bluuebunny/crossref_metadata_2025_split huggingface dataset:
Change in End-Tidal Co 2 After Mini-Fluid Challenge to Determine Fluid Responsiveness
Authors: Budnick Isadore M. , Popovich John J. , Barros Andrew J. , Kadl Alexandra 
Published: February 2023

OBJECTIVES:
Distributive shock is a major cause of morbidity and mortality in the ICU. IV fluid resuscitation is a vital intervention to improve cardiac output and end-organ perfusion during the initial resuscitation and for those who remain fluid responsive. Noninvasive measures of fluid responsiveness are lacking. The aim of this study is to assess whether changes in end-tidal c
o
2 after mini-fluid challenge, or 250 mL bolus, can predict fluid responsiveness in mechanically ventilated patients with distributive shock.

DESIGN:
Single-center prospective study.

SETTING:
Patients were enrolled from 2019 to 2021 from the medical ICU within a single academic hospital.

PATIENTS:
Thirty-eight patients with paired measurements of fluid responsiveness as determined by bioreactance who were admitted to the ICU with a diagnosis of distributive shock and on mechanical ventilation.

INTERVENTIONS:
Stroke volume index (SVI), cardiac index, heart rate, systolic blood pressure, diastolic blood pressure, mean arterial pressure, and ETco
2 were measured before and after completion of a mini-fluid challenge. Test characteristics of change in ETco
2 (ΔETco
2) greater than or equal to 2 after mini-fluid challenge to determine fluid responsiveness were calculated with percentage change in SVI greater than or equal to 10% used as the reference standard.

MEASUREMENTS AND MAIN RESULTS:
The sensitivity and specificity of a ΔETco
2 greater than or equal to 2 mm Hg as a predictor of a change in SVI greater than or equal to 10% following a mini-fluid challenge were 20.0% and 91.3%, respectively. The area under the receiver operating characteristic curve was 0.62.

CONCLUSIONS:
A ΔETco
2 greater than or equal to 2 mm Hg after mini-fluid challenge has limited test performance for determining fluid responsiveness in intubated patients with distributive shock.
Efficacy and Safety of Sugammadex to Shorten Time-to-Extubation Following Cardiac Surgery: A Single-Center Randomized Placebo-Controlled Trial
Authors: Bardia Amit , Treggiari Miriam M. , Dai Feng , Johnson Chanel , Singh Manila , Kunze Kim , Tickoo Mayanka , Tantawy Hossam , Giersson Arnar , Darr Umer , Schonberger Robert B. 
Published: February 2023

OBJECTIVES:
Residual neuromuscular blockade (NMB) is an important and modifiable factor associated with prolonged mechanical ventilation after cardiac surgery. Studies evaluating the use of sugammadex for residual NMB reversal in the post-cardiac surgery ICU setting are lacking. We conducted a randomized trial to determine the efficacy of sugammadex in reducing time to extubation in patients admitted to the ICU after cardiac surgery.

DESIGN:
Single-center, randomized, double-blind, placebo-controlled trial.

SETTING:
University-based cardiothoracic ICU.

SUBJECTS:
Patients (n = 90) undergoing elective aortic valve replacement (AVR) and/or coronary artery bypass grafting (CABG) surgery.

INTERVENTIONS:
Participants were randomized to receive either sugammadex (2 mg/kg) or placebo after arrival to the ICU.

