bluuebunny/crossref_metadata_2025_split huggingface dataset:
Gender differences in clinical presentations and sensory profiles in patients with fibromyalgia: implications of peripheral and central mechanisms
Authors: Liu Min , Harris Stephany , Andreou Anna P. , Bo Xuenong , Al-Kaisy Adnan 
Published: January 2025

Introduction:
Fibromyalgia has a high female predominance and research work has been focussing mainly on women.

Objectives:
We aimed to answer (1) gender differences in pain scores and quality of life, (2) any gender-specific subgroups defined by quantitative sensory testing (QST), and (3) correlations of QST parameters with pain intensity and questionnaire scores.

Methods:
We evaluated clinical presentations and QST profiles from 38 male and 38 age-matched female patients.

Results:
Women reported significantly higher scores in average daily pain, daily sleep interference score, average weekly pain, weekly sleep interference score, and revised fibromyalgia impact questionnaire (rFIQ). Based on LOGA classification, L0G2, mechanical allodynia or hyperalgesia without abnormal sensory loss, was the most common QST subtype which accounted for 28.9% of men and 26.3% of women. Approximately 34.2% of men and 26.3% of women displayed loss of function of small fibres with an increased cold or warm detection threshold. Cold detection threshold was negatively correlated with pain intensity and functional impairment, suggesting a peripheral mechanism. Central sensitization, defined as allodynia and hyperalgesia to thermal or mechanical stimuli, was found in two-thirds of male and female patients. Mechanical pain sensitivity was positively correlated with the severity of pain and associated symptoms in women, but not men.

Conclusion:
There was a marked gender difference in reported pain and quality of life. We have confirmed that central sensitization is a major mechanism for women. Our data suggested an important role of small fibre pathology in both men and women.
Improvement in Temple Hollowing with VYC-20L Hyaluronic Acid Filler: A Multicenter, Randomized Controlled Trial of Safety and Effectiveness
Authors: Montes José Raúl , Hooper Deirdre , Jones Derek , Biesman Brian , Baumann Leslie , Beer Kenneth , Yoelin Steve , Leung Kelly , Chawla Smita 
Published: January 2025

Background:
Temple hollowing is characterized by the reduction of volume in the temporal fossa, which can result in a skeletonized look and contribute to an aged appearance. This study aimed to evaluate the safety and effectiveness of the VYC-20L injectable gel for improvement of temple hollowing.

Methods:
Adults with minimal, moderate, or severe temple hollows were randomized 2:1 to receive VYC-20L or no treatment. Participants were followed for 13 months for safety and effectiveness assessments. Treatment effectiveness was assessed by blinded evaluating investigators using the validated Allergan Temple Hollowing Scale (ATHS) and the Global Aesthetic Improvement Scale (GAIS), and by participants using GAIS, FACE-Q scales, and patient satisfaction questionnaires. Adverse events and injection site responses (ISRs) were monitored.

Results:
At Month 3, 80.4% of the treatment group vs 13.5% of the untreated control group achieved a ≥1-grade improvement in both temples on the ATHS (P < 0.0001). The ATHS responder rate remained high throughout Month 13. The GAIS responder rates at Month 3 (responses of Improved or Much improved) were high in the treatment group, as assessed by the blinded evaluating investigator (83.8%) and participants (92.9%). Furthermore, satisfaction with Facial Appearance and Temples on the FACE-Q questionnaires increased significantly from baseline (both P < 0.0001). Adverse events and ISRs were mostly mild and consistent with the known safety profile of fillers.

Conclusions:
VYC-20L treatment showed favorable safety and effectiveness results in restoring temple volume, with significant aesthetic improvement and high participant satisfaction. Treatment effects lasted for over a year.
Using Transorbital Sonography for Assessing Traumatic Brain Injury in Patients With Periorbital Hematoma
Authors: Bao Yi-Ping , Shen Tian-Yu , Lou Zi-Wei , Zhou Yang , Zhang Ling 
Published: January 2025

Objective:
The aim of this study is to assess the comparative effectiveness of transorbital sonography (TOS) and the pupillary penlight visual assessment method in patients with traumatic brain injury (TBI) and periorbital hematoma.

Methods:
A total of 140 patients with traumatic brain injury (TBI), meeting the inclusion and exclusion criteria, were selected from a tertiary hospital in Zhejiang Province between January 2022 and December 2023. Pupillary function in all patients was assessed using both TOS and the pupillary penlight visual assessment method on the first, third, and seventh day after admission. The stability and consistency of the measurement results were compared. Stability was determined using the coefficient of variation, whereas consistency was assessed using the intraclass correlation coefficient.

