bluuebunny/crossref_metadata_2025_split huggingface dataset:
Veno-arterial ECMO support for severe amlodipine toxicity combined with cardiogenic shock: A case report
Authors: Sun Yi , Wang Tingting , Xia Jiading , Hua Liwei , Cao Shuchen , Zhang Kun 
Published: February 2025

Introduction: Management of severe circulatory collapse in the setting of amlodipine toxicity can be challenging. High doses of vasopressors and conventional therapies fail to improve hemodynamics, resulting in the use of veno-arterial extracorporeal membrane oxygenation (VA-ECMO) to treat severe cardiogenic shock and peripheral vasodilatation. Therapeutic plasma exchange (TPE), which helps remove plasma protein-bound toxins and significantly reduces mortality, may be a useful adjunct to invasive hemodynamic support in severe cases of amlodipine poisoning. Case summary: A 32-year-old female with a history of intentional consumption of ninety 5-mg amlodipine tablets (totaling 450 mg) was admitted to our intensive care unit (ICU) after 3 h. Her amlodipine serum concentration was 147 ng/mL. She presented with cardiogenic shock and fatal vasoplegia and received VA-ECMO and TPE. The patient was weaned off ECMO after 4 days and discharged home on Day 10 of hospitalization. Conclusion: Amlodipine toxicity can result in severe cardiac failure with circulatory collapse. We describe the case of a patient with cardiovascular collapse who successfully bridged to recovery from refractory shock secondary to severe amlodipine toxicity as a result of ECMO and TPE treatment.
Balanced Salt Solution Versus Normal Saline as Resuscitation Fluid in Pediatric Septic Shock: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
Authors: Chandelia Sudha , Angurana Suresh Kumar , Prasad Shankar , Tiwari Mithlesh Kumar , Jayashree Muralidharan , Nallasamy Karthi , Bansal Arun 
Published: February 2025

Objective Fluid resuscitation is an important intervention in children with septic shock. The composition of resuscitation fluid is a matter of debate. Our aim was to study the effects of balanced salt solution (BSS) versus normal saline (NS) for resuscitation in pediatric septic shock. Data sources We searched MEDLINE, Embase, LILAC, Cochrane Collaboration, ClinicalTrials.gov, and World Health Organization International Clinical Trials Registry Platform. Study selection Two independent authors screened title and abstracts and then full papers of included studies. Data extraction Two authors extracted data from full papers independently. Random-effects model was used for analysis of RCTs. We used Cochrane's risk of bias tool for assessing the quality of studies. Primary outcome was mortality and secondary outcomes were rates of acute kidney injury (AKI), need for renal replacement therapy (RRT), and adverse effects (hyperchloremia, metabolic acidosis, and fluid overload); and duration of PICU and hospital stay. Data synthesis Five RCTs with 992 children were included. Resuscitation with BSS versus NS was not associated with reduction in mortality (RR 0.82, 95% CI 0.45-1.50, p = 0.52; RCTs = 5); with similar results on sensitivity analysis (RR 0.76, 95% CI 0.41-1.41, p = 0.52; 4 RCTs = 4). However, resuscitation with BSS was associated with lower rates of AKI (sensitivity analysis RR 0.64, 95% CI 0.50-0.82, p = 0.0004; RCTs = 3); lesser need for RRT (RR 0.52, 95% CI 0.35-0.76, p = 0.0008; RCTs = 2); and lower rate of hyperchloremia (RR 0.74, 95% CI 0.62-0.87, p = 0.0002; RCTs = 3). The data is scant for other secondary outcomes (metabolic acidosis, fluid overload, and duration of PICU and hospital stay) to make any suggestions. The overall ‘risk of bias’ was low and unclear in most domains. Conclusion Use of BSS as resuscitation fluid in pediatric septic shock was not associated with reduction in mortality. However, BSS was associated with decreased risk of AKI, need of RRT and hyperchloremia. Clinical Trial Registration (if any) PROSPERO (CRD42022332208).
Moringa Oleifera Leaf Extract Enhances the Viability and Inhibits Ferroptosis in High Glucose-induced Rat Podocytes by Downregulating ACSL4
Authors: Liu Meixiao , Sui Yuelin , Pang Yin , Liu Jianhui , Zhang Haifeng 
Published: February 2025

