bluuebunny/crossref_metadata_2025_split huggingface dataset:
Brief Assessment of Patient Phenotype to Explain Variability in Postsurgical Pain and Opioid Consumption after Cesarean Delivery: Performance of a Novel Brief Questionnaire Compared to Long Questionnaires
Authors: He Jingui , Wilson Jenna M. , Fields Kara G. , Zachos K. Mikayla Flowers , Franqueiro Angelina R. , Reale Sharon C. , Farber Michaela K. , Bateman Brian T. , Edwards Robert R. , Rathmell James P. , Soens Mieke , Schreiber Kristin L. 
Published: January 2024

Background
Understanding factors that explain why some women experience greater postoperative pain and consume more opioids after cesarean delivery is crucial to building an evidence base for personalized prevention. Comprehensive psychosocial assessment with validated questionnaires in the preoperative period can be time-consuming. A three-item questionnaire has shown promise as a simpler tool to be integrated into clinical practice, but its brevity may limit the ability to explain heterogeneity in psychosocial pain modulators among individuals. This study compared the explanatory ability of three models: (1) the 3-item questionnaire, (2) a 58-item questionnaire (long) including validated questionnaires (e.g., Brief Pain Inventory, Patient Reported Outcome Measurement Information System [PROMIS]) plus the 3-item questionnaire, and (3) a novel 19-item questionnaire (brief) assessing several psychosocial factors plus the 3-item questionnaire. Additionally, this study explored the utility of adding a pragmatic quantitative sensory test to models.

Methods
In this prospective, observational study, 545 women undergoing cesarean delivery completed questionnaires presurgery. Pain during local anesthetic skin wheal before spinal placement served as a pragmatic quantitative sensory test. Postoperatively, pain and opioid consumption were assessed. Linear regression analysis assessed model fit and the association of model items with pain and opioid consumption during the 48 h after surgery.

Results
A modest amount of variability was explained by each of the three models for postoperative pain and opioid consumption. Both the brief and long questionnaire models performed better than the three-item questionnaire but were themselves statistically indistinguishable. Items that were independently associated with pain and opioid consumption included anticipated postsurgical pain medication requirement, surgical anxiety, poor sleep, pre-existing pain, and catastrophic thinking about pain. The quantitative sensory test was itself independently associated with pain across models but only modestly improved models for postoperative pain.

Conclusions
The brief questionnaire may be more clinically feasible than longer validated questionnaires, while still performing better and integrating a more comprehensive psychosocial assessment than the three-item questionnaire.

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What This Article Tells Us That Is New
Influence of Fractional Inspired Oxygen Tension on Lung Perfusion Distribution, Regional Ventilation, and Lung Volume during Mechanical Ventilation of Supine Healthy Swine
Authors: Ribeiro Bruno M. , Tucci Mauro R. , Victor Júnior Marcus H. , Melo Jose R. , Gomes Susimeire , Nakamura Maria A. M. , Morais Caio C. A. , Beraldo Marcelo A. , Lima Cristhiano A. S. , Alcala Glasiele C. , Amato Marcelo B. P. 
Published: January 2024

Background
Lower fractional inspired oxygen tension (Fio2
) during general anesthesia can reduce lung atelectasis. The objectives are to evaluate the effect of two Fio2
(0.4 and 1) during low positive end-expiratory pressure (PEEP) ventilation over lung perfusion distribution, volume, and regional ventilation. These variables were evaluated at two PEEP levels and unilateral lung atelectasis.

Methods
In this exploratory study, 10 healthy female piglets (32.3 ± 3.4 kg) underwent mechanical ventilation in two atelectasis models: (1) bilateral gravitational atelectasis (n = 6), induced by changes in PEEP and Fio2
in three combinations: high PEEP with low Fio2
(Fio2
= 0.4), zero PEEP (PEEP0) with low Fio2
(Fio2
= 0.4), and PEEP0 with high Fio2
(Fio2
= 1); and (2) unilateral atelectasis (n = 6), induced by left bronchial occlusion, with the left lung aerated (Fio2
= 0.21) and low aerated (Fio2
= 1; n = 5 for this step). Measurements were conducted after 10 min in each step, encompassing assessment of respiratory mechanics, oxygenation, and hemodynamics; lung ventilation and perfusion by electrical impedance tomography; and lung aeration and perfusion by computed tomography.

