bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effects of a Clonidine Taper on Dexmedetomidine Use and Withdrawal in Adult Critically Ill Patients—A Pilot Study
Authors: Bhatt Krupa , Thompson Quan Ashley , Baumgartner Laura , Jia Shawn , Croci Rhiannon , Puntillo Kathleen , Ramsay James , Bouajram Rima H 
Published: November 2020

Objectives:
Prolonged use of dexmedetomidine has become increasingly common due to its favorable sedative and anxiolytic properties. Hypersympathetic withdrawal symptoms have been reported with abrupt discontinuation of prolonged dexmedetomidine infusions. Clonidine has been used to transition patients off dexmedetomidine infusions for ICU sedation. The objective of this study was to compare the occurrence of dexmedetomidine withdrawal symptoms in ICU patients transitioning to a clonidine taper versus those weaned off dexmedetomidine alone after prolonged dexmedetomidine infusion.

Design:
This was a single-center, prospective, double cohort observational study conducted from November 2017 to December 2018.

Setting:
Medical-surgical, cardiothoracic, and neurosurgical ICUs in a tertiary care hospital.

Patients:
We included adult ICU patients being weaned off dexmedetomidine after receiving continuous infusions for at least 3 days.

Interventions:
Patients were either weaned off dexmedetomidine alone or with a clonidine taper at the discretion of the providers.

Measurements and Main Results:
The primary outcome was the incidence of at least two dexmedetomidine withdrawal symptoms during a single assessment within 24 hours of dexmedetomidine discontinuation. Time on dexmedetomidine after wean initiation and difference in medication cost were also evaluated. Forty-two patients were included in this study: 15 received clonidine (Group C) and 27 weaned off dexmedetomidine alone (Group D). There was no significant difference in the incidence of two or more withdrawal symptoms between groups (73% in Group C vs 59% in Group D; p = 0.51). Patients in Group C spent less time on dexmedetomidine after wean initiation compared with patients in Group D (19 vs 42 hr; p = 0.02). An average cost savings of $1,553.47 per patient who received clonidine was observed. No adverse effects were noted.

Conclusions:
Our study demonstrated that patients receiving clonidine were able to wean off dexmedetomidine more rapidly, with a considerable cost savings and no difference in dexmedetomidine withdrawal symptoms, compared with patients weaned off dexmedetomidine alone. Clonidine may be a safe, effective, and practical option to transition patients off prolonged dexmedetomidine infusions.
Incidence, Risk Factors, and Clinical Consequence of Enteral Feeding Intolerance in the Mechanically Ventilated Critically Ill: An Analysis of a Multicenter, Multiyear Database
Authors: Heyland Daren K. , Ortiz Alfonso , Stoppe Christian , Patel Jayshil J. , Yeh D. Dante , Dukes George , Chen Yaozhu J. , Almansa Cristina , Day Andrew G. 
Published: November 2020

OBJECTIVES:
To determine the incidence of enteral feed intolerance, identify factors associated with enteral feed intolerance, and assess the relationship between enteral feed intolerance and key nutritional and clinical outcomes in critically ill patients.

DESIGN:
Analysis of International Nutrition Survey database collected prospectively from 2007 to 2014.

SETTING:
Seven-hundred eighty-five ICUs from around the world.

PATIENTS:
Mechanically ventilated adults with ICU stay greater than or equal to 72 hours and received enteral nutrition during the first 12 ICU days.

INTERVENTIONS:
None.

MEASUREMENT AND MAIN RESULTS:
We defined enteral feed intolerance as interrupted feeding due to one of the following reasons: high gastric residual volumes, increased abdominal girth, distension, subjective discomfort, emesis, or diarrhea. The current analysis included 15,918 patients. Of these, 4,036 (24%) had at least one episode of enteral feed intolerance. The enteral feed intolerance rate increased from 1% on day 1 to 6% on days 4 and 5 and declined daily thereafter. After controlling for site and patient covariates, burn (odds ratio 1.46; 95% CIs, 1.07–1.99), gastrointestinal (odds ratio 1.45; 95% CI, 1.27–1.66), and sepsis (odds ratio 1.34; 95% CI, 1.17–1.54) admission diagnoses were more likely to develop enteral feed intolerance, as compared to patients with respiratory-related admission diagnosis. enteral feed intolerance patients received about 10% less enteral nutrition intake, as compared to patients without enteral feed intolerance after controlling for important covariates including severity of illness. Enteral feed intolerance patients had fewer ventilator-free days and longer ICU length of stay time to discharge alive (all p < 0.0001). The daily mortality hazard rate increased by a factor of 1.5 (1.4–1.6; p < 0.0001) once enteral feed intolerance occurred.

