bluuebunny/crossref_metadata_2025_split huggingface dataset:
Interaction of eosinophilic and neutrophilic inflammation in patients with chronic rhinosinusitis
Authors: Sima Yutong , Wang Xiangdong , Zhang Luo 
Published: November 2023

Purpose of review
In the past year, the endotype of chronic rhinosinusitis (CRS) has been studied from a new perspective. Eosinophilic and neutrophilic inflammation are not independent processes in the pathogenesis of CRS. In this review, we will focus on recent research on mixed eosinophilic-neutrophilic inflammation in CRS and discuss the mechanism and potential treatments.

Recent findings
Traditionally, patients with eosinophilic CRS (ECRS) present with severe clinical manifestations, comorbidities, and a higher recurrence rate. Recent studies have found that approximately 40% of patients with ECRS present with neutrophilic infiltration, while patients with predominantly eosinophilic infiltration along with neutrophilic inflammation present with more complex inflammation, clinical manifestations and exhibit refractory characteristics.

Summary
The complex inflammatory profile and refractory clinical characteristics of mixed eosinophilic-neutrophilic inflammation in CRS are current challenges for clinicians. We summarize the features of eosinophilic and neutrophilic inflammation and current studies on the mechanisms of mixed eosinophilic-neutrophilic inflammation and suggest potentially effective therapeutic methods. We hope that this review will help with determining precise treatment options for patients.
The Accuracy of the NSQIP Universal Surgical Risk Calculator Compared to Operation-Specific Calculators
Authors: Cohen Mark E. , Liu Yaoming , Hall Bruce L. , Ko Clifford Y. 
Published: November 2023

Objective:
To compare the performance of the ACS NSQIP “universal” risk calculator (N-RC) to operation-specific RCs.

Background:
Resources have been directed toward building operation-specific RCs because of an implicit belief that they would provide more accurate risk estimates than the N-RC. However, operation-specific calculators may not provide sufficient improvements in accuracy to justify the costs in development, maintenance, and access.

Methods:
For the N-RC, a cohort of 5,020,713 NSQIP patient records were randomly divided into 80% for machine learning algorithm training and 20% for validation. Operation-specific risk calculators (OS-RC) and OS-RCs with operation-specific predictors (OSP-RC) were independently developed for each of 6 operative groups (colectomy, whipple pancreatectomy, thyroidectomy, abdominal aortic aneurysm (open), hysterectomy/myomectomy, and total knee arthroplasty) and 14 outcomes using the same 80%/20% rule applied to the appropriate subsets of the 5M records. Predictive accuracy was evaluated using the area under the receiver operating characteristic curve (AUROC), the area under the precision-recall curve (AUPRC), and Hosmer-Lemeshow (H-L) P values, for 13 binary outcomes, and mean squared error for the length of stay outcome.

Results:
The N-RC was found to have greater AUROC (P = 0.002) and greater AUPRC (P < 0.001) compared to the OS-RC. No other statistically significant differences in accuracy, across the 3 risk calculator types, were found. There was an inverse relationship between the operation group sample size and magnitude of the difference in AUROC (r = −0.278; P = 0.014) and in AUPRC (r = −0.425; P < 0.001) between N-RC and OS-RC. The smaller the sample size, the greater the superiority of the N-RC.

Conclusions:
While operation-specific RCs might be assumed to have advantages over a universal RC, their reliance on smaller datasets may reduce their ability to accurately estimate predictor effects. In the present study, this tradeoff between operation specificity and accuracy, in estimating the effects of predictor variables, favors the N-R, though the clinical impact is likely to be negligible.
Combined Face and Whole Eye Transplantation: Cadaveric Rehearsals and Feasibility Assessment
Authors: Brydges Hilliard T. , Onuh Ogechukwu C. , Chaya Bachar F. , Tran David L. , Cassidy Michael F. , Dedania Vaidehi S. , Ceradini Daniel J. , Rodriguez Eduardo D. 
Published: November 2023

Background:
In properly selected patients, combined face and whole eye transplantation (FWET) may offer a more optimal aesthetic and potentially functional outcome while avoiding the complications and stigma of enucleation and prosthetics. This study presents the most comprehensive cadaveric assessment for FWET to date, including rehearsal allograft procurement on a brain-dead donor.

Methods:
Over a 2-year period, 15 rehearsal dissections were performed on 21 cadavers and one brain-dead donor. After identification of a potential recipient, rehearsals assessed clinical feasibility and enabled operative planning, technical practice, refinement of personalized equipment, and improved communication among team members. Operative techniques are described.