Results
During bilateral gravitational atelectasis, PEEP reduction increased atelectasis in dorsal regions, decreased respiratory compliance, and distributed lung ventilation to ventral regions with a parallel shift of perfusion to the same areas. With PEEP0, there were no differences between low and high Fio2
in respiratory compliance (23.9 ± 6.5 ml/cm H2O vs. 21.9 ± 5.0; P = 0.441), regional ventilation, and regional perfusion, despite higher lung collapse (18.6 ± 7.6% vs. 32.7 ± 14.5%; P = 0.045) with high Fio2
. During unilateral lung atelectasis, the deaerated lung had a lower shunt (19.3 ± 3.6% vs. 25.3 ± 5.5%; P = 0.045) and lower computed tomography perfusion to the left lung (8.8 ± 1.8% vs. 23.8 ± 7.1%; P = 0.007).

Conclusions
PEEP0 with low Fio2
, compared with high Fio2
, did not produce significant changes in respiratory system compliance, regional lung ventilation, and perfusion despite significantly lower lung collapse. After left bronchial occlusion, the shrinkage of the parenchyma with Fio2
= 1 enhanced hypoxic pulmonary vasoconstriction, reducing intrapulmonary shunt and perfusion of the nonventilated areas.

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Glycemic Variability As a Prognostic Factor for Mortality in Patients With Critical Illness: A Systematic Review and Meta-Analysis
Authors: Hryciw Brett N. , Ghossein Jamie , Rochwerg Bram , Meggison Hilary , Fernando Shannon M. , Kyeremanteng Kwadwo , Tran Alexandre , Seely Andrew J. E. 
Published: January 2024

OBJECTIVES:
To perform a systematic review and meta-analysis to evaluate the association of various measures of glycemic variability, including time-domain and complexity-domain, with short-term mortality in patients with critical illness.

DATA SOURCES:
We searched Embase Classic +, MEDLINE, and the Cochrane Database of Systematic Reviews from inception to November 3, 2023.

STUDY SELECTION:
We included English language studies that assessed metrics of glycemic variation or complexity and short-term mortality in patients admitted to the ICU.

DATA EXTRACTION:
Two authors performed independent data abstraction and risk-of-bias assessments. We used a random-effects model to pool binary and continuous data and summarized estimates of effect using odds ratios and mean difference. We used the Quality in Prognosis Studies tool to assess risk of bias and the Grading of Recommendations, Assessment, Development and Evaluations to assess certainty of pooled estimates.

DATA SYNTHESIS:
We included 41 studies (n = 162,259). We demonstrate that increased sd, coefficient of variance, glycemic lability index, and decreased time in range are probably associated with increased mortality in critically ill patients (moderate certainty) and that increased mean absolute glucose, mean amplitude of glycemic excursion, and detrended fluctuation analysis may be associated with increased mortality (low certainty).

CONCLUSIONS:
We found a consistent association between increased measures of glycemic variability and higher short-term mortality in patient with critical illness. Further research should focus on standardized measurements of glycemic variation and complexity, along with their utility as therapeutic targets and prognostic markers.
Prevalence of Delirium After Abdominal Surgery and Association With Ketamine: A Retrospective, Propensity-Matched Cohort Study
Authors: Faisal Hina , Qamar Fatima , Hsu En Shuo , Xu Jiaqiong , Lai Eugene C. , Wong Stephen T. , Masud Faisal N. 
Published: January 2024

IMPORTANCE:
Delirium is a common postoperative complication for older patients in the ICU. Ketamine, used primarily as an analgesic, has been thought to prevent delirium.

OBJECTIVE:
Determine the prevalence and association of delirium with low-dose ketamine use in ICU patients after abdominal surgery.

DESIGN:
Single-center, retrospective, propensity-matched cohort study.

SETTING:
Eight hospital academic medical center.

PATIENTS:
Cohort comprising 1836 patients admitted to the ICU after abdominal surgery between June 23, 2018 and September 1, 2022.

MAIN OUTCOMES AND MEASURES:
Propensity score matching (PSM) with a 3:1 ratio between no-ketamine use and ketamine use was performed through a greedy algorithm (caliper of 0.005). Outcomes of interest included: delirium (assessed by Confusion Assessment Method—ICU), mean pain score (Numeric Pain Scale or Critical Care Pain Observation Tool score as available), mean opioid consumption (morphine milligram equivalents), length of stay (d), and mortality.