CONCLUSIONS:
Enteral feed intolerance occurs frequently during enteral nutrition delivery in the critically ill. Burn and gastrointestinal patients had the highest risk of developing enteral feed intolerance. Enteral feed intolerance is associated with lower enteral nutrition delivery and worse clinical outcomes. Identification, prevention, and optimal management of enteral feed intolerance may improve nutrition delivery and clinical outcomes in important “at risk” populations.
CHARACTERIZING THE NATURAL HISTORY OF FOVEAL-SPARING ATROPHIC LATE-ONSET RETINAL DEGENERATION
Authors: Borooah Shyamanga , Papastavrou Vasileios T. , Lando Leonardo , Moghimi Sasan , Lin Tiezhu , Dans Kunny , Motevasseli Tahmineh , Cameron James R. , Freeman William R. , Dhillon Baljean , Browning Andrew C. 
Published: November 2020

Purpose:
To identify quantifiable markers of disease progression in patients with foveal-sparing atrophic late-onset retinal degeneration using fundus autofluorescence and spectral-domain optical coherence tomography imaging.

Methods:
Natural history study evaluating patients within a 3-year interval. Disease progression was assessed based on the area of retinal atrophy, macular topographic distribution of lesions, retinal and choroidal thickness and volume, and choroidal vascularity index.

Results:
Twenty-four eyes (12 individuals) were included for fundus autofluorescence, and 31 eyes (16 individuals) for spectral-domain optical coherence tomography studies. Measurements were symmetrical between eyes of the same patient. The area of atrophy significantly enlarged (P = 0.002), with a growth rate of 2.67 mm2/year (SD: 2.13; square rooted: 0.57 mm/year, SD = 0.34). Baseline area of atrophy and progression both correlated with age. Most atrophic lesions were found in the temporal macula and progressed nasally at follow-up. Central choroidal and retinal thicknesses and volume in late-onset retinal degeneration cases were significantly reduced compared with controls, but only central retinal thickness decreased significantly at follow-up.

Conclusion:
This study identifies the area of atrophy and central retinal thickness, but not chorioretinal volume or choroidal thickness, as markers of short-term progression in late-onset retinal degeneration. These findings may be useful for disease monitoring and late-onset retinal degeneration interventional studies.
RETINAL PIGMENT EPITHELIAL LESIONS ASSOCIATED WITH A SPORADIC CASE OF FAMILIAL ADENOMATOUS POLYPOSIS
Authors: Alsberge Joseph B. , Peng Michelle Y. , Agarwal Anita , McDonald H. Richard 
Published: November 2020

Purpose:
To report a sporadic case of a familial adenomatous polyposis (FAP) discovered in a patient with bilateral retinal pigment epithelial lesions.

Methods:
Case report.

Results:
A 30-year-old Asian woman presented for evaluation of bilateral pigmented lesions at the level of the retinal pigment epithelium. She had no personal or family history of colonic polyps or colon cancer. Colonoscopy revealed innumerable adenomatous polyps and genetic testing revealed a mutation in the adenomatous polyposis coli gene consistent with FAP. She subsequently underwent prophylactic total colectomy.

Conclusion:
The pigmented retinal pigment epithelium lesions of FAP have a characteristic appearance and it is vital for the retinal specialist to be familiar with them. De novo mutations in the APC gene are responsible for 20% to 30% of FAP cases. In the presence of the characteristic retinal pigment epithelium lesions, it is important to send the patient for work up of FAP even in the absence of family history of FAP.
Impact of Invasive Quantitative Respiratory Cultures on Antimicrobial Therapy for Suspected Pneumonia in Trauma
Authors: Allen Lauren , Minson Quentin , Burke Christopher 
Published: November 2020

Background:
Invasive quantitative respiratory cultures are generally not recommended because of a lack of demonstrated benefit. There is insufficient literature regarding specific populations such as trauma. The objective of this study was to evaluate the effect of invasive quantitative respiratory sampling on de-escalation to targeted antimicrobial therapy for the management of pneumonia in a trauma population.

Methods:
This was a single-center retrospective cohort study conducted at an American College of Surgeons-verified Level II Trauma Center in Nashville, TN. Adult patients admitted to the trauma service and diagnosed with pneumonia from July 2013 to August 2018 were divided into 2 groups: invasive quantitative respiratory sampling versus noninvasive respiratory sampling. The primary endpoint was rate of targeted antimicrobial therapy. Secondary endpoints included in-hospital mortality, antibiotic days of therapy, and frequency of discontinuation of antibiotics when quantitative cultures were below the diagnostic threshold.

