bluuebunny/crossref_metadata_2025_split huggingface dataset:
An Initiative to Stop Antibiotics Prescribed for Urinary Symptoms When Urine Culture Is Negative
Authors: Kofoed Benjamin , Morris Jacob , Rich Jennifer 
Published: November 2023

ABSTRACT
Urinary symptoms pose frequent diagnostic and management challenges in the emergency department (ED). In our regional health system, we identified the problem of patients started on antibiotics for urinary symptoms in the ED without a process for eventual review or discontinuation if urine culture (UC) later resulted as negative. To address this gap, we implemented a pharmacist-driven follow-up process to discontinue antibiotics after a negative UC. After project implementation, cases reviewed by a pharmacist increased from 0% to 96.7%. Patients contacted to discontinue antibiotics increased from 0% to 40% postintervention. This process improvement is now shared across five rural departments. Our results have broad applicability in any ED environment.
Bleomycin Sclerotherapy Is Laboratory Monitoring Necessary?
Authors: Mack Joana M. , DeHart Austin N. , Verkamp Bethany , Lewis P. Spencer , Crary Shelley E. 
Published: November 2023

Objectives:
Bleomycin is a chemotherapeutic agent also used as a sclerosant for the management of vascular malformations. Although effective and with a low complication profile, the safety and monitoring necessary for this indication is still controversial. This study examines routine periprocedural laboratory results on a cohort of patients undergoing bleomycin sclerotherapy.

Methods:
Retrospective chart review of prospectively collected data was performed on patients who underwent bleomycin sclerotherapy for vascular malformations from 2011 to 2018. Complete blood count and liver function were assessed before and after sclerotherapy.

Results:
Forty-six patients were identified who underwent a total of 71 sclerotherapy sessions with bleomycin. A median dose of 5 U/m2 of bleomycin was used per procedure (8 U total). No difference between preprocedure and postprocedure values was detected for white blood cell count (7.7–7.9; P = .63) or absolute neutrophil count (4009–4414; P = .20). A nominal difference was found in hemoglobin (12.7–13.0; P = .001), hematocrit (37.0–38.6; P = .001), and platelet counts (278–302; P = .001). No patient had absolute neutrophil count levels below 500 cells/μL. On liver function tests, no change was detected for direct bilirubin (0.19–0.17; P = .4). A small decrease in total bilirubin (0.49–0.41; P = .004), aspartate aminotransferase (32.1–26.9; P < .001), and alanine aminotransferase (31.2–24.3; P < .001) was shown.

Conclusion:
This study suggests that laboratory assessment of immune and liver function, as commonly performed in chemotherapy protocols, is not required following intralesional bleomycin sclerotherapy. Clinically relevant abnormalities are unlikely to be detected as demonstrated in this cohort of patients with vascular malformations.
Prognostic significance of preoperative nutritional status for postoperative acute kidney injury in older patients undergoing major abdominal surgery: a retrospective cohort study
Authors: Sun Rao , Zhou Zhiqiang , Li Xinhua , Xu Qiaoqiao , Zhou Biyun , Yu Honghui , Zhang Wanjun , Sun Qi , Zhang Xiang , Luo Xiaoxiao , Li Shiyong , Luo Ailin 
Published: November 2023

Background:
The association between malnutrition and postoperative acute kidney injury (AKI) has not been well studied. In this study, we examined the association between preoperative nutritional status and postoperative AKI in older patients who underwent major abdominal surgery, as well as the predictive value of malnutrition for AKI.

Materials and methods:
We retrospectively included patients aged 65 or older who underwent major elective abdominal surgery. The nutritional status of the patient was evaluated using 3 objective nutritional indices, such as the geriatric nutritional risk index (GNRI), the prognostic nutritional index (PNI), and the controlling nutritional status (CONUT). AKI was determined using the KDIGO criteria. We performed logistic regression analysis to investigate the association between preoperative nutritional status and postoperative AKI, as well as the predictive value of nutritional scores for postoperative AKI.