RESULTS:
Prevalence of delirium was 47.71% (95% CI, 45.41–50.03%) in the cohort. Of 1836 patients, 120 (6.54%) used low-dose ketamine infusion. After PSM, the prevalence of delirium was 56.02% (95% CI, 51.05–60.91%) in all abdominal surgery patients. The ketamine group had 41% less odds of delirium (odds ratio [OR] = 0.59; 95% CI, 0.37–0.94; p = 0.026) than patients with no-ketamine use. Patients with ketamine use had higher mean pain scores (3.57 ± 2.86 vs. 2.21 ± 2.09, p < 0.001). In the subgroup analysis, patients in the ketamine-use group 60 years old or younger had 64% less odds of delirium (OR = 0.36; 95% CI, 0.13–0.95; p = 0.039). The mean pain scores were higher in the ketamine group for patients 60 years old or older. There was no significant difference in mortality and opioid consumption.

CONCLUSIONS AND RELEVANCE:
Low-dose ketamine infusion was associated with lower prevalence of delirium in ICU patients following abdominal surgery. Prospective studies should further evaluate ketamine use and delirium.
Point-of-Care Echocardiography in the Difficult-to-Image Patient in the ICU: A Narrative Review
Authors: Grotberg John C. , McDonald Rachel K. , Co Ivan N. 
Published: January 2024

OBJECTIVES:
The objective of this narrative review was to address common obstacles encountered in the ICU to acquiring quality and interpretable images using point-of-care echocardiography.

DATA SOURCES:
Detailed searches were performed using PubMed and Ovid Medline using medical subject headings and keywords on topics related to patient positioning, IV echo contrast, alternative subcostal views, right ventricular outflow tract (RVOT) hemodynamics, and point-of-care transesophageal echocardiography. Articles known to the authors were also selected based on expert opinion.

STUDY SELECTION:
Articles specific to patient positioning, IV echo contrast, alternative subcostal views, RVOT hemodynamics, and point-of-care transesophageal echocardiography were considered.

DATA EXTRACTION:
One author screened titles and extracted relevant data while two separate authors independently reviewed selected articles.

DATA SYNTHESIS:
Impediments to acquiring quality and interpretable images in critically ill patients are common. Notably, body habitus, intra-abdominal hypertension, dressings or drainage tubes, postoperative sternotomies, invasive mechanical ventilation, and the presence of subcutaneous emphysema or lung hyperinflation are commonly encountered obstacles in transthoracic image acquisition in the ICU. Despite these obstacles, the bedside clinician may use obstacle-specific maneuvers to enhance image acquisition. These may include altering patient positioning, respiratory cycle timing, expanding the subcostal window to include multilevel short-axis views for use in the assessment of RV systolic function and hemodynamics, coronal transhepatic view of the inferior vena cava, and finally point-of-care transesophageal echocardiography.

CONCLUSIONS:
Despite common obstacles to point-of-care echocardiography in critically ill patients, the beside sonographer may take an obstacle-specific stepwise approach to enhance image acquisition in difficult-to-image patients.
Treatment Patterns of Bone-targeting Agents Among Solid Tumor Patients With Bone Metastases
Authors: Nicholson Gina , Carlson Katherine B. , Hernandez Rohini K. , Schenfeld Jennifer , Cadieux Benoit , Henry David , De Sousa Barbosa Vitor Jose , Saad Hossam 
Published: January 2024

Objectives:
This study evaluated real-world treatment patterns of approved bone-targeting agents (BTAs) with various mechanisms of action—pamidronate, zoledronic acid, and denosumab—for the prevention of skeletal-related events in patients with bone metastases (BM) from solid tumors.

Methods:
Adult patients with BM secondary to solid tumors between January 1, 2014, and December 31, 2018, were identified from the Flatiron Health Oncology Services Comprehensive Electronic Records database and categorized by BTA use and therapy type. Time from diagnosis to initiation, persistence (mean time on treatment), and compliance (≥12 administrations/year) with BTA with up to 4 years of follow-up were examined.

Results:
This study included 27,268 patients with BM (breast cancer, 32.7%; lung cancer, 16.5%; prostate cancer, 17.2%; and other solid tumors, 33.6%); of these, 41.4% initiated denosumab after BM diagnosis; 21.3%, zoledronic acid; 0.6%, pamidronate; and 36.7% had no treatment record. Mean (SD) time to initiation for denosumab or zoledronic acid was 68.6 (157.0) days (denosumab, 70.3 (160.4) days; zoledronic acid, 65.2 [150.2] days). Mean persistence and compliance (first year of treatment) were significantly higher for denosumab than for zoledronic acid (22.0 vs. 14.9 mo [P<0.0001] and 42.3% vs. 34.8% [P<0.0001], respectively). Treatment compliance was the highest in patients with breast cancer (denosumab, 48.2%; zoledronic acid, 39.1%).

