings to better understand the quality of life and satisfaction of Hispanic patients after traumatic lower extremity injury.
PI3K-mediated Kif1a DNA methylation contributes to neuropathic pain: an in vivo study
Authors: Jiang Wei , Yu Peng , Yang Yu , Cai Meng-Tan , Gan Lin , Qu Kang , Cheng Ying-Ying , Dong Ming 
Published: February 2025

Abstract
Neuropathic pain (NP) is a chronic condition caused by nerve injuries, such as nerve compression. Understanding its underlying neurobiological mechanisms is critical for developing effective treatments. Previous studies have shown that Kinesin family member 1A (Kif1a) heterozygous deficient mice display sensory deficits in response to nociceptive stimuli. PI3K has been found to mitigate these sensory deficits by enhancing Kif1a transcription, highlighting KIF1A's key role in sensory pain. However, the exact mechanism through which PI3K regulates KIF1A expression in relation to pain remains unclear. In this study, we observed a significant increase in PI3K/AKT/CREB (cyclic AMP response element-binding protein) protein levels in the dorsal root ganglia and spinal cord after chronic constriction injury in both male and female C57BL/6 mice. Notably, elevated levels of TET1, as well as Kif1a mRNA and protein, were detected in both male and female mice. Activated (phosphorylated-CREB) p-CREB recruited the DNA demethylase TET1, which interacted with the Kif1a promoter, reducing methylation and increasing Kif1a mRNA and protein expression. PI3K inhibition using wortmannin reversed the demethylation of Kif1a and decreased its expression in male mice. Furthermore, TET1 knockdown or overexpression significantly affected pain-related behaviors, as well as Kif1a methylation and transcription. Female mice given intrathecal injections of PI3K inhibitors exhibited similar molecular and behavioral outcomes as male mice. These findings offer new insights into NP mechanisms, suggesting that targeting the PI3K/KIF1A axis could be a promising therapeutic approach for NP treatment.
Mortality from infectious pneumonia associated with the severity of airflow limitation in pneumoconiosis: Proportional mortality study as a case-control study
Authors: Kang WonYang , Kim Daeho , Kim Mi-Yeon , Moon Subin , Lee YouLim , Lee Sungsook , Choi Byung-Soon 
Published: February 2025

Abstract

Objective: The aim of this study was to investigate whether the mortality risk from infectious pneumonia was associated with the severity of airflow limitation among subjects in the cohort of pneumoconiosis.

Methods: Proportional mortality study was designed as a case-control study with 347 cases and 328 controls. Mortality odds ratios (OR) were evaluated according to the severity of airflow limitation.

Results: The odds of mortality from pneumonia among the severe and very severe airflow limitation groups who performed spirometry at the time less than 1 year ago before death were 2.34 (OR 2.34; 95% CI 1.04 to 5.28) and 8.77 times (OR 8.77; 95% CI 1.69 to 45.68) greater compared to the non-airflow limitation group.

Conclusions: Severe airflow limitation in pneumoconiosis increases mortality from infectious pneumonia, presenting a dose-response relationship.
Interactive Workshop on Identifying Health Effects of Climate Change in the Clinical Setting: An Occupational and Environmental Health Solution
Authors: Saberi Pouné , Green-McKenzie Judith 
Published: February 2025

Objective
To provide clinicians an occupational framework to assess climate-related health conditions, determine at-risk workers, and devise solutions.

Methods
An interactive workshop was presented at the 2022 American Occupational Health Conference (AOHC). Six climactic events related to occupational health were chosen with corresponding cases from National Institute of Environmental Health Sciences. Participants answered and discussed scripted questions. A 5-point Likert® Scale utilized by AOHC evaluated the workshop’s quality and utility, and the audience’s ability to apply the knowledge.

Results
Sixty-one (N = 66) participants ranked the workshop highly (4.4-4.6/5). Most participants (90%) reported incorporation of practical knowledge gained, increased advocacy capacity and ability to teach about the issue.

Conclusions
Successful integration of engaging interactive sessions in clinician education on climate change and health is critical as climactic conditions can increase patient vulnerability in their role as workers.
Giant spigelian hernia in an elderly woman: a case report
Authors: Shitu Hauwa , Mubezi Isaac , Akoh Jacob A 
Published: February 2025

Introduction and importance
Spigelian hernias are an uncommon type of abdominal hernia, constituting just 1-2% of all cases. These hernias develop through defects in the abdominal wall near the semilunar line. Their rarity and subtle presentation often complicate preoperative diagnosis. The case highlights the challenges of diagnosing and managing Spigelian hernias in low- and middleincome countries, where access to advanced diagnostic tools like imaging and specialized surgical care is limited, complicating patient management.