Results:
A total of 88 patients were sampled, with 27 in the invasive quantitative group and 66 in the noninvasive group. There was no difference in rates of targeted therapy in patients with invasive quantitative sampling (17 [63%] vs. 35 [57%]; relative risk = 1.10; 95% confidence interval [0.76, 1.57]). No statistically significant differences were observed for in-hospital mortality (8 patients vs. 6 patients, p = .35) or antimicrobial days of therapy (10.3 ± 8.8 vs. 7.8 ± 3.6, p = .161). Only 2 patients (17%) had antibiotics withheld when below the diagnostic threshold.

Conclusions:
Invasive quantitative respiratory sampling did not result in significant changes in targeted antibiotic therapy in a trauma population.
Center Donor Refusal Rate Is Associated With Worse Outcomes After Listing in Pediatric Heart Transplantation
Authors: Butts Ryan J. , Baez Hernandez Nathanya , Kirk Richard , Bano Maria , Davies Ryan 
Published: November 2020

Background.
Pediatric donor heart acceptability differs among transplant centers. However, the impact of center donor acceptance on waitlist and posttransplant outcomes has not been investigated. The aim of our study was to investigate associations between transplant center refusal rate (RR) and outcomes after listing.

Methods.
Retrospective analysis was performed using United Network for Organ Sharing/Organ Procurement and Transplant Network pediatric (<18 y) heart transplant data from 2007 to 2017. Center RR was defined as the median number of refusals per listed patient. Associations between RR center quartile and waitlist time, waitlist removal for death or clinical deterioration, posttransplant survival, and survival after listing were investigated.

Results.
There were 5552 listed patients in 59 centers who met inclusion criteria. The lowest quartile RR centers had a median RR of ≤1 per listed patient, and highest RR centers percentile had a median RR of ≥4. Highest RR centers had shorter time to first offer (19 versus 38 d; P < 0.001), with longer waitlist times (203 versus 145 d; P < 0.001), were more likely to remove patients from the waitlist due to death or deterioration (24.1% versus 14.6%; P < 0.001), less likely to transplant listed patients (63.1% versus 77.6%; P < 0.001), and had a lower likelihood of survival 1 year after listing (79.2% versus 91.6%; odds ratio, 1.6; 95% confidence interval, 1.2-2.0; P < 0.001) compared with low RR centers.

Conclusions.
Patients listed at high RR centers had worse survival from listing despite having shorter times to first offer.
Predicting Self-harm Incidents Following Inpatient Visits using Disease Comorbidity Network
Authors: Xu Zhongzhi , Zhang Qingpeng , Fai Yip Paul Siu 
Published: November 2020

AbstractSelf-harm is serious but preventable, particularly if the risk can be identified early. But the early detection of self-harm individuals is so far not satisfied. This study aims to develop and test a comorbidity network-enhanced deep learning framework to improve the prediction of individual self-harm within 12 months after hospital discharge. Between January 1, 2007, and December 31, 2010, we obtained 2,323 patients with self-harm clinical record from 1,764,094 inpatients across 44 public hospitals in Hong Kong and 46,460 randomly sampled population controls from those same hospitals. Eighty percent (80%) of the study sample was randomly selected for model training, and the remaining 20% was set aside for model testing. The proposed comorbidity network-enhanced model was compared with a baseline deep learning model for self-harm prediction. The C-statistic, precision and sensitivity were used to evaluate the prediction accuracy of the proposed model and the baseline model. Experiments demonstrated that the proposed comorbidity network-enhanced model outperformed baseline model in identifying patients who would self-harm within 12 months (C-statistic of proposed model 0.89). The precision was 0.54 for positive cases and 0.98 for negative cases, whilst the sensitivity was 0.72 for positive cases and 0.96 for negative cases. Results indicated that it is critical to consider the general disease comorbidity patterns in self-harm screening and prevention programs. The model also extracted the most predictive diagnoses, and pairs of comorbid diagnoses which provide medical professionals with an effective screening strategy.
Creatine Kinase during Non-ST-Segment Elevation Acute Coronary Syndromes is Associated with Major Bleeding
Authors: Brewster Lizzy M. , Fernand Jim D. 
Published: November 2020

