bluuebunny/crossref_metadata_2025_split huggingface dataset:
Coronary Perforation Occurring During Percutaneous Coronary Intervention Is Associated With Persistently High Mortality and Complications
Authors: Movahed Mohammad Reza , Satapathy Nishant , Hashemzadeh Mehrtash 
Published: February 2025

Introduction:
Coronary perforation is one of the major complications of percutaneous coronary intervention (PCI). The goal of this study was to evaluate adverse outcomes and mortality in patients suffering from coronary perforation during PCI above the age of 30.

Methods:
The National Inpatient Sample database, years 2016–2020, was studied using International Classification of Diseases, Tenth Revision codes. Patients suffering from perforation were compared with patients without perforation during PCI.

Results:
PCI was performed in a weighted total of 10,059,269 patients. Coronary perforation occurred in 11,725 (0.12%) of all PCI performed. The mortality rate of patients with perforations was very high in comparison to patients without perforations. (12.9% vs. 2.5%, odds ratio, 5.6; CI, 5-6.3; P < 0.001). Furthermore, patients with coronary perforations had much higher rates of urgent coronary bypass surgery, tamponade, cardiac arrest, and major cardiovascular outcomes. Mortality remained high and over 10% in the 5-year study period.

Conclusions:
Using a large national inpatient database, all-cause inpatient mortality in patients with coronary perforation is very high (over 10%), with persistently high mortality rates over the years, suggesting that treatment of perforations needs further improvement.
Visual and subject-reported outcomes of a wavefront shaping extended depth of focus intraocular lens implanted bilaterally with monovision
Authors: Teus Miguel A. , Kohnen Thomas , Ball James , Saelens Isabelle E.Y. , Sutton Gerard , Lawless Michael , Vives Caridad Perez , Lapid-Gortzak Ruth 
Published: February 2025

Purpose:
To report visual and subject-reported outcomes after bilateral implantation of non-diffractive extended-depth-of-focus (EDoF) intraocular lens (IOL) (AcrySof IQ Vivity) with monovision correction during cataract or refractive lens exchange (RLE) surgery.

Setting:
Europe, Australia, and New Zealand

Design:
Subgroup analysis of Vivity registry

Methods:
Binocular uncorrected and corrected visual acuities at distance (UCDVA/CDVA), intermediate (UCIVA/DCIVA), and near (UCNVA/DCNVA) were assessed at 3-6 months after implantation. Subject-reported outcomes (satisfaction, spectacle independence, visual disturbances) were evaluated. Data were reported by surgery type and monovision level at low (>-0.75D and ≤-0.50D), medium (>-1.00D and ≤-0.75D), and high (≤-1.00D).

Results:
Overall, 200 (of 885) subjects met the monovision criteria (cataract, n=170; RLE, n=24). Excellent binocular UCDVA and UCIVA and excellent/good UCNVA (mean±SD logMAR) were noted for cataract (0.031±0.102; 0.081±0.114; 0.217±0.144) and RLE (0.006±0.093; -0.003±0.089; 0.123±0.097) groups, respectively. Most subjects were spectacle-independent for distance and intermediate vision and very/fairly satisfied with sight; >87% from each surgery group reported no visual disturbances. Excellent UCDVA was preserved at low and medium monovision. Better UCNVA was observed for medium and high vs. low monovision levels, whereas spectacle independence for distance and intermediate was higher for medium vs. low/high monovision. High subject satisfaction and minimal visual disturbances were reported regardless of monovision level.