Results:
A total of 2775 patients were included in the study, of which 707 (25.5%), 291 (10.5%), and 517 (18.6%) had moderate to severe malnutrition according to GNRI, PNI, and CONUT calculations. After surgery, 144 (5.2%) patients developed AKI, 86.1% at stage 1, 11.1% at stage 2, and 2.8% at stage 3 as determined by KDIGO criteria. After adjustment for traditional risk factors, worse nutritional scores were associated with a higher AKI risk. In addition to traditional risk factors, these nutritional indices improved the predictive ability of AKI prediction models, as demonstrated by significant improvements in integrated discrimination and net reclassification.

Conclusions:
Poor preoperative nutritional status, as assessed by GNRI, PNI and CONUT scores, was associated with an increased risk of postoperative AKI. Incorporating these scores into AKI prediction models improved their performance. These findings emphasize the need for screening surgical patients for malnutrition risk. Further research is needed to determine whether preoperative malnutrition assessment and intervention can reduce postoperative AKI incidence.
Does Initiation of Prophylactic Antiseizure Medication Improve Neurological Outcomes in Patients With Acute Intracerebral Hemorrhage?
Authors: Chhabra Nikita , Crepeau Amy Z. , Demaerschalk Bart M. , Knox Molly G. , Freeman William David , Valencia Sanchez Cristina , Marks Lisa A. , O’Carroll Cumara B. 
Published: November 2023

Objective:
The objective of this study was to critically assess current evidence regarding the role of prophylactic antiseizure medication in patients presenting with acute intracerebral hemorrhage (ICH).

Methods:
The objective was addressed through the development of a structured critically appraised topic. This included a clinical scenario with a clinical question, literature search strategy, critical appraisal, results, evidence summary, commentary, and bottom-line conclusions. Participants included resident neurologists, a medical librarian, and content experts in the fields of epilepsy, stroke neurology, neurohospitalist medicine, and neurocritical care.

Results:
A randomized clinical trial was selected for critical appraisal. The trial assessed whether prophylactic levetiracetam (LEV) use reduced the risk of acute seizures in patients with ICH, as defined by clinical or electrographic seizure, captured by continuous electroencephalogram 72 hours after enrollment. A total of 42 patients were included in the final analysis (19 in the LEV group and 23 in the placebo group). There was a significantly higher occurrence of seizures in the placebo versus LEV group (LEV 16% vs placebo 43%, P = 0.043). There were no differences in functional outcomes between the groups at 3, 6, or 12 months (P > 0.1).

Conclusions:
The role of prophylactic treatment with antiseizure medication in ICH remains unclear.
The Impact of Body Mass Index on Adverse Outcomes Associated with Panniculectomy: A Multimodal Analysis
Authors: Laspro Matteo , Cassidy Michael F. , Brydges Hilliard T. , Barrow Brooke , Stead Thor S. , Tran David L. , Chiu Ernest S. 
Published: November 2023

Background:
Overhanging pannus may be detrimental to ambulation, urination, sexual function, and social well-being. Massive weight loss patients often have high residual body mass index (BMI) and comorbidities presenting a unique challenge in panniculectomy patient selection. This study aims to better characterize the role of BMI in postoperative complications following panniculectomy.

Methods:
A meta-analysis attempted to assess the impact of BMI on complications following panniculectomy. Cochrane Q and I
2 test statistics measured study heterogeneity, with subsequent random effects meta-regression investigating these results. After this, all panniculectomy patients in the National Surgical Quality Improvement Program database in the years 2007 to 2019 were analyzed. Univariate and multivariable tests assessed the relative role of BMI on 30-day postoperative complications.

Results:
Thirty-four studies satisfied inclusion criteria, revealing very high heterogeneity (Cochrane Q = 2453.3; I
2 = 99.1%), precluding further meta-analysis results. Receiver operating characteristic curves demonstrated BMI was a significant predictor of both all causes (area under the curve, 0.64; 95% CI, 0.62 to 0.66) and wound complications (area under the curve, 0.66; 95% CI, 0.63 to 0.69). BMI remained significant following multivariable regression analyses. Restricted cubic spines demonstrated marginal increases in complication incidence above 33.2 and 35 kg/m2 for all-cause and wound complications, respectively.