AbstractBackgroundIt was recently reported that highly elevated plasma activity of the ADP-scavenging enzyme creatine kinase (CK), to >10 times the upper reference limit (URL), is independently associated with fatal or non-fatal bleeding during treatment for ST-segment elevation myocardial infarction (OR 2.6 [95% CI, 1.8 to 2.7]/log CK increase). Evidence indicates that CK attenuates ADP-dependent platelet aggregation. This study investigates whether moderately elevated CK in non-ST-segment elevation acute coronary syndromes (NSTE-ACS) is associated with major bleeding.MethodsThe Thrombolysis In Myocardial Ischemia (TIMI) 3B trial compared rt-PA (35 to 80 mg) with placebo, and early catheterization with conservative management in patients with NSTE-ACS. Main outcomes of the current study are the independent association of peak plasma CK (CKmax) with adjudicated fatal or non-fatal major bleeding (primary), and with combined major bleeding, stroke, and all-cause mortality (secondary) in multivariable binomial logistic regression analysis, with co-variables including age, sex, BMI, SBP, creatinine, and treatment assignment. Discrimination was assessed with C-statistics.ResultsThe study included 1473 patients (66% men, 80% white, mean age 59 y, SE 0.3). CKmax ranged between 15 and 19045 IU/L (mean (SE), 450(24) IU/L; i.e. 2 times URL). Major bleeding occurred in 2.0% (mean age 65(1.3) y; mean CKmax 1015(318) IU/L; 6 times URL), and the combined outcome in 4.3% of the patients, adjusted OR per log CK increase respectively 3.1 [1.6 to 5.8] for major bleeding, and 3.9 [2.5 to 6.1] for the combined outcome; C-index 0.8 for both outcomes.DiscussionThe presented data add to the existing evidence that proportionate to its plasma activity, the ADP-binding enzyme CK is strongly and independently associated with non-fatal and fatal major bleeding during ACS treatment. CK might increase the accuracy of prediction models for major bleeding in patients treated with antithrombotic or thrombolytic drugs for ACS.ClinicalTrials.gov identifierNCT00000472
SARS-CoV-2 Seroprevalence in a Cohort of Asymptomatic, RT-PCR Negative Croatian First League Football Players
Authors: Vince Adriana , Zadro Renata , Šostar Zvonimir , Sternak Sunčanica Ljubin , Vraneš Jasmina , Škaro Vedrana , Projić Petar , Molnar Vilim , Matišić Vid , Baršić Bruno , Lauc Gordan , Lovrić-Makarić Zvjezdana , Bahtijarević Zoran , Vlahović Tomislav , Šikić Sandra , Polašek Ozren , Primorac Dragan 
Published: November 2020

AbstractBackgroundDuring the COVID-19 pandemic the Croatian Football Federation has launched a new model of pre-season systematic examination of football players, emphasizing the diagnosis of asymptomatic SARS-CoV-2 infection and preventing further spread among the players.ObjectivesThe aim of this study was to assess the prevalence and dynamics of SARS-CoV-2 IgA and IgG antibodies in the cohort of asymptomatic and SARS-CoV-2 PCR negative professional football players in the Croatian First Football League by using a commercial ELISA antibody assay in the paired serum samples taken 2 months apart.MethodsSerology testing was performed from May till July 2020 in a cohort of 305 asymptomatic football players and club staff members. RT-PCR for detection of SARS-CoV-2 from nasopharyngeal swabs was performed on three occasions, and Euroimmun ELISA for detection of IgA and IgG (S1 and NCP) antibodies was tested in paired serum samples in May and July.ResultsAll RT-PCR results were negative. Sixty-one (20%) participants were reactive in one or two classes of antibodies at baseline and/or follow-up serology testing. IgA reactivity was found in 41 (13.4% [95% CI=10.7-17.7]) baseline sera and 42 (13.8% [95% CI=10.3-18.9]) follow-up sera. IgG to S1 protein was found in 6 (2% [95% CI=0.9-4.2]) participants at baseline and 1 (0.33% [95% CI=0.0006-1.83]) at follow-up. IgG to NCP was found in 2 (0.7% [95% CI=0.2-2.4]) participants at baseline and 8 (2.6% (95% CI=1.3-5.1]) participants at follow-up. Noticeable dynamics in the paired sera was observed in 18 (5.9%) participants (excluding borderline IgA results) or 32 (10.5%) (including IgA borderline results).ConclusionVarious patterns of IgA and IgG reactivity were found in the paired serum samples. Based on serology dynamics we estimate that in 5.9%-10.5% of PCR negative football players asymptomatic exposure to SARS-CoV-2 during pandemics could not be excluded.
SARS-CoV-2 Innate Effector Associations and Viral Load in Early Nasopharyngeal Infection
Authors: Liou Theodore G , Adler Frederick R , Cahill Barbara C , Cox David R , Cox James E , Grant Garett J , Hanson Kimberly E , Hartsell Stephen C , Hatton Nathan D , Helms My N , Jensen Judy L , Kartsonaki Christiana , Li Yanping , Leung Daniel T , Marvin James E , Middleton Elizabeth A , Osburn-Staker Sandra M , Packer Kristyn A , Shakir Salika M , Sturrock Anne B , Tardif Keith D , Warren Kristi Jo , Waddoups Lindsey J , Weaver Lisa J , Zimmerman Elizabeth , Paine Robert 
Published: November 2020