Results:
Facial allograft procurement closely followed previously described face transplant techniques. Ophthalmic to superficial temporal (O-ST) vessel anastomosis for globe survival was assessed. Craniectomy allowed for maximal optic nerve and ophthalmic vessel pedicle length. Appropriate pedicle length and vessel caliber for O-ST anastomosis was seen. Research procurement demonstrated collateral blood flow to the orbit and surrounding structures from the external carotid system as well as confirmed the feasibility of timely O-ST anastomosis. Personalized cutting guides enabled highly accurate bony inset.

Conclusions:
This study formalizes an approach to FWET, which is feasible for clinical translation in judiciously selected patients. O-ST anastomosis seems to minimize retinal ischemia time and allow perfusion of the combined allograft on a single external carotid pedicle. Although restoration of vision likely remains out of reach, globe survival is possible.
Use trends of chlorthalidone and hydrochlorothiazide among United States adults with hypertension: National Health and Nutrition Examination Survey 2009–2018
Authors: Hale Genevieve , Puchades Emily , Jacomino Gema , El-Mcharfie Layall , Perez Alexandra 
Published: November 2023

Objectives:
To estimate the national prevalence of chlorthalidone and hydrochlorothiazide use among adults diagnosed with hypertension by sociodemographic subgroup, healthcare access status, and clinical factors.

Methods:
Data was extracted from the National Health and Nutrition Examination Survey for 2009–2010 through 2017–2018 survey waves. Patients at least 20 years old, diagnosed with hypertension, and on hydrochlorothiazide or chlorthalidone were included. Uni-variable logistic regression models estimated the odds of being on chlorthalidone compared with hydrochlorothiazide use by sociodemographic and clinical factors. Analyses were adjusted for multi-stage complex survey design and are nationally representative.

Results:
Two thousand five hundred and eighty-five participants were included with 95.2% participants using hydrochlorothiazide and 4.8% using chlorthalidone. Participants over 65 years were more likely to be on chlorthalidone compared with younger counterparts [odds ratio (OR) 1.8; 95% confidence interval (CI) 1.12–2.88]. Participants with hypokalemia (OR 2.62; 95% CI 1.56–4.42) or hyponatremia [OR 2.298; 95% CI 1.23–4.30) were more likely to be using chlorthalidone compared with patients with normal levels.

Conclusion:
Chlorthalidone, a potent and effective first-line antihypertensive agent and thoroughly studied thiazide diuretic with substantial cardiovascular benefits, continues to be underutilized in patients with hypertension. Findings demonstrated that individuals receiving chlorthalidone were more likely to be 65 years or older and to experience hyponatremia or hypokalemia. Sociodemographic factors, healthcare access and use, clinical factors, and medical conditions did not appear to sway the choice in thiazide diuretic use.
Usefulness of cone-beam computed tomography-reformatted epidurography in percutaneous epidural adhesiolysis: A pilot study
Authors: Kao Hao-Lun , Huang Guo-Shu , Tang Chi-Tun , Yang Fu-Chi , Chao Kuo-Hua , Huang Han-Bin , Hsu Yi-Chih 
Published: November 2023

Background:
Conventional epidurography (CE) is thought to have insufficient usefulness on percutaneous epidural adhesiolysis (PEA). We aimed to evaluate the association between the outcome of PEA and cone-beam computed tomography-reformatted epidurography (CBCT-RE).

Methods:
After ethics board approval and written informed consent were obtained, we performed 30 PEA in 26 participants, and evaluated their post-PEA image findings. Two independent radiologists categorized and recorded the occurrence of contrast in the intracanal ventral and extraforaminal regions on CE, and in the dorsal canal (DC), ventral canal (VC), dorsal foramen (DF), and ventral foramen (VF) on CBCT-RE. Reproducibility was assessed using intraclass correlation coefficients (ICCs). Baseline characteristics along with contrast distribution patterns of CE and CBCT-RE were analyzed in terms of their association with symptom relief at 1 month after PEA.

Results:
The rate of patients with symptoms relief >50% after PEA was 63.3%. The inter-reader agreement was higher for CBCT-RE (ICC = 0.955) than for CE (ICC = 0.793). Participants with contrast coexisting in VC and DF adjacent to the irritated nerve root on CBCT-RE (p = 0.015) had a significantly better response after PEA than those without contrast at these locations on CBCT-RE, independent of baseline characteristics (adjusted odds ratio: 11.414 [p = 0.012]).

