bluuebunny/crossref_metadata_2025_split huggingface dataset:
Severe traumatic brain injury and hypotension is a frequent and lethal combination in mountain trauma patients – an analysis of the International Alpine Trauma Registry
Authors: Rauch Simon , Marzolo Matilde , Cappello Tomas Dal , Ströhle Mathias , Mair Peter , Pietsch Urs , Brugger Hermann , Strapazzon Giacomo , Group IATR Study 
Published: November 2020

Abstract
Background: Hypotension is associated with worse outcome in patients with traumatic brain injury (TBI) and maintaining a systolic blood pressure (SBP) ≥110 mmHg is recommended. The aim of this study was to assess the incidence of TBI in patients suffering multi-trauma in remote and mountainous areas; to describe associated factors, treatment and outcome compared to non-hypotensive patients with TBI and patients without TBI; and to evaluate pre-hospital variables to predict admission hypotension.Methods: Data from the International Alpine Trauma Registry including mountain multi-trauma patients (ISS≥16) collected between 2010 and 2019 were analysed. Patients were divided into three groups: 1) TBI with hypotension, 2) TBI without hypotension and 3) no TBI. TBI was defined as Abbreviated Injury Scale (AIS) of the head/neck ≥3 and hypotension as SBP <110 mmHg on hospital arrival.Results: A total of 287 patients were included. Fifty (17%) had TBI and hypotension, 92 (32%) suffered TBI without hypotension and 145 (51%) patients did not have TBI. Patients in group 1 were more severely injured (mean ISS 43.1±17.4 vs 33.3±15.3 vs 26.2±18.1 for group 1 vs 2 vs 3, respectively, p<0.001). Mean SBP on hospital arrival was 83.1±12.9 vs 132.5±19.4 vs 119.4±25.8 mmHg (p<0.001) despite patients in group 1 received more fluids. Patients in group 1 had higher INR, lower haemoglobin and lower base excess (p<0.001). The rate of hypothermia on hospital arrival was different between the groups (p=0.029). Patients in group 1 had the highest mortality (24% vs 10% vs 1%, p<0.001).Conclusion: Multi-trauma in the mountains goes along with severe TBI in almost 50%. One third of patients with TBI is hypotensive on hospital arrival and this is associated with a worse outcome. No single variable or set of variables easily obtainable at scene was able to predict admission hypotension in TBI patients.
Excessive sedation as a risk factor for delirium: a comparison between two cohorts of critically-ill patients with and without COVID-19
Authors: Rasulo Frank A , Calza Stefano , Piva Simone , Marchesi Mattia , Nocivelli Gian Piero , Cattaneo Sergio , Matta Basil , Cunningham Daniel , Filippini Matteo , Terranova Francesco , Beretta Silvia , Latronico Nicola 
Published: November 2020

Abstract
Background: Excessive sedation has been associated with poor outcome in critically-ill patients with acute respiratory Distress Syndrome (ARDS). The on-going pandemic has seen many critically-ill COVID-19 with ARDS, yet the incidence of excessive sedation and its association to delirium in these patients has to date not been assessed. We aimed at comparing the incidence and outcome of excessive sedation and delirium in two cohorts of critically-ill patients. Methods: This was an international, dual center retrospective analysis of prospectively collected data from two cohorts of critically ill patients, with and without COVID-19 disease, pertaining to two different hospital settings. Depth of sedation was monitored through processed EEG and delirium through the Confusion Assessment Method for the ICU(CAM-ICU). The main outcomes were the incidence of excessive sedation and delirium between the two cohorts, and secondary outcomes were length of ICU and hospital stay and mechanical ventilation duration.Results: Fifty-seven non-COVID-19 and 21 COVID-19 patients were included, 38(49%) of whom had ARDS. Twenty-seven(47.3%) non-COVID-19 and 11(52.3%) COVID-19 patients fulfilled the criteria for excessive sedation. Excessively sedated patients were older(p=0.034) and had delirium more frequently(p<0.001). There was a trend in excessive sedation in ARDS patients, while there was no correlation between excessive sedation and COVID-19 diagnosis. COVID-19 with ARDS was related to delirium at the limit of significance. On adjusted analysis excessive sedation was independently related to delirium(p=0.008). Patients with delirium had longer MV duration, ICU-LOS and H-LOS. In the adjusted analysis, delirium was an independent predictor of ICU-LOS(p=0.005) and MV duration(p=0.039). SAPS II was higher in the non-COVID-19 patients when compared to COVID-19 patients. Despite this, COVID-19 patients remained ventilated for a longer period of time, had a longer ICU and H-LOS. Conclusion: Besides age, excessive sedation might represent an important risk factor for delirium in COVID-19 and non-COVID-19 critically ill patients, which may lead to an increased ICU-LOS, H-LOS and MV duration. The use of continuous EEG-based monitoring for quantification of sedation depth, along with frequent delirium assessment in critically-ill COVID-19 patients is warranted along with larger prospective trials aimed at verifying weather the use of EEG-based monitoring leads to improved outcome.
Clinical outcomes of gastroscopy in critically ill patients using high-dose proton pump inhibitor for suspected bleeding
Authors: Kwack Won Gun 
Published: November 2020