Results:
The coefficients of variation for the pupillary transverse diameter values measured by TOS were 29.84% (left) and 29.55% (right) on day 1, 27.81% (left) and 26.88% (right) on day 3, and 26.80% (left) and 25.51% (right) on day 7. These values were consistently lower than those obtained through the pupillary penlight visual assessment method, indicating superior stability with the TOS measurement. In addition, the intraclass correlation coefficient analysis demonstrated consistency between the 2 methods, with values ranging from 0.562 to 0.809 (P<0.05), indicating good consistency.

Conclusion:
TOS represents an innovative tool for neurological assessment. It has been validated that the presence or absence of eyelid edema does not compromise the accuracy of ultrasound-based pupillary function measurements. The 2 methods of measurement exhibit good consistency, with the TOS method demonstrating superior stability in monitoring data. This approach provides a more accurate means of assessing pupillary function in patients with TBI who have periorbital hematoma or facial swelling, particularly when opening the eyelid is challenging, thereby addressing a significant clinical nursing challenge.
Surgical Opioid Stewardship: From the Epidemic Through the Pandemic and Beyond
Authors: Podder Sourav K , Koeneman Scott , Fagenson Alexander M , Schleider Christine , Philp Matthew M , Noonan Kristin M , Braun Pamela A , Smith Meghan , Cowan Scott W , Pitt Henry A ,   for the Pennsylvania New Jersey – Surgical Opioid Stewardship
Published: January 2025

Background:
In response to the opioid epidemic, prescribing guidelines and statewide surgical opioid management programs were initiated in 2018-19. This analysis aims to document the sustainability of a regional opioid stewardship consortium through the pandemic and beyond.

Study Design:
From September 2019 through August 2023, 15 NSQIP hospitals in two states gathered opioid-specific variables on patients undergoing 12 procedures. Operations were performed by seven specialties including general surgery, gynecology, orthopedic surgery, neurosurgery, surgical oncology, urology, and vascular surgery. Data were gathered on preoperative opioid use, intraoperative opioids and blocks, opioid avoidance strategies and discharge opioid prescriptions. Cochran-Armitage trend and Wald tests were utilized to assess temporal effects with p values <0.001 considered significant.

Results:
Among 18,325 patients who underwent surgery, 54% were women, with a median age of 60 years. The percentage of patients taking opioids preoperatively decreased significantly (p<0.001) in the overall cohort from 17% to 10%. The utilization of intraoperative blocks also increased significantly (p<0.001) among all patients from 21% to 27%. The utilization of opioid avoidance strategies was maintained in the majority of the patients (68-70%) and the percentage of postoperative opioid prescriptions on discharge remained the same (81%) over the four-year study period.

Conclusion:
From 2019 to 2023, the percentage of patients taking opioids preoperatively decreased significantly, and the utilization of intraoperative blocks also increased significantly. The PENNJ-SOS program played a key role in combatting the opioid crisis over the four years of data collection, adapting effectively to the challenges posed by the Coronavirus Disease 2019 pandemic.
Impact of a 7-Gene Predictive Biosignature on Adjuvant Radiation Therapy Recommendations in Patients Undergoing Breast-Conserving Surgery for Ductal Carcinoma in Situ
Authors: Margenthaler Julie A , Zoberi Imran , Thomas Maria , Kennard Kaitlyn 
Published: January 2025

Background:
Breast conservation therapy for patients with DCIS includes breast conserving surgery (BCS) with post-operative radiotherapy (RT). Because RT does not impact overall survival, identifying women who do not benefit from RT would allow de-escalation of therapy. We evaluated the impact of a novel 7-gene DCIS biosignature on adjuvant radiation recommendations for patients undergoing BCS for DCIS.

Methods:
7-gene biosignature was evaluated in women diagnosed with DCIS between 2019-2022. 7-gene biosignature is reported as a “decision score” (DS) and categorical risk groups. RT recommendation before and after 7-gene biosignature was identified through retrospective chart review after IRB approval. The impact of DCISionRT on RT recommendations was assessed using McNemar’s test. The 7-gene biosignature decision score (DS) was compared between treatment types by t-test.