Conclusion:
CBCT-RE with identifying contrast distribution patterns is useful for predicting outcome of PEA.
Athletic Trainer and Emergency Medical Technician or Paramedic Opinions of Each Other's Understanding of Essential Emergent Football Injury Situation Tasks
Authors: Reed Amber , Nyland John , Richards Jarod 
Published: November 2023

Objective
Improving the role understanding between essential emergency healthcare providers may improve teamwork and efficacy. This study asked licensed athletic trainers (ATs) and emergency medical technicians (EMTs) or paramedics for their opinions of the others' understanding of essential tasks in an emergent football injury situation. The hypothesis was that groups would have differing opinions.

Methods
An electronic survey was emailed to 160 licensed EMTs or paramedics and 45 licensed ATs. All participants were full-time employees with ≥1 year experience at their current position. In addition to demographic questions (age, sex, experience), respondents completed 11, 5-point Likert-scale type questions (end range: “strongly agree” or “strongly disagree”) regarding their opinion of the other profession's understanding of essential tasks in an emergent football injury situation. Participants also answered questions about the amount of control of the injury situation they assumed upon scene arrival and how frequently they partnered with the other profession when covering a game. An α level of P ≤ 0.05 was selected to indicate statistical significance.

Results
Thirty-four EMTs or paramedics (21% return) and 12 ATs (26.7% return) responded. Group demographics did not differ with the exception of the EMT or paramedic group having more men (P = 0.006). Emergency medical technicians/paramedics perceived that ATs better understood facemask removal timing (P = 0.002), facemask removal technique (P = 0.04), and extremity splinting (P = 0.02). Athletic trainers perceived that EMTs/paramedics better understood proper airway management (P < 0.001) and cardiopulmonary resuscitation (P < 0.001). EMT/paramedics more strongly perceived control of the injury situation upon scene arrival than ATs (P = 0.005). As AT experience increased, they more strongly agreed that they frequently partnered with EMTs/paramedics (r = 0.84, P < 0.001); however, an insignificant relationship was observed for EMTs/paramedics.

Conclusions
Opinions differed about the other profession's understanding of essential tasks. More experienced ATs partnered more strongly with EMTs/paramedics. Both professional groups would benefit from collaborative workshops or seminars to improve the teamwork needed to optimize an emergent football injury situation. The development and implementation of practices such as these may also improve teamwork and patient-center healthcare at mass participant sporting events such as marathons, triathlons, and road cycling events.
Rapid Expansion of the Healing Emotional Lives of Peers Program During COVID-19: A Second Victim Peer Support Program for Healthcare Professionals
Authors: Rivera-Chiauzzi Enid Y. , Huang Lily , Osborne Alayna K. , Musch Ashley A. , Berkland Bridget E. , Meyer Anne T. , Vitek Sairey M. , Wieneke Kaisa C. , Allyse Megan A. , Riggan Kirsten A. , Finney Robyn E. 
Published: November 2023

Objectives
In 2018, the Healing Emotional Lives of Peers (HELP) Program was implemented at Mayo Clinic Rochester to guide healthcare professionals (HCPs) after a second victim experience, such as adverse patient events or medical errors. The HELP program was expanded to all HCPs in response to the anticipated stressors of the COVID-19 pandemic. This article aims to describe the rapid expansion of the peer support program and evaluate the effectiveness of peer support provided to affected colleagues (ACs).

Methods
Quantitative data collected from workshop evaluations, activations, and associated metrics (TPS Self-Assessment, Encounter Form, and AC Self-Assessment) were summarized through standard descriptive statistics using SAS version 9.4 software. Open-ended responses were qualitatively analyzed for iterative themes about the HELP program and associated workshops.

Results
Between April 2020 and December 2021, 22 virtual workshops to train peer supporters were conducted with 827 attendees. Of these, 464 employees completed the workshop evaluation. A total of 94.2% rated the workshop as excellent or very good. Participants perceived the workshop to be highly effective and felt more prepared to support ACs. Between May 2020 and December 2021, 247 activations were submitted through the HELP Program’s intranet Web site and peer support was requested for 649 employees. Of the 268 TPS Self-Assessments, 226 (84.3%) felt that they provided helpful support to an AC. One hundred ACs evaluated support received, with 93% being “extremely” or “very satisfied.” Affected colleagues appreciated having a TPS provide judgment-free support.