Case presentation
This case involves an elderly woman with no known chronic conditions, not on any medication, and no prior surgical history, who presented with a history of a prolonged, large, non-reducible swelling,Due to a lack of access to preoperative imaging, clinical evaluation was used to guide surgical management, leading to a successful repair.

Clinical discussion
Spigelian hernias often present without clear symptoms, making them difficult to diagnose, especially in settings with limited diagnostic resources like ultrasound or CT. In this case, the hernia involved multiple abdominal structures, which posed a significant risk for complications such as strangulation.
Early surgical intervention is critical, particularly for elderly patients who are at higher risk.

Conclusion
This case demonstrates the importance of prompt surgical intervention in managing Spigelian hernias and the challenges faced in resource-limited settings. The Operation Hernia, A Global outreach program at no cost, provided crucial access to expert care in underserved regions, significantly improving patient outcomes.
Blood Glucose Range for Hyperglycemic PICU Children With Primary Neurologic Diagnoses: Analysis of the Heart and Lung Failure—Pediatric Insulin Titration Trial
Authors: LaRovere Kerri L. , Asaro Lisa A. , Coughlin-Wells Kerry , Nadkarni Vinay M. , Agus Michael S.D. ,   for the Heart and Lung Failure—Pediatric Insulin Titration (HALF-PINT) Study Investigators
Published: February 2025

Objectives:
To compare two blood glucose (BG) ranges in critically ill children with and without primary neurologic diagnoses in the Heart and Lung Failure—Pediatric Insulin Titration trial (HALF-PINT; ClinicalTrials.gov Identifier NCT01565941).

Design:
Non-prespecified post hoc analysis.

Setting:
Thirty-one PICUs in the United States, and one in Canada.

Patients:
Non-diabetic children enrolled from April 2012 to September 2016 with cardiovascular or respiratory failure and hyperglycemia. Patients in the neurologic subgroup had primary neurologic diagnoses on ICU admission.

Interventions:
Patients were randomized to insulin infusion to target lower-BG (80–110 mg/dL; 4.4–6.1 mmol/L) or higher-BG (150–180 mg/dL; 8.3–10 mmol/L).

MEASUREMENTS AND MAIN RESULTS:
Primary diagnosis (neurologic vs. non-neurologic), daily BG and insulin values, outcomes (number of PICU-free days through day 28 and 1-y post-PICU discharge adaptive behavior composite score of Vineland Adaptive Behavior Scales, Second Edition). Of 698 patients analyzed, 64 (30 lower-BG target, 34 higher-BG target) had primary neurologic diagnoses and 634 (319 lower-BG target, 315 higher-BG target) had non-neurologic diagnoses. Within the neurologic subgroup, patients in the lower-BG targeting group had fewer ICU-free days compared with those in the higher-BG targeting group (median 8.5 vs. 21.1 d), whereas there was no difference between BG groups in the non-neurologic subgroup (20.5 vs. 19.3 d; interaction p = 0.02). One-year adaptive behavior composite score was less favorable for the lower-BG targeting group in those with neurologic diagnoses (mean 63.3 vs. 87.6), but no different in those with non-neurologic diagnoses (81.9 vs. 78.4; interaction p = 0.02). Lower-BG targeting was associated with more hypoglycemia (< 60 mg/dL) in both diagnostic subgroups, with no differential effect across subgroups (p = 0.47).

Conclusions:
In this non-prespecified analysis of the HALF-PINT trial data, lower-BG targeting in hyperglycemic critically ill children with primary neurologic diagnoses was associated with unfavorable outcomes, while such BG targeting in those with non-neurologic diagnoses was not associated with adverse outcomes.
Leveraging Communities of Practice to Support Translation of Knowledge Into Action Among State, Tribal, Local, and Territorial Public Health Agencies: Lessons Learned From the COVID-19 Pandemic
Authors: Bosold Alyssa , Machta Rachel , Brenner Jackie , Porterfield Deborah S. 
Published: February 2025

Context:
During the COVID-19 pandemic, communities of practice (CoPs) supported state, Tribal, local, and territorial (STLT) public health agencies. No studies have examined the collective role of these CoPs in helping STLT public health agencies translate guidance into practice.

Objectives:
This qualitative study examines the types of CoPs that supported STLT public health agencies during the COVID-19 response, how CoPs assisted in translating guidance into practice, and the characteristics of CoPs that made them valuable to STLT public health members. We report lessons for future public health emergencies (PHEs) for STLT public health agencies and membership organizations that represent them.

Design:
We conducted 21 in-depth interviews with CoP leaders, STLT public health participants, and federal agency sponsors and collaborators.

Participants:
We interviewed 9 CoP leads, 6 STLT participants, and 6 federal agency representatives.