MEASUREMENTS AND MAIN RESULTS:
The primary study endpoint was time from study drug administration to extubation. Of the 90 patients included in the study (45 in each group), a total of 68 patients underwent CABG, 13 AVR, and nine combined AVR and CABG. Baseline characteristics and intraoperative anesthetic medications were comparable between groups. Patients in sugammadex group had reduced time to extubation compared with the placebo group (median [interquartile range (IQR)]—sugammadex group: 126.0 min [84.0–274.0 min] vs placebo: 219.0 min [121.0–323.0 min]; difference in means [95% CI], 72.8 [1.5-144.1 min]; p = 0.01. There were no differences in negative inspiratory force (mean [sd]—sugammadex group: 33.79 cm H2O [8.39 cm H2O] vs placebo: –31.11 cm H2O [7.17 cm H2O]) and vital capacity (median [IQR]—sugammadex group: 1.1 L [0.9–1.3 L] vs placebo: 1.0 L [0.9–1.2 L]). There were no differences between groups in postoperative blood product requirement, dysrhythmias, length of ICU, or hospital stay. There were no serious adverse events in either group.

CONCLUSIONS:
This randomized trial showed that the administration of sugammadex after cardiac surgery decreased time to extubation by approximately 1 hour. Larger trials may be required to confirm these findings and determine the clinical implications.
Child Opportunity Index and Hospital Utilization in Children With Traumatic Brain Injury Admitted to the PICU
Authors: Gray Monica M. , Malay Sindhoosha , Kleinman Lawrence C. , Stange Kurt C. , Borawski Elaine A. , Shein Steven L. , Slain Katherine N. 
Published: February 2023

IMPORTANCE:
The need to understand how Community-based disparities impact morbidity and mortality in pediatric critical illness, such as traumatic brain injury. Test the hypothesis that ZIP code-based disparities in hospital utilization, including length of stay (LOS) and hospital costs, exist in a cohort of children with traumatic brain injury (TBI) admitted to a PICU using the Child Opportunity Index (COI).

DESIGN:
Multicenter retrospective cohort study.

SETTING:
Pediatric Health Information System (PHIS) database.

PATIENTS:
Children 0–18 years old admitted to a PHIS hospital with a diagnosis of TBI from January 2016 to December 2020 requiring PICU care. To identify the most severely injured children, a study-specific definition of “Complicated TBI” was created based on radiology, pharmacy, and procedure codes.

INTERVENTIONS:
None.

Main Outcomes and Measures:
Using nationally normed ZIP code-level COI data, patients were categorized into COI quintiles. A low COI ZIP code has low childhood opportunity based on weighted indicators within educational, health and environmental, and social and economic domains. Population-averaged generalized estimating equation (GEE) models, adjusted for patient and clinical characteristics examined the association between COI and study outcomes, including hospital LOS and accrued hospital costs. The median age of this cohort of 8,055 children was 58 months (interquartile range [IQR], 8–145 mo). There were differences in patient demographics and rates of Complicated TBI between COI levels. The median hospital LOS was 3.0 days (IQR, 2.0–6.0 d) and in population-averaged GEE models, children living in very low COI ZIP codes were expected to have a hospital LOS 10.2% (95% CI, 4.1–16.8%; p = 0.0142) longer than children living in very high COI ZIP codes. For the 11% of children with a Complicated TBI, the relationship between COI and LOS was lost in multivariable models. COI level was not predictive of accrued hospital costs in this study.

CONCLUSIONS:
Children with TBI requiring PICU care living in low-opportunity ZIP codes have higher injury severity and longer hospital LOS compared with children living in higher-opportunity ZIP codes. Additional studies are needed to understand why these differences exist.
Extracorporeal Membrane Oxygenation for COVID-19: Comparison of Outcomes to Non-COVID-19–Related Viral Acute Respiratory Distress Syndrome From the Extracorporeal Life Support Organization Registry
Authors: Chandel Abhimanyu , Puri Nitin , Damuth Emily , Potestio Christopher , Peterson Lars-Kristofer N. , Ledane Julia , Rackley Craig R. , King Christopher S. , Conrad Steven A. , Green Adam 
Published: February 2023