Conclusions
The HELP Program promotes a culture of safety by helping HCPs process traumatic events. To effectively meet the needs of patients, healthcare organizations need to prioritize the well-being of their employees through interpersonal support.
Initial antiretroviral therapy regimen and risk of heart failure
Authors: Silverberg Michael J. , Pimentel Noel , Leyden Wendy A. , Leong Thomas K. , Reynolds Kristi , Ambrosy Andrew P. , Towner William J. , Hechter Rulin C. , Horberg Michael , Vupputuri Suma , Harrison Teresa N. , Lea Alexandra N. , Sung Sue Hee , Go Alan S. , Neugebauer Romain 
Published: November 2023

Objective(s):
Heart failure risk is elevated in people with HIV (PWH). We investigated whether initial antiretroviral therapy (ART) regimens influenced heart failure risk.

Design:
Cohort study.

Methods:
PWH who initiated an ART regimen between 2000 and 2016 were identified from three integrated healthcare systems. We evaluated heart failure risk by protease inhibitor, nonnucleoside reverse transcriptase inhibitors (NNRTI), and integrase strand transfer inhibitor (INSTI)-based ART, and comparing two common nucleotide reverse transcriptase inhibitors: tenofovir disoproxil fumarate (tenofovir) and abacavir. Follow-up for each pairwise comparison varied (i.e. 7 years for protease inhibitor vs. NNRTI; 5 years for tenofovir vs. abacavir; 2 years for INSTIs vs. PIs or NNRTIs). Hazard ratios were from working logistic marginal structural models, fitted with inverse probability weighting to adjust for demographics, and traditional cardiovascular risk factors.

Results:
Thirteen thousand six hundred and thirty-four PWH were included (88% men, median 40 years of age; 34% non-Hispanic white, 24% non-Hispanic black, and 24% Hispanic). The hazard ratio (95% CI) were: 2.5 (1.5–4.3) for protease inhibitor vs. NNRTI-based ART (reference); 0.5 (0.2–1.8) for protease inhibitor vs. INSTI-based ART (reference); 0.1 (0.1–0.8) for NNRTI vs. INSTI-based ART (reference); and 1.7 (0.5–5.7) for tenofovir vs. abacavir (reference). In more complex models of cumulative incidence that accounted for possible nonproportional hazards over time, the only remaining finding was evidence of a higher risk of heart failure for protease inhibitor compared with NNRTI-based regimens (1.8 vs. 0.8%; P = 0.002).

Conclusion:
PWH initiating protease inhibitors may be at higher risk of heart failure compared with those initiating NNRTIs. Future studies with longer follow-up with INSTI-based and other specific ART are warranted.
Effect of Laparoscopic and Open Pancreatoduodenectomy for Pancreatic or Periampullary Tumors
Authors: Qin Tingting , Zhang Hang , Pan Shutao , Liu Jun , Li Dewei , Chen Rufu , Huang Xiaobing , Liu Yahui , Liu Jianhua , Cheng Wei , Chen Xuemin , Zhao Wenxing , Li Jingdong , Tan Zhijian , Huang Heguang , Li Deyu , Zhu Feng , Yu Guangsheng , Zhou Baoyong , Zheng Shangyou , Tang Yichen , Ke Jianji , Liu Xueqing , Chen Botao , Chen Weibo , Ma Hongqin , Xu Jian , Liu Yifeng , Lin Ronggui , Dong Yadong , Yu Yahong , Wang Min , Qin Renyi ,   Minimally Invasive Treatment Group in the Pancreatic Disease Branch of China’s International Exchange and Promotion Association for Medicine and Healthcare (MITG-P-CPAM)
Published: November 2023

Objective:
This study aimed to estimate whether the potential short-term advantages of laparoscopic pancreaticoduodenectomy (LPD) could allow patients to recover in a more timely manner and achieve better long-term survival than with open pancreaticoduodenectomy (OPD) in patients with pancreatic or periampullary tumors.

Summary Background Data:
LPD has been demonstrated to be feasible and may have several potential advantages over OPD in terms of shorter hospital stay and accelerated recovery than OPD.

Methods:
This noninferiority, open-label, randomized clinical trial was conducted in 14 centers in China. The initial trial included 656 eligible patients with pancreatic or periampullary tumors enrolled from May 18, 2018, to December 19, 2019. The participants were randomized preoperatively in a 1:1 ratio to undergo either LPD (n=328) or OPD (n=328). The 3-year OS, quality of life, which was assessed using the 3-level version of the EQ-5D (EQ-5D-3L), depression, and other outcomes were evaluated.

