bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effect of Anterior Chamber Air Injection on Intraocular Lens Stability after Phacovitrectomy with Gas/Air Tamponade
Authors: Zhou Zigan , Sun Bi , Wu Xingyi , Liu Yuhao , Guo Binghua , Yang Chen , Lin Zhong , Wu Ronghan 
Published: January 2025

Purpose:
Anterior chamber air injection (ACAI) is a surgical technique used to decrease the occurrence of postoperative intraocular lens (IOL) haptic dislocation following phacovitrectomy with gas/air tamponade. The impact of this technique on IOL stability remains uncertain, prompting the design of this study to investigate further.

Methods:
This study included 51 eyes of 51 patients who underwent phacovitrectomy with gas/air tamponade. The patients were divided into two groups: Group 1 (ACAI group, 26 eyes) and Group 2 (non-ACAI group, 25 eyes). IOL position (IOLP) is used to determine the IOL axial movement. The study analyzed changes in lens/IOL decentration, tilt, and aqueous depth (AQD) using repeated measures analysis of variance. The linear regression model was employed to investigate the factors influencing the IOL stability.

Results:
There was no significant difference in IOL decentration, tilt, mean prediction error, and mean absolute error between the two groups. ACAI not only caused the IOLP to move axially forward but also the AQD to take longer to stabilize. Preoperative lens tilt is a significant factor influencing postoperative IOL tilt. Additionally, sex, ACAI, and aqueous width are identified as factors that affect IOLP.

Conclusion:
ACAI is a factor that can affect IOL instability, and the surgeon needs to consider the necessity of ACAI when performing phacovitrectomy with gas/air tamponade.
EUS-Guided Gastroenterostomy for Benign Gastric Outlet Obstruction
Authors: Canakis Andrew , Tugarinov Nicol , Bapaye Jay , Gilman Andrew J. , Hathorn Kelly E. , Twery Benjamin , Sharaiha Reem Z. , Baron Todd H. , Irani Shayan S. 
Published: January 2025

Background and Aims:
Gastric outlet obstruction (GOO) is a clinical manifestation of mechanical obstruction at the antropyloric region or proximal small bowel. The goal of endoscopic management is to relieve the obstruction so patients can resume per oral intake. Most studies have focused on malignant causes of GOO; yet only a handful have explored outcomes related to benign etiologies. Endoscopic ultrasound-guided gastroenterostomy (EUS-GE) has emerged as a novel method to bypass the obstruction with a lumen apposing metal stent. In this systematic review and meta-analysis, we aim to explore the technical and clinical success of EUS-GE for benign GOO.

Methods:
Multiple databases were searched for studies looking at EUS-GE for benign GOO from inception until July 2024. The primary outcome was technical and clinical success. Secondary outcomes included rates of reintervention and adverse events (AE).

Results:
Ten studies met inclusion criteria (n=181 patients). The most common etiologies were from chronic (n=48) and acute (n=41) pancreatitis followed by peptic strictures (n=19) and surgical anastomotic strictures (n=13). The mean procedure time was 66 minutes. The pooled rate of technical success was 95% (95% CI: 87.34-98.16; I
2=0%). The pooled rate of clinical success was 90.6% (95% CI: 81.1-95.4; I
2=0%). Total adverse events and reintervention rates were 11% (95% CI: 6.06-22.33; I
2=38.7%) and 7% (95% CI: 2.23-20.95; I
2=35.9%), respectively.

Conclusion:
The results of this meta-analysis demonstrate the efficacy and relative safety profile of EUS-GE for benign GOO. Further studies are needed to determine the optimal patient selection related to clinical success based on the underlying etiology.
Equity and the operational considerations of the kidney transplant allocation system
Authors: Mohan Sumit , Yu Miko , Husain S. Ali 
Published: January 2025

Purpose of review
Demonstrate the impact of allocation system design on access to the waitlist and transplantation for patients with end-stage kidney disease (ESKD).

Recent findings
Minoritized groups are more likely to be declined from transplant listing owing to psychosocial criteria. Lack of consistent definitions, screening tools with differential subgroup validity, and insufficient evidence-base contribute to concerns about reliance on psychosocial factors in transplant listing decisions.