Conclusions:
Reported literature regarding postoperative complications in panniculectomy patients is highly heterogeneous and may limit evidence-based care. Complication incidence positively correlated with BMI, although the receiver operating characteristic curve demonstrated its limitations as the sole predictive variable. Furthermore, restricted cubic splines demonstrated diminishing marginal predictive capacity of BMI for incremental increases in BMIs above 33.2 to 35 kg/m2. These findings support a reevaluation of the role of BMI cutoffs in panniculectomy patient selection.
Pharmacokinetics, Safety, and Tolerability of the Novel Tetrameric, High-Relaxivity, Macrocyclic Gadolinium-Based Contrast Agent Gadoquatrane in Healthy Adults
Authors: Hofmann Birte Maria , Riecke Kai , Klein Stefan , Berse Matthias , Rottmann Antje , Sutter Gabriele , Ebert Wolfgang 
Published: November 2023

ObjectivesGadolinium (Gd)–based contrast agents are well established in clinical routine and have been proven safe and effective. However, there is a need for “next-generation” Gd-based contrast agents that would allow lowering the Gd dose used for routine contrast-enhanced magnetic resonance imaging procedures. The objective of this first-in-human study was to investigate the pharmacokinetic profile, safety, and tolerability of gadoquatrane, a novel high-relaxivity Gd-based contrast agent.Materials and MethodsThis study was conducted in 2018/2019 as a prospective, randomized, single-blind, single-dose, placebo-controlled, escalating-dose study. Healthy volunteers were randomly assigned (6:2) to intravenous administration of gadoquatrane (0.025 to 0.2 mmol Gd/kg body weight) or placebo. Study procedures included collection of blood samples and excreta for pharmacokinetic analyses and safety assessments.ResultsForty-nine healthy study participants (mean age ± SD, 35 ± 6.3 years; 24 female) were evaluated. The effective half-life of gadoquatrane in plasma was short and similar in all dose groups (1.4–1.7 hours). Plasma concentrations around the lower quantitation limit (0.0318 μmol Gd/L) were reached 15–72 hours after administration. The volume of distribution at steady state was ~0.2 L/kg in all dose groups. The clearance (total and renal) was ~0.1 L/h per kilogram in all groups. Across dose groups, the exposure of gadoquatrane increased dose-proportionally. Metabolite profiling revealed no hint of degradation in vivo or release of free Gd. Seven of 36 participants (19.4%) receiving gadoquatrane and 4 of 13 participants (30.8%) receiving placebo experienced mild or moderate treatment-emergent adverse events. No serious adverse events occurred. The analysis of the Gd concentration-QTc interval relationship indicated no risk of QT/QTc prolongation (>10 milliseconds) with gadoquatrane at clinical dose levels.ConclusionsGadoquatrane with its high-relaxivity, pharmacokinetic similarity to established Gd-based contrast agents and high tolerability is a promising “next-generation” contrast agent for magnetic resonance imaging.
Surgical Techniques and Related Perioperative Outcomes After Robot-assisted Minimally Invasive Gastrectomy (RAMIG)
Authors: de Jongh Cas , Cianchi Fabio , Kinoshita Takahiro , Kingma Feike , Piccoli Micaela , Dubecz Attila , Kouwenhoven Ewout , van Det Marc , Mala Tom , Coratti Andrea , Ubiali Paolo , Turner Paul , Kish Pursnani , Borghi Felice , Immanuel Arul , Nilsson Magnus , Rouvelas Ioannis , Hӧlzen Jens P. , Rouanet Philippe , Saint-Marc Olivier , Dussart David , Patriti Alberto , Bazzocchi Francesca , van Etten Boudewijn , Haveman Jan W. , DePrizio Marco , Sabino Flávio , Viola Massimo , Berlth Felix , Grimminger Peter P. , Roviello Franco , van Hillegersberg Richard , Ruurda Jelle ,   UGIRA Collaborative Group
Published: November 2023

Objective:
To gain insight into the global practice of robot-assisted minimally invasive gastrectomy (RAMIG) and evaluate perioperative outcomes using an international registry.

Background:
The techniques and perioperative outcomes of RAMIG for gastric cancer vary substantially in the literature.

