bluuebunny/crossref_metadata_2025_split huggingface dataset:
High remnant cholesterol and atherosclerotic cardiovascular disease in healthy women and men ages 70-100
Authors: Riis Julie , Nordestgaard Børge G , Afzal Shoaib 
Published: February 2025

Abstract

Aims
High remnant cholesterol has been increasingly recognized as an important risk factor for atherosclerotic cardiovascular disease (ASCVD). However, uncertainty remains regarding this association in old age. The aim of this study was to test the hypothesis that higher remnant cholesterol is associated with higher incidence of ASCVD in healthy women and men aged 70-100.

Methods
90,875 women (57%) and men aged 20-100 and without ASCVD, diabetes, or lipid-lowering therapy at baseline were included in the Copenhagen General Population Study in 2003-2015. During a median follow-up of 12.8 years, 7,352 were diagnosed with ASCVD. Incidence rates and hazard ratios were calculated according to age and sex.

Results
The highest incidence rate of ASCVD was observed in individuals aged 70-100 with a remnant cholesterol level &gt;1.0 mmol/L (&gt;39 mg/dL) (23 per 1000 person-years; 95% confidence interval [CI]: 21-25). Likewise, incidence rates of ASCVD per 1.0 mmol/L (39 mg/dL) higher remnant cholesterol were highest in individuals aged 70-100. Multivariable adjusted hazard ratio for 1.0 mmol/L (39 mg/dL) higher remnant cholesterol was 1.31 (95% CI: 1.20-1.44) in those aged 70-100, which was comparable to hazard ratios in younger age groups. Similar relationships were observed for women and men separately.

Conclusion
Higher remnant cholesterol was associated with higher incidence of ASCVD in those aged 70-100. The present results suggest that while relative rates of ASCVD for high versus low remnant cholesterol do not increase with higher age, elevated remnant cholesterol contribute substantially to the absolute risk of ASCVD at age 70-100.
Antibiotic resistance profiles of Enterococcus spp. isolates discovered from food-producing mussels (Mytilus galloprovincialis) farmed in Central Italy
Authors: Ferri Gianluigi , Pennisi Luca , Olivieri Vincenzo , Olivastri Alberto , Festino Anna Rita , Vergara Alberto 
Published: February 2025

Abstract

Aims
This study investigated the antimicrobial resistance phenomenon (phenotypical and genotypical profiles) in Enterococcus isolates, enrolled as marine bio sentinels, identified from bivalve lamellibranches (Mytilus galloprovincialis) farmed for human consumption on three different mariculture farms located along the coasts of the Central Adriatic Sea (Italy).

Methods and results
A total of 790 samples were collected and microbiologically screened by using culture-dependent methods, which permitted the identification of 118 enterococci (86 Enterococcus faecium, 24 Enterococcus durans, and eight Enterococcus gallinarum). In the antimicrobial susceptibility tests, all the isolates were mainly resistant to tetracyclines (54.54%), vancomycin (45.45%), nitrofurantoin (31.81%), quinupristin-dalfopristin (15.90%), teicoplanin (9.09%), and linezolid (6.82%). Uniplex and multiplex polymerase chain reaction (PCR) assays amplified many antibiotic resistance genes such as tetA (49.15%), tetK (16.95%), tetL (15.25%), tetD (7.63%), vanD (13.56%), vanN (13.56%), nfsA (14.41%), cfr (11.02%), vgaA and vatD (10.17%), and qnrS (6.78%). The calculated multiple antibiotic resistance index (MAR=0.21) and antibiotic resistance pattern abundance (ARPA=0.58) revealed relevant anthropic pollution from the identified Enterococcus isolates.

Conclusions
These findings confirm the involvement of the Enterococcus genus in the harboring of antimicrobial resistance genetic forms and highlight the consistent genetic trading that can remain silent in bacterial isolates.
Endoscopic approach to large non-pedunculated colorectal polyps
Authors: Gupta Sunil , He Tony , Mosko Jeffrey D 
Published: February 2025