Summary
Although kidney transplantation is the preferred treatment choice, a shrinking proportion of prevalent patients are waitlisted for this option in the United States, even among our youngest ESKD patients. Recent HRSA proposals to expand data collection to encompass the prewaitlisting process suggest a timely need to capture additional data on transplant referrals to improve access to transplantation. In 2021, KAS250 was implemented in response to concerns of geographic inequities in transplant rates. However, updates to this system have also resulted in a dramatic rise in organ offers, the number of offers needed to successfully place an organ and lowered utilization rates. Since KAS250, the use of alternative pathways to improve organ utilization rates, such as out-of-sequence placements has increased dramatically across the organ quality spectrum and risk exacerbating disparities in access to transplant. Additionally, the current absence of meaningful oversight risks undermining the perception of the transplant system as an objective process.

Summary
There is a need for a more robust evaluation of recent iterative changes in waitlist and organ allocation practices to ensure equity in access for our most vulnerable patients.
Development and Testing of an Objective Structured Clinical Examination for Evaluating Nurses in Infusion Therapy
Authors: Meszaros Mariana de Jesus , de Almeida Angélica Olivetto , Aoki Roberta Nazario , Vieira Ana Paula Gadanhoto , Castelani Mariana Aparecida , Silva Juliany Lino Gomes , Lima Maria Helena de Melo , Oliveira-Kumakura Ana Railka de Souza 
Published: January 2025

This study aimed to develop, assess, and test an Objective Structured Clinical Examination (OSCE) to evaluate nurses’ competency in planning and managing infusion therapy. The study adopted a methodological approach with a quantitative design and was conducted from December 2020 to August 2021 at a university hospital in São Paulo, Brazil. Data collection occurred in 3 stages: development of scenarios and assessment checklists, evaluation of expert consensus, and testing scenarios with the target audience. Data analysis involved calculating the Modified Kappa coefficient. The OSCE comprised 8 clinical stations, designed based on the theoretical framework of the Vessel Health and Preservation model and the Infusion Therapy Standards of Practice, which delineate evidence-based procedures for vascular access and infusion therapy. During expert assessment and examination testing, all evaluated items demonstrated coefficient values ≥0.74. Thus, the study successfully developed evidence-based OSCE for infusion therapy, showing strong expert consensus. Testing with nurses yielded positive outcomes, affirming the effectiveness of the educational practice’s design and structure.
Evaluation of Generative Artificial Intelligence Models in Predicting Pediatric Emergency Severity Index Levels
Authors: Ho Brandon , Lu Meng , Wang Xuan , Butler Russell , Park Joshua , Ren Dennis 
Published: January 2025

Objective
Evaluate the accuracy and reliability of various generative artificial intelligence (AI) models (ChatGPT-3.5, ChatGPT-4.0, T5, Llama-2, Mistral-Large, and Claude-3 Opus) in predicting Emergency Severity Index (ESI) levels for pediatric emergency department patients and assess the impact of medically oriented fine-tuning.

Methods
Seventy pediatric clinical vignettes from the ESI Handbook version 4 were used as the gold standard. Each AI model predicted the ESI level for each vignette. Performance metrics, including sensitivity, specificity, and F1 score, were calculated. Reliability was assessed by repeating the tests and measuring the interrater reliability using Fleiss kappa. Paired t tests were used to compare the models before and after fine-tuning.

Results
Claude-3 Opus achieved the highest performance amongst the untrained models with a sensitivity of 80.6% (95% confidence interval [CI]: 63.6–90.7), specificity of 91.3% (95% CI: 83.8–99), and an F1 score of 73.9% (95% CI: 58.9–90.7). After fine-tuning, the GPT-4.0 model showed statistically significant improvement with a sensitivity of 77.1% (95% CI: 60.1–86.5), specificity of 92.5% (95% CI: 89.5–97.4), and an F1 score of 74.6% (95% CI: 63.9–83.8, P < 0.04). Reliability analysis revealed high agreement for Claude-3 Opus (Fleiss κ: 0.85), followed by Mistral-Large (Fleiss κ: 0.79) and trained GPT-4.0 (Fleiss κ: 0.67). Training improved the reliability of GPT models (P < 0.001).

