bluuebunny/crossref_metadata_2025_split huggingface dataset:
Expanding Medical Education to Include Substance Use Disorders During Pregnancy and Postpartum: Preliminary Effectiveness of a Pilot Curriculum for Medical Students
Authors: Martin Caitlin E. , Martinez Telleria Mariana , Hostetter Kara , Thumma Lillia , Edwards Cherie , Thakkar Bhushan 
Published: January 2024

Objective
To effectively combat the simultaneous overdose and maternal mortality crises, a multimodal approach is needed. The aim of this study is to evaluate the preliminary effectiveness of a pilot, experiential learning, substance use disorder (SUD) curriculum embedded into a third-year medical student obstetrics and gynecology clerkship to improve self-reported confidence in SUD clinical skills.

Methods
This SUD curriculum was designed and implemented in an outpatient clinic, which provides integrated obstetric, gynecologic, and addiction medicine services for pregnant and parenting people with SUD. Third-year medical students on their obstetrics and gynecology clerkship rotated 1 full day through the OB MOTIVATE clinic between August 2020 and April 2022 and completed this curriculum. Students completed preclinic assignments and in-clinic tasks (eg, practicing SBIRT under supervision: screening, brief intervention, referral to treatment). Paired t tests assessed changes in outcomes, with increasing scores (range 1-5) demonstrating improvement.

Results
Sixty-three students rotated through the OB MOTIVATE clinic; 57 completed the curriculum and surveys. Results from the self-assessment tools demonstrated significant improvements in confidence in SUD clinical skills, including performing SBIRT (2.46 ± 0.80 vs 4.07 ± 0.59, P < 0.01), motivational interviewing (2.98 ± 0.86 vs 4.16 ± 0.65, P < 0.01), using evidence-based medicine (2.91 ± 1.09 vs 4.23 ± 0.66, P < 0.01), and collecting an SUD history (3.25 ± 1.04 vs 4.35 ± 0.55, P = 0.01).

Conclusions
The integration of interventional curriculums into medical school and residency programs could be an effective avenue to reinforce addiction knowledge and teach new skills. This practical 1-day pilot curriculum demonstrated preliminary effectiveness at introducing third-year medical students to the complexities of SUD in pregnancy and postpartum. Further investigations of feasible and acceptable SUD educational interventions are warranted.
Topographical Features of Pediatric Electroencephalography during High Initial Concentration Sevoflurane for Inhalational Induction of Anesthesia
Authors: Martin Jessica C. , Liley David T. J. , Beer Christopher F. L. A. , Davidson Andrew J. 
Published: January 2024

Background
High-density electroencephalographic (EEG) monitoring remains underutilized in clinical anesthesia, despite its obvious utility in unraveling the profound physiologic impact of these agents on central nervous system functioning. In school-aged children, the routine practice of rapid induction with high concentrations of inspiratory sevoflurane is commonplace, given its favorable efficacy and tolerance profile. However, few studies investigate topographic EEG during the critical timepoint coinciding with loss of responsiveness—a key moment for anesthesiologists in their everyday practice. The authors hypothesized that high initial sevoflurane inhalation would better precipitate changes in brain regions due to inhomogeneities in maturation across three different age groups compared with gradual stepwise paradigms utilized by other investigators. Knowledge of these changes may inform strategies for agent titration in everyday clinical settings.

Methods
A total of 37 healthy children aged 5 to 10 yr underwent induction with 4% or greater sevoflurane in high-flow oxygen. Perturbations in anesthetic state were investigated in 23 of these children using 64-channel EEG with the Hjorth Laplacian referencing scheme. Topographical maps illustrated absolute, relative, and total band power across three age groups: 5 to 6 yr (n = 7), 7 to 8 yr (n = 8), and 9 to 10 yr (n = 8).

Results
Spectral analysis revealed a large shift in total power driven by increased delta oscillations. Well-described topographic patterns of anesthesia, e.g., frontal predominance, paradoxical beta excitation, and increased slow activity, were evident in the topographic maps. However, there were no statistically significant age-related changes in spectral power observed in a midline electrode subset between the groups when responsiveness was lost compared to the resting state.

Conclusions
High initial concentration sevoflurane induction causes large-scale topographic effects on the pediatric EEG. Within the minute after unresponsiveness, this dosage may perturb EEG activity in children to an extent where age-related differences are not discernible.