Conclusions:
Real-world BTA treatment patterns in the United States suggest that over one-third of patients with BM secondary to solid tumors remain untreated and less than 50% of the patients received ≥12 administrations/year of BTA therapy.
Histological features of chronic hepatitis B patients with normal alanine aminotransferase according to different criteria
Authors: Huang Rui , Liu Jiacheng , Wang Jian , Qiu Yuanwang , Zhu Li , Li Yiguang , Liu Yilin , Zhan Jie , Xue Ruifei , Jiang Suling , Geng Yu , Wan Yawen , Li Ming , Mao Minxin , Gao Dongmei , Gu Yan , Zhang Yao , Yin Shengxia , Tong Xin , Xia Juan , Yan Xiaomin , Ding Weimao , Chen Yuxin , Li Jie , Zhu Chuanwu , Wu Chao 
Published: January 2024

Background:
The upper limits of normal (ULNs) for alanine aminotransferase (ALT) are different among international guidelines for chronic hepatitis B (CHB). We aimed to investigate the proportion of significant histological disease in Asian patients with CHB with detectable hepatitis B virus (HBV) DNA under diverse ALT ULNs.

Methods:
Consecutive patients with CHB and detectable HBV DNA who underwent liver biopsy were retrospectively included from four tertiary hospitals. Above grade 2 inflammation and stage 2 fibrosis were defined as significant inflammation and significant fibrosis, respectively. Significant histological disease was defined as above grade 2 inflammation or stage 2 fibrosis.

Results:
Among the 414 patients with detectable HBV DNA and normal ALT, the proportion of those with significant histological disease was lower (59.7%) according to the ULN for ALT at 30/19 U/L (male/female), while the corresponding proportions were 66.7% and 62.3% according to the ULNs of 40 U/L and 35/25 U/L (male/female), respectively. In patients with detectable HBV DNA and normal ALT levels without significant fibrosis, the proportions of significant inflammation were comparable among different ULNs of ALT at 40 U/L (30.7%), 35/25 U/L (27.3%) and 30/19 U/L (25.0%). The proportion of significant histological disease was significantly lower in patients with normal ALT for 2 determinations at least 6 months apart compared to patients with normal ALT once.

Conclusions:
Although a more stringent ALT ULN may reduce the risk of the presence of significant histological disease in patients with detectable HBV DNA, the rates of significant histological disease remain high. Persistently normal ALT levels are more important for excluding patients with CHB with a high probability of significant histological disease.
Post-operative Photoreceptor Integrity and Anatomic Outcomes Based on Presenting Morphologic Stage of Rhegmatogenous Retinal Detachment
Authors: El-Sehemy Ahmed , Melo Isabela Martins , Pecaku Aurora , Zajner Chris , Naidu Sumana , Motekalem Yasmin , Muni Rajeev H. 
Published: January 2024

Purpose:
To evaluate outer retinal recovery on post-operative optical coherence tomography (OCT) based on presenting morphologic stage of rhegmatogenous retinal detachment (RRD).

Methods:
Retrospective cohort of consecutive primary fovea-involving RRDs, referred from January 2012-September 2022. Baseline OCTs were assessed for morphologic stage of RRD. Post-operative OCTs were graded at 3, 6 and 12 months for external limiting membrane (ELM), ellipsoid zone (EZ) and interdigitation zone (IDZ) discontinuity, epiretinal membrane (ERM) formation and severity, and residual subfoveal fluid.

Results:
351 patients were included. Increasing baseline morphologic stage of RRD was significantly associated with ELM, EZ and IDZ discontinuity at all time points post-operatively(p<.001) and was shown to be an independent predictor of foveal photoreceptor integrity after adjusting for height of detachment, time to surgery and duration of fovea involvement(p<.001). Earlier stages were associated with subfoveal fluid(p<.001). There was no association between the stages of RRD and ERM severity. However, late stages presented with earlier development of ERM(p=.012).

Conclusion:
Increasing morphologic stage of RRD is associated with delayed recovery of outer retinal bands in the first year and faster development of ERM following RRD repair. Our results suggest that the stages may serve as a prognostic biomarker for postoperative photoreceptor recovery.
Efficacy of Micropulse Laser Cyclophotocoagulation Therapy in Primary Angle Closure Glaucoma
Authors: Chauhan Divya , Midha Neha , Mahalingam Karthikeyan , Angmo Dewang , Sihota Ramanjit , Gupta Shikha , Chawla Rohan , Dada Tanuj 
Published: January 2024

Précis:
In primary angle closure glaucoma (PACG), micropulse cyclophotocoagulation resulted in a significant reduction in intraocular pressure (IOP), and the number of antiglaucoma medications without any sight-threatening complications. However, the IOP lowering efficacy decreased over time.