Abstract
Large non-pedunculated colorectal polyps ≥20 mm (LNPCPs) constitute approximately 1% of all colorectal polyps and present a spectrum of risks, including overt and covert submucosal invasive cancer (T1 colorectal cancer (CRC)). Importantly, a curative resection may be achieved for LNPCPs with superficial T1 CRC (T1a or T1b &lt;1000 µm into submucosa), if an enbloc R0 excision (clear margins) with favourable histology is achieved (ie, absence of high-grade tumour budding, lympho-vascular invasion, and poor differentiation). Thus, while consensus recommendations advocate for endoscopic resection as the primary treatment option for LNPCPs, thorough optical assessment is imperative for selecting the most suitable ER strategy. In this review, we highlight the critical components of optical evaluation that assist in predicting the risk of T1 CRC, including morphology (Paris and LST classifications), surface pit/vascular pattern (JNET and Kudo classifications), and lesion location. Different resection modalities, including endoscopic submucosal dissection and endoscopic mucosal resection are discussed, along with important considerations that may influence the resection strategy of choice, such as access to the LNPCP and submucosal fibrosis.
Current approaches to studying human resting-state function in inflammatory bowel disease
Authors: McIver Theresa A , Bernstein Charles N , Kornelsen Jennifer 
Published: February 2025

Abstract
Crohn’s disease and ulcerative colitis are 2 subtypes of Inflammatory Bowel Disease (IBD). The chronic, alternating periods of relapsing, and remitting inflammation of the gastrointestinal tract that underlie these diseases trigger a range of gut-related symptoms, in addition to being related to burdensome psychological and cognitive comorbidities. With advancing knowledge of the brain–gut axis and its dysregulation in diseases such as IBD, understanding IBD-related brain changes is an important focus for current research in this area. “Resting state” function refers to the spontaneous fluctuations in neural activity when a person is awake and resting—not focussing attention on a task or stimulus. The recent surge in human resting-state functional magnetic resonance imaging (rs-fMRI) studies suggest that resting function is altered in IBD, representing a potential neural biomarker to target in the development of novel interventions. There are, however, multiple factors that contribute to the approach of these studies, including factors related to participant sample characteristics (IBD subtype and incorporation of disease activity in group definition and comparison), application of different resting-state metrics to assess resting brain activity (via regional homogeneity or amplitude of low-frequency fluctuations) or functional connectivity (via independent component analysis, region-of-interest, seed-to-voxel, or graph theory analyses) and incorporation of additional, multimodal variables of interest. The present review provides a summary of current approaches to studying resting-state brain function in IBD, the most commonly identified brain regions/networks to exhibit aberrant function, and avenues for advancement that forthcoming research in this field can strive to address.
Early life factors, diet and microbiome, and risk of inflammatory bowel disease
Authors: Mak Joyce Wing Yan , Lo Aaron Tsz Wang , Ng Siew Chien 
Published: February 2025

Abstract
Inflammatory bowel diseases (IBD), including Crohn’s disease (CD) and ulcerative colitis (UC), result from a loss of immune tolerance to gut microbiota, leading to inflammation. Their incidence is increasing, especially in newly industrialized countries. The etiology is multifactorial, involving genetic, immune, microbiota, and environmental factors. Maternal microbiome changes during pregnancy can elevate IBD risk in offspring, influenced by diet, smoking, and antibiotic exposure. Early life microbiota manipulation shows promise for preventing IBD. Epidemiological and pre-clinical studies highlight diet’s significant role in IBD development. High-inflammatory dietary patterns correlate with increased CD risk, while Mediterranean-like diets promote beneficial gut microbiome changes and reduce inflammation. Certain food additives, such as emulsifiers and artificial sweeteners, may exacerbate IBD by altering gut microbiota. A systematic review indicates that higher ultra-processed food consumption significantly increases CD risk. Lifestyle modifications, including healthy dietary adherence, could substantially reduce IBD risk, with studies showing that favorable choices can halve the risk in genetically predisposed individuals. Additionally, maternal diet impacts offspring IBD risk, as seen in mouse models where high-fat diets led to increased inflammation. Evidence suggests that maternal probiotics and specific dietary patterns may mitigate these risks. Overall, these findings emphasize the potential for dietary interventions to modulate gut microbiota and immune responses, offering promising avenues for IBD prevention and management. Further large-scale studies are needed to explore the impact of dietary strategies on IBD risk and gut health.
Role of endoscopic retrograde cholangiopancreatography in pancreatitis
Authors: Nabi Zaheer , Nageshwar Reddy Duvvur 
Published: February 2025