Results:
101 patients underwent BCS for DCIS. Of those, 24 (24%) met RTOG 9804 criteria and 45 (45%) had nuclear grade 3 DCIS. Prior to 7-gene biosignature testing, all 101 patients were recommended RT; after testing, 35 patients omitted RT, corresponding to a 35% decision change (p<0.0001). Patients who ultimately omitted radiation had a significantly lower decision score (DS median 0.9) versus those who received RT (DS median 3.7) (p<0.0001). There were 22 of 39 patients (56%) with DS<2 and 11 of 40 patients (28%) with DS 2-4 who were not treated with RT. More patients with DS>4 (20/22, 91%) were treated with RT than DS<2, p<0.001, and patients with DS>4 were treated with an increased RT dose, p=.028.

Conclusions:
7-gene biosignature test resulted in a 35% reduction in patients treated with adjuvant RT. Patients with higher decision scores were more likely to receive RT and to receive a greater RT dose.
Comparison of Partial Endoscopic vs Surgical Fundoplication after Hiatal Hernia Repair
Authors: Hodgens Brian , Godwin George , Rhodes Marvin , Korver Isaac , Abshier Chase , Boyd Cooper , Jorgensen Brynne , Sunkavalli Madhu , Blackhurst Dawn , Kothari Shanu 
Published: January 2025

Background:
The concomitant hiatal hernia repair with endoscopic fundoplication (c-TIF) is a novel anti-reflux procedure that addresses the hiatus and the gastro-esophageal flap valve for surgical candidates with GERD. We aim to compare the outcomes of a hiatal hernia repair with endoscopic fundoplication (TIF) vs surgical partial fundoplication (anterior and posterior) with regards to quality-of-life scores at 12 months after surgery.

Study Design:
Following IRB approval, a prospectively maintained anti-reflux database was retrospectively reviewed to identify patients who underwent a c-TIF procedure or a surgical hiatal hernia repair with partial fundoplication. The primary endpoint was QoL scores at 2, 6, and 12 months from surgery with attention to bloating and dysphagia scores. Secondary endpoints were PPI use, 30-day outcomes, OR time and costs, re-operation within 1 year. The three groups were compared using analysis of variance for continuous variables and Pearson’s Chi-square test for categorical variables. P-values < 0.05 were considered indicative of statistical significance.

Results:
Demographics between groups were similar except for age, PPI use, and presenting symptoms. There was no difference between the three groups with regards to post-operative QoL scores, PPI use, dysphagia, or bloating. All three types of fundoplication are associated with significant improvement of all symptom types and 65-80% of patients are no longer using a PPI at 12 months.

Conclusion:
There are no differences in outcomes between the c-TIF and a surgical partial fundoplication. QoL scores significantly decrease with all partial fundoplications and there are no differences in dysphagia or bloating between the three types of fundoplication. Long term data is necessary to see if either technique provides superior control of symptoms while minimizing dysphagia and bloating.
Impact of Massive Transfusion Activation on Time to Delivery of the First Cooler and Patient Survival: A Study of 4,313 Consecutive Activations
Authors: Van Gent Jan-Michael , Bavishi Devi , Clements Thomas W , Dickey James B , Hobbs Rhonda , Bai Yu , Kao Lillian S , Cotton Bryan A 
Published: January 2025

Background:
In 2012, TQIP guidelines for massive transfusion protocols (MTP) recommended delivery of blood product coolers within 15 minutes. Subsequent work found that every minute delay in cooler arrival was associated with a 5% increased risk of mortality. We sought to assess the impact and sustainability of quality improvement (QI) interventions on time to MTP cooler delivery and their association with trauma patient survival.

Study Design:
In 2009, a quality improvement (QI) process was initiated to improve MTP activation and delivery of blood (QI #1). In 2012, TQIP Best Practice Guidelines were implemented at our facility (QI #2). In 2016, we implemented measures to activate our MTP based off prehospital ABC score >1 or any prehospital blood transfusion (QI #3). All patients receiving MTP from 01/2009 and 12/2022 were included. Patients were compared by year and their respective QI interventions. Primary outcome was time from MTP activation to delivery of the first cooler. A regression model was then constructed to evaluate time to first cooler on outcomes.

Results:
During the study period, 52,328 trauma patients were admitted, with 4,313 MTP trauma activations. With each subsequent QI intervention, time to first MTP cooler and mortality both decreased, while injury severity increased. Multivariate regression noted that when time to first cooler could be kept to 8 minutes or less, mortality was reduced by 35% (OR 0.64, 95% C.I. 0.44-0.92; p=0.019).

