bluuebunny/crossref_metadata_2025_split huggingface dataset:
Polysomnographic characteristics of excessive daytime sleepiness phenotypes in obstructive sleep apnea: results from the international sleep apnea global interdisciplinary consortium
Authors: Thorarinsdottir Elin H , Pack Allan I , Gislason Thorarinn , Kuna Samuel T , Penzel Thomas , Yun Li Qing , Cistulli Peter A , Magalang Ulysses J , McArdle Nigel , Singh Bhajan , Janson Christer , Aspelund Thor , Younes Magdy , de Chazal Philip , Tufik Sergio , Keenan Brendan T 
Published: February 2024

Abstract

Study Objectives
Excessive daytime sleepiness (EDS) is a major symptom of obstructive sleep apnea (OSA). Traditional polysomnographic (PSG) measures only partially explain EDS in OSA. This study analyzed traditional and novel PSG characteristics of two different measures of EDS among patients with OSA.

Methods
Sleepiness was assessed using the Epworth Sleepiness Scale (&gt;10 points defined as “risk of dozing”) and a measure of general sleepiness (feeling sleepy ≥ 3 times/week defined as “feeling sleepy”). Four sleepiness phenotypes were identified: “non-sleepy,” “risk of dozing only,” “feeling sleepy only,” and “both at risk of dozing and feeling sleepy.”

Results
Altogether, 2083 patients with OSA (69% male) with an apnea–hypopnea index (AHI) ≥ 5 events/hour were studied; 46% were “non-sleepy,” 26% at “risk of dozing only,” 7% were “feeling sleepy only,” and 21% reported both. The two phenotypes at “risk of dozing” had higher AHI, more severe hypoxemia (as measured by oxygen desaturation index, minimum and average oxygen saturation [SpO2], time spent &lt; 90% SpO2, and hypoxic impacts) and they spent less time awake, had shorter sleep latency, and higher heart rate response to arousals than “non-sleepy” and “feeling sleepy only” phenotypes. While statistically significant, effect sizes were small. Sleep stages, frequency of arousals, wake after sleep onset and limb movement did not differ between sleepiness phenotypes after adjusting for confounders.

Conclusions
In a large international group of patients with OSA, PSG characteristics were weakly associated with EDS. The physiological measures differed among individuals characterized as “risk of dozing” or “non-sleepy,” while “feeling sleepy only” did not differ from “non-sleepy” individuals.
Changes in Multiple Aspects of Pain Outcomes After Rehabilitation
Authors: Uthaikhup Sureeporn , Sremakaew Munlika , Treleaven Julia , Jull Gwendolen , Barbero Marco , Falla Deborah , Cescon Corrado 
Published: February 2024

Objectives:
To examine changes in pain outcomes to fully evaluate the effect of adding sensorimotor training to manual therapy and exercise in patients with chronic neck pain and sensorimotor deficits. Concordance was examined between pain distribution and pain intensity and patient-reported outcomes.

Methods:
Participants (n=152) were randomly allocated into four intervention groups: One group received local neck treatment (NT) comprising manual therapy and exercise and the other three groups received additional sensorimotor training (either joint position sense/oculomotor exercises, balance exercises or both). Treatment was delivered twice a week for six weeks. Pain and patient-reported outcomes were measured at baseline, post-treatment and 3-, 6- and 12-month follow-ups.

Results:
There were greater changes in pain location, extent and intensity at 6- and 12-month follow-ups in the sensorimotor training groups compared to the NT group (P<0.05). A greater number of patients in the sensorimotor training groups gained ≥ 50% reduction in pain extent and intensity relative to the NT group at 6- and 12-months (P<0.05). Clinical improvement in pain extent was concordant with pain intensity (adjusted kappa=056-0.66, %agreement=78.3-82.9, P<0.001) and disability (adjusted kappa=0.47-0.58, %agreement=73.7-79.0, P<0.01) at 3-, 6- and 12-month follow-ups, but not with function and well-being. The concordance tended to decline with time.