Abstract
Endoscopic retrograde cholangiopancreatography (ERCP) has evolved from mainly a diagnostic tool to a treatment method, thanks to newer noninvasive techniques like magnetic resonance cholangiopancreatography (MRCP) and endoscopic ultrasound (EUS). This paper looks at how ERCP is used to treat conditions such as acute gallstone pancreatitis, pancreas divisum (PD), sphincter of Oddi dysfunction (SOD), and chronic pancreatitis (CP). For acute gallstone pancreatitis, early ERCP to reduce severity or mortality is now questioned, except when there is cholangitis or ongoing bile duct blockage. For patients with recurring acute pancreatitis due to PD, endoscopic treatment aims to lower duct pressure, but there is not enough strong evidence to support its long-term success. In SOD cases, recent research suggests being more careful with endoscopic sphincterotomy. ERCP plays a clearer role in CP by helping to manage duct stones and strictures in suitable patients. The rising use of pancreatoscopy-assisted lithotripsy as an alternative to ESWL is also discussed.
Who is at Risk for Implant Irritation After Fixation of a Tibial Tubercle Fracture? A Multicenter Study
Authors: Maxwell Bryce E. , Edobor-Osula O. Folorunsho , Blanco John S. , Crawford Lindsay M. , Greenhill Dustin A. , Griffith Alexander H. , Kaushal Neil K. , Kell David M. , Rashiwala Abhi , Schlechter John A. , Thomas Evelyn S. , Tornberg Haley N. , Williams Brendan A. , Patel Neeraj M. 
Published: February 2025

Background:
Tibial tubercle fractures are typically treated surgically with screws. Implant irritation is the most common complication. However, detailed investigation of this problem is challenging, since most research is limited to small, single-center studies. Understanding who is at the highest risk may improve patient counseling and potentially guide surgical techniques. The purpose of this study is to identify risk factors for implant irritation in patients undergoing fixation of tibial tubercle fractures.

Methods:
This retrospective cohort study included tibial tubercle fractures fixed with screws at 7 tertiary children’s hospitals in the Tibial Tubercle Study (TITUS) Group. Exclusion criteria included age 18 years or older, primary fixation with nonscrew implants, or <6 months of follow-up. Demographic, perioperative, and postoperative data was collected. The primary outcome of interest was postoperative implant irritation. Univariable analysis was followed by multivariable regression to adjust for confounders. Odds ratios (OR) are reported with 95% CIs.

Results:
Of the 475 patients included, implant irritation was reported in 12.8% while 10.7% subsequently underwent unplanned removal. Patients weighing <70 kg reported more irritation than those weighing 70 kg or more (17.3% vs. 9.4%, P=0.01). However, in patients weighing <70 kg, there was no difference in the rate of symptomatic implants when stratifying by screw size. White patients reported more irritation than nonwhite patients (24.8% vs. 9.6%, P<0.001). Significant institutional variation in implant irritation rates was reported, ranging from 0% to 29% (P=0.004). Screw number, size, configuration, washer use, or pre-existing Osgood-Schlatter syndrome were not associated with symptomatic implants. When adjusting for confounders in multivariable analysis, white patients (OR: 3.2, 95% CI: 1.5-6.6; P=0.002) and those weighing <70 kg (OR: 2.2, 95% CI: 1.2-4.2; P=0.02) had higher odds of experiencing implant irritation. One of the 7 study sites was also independently associated with increased odds of symptomatic screws (OR: 7.8, 95% CI: 1.1-54.9; P=0.04).

Conclusions:
Implant irritation was reported by 12.8% of patients following screw fixation of a tibial tubercle fracture. Even when accounting for institutional variability, white patients and those weighing <70 kg had higher odds of symptomatic screws. This information can be used to enhance patient counseling and potentially adjust surgical techniques in some patients.

Level of Evidence:
Level III.
Blood Transfusion Practices in Intensive Care: A Prospective Observational Binational Study
Authors: Flint Andrew W. J. , Poole Alexis , Raasveld Senta Jorinde , Bailey Michael , Brady Karina , Chen Pin-Yen , Chen Yan , Cooper D. Jamie , French Craig , Higgins Alisa , Irving Adam H. , McAllister Richard E. , Neto Ary Serpa , Trapani Tony , Waters Neil , Winearls James , Reade Michael C. , Wood Erica M. , Vlaar Alexander P. J. , McQuilten Zoe K. 
Published: February 2025

IMPORTANCE:
Blood transfusions are a common and potentially lifesaving intervention in ICU patients but are associated with harm and often transfused inconsistently with guidelines. However, it is not well known how ICU transfusion practice has recently changed and if there is variation in transfusion practice.

OBJECTIVES:
To describe blood transfusion practices in ICU, the variation in practice across sites, and to compare transfusion practices against national guidelines and with prior published practice.

DESIGN, SETTING, AND PARTICIPANTS:
A prospective, multicenter, binational, observational study conducted in 40 Australian and New Zealand ICUs from October 2021 to July 2022. All adult (≥ 18 yr) ICU patients admitted over 1 week were included and followed until ICU discharge or 28 days.