Conclusions:
Monovision correction with the non-diffractive EDoF IOL demonstrated excellent-to-good VA at all distances, high levels of spectacle independence and subject satisfaction, and minimal visual disturbances after cataract and RLE surgeries. Overall, medium monovision level performed most favorably, achieving good near VA while preserving excellent distance and intermediate vision.
Prostatic Adenocarcinoma Presenting as a “Giant” Abdominal Mass on PSMA PET/CT
Authors: Huang Juncheng , Loi Hoi Yin 
Published: February 2025

We report a 75-year-old man who presented with an abdominal mass associated with urinary retention. Physical examination revealed an enlarged prostate. Bedside ultrasound demonstrated a very large abdominal-pelvic mass inseparable from the bladder. PSA levels were high at 2393 ng/mL. Transrectal ultrasound-guided biopsy confirmed prostatic acinar adenocarcinoma (Gleason 4+5). PSMA PET/CT scan showed a large, intensely PSMA-avid abdominal-pelvic mass involving the prostate, seminal vesicles, and bladder, with peritoneal metastasis. No osseous metastasis was noted. This case highlights how prostatic adenocarcinoma can present as a giant abdominopelvic mass, clearly illustrated on PSMA PET/CT.
Pediatric Resuscitation Skill of Bag-Tube Manual Ventilation: Developing and Using a Mobile Simulation Program to Assess Competency of a Multiprofessional PICU Team
Authors: McCormick Anna E. , Friess Stuart H. , Quayle Kimberly S. , Lin John C. , Manga Arushi 
Published: February 2025

Objectives:
To assess the skill of bag-tube manual ventilation with the flow-inflating bag in multiprofessional PICU team members using a mobile simulation unit.

Design:
Prospective observational study from January 2022 to April 2022.

Setting:
In situ mobile simulation using the flow-inflating bag in an academic PICU.

Subjects:
Multiprofessional PICU team members including nurses, respiratory therapists, nurse practitioners, fellows, and attendings.

Interventions:
None.

Measurements and Main Results:
We enrolled 129 participants who twice completed 1-minute tasks performing bag-tube manual ventilation with a flow-inflating bag. Sessions were video recorded; four could not be analyzed. Only 30% of participants reported being very to extremely confident, and the majority (62%) reported infrequent skill performance. Task success was defined as achieving target pressure ranges during 80% of the delivered breaths, respiratory rate (RR) of 25–35 breaths/min, and successful pop-off valve engagement. Only five of 129 participants (4%) achieved successful ventilation as defined. Overall, participants were more likely to deliver lower pressures and faster rate. Maintaining target positive end-expiratory pressure (PEEP) was least likely to be achieved (19% success), followed by RR (52%), pop-off valve (64%), then peak inspiratory pressure (71%). Nurses were less likely to achieve target pressures compared with all other professions.

Conclusions:
Multiprofessional PICU team members have highly variable self-confidence with bag-tube manual ventilation using a flow-inflating bag. Observed performance demonstrates rare success with achieving targeted ventilation parameters, in particular maintenance of PEEP. Future research should focus on developing mobile simulation units to facilitate profession-specific, real-time coaching to teach high-quality manual ventilation that can be translated to the bedside.
Tracheal Intubation by Attending Physicians in a U.S. Registry, 2016–2020: Analysis by PICU Participation in a Skills Maintenance Program and Fellowship Training
Authors: Kishida Mizue , Berg Robert A. , Napolitano Natalie , Berkenbosch John , Talukdar Andrea , Jung Philipp , Malone Matthew P. , Parsons Simon J. , Harwayne-Gidansky Ilana , Nett Sholeen , Glater Lily , Krawiec Conrad , Shenoi Asha , Al-Subu Awni , Polikoff Lee , Kelly Serena P. , Adams Carolyn K. , Giuliano John S. , Ambati Shashikanth , Tellez David , Martin Rebecca J. , Lee Anthony , Breuer Ryan K. , Biagas Katherine V. , Mallory Palen P. , Corbett Kelly L. , Bysani G. Kris , Ducharme-Crevier Laurence , Wirkowski Samantha , Pinto Matthew , Toal Megan , Marlow Rachel K. , Adu-Darko Michelle , Shults Justine , Nadkarni Vinay , Nishisaki Akira ,   for the National Emergency Airway Registry for Children (NEAR4KIDS) and Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network
Published: February 2025

Objectives:
Tracheal intubation (TI) is a critical skill for PICU attending physicians to maintain. We hypothesize that attendings perform fewer TIs and have lower success rate in PICU programs with a Pediatric Critical Care Medicine (PCCM) fellowship.