Methods:
Prospectively registered RAMIG cases for gastric cancer (≥10 per center) were extracted from 25 centers in Europe, Asia, and South-America. Techniques for resection, reconstruction, anastomosis, and lymphadenectomy were analyzed and related to perioperative surgical and oncological outcomes. Complications were uniformly defined by the Gastrectomy Complications Consensus Group.

Results:
Between 2020 and 2023, 759 patients underwent total (n=272), distal (n=465), or proximal (n=22) gastrectomy (RAMIG). After total gastrectomy with Roux-en-Y-reconstruction, anastomotic leakage rates were 8% with hand-sewn (n=9/111) and 6% with linear stapled anastomoses (n=6/100). After distal gastrectomy with Roux-en-Y (67%) or Billroth-II-reconstruction (31%), anastomotic leakage rates were 3% with linear stapled (n=11/433) and 0% with hand-sewn anastomoses (n=0/26). Extent of lymphadenectomy consisted of D1+ (28%), D2 (59%), or D2+ (12%). Median nodal harvest yielded 31 nodes (interquartile range: 21–47) after total and 34 nodes (interquartile range: 24–47) after distal gastrectomy. R0 resection rates were 93% after total and 96% distal gastrectomy. The hospital stay was 9 days after total and distal gastrectomy, and was median 3 days shorter without perianastomotic drains versus routine drain placement. Postoperative 30-day mortality was 1%.

Conclusions:
This large multicenter study provided a worldwide overview of current RAMIG techniques and their respective perioperative outcomes. These outcomes demonstrated high surgical quality, set a quality standard for RAMIG, and can be considered an international reference for surgical standardization.
THE EFFECTIVENESS OF SPIRITUAL SUPPORT FOR CANCER PATIENTS TO IMPROVE THE QUALITY OF LIFE: A LITERATURE REVIEW
Authors: Rupang Ernita Rante , Rumambo Pandin Moses Glorino , Yunitasari Esti 
Published: November 2023

ABSTRACTBackgroundThe efficacy of spiritual support for cancer patients is crucial in the course of treatment. As a result, it is crucial to consider the mentoring techniques employed. The purpose of this review of the literature is to methodically look at worldwide research from the previous ten years that has been published in English-language journals from different nations that relates to the usefulness of spiritual support for cancer patients to improve quality of lifeMethodThe method used in this literature review is by database search strategy: data search using a systematic and comprehensive electronic database from several indexing and hand searching. The following indexes were searched for research data: Scopus, CINAHL, PubMed, and Proquest. By utilizing the search terms “OR” spirituality accompanying “AND” quality of life, spirituality support. The eligibility requirements established by the PICO model (Population, Intervention, Comparison/controls, Outcome) were taken into consideration when conducting the article search. Population: cancer patients, Intervention: Spiritual support, Comparison: Intervention provided, Outcome: Improved quality of life.The process of selecting and extracting data involves stating the problem to be studied, pertinent groups, intervention to be provided, and results to be measured. The author then goes on to clarify the selection and analysis process by outlining the specific inclusion and exclusion criteria as follows:The inclusion criteriafor the articles reviewed were: the article had to be a full paper, the research subjects were cancer patients, the intervention carried out was spiritual assistance with a comparison of cancer patients without usual care spiritual assistance. An improvement in cancer patients’ quality of life is the search’s result.The exclusion criteriafor articles reviewed are: articles other than English, research articles before 2017 and articles that are not free accessResult11 articles were examined. Focuses on providing spiritual support to cancer sufferers, including how to do it and the results. Spiritual support provided through a variety of techniques, including mindfulness, meditation, music therapy, and telephone counseling, encourages patients to be more passionate about their treatments and enhances their quality of life. The patient is religious preferences should be taken into consideration when providing care.ConclusionSpiritual support has a positive impact on a cancer patient is quality of life by giving them a sense of calm and desire to keep going through the treatment and their daily lives. Through improving coping mechanisms, bringing patients closer to something transcendent (God), and providing a sense of comfort for cancer patients going through chemotherapy, spiritual assistance techniques like mindfulness, listening to music, and counseling can help patients improve their quality of life.
Assessing Occupational Hazards and Factors Contributing to the Health Effects Faced By Female Market Traders in Nakasero Market, Central Kampala Uganda
Authors: Ronald Waneloba 
Published: November 2023

