bluuebunny/crossref_metadata_2025_split huggingface dataset:
Core decompression combined with platelet-rich plasma-augmented bone grafting for femur head necrosis: a systematic review and meta-analysis
Authors: Zhu Bo , Li Jianmin , Li Xuejia , Feng Shengyi , Li Bo 
Published: January 2024

Background:
The clinical potential of biologic augmentation in core decompression and bone grafting for femoral head necrosis is widely acknowledged, with platelet-rich plasma (PRP) being a frequently employed biologic adjunct. However, its clinical application is not standardized, and high-level evidence is lacking. This study aimed to evaluate the efficacy and safety of core decompression and bone grafting combined with PRP for femur head necrosis.

Methods:
Several databases were systematically retrieved for randomized controlled trials comparing core decompression and bone grafting combined with or without PRP. A systematic review and meta-analysis were conducted following the PRISMA 2020 and AMSTAR 2 guidelines. The study is registered with PROSPERO under the code CRD42022361007, and it is also listed in the research registry under the identification number reviewregistry1537.

Results:
Eleven studies with 642 participants (742 hips) were included. The pooled estimates revealed that when core decompression and bone grafting were combined with PRP, the Harris hip score (mean difference: 7.98; 95% CI: 5.77–10.20; P<0.001), visual analog scale (SMD: −0.68; 95% CI: −0.96 – −0.40; P<0.001) and the pain component of Harris hip score (SMD: 8.4; 95% CI: 4.12–12.68; P<0.001), and reduction of radiographic progression [risk ratio (RR): 0.40; 95% CI: 0.27–0.59; P<0.001] were superior to core decompression and bone grafting alone. Fewer patients with treatment failure (RR: 0.27; 95% CI: 0.14–0.52; P<0.001) and higher good-to-excellent results (RR: 1.48; 95% CI: 1.17–1.86; P<0.001) were observed in treatment groups than control groups. Meanwhile, the pooled analysis substantiated the superior safety profile of PRP (RR: 0.29; 95% CI: 0.11–0.77; P=0.01).

Conclusions:
The combination of core decompression and bone grafting with PRP is superior to the approach without PRP, demonstrating enhanced effectiveness in terms of function, pain relief, and radiographic progression. Additionally, it results in lower rates of treatment failure and adverse events. However, further high-quality RCTs are needed to evaluate their effectiveness due to methodological and implementation limitations observed in the existing evidence.
Nutritional management during critical illness in those with previous obesity surgery
Authors: Correia Maria Isabel Toulson Davisson , Rosenfeld Ricardo Schilling 
Published: January 2024

Purpose of review
The prevalence of overweight and obesity in our society is a pressing concern that has demanded immediate attention. Traditional treatments have proven ineffective for many individuals, leading to a surge in bariatric surgery as a last resort. While the rate of early and late postoperative complications may be low, when they occur, they place these patients at higher risk of requiring intensive care treatment. Therefore, it is our aim to discuss the nutritional care of these individuals.

Recent findings
Nutritional management of critically ill postbariatric surgical patients is related to the difficulty of providing an adequate nutritional assessment, calculating the macro and micronutrient requirements, choosing the right therapy, and defining the timely moment to initiate it. The anatomic changes related to the bariatric operation pose a high risk for a nonfunctional gastrointestinal tract both in the early postoperative and late postoperative. Therefore, the route of nutrition will greatly rely on the absorptive capacity, as well as on the nutritional status, with parenteral nutrition being an early option, especially for those with high critical care severity scores. Also, these patients are known to have an altered microbiota which may influence the absorptive capacity. Immunonutrition, prebiotics, probiotics, and symbiotics may represent potential options, but there is currently little support for ‘one size fits all’.