Design:
Retrospective study using the National Emergency Airway Registry for Children (NEAR4KIDS) from July 2016 to June 2020. Exposures were presence of PCCM fellowship and attending TI skill maintenance program (SMP). The primary outcome was attending’s first attempt success and the secondary outcome was adverse airway outcome in the first attempt.

Setting:
Thirty-three PICUs in North America.

Patients:
Children receiving TI.

Interventions:
None.

Measurements and Main Results:
Overall, 23 of 33 PICUs had a PCCM fellowship with three of 23 having an attending TI SMP. Attendings performed TI in 24.1% (2,728/11,323): 13.9% (13.8 TI/yr per PICU) in PICUs with a fellowship vs. 66.0% (36.6 TI/yr per PICU) without a fellowship (p < 0.001). Attending first attempt success in PICUs with vs. without fellowships was 70.5% vs. 81.3% (difference, 10.8% [95% CI, 7.6–14.0%]; p < 0.0001). After controlling for confounders, attendings in a PICU with a fellowship had lower odds for first attempt success (adjusted odds ratio [aOR], 0.65 [95% CI, 0.47–0.90]). We failed to find an association between attending first attempt success and PICU program type, with vs. without a TI SMP (74.0% vs. 69.5%; p = 0.146). The adverse airway outcome rate of the TI with attending’s first attempt was lower in PICU programs with vs. without a TI SMP (32.8% vs. 40.3%; p = 0.020). However, after adjusting for confounders, we failed to exclude the possibility of near halving of odds of adverse outcome (aOR, 0.75 [95% CI, 0.55–1.01]; p = 0.058).

Conclusions:
Attendings in PICU programs with a fellowship have fewer opportunities to perform TI and lower first attempt success rates. Opportunities exist for attending TI skill maintenance, especially in PICUs with a PCCM fellowship.
Durable Central Venous Access for Pediatric Cardiac Patients: Secondary Analysis of a Single-Center, Retrospective Cohort Study, 2015–2021
Authors: Shostak Eran , Dagan Ovadia , Tzeitlin Yelena , Goldberg Ori , Raz Gal , Amir Gabriel , Feinstein Yael , Schiller Ofer 
Published: February 2025

OBJECTIVES:
There are several options for durable venous access for pediatric cardiac patients and the insertion techniques, locations, and complications potentially differ. The study aimed to evaluate our experience of upper extremity peripherally inserted central catheters (PICCs) and durable tunneled femoral central venous catheters (TF-CVCs) in young pediatric cardiac ICU (PCICU) patients.

Design:
Retrospective cohort study, 2015–2021.

Setting:
PCICU in a tertiary medical care center.

Patients:
All patients younger than 1.5 years old who underwent bedside insertion of TF-CVC or upper extremity PICC between December 2015 and December 2021.

Interventions:
None.

Measurements and Main Results:
The cohort included 226 durable lines, inserted in patients 2–550 days old, with 111 upper extremity PICCs and 115 TF-CVCs. In the two groups, receipt of PICC vs. TF-CVC placement was associated with older age (125.6 vs. 53.4 d; p = 0.005), and shorter duration of mechanical ventilation (9.0 vs. 25.5 d; p < 0.001). PICC vs. TF-CVC use was associated with a higher rate of central line-associated bloodstream infection (CLABSI) (7.14 vs. 2.38/1000 line days; p = 0.004) and more thrombosis events (5 vs. 0; p = 0.008). When adjusted for CLABSI-free line days, TF-CVCs (relative to upper limb PICCs) was associated with close to one-third of the odds of CLABSI (odds ratio [OR], 0.31 [95% CI, 0.13–0.78]); similarly, when adjusted for line days close to one-third of the odds of any complication, that is, CLABSI, dislodgment, occlusion, or thrombosis (OR, 0.31 [95% CI, 0.14–0.65]).