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Electroencephalographic Features of Elderly Patients during Anesthesia Induction with Remimazolam: A Substudy of a Randomized Controlled Trial
Authors: Kim Hyoungkyu , Min Byoung-Kyong , Lee UnCheol , Sim Ji-Hoon , Noh Gyu-Jeong , Lee Eun-Kyung , Choi Byung-Moon 
Published: January 2024

Background
Although remimazolam is used as a general anesthetic in elderly patients due to its hemodynamic stability, the electroencephalogram characteristics of remimazolam are not well known. The purpose of this study was to identify the electroencephalographic features of remimazolam-induced unconsciousness in elderly patients and compare them with propofol.

Methods
Remimazolam (n = 26) or propofol (n = 26) were randomly administered for anesthesia induction in surgical patients. The hypnotic agent was blinded only to the patients. During the induction of anesthesia, remimazolam was administered at a rate of 6 mg · kg−1 · h−1, and propofol was administered at a target effect-site concentration of 3.5 μg/ml. The electroencephalogram signals from eight channels (Fp1, Fp2, Fz, F3, F4, Pz, P3, and P4, referenced to A2, using the 10 to 20 system) were acquired during the induction of anesthesia and in the postoperative care unit. Power spectrum analysis was performed, and directed functional connectivity between frontal and parietal regions was evaluated using normalized symbolic transfer entropy. Functional connectivity in unconscious processes induced by remimazolam or propofol was compared with baseline. To compare each power of frequency over time of the two hypnotic agents, a permutation test with t statistic was conducted.

Results
Compared to the baseline in the alpha band, the feedback connectivity decreased by averages of 46% and 43%, respectively, after the loss of consciousness induced by remimazolam and propofol (95% CI for the mean difference: −0.073 to −0.044 for remimazolam [P < 0.001] and −0.068 to −0.042 for propofol [P < 0.001]). Asymmetry in the feedback and feedforward connectivity in the alpha band was suppressed after the loss of consciousness induced by remimazolam and propofol. There were no significant differences in the power of each frequency over time between the two hypnotic agents (minimum q value = 0.4235).

Conclusions
Both regimens showed a greater decrease in feedback connectivity compared to a decrease in feedforward connectivity after loss of consciousness, leading to a disruption of asymmetry between the frontoparietal connectivity.

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Retention of Antibiotic Cement Delivery Implants in Orthopedic Infection Associated with United Fractures Does Not Increase Recurrence Risk
Authors: Ganta Abhishek , Merrell Lauren A. , Adams Jack , Konda Sanjit R. , Egol Kenneth A. 
Published: January 2024

OBJECTIVES:
To evaluate if retention of antibiotic cement delivery devices after resolution of orthopedic infection is associated with recurrence.

METHODS:

Design:
Retrospective Cohort

Setting:
Academic Medical Center

Patient Selection Criteria:
Patients with a fracture definitively treated with internal fixation that went on to unite and developed a confirmed fracture-related infection or osteomyelitis following a remote fracture surgery, and had implantation of antibiotic-impregnated cement for infection management.
Outcome Measures and Comparisons: Patients were divided into whom the antibiotic implants were retained (Retained Cohort), and whom the antibiotic implants were removed (Removed Cohort). Outcome measures included: clinical infection resolution, infection recurrence, time to resolution of infection signs, symptoms and laboratory values, reoperation and readmission rates, need for soft tissue coverage (local flap vs free tissue transfer) due to recurrence.

RESULTS:
Of 98 patients treated for FRI in united fractures or osteomyelitis following a remote fracture surgery, 39 (39.8%) underwent implantation of antibiotic-impregnated cement delivery devices: 21 (21.4%) beads, 7 (7.1%) rods, and 11 (11.2%) blocks. Twenty patients (51.3%) comprised the Retained Cohort and 19 patients (48.7%) comprised the Removed Cohort. There were few differences in demographics ([ASA Score, p=0.026] and [Diabetes, p=0.047]), infection location, and pathogenic profiles. The cohorts demonstrated no difference in eventual resolution of infection (100% in the Retained Cohort, 95% in the Removed Cohort, p=0.487) and experienced similar time to clinical infection resolution, based on signs, symptoms and laboratory values (p=0.360). There was no difference in incidence of subsequent infection recurrence following clinical infection resolution (1 recurrence Retained vs 2 recurrences Removed, p=0.605) for those considered “cured”. Compared to the Retained Cohort, the Removed Cohort underwent more reoperations (0.40 vs 1.84 reoperations, p<0.001) and admissions following implantation (p<0.001).