Abstract
Background: Gastroscopy is a useful procedure for gastrointestinal (GI) bleeding. No definite clinical guidelines recommend on the choice of gastroscopy implementation in the intensive care unit (ICU) patient with suspected GI bleeding. The objective of this retrospective study was to compare the clinical effectiveness of gastroscopy in critically ill patients using high-dose proton pump inhibitor for suspected bleeding.Methods: ICU patients using a high-does proton pump inhibitor for suspected GI bleeding from January 2015 to February 2020 were retrospectively included. Massive GI bleeding, such as hematemesis and hematochezia, were excluded. After propensity score matching (PSM) between the gastroscopy and no gastroscopy groups, the change in hemoglobin level, requirement of RBC transfusion, length of ICU stay, and ICU mortality were compared. Results: Of the 116 subjects included, 34 patients had gastroscopy during ICU stay. Among the gastroscopy group, 13 (38.2%) patients showed normal findings, and the most frequent abnormal finding was gastric ulcer (n = 9, 26.5%), and 12 patients (35.3%) had a hemostatic procedure. After PSM, the gastroscopy group needed more red blood cell transfusion than the no-gastroscopy group (P = 0.01). There was no significant difference in the change in hemoglobin level (P = 0.10), length of ICU stay (P = 0.64), and ICU mortality (P = 0.55).Conclusion: This retrospective study showed that gastroscopy had no definite clinical benefit in ICU patients using high-dose proton pump inhibitor for suspected GI bleeding.
Is mild hypernatremia an independent predictor of poor clinical outcome in neurocritically ill patients?
Authors: Lee Yun Im , Ahn Joonghyun , Ryu Jeong-Am 
Published: November 2020

Abstract
Background: Hypernatremia is a common complication encountered during the treatment of neurocritically ill patients. However, it is unclear whether clinical outcomes correlate with the severity of hypernatremia in such patients. Therefore, we investigated the impact of hypernatremia on mortality of these patients, depending on the degree of hypernatremia.Methods: Among neurosurgical patients admitted to the intensive care unit (ICU) in a tertiary hospital from January 2013 to December 2019, patients who were hospitalized in the ICU for more than 5 days and whose serum sodium levels were obtained during ICU admission were included. Hypernatremia was defined as the highest serum sodium level exceeding 150 mEq/L observed. We classified the patients into four subgroups according to the severity of hypernatremia and performed propensity score matching analysis.Results: Among 1,146 patients, 353 patients (30.8%) showed hypernatremia. Based on propensity score matching, 290 pairs were included in the analysis. The hypernatremia group had higher rates of in-hospital mortality and 28-day mortality in both overall and matched population (both p < 0.001 and p = 0.001, respectively). In multivariable analysis of propensity score-matched population, moderate and severe hypernatremia were significantly associated with in-hospital mortality (adjusted odds ratio [OR]: 4.58, 95% confidence interval [CI]: 2.15 – 9.75 and adjusted OR: 6.93, 95% CI: 3.46 – 13.90, respectively) and 28-day mortality (adjusted OR: 3.51, 95% CI: 1.54 – 7.98 and adjusted OR: 10.60, 95% CI: 5.10 – 21.90, respectively) compared with the absence of hypernatremia. However, clinical outcomes, including in-hospital mortality and 28-day mortality, were not significantly different between the group without hypernatremia and the group with mild hypernatremia (p = 0.720 and p = 0.690, respectively). The mortality rates of patients with moderate and severe hypernatremia were significantly higher in both overall and matched population. Interestingly, the mild hypernatremia group of matched population showed the best survival rate.Conclusions: Moderate and severe hypernatremia were associated with poor clinical outcomes in neurocritically ill patients. However, the prognosis of patients with mild hypernatremia was similar with that of patients without hypernatremia. Therefore, mild hypernatremia may be allowed during treatment of intracranial hypertension using hyperosmolar therapy.
The role of eosinophils and corresponding cytokines and chemokines asthma-COPD overlap (ACO) patients
Authors: Li Qinglan , Lu Liang , Geng Shiyang , Zhang Huiyun , Li Xin , Lu Sijing 
Published: November 2020