Conclusions:
In our 2015–2021 PCICU experience of using durable TF-CVC inserted at the bedside, vs. upper extremity PICCs, in neonates and infants, we found an associated one-third the odds of CLABSI and overall complications. A prospective study of subcutaneous tunneling in various locations of catheters on CLABSI and overall complication rates is needed.
Dieulafoy Lesion in a Pediatric Patient
Authors: Barshay Meylakh , Cowan Maiya , Beucher Meghan 
Published: February 2025

Objective:
Our aim is to describe a rare etiology of an upper gastrointestinal bleeding (UGIB) to help pediatric emergency medicine clinicians improve their understanding of its presentation as well as the standard therapeutic approach to UGIB.

Methods:
This is a retrospective case report of a patient who presented to the Pediatric Emergency Department of Hasbro Children's Hospital and who was found to have a UGIB secondary to a Dieulafoy lesion.

Results:
The etiology of UGIBs varies by geography and patient age but includes esophagitis, Mallory-Weiss tears, gastritis, peptic ulcers, and foreign body ingestion. Given the overlapping presenting symptoms, history and physical are critical to identifying likely etiology and guiding treatment. This patient improved after definitive treatment with endoscopy and hemo-clips.

Conclusions:
Children with symptoms of UGIB should receive prompt resuscitation and stabilization, and clinicians should maintain an index of clinical suspicion for less common pediatric pathologies, such as malignancy or arterial bleeding.
Eosinophilic Salpingitis
Authors: AbdullGaffar Badr , Almulla Amal 
Published: February 2025

Chronic salpingitis presents with various inflammatory patterns due to different causes. Eosinophil-rich salpingitis is rare and primarily associated with parasitic infestations. We aim to report our findings of eosinophil-rich salpingitis in a series of women who presented with ruptured hemorrhagic ovarian corpus luteum cysts and tubal schistosomiasis accompanied by ectopic tubal pregnancies. Eight women (age range: 31–40 yr, average age: 34 yr) met the inclusion criteria for eosinophil-rich salpingitis. The tubes showed a dense eosinophilic infiltrate throughout the tubal wall with edema and hemosiderin pigment deposition﻿. The mucosal plicae were broadened due to vascular congestion, edema, and conspicuous eosinophilic infiltrates with siderophages. Luminal hemorrhage was present. Six patients had ipsilateral ruptured hemorrhagic ovarian corpus luteum cysts with ruptured tubal ectopic pregnancies, whereas 2 patients had Schistosoma ova in the tube. The close proximity of the tubal fimbriae to the ovary suggests that the tubal cavity is a potential reservoir of the extruded contents from ruptured hemorrhagic luteal cysts. Theoretically, the engulfed contents could move down the tubal lumen, adhere to the epithelium, and elicit an allergic inflammatory reaction in the tubal mucosa and mural wall. This phenomenon may play a role in postinflammatory fibrous adhesion and ectopic pregnancies. Eosinophilic salpingitis is a rare, unilateral, localized, secondary inflammatory reaction of the fallopian tubes. Apart from parasitic infestations, an inflammatory response to ruptured hemorrhagic corpus luteum cysts should be considered as a potential association when other causes are excluded. Certain histopathologic features may provide clues to this association. Further validation is warranted to determine whether these findings are associations or mere coincidences.
Ideal Outcome after Left Pancreatectomy in North America, Germany, the Netherlands, and Sweden
Authors: Hendriks Tessa E , Augustinus Simone , Andersson Bodil , Williamson Caroline , Beane Joal D. , Davis Catherine , Ghadimi Michael , Werner Jens , Uhl Waldermar , Wellner Ulrich F. , Keck Tobias , Bonsing Bert A , Groot Koerkamp Bas , van Santvoort Hjalmar C. , Björnsson Bergthor , Besselink Marc G , Pitt Henry A , Tingstedt Bobby ,   for Global Audits on Pancreatic Surgery Group (GAPASURG)
Published: February 2025