Conclusions
Generative AI models demonstrate promising accuracy in predicting pediatric ESI levels, with fine-tuning significantly enhancing their performance and reliability. These findings suggest that AI could serve as a valuable tool in pediatric triage.
Biodistribution and Dosimetry Evaluation of the Radiolabeled Somatostatin Receptor Antagonist 68Ga-DATA5m LM4 in Molecular Imaging of Well-Differentiated Gastroenteropancreatic Neuroendocrine Tumors Patients
Authors: Ballal Sanjana , Sheokand Parvind , Yadav Madhav P. , Roesch Frank , Viswanathan Rahul , Satapathy Swayamjeet , Tripathi Madhavi , Moon Euy Sung , Mishra Prashant , Rastogi Sameer , Agarwal Shipra , Bal Chandrasekhar 
Published: January 2025

Purpose
This study aimed to assess the biodistribution and radiation dosimetry of 68Ga-DATA5m LM4 in patients with gastroenteropancreatic neuroendocrine tumors.

Patients and Methods
Eight patients (5 females and 3 males) with various gastroenteropancreatic neuroendocrine tumors were included in the study. Each patient underwent 3 whole-body PET scans at 10, 60, and 120 minutes after receiving an IV injection of approximately 162.5 MBq of 68Ga-DATA5m LM4. Organs considered for dosimetric analysis included the liver, heart, spleen, kidneys, adrenal glands, and lumbar vertebrae (L2 to L4). Dosimetric calculations were performed using the OLINDA/EXM 2.2 software.

Results
Physiological uptake of 68Ga-DATA5m LM4 was observed in the pituitary gland, spleen, liver, adrenal glands, and the urinary tract (kidneys and urinary bladder) for all patients. The kidneys received the highest absorbed doses at (4.77E-02 ± 1.49E-02 mSv/MBq). The mean effective dose was 2.61E-03 ± 5.99E-04 mSv/MBq.

Conclusions

68Ga-DATA5m LM4 injection is safe and is primarily excreted through urine, delivering the highest radiation dose to the kidneys.
Impact of the Good Samaritan Law on bystander intervention willingness and perceived legal risks in India
Authors: Kewalramani Divya , Choron Rachel L. , Whitley Daniel , Teichman Amanda , Raina Karuna , Singh Gautam , Piplani Charoo , Englert Zachary , Hanna Joseph , Peck Gregory L. , Barie Philip S. , Tewari Piyush , Narayan Mayur 
Published: January 2025

BACKGROUND
Road traffic crashes (RTCs) are a global health burden, particularly in India, where response times for first responders can be prolonged. Prior to enactment of a Good Samaritan Law (GSL) in 2016, involved bystanders could face criminal and financial liability for assisting at an RTC site. This study evaluates the impact of GSL on bystander RTC attitudes, awareness, and experiences in India, comparing outcomes pre- and post-GSL implementation across metropolitan cities (MCs) and nonmetropolitan cities (NMCs). We hypothesized that GSL would lead to increased bystander willingness to assist the RTC victim.

METHODS
This retrospective, cross-sectional, observational study analyzed data from two national surveys conducted in 2013 (pre-GSL, n = 1,027) and 2018 (post-GSL, n = 3,667) across 7 and 11 Indian cities, respectively. Difference-in-difference analysis, propensity score matching, and regression models were used to assess changes in willingness to assist RTC victims, awareness of GSL, legal and financial fears, and awareness of GSL.

RESULTS
Post-GSL implementation saw an increase in willingness to assist RTC victims (Δ = +65.4%, p < 0.001) and substantial decreases in fear regarding legal (Δ = −81%, p < 0.001) and financial consequences (Δ = −75.8%, p < 0.001) of rendering assistance. GSL awareness was higher in NMCs (n = 2,215, 31.2%) compared with MCs (n = 838, 9.25%) among general citizens (p < 0.001). Males showed higher willingness to assist RTC victims (p < 0.01), whereas individuals with postgraduate education demonstrated increased awareness of GSL (p < 0.01).

CONCLUSION
The implementation of GSL in India has transformed bystander intervention in RTCs, increasing the reported likelihood of assistance and substantially reducing legal and financial concerns. This shift demonstrates GSL's potential to improve outcomes for RTC victims. However, disparities in awareness between MCs and NMCs, as well as sex- and education-based differences, highlight the need for targeted educational campaigns. Future initiatives should focus on improving application of the law and strengthening the entire trauma chain of survival.