Discussion:
Multiple aspects of the pain experience improved in the longer term by adding sensorimotor training to NT for patients with neck pain and sensorimotor deficits. The concordance between pain and patient-reported outcomes was not always evident and varied over time, suggesting the need for multidimensional assessments of pain.
Enabling Technologies for Gynecologic Vaginal Surgery
Authors: Balgobin Sunil , Balk Ethan M. , Porter Anne E. , Misal Meenal , Grisales Tamara , Meriwether Kate V. , Jeppson Peter C. , Doyle Paula J. , Aschkenazi Sarit O. , Miranne Jeannine M. , Hobson Deslyn T. , Howard David L. , Mama Saifuddin , Gupta Ankita , Antosh Danielle D. ,   for the Society of Gynecologic Surgeons Systematic Review Group
Published: February 2024

OBJECTIVE:To systematically review the literature to evaluate clinical and surgical outcomes for technologies that facilitate vaginal surgical procedures.DATA SOURCES:We systematically searched MEDLINE, EMBASE, and ClinicalTrials.gov from January 1990 to May 2022.METHODS OF STUDY SELECTION:Comparative and single-arm studies with data on contemporary tools or technologies facilitating intraoperative performance of vaginal gynecologic surgical procedures for benign indications were included. Citations were independently double screened, and eligible full-text articles were extracted by two reviewers. Data collected included study characteristics, technology, patient demographics, and intraoperative and postoperative outcomes. Risk of bias for comparative studies was assessed using established methods, and restricted maximum likelihood model meta-analyses were conducted as indicated.TABULATION, INTEGRATION, AND RESULTS:The search yielded 8,658 abstracts, with 116 eligible studies that evaluated pedicle sealing devices (n=32), nonrobotic and robotic vaginal natural orifice transluminal endoscopic surgery (n=64), suture capture devices (n=17), loop ligatures (n=2), and table-mounted telescopic cameras (n=1). Based on 19 comparative studies, pedicle sealing devices lowered vaginal hysterectomy operative time by 15.9 minutes (95% CI, −23.3 to −85), blood loss by 36.9 mL (95% CI, −56.9 to −17.0), hospital stay by 0.2 days (95% CI, −0.4 to −0.1), and visual analog scale pain scores by 1.4 points on a subjective 10-point scale (95% CI, −1.7 to −1.1). Three nonrandomized comparative studies and 53 single-arm studies supported the feasibility of nonrobotic vaginal natural orifice transluminal endoscopic surgery for hysterectomy, adnexal surgery, pelvic reconstruction, and myomectomy. Data were limited for robotic vaginal natural orifice transluminal endoscopic surgery, suture capture devices, loop ligatures, and table-mounted cameras due to few studies or study heterogeneity.CONCLUSION:Pedicle sealing devices lower operative time and blood loss for vaginal hysterectomy, with modest reductions in hospital stay and pain scores. Although other technologies identified in the literature may have potential to facilitate vaginal surgical procedures and improve outcomes, additional comparative effectiveness research is needed.SYSTEMATIC REVIEW REGISTRATION:PROSPERO, CRD42022327490.
Pilot Trial on Ischemic Conditioning of the Gastric Conduit in Esophageal Cancer: Feasibility and Impact on Anastomotic Leakage (TIGOAL-I)
Authors: Fernández-Moreno María-Carmen , Barrios Carvajal María Eugenia , López Mozos Fernando , Martí Obiol Roberto , Guijarro Rozalén Jorge , Casula Elisabetta , Ortega Joaquín 
Published: February 2024

Objective:
To evaluate the feasibility, safety, and effectiveness of gastric conditioning using preoperative arterial embolization (PAE) before McKeown esophagectomy at a tertiary university hospital.

Background:
Cervical anastomotic leakage (AL) is a common complication of esophagectomy. Limited clinical evidence suggests that gastric conditioning mitigates this risk.

Methods:
This pilot randomized clinical trial was conducted between April 2016 and October 2021 at a single-center tertiary hospital. Eligible patients with resectable malignant esophageal tumors, suitable for cervical esophagogastrostomy, were randomized into 2 groups: one receiving PAE and the other standard treatment. The primary endpoints were PAE-related complications and incidence of cervical AL.

Results:
The study enrolled 40 eligible patients. PAE-related morbidity was 10%, with no Clavien-Dindo grade III complications. Cervical AL rates were similar between the groups (35% vs 25%, P = 0.49), even when conduit necrosis was included (35% vs 35%, P = 1). However, AL severity, including conduit necrosis, was higher in the control group according to the Clavien-Dindo ≥IIIb (5% vs 30%, P = 0.029) and Comprehensive Complication Index (20.9 vs 33.7, P = 0.01). No significant differences were found in other postoperative complications, such as pneumonia or postoperative mortality.

Conclusions:
PAE is a feasible and safe method for gastric conditioning before McKeown minimally invasive esophagectomy and shows promise for preventing severe AL. However, further studies are required to confirm its efficacy.
Associations Between Family-Assessed Quality-of-Dying-and-Death Latent Classes and Bereavement Outcomes for Family Surrogates of ICU Decedents
Authors: Wen Fur-Hsing , Prigerson Holly G. , Hu Tsung-Hui , Huang Chung-Chi , Chou Wen-Chi , Chuang Li-Pang , Chiang Ming Chu , Tang Siew Tzuh 
Published: February 2024

Objectives:
To examine associations between family surrogates’ bereavement outcomes and four previously determined quality of dying and death (QODD) latent classes (high, moderate, poor-to-uncertain, and worst).