OBJECTIVES:To compare complications and mortality between patients that required extracorporeal membrane oxygenation (ECMO) support for acute respiratory distress syndrome (ARDS) due to COVID-19 and non-COVID-19 viral pathogens.DESIGN:Retrospective observational cohort study.SETTING:Adult patients in the Extracorporeal Life Support Organization registry.PATIENTS:Nine-thousand two-hundred ninety-one patients that required ECMO for viral mediated ARDS between January 2017 and December 2021.INTERVENTIONS:None.MEASUREMENTS AND MAIN RESULTS:The primary outcomes of interest were mortality during ECMO support and prior to hospital discharge. Time-to-event analysis and logistic regression were used to compare outcomes between the groups. Among 9,291 included patients, 1,155 required ECMO for non-COVID-19 viral ARDS and 8,136 required ECMO for ARDS due to COVID-19. Patients with COVID-19 had longer duration of ECMO (19.6 d [interquartile range (IQR), 10.1–34.0 d] vs 10.7 d [IQR, 6.3–19.7 d];p< 0.001), higher mortality during ECMO support (44.4% vs 27.5%;p< 0.001), and higher in-hospital mortality (50.2% vs 34.5%;p< 0.001). Further, patients with COVID-19 were more likely to experience mechanical and clinical complications (membrane lung failure, pneumothorax, intracranial hemorrhage, and superimposed infection). After adjusting for pre-ECMO disease severity, patients with COVID-19 were more than two times as likely to die in the hospital compared with patients with non-COVID-19 viral ARDS.CONCLUSIONS:Patients with COVID-19 that require ECMO have longer duration of ECMO, more complications, and higher in-hospital mortality compared with patients with non-COVID-19–related viral ARDS. Further study in patients with COVID-19 is critical to identify the patient phenotype most likely to benefit from ECMO and to better define the role of ECMO in the management of this disease process.
Gracilis Muscle Interposition for the Treatment of Rectovaginal Fistula: A Systematic Review and Pooled Analysis
Authors: Maspero Marianna , Otero Piñeiro Ana , Steele Scott R. , Hull Tracy L. 
Published: February 2023

BACKGROUND:
A rectovaginal fistula is a debilitating condition that often severely impacts quality of life. Despite many treatment options available, the best surgical treatment is far from being established and many patients will undergo several procedures before fistula closure is achieved. Gracilis muscle interposition, i.e. the transposition of the gracilis muscle into the rectovaginal septum, is an option for complex and persistent fistulasF, but literature on the subject is scarce, mainly consisting of small case series.

OBJECTIVE:
To assess the success rate of gracilis muscle interposition for the surgical treatment of rectovaginal fistula.

DATA SOURCES:
MEDLINE, EMBASE, Cochrane Library, Web of Science

STUDY SELECTION:
Studies comprising at least 5 patients who underwent gracilis muscle interposition for rectovaginal fistula were included. No date or language restrictions were applied.

INTERVENTION:
Gracilis muscle interposition.

MAIN OUTCOME MEASURES:
The primary outcome is fistula closure rate (%). Other domains analyzed are stoma closure rate, postoperative complications, quality of life, fecal continence, sexual function.

RESULTS:
Twenty studies were included, for a total of 384 patients. The pooled fistula closure rate for gracilis muscle interposition was 64% (95% CI, 53% - 74%, range, 33 – 100%). Risk factors for failure were smoking, underlying Crohn’s disease and more than 2 previous repairs, while stoma formation was associated with improved outcomes. Postoperative complications ranged from 0 to 37%, mostly related to surgical site occurrences at the harvest site and perineal area. No deaths occurred. Gracilis muscle interposition improved quality of life and fecal continence, while impairment of sexual function was common.

LIMITATIONS:
Most of the included studies were small case series.

CONCLUSIONS:
Gracilis muscle interposition is a safe and moderately effective treatment that could be taken into consideration as second- or third-line therapy for recurrent RVF.
PROSPERO registration number: CRD42022319621
Surgical Matricectomy Versus Phenolization in the Treatment of Ingrown Toenails: A Randomized Controlled Trial
Authors: Shajil Chandana , Kumari Rashmi 
Published: February 2023

BACKGROUND
Treatment of ingrown toenail includes various nonsurgical and surgical treatments. However, there is no consensus on the ideal first-choice treatment.