Summary
The nutritional care of critically ill patients postbariatric surgery is a complex and nuanced process requiring a multifaceted precision approach. The distinct nutritional challenges of early and late postoperative patients necessitate a thorough nutritional assessment and a highly individualized nutritional care plan.
Predictors and impact of aspiration pneumonia in patients undergoing esophagogastroduodenoscopy: national inpatient sample 2016–2020
Authors: Patel Jay , Sohal Aalam , Chaudhry Hunza , Kalra Shivam , Kohli Isha , Singh Ishandeep , Dukovic Dino , Yang Juliana 
Published: January 2024

Objectives
Aspiration pneumonia is a rare but feared complication among patients undergoing esophagogastroduodenoscopy (EGD). Our study aims to assess the incidence as well as risk factors for aspiration pneumonia in patients undergoing EGD.

Methods
National Inpatient Sample 2016–2020 was used to identify adult patients undergoing EGD. Patients were stratified into two groups based on the presence of aspiration pneumonia. Multivariate logistic regression analysis was performed to identify the risk factors associated with aspiration pneumonia. We adjusted for patient demographics, Elixhauser comorbidities and hospital characteristics.

Results
Of the 1.8 million patients undergoing EGD, 1.9% of the patients developed aspiration pneumonia. Patients with aspiration pneumonia were mostly males (59.54%), aged >65 years old (66.19%), White (72.2%), had Medicare insurance (70.5%) and were in the lowest income quartile (28.7%). On multivariate analysis, the age >65 group, White race, congestive heart failure (CHF), neurological disorders and chronic obstructive pulmonary disease were associated with higher odds of aspiration pneumonia. This complication was associated with higher in-hospital mortality (9% vs. 0.8%; P < 0.001) and longer length of stay (10.54 days vs. 4.85 days; P < 0.001).

Conclusion
Our study found that rates of post-EGD aspiration pneumonia are increasing. We found a significant association between various comorbidities and aspiration pneumonia. Our data suggests that we need to optimize these patients before EGD, as the development of aspiration is associated with worsened outcomes. Further prospective studies are needed to clarify these associations.
Beyond Hospital-Level Aggregated Data
Authors: Yang Christine , Kuebeler Mark K. , Jiang Rebecca , Knox Melissa K. , Wong Janine J. , Mehta Paras D. , Dorsey Lynette E. , Petersen Laura A. 
Published: January 2024

Background:
Studies of nurse staffing frequently use data aggregated at the hospital level that do not provide the appropriate context to inform unit-level decisions, such as nurse staffing.

Objectives:
Describe a method to link patient data collected during the provision of routine care and recorded in the electronic health record (EHR) to the nursing units where care occurred in a national dataset.

Research Design:
We identified all Veterans Health Administration acute care hospitalizations in the calendar year 2019 nationwide. We linked patient-level EHR and bar code medication administration data to nursing units using a crosswalk. We divided hospitalizations into segments based on the patient’s time-stamped location (ward stays). We calculated the number of ward stays and medication administrations linked to a nursing unit and the unit-level and facility-level mean patient risk scores.

Results:
We extracted data on 1117 nursing units, 3782 EHR patient locations associated with 1,137,391 ward stays, and 67,772 bar code medication administration locations associated with 147,686,996 medication administrations across 125 Veterans Health Administration facilities. We linked 89.46% of ward stays and 93.10% of medication administrations to a nursing unit. The average (standard deviation) unit-level patient severity across all facilities is 4.71 (1.52), versus 4.53 (0.88) at the facility level.

Conclusions:
Identification of units is indispensable for using EHR data to understand unit-level phenomena in nursing research and can provide the context-specific information needed by managers making frontline decisions about staffing.
Greater accuracy of radiomics compared to deep learning to discriminate normal subjects from patients with dementia: a whole brain 18FDG PET analysis
Authors: Bestetti Alberto , Calabrese Luigi , Parini Vincenzo , Fornara Carla 
Published: January 2024

Objective FDG PET imaging plays a crucial role in the evaluation of demented patients by assessing regional cerebral glucose metabolism. In recent years, both radiomics and deep learning techniques have emerged as powerful tools for extracting valuable information from medical images. This article aims to provide a comparative analysis of Radiomics and 3D-deep learning (CNN) approaches in the evaluation of 18F-FDG PET whole-brain images in patients with dementia and normal controls.