Background:
Composite outcome measures aim to provide a more holistic view when determining the effectiveness and safety of surgical interventions. Recently, ‘Ideal Outcome’ (IO) harmonized the European and American composite outcome of pancreatic surgery. The rate of IO after pancreatoduodenectomy was 54% but is unknown after left pancreatectomy(LP).

Methods:
This transatlantic analysis included patients after LP from the audits in North America (NSQIP), Germany (StuDoQ), the Netherlands (DPCA), and Sweden (SNPPCR) (2014 – 2020). IO is obtained in the absence of (1)in-hospital mortality, (2)severe complications (Clavien-Dindo≥3), (3)postoperative pancreatic fistula (ISGPS grade B/C), (4)reoperation, (5)hospital stay exceeding the 75th-percentile, and (6)readmission. Clinical predictors of IO were identified using a multivariable logistic regression.

Results:
Overall, 20,126 patients after LP were included (37.8% minimally invasive). The rate of IO after LP was 59.1%. The rate of IO varied among the four audits: North America 58.5%, Germany 53.4%, the Netherlands 56.9%, and Sweden 61.7% (P<0.001). Among all variables, the rate of postoperative pancreatic fistula differed the most: North America 9.8%, Germany 23.9%, the Netherlands 20.5%, and Sweden 10.6% (P<0.001). Minimally invasive LP was associated with higher rates of IO (65.4% vs 53.3%, P<0.001) compared to open LP. No difference in the IO was observed between robot-assisted and laparoscopic LP.

Conclusion:
The new composite outcome measure IO was reached in 59% patients after LP and varied between four transatlantic audits. Minimally invasive LP was associated with higher rates of IO. IO can be used for evaluating, comparing, and improving patient outcomes between the four audits, especially regarding postoperative pancreatic fistula.
Diagnostic Performance of Gene Expression and dd-cfDNA in Multiorgan Transplant Recipients
Authors: Zaky Ziad S. , Clifford Stephanie A. , Fleming James N. 
Published: February 2025

Background.
The aim of this analysis was to evaluate early signals of the utility of gene expression profile (GEP) and donor-derived cell-free DNA (dd-cfDNA) for ruling out subclinical rejection in multiorgan transplant recipients.

Methods.
This was a prospective, single-center, observational pilot study that began enrolling patients in September 2022. Participants were enrolled after providing informed consent and had biomarker samples drawn before surveillance or for-cause biopsy. GEP result of TX was considered negative and a dd-cfDNA of ≤0.69% was considered negative, regardless of a nonrenal organ.

Results.
There were 49 participants with 55 surveillance and/or for-cause biopsies. After exclusion of biopsies not paired with biomarkers, 51 biopsies were evaluated with at least 1 biomarker. Fifty-one biopsies had paired GEP results, whereas 47 biopsies had paired dd-cfDNA results. Overall, there were 12 biopsy-proven acute rejections (24%), 5 of which were T cell–mediated rejections (4-1A and 1-1B), 2 were antibody-mediated rejections, and 5 were borderline for T cell–mediated rejections. GEP by itself in 51 biopsies demonstrated a sensitivity of 17%, specificity of 74%, positive predictive value of 17%, negative predictive value of 74%, and balanced accuracy of 61%. Among 47 paired biopsies, dd-cfDNA demonstrated a sensitivity of 67% and specificity of 37%. Median dd-cfDNA was above the positivity threshold for both participants with rejection on biopsy and without (1.86% versus 1.35%, respectively). When evaluating GEP, specifically in surveillance biopsies and patients with liver transplants, diagnostic performance was maintained.