OBJECTIVE
To compare phenolization versus surgical matricectomy (SM) after lateral nail plate avulsion in terms of efficacy, recurrence rates, postoperative outcomes, and cosmesis.

METHODS
The authors enrolled 45 consenting patients and randomized them into 2 groups (Group 1 = phenolization and Group 2 = SM) using stratified block randomization and followed them up at 1 week, 1 month, and 6 months.

RESULTS
The median percentage improvement in pain visual analog scale (VAS) score was comparable between the 2 groups (p = 0.793). The mean photo VAS showed significant improvement in Group 1 at 1 week (p = 0.00) and 1 month (p = 0.02) but not at 6 months (p = 0.44). The median number of days for pain relief (p = 0.169), for healing (p = 0.192), and for resuming work (p = 0.136) were not significantly different between the 2 groups. The time required to regain normal morphology was significantly longer in Group 2 (p = 0.006). None of the patients in either group presented with recurrence at 6 months and 1 year. The authors observed failure of treatment in 1 patient in Group 2.

CONCLUSION
Both procedures were equally efficacious, had minimal complications, and showed no recurrence at 6 months and 1 year.
Efficacy of Platelet-Rich Plasma Versus Autologous Fat Transfer With Nanofat in the Treatment of Infraorbital Dark Circles: A Single-Blinded Randomized Comparative Clinical Trial
Authors: Kadry Ahmed , Gamal Ahmed , Alkhalifah Azzam , Ibrahim Shady Mahmoud Attia 
Published: February 2023

BACKGROUND
Treating infraorbital dark circles is one of the commonest aesthetic demands worldwide. Autologous fat transfer is commonly used to treat dark circles by filling the grooves, without effect on skin quality. Platelet-rich plasma has been reported to improve skin quality. Autologous fat can be emulsified and filtered to produce nanofat, which is then injected superficially in the dark circles to improve skin quality and discoloration.

OBJECTIVE
To compare the efficacy of platelet-rich plasma versus combined fat transfer and nanofat in treating infraorbital dark circles.

MATERIALS AND METHODS
30 patients with infraorbital dark circles of combined etiological factors were randomized into 2 equal groups: Group A treated with platelet-rich plasma and Group B treated with autologous fat transfer with emulsified fat injection.

RESULTS
Excellent and moderate responses were observed in 3 (20%) and 2 (13%) patients in group A versus 7 (46.7%) and 4 (27%) in group B, respectively. Nonresponders were 8 (53.3%) in group A and only 1 patient (6.7%) in group B. The difference was statistically significant regarding improvement (p = .048) and patient satisfaction (p = .032).

CONCLUSION
Autologous fat transfer with nanofat is significantly superior to platelet-rich plasma in improvement and satisfaction.
An unusual case of long-term survival with excellent quality of life after surgery of rectal cancer with metastasis to the liver, lung, and scalp
Authors: Tsui Yu-Wen , Tsai Chia-Yu , Chen Hung-Chi 
Published: February 2023

Abstract
With improvements in therapies for colorectal cancer, patient survival can be extended remarkably. Multiple treatment modalities can be combined, and collaboration among different departments is important. A patient presented with rectal cancer with metastases to the liver, lungs, and scalp, which were excised completely. The scalp lesion recurred twice, and the final procedure was a free flap reconstruction after wide excision. Since then, there has been no recurrence, and the patient has had an excellent quality of life after 8 years of follow-up. The overall survival of colorectal cancer is increasing owing to improvements in surgery, chemotherapy, and targeted therapy. Aggressive treatment is helpful in patients with metastatic colorectal cancer.
Rational use of antimicrobials: a nationwide cross-sectional survey among people of Pakistan
Authors: Khadka Sitaram , Hashmi Furqan K. , Yadav Gopal K. , Lamichhane Sabitri , Giri Santoshi , Tariq Fatima , Amin Sabahat , Zaheer Warda , Akram Kiran , Asghar Ifra , Zahra Kainat , Bajwa Faiza , Ul-ain Noor , Adnan Muhammad A.J. 
Published: February 2023