Methods
18F-FDG brain PET and clinical score were collected in 85 patients with dementia and 125 healthy controls (HC). Patients were assigned to various form of dementia on the basis of clinical evaluation, follow-up and voxels comparison with HC using a two-sample Student’s t-test, to determine the regions of brain involved. Radiomic analysis was performed on the whole brain after normalization to an optimized template. After feature selection using the minimum redundancy maximum relevance method and Pearson’s correlation coefficients, a Neural Network model was tested to find the accuracy to classify HC and demented patients. Twenty subjects not included in the training were used to test the models. The results were compared with those obtained by conventional CNN model.

Results
Four radiomic features were selected. The validation and test accuracies were 100% for both models, but the probability scores were higher with radiomics, in particular for HC group (P = 0.0004).

Conclusion
Radiomic features extracted from standardized PET whole brain images seem to be more accurate than CNN to distinguish patients with and without dementia.
Road map to small bowel endoscopy quality indicators
Authors: Shiha Mohamed G. , Sanders David S. , Sidhu Reena 
Published: January 2024

Purpose of review
Quality indicators for upper and lower gastrointestinal endoscopy are well established and linked to patient outcomes. However, there is a perceived gap in the development and implementation of quality indicators for small bowel endoscopy. In this review, we aimed to discuss the development of quality indicators in small bowel endoscopy and their implementation in clinical practice.

Recent findings
The proposed quality indicators for small bowel endoscopy focus on process measures, which mainly evaluate the procedural aspects, rather than the outcomes or the overall patient experience. These quality indicators have rarely been studied in clinical practice, leading to a limited understanding of their applicability and impact on patient outcomes and experience.

Summary
Real-world studies evaluating the quality indicators of small bowel endoscopy are warranted to establish an evidence-based framework for their practical application and effectiveness. Linking these indicators to relevant patient outcomes is crucial for their broader acceptance and implementation.
Interleukin 6 Levels and Disease Activity in Takayasu Arteritis
Authors: Souza Pedreira Ana Luisa , Leite de Castro Flores Marília , Barreto Santiago Mittermayer 
Published: January 2024

Background
Various studies have suggested interleukin 6 (IL-6) as a potential biomarker for detecting disease activity in Takayasu arteritis.

Methods
A systematic review and meta-analysis was performed to assess differences in IL-6 levels in patients with active (aTA) and inactive Takayasu arteritis (iTA), as well as healthy controls (HCs), using validated activity scores. Study quality and the risk of bias were assessed using STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) and the Newcastle-Ottawa and Joanna Briggs checklist, respectively. For the meta-analysis, we pooled the raw mean IL-6 levels in each group and then estimated and pooled the crude mean differences between the groups. We applied a random-effects model in all analyses.

Results
Of the 93 eligible articles, 10 were included after removing duplicates and studies that met the exclusion criteria. Overall, 1825 patients with a mean age ranging from 24 to 40.6 years were included. The pooled levels of IL-6 increased depending on disease activity as follows: HCs: 3.08 (95% confidence interval [CI], 0.88–5.28), iTA: 7.21 (3.61–10.82), and aTA: 22.67 (12.44–32.91) pg/mL. Patients with aTA had higher IL-6 levels than HCs (21.52 [95% CI, −0.43 to 43.47]) and those with iTA (16.69 [95% CI, 5.32–28.06]), whereas IL-6 levels were not different between HCs and patients with iTA (3.62 [95% CI, −13.18 to 20.42]).

Conclusions
Interleukin 6 levels are significantly increased in patients with aTA compared with those with iTA and HCs but not in patients with iTA compared with HCs. More studies are needed to establish the IL-6 cutoff value for assessing disease activity.
Chronic Nonbacterial Osteomyelitis Associated With Familial Mediterranean Fever in Children
Authors: Karaçayir Nihal , Tunçez Şerife , Öner Nimet , Çelikel Elif , Bağlan Esra , Gezgin-Yildirim Deniz , Bakkaloğlu Sevcan A. 
Published: January 2024

Objective
Chronic nonbacterial osteomyelitis (CNO) is a noninfectious autoinflammatory bone condition that frequently occurs alongside other inflammatory diseases, such as familial Mediterranean fever (FMF). We aimed to determine the demographic, clinical, laboratory, and radiological characteristics of patients diagnosed with both FMF and CNO.