Abstract
Background: ACO has been characterized as a kind of clinical disease with overlap symptoms of asthma and COPD. However, little is known of the role of eosinophils and corresponding cytokines and chemokines in ACO patients with different treatment responses. Methods: To evaluate factors which associates with different treatment responses in patients with ACO. In the present study, we investigated the eosinophils proportion of peripheral blood from ACO patients with acute exacerbation (AE) after treatment, ACO patients with clinical response (CR) after treatment, and healthy volunteers (HV) by using flow cytometry analysis. The plasma levels of corresponding cytokines and chemokines from the three groups were evaluated by ELISA.Results: The results showed that ACO patients that had acute exacerbation have relatively lower eosinophils proportions compared to healthy volunteers but have higher eosinophils inflammation compared with patients with clinical response. The percentage of NK1R+ expression population eosinophils was also decreased. Further analysis revealed ACO patients that had acute exacerbation also have relatively higher plasma levels of cytokines and chemokines compared to patients with clinical response after treatments and healthy volunteers.Conclusion: ACO patients from AE group have relatively lower eosinophil proportion and NK1R+ expression population eosinophil proportion, but higher plasma levels of cytokines and chemokines. Inhibitors of cytokines and chemokines are likely useful agents for treatment of ACO patients which had acute exacerbations.
Reinfection with SARS-CoV-2 in a splenectomized patient from Kocaeli, Turkey
Authors: Deniz Müge Toygar , Akhan Sıla , Esgin Melih Berkay , Sayan Murat , Barış Serap Argun 
Published: November 2020

Abstract
Background: The COVID-19 pandemic has resulted in more than 31 million cases diagnosed and 965,000 deaths as of September 21, 2020. As the number of cases increases, clinical conditions such as prolonged viral release, reinfection, and reactivation are being encountered more frequently.Case presentation: This article presents a case who was reinfected with COVID-19 and developed a more severe second disease unlike other cases in the literature.Conclusions: Reinfection in a splenectomy case may help researchers understand the pathogenesis of the disease and can be a guide for the development of vaccines and new treatments.
Brine-Shrimp Lethality Bioassay of different extracts of the medicinal plant matricaria (chamomilla) flowers
Authors: Ali Amal Elnour , Ali Shayob Mohammed El Hassan , EL-Rhman Suad Abd Elgadir Abdo , Mohamed Mona Abd ELmoneim , Khider Tarig Osman 
Published: November 2020

Abstract
The present study aimed to throw some light on phytochemical constituents of Matricaria (cammomile) flowers. The grinded flowers were extracted successively by petroleum ether (40-60°C), chloroform, 95% ethanol, and ethyl acetate; using soxhlet apparatus respectively. The extracts were concentrated under vacuum (rotatory evaporator).Phytochemical screening of matricaria flowers, were performed using standard methods, showed the presence of alkaloids, flavonoids, terpenoids, saponins, and anthraquinone. The 95% ethanolic crude extract was subjected to column chromatography and nine fractions were collected. Fractions 1-6 have the same Rf value, (using thin layer pre-coated silica gel (0.25cm). were combined and subjected to spectroscopic analysis; infrared spectra showed absorption at 1860, 1637 and 805 cm’ indicating the presence of c=o, c=c, and c-o groups respectively. Ultra violet absorption at 250-283nm assign for the presence of flavonoids, (lit. 250-280). Finally GC/MS spectra performed the presence flavonoids.Crude extracts (ethanol, methanol, petroleum ether, and chloroform) were investigated for antimicrobial activities against four strains of bacteria (Staphylococcus aureus, Escherichia coli, Bacillus sub tills, Pseudomonas aeruginosa, and two fungi: Asperigillus niger, and Candida albican) with disc diffusion method, the diameter of growth inhibition zone ranged 15-22mm.The distilled essential oil (hydro distillation) of matricaria flowers was subjected to GC/MS, a Number of aliphatic compounds were detected e.g. 2, 3 heptadione and 3-hexa none, 2, 5 dimethyl.
p53+/-Rb1-ASCL1low&nbsp;phenotype&nbsp;predicts better prognosis after surgical resection in large cell neuroendocrine carcinoma: a molecular characteristic and clinical-pathological investigation of lung neuroendocrine tumors
Authors: Dong Yuting , Zhang Qian , Wang Guoping , Duan Yaqi , Huo Zitian 
Published: November 2020