ABSTRACTBackgroundIn Uganda, the informal sector, particularly public markets, presents a concerning array of unregulated workplace hazards, predominantly affecting female traders. These hazards pose significant threats to the health of female market traders, who make up the majority of the workforce. However, there has been limited attention given to identifying and addressing the occupational risks faced by these women. This study aimed to assess the occupational hazards and the contributing factors to health effects among female market traders in Nakasero market, central Kampala.MethodsA descriptive cross-sectional study was conducted among female market traders in Nakasero market, central Kampala. The study employed a mixed-methods approach, utilizing both quantitative and qualitative methods. Data collection involved face-to-face, interviewer-administered, semi-structured questionnaires and key informant interviews. Quantitative data were analyzed using EPIDATA 3.02, STATA 14, and Microsoft Excel, while qualitative data were subjected to deductive thematic analysis.ResultsThe hazards encompassed biological risks, where a significant proportion reported suffering from mosquito bites within the market (87.36%), and urinary tract infections (UTIs) attributed to microorganisms stemming from unclean toilet facilities (80.46%). Furthermore, the investigation revealed the presence of physical, ergonomic, and psychological hazards, all of which posed a threat to the health of female market traders.Various factors contributed to the health effects experienced by these traders. Notably, many of them endured prolonged working hours without adequate rest or sleep, with 47% of female market traders spending over 12 hours in the market. The study also found that a majority of respondents failed to use personal protective equipment (PPE), totaling 70.49%. Additionally, a substantial portion (42%) admitted to not practicing proper hand hygiene while in the market. Issues related to sanitary facilities were prevalent, including a shortage of toilet stalls, unclean conditions, and occasional water shortages. Poor market infrastructure, inadequate working space, and overcrowding further compounded the challenges faced by female market traders.The health effects and problems reported by these traders encompassed a spectrum of issues, including musculoskeletal pain, malaria, UTIs, respiratory problems, COVID-19, skin conditions, headaches, and obesity.ConclusionThis study underscores the ongoing occupational hazards and health effects faced by female market traders in public markets throughout Uganda, arising from a combination of various contributing factors. Addressing these issues is crucial to safeguard the well-being of these women and improve their working conditions.
Hypoxia inducible factors inhibit respiratory syncytial virus infection by modulation of nucleolin expression
Authors: Zhuang Xiaodong , Gallo Giulia , Sharma Parul , Ha Jiyeon , Magri Andrea , Borrmann Helene , Harris James M , Tsukuda Senko , Bentley Eleanor , Kirby Adam , Neck Simon de , Yang Hongbing , Balfe Peter , Wing Peter AC , Matthews David , Harris Adrian L , Kipar Anja , Stewart James P , Bailey Dalan , McKeating Jane A 
Published: November 2023

ABSTRACTRespiratory syncytial virus (RSV) is a global healthcare problem, causing respiratory illness in young children and elderly individuals. However, our knowledge of the host pathways that define susceptibility to RSV infection and disease severity is limited. Hypoxia inducible factors (HIFs) define cellular metabolic processes in response to low oxygen and are recognised to play a key role in regulating inflammatory responses in the lower respiratory tract. We demonstrate a role for hypoxia inducible factors (HIFs) to suppress RSV entry and RNA replication. We show that hypoxia and HIF prolyl-hydroxylase inhibitors significantly reduce expression of the RSV entry receptor nucleolin and inhibit viral driven cell-cell fusion. We identify a HIF regulated microRNA, miR-494, that regulates nucleolin expression. In RSV-infected mice, treatment with the clinically approved HIF prolyl-hydroxylase inhibitor, Daprodustat, reduced the level of infectious virus and infiltrating monocytes and neutrophils in the lung. This study highlights a role for HIF-signalling to limit multiple aspects of RSV infection and associated inflammation and informs future therapeutic approaches for treating this respiratory pathogen.