MAIN OUTCOMES AND MEASURES:
Types of transfusion, thresholds and reasons for transfusions, the use of viscoelastic hemostatic assays (VHAs), variation in transfusion practice across sites, and changes in transfusion practice over time.

RESULTS:
Of 927 patients, 217 (23.4%) received a blood transfusion during their ICU admission—192 (20.7%) received RBCs, 63 (6.8%) received platelets, 49 (5.3%) received fresh frozen plasma (FFP), and 29 (3.1%) received cryoprecipitate. Massive transfusion protocols were implemented nine times for six patients (0.7%). VHA were used in 25 of 268 (9.3%) non-RBC transfusions. Compared with national guidelines, 89.0% of RBC transfusions, 30.3% of platelet, 27.4% of FFP, and 20.0% of cryoprecipitate transfusions were consistent. Compared with ICU transfusion practices in 2008, after adjusting for confounding variables, ICU patients who received RBC and FFP were transfused more units each, and variation in total transfusions across sites increased for RBC, platelets, and FFP.

CONCLUSIONS AND RELEVANCE:
Blood transfusions are common in ICU, but the practice is heterogeneous and frequently inconsistent with national guidelines, and the number of units transfused per patient has increased. More evidence is required.
Securing Jugular Central Venous Catheters With Dressings Fixed to a Liquid Adhesive to Prevent Dressing Failure in Intensive Care Patients (the STICKY Trial): A Randomized Controlled Trial
Authors: Marsh Nicole , O’Brien Catherine , Larsen Emily N. , Alexandrou Evan , Ware Robert S. , Pearse India , Coyer Fiona , Patel Maharshi S. , Royle Ruth H. , Rickard Claire M. , Sosnowski Kellie , Harris Patrick N. A. , Laupland Kevin B. , Bauer Michelle J. , Fraser John F. , McManus Craig , Byrnes Joshua , Corley Amanda 
Published: February 2025

OBJECTIVES:
Central venous catheters (CVCs) are vital for treating ICU patients. However, up to a quarter of CVCs fail from mechanical or infective complications. Poor securement of CVCs to the skin contributes to catheter failure, particularly CVCs placed in the jugular vein, which are highly vulnerable to pullout forces. This study evaluated the effectiveness of medical liquid adhesive (MLA) for improving jugular CVC dressing adhesion.

DESIGN:
Multisite parallel group, superiority, randomized controlled trial.

SETTING:
Four metropolitan Australian ICUs.

PATIENTS:
Eligible patients were 18 years old or older, within 12 hours of jugular CVC insertion, expected to need the CVC for greater than or equal to 72 hours, and remain in ICU for greater than or equal to 24 hours.

INTERVENTIONS:
Patients were randomly allocated (stratified by hospital and gender) to standard CVC dressings with the application of MLA to skin under the dressing border (intervention) or standard care CVC dressings (control).

MEASUREMENTS AND MAIN RESULTS:
The primary endpoint was dressing failure within 7 days due to lifting edges. Secondary outcomes included the total number of dressing changes, skin injury, and CVC failure. In total, 160 participants (82 control; 78 intervention) were enrolled. There were 22 (28%) and 41 (50%) cases of premature dressing failure in the intervention and control groups respectively (odds ratio, 0.39; 95% CI, 0.20–0.76; p = 0.005). The intervention group had fewer dressing changes (incidence rate ratio [IRR], 0.74; 95% CI, 0.55–0.99). Time to dressing failure (log-rank test; p = 0.12) and all-cause CVC failure (IRR, 1.44; 95% CI, 0.36–5.79) did not differ between groups. Three skin injuries occurred: one in the intervention (blister) and two in the control (maceration and skin tear) groups.

CONCLUSIONS:
MLA is associated with significantly decreased jugular CVC dressing failure and longer dressing dwell, with an acceptable safety profile. MLA should be considered to preserve jugular CVC dressings in ICU.
A Focused Update to the Clinical Practice Guidelines for the Prevention and Management of Pain, Anxiety, Agitation/Sedation, Delirium, Immobility, and Sleep Disruption in Adult Patients in the ICU
Authors: Lewis Kimberley , Balas Michele C. , Stollings Joanna L. , McNett Molly , Girard Timothy D. , Chanques Gerald , Kho Michelle E. , Pandharipande Pratik P. , Weinhouse Gerald L. , Brummel Nathan E. , Chlan Linda L. , Cordoza Makayla , Duby Jeremiah J. , Gélinas Céline , Hall-Melnychuk Erin L. , Krupp Anna , Louzon Patricia R. , Tate Judith A. , Young Bethany , Jennings Ron , Hines Anitra , Ross Chris , Carayannopoulos Kallirroi Laiya , Aldrich J. Matthew 
Published: February 2025

Rationale:
Critically ill adults are at risk for a variety of distressing and consequential symptoms both during and after an ICU stay. Management of these symptoms can directly influence outcomes.