CONCLUSIONS:
Retention of antibiotic-impregnated cement delivery devices in patients with orthopedic infection following fractured bones that have healed was not associated with infection recurrence. Additional surgical intervention with the sole purpose of removing antibiotic delivery devices may not be warranted.
Health care–related transportation insecurity is associated with adverse health outcomes among adults with chronic liver disease
Authors: Ufere Nneka N. , Lago-Hernandez Carlos , Alejandro-Soto Alysa , Walker Tiana , Li Lucinda , Schoener Kimberly , Keegan Eileen , Gonzalez Carolina , Bethea Emily , Singh Siddharth , El-Jawahri Areej , Nephew Lauren , Jones Patricia , Serper Marina 
Published: January 2024

Background:
Health care–related transportation insecurity (delayed or forgone medical care due to transportation barriers) is being increasingly recognized as a social risk factor affecting health outcomes. We estimated the national burden and adverse outcomes of health care–related transportation insecurity among US adults with chronic liver disease (CLD).

Methods:
Using the U.S. National Health Interview Survey from 2014 to 2018, we identified adults with self-reported CLD. We used complex weighted survey analysis to obtain national estimates of health care–related transportation insecurity. We examined the associations between health care–related transportation insecurity and health care–related financial insecurity, food insecurity, self-reported health status, work productivity, health care use, and mortality.

Results:
Of the 3643 (representing 5.2 million) US adults with CLD, 267 [representing 307,628 (6%; 95% CI: 5%–7%)] reported health care–related transportation insecurity. Adults with CLD experiencing health care–related transportation insecurity had 3.5 times higher odds of cost-related medication nonadherence [aOR, 3.5; (2.4–5.0)], 3.5 times higher odds of food insecurity [aOR, 3.5; (2.4–5.3)], 2.5 times higher odds of worsening self-reported health status over the past year [aOR, 2.5; (1.7–3.7)], 3.1 times higher odds of being unable to work due to poor health over the past year [aOR, 3.1; (2.0–4.9)], and 1.7 times higher odds of being in a higher-risk category group for number of hospitalizations annually [aOR, 1.7; (1.2–2.5)]. Health care–related transportation insecurity was independently associated with mortality after controlling for age, income, insurance status, comorbidity burden, financial insecurity, and food insecurity [aHR, 1.7; (1.4–2.0)].

Conclusions:
Health care–related transportation insecurity is a critical social risk factor that is associated with health care–related financial insecurity, food insecurity, poorer self-reported health status and work productivity, and increased health care use and mortality among US adults with CLD. Efforts to screen for and reduce health care–related transportation insecurity are warranted.
HBV infection effects prognosis and activates the immune response in intrahepatic cholangiocarcinoma
Authors: Li Zhizhen , Gao Qingxiang , Wu Yingjun , Ma Xiaoming , Wu Fangyan , Luan Siyu , Chen Sunrui , Shao Siyuan , Shen Yang , Zhang Ding , Feng Feiling , Yuan Lei , Wei Shaohua 
Published: January 2024

Background:
The impact of HBV infection on the prognosis of patients with intrahepatic cholangiocarcinoma (ICC) remains uncertain, and the underlying mechanism has not been elucidated. This study aims to explore the potential mechanism via clinical perspectives and immune features.

Methods:
We retrospectively reviewed 1308 patients with ICC treated surgically from January 2007 to January 2015. Then, we compared immune-related markers using immunohistochemistry staining to obtain the gene expression profile GSE107943 and related literature for preliminary bioinformatics analysis. Subsequently, we conducted a drug sensitivity assay to validate the role of TNFSF9 in the ICC organoid-autologous immune cell coculture system and in the patient-derived organoids–based xenograft platform.