Purpose:
The purpose of this study was to evaluate the efficacy and safety of micropulse trans-scleral cyclophotocoagulation (MP-TSCPC) in PACG.

Patients and Methods:
Thirty-three phakic PACG eyes with patent laser peripheral iridotomy and IOP uncontrolled on maximum tolerable antiglaucoma medications (AGMs), scheduled for trabeculectomy, were given a trial of MP-TSCPC (810 nm laser, 2000 mw power for 180 seconds, 360 degrees). The primary outcome measure was a success at 1 year with IOP ≤18 mm Hg and ≤15 mm Hg with (qualified success) or without (absolute success) AGMs after a single session of MP laser. Secondary outcome measures were changes in pupillary diameter, visual acuity, central macular thickness, and subjective pain perception.

Results:
Thirty-two out of 33 PACG patients completed 12 months of follow-up. The mean age of patients was 54.7±8.9 years; male:female ratio was 1:1. The baseline IOP was 25.7±5.3 mm Hg, which reduced to 17.9±4.6 mm Hg at the end of 12 months (P<0.0001). Twenty eyes (62.5%) achieved qualified success, and 1 eye (3.125%) had absolute success at 12 months for IOP ≤18 mm Hg; 6 eyes (18.75%) had qualified success, and 1 eye (3.125%) had absolute success for IOP ≤15 mm Hg at 12 months follow-up. A significant reduction was also observed in the number of AGMs (4.4±0.8 at baseline to 2.9±1.1 at 12 months; P <0.0001). Five eyes (15.6%) received additional treatment—3 eyes (9.4%) requiring a subsequent filtering procedure, and 2 eyes (6.2%) requiring an additional MP-TSCPC session. No significant change in pupillary diameter (P=0.489) or central macular thickness (P=0.938) was noted at 12 months. There was a transient drop of visual acuity >2 lines in 1 patient due to cystoid macular edema, and no major postlaser complications were noted.

Conclusions:
MP-TSCPC can be used as an interim procedure to reduce IOP in PACG eyes and delay the need for invasive surgery. Most patients require continued use of glaucoma medications, and target IOPs achieved are in the high teens.
Access to Eye Care Providers and Glaucoma Severity in the National Institutes of Health All of Us Research Program
Authors: Paul Megan , Kitayama Ken , Yu Fei , Tseng Victoria L. , Coleman Anne L. 
Published: January 2024

Précis:In the “All of Us (AoU) Research Program,” individuals with access to vision care were more likely to have mild, moderate, or severe glaucoma and undergo incisional surgery compared with those without vision care access.Purpose:To examine the associations between access to eye care, glaucoma severity, and incisional glaucoma surgery using data from the National Institute of Health AoU Research Program.Materials and Methods:Individuals with International Classification of Diseases Ninth or 10thRevision codes and who answered the survey question about eye care access in AoU were included in the study. The exposure variable was access to eye care services, with outcome variables (1) glaucoma severitys and (2) likelihood of incisional surgery. Unadjusted multinomial logistic regression compared access to eye care services and glaucoma severity. In addition, unadjusted logistic regression models compared access to eye care and the likelihood of incisional surgery. These were repeated using adjusted analyses, controlling for sex assigned at birth, race and ethnicity, and age.Results:Compared with individuals without access to eye care services, those with access were more likely to have all levels of glaucoma severity [mild adjusted odds ratio (aOR): 5.81, 95% CI: 3.15–10.73, moderate aOR: 4.44, 95% CI: 2.45–8.02, severe aOR: 6.95, 95% CI: 2.69–17.93, and unspecified aOR: 3.06, 95% CI: 2.72, 3.45]. Access to eye care was associated with increased odds of any incisional glaucoma surgery (aOR: 3.00, 95% CI: 1.24–9.90) and of trabeculectomy (aOR: 3.30, 95% CI: 1.02–20.28) but not of tube shunt procedures (aOR: 2.65, 95% CI: 0.80–16.38).Conclusions:This study demonstrated that access to eye care services was associated with a higher prevalence of all levels of glaucoma severity; those with access to eye care services were more likely to undergo incisional surgery than those without access. Future research should focus on methods to best encourage eye care to limit glaucoma progression.