Conclusion:
With increased MTP activations, delivery of the first cooler was faster and mortality improved. Keeping cooler times under 8 minutes was associated with increased survival. The measurement and monitoring of “Door-to-cooler” time should be considered as a metric to assess performance and delivery of institutional MTP.
Southern Surgical Association: Leadership Pre and Post Flexner’s Report
Authors: Holman William L 
Published: January 2025

Preface:
The Joseph M Donald Endowment for the Archival Collection of the Southern Surgical Association is named for the 73rd President Elect of the Southern Surgical Association (Figure 1), who died in 1961 at age 57 before he had the opportunity to deliver his Presidential Address. Dr Donald’s career as a surgeon in Birmingham began in 1931 after the completion of his residency at the Mayo Clinic. He was one of four generations of Donalds to serve Alabama as physicians. Joe practiced General Surgery at three hospitals in Birmingham, including work as voluntary faculty at University Hospital under Dr James Mason and later Dr Champ Lyons.
Dr Donald interrupted his practice to serve in the European Theater with the US Army Medical Corps during the Second World War. He was a Governor and Regent of the American College of Surgeons (ACS) and a leader in the Alabama Chapter of the ACS. Two of his sons, Joseph, Jr and Thomas trained as surgeons. From 1854 until the present, twenty-four Donald or Donald-related physicians have practiced in Alabama (personal communication, Dr Thomas T Donald). The present talk is dedicated to the memory of Dr Joseph Marion Donald and his contributions to the field of surgery.
Reducing blood culture contamination: an environmental imperative
Authors: Gregg Sophie , Purcell Niamh , Doyle Maeve , Chan Grace 
Published: January 2025

Abstract
Blood culture (BC) investigation remains the gold standard for diagnosis of bloodstream infections. However, BC contamination can have clinical implications for the patient, cost implications for service providers and less well documented, environmental impacts. Efforts to reduce BC contamination are a longstanding theme in quality improvement initiatives in emergency departments and hospitals, prompted by the hospital costs, healthcare inefficiencies and antimicrobial stewardship efforts. The WHO global analysis of health care waste in the context of COVID-19, has reported that tens of thousands of tonnes of extra medical waste was produced from the response to the COVID-19 pandemic, basing its estimates on the quantity of personal protective equipment (PPE). Additionally, recent literature has also shown increased BC contamination rates during the COVID-19 pandemic. Our study reviews the trend of BC contamination during the COVID-19 pandemic in our institution’s Emergency Department. We further discuss some of the potential implications of BC contamination, including potential environmental, economic and efficiency implications.
Cohort profile: Medical Birth Registry at Kilimanjaro Christian Medical Centre (KCMC), Tanzania 2000-2023
Authors: Buckley Daire , Khashan Ali , Mboya Innocent , Mitao Modesta , Nkya Gustav , Senkoro Allen , Lyimo Allen , Pima Francis M. , Munishi Lucy , Woodworth Simon , Manongi Raheli , Masenga Gileard , Mahande Michael , Tarimo Clifford Silver , Daltveit Anne Kjersti , Lie Rolve Terje , Mchome Bariki , Mmbaga Blandina T. 
Published: January 2025