Design:
Prospective, longitudinal, observational study.

Setting:
Medical ICUs at two academically affiliated medical centers in Taiwan.

Patients/Participants:
Three hundred nine family surrogates responsible for decision-making for critically ill patients at high risk of death (Acute Physiology and Chronic Health Evaluation II scores > 20) from a disease.

Interventions:
None.

Measurements and Main Results:
Participants were assessed by the depression and anxiety subscales of the Hospital Anxiety and Depression Scale, the Impact of Event Scale-Revised, 11 items of the Prolonged Grief Disorder (PGD) scale, and the Medical Outcomes Study 36-Item Short-Form Health Survey at 1, 3, 6, 13, 18, and 24 months post-loss. We simultaneously examined associations of four QODD latent classes with physical and mental health-related quality of life (HRQOL) and symptoms of anxiety, depression, post-traumatic stress disorder (PTSD), and PGD assessed over 24 bereavement months using multivariate hierarchical linear modeling. Surrogates’ distinct QODD latent classes assessed at 1-month post-loss were significantly associated with bereavement outcomes, except for physical HRQOL and PGD symptoms. Significantly more depressive symptoms and worse mental HRQOL (β [95% CI]) were reported by bereaved surrogates in the moderate (1.958 [1.144–2.772], –2.245 [–3.961 to –0.529]), poor-to-uncertain (2.224 [1.438–3.010], –7.026 [–8.683 to –5.369]), and worst (2.081 [1.215–2.964], –4.268 [–6.096 to –2.440]) QODD classes than those in the high QODD class. Bereaved surrogates in the moderate (2.095 [1.392–2.798]) and poor-to-uncertain (0.801 [0.123–1.480]) QODD classes reported more anxiety symptoms, whereas those in the poor-to-uncertain QODD class suffered more PTSD symptoms (2.889 [1.005–4.774]) than those in the high QODD class.

Conclusions:
The four distinct QODD latent classes were significantly associated with ICU family surrogates’ bereavement outcomes, suggesting targets to improve end-of-life care quality in ICUs.
A fatal outcome due to a continuous dosage of gentamicin: a case report
Authors: Ronda-Roca Gerard , Sancho-López Aránzazu , Ruiz-Antorán Belén , Montero-Hernández Esther , San Martin-Espinosa Alicia 
Published: February 2024

Summary
Gentamicin, an aminoglycoside antibiotic, exerts its bactericidal effect primarily through the inhibition of ribosomes in Gram-negative bacteria. It has a concentration-dependent pharmacodynamic effect, making an extended-interval dosage preferable. The total dose is, therefore, usually administered as a single daily dose instead of divided portions two or three times a day. This dosage has shown an excellent efficacy because an appropriate peak concentration is obtained, whilst the risk of nephrotoxicity is reduced as this is correlated with the residual concentration of gentamicin. In the European Medicines Agencies Summary of Products Characteristics, it is stated that deterioration of kidney function could be expected in 1/10 to 1/100 patients treated with gentamicin. We present a 92-year-old female patient with a weight of 39 kg, history of chronic kidney disease (CKD) and chronic heart failure that presented a fatal nephrotoxicity due to a prescription error of gentamicin.
Giant Cell Tumor of Bone, Rare Inferior Orbit Location
Authors: Garcia Jasmine , Bryson Staci , Mansueto Lisa A. 
Published: February 2024

Summary:
Giant cell tumor of bone (GCTB) typically presents in the epiphysis of long bones and occurs in the skull in less than 1% of cases. When GCTB is diagnosed in the skull, it is primarily seen in the temporal and sphenoid bones. GCTB is an osteoclastic stromal tumor that is locally aggressive and tends to recur. We present a case of a 43-year-old woman with slowly progressive, left-sided proptosis, eyelid swelling, photophobia, epiphora, and pressure sensation. Computed tomography and magnetic resonance imaging revealed an enhancing tumor in the left inferior orbit with infiltration into the maxillary sinus roof. Histological examination was conclusive for a giant cell tumor of the maxillary bone presenting as an inferior orbital mass. Gross total surgical resection was performed via an inferior anterior orbitotomy, and the patient had resolution of symptoms without recurrence in her postoperative course to date. This report contributes to the scarce literature available on this type of tumor of skull bones, specifically presenting the first case in the maxillary bone of the floor of the orbit.
Modeling the Lifetime Impact of Reconstructive Plastic Surgery Training: Implications for Building Capacity in Global Surgery
Authors: Cai Lawrence , Meyers Natalie , Chang James 
Published: February 2024

Background:
Training local surgeons and building local surgical capacity is critical to closing the gap in unmet surgical burden in low- and middle-income country (LMIC) settings. We propose a conceptual framework to quantify the impact of a single surgeon’s training across multiple generations of trainees.