Background: Diabetic nephropathy (DN) is a severe complication in patients with diabetes mellitus, which is mainly characterized by glomerular podocyte injury. Ferroptosis is crucial in the pathogenesis of DN. Moringa oleifera leaf extract (MOLE) has attracted attention due to its multiple pharmacological activities, but it is unclear whether it can delay the progression of DN by inhibiting ferroptosis. Purpose: To investigate whether MOLE can alleviate podocyte injury and delay the progression of DN by inhibiting ferroptosis. Methods: DN model cells were established using rat podocytes induced by high glucose (HG); the cells were processed with MOLE, dapagliflozin (DAPA, positive control), and acyl-CoA synthetase long-chain family member 4 (ACSL4) overexpression plasmids. Cell viability, Fe2+ concentration, reactive oxygen species (ROS), malondialdehyde (MDA), and glutathione (GSH) levels were monitored by Cell Counting Kit-8 (CCK-8) and corresponding kits. Results: MOLE treatment markedly enhanced HG-induced rat podocyte viability, decreased intracellular Fe2+ concentration, ROS level, MDA concentration, and elevated GSH concentration. ACSL4 overexpression reversed the protective effect of MOLE on podocytes. Conclusion: MOLE ameliorates rat podocyte injury and delays DN progression by inhibiting ACSL4-mediated ferroptosis. This finding provides a theoretical basis for further developing MOLE-based therapeutic agents for DN treatment.
Wilson’s Disease: A Case Study, Societal Challenges and Environmental Influences on Diagnosis and Management
Authors: Srivastava Sunita , Kumar Anil , Dogra Preeti , Jaifirin Daniel 
Published: February 2025

Introduction: Wilson’s disease is a rare autosomal recessive disorder caused by mutations in the ATP7B gene, which leads to excessive copper accumulation in organs such as the liver, brain and other vital tissues. This copper buildup can result in severe complications, including cirrhosis, liver failure and neurological deficits. It adds a lot of physical disability and psychosocial burden on the patient and their family. Methodology: This article reports the diagnosis and management of a 30-year-old patient who was admitted and seeking treatment at a tertiary care hepatology hospital in New Delhi. It focuses on the presentation of the case with specific medical and nursing management, paying close attention to the societal challenges and environmental influences. Results: A confirmatory diagnosis of Wilson’s disease was made. The patient was treated with Cuprimine (D-Penicillinase) along with zinc, other antibiotics and dietary modifications. Conclusion: Early diagnosis and prompt treatment along with a copper-restricted diet can enhance health outcomes to a great extent.
Assessing antineoplastic drug contamination in South African oncology pharmacies: Workplace and biological monitoring
Authors: Botha Ruan , Nelson Gill , Sessink Paul , Brouwer Derk 
Published: February 2025

Introduction Antineoplastic drugs (ADs) are hazardous substances commonly used in medical oncology, posing health risks to pharmacy personnel through occupational exposure. Despite safety guidelines, contamination of surfaces in oncology pharmacies remains prevalent. In this study, we assessed surface contamination and biological uptake of ADs in selected South African oncology pharmacies. Methods Six pharmacies (three from each of two medical oncology service providers, SP1 and SP2) participated. Surface wipe samples were collected from three areas in each pharmacy (containment-primary engineering control (C-PEC), floor, adjacent surface) before and after decontamination procedures. Nine ADs were quantified, using high-pressure liquid chromatography tandem mass spectrometry (HPLC-MS/MS). 24-h urine samples were collected from six pharmacy personnel. The DeRmal Exposure Assessment Method (DREAM) was used to estimate exposure risks. The results were compared with those from an observational study that assessed compliance with safety protocols in the same six pharmacies. Results Surface contamination was higher in SP1 than in SP2 pharmacies, with 5-fluorouracil (5-FU) being the most frequently detected AD. Post-decontamination samples showed a 17.4% reduction in 5-FU contamination, although SP1 pharmacies still had higher post-decontamination concentrations than SP2 pharmacies, especially on floors. Cyclophosphamide and ifosphamide were detected in the urine of two participants from SP1. Conclusion We demonstrated higher contamination and occupational exposure risks in SP1 than in SP2 pharmacies, indicating a need for strict decontamination protocols and better use of personal protective equipment in the SP1 pharmacies. The SP2 pharmacies may serve as a model for oncology pharmacy safety in South Africa.
A 4-Day Exposure to High Altitude Prolongs QTc in Healthy Human Subjects
Authors: Gudelunas Koa , Chinn Gregory A. , Barreto-Chang Odmara L. , Campbell Leah , Sall Jeffrey W. 
Published: February 2025