Results:
Data from 656 patients (328 men [69.9%]; mean [SD] age: 56.2 [10.7] years) who underwent PD were analyzed. For malignancies, the 3-year OS rates were 59.1% and 54.3% in the LPD and OPD groups, respectively (P=0.33, hazard ratio [HR]: 1.16, 95% confidence interval [CI]: 0.86-1.56). The 3-year OS rates for others were 81.3% and 85.6% in the LPD and OPD groups, respectively (P=0.40, HR: 0.70, 95% CI: 0.30-1.63). No significant differences were observed in quality of life, depression and other outcomes between the two groups.

Conclusions:
In patients with pancreatic or periampullary tumors, LPD performed by experienced surgeons resulted in a similar 3-year OS compared with OPD.
Influence of Preoperative Educational Intervention for Patients Undergoing Fecal Ostomy Surgery
Authors: García-Cabrera Ana María , de la Portilla de Juan Fernando , Navarro-Morales Laura , Ribera García Sebastián , Durán Ventura María del Carmen , Fernández Luque Inés , Padillo-Ruiz Francisco Javier 
Published: November 2023

PURPOSE:
This aim of this study was to compare the impact on hospital stay and short-term overall complications prior to and following the introduction of an outpatient preoperative ostomy education program to an existing inpatient ostomy education program.

DESIGN:
A comparison cohort study.

SUBJECTS AND SETTING:
One hundred thirty-eight consecutive patients undergoing ostomy surgery were included. One group (n = 65, 47%) was given an experimental preoperative ostomy education intervention, along with standard care including a postoperative educational intervention during the initial hospital course. A second group (n = 73, 53%) received the same standardized education in the postoperative period. Data were collected from a single tertiary center located in Seville, Spain, during a 12-month period between July 2014 and June 2015.

METHODS:
Data were collected in 2 phases. Data from participants undergoing postoperative (standard) education were collected retrospectively. Data for the group receiving preoperative education were collective prospectively. Outcome variables were postoperative length of stay, surgical complications (severity was assessed by the Clavien-Dindo grading system), subsequent interventions, and readmission rates.

RESULTS:
Analysis indicated no differences between the average length of postoperative hospital stay (12.32 days in the preoperative education group vs 12.76 days in the postoperative education group, P = .401). In contrast, overall complications, mortality, and readmission rates were significantly higher in the preoperative education program group (P = .027, P = .047, and P = .046, respectively).

CONCLUSIONS:
Delivering a standardized educational intervention during the preoperative period versus postoperative education delivery during the ostomy surgery hospital course did not reduce length of stay. Analysis indicated that overall complications, mortality, and readmission rates were significantly higher in the preoperative education program group but we hypothesize that intervening factors may have influenced these outcomes.
Peristomal Moisture-Associated Skin Damage Treatment: Use of Cyanoacrylate Liquid Skin Protectant
Authors: Hill Rosemary H. , Smith Stephen L. 
Published: November 2023

BACKGROUND:
Despite recent advances in ostomy care, the incidence of stoma and peristomal skin complications including peristomal moisture-associated skin damage (MASD) remains as high as 80% of patients living with ostomies. We evaluated a cyanoacrylate liquid skin protectant (CLSP) for the treatment and healing of peristomal MASD in patients with an ileostomy, ileal conduit, or colostomy.

CASES:
Five patients (24-85 years old) with peristomal MASD related to an ileostomy (n = 2), ileal conduit (n = 2), or colostomy (n = 1) were evaluated in this case study. All were treated with a CLSP in an attempt to reduce peristomal MASD caused by effluent leakage, which resulted in painful denudation of the peristomal skin. All patients received 1 to 2 applications of the CLSP prior to replacement of the pouching system. Prior to CLSP application, patients underwent assessment focusing on the causes of ostomy pouching system undermining and leakage. Interventions to prevent recurrent undermining and leakage, usually focused on modifications of the pouching system, were completed when indicated.

CONCLUSIONS:
For these 5 patients, complete resolution of peristomal MASD was observed at 2 to 8 days following CLSP treatment. More severe peristomal MASD cases required 7 to 8 days for complete resolution while less severe peristomal MASD resolved within 2 to 3 days. Patients showed less frequent pouching system changes, healing of peristomal skin, and reduced peristomal MASD associated with the CLSP treatment and addressing underlying etiology. On a pain scale of 0 to 10, patients reported less pain with an average of more than 7 out of 10 prior to the CLSP treatment and less than 4 out of 10 after treatment.