Objectives:
The objective was to update and expand the Society of Critical Care Medicine’s 2018 Clinical Practice Guidelines for the Prevention and Management of Pain, Agitation/Sedation, Delirium, Immobility, and Sleep Disruption in Adult Patients in the ICU.

Panel Design:
The interprofessional inclusive guidelines task force was composed of 24 individuals including nurses, physicians, pharmacists, physiotherapists, psychologists, and ICU survivors. The task force developed evidence-based recommendations using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach. Conflict-of-interest policies were strictly followed in all phases of the guidelines, including task force selection and voting.

Methods:
The task force focused on five main content areas as they pertain to adult ICU patients: anxiety (new topic), agitation/sedation, delirium, immobility, and sleep disruption. Using the GRADE approach, we conducted a rigorous systematic review for each population, intervention, control, and outcome question to identify the best available evidence, statistically summarized the evidence, assessed the quality of evidence, and then performed the evidence-to-decision framework to formulate recommendations.

Results:
The task force issued five statements related to the management of anxiety, agitation/sedation, delirium, immobility, and sleep disruption in adults admitted to the ICU. In adult patients admitted to the ICU, the task force issued conditional recommendations to use dexmedetomidine over propofol for sedation, provide enhanced mobilization/rehabilitation over usual mobilization/rehabilitation, and administer melatonin. The task force was unable to issue recommendations on the administration of benzodiazepines to treat anxiety, and the use of antipsychotics to treat delirium.

Conclusions:
The guidelines task force provided recommendations for pharmacologic management of agitation/sedation and sleep, and nonpharmacologic management of immobility in critically ill adults. These recommendations are intended for consideration along with the patient’s clinical status.
A Rare Cutaneous Presentation of Malignant Tenosynovial Giant Cell Tumor
Authors: Luyten Sophia , Mehta Apoorva , Gru Alejandro A. 
Published: February 2025

Abstract:
Malignant tenosynovial giant cell tumor (MTGCT) is a rare and aggressive variant of tenosynovial giant cell tumors, with fewer than 60 reported cases. Although typically localized to joints and soft tissues, cutaneous presentations of MTGCT are exceedingly rare, with only a handful of documented cases involving direct dermal invasion. Here we report the case of an 88-year-old man with a history of nonmelanoma skin cancers who presented with a friable, ulcerated 2.5 cm nodule on the midchest. The lesion, present for approximately 1 month, was excised and found to be a malignant TGCT. Histopathology revealed a neoplasm with multinucleated giant cells and malignant features such as numerous and atypical mitotic figures, necrosis, and severe cellular pleomorphism. Immunohistochemistry showed positivity for CD45 and CD68, with weak partial expression of smooth muscle actin, and negative for CD34, P40, SOX10, pancytokeratin, CD163, CD1a, S100, and Melan-A, confirming the diagnosis. The patient underwent complete surgical excision. This case highlights a rare presentation of MTGCT with direct cutaneous involvement, adding to the sparse literature on this malignancy. Early recognition and accurate diagnosis of such unusual presentations are crucial because of the tumor's aggressive potential.
Dermatofibrosarcoma Protuberans Arising in a Digit: A Case Report
Authors: Sun Samantha , Odom Jordan , Ruiz Nathalie , Moody Patricia 
Published: February 2025

Abstract:
Dermatofibrosarcoma protuberans (DFSP) is a rare slow-growing soft tissue sarcoma that is usually found on the trunk or extremities. This report highlights an exceedingly rare case in which a DFSP arose on the digit of a 43-year-old man. Clinical and histologic analysis revealed an atypical CD34-positive tumor with differentials including DFSP and multiple similar entities. However, fluorescence in situ hybridization studies revealed a COL1A1 translocation to the platelet-derived growth factor B (22q13.1) locus, t(17;22)(q22;q13), confirming the diagnosis of DFSP. Although rare, this case highlights the importance of including DFSP on the differential in CD34-positive acral tumors, with cytogenetic analysis crucial for accurate diagnosis and treatment.