Abstract
Background: Based on morphology, necrosis degree, and proliferation status, lung neuroendocrine tumors (NETs) are commonly divided into four subtypes: typical carcinoid (TC), atypical carcinoid (AC), large cell neuroendocrine carcinoma (LCNEC), and small cell lung carcinoma (SCLC). However, cases difficult to classify still exist in diagnosis. Methods: We immunohistochemically investigated the molecular phenotypes in lung NETs and assessed their prognostic value. Results: After morphological re-analysis of 179 NETs, 19 cases were classified as undefined, which included 3 cases showing carcinoid morphology with high proliferation (Ki67>20% or mitotic count>10/2mm2), and 16 cases showing intermediate differentiated morphology with Ki67 among 20% to 60%. Furthermore, molecular phenotypes were determined by expression of p53, Rb1, ASCL1, STK11, and gene mutation status of KRAS. Interestingly, p53wtRb1+ distinguished an unique subcategory from undefined lung NET cases which differ from SCLC or LCNEC in prognosis, indicating WD-NET G3 existed in lung NETs. Additionally, in LCNEC, high ASCL1 expression was only relevant to lymph node metastasis rather than overall survival. However, in p53+/-Rb1- LCNEC phenotype, low ASCL1 predicted better outcomes, along with less risk of lymph node metastasis. Conclusion: This study provided evidence for existence of WD-NET G3 in NETs and revealed promising prognosis of p53+/-Rb1- ASCL1low subcategory in LCNEC, which could be beneficial to the evaluation of patient status in future clinic practice.
A Randomized, Controlled Study on the Safety and Efficacy of Maraviroc and/or Favipiravir vs Currently Used Therapy in Severe COVID-19 Adults. “COMVIVIR” Trial.
Authors: Pérez-García Adolfo , Villalobos-Osnaya Alma , Hernández-Medel Maria Luisa , Perez-Navarro Lucia Monserrat , Medina-Hernandez Elba O. , Cabrera-Orejuela Diana Sofia , Espinoza-Garcia Ana Maria , Solleiro-Villavicencio Helena , Leon-Hernandez Mireya , Mayor Arianna Rodriguez-Cal Y , Servin-Murillo Manli M. , Carillo-Ruiz Jose Damian , Serrano-Loyola Raul , Guerrero-Avendaño Guadalupe Mercedes Lucia , Reyes-Teran Gustavo , Sierra-Madero Juan , de Oca Gonzalo Salgado-Montes , Avila-Rios Santiago , Lopez-Alvarenga Juan Carlos , Hernandez-Ruiz Joselin 
Published: November 2020

Abstract
Multiple studies have established that hyperinflammatory response induced by SARS CoV-2 is a main cause of complications and death in infected subjects. Such dysfunctional immune response has been described as a dysregulated and exacerbated production of cytokines and chemokines that attracts and activates inflammatory cells, which start and sustain pulmonary and systemic damage, thus causing complications that lead to multi organ failure and death. Therefore, we suggest that blocking key inflammation receptors could help to reduce migration and activation of T cells, monocytes/macrophages and neutrophils, thus mitigating the cytokine dysregulation and averting severe complications and death. Importantly, the optimum treatment for COVID-19 severe patients should combine a modulator of the immune response plus a direct antiviral drug against SARS-CoV-2, in order to address both the hyperinflammatory effects of the immune dysregulation and the viral load. Methods: Maraviroc (MVC), a CCR5 antagonist, and Favipiravir (FPV), an antiviral, will be evaluated single and combined, added to the treatment currently used at the Hospital General de México Dr. Eduardo Liceaga for severe COVID-19 patients. One hundred patients will be allocated in four arms [Current treatment only (CT), CT+MVC, CT+FPV, CT+MVC+FPV]. Percentage of patients free of mechanical ventilation or death at day 28, immunophenotyping and viral load will be compared between groups. Discussion: New immune focused therapies are targeting strong inflammation mediators such as IL-6 and IL1-β; nevertheless, to our best knowledge, only one study explores chemotaxis control. The use of a drug therapy that addresses both the regulation of the immune response and the inhibition of viral replication could at the same time, help to alleviate the hyperinflammatory condition and reduce the time of the viral clearance process, therefore improving treatment outcomes.
Perceived changes of specific attitudes, perceptions and behaviors during the Corona pandemic and their relation to wellbeing
Authors: Büssing Arndt , Recchia Daniela Rodrigues , Hein Rudolf , Dienberg Thomas 
Published: November 2020