Methods:
A literature review was conducted to identify existing models for quantifying the impact of training. A model to estimate the attributable impact of surgical training was devised, based on a surgeon’s attributable impact on a trainee and the lifetime number of cases trainees would perform. A quantitative survey was sent to high-income country and LMIC-based surgeons to determine the model’s inputs across eight index procedures in reconstructive plastic surgery.

Results:
We found no existing models for quantifying the multigenerational impact of training in surgery, medicine, or nonmedical fields. Twenty-eight US-based academic plastic surgeons and 19 LMIC-based surgeons representing 10 countries provided responses. The lifetime impact of multigenerational surgical training ranged from 4100 attributable cases (skin graft) to 51,900 attributable cases (cleft lip repair) in high-income countries and from 18,200 attributable cases (carpal tunnel release) to 134,300 attributable cases (cleft lip repair) in LMICs.

Conclusions:
There is a sizeable impact in the first generation of training, and this impact is even greater in the second generation of training, highlighting the importance of a “multiplier effect,” particularly in LMIC settings. Given the paucity of surgeons, this multiplier effect is critical in closing the surgical gap, as efforts are underway to train new cohorts of reconstructive plastic surgeons.
Cardiac Rehabilitation Use After Heart Failure Hospitalization Associated With Advanced Heart Failure Center Status
Authors: Thompson Michael P. , Hou Hechuan , Fliegner Max , Guduguntla Vinay , Cascino Thomas , Aaronson Keith D. , Likosky Donald S. , Sukul Devraj , Keteyian Steven J. 
Published: February 2024

Purpose:
Cardiac rehabilitation (CR) is an evidence-based, guideline-endorsed therapy for patients with heart failure with reduced ejection fraction (HFrEF) but is broadly underutilized. Identifying structural factors contributing to increased CR use may inform quality improvement efforts. The objective here was to associate hospitalization at a center providing advanced heart failure (HF) therapies and subsequent CR participation among patients with HFrEF.

Methods:
A retrospective analysis was performed on a 20% sample of Medicare beneficiaries primarily hospitalized with an HFrEF diagnosis between January 2008 and December 2018. Outpatient claims were used to identify CR use (no/yes), days to first session, number of attended sessions, and completion of 36 sessions. The association between advanced HF status (hospitals performing heart transplantation or ventricular assist device implantations) and CR participation was evaluated with logistic regression, accounting for patient, hospital, and regional factors.

Results:
Among 143 392 Medicare beneficiaries, 29 487 (20.6%) were admitted to advanced HF centers (HFCs) and 5317 (3.7%) attended a single CR session within 1 yr of discharge. In multivariable analysis, advanced HFC status was associated with significantly greater relative odds of participating in CR (OR = 2.20: 95% CI, 2.08-2.33; P < .001) and earlier initiation of CR participation (–8.5 d; 95% CI, –12.6 to 4.4; P < .001). Advanced HFC status had little to no association with the intensity of CR participation (number of visits or 36 visit completion).

Conclusions:
Medicare beneficiaries hospitalized for HF were more likely to attend CR after discharge if admitted to an advanced HFC than a nonadvanced HFC.
Deep Learning Models Used in the Diagnostic Workup of Keratoconus: A Systematic Review and Exploratory Meta-Analysis
Authors: Bodmer Nicolas S. , Christensen Dylan G. , Bachmann Lucas M. , Faes Livia , Sanak Frantisek , Iselin Katja , Kaufmann Claude , Thiel Michael A. , Baenninger Philipp B. 
Published: February 2024

Purpose:
The prevalence of keratoconus in the general population is reported to be up to 1 of 84. Over the past 2 decades, diagnosis and management evolved rapidly, but keratoconus screening in clinical practice is still challenging and asks for improving the accuracy of keratoconus detection. Deep learning (DL) offers considerable promise for improving the accuracy and speed of medical imaging interpretation. We establish an inventory of studies conducted with DL algorithms that have attempted to diagnose keratoconus.