Conclusions.
In this pilot analysis, GEP maintained a high negative predictive value in a multiorgan cohort, regardless of the nonrenal organ. dd-cfDNA did not have good performance when using the kidney threshold cutoff, which was expected and driven by the liver component of multiorgan recipients. Further technological advances with dd-cfDNA to differentiate organs and multiple donors could be impactful. The results support the use of GEP for ruling out kidney rejection in a multiorgan population, including those with a liver transplant. Further evaluation is necessary to confirm the results.
Disrupting Viral Replication in Human Metapneumovirus: Targeting Key Proteins with Unani Phytochemicals through Structural Dynamics and Energetics
Authors: Dubey Amit 
Published: February 2025

AbstractEmerging viral infections pose significant global health challenges, necessitating the exploration of novel antiviral therapeutics. This study investigates the antiviral potential of bioactive compounds derived from theUnani system of medicine, leveragingmolecular docking, molecular dynamics simulations, pharmacokinetic profiling, and quantum chemical calculationsto assess their efficacy against theHuman Metapneumovirus (HMPV) target protein (PDB ID: 5WB0).Molecular docking studies revealed thatCrocin (−9.5 kcal/mol), Quercetin (−9.3 kcal/mol), and Oleuropein (−9.0 kcal/mol)exhibited remarkable binding affinities, engaging inmultiple hydrogen bonds and hydrophobic interactions, comparable to standard antiviral drugsRemdesivir (−9.2 kcal/mol) and Favipiravir (−8.8 kcal/mol). These findings were further supported bymolecular dynamics simulations, where Crocin and Quercetin maintained exceptionalbinding stability (RMSD ~1.8 Å, MM-PBSA energy ~ −80.5 kcal/mol), reinforcing their potential asHMPV inhibitors.Additionally,pharmacophore modeling and electronic structure analysishighlighted stronghydrogen bonding capacity, dipole moment, and electrostatic potentialfor these bioactives, facilitating optimal target interactions.Pharmacokinetic and toxicological assessmentsconfirmed theirhigh bioavailability, metabolic stability, and minimal toxicity, positioning them as promising candidates for further drug development.Overall, this comprehensive computational study underscores thetherapeutic relevance of Unani-derived compounds, paving the way fornatural antiviral interventions. Futurein vitro and in vivo investigationswill be essential to validate their clinical efficacy and optimize their drug-like properties.
FlowerPatch: New Method to Measure Nectar Volume in Artificial Flowers
Authors: Lara E. , Agosto J. , Tugrul G. , Megret R. , Flórez E. 
Published: February 2025

AbstractThis article proposes a new Flower Patch Nectar Sensor to address the problem of detecting and measuring nectar in artificial flowers used in experiments on pollinator behavior. Traditional methods have focused mainly on recording the visits of pollinators to the flowers, without addressing the dynamic variations in nectar in terms of volume and concentration. The proposed approach provides more detailed information about the nectar consumption by bees and allows determination of the optimal time to refill the flowers. This study introduces an innovative method that uses electrodes and an oscillator circuit to measure the volume of nectar present in the flower. The system correlates the concentration of nectar with a frequency signal that can be processed by a microcontroller. It was evaluated using initial volumes ranging from 1 µL to 4 µL, demonstrating its ability to accurately detect variations in nectar, even up to the point where the frequency approaches zero. The results confirm that this method allows us to identify how the reward offered to pollinators (represented by nectar) varies over time, in terms of concentration, under both controlled and natural conditions. Additionally, graphs are presented that show the relationship between an initial volume of 4 µL and variations in the frequency signal over a period of 25 minutes, highlighting the influence of these factors on nectar dynamics. This work not only introduces an innovative approach for the dynamic monitoring of nectar in artificial flowers, but also lays the groundwork for future studies on the physical and chemical modeling of nectar in response to environmental conditions.