AbstractPurposeBirth registry data is integral to healthcare providers, and policymakers. The primary aim of the data is to record, track, and monitor maternal and new-born outcomes. The objectives of the Kilimanjaro Christian Medical Centre (KCMC) medical birth register are to serve as tools for monitoring births and key obstetric outcomes such as caesarean sections, and maternal and perinatal deaths for clinical, administrative and research purposes. (1) Subsequent births and births can also be followed to serve to bridge a gap in maternal and new-born health information within the Kilimanjaro Region of Tanzania.ParticipantsParticipants are women who give birth at the Obstetrics and Gynaecology Department of The Kilimanjaro Christian Medical Centre (KCMC) in the Moshi Municipality, Kilimanjaro Region, Northern Tanzania.MethodsThe KCMC Medical Birth Registry was established in 2000. Initially, it was based on a desktop database. In 2020 it was transformed into a digital system, Castor EDC platform, and in January 2024 it was moved to the open-source DHIS2 system. There were over 60,000 births from 2000-2019 were recorded. A total of 8,042 births were recruited from the KCMC facility from January 2020 to December 2023. Participants were interviewed by trained research midwives within 24 hours of giving birth. A standardised questionnaire is used during interviews to capture relevant information on maternal and paternal background characteristics, maternal information before and during the current pregnancy, and obstetric/ clinical information about births (including singletons and multiple births).Findings to dateOf the total cohort, 4002 (49.8%) participants had a spontaneous vaginal delivery, while almost a third of participants delivered by caesarean section. Instrumental assistance was primarily in the form of a forceps delivery (11.9%), followed by ventouse delivery (1.3%). Additional neonatal outcomes included child status (live/stillborn), and the Apgar score among a long list of variables. A varied proportion of data was missing (ranging from 3% to 7%) from both clinical and postpartum variables. Since 2000, more than 40 peer-reviewed papers have been published using this database.Future plansAs the methods of the birth registry data collection continue to improve, the data that is collected from the birth registry systems will aid policymakers in monitoring the country’s progression and develop targets for strengthening healthcare systems at both a national and international level. From a research perspective, the data is available for international collaboration for conducting high-quality research into the cause and prevention of adverse pregnancy outcomes in low-resource settings.
Hypoxia-inducible factor 2α promotes protective Th2 cell responses during intestinal helminth infection
Authors: Labuda Jasmine C. , Olsen Tayla M. , Verma Sheenam , Kimmel Samantha , Edwards Thomas H. , Dufort Matthew J. , Harrison Oliver J. 
Published: January 2025

AbstractTh2 cells must sense and adapt to the tissue milieu in order to provide protective host immunity and tissue repair. Here, we examined the mechanisms promoting Th2 cell differentiation and function within the small intestinal lamina propria. Single cell RNA-seq analyses of CD4+T cells from the small intestinal lamina propria of helminth infected mice revealed high expression of the geneEpas1, encoding the transcription factor hypoxia-inducible factor 2a (HIF2α).In vitro, exposure to hypoxia or genetic HIF2α activation promoted Th2 cell differentiation, even under non-polarizing conditions. In mice, HIF2α activation in CD4+T cells promoted intestinal Th2 cell accumulation in the absence of infection, and HIF2α-deficiency impaired CD4+T cell-mediated host immunity to intestinal helminth infection. Our findings identified hypoxia, and the oxygen-regulated transcription factor Hypoxia-Inducible Factor 2α (HIF2α), as key regulators of Th2 cell differentiation and function within the small intestine.
EEG correlates of active removal from working memory
Authors: Shan Jiangang , Postle Bradley R. 
Published: January 2025

AbstractThe removal of no-longer-relevant information from visual working memory (WM) is important for the functioning of WM, given its severe capacity limitation. Previously, with an “ABC-retrocuing” WM task, we have shown that removing information can be accomplished in different ways: by simply withdrawing attention from the newly irrelevant memory item (IMI; i.e., via “passive removal”); or by or “actively” removing the IMI from WM (Shan and Postle, 2022). Here, to investigate the neural mechanisms behind active removal, we recorded electroencephalogram (EEG) signals from human subjects (both sexes) performing the ABC-retrocuing task. Specifically, we tested the hijacked adaptation model, which posits that active removal is accomplished by a top-down-triggered down-modulation of the gain of perceptual circuits, such that sensory channels tuned to the to-be-removed information become less sensitive. Behaviorally, analyses revealed that, relative to passive removal, active removal produced a decline in the familiarity landscape centered on the IMI. Neurally, we focused on two epochs of the task, corresponding to the triggering, and to the consequence, of active removal. With regard to triggering, we observed a stronger anterior-to-posterior traveling wave for active versus passive removal. With regard to the consequence(s) of removal, the response to a task-irrelevant “ping” was reduced for active removal, as assessed with ERP and with posterior-to-anterior traveling waves, suggesting that active removal led to decreased excitability in perceptual circuits centered on the IMI.Significance StatementThe removal of no-longer-relevant information from working memory is critical for the flexible control of behavior. However, to our knowledge, the only explicit accounts of this operation describe the simple withdrawal of attention from that information (i.e., “passive removal”). Here, with measurements of behavior and electroencephalography (EEG), we provide evidence for a specific mechanism for the active removal of information from WM–hijacked adaptation–via the top-down triggering of an adaptation-like down-regulation of gain of the perceptual circuits tuned to the to-be-removed information. These results may have implications for disorders of mental health, including rumination, intrusion of negative thoughts, and hallucination.