Abstract
Background During the COVID-19 pandemic, most people had to cope with the restrictions of the lockdown, leaving them to their fears, insecurity and isolation. On the other hand, due to the unexpected ‘extra time’ there was room for new experiences and for personal reflections on what is essential in life, to perceive nature and relations more consciously etc. We, therefore, intended to analyze perceived changes of attitudes and behaviors during the time of lockdown, and whether these perceptions would contribute to personal wellbeing during the pandemic.Method An anonym cross-sectional online survey was performed for data collection, using standardized questionnaires, i.e., the WHO-Five Well-being Index (WHO-5), Brief Multidimensional Life Satisfaction Scale (BMLSS), Awe/Gratitude scale (GrAw-7), and the newly developed Perceived Changes Questionnaire (PCQ).Results Within the number of respondents (n=1,277), women were predominating (67.5%). Participants´ mean age was 50.9 ± 14.9 years. Exploratory factor analyses showed that the 24-item Perceived Changes Questionnaire differentiated five factors that would account for 61% of variance: 1) Nature / Silence / Contemplation (Cronbach´s alpha =.87), 2) Spirituality (Cronbach´s alpha =.83), 3) Relationships (Cronbach´s alpha =.80), 4) Reflection on life (Cronbach´s alpha =.74), 5) Digital media usage (Cronbach´s alpha =.74). Strongest changes were observed for Relationships and Nature / Silence / Contemplation. Perceived changes were stronger among older persons, among persons with higher wellbeing, and among those who relied on their faith as a resource. These changes were predicted best by a person´s perception of wondering awe in distinct situations with subsequent feelings of gratitude. Stepwise regression analyzes revealed that participants´ wellbeing was explained best by low perceived burden and high life satisfaction (R2=.46). Awe/gratitude, perceived changes in terms of Nature / Silence / Contemplation and low Reflections of live are further variables that would predict a person´s wellbeing among the COVID-19 pandemic,Conclusions During the Corona pandemic, people tried to find ways to adapt to the outcomes of the restrictions. The perceived changes of attitudes and behaviors can be interpreted in terms of a reappraisal strategy. These can be measured with the extended version of the PCQ which was found to have good quality indices and a plausible factor structure. The reported changes contribute to persons´ wellbeing only to some extend, indicating that they represent an independent quality of relevance in peoples´ life.
Multidisciplinary Approach to Enhancing Provider Well-Being in a Metropolitan Medical Group in the United States
Authors: Shields Lisa Barbara , Jennings James T. , Honaker Joshua T. 
Published: November 2020

Abstract
Background: Physician burnout refers to depersonalization, emotional exhaustion, and a sense of lower personal accomplishment. Affecting approximately 50% of physicians in the United States, physician burnout negatively impacts both the physician and patient. Over a 3-year-period, this prospective study evaluated the multidisciplinary approach to decreasing provider burnout and improving provider well-being in our metropolitan community. Methods: A multidisciplinary Well-Being Task Force was established at our Institution in 2017 to assess the myriad factors that may play a role in provider burnout and offer solutions to mitigate the stressors that may lead to decreased provider well-being. Four multifaceted strategies were implemented: (1) provider engagement & growth; (2) workflow/office efficiencies; (3) relationship building; and (4) communication. Providers at our Institution took the Mayo Clinic’s well-being index survey on 3 occasions over 3 years. Their scores were compared to those of providers nationally at baseline and at 1 and 2 years after implementing organizational and individualized techniques to enhance provider well-being. Lower well-being index scores reflected better well-being. Results: The average overall well-being index scores of our Institution’s providers decreased from 1.76 at baseline to 1.32 2 years later compared to an increase in well-being index scores of physicians nationally (1.73 to 1.85). Both male and female providers’ average well-being index scores at our Institution decreased over the 3 years of this study, from 1.72 to 1.58 for males and 1.78 to 1.21 for females, while physicians’ scores nationally increased for both genders. The average well-being index scores were highest for providers at our Institution who graduated from medical school less than 5 years earlier (2.0) and who graduated 15-24 years earlier (2.3), whereas the average lowest scores were observed in providers who graduated ³ 25 years earlier (1.37). Obstetricians/gynecologists and internal medicine physicians had the highest average well-being index scores (2.48 and 2.4, respectively) compared to other medical specialties. The turnover rate of our Institution’s providers was 5.6% in 2017 and 3.9% in 2019, reflecting a 30% decrease. Conclusion: This study serves as a model to reduce provider burnout and enhance well-being through both organizational and individual interventions.