Introduction Long QTc syndrome can predispose patients to fatal ventricular arrhythmias. We studied the effects of a rapid ascent and a multiday stay at high altitude on QTc interval. Methods We recorded electrocardiograms (ECGs) on study subjects at sea level and then again after a 1-d ascent to 3800 m. Two sea-level ECGs were recorded at the initial screening visit (SL1) and 14 days later (SL2). Altitude ECGs were recorded at approximately 16 and 86 h after arrival. SpO2 was recorded prior to each ECG measurement. We defined prolonged QTc as a QTc interval >450 ms for men and >470 ms for women. We used multivariate analysis to analyze the QTc interval for the effect of drugs, altitude, and changes in electrolytes. Results We enrolled 107 subjects: 61 males and 46 females between the ages of 19 and 54 y, with a median age of 34 y. QTcF (QT interval for varying heart rates using Fridericia's formula) at SL1 was 405±17 ms; at SL2, 404±17 ms; at 16 h, 411±18 ms; and at 86 h, 427±24 ms. After 86 h at altitude, 12 participants met the criteria for prolonged QT syndrome, and 61% of subjects had QTc prolongation of >20 ms from sea-level values. This was independent of changes in serum electrolyte levels, (i.e., sodium, potassium, and calcium), bicarbonate levels, and SpO2. Conclusion High altitude exposure can lengthen a healthy adult's QTc interval by more than 20 ms. It remains unknown whether this increase might raise the risk of torsades de pointes in people with long QT intervals at baseline.
Theoretical and Methodological Imperatives in Longitudinal Healthcare Design and Research
Authors: Wan Thomas TH , Lin Ming-Yin , Wan Hunter S 
Published: February 2025

It is a challenge in pursuing an integrative approach to healthcare outcomes research. This paper articulates the need for conducting longitudinal data analysis to gain theoretical support for causal inquiries, using parallel latent growth curve modeling with multilevel predictors. Furthermore, the availability of time constant and time-varying predictors in multi-wave study design and analysis is imperative in the healthcare investigation of trajectories in disease progression and prevention. The two-fold purpose of this paper is to address how the measurement of healthcare outcomes is quantified and used in longitudinal studies, and how the variability of outcomes can be analyzed by growth curve modeling with parallel change parameters. Future longitudinal studies should be based on evidence-based design and thorough deductive reasoning coupled with a sound and parsimonious theoretical framework.
Comparing static versus dynamic ultrasound techniques: A randomized pilot trial of novice and advanced users
Authors: Hayward Geoffrey , Huang Henry , Regan Bethany R , Bellomo Maria-Chiara , Kendall Mark C 
Published: February 2025

Background: Ultrasound training requires proper instruction and guidance tailored both to novice and advanced ultrasound users. The aim of the current investigation was to compare the performance of novice and advanced sonographers using a tofu model for IV cannula placement using either ultrasound static (US) or dynamic (UD) techniques. Methods: Eighty volunteers were allocated to either the novice or advanced group according to prior ultrasonography experience. Participants were randomly assigned (1:1) to either the US or UD group. A modified version of the global rating scale was used to assess performance. The primary outcome was the assessment scale composite score. Secondary outcomes included time to procedure completion and the number of needle passes. Results: In the novice cohort, the US group scored significantly higher than participants in the UD, median difference 9 (95% CI: 0–19), p = 0.01. In the advanced cohort, there was no difference in the performance score. Advanced participants performed the UD technique in less time than those using the US technique, 28.5 s (IQR 24–40) vs 42.5 s (IQR 30–55), median difference 14 (95% CI: 1–27), p = 0.02, respectively. Novices showed no difference in time to completion for either technique. In the novice cohort, the number of needle passes was less in the US group, median of 1 (IQR 1–2) compared to the UD group, median of 2 (IQR 1–3.75), median difference −1 (95% CI: −2 to 0), p = 0.03. There was no difference in the number of needle passes in either techniques involving the advanced users. Conclusion: Compared to the real time UD method, the US technique for intravenous cannulation is more fitted for novice users and should be considered more widely as the introductory technique to improve their procedural efficiency of ultrasound guided intravenous cannulation.
Lung Ultrasound for Assessment of Interstitial Lung Disease in Systemic Sclerosis: Relationship With High-Resolution Computed Tomography and Nailfold Capillaroscopy
Authors: Elziaty Rahma A , Aboelyazeed Alaa A , Hegazy Sherif NA , Khalifa Ahmed A , Khalil Salma A 
Published: February 2025