Methods
We reviewed the medical records of pediatric patients with both CNO and FMF at 3 pediatric rheumatology centers in Turkey from December 2008 to 2022. Patients' demographics, laboratory features, imaging findings, and treatment were recorded.

Results
Twelve patients with FMF and CNO were included in the study. Half of them were girls. The mean ages at onset for FMF and CNO symptoms were 80 and 116 months, whereas the ages at diagnosis for FMF and CNO were 100 and 125 months, respectively. Ten patients (83.3%) had M694V mutation on at least 1 allele of the Mediterranean fever (MEFV) gene. The most common sites of osteitis were the long bones (58.3%), pelvis (50%), and clavicles (25%). Ten patients (83%) received nonsteroidal anti-inflammatory drugs; 8 (66%) received disease-modifying antirheumatic drugs; biological therapy was administered to 5 patients (41%), who did not respond to these treatments; and all patients received colchicine.

Conclusion
The increased frequency of FMF in patients with CNO is of interest. Because most patients with CNO and FMF carried a homozygous or combined heterozygous M694V mutation, we speculated that the M694V mutation may play a role in the development of osteitis. Further studies are needed to elucidate the link between FMF and CNO.
Laparoscopic Median Arcuate Ligament Release: Surgical Technique and Clinical Outcomes
Authors: Belluzzi Amanda , Salame Marita , Abi Mosleh Kamal , Rasmussen Todd E. , Kendrick Michael L. , Ghanem Omar M. 
Published: January 2024

Background:
Median arcuate ligament syndrome (MALS) is characterized by a constellation of symptoms related to the compression of the celiac artery trunk. Laparoscopic release of the ligament has demonstrated its effectiveness in alleviating these symptoms while showing lower postoperative complication rates, reduced hospital stays, and improved clinical outcomes. This study describes a single institution’s experience with this procedure and reports on the preoperative assessment, surgical technique, and clinical outcomes of patients with MALS.

Methods:
We performed a retrospective chart review of all patients who underwent a primary laparoscopic MAL release (MALR) at a single high-volume academic institution from June 2021 to July 2023. Patient demographics, preoperative assessment, postoperative complications, and resolution of preoperative symptoms data were collected.

Results:
A total of 30 patients underwent laparoscopic MALR, with 76.7% being female and a mean age of 33.4±16.3 years. The most common presenting symptom was postprandial epigastric pain (100%), followed by abdominal pain and nausea (83.3%), among others. The preoperative evaluation for all patients included a duplex mesenteric doppler and CT angiogram during inspiration and expiration and 3D reconstruction. Successful laparoscopic decompression of the celiac artery was achieved in 96.6% of cases, with only one conversion to an open procedure. There was only one reported early (<30 d postoperatively) complication with no subsequent late complications or mortality. None of the patients required reintervention or reoperation. Only 1 patient required postoperative celiac plexus/splanchnic block injection to alleviate pain.

Conclusions:
MALS can be effectively and safely managed using a laparoscopic approach when performed by an experienced minimally invasive surgeon. Further studies with longer follow-ups are needed to confirm the long-term effectiveness of this technique.
Faster refill in an urban emergency medical services system saves lives: A prospective preliminary evaluation of a prehospital advanced resuscitative care bundle
Authors: Broome Jacob M. , Nordham Kristen D. , Piehl Mark , Tatum Danielle , Caputo Sydney , Belding Cameron , De Maio Valerie J. , Taghavi Sharven , Jackson-Weaver Olan , Harris Charlie , McGrew Patrick , Smith Alison , Nichols Emily , Dransfield Thomas , Rayburn David , Marino Megan , Avegno Jennifer , Duchesne Juan 
Published: January 2024

INTRODUCTION
Military experience has demonstrated mortality improvement when advanced resuscitative care (ARC) is provided for trauma patients with severe hemorrhage. The benefits of ARC for trauma in civilian emergency medical services (EMS) systems with short transport intervals are still unknown. We hypothesized that ARC implementation in an urban EMS system would reduce in-hospital mortality.