Methods:
This systematic review was conducted according to the recommendations of the PRISMA statement. We searched (Pre-)MEDLINE, Embase, Science Citation Index, Conference Proceedings Citation Index, arXiv document server, and Google Scholar from inception to February 18, 2022. We included studies that evaluated the performance of DL algorithms in the diagnosis of keratoconus. The main outcome was diagnostic performance measured as sensitivity and specificity, and the methodological quality of the included studies was assessed using QUADAS-2.

Results:
Searches retrieved 4100 nonduplicate records, and we included 19 studies in the qualitative synthesis and 10 studies in the exploratory meta-analysis. The overall study quality was limited because of poor reporting of patient selection and the use of inadequate reference standards. We found a pooled sensitivity of 97.5% (95% confidence interval, 93.6%–99.0%) and a pooled specificity of 97.2% (95% confidence interval, 85.7%–99.5%) for topography images as input.

Conclusions:
Our systematic review found that the overall diagnostic performance of DL models to detect keratoconus was good, but the methodological quality of included studies was modest.
Pain in Parkinson disease: a deep phenotyping study
Authors: Salabasidou Elena , Binder Tobias , Volkmann Jens , Kuzkina Anastasia , Üçeyler Nurcan 
Published: February 2024

Abstract
In our prospective cross-sectional study, we comprehensively characterized Parkinson disease (PD)–related pain in monocentrically recruited patients with PD using standardized tools of pain assessment and categorization. One hundred fifty patients were systematically interviewed and filled in questionnaires for pain, depression, motor, and nonmotor symptoms. Patients with PD-related pain (PD pain), patients without PD-related pain (no PD pain), and patients without pain (no pain) were compared. Pain was present in 108/150 (72%) patients with PD, and 90/150 (60%) patients were classified as having PD-related pain. Most of the patients with PD (67/90, 74%) reported nociceptive pain, which was episodic (64/90, 71%), primarily nocturnal (56/90, 62%), and manifested as cramps (32/90, 36%). Parkinson disease–related pain was most frequently located in the feet (51/90, 57%), mainly at the toe joints (22/51, 43%). 38/90 (42%) patients with PD-related pain received analgesic medication with nonsteroidal anti-inflammatory drugs being the most frequently used (31/42, 82%) and opioids most effective (70% pain reduction of individual maximum pain intensities, range 22%-100%, confidence interval 50%-90%). All patients received oral PD treatment; however, levodopa equivalent dose showed no correlation with mean pain intensities (Spearman ρ = 0.027, P > 0.05). Our data provide a comprehensive analysis of PD-related pain, giving evidence for mainly non-neuropathic podalgia, which bears the potential to rethink assessment and analgesic treatment of pain in PD in clinical practice.
High-speed imaging of evoked rodent mechanical behaviors yields variable results that are not predictive of inflammatory injury
Authors: Rodríguez García Dianise M. , Szabo Aniko , Mikesell Alexander R. , Zorn Samuel J. , Tsafack Ulrich Kemmo , Sriram Anvitha , Waltz Tyler B. , Enders Jonathan D. , Mecca Christina M. , Stucky Cheryl L. , Sadler Katelyn E. 
Published: February 2024

Abstract
Few analgesics identified using preclinical models have successfully translated to clinical use. These translational limitations may be due to the unidimensional nature of behavioral response measures used to assess rodent nociception. Advances in high-speed videography for pain behavior allow for objective quantification of nuanced aspects of evoked paw withdrawal responses. However, whether videography-based assessments of mechanical hypersensitivity outperform traditional measurement reproducibility is unknown. First, we determined whether high-speed videography of paw withdrawal was reproducible across experimenters. Second, we examined whether this method distinguishes behavioral responses exhibited by naive mice and mice with complete Freund's adjuvant (CFA)-induced inflammation. Twelve experimenters stimulated naive C57BL/6 mice with varying mechanical stimuli. Paw withdrawal responses were recorded with high-speed videography and scored offline by one individual. Our group was unable to replicate the original findings produced by high-speed videography analysis. Surprisingly, ∼80% of variation was not accounted for by variables previously reported to distinguish between responses to innocuous and noxious stimuli (paw height, paw velocity, and pain score), or by additional variables (experimenter, time-of-day, and animal), but rather by unidentified factors. Similar high-speed videography assessments were performed in CFA- and vehicle-treated animals, and the cumulative data failed to reveal an effect of CFA injection on withdrawal as measured by high-speed videography. This study does not support using paw height, velocity, or pain score measurements from high-speed recordings to delineate behavioral responses to innocuous and noxious stimuli. Our group encourages the continued use of traditional mechanical withdrawal assessments until additional high-speed withdrawal measures are validated in established pain models.