Background:
The misuse of antibiotics in low- and middle-income countries is getting escalated leading to the emergence of antimicrobial resistance. This study aims to evaluate the knowledge, behavior, and practice of antimicrobial misuse among the Pakistani population for the implementation of an effective stewardship plan that ensures the rational use of medicines.

Methods:
It was a nationwide cross-sectional survey conducted among 1011 participants in Pakistan from March 2022 to August 2022. Statistical analysis was done through SPSS v21. The original Bloom’s cut-off point was utilized to categorize the participants’ overall knowledge, behavior, and practice. The χ2 test was used to test for group differences. For multivariable logistic regression analyses, adjusted odds ratio (AOR) was calculated at 95% CI.

Results:
The majority of the respondents were female 69.3%, in a state of good health 81.5%, and non-health care professionals 64.0%. More than half of the participants (55.3%) demonstrated true knowledge, whereas more than four-fifths (88.6%) and almost half (47.9%) of the participants showed moderate to good behavior and practice about the rational use of antimicrobials. The employed participants (AOR: 2.12, 95% CI: 1.51–2.98), health professionals (AOR: 1.64, 95% CI: 1.25–2.17), urban residents (AOR: 1.61, 95% CI: 1.12–2.38) and participants without comorbidities (AOR: 1.89, 95% CI: 1.32–2.70) had significant association with good/true knowledge. Lower education (AOR: 1.69, 95% CI: 1.06–2.70), rural residence (AOR: 2.06, 95% CI: 1.42–3.01), and lower monthly income <50 PKR (AOR: 1.67, 95% CI: 1.28–2.17) were significant factors affecting practice about rational use of antimicrobials. However, none of the factors had significant association with behavior of the participants.

Conclusion:
Implementation of an effective management plan for rational use of medicines is suggested to halt antibiotic misuse which harms public health. Adequate training programs for health care professionals and educational interventions for the general public are required. Strict enforcement of rules and regulations, Drug Sale Rules 2007, and implementation of Pakistan’s National Action Plan on antimicrobial resistance are essential.
Topical Dimethyl Sulfoxide for Congested Nipple–areolar Complexes in Breast Surgery: A Pilot Study
Authors: Silverstein Max L. , McLean Paige , Crowley Jiwon S. , Gosman Amanda A. 
Published: February 2023

Background:
Necrosis of the nipple–areolar complex (NAC) is a major complication of breast surgery that most commonly results from venous congestion. Several conservative rescue therapies have been proposed for relieving NAC congestion, but each carries certain drawbacks, including cost and side effect profile. In this study, we evaluated the effectiveness of topical dimethyl sulfoxide (DMSO), an inexpensive compound with vasodilatory, free radical scavenging, and antiinflammatory properties in rescuing congested NACs.

Methods:
We conducted a review of all 15 patients treated with DMSO for NAC congestion at our institution between May 2019 and October 2020. DMSO was applied in liquid form on a soaked gauze pad in the hospital; patients were instructed to apply a DMSO cream to the NAC twice a day following discharge. Patient characteristics and data related to DMSO treatment and NAC healing were compared via univariate analysis.

Results:
Eighteen congested NACs from 15 patients who underwent mastectomy, breast reduction, mastopexy, or breast reconstruction were treated with DMSO. Of the 18 treated NACs, 15 healed with DMSO treatment alone. The average length of DMSO treatment was 9.4 ± 8.5 days (mean ± standard deviation); NAC healing took place over 9.9 ± 9.6 days. There were no complications related to DMSO treatment.