METHODS
This was a prospective analysis of ARC bundle administration between 2021 and 2023 in an urban EMS system with 70,000 annual responses. The ARC bundle consisted of calcium, tranexamic acid, and packed red blood cells via a rapid infuser. Advanced resuscitative care patients were compared with trauma registry controls from 2016 to 2019. Included were patients with a penetrating injury and systolic blood pressure ≤90 mm Hg. Excluded were isolated head trauma or prehospital cardiac arrest. In-hospital mortality was the primary outcome of interest.

RESULTS
A total of 210 patients (ARC, 61; controls, 149) met the criteria. The median age was 32 years, with no difference in demographics, initial systolic blood pressure or heart rate recorded by EMS, or New Injury Severity Score between groups. At hospital arrival, ARC patients had lower median heart rate and shock index than controls (p ≤ 0.03). Fewer patients in the ARC group required prehospital advanced airway placement (p < 0.001). Twenty-four-hour and total in-hospital mortality were lower in the ARC group (p ≤ 0.04). Multivariable regression revealed an independent reduction in in-hospital mortality with ARC (odds ratio, 0.19; 95% confidence interval, 0.05–0.68; p = 0.01).

CONCLUSION
Early ARC in a fast-paced urban EMS system is achievable and may improve physiologic derangements while decreasing patient mortality. Advanced resuscitative care closer to the point of injury warrants consideration.

LEVEL OF EVIDENCE
Therapeutic/Care Management; Level IV.
ROBOtic Care Outcomes Project (ROBOCOP) for Acute Gallbladder Pathology
Authors: Greenberg Shannon , Assali Marc Abou , Li Yanli , Bossie Hannah , Neighorn Chris , Wu Esther , Mukherjee Kaushik 
Published: January 2024

Abstract

Background
Robotic cholecystectomy is being increasingly used for patients with acute gallbladder disease who present to emergency department, but clinical evidence is limited. We aimed to compare the outcomes of emergent laparoscopic and robotic cholecystectomies in a large real-world database.

Methods
Patients who received emergent laparoscopic or robotic cholecystectomies from 2020 to 2022 were identified from the Intuitive Custom Hospital Analytics database, based on de-identified extraction of electronic health record data from US hospitals. Conversion to open or subtotal cholecystectomy and complications were defined using ICD10 and/or CPT codes. Multivariate logistic regression with inverse probability treatment weighting (IPTW) was performed to compare clinical outcomes of laparoscopic versus robotic approach after balancing covariates. Cost analysis was performed with activity-based costing and adjustment for inflation.

Results
Of 26,786 laparoscopic and 3,151 robotic emergent cholecystectomy patients being included, 64% were female, 60% were ≥ 45 years, and 24% were obese. Approximately 5.5% patients presented with pancreatitis, and 4% each presenting with sepsis and biliary obstruction. After IPTW, distributions of all baseline covariates were balanced. Robotic cholecystectomy decreased odds of conversion to open (OR 0.68 [95%CI 0.49, 0.93, p = 0.035]), but increased odds of subtotal cholecystectomy (OR 1.64 [95% CI 1.03, 2.60, p = 0.037]). Surgical site infection, readmission, length of stay, hospital acquired conditions, bile duct injury or leak, and hospital mortality were similar in both groups. There was no significant difference in hospital cost.

Conclusions
Robotic cholecystectomy has reduced odds of conversion to open and comparable complications, but increased odds of subtotal cholecystectomy compared to laparoscopic cholecystectomy for acute gallbladder diseases. Further work is required to assess the long-term implications of these differences.

Level of Evidence
III, Therapeutic/Care Management Case-Control (Retrospective)