Results:
The analysis revealed that tumors in patients without HBV infection exhibited greater size and a higher likelihood of lymphatic metastasis, tumor invasion, and relapse. After resection, HBV-infected patients had longer survival time than uninfected patients (p<0.01). Interestingly, the expression of immune-related markers in HBV-positive patients with ICC was higher than that in uninfected patients (p<0.01). The percentage of CD8+ T cells in HBV-positive tissue was higher than that without HBV infection (p<0.05). We screened 21 differentially expressed genes and investigated the function of TNFSF9 through bioinformatics analyses. The expression of TNFSF9 in ICC organoids with HBV infection was lower than that in organoids without HBV infection. The growth of HBV-negative ICC organoids was significantly inhibited by inhibiting the expression of TNFSF9 with a neutralizing antibody. Additionally, the growth rate was faster in HbsAg (−) ICC patient-derived organoids–based xenograft model than in HbsAg (+) group.

Conclusions:
The activation of the immune response induced by HBV infection makes the prognosis of HBV-positive patients with ICC differ from that of uninfected patients.
Preserflo MicroShunt: Efficacy and Endothelial Cell Density
Authors: Anton Steindor Friedrich , Trigaux Céline , Holtmann Christoph , Spaniol Kristina , Geerling Gerd , Borrelli Maria 
Published: January 2024

Précis:
A main safety concern associated with new glaucoma implants is corneal endothelial cell loss, which could even be observed in already established procedures.

Purpose:
The purpose of this study was to evaluate the efficacy and corneal safety, especially corneal endothelial cell loss (ECL), after Preserflo MicroShunt implantation.

Methods:
A monocentric, prospective clinical observational study of patients with a follow-up of at least 12 months who underwent Preserflo MicroShunt implantation at the Department of Ophthalmology, University Hospital of Düsseldorf, Germany, between January 2020 and October 2021. Endothelial cell density (ECD), the distance between the tip of the implant and the corneal endothelium, and the success of the surgery were analyzed.

Results:
In total, 14 eyes of 12 patients were included. After a mean follow-up of 20±2.7 months intraocular pressure was significantly reduced by 8.2 mm Hg (P=0.0041); in 28.6% of patients, a revision surgery was necessary. Reduction of preoperative and follow-up ECD was not statistically significant (ECL of 45 cells/mm2, ECDpreoperative=2074±703.6 cells/mm2, ECDlast follow-up=2029±742.3 cells/mm2, P=0.42). A longer intracameral shunt tube length correlated significantly with a higher distance between the shunt tip and corneal endothelium (r=0.61, P=0.036).

Conclusions:
Preserflo MicroShunt effectively lowered intraocular pressure without substantial ECL after a minimum follow-up period of 17 months.
Air pollution as a potential risk factor for hepatocellular carcinoma in Taiwanese patients after adjusting for chronic viral hepatitis
Authors: Jang Tyng-Yuan , Ho Chi-Chang , Wu Chih-Da , Dai Chia-Yen , Chen Pau-Chung 
Published: January 2024

Background:
Air pollution is a risk factor for hepatocellular carcinoma (HCC). However, the effect of air pollution on HCC risk in patients with hepatitis remains unclear.

Methods:
This cross-sectional study recruited 348 patients with chronic hepatitis who were tested for serum hepatitis B surface antigen (HBsAg) and for antibodies against hepatitis B core antigen (HBcIgG) and hepatitis C virus (anti-HCV) in 2022. The diagnosis of HCC was based on the International Classification of Diseases, 10th revision (ICD-10). Daily estimates of air pollutants were aggregated into mean estimates for the previous year based on the date of recruitment or HCC diagnosis.

Results:
Out of 348 patients, 12 had HCC (3.4%). Patients with HCC were older (71.7 vs 50.9 years; p = 0.004), had higher proportion of HBsAg seropositivity (41.7% vs 5.1%; p < 0.001), and substantially higher levels of particulate matter 2.5 (PM2.5) (21.5 vs 18.2 μg/m3; p = 0.05). Logistic regression analysis revealed that the factors associated with HCC were age (odds ratio [OR]: 1.10; CI, 1.03-1.17; p = 0.01), PM2.5 level (OR: 1.51; CI, 1.02-2.23; p = 0.04), and HBsAg seropositivity (OR: 6.60; CI, 1.51-28.85; p = 0.01) (Table 3). There was a combined effect of PM2.5 and HBsAg seropositivity on the risk of HCC development (OR: 22.17; CI, 3.33-147.45; p = 0.001).