Conclusions:
This pilot study shows that DMSO may be an effective topical treatment for NAC congestion following breast surgery. Given its low cost, ease of application, and lack of side effects, future studies should prospectively compare DMSO against other topical treatments, like nitroglycerin ointment.
Hybrid Stromal Vascular Fraction (Hybrid-SVF): A New Paradigm in Mechanical Regenerative Cell Processing
Authors: Tiryaki Tunc , Cohen Steven Roy , Canikyan Turkay Serli , Kocak Polen , Sterodimas Aris , Schlaudraff Kai-Uwe , Akgün Demir Işil , Agovino Annarita , Kul Yaren 
Published: February 2023

Background:
Enzymatic digestion of extracellular matrix (ECM) from lipoaspirate is the conventional form of harvesting stromal vascular fraction (SVF) called enzymatically digested SVF (E-SVF). Mechanical SVF (M-SVF) isolation has emerged as an alternative method, but it has also some limitations in terms of lower cell viability and diminished cell counts. To enhance the SVF qualitatively and quantitatively, we propose a novel concept called "hybrid-SVF,” in which we combine M-SVF with the concentrated parts of adipose tissue after centrifugation, which is called stromal vascular matrix (SVM).

Methods:
Hybrid-SVF injection was applied as an adjunctive therapy to fat grafting in 88 patients and 11 samples were evaluated in the laboratory for cell count, viability and cell activity.

Results:
Experimental results determined that SVM part showed higher cellular activity. SVM and M-SVF showed higher cellular potency than E-SVF. Clinically, none of the patients required an additional session for fat grafting since there was no significant graft resorption. However, seven patients asked for further volume augmentation due to their individual preferences. No major complication was encountered.

Conclusions:
The usage of hybrid-SVF has a very high regenerative potential due to the ECM support and exceptionally high cell yield in addition to preserved cell potency. Although there are ongoing studies focusing on optimizing cell counts and further clinical applications, we believe that our preliminary results might create a paradigm shift in the area of regenerative fat grafting.
Left Internal Mammary Vein Size and Its Impact on Microsurgical Breast Reconstruction
Authors: Seth Akhil K. , Halvorson Eric G. , Caterson Stephanie A. , Carty Matthew J. , Erdmann-Sager Jessica 
Published: February 2023

Background:
The internal mammary vessels are the preferred recipient during free-flap breast reconstruction (FFBR). Previous studies have demonstrated that the left internal mammary vein (IMV) is consistently smaller than the right, but with unclear clinical implications. This study explores the impact of IMV size difference on FFBR complication rates.

Methods:
Abdominal-based FFBRs were retrospectively reviewed. Venous coupler size was considered a proxy for IMV diameter. Outcomes of three patient cohorts (all, unilateral, and bilateral reconstructions) were analyzed with univariate and multivariate analysis.

Results:
Our cohort consisted of 582 patients who underwent 874 abdominal-based FFBR, with a similar number of unilateral (n = 290) and bilateral (n = 292), and right (n = 424) and left (n = 450) reconstructions. Mean follow-up was over 4-years. For all reconstructions, the left IMV (2.7 ± 0.4 mm) was smaller than the right (3.0 ± 0.4 mm) (P < 0.0001). Complication rates between left- and right-sided FFBR were similar, but with a trend toward increased fat necrosis on the left (n = 17, 3.8% versus n = 8, 1.9%). Further subgroup analysis showed significantly higher fat necrosis in unilateral left-sided FFBR (n = 12 versus n = 2, P = 0.02), with left-sided FFBR being an independent risk factor for fat necrosis on multivariate analysis.

Conclusions:
The left-side IMV is significantly smaller than the right IMV. In bilateral reconstructions, the smaller size of the left IMV did not result in a greater risk of complications; however, in unilateral FFBR, fat necrosis was significantly higher on the left side.