AbstractTo examine innate immune responses in early SARS-CoV-2 infection that may change clinical outcomes, we compared nasopharyngeal swab data from 20 virus-positive and 20 virus-negative individuals. Multiple innate immune-related and ACE-2 transcripts increased with infection and were strongly associated with increasing viral load. We found widespread discrepancies between transcription and translation. Interferon proteins were unchanged or decreased in infected samples suggesting virally-induced shut-off of host anti-viral protein responses. However, IP-10 and several interferon-stimulated gene proteins increased with viral load. Older age was associated with modifications of some effects. Our findings may characterize the disrupted immune landscape of early disease.
A household case evidences shorter shedding of SARS-CoV-2 in naturally infected cats compared to their human owners
Authors: Neira Víctor , Brito Bárbara , Agüero Belén , Berrios Felipe , Valdés Valentina , Gutierrez Alberto , Ariyama Naomi , Espinoza Patricio , Retamal Patricio , Holmes Edward C. , Gonzalez-Reiche Ana S. , Khan Zenab , van de Guchte Adriana , Dutta Jayeeta , Miorin Lisa , Kehrer Thomas , Galarce Nicolás , Almonacid Leonardo I. , Levican Jorge , van Bakel Harm , García-Sastre Adolfo , Medina Rafael A. 
Published: November 2020

AbstractSevere acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has been detected in domestic and wild cats. However, little is known about natural viral infections of domestic cats, although their importance for modeling disease spread, informing strategies for managing positive human-animal relationships and disease prevention. Here, we describe the SARS-CoV-2 infection in a household of two human adults and sibling cats (one male and two females) using real-time RT-PCR, an ELISA test, viral sequencing, and virus isolation. On May 2020, the cat- owners tested positive for SARS-CoV-2. Two days later, the male cat showed mild respiratory symptoms and tested positive. Four days after the male cat, the two female cats became positive, asymptomatically. Also, one human and one cat showed antibodies against SARS-CoV-2. All cats excreted detectable SARS-CoV-2 RNA for a shorter duration than humans and viral sequences analysis confirmed human-to-cat transmission. We could not determine if cat-to-cat transmission also occurred.Article Summary LineSARS-CoV-2 in naturally infected cats present a shorter shedding pattern compared to their owners.
Difference of brain cortical thickness and area of different lobes between fetuses with intrauterine growth restriction and control group assessed by 3 Tesla MRI
Authors: Moradi Behnaz , Shirazi Mahboobeh , nezhad Zohreh Alibeigi , Saadat Nazanin Seyed , Hashemi Hassan , Kazemi Mohammad Ali , Gity Masoumeh , Rahmani Maryam , Ghanaati Hossein 
Published: November 2020

AbstractBackgroundIntrauterine growth restricted (IUGR) is a major factor of perinatal and long-term morbidity and is associated with abnormal fetal brain development but its pattern of brain involvement is still unknown.Materials and Methods42 women with IUGR pregnancy and 28 women with normally-grown fetuses between 28-38 weeks underwent 3Tesla MRI. Cortical thickness was assessed in 4 regions and was corrected by biparietal diameter/2. Also, whole brain surface area (WBA) and areas of 6 brain regions were included and corrected by WBA.ResultsIUGR fetuses had significantly thinner cortical thickness in the insula and temporal lobes compared to the control group (0.034 vs 0.043 and 0.036 vs 0.047 respectively, P value of < 0.05). They had significantly reduced WBA (P value: 0.028). The corrected brain areas were not significantly different between groups except for the corrected areas of cerebellum and hippocampus which were increased in IUGR fetuses compared to the control group (0.147vs 0.130,0.017vs 0.0125 respectively, P value of < 0.05).ConclusionIUGR fetuses had significantly thinner insular and temporal lobe cortex and smaller WBA compared to the control group. Among different brain regions, cerebellum and hippocampus were less affected by growth restriction in utero period.