Background: Lung ultrasound (LUS) has been recently proposed as a convenient and radiation-free imaging modality for the evaluation of systemic sclerosis–related interstitial lung disease. Objectives: The current study evaluates the relation between LUS and both high-resolution computed tomography (HRCT) and capillaroscopy findings in patients with systemic sclerosis. Design: This cross-sectional study included 32 patients with systemic sclerosis. Methods: Besides clinical evaluation, all participants underwent LUS, HRCT, pulmonary function tests (PFT), and nailfold video-capillaroscopy (NVC). All participants’ data were compared and correlated. Results: There is an excellent agreement between number of B-lines and HRCT score (interclass correlation = 0.864, P-value < .001). A significant positive correlation exists between number of B-lines and disease duration ( r = 0.459, P-value = .008). Conversely, the number of B-lines is negatively correlated with capillary density ( r = −0.687, P-value < .001), forced expiratory volume in the first second (FEV1) ( r = −0.886, P-value < .001), and forced vital capacity (FVC) ( r = −0.898, P-value < .001). Patients with either neoangiogenesis or previous/current digital ulcers had significantly higher number of B-lines than those without ( P-value < .001, .016, respectively). Conclusion: The number of B-lines parallels the HRCT score and the extent of digital vascular damage as indicated by NVC and clinical digital ulcers. Lung ultrasound has proven to be a reliable radiation-free modality for screening of systemic sclerosis–related interstitial lung disease and detecting its extent.
Retrospective Analysis of 28 Cases of Complex Regional Pain Syndrome
Authors: Beizeng Wu , Wen Bai , Xiaoxia Li , Yanhong Huang , Shubin Qiao 
Published: February 2025

Background: Complex Regional Pain Syndrome (CRPS) is a chronic condition characterized by persistent pain and local autonomic dysfunction. Its exact cause remains unclear, making diagnosis and treatment challenging. Objective: The objective was to investigate the clinical characteristics of CRPS patients and identify risk factors influencing its onset. Design: Retrospective analysis of medical records from 28 CRPS patients, examining variables such as demographics, comorbidities, triggering events, pain duration and location, previous examinations and treatments, clinical findings, auxiliary tests, initial and follow-up treatment outcomes, symptom relief time, and degree. Methods: Statistical methods were used to analyze the clinical data of 28 CRPS patients, assessing general characteristics and risk factors associated with the disease. Results: Females accounted for 57.14% of the cases, with an average patient age of 57.89 years. About 82.14% of patients experienced a triggering event prior to the onset of pain. The median time to diagnosis was 4.5 months, with a maximum duration of up to 7 years. Misdiagnosis occurred in 46.43% of patients. Laboratory tests showed that 77.78% (7 of 9) had abnormal bone metabolism; among those who underwent bone density scans, 66.67% (6 of 9) had osteoporosis, whereas 11.11% (1 of 9) had reduced bone mass. X-rays of 25 patients revealed that 44% (11 of 25) had either reduced bone mass or osteoporosis, with 2 showing more severe osteoporosis on the affected side compared with the healthy side. Rheumatoid arthritis was observed in 7.14% of patients. Post-treatment, significant pain relief was noted in 26 patients. Conclusion: This study helps clinicians more accurately identify and manage CRPS, reducing misdiagnosis and delayed diagnosis. In addition, the data suggest that osteoporosis and rheumatoid arthritis may be potential risk factors for CRPS.
Association between guideline-directed medical therapy and reintervention risk following peripheral vascular interventions in patients with peripheral artery disease
Authors: Callegari Santiago , Romain Gaëlle , Capuano Isabella , Cleman Jacob , Scierka Lindsey , Smolderen Kim G , Mena-Hurtado Carlos 
Published: February 2025