LEVEL OF EVIDENCE
Prognostic and Epidemiological; Level III.
Burn-induced mitochondrial dysfunction in hepatocytes: The role of methylation-controlled J protein silencing
Authors: Pratap Akshay , Monge Kenneth Meza , Qualman Andrea C. , Kovacs Elizabeth J. , Idrovo Juan-Pablo 
Published: January 2025

BACKGROUND
Burn injuries trigger a systemic hyperinflammatory response, leading to multiple organ dysfunction, including significant hepatic damage. The liver plays a crucial role in regulating immune responses and metabolism after burn injuries, making it critical to develop strategies to mitigate hepatic impairment. This study investigates the role of methylation-controlled J protein (MCJ), an inner mitochondrial protein that represses complex I in burn-induced oxidative stress and mitochondrial dysfunction, using an in vitro Alpha Mouse Liver 12 cell model.

METHODS
Alpha Mouse Liver 12 cells were treated with serum from burn-injured mice (SBIM) to simulate burn injury in vitro. Methylation-controlled J protein was silenced using shRNA. Cell viability, apoptosis markers, reactive oxygen species levels, antioxidant response elements, electron transport chain components, and mitochondrial respiration were assessed using various techniques, including Cell Counting Kit-8 assay, Western blotting, MitoSOX Red staining, and Seahorse XF analysis.

RESULTS
Serum from burn-injured mice treatment (10%) for 8 hours reduced Alpha Mouse Liver 12 cell viability to 50% of control levels and increased MCJ expression fivefold. It also significantly upregulated apoptosis markers: cleaved caspase-3 (4-fold), Bax (3.8-fold), and cytosolic cytochrome c (3.5-fold). Methylation-controlled J protein silencing improved cell viability to 85% of control levels and reduced apoptosis markers by 75% to 78%. Serum from burn-injured mice increased reactive oxygen species levels by 3-fold, while MCJ silencing reduced this by 2.5-fold. Antioxidant proteins (NRF2, HO-1, NQO-1, GCLC, catalase) were suppressed by SBIM but upregulated 3.2- to 3.8-fold with MCJ silencing. Serum from burn-injured mice reduced electron transport chain components (NDUFS1, SDHB, MTCO2) by 45% to 65%, which MCJ silencing restored 2.5- to 3-fold. Mitochondrial respiration improved significantly with MCJ silencing: basal respiration (+26%), maximal respiration (+66%), adenosine triphosphate production (+25%), and spare respiratory capacity (+63%).

CONCLUSION
Methylation-controlled J protein plays a critical role in burn-induced hepatocyte damage. Its silencing alleviates SBIM-induced cytotoxicity, oxidative stress, and mitochondrial dysfunction. These findings highlight MCJ as a potential therapeutic target for preserving liver function in burn patients, warranting further in vivo studies to explore its clinical potential.
The inability to predict futility in hemorrhaging trauma patients using 4-hour transfusion volumes and rates
Authors: Van Gent Jan-Michael , Clements Thomas W. , Rosario-Rivera Bedda L. , Wisniewski Stephen R. , Cannon Jeremy W. , Schreiber Martin A. , Moore Ernest E. , Namias Nicholas , Sperry Jason L. , Cotton Bryan A. 
Published: January 2025

BACKGROUND
Blood shortages and utilization stewardship have motivated the trauma community to evaluate futility cutoffs during massive transfusions (MTs). Recent single-center studies have confirmed meaningful survival in ultra-MT (≥20 U) and super-MT (≥50 U), while others advocate for earlier futility cut points. We sought to evaluate whether transfusion volume and intensity cut points could predict 100% mortality in a multicenter analysis.

METHODS
A prospective, multicenter, observational cohort study was performed at seven trauma centers. Injured patients at risk for MT who required both blood transfusion and hemorrhage control procedures were enrolled. Four-hour volumes and intensities (average units per hour) were evaluated. Primary outcome of interest was 28-day mortality.

RESULTS
A total of 1,047 patients met the study inclusion with an overall mortality rate of 17% (n = 176). The median age was 35 years, 80% were male, and 62% had a penetrating mechanism, with an Injury Severity Score of 22. At 4 hours, transfusion volumes below 110 U and transfusion intensity averaging up to 21 U/h did not demonstrate futility. Total transfusion volume above 110 U was associated with 100% mortality (n = 9). Multivariable analysis noted only nonmodifiable risk factors as predictors of increased mortality (blunt mechanism, shock index).

CONCLUSION
In this study from seven Level 1 trauma centers, survival was observed at transfusion volumes up to 110 U and at transfusion velocities up to 21 U/h during the first 4 hours of resuscitation. Data are limited on transfusion volumes above 110 U in the first 4 hours. Survival can be observed in both the ultra and super-MT settings.