Conclusion:
In this study, we demonstrated that PM2.5 and HBsAg seropositivity were associated with HCC occurrence and had synergistic effects after adjusting for confounding factors.
Cost-Effectiveness of Diffusion-Weighted Magnetic Resonance Imaging Versus Second-Look Surgery in Treating Cholesteatoma: A Modeling Study
Authors: Bu Daniel D. , Schwam Zachary G. , Wanna George B. , Perez Enrique , Cosetti Maura K. 
Published: January 2024

Objective
To evaluate whether canal wall-up (CWU) tympanomastoidectomy with diffusion-weighted magnetic resonance imaging (DW-MRI) is a cost-effective method of treating cholesteatoma compared with CWU with second-look surgery.

Design and Setting
Cost-effectiveness analysis was conducted using a Markov state transition model. The simulation model adhered to the Panel Recommendations on Cost-Effectiveness in Health and Medicine established by the US Public Health Service. One-way and Monte Carlo probability sensitivity analyses were conducted for validation.

Interventions
Tympanomastoidectomy with DW-MRI versus tympanomastoidectomy with second-look surgery.

Main Outcome Measures
Effectiveness and health utility were measured using quality-adjusted life years (QALYs). Costs were derived from Medicare reimbursement using the perspective of the payer. Probabilities for outcomes and complications were taken from existing literature. Cost-effectiveness was assessed using the incremental cost-effectiveness ratio.

Results
With base case analysis, the total cost was $15,069 when treated with CWU and second-look surgery versus $13,126 when treated with CWU and DW-MRI. The second-look treatment pathway yielded 17.05 QALYs, whereas the DW-MRI pathway yielded 16.91 QALYs in terms of health benefit accrued across the lifetime of the patient. The cost-effectiveness incremental cost-effectiveness ratio was $21,800/QALY. Using the conventional $50,000 willingness-to-pay threshold, second-look surgery was the more cost-effective approach 63.7% of the time by simulation.

Conclusions
Both treatment pathways were found to be cost-effective, with second-look surgery incrementally cost-effective 63.7% of the time. Assumptions were validated by one-way and Monte Carlo probability sensitivity analysis.

Professional Practice Gap and Educational Need
There is ample variation in treatment pathways regarding usage of DW-MRI and second-look surgery for cholesteatoma.

Learning Objective
To evaluate the cost-effectiveness of DW-MRI and second-look surgery approaches, accounting for health-related quality-of-life outcomes and costs for the duration of the patient lifetimes.

Desired Result
To inform the discussion on the treatment for cholesteatoma given emergent noninvasive technologies.

Level of Evidence: Level III.

Indicate IRB or IACUC: Exempt.
Combining Intraoperative Electrocochleography with Robotics-Assisted Electrode Array Insertion
Authors: Kashani Rustin G. , Kocharyan Armine , Bennion Douglas M. , Scheperle Rachel A. , Etler Christine , Oleson Jacob , Dunn Camille C. , Claussen Alexander D. , Gantz Bruce J. , Hansen Marlan R. 
Published: January 2024

Objective
To describe the use of robotics-assisted electrode array (EA) insertion combined with intraoperative electrocochleography (ECochG) in hearing preservation cochlear implant surgery.

Study Design
Prospective, single-arm, open-label study.

Setting
All procedures and data collection were performed at a single tertiary referral center.

Patients
Twenty-one postlingually deaf adult subjects meeting Food and Drug Administration indication criteria for cochlear implantation with residual acoustic hearing defined as thresholds no worse than 65 dB at 125, 250, and 500 Hz.

Intervention
All patients underwent standard-of-care unilateral cochlear implant surgery using a single-use robotics-assisted EA insertion device and concurrent intraoperative ECochG.

Main Outcome Measures
Postoperative pure-tone average over 125, 250, and 500 Hz measured at initial activation and subsequent intervals up to 1 year afterward.

Results
Twenty-two EAs were implanted with a single-use robotics-assisted insertion device and simultaneous intraoperative ECochG. Fine control over robotic insertion kinetics could be applied in response to changes in ECochG signal. Patients had stable pure-tone averages after activation with normal impedance and neural telemetry responses.

Conclusions
Combining robotics-assisted EA insertion with intraoperative ECochG is a feasible technique when performing hearing preservation implant surgery. This combined approach may provide the surgeon a means to overcome the limitations of manual insertion and respond to cochlear feedback in real-time.