Introduction: Reintervention following peripheral vascular intervention (PVI) for peripheral artery disease (PAD) is common. Guideline-directed medical therapy (GDMT) is recommended post-PVI, yet its association with reintervention outcomes remains unclear. Methods: We analyzed Vascular Quality Initiative registry data linked with Medicare outcome for patients undergoing PVI for PAD (2017–2018). GDMT was defined as the receipt of statin, antiplatelet, and angiotensin-converting enzyme or angiotensin receptor blocker (ACE/ARB) therapy if hypertensive at discharge. Competing risk analyses and conditional risk models assessed the reintervention outcome, and the recurrent reintervention outcomes within 2 years, by GDMT receipt, compliance with each GDMT element, the number of elements received, and GDMT rate across sites and operators in a 1:1 propensity score-matched cohort. Results: We included 13,244 patients (mean age 72.0 ± 9.9, women 41.0%). The reintervention outcome did not differ by GDMT receipt (cumulative incidence: 43.0% [95% CI 41.0–44.9%] in no GDMT vs 41.2% [95% CI 39.4– 43.0%] in GDMT; subhazard ratio (sHR): 1.03 [95% CI 0.97–1.10]), compliance with GDMT elements, the number of elements received, or site and operator GDMT rates (sHR per 10% increase: 1.00 [95% CI 0.98–1.03] and 1.00 [95% CI 0.98–1.02]) (all p > 0.05). However, a higher operator GDMT rate reduced the recurrent reintervention risk (HR: 0.98 [95% CI 0.97–1.00], p = 0.026). Conclusion: Around 40% of patients undergoing a PVI experience reintervention within 2 years, but the outcome was not reduced with GDMT receipt, and higher GDMT rates by site and operators were not associated with reintervention risk. Future studies should focus on medication adherence, refills, and more granular GDMT data for PAD care surveillance postrevascularization.
Experimental and numerical investigation on the behavior of composite reinforced concrete columns encased by steel section and hybrid GFRP section
Authors: Salman Ban Fadhil , Allawi Abbas A 
Published: February 2025

GFRP was employed in constructions as an alternative to steel, which has many advantages like lightweight, large tensile strength and resist corrosion. Existing researches are insufficient in studying the influence of hybrid reinforced concrete composite columns encased by GFRP I-section (RCCCEG) and I-section steel (RCCCES). In this study twenty one (RC) specimens of a cross-section of 130 mm × 160 mm, with different length (long 1600 mm and short 750 mm) were encased by using I-section (steel and GFRP) and tested under various loading (concentric, eccentric and flexural loads). The test was focused on the influence of many parameters; load-carrying capacity, mode of failure, deformation and drawing an interaction diagram (N-M) for columns. The research explores the feasibility and effectiveness of the employing GFRP and steel sections. The test results concluded that all the composite columns with I-section steel presented similar failure modes to I-section GFRP composite column. Increasing in strength and ductility in short and slender reinforced concrete composite columns related to reinforced concrete columns. The eccentric load has a significant reduction in column strength, especially in slender column. The 3D FE models of (RCCC) were established by ABAQUS. (RCCC) was studied in terms of failure mode, deformation and bearing capacity also an analytical study was employed to obtain analytical results for short specimens subjected to flexural load and employing these outcomes for drawing interaction diagram (N-M) for short columns. Based on the verification of FE analysis, the experimental and theoretical results showed a good agreement.
Profiles of professional resistance in street-level bureaucracy programs. A quantitative-multidimensional typology
Authors: Villalobos Dintrans Cristóbal , Duboy-Luengo Mitzi , Miranda Catalina , Reininger Taly , Munoz-Arce Gianinna 
Published: February 2025

Summary Through a representative survey of front-line professionals from three social programs in Chile ( N = 1,694)—a country marker by the implementation neoliberal policies—we use latent class analysis (LCA) to build typologies of front-line professionals, according to the resistance actions that develop in their professional intervention practices. In this way, we explore the prevalence of each typology and the relationship between these typologies and sociodemographic and work characteristics. Findings The results show the existence of four typologies: (a) an adaptive focused professionals (38.3%), who mainly perform subtle and individual forms of resistance; (b) an organization focused professionals (21.6%) are professionals who frequently carried out resistance actions focused on the collective organization of demands; (c) multifocal resistant professionals (2.0%), who perform most of the resistance actions and; (d) complaint professionals (38.0%), who tend not to develop actions of professional resistance. Additionally, the analysis shows that the typologies vary according to gender, years of experience, place of work and the political institutional context of the intervention. Applications These results inform contemporary social work-practice in two ways. On the one hand, understanding the configurations, differences, and prevalences of professional resistance to front-line professionals (a very little explored field) and, on the other, helping to comprehend the relationship between professional resistance, sociodemographic characteristics, and working conditions. Both axes constitute central aspects of insight the implementation of social intervention, with important consequences for the development of contemporary social policies.