LEVEL OF EVIDENCE
Therapeutic/Care Management; Level II.
The abdomen does not lie, but the labs might: Predictors of intra-abdominal injury on computed tomography imaging in pediatric blunt trauma patients
Authors: Otaibi Banan W. , Khurshid Muhammad Haris , Hejazi Omar , Hage Kati , Stewart Collin , Colosimo Christina , Spencer Audrey L. , Ditillo Michael , Magnotti Louis J. , Joseph Bellal 
Published: January 2025

INTRODUCTION
Multiple studies have indicated that isolated abnormal laboratory results necessitate obtaining abdominal computed tomography (CT) for pediatric patients with blunt abdominal trauma (BAT), regardless of the normal abdominal examination. This study aims to identify the predictors of intra-abdominal injury (IAI) and the role of laboratory tests in CT imaging among pediatric BAT patients.

METHODS
This is a retrospective review at a Level II pediatric trauma center (2018–2022). Children (younger than 18 years) who presented with BAT and received abdominal CT imaging were included. Outcomes were rates of IAI and interventions. Multivariable regression analysis was performed.

RESULTS
Over 5 years, 483 patients met the inclusion criteria. The mean age was 13 years, 58.2% were male, and the median Glasgow Coma Scale was 15. Overall, 19.3% had abdominal pain; 6.2%, postinjury emesis; 26.1%, abdominal tenderness; and 10.6%, pelvic tenderness. On initial imaging, 7.0% had a positive focused assessment with sonography in trauma examination, and 7.2% had an abnormal plain x-ray. On initial laboratory testing, 7.9% had abnormal serum aspartate aminotransferase (AST), 3.1% had abnormal hematocrit, 1.2% had abnormal urine analysis, and 0.8% had abnormal lipase. Seventeen percent had at least one IAI, of which 17% underwent intervention. Multivariable regression analysis identified abdominal tenderness, abnormal plain x-ray, positive focused assessment with sonography in trauma, blood transfusion requirements, and abnormal AST as independent predictors of IAI on abdominal CT imaging. Moreover, among patients with IAI, only 37.3% had abnormal laboratory results, and all had at least one of the predictors of IAI (in addition to or other than abnormal AST). Among patients with abnormal laboratory results (n = 57), nine patients had none of the predictors of IAI, out of which none were found to have IAI on abdominal CT.

CONCLUSION
More than 80% of all abdominal CT imaging had negative results. Our findings highlight the significance of clinical findings in the trauma bay, regardless of laboratory findings, when deciding to order abdominal CT imaging for pediatric BAT patients.

LEVEL OF EVIDENCE
Therapeutic/Care Management; Level III.
ChronicStaphylococcus aureusinfection of osteocytes promotes an intracellular viable-but-non-culturable phenotype
Authors: Gunn Nicholas J. , Zelmer Anja R. , Kidd Stephen P. , Solomon L. Bogdan , Carda-Diéguez Miguel , Mira Alex , Yang Dongqing , Atkins Gerald J. 
Published: January 2025

Introductory paragraphInfectious osteomyelitis is a potentially severe disease with an increased incidence of 10% over the last 10 years (1, 2) and a 20% recurrence rate creating chronic infections (3). Diagnosis and pathogen identification remain challenging, with culture-negative results in 7-39% of cases (4–6), of which 14-27% are PCR-positive from drained fluids (7). Of recent intensive research focus, osteomyelitis associated with Prosthetic Joint Infection (PJI) is a serious and growing complication of orthopaedic joint replacement surgery, with a failure to cure rate within 2-years internationally of between 15-46% (8, 9). Osteocytes act as potential long-term reservoirs for intracellularStaphylococcus aureus, protecting it against the immune responses and antimicrobial treatment (10–15). However, the intra-osteocytic adaptation mechanisms byS. aureusremain understudied, and it is unknown why so many infections are culture-negative but PCR-positive. Here, we found that in chronic intra-osteocytic infections,S. aureusconsistently adopts a viable but non-culturable (VBNC) state. Whole genome sequencing of parental and a revertant strain indicated that initially,S. aureuscells possessing TarP and a complete T7SS dominate the bacterial community but these cell numbers declined with genetic rearrangements seemingly linked with the shift to a VBNC state. The subsequent acquisition of a single nucleotide polymorphism (SNP) insrrBwas associated with resuscitation to a culturable state, suggesting at least one mechanism underlying entrance and exit from the intracellular VBNC state.