Results:
Three types of CoPs, each with unique advantages, supported STLT public health agencies during the COVID-19 pandemic: (1) CoPs led by federal agencies, (2) CoPs led by membership organizations or associations that represent STLT public health agencies, and (3) CoPs led by other nonfederal organizations, such as philanthropic organizations and academic institutions. The most valuable CoPs to STLT public health agencies had a clear focus on issues of significance to their members, strong connections between members, and a structure tailored to the group’s goals. STLT public health agencies valued CoP support with implementing guidance-based policies and practices and facilitating bidirectional communication with federal agencies. STLT public health agencies also benefitted from tailored and implementation-focused resources developed through CoPs.

Conclusion:
Our study affirms the importance of CoPs in facilitating collaboration and information-sharing among multiple actors during PHEs. During the COVID-19 pandemic, CoPs helped STLT public health agencies implement guidance, tailor approaches to specific contexts, and generate practice-based discoveries to advance the field.
The Prevention and Treatment of Postoperative Delirium in the Elderly: A Narrative Systematic Review of Reviews
Authors: Deblois Simon , Bergeron Nicolas , Vu Thien Tuong Minh , Paquin-Lanthier Gabriel , Nauche Bénédicte , Pomp Alfons 
Published: February 2025

Objectives:
Postoperative delirium (POD) is a common complication after major surgeries, posing significant challenges to patient recovery and outcomes, particularly among the elderly. A narrative systematic review was conducted to assess the clinical effectiveness and safety of interventions aimed at preventing and treating POD.

Methods:
A review of the literature from 2017 to September 29, 2023, was conducted using MEDLINE, EMBASE, and CINAHL. Systematic reviews, with or without meta-analyses, as well as practice guidelines, were included. Participants were adults, ≥60 years. The methodological quality of included reviews was appraised using AMSTAR 2.

Results:
After the search strategy identified 2295 references, 36 review studies were selected. Multicomponent interventions, incorporating both pharmacological and nonpharmacological approaches, demonstrate promise, particularly in hip fracture patients. Notably, dexmedetomidine emerges as a potential preventive measure, showing a notable reduction in delirium incidence following cardiac surgery. While several pharmacological interventions show potential, evidence remains inconclusive, necessitating further investigation. Similarly, varying anesthesia type and monitoring methods has mixed outcomes on delirium prevention. Despite methodological variations and quality appraisal limitations, this review underscores the importance of multicomponent interventions and the potential efficacy of dexmedetomidine in mitigating POD. Integration of evidence-based protocols into clinical practice is advocated to improve patient outcomes. However, the complex interplay between intervention components calls for further research to optimize delirium management strategies.

Conclusions:
The strength of evidence associated with multicomponent interventions and dexmedetomidine use should require a genuine commitment from health care institutions to support their integration into efficient strategies to prevent and treat POD. Ongoing research is vital to uncover their full potential and refine clinical protocols, ultimately enhancing patient care outcomes.
Factors Predicting Major Complications and Mortality in Percutaneous Endoscopic Gastrostomy: 8 Years of Experience of a Tertiary Surgery Center
Authors: Yildirim Murat , Kocabay Asim , Koca Bulent , Saglam Ali Ihsan , Ozkan Namik 
Published: February 2025

Background:
Percutaneous endoscopic gastrostomy (PEG) is a safe method of choice for patients who need long-term nutritional support. However, complications and high mortality rates have been reported. Based on 8 years of experience in tertiary care hospitals, we aimed to identify risk factors associated with major complications and 30-day mortality after PEG.

Methods:
Patients who underwent PEG in the General Surgery clinic of Tokat Gaziosmanpaşa University, Faculty of Medicine between January 2014 and March 2022 were included in the study. Data regarding patient demographics, comorbidities, laboratory data, drugs used together, and indications for PEG tube placement were collected.

Results:
There were 429 patients. The mean age of the patients was 66.9±16.75 years, and 180 (44%) patients were female. The mean follow-up period was 8.84±6.75 months. Twenty patients (4.9%) had major complications. Female sex [Odds Ratio (OR) 0.33, 95% CI, CI=1.23-8.87, P=0.02] and diabetes mellitus (DM) (OR=0.23, 95% CI=1.93-6, P=0.002) were the independent variables associated with major complications. The all-cause 30-day mortality rate was 5.9% (n=24). Malignancy, DM, corticosteroid use, low albumin, and platelet values were associated with increased mortality in multivariate analysis as indications for PEG.

Conclusions:
Female sex and patients with DM may potentially face major complications. The patients with cancer, diabetes, and corticosteroid use were associated with higher mortality. In addition, low serum albumin and platelet levels were an effective factor for survival in patients undergoing PEG, and this should be taken into account in decision-making.