bluuebunny/crossref_metadata_2025_split huggingface dataset:
Dexmedetomidine for Prolonged Sedation in the PICU: A Systematic Review and Meta-Analysis*
Authors: Daverio Marco , Sperotto Francesca , Zanetto Lorenzo , Coscini Nadia , Frigo Anna Chiara , Mondardini Maria Cristina , Amigoni Angela 
Published: March 2020

Objectives:We aimed to systematically describe the use of dexmedetomidine as a treatment regimen for prolonged sedation in children and perform a meta-analysis of its safety profile.Data Sources:PubMed, EMBASE, Cochrane Library, Scopus, Web of Science, ClinicalTrials.gov, and CINAHL were searched from inception to November 30, 2018.Study Selection:We included studies involving hospitalized critically ill patients less than or equal to 18 years old receiving dexmedetomidine for prolonged infusion (≥ 24 hr).Data Extraction:Data extraction included study characteristics, patient demographics, modality of dexmedetomidine use, associated analgesia and sedation details, comfort and withdrawal evaluation scales, withdrawal symptoms, and side effects.Data Synthesis:Literature search identified 32 studies, including a total of 3,267 patients. Most of the studies were monocentric (91%) and retrospective (88%); one was a randomized trial. Minimum and maximum infusion dosages varied from 0.1–0.5 µg/kg/hr to 0.3–2.5 µg/kg/hr, respectively. The mean/median duration range was 25–540 hours. The use of a loading bolus was reported in eight studies (25%) (range, 0.5–1 µg/kg), the mode of weaning in 11 (34%), and the weaning time in six of 11 (55%; range, 9–96 hr). The pooled prevalence of bradycardia was 2.6% (n= 10 studies; 14/387 patients; 95% CI, 0.3–7.3;I2= 75%), the pooled prevalence incidence of bradycardia was 2.6% (n= 10 studies; 14/387 patients; 95% CI, 0.3–7.3;I2= 75%), the pooled incidence of hypotension was 6.1% (n= 8 studies; 19/304 patients; 95% CI, 0.8–15.9;I2= 84%). Three studies (9%) reported side effects’ onset time which in all cases was within 12 hours of the infusion starting.Conclusions:High-quality data on dexmedetomidine use for prolonged sedation and a consensus on correct dosing and weaning protocols in children are currently missing. Infusion of dexmedetomidine can be considered relatively safe in pediatrics even when longer than 24 hours.
Efficacy and Safety of Dexmedetomidine for Prolonged Sedation in the PICU: A Prospective Multicenter Study (PROSDEX)*
Authors: Sperotto Francesca , Mondardini Maria C. , Dell’Oste Clara , Vitale Francesca , Ferrario Stefania , Lapi Maria , Ferrero Federica , Dusio Maria P. , Rossetti Emanuele , Daverio Marco , Amigoni Angela 
Published: March 2020

Objectives:
We sought to evaluate dexmedetomidine efficacy in assuring comfort and sparing conventional drugs when used for prolonged sedation (≥24 hr) in critically ill patients, by using validated clinical scores while systematically collecting drug dosages. We also evaluated the safety profile of dexmedetomidine and the risk factors associated with adverse events.

Design:
Observational prospective study.

Setting:
Nine tertiary-care PICUs.

Patients:
Patients less than 18 years who received dexmedetomidine for greater than or equal to 24 hours between January 2016 and December 2017.

Interventions:
None.

Measurements and Main Results:
One-hundred sixty-three patients (median age, 13 mo; interquartile range, 4–71 mo) were enrolled. The main indication for dexmedetomidine use was as an adjuvant for drug-sparing (42%). Twenty-three patients (14%) received dexmedetomidine as monotherapy. Seven percent of patients received a loading dose. The median infusion duration was 108 hours (interquartile range, 60–168 hr), with dosages between 0.4 (interquartile range, 0.3–0.5) and 0.8 µg/kg/hr (interquartile range, 0.6–1.2 µg/kg/hr). At 24 hours of dexmedetomidine infusion, values of COMFORT-B Scale (n = 114), Withdrawal Assessment Tool-1 (n = 43) and Cornell Assessment of Pediatric Delirum (n = 6) were significantly decreased compared with values registered immediately pre dexmedetomidine (p < 0.001, p < 0.001, p = 0.027). Dosages/kg/hr of benzodiazepines, opioids, propofol, and ketamine were also significantly decreased (p < 0.001, p < 0.001, p = 0.001, p = 0.027). The infusion was weaned off in 85% of patients, over a median time of 36 hours (interquartile range, 12–48 hr), and abruptly discontinued in 15% of them. Thirty-seven percent of patients showed hemodynamic changes, and 9% displayed hemodynamic adverse events that required intervention (dose reduction in 79% of cases). A multivariate logistic regression model showed that a loading dose (odds ratio, 4.8; CI, 1.2–18.7) and dosages greater than 1.2 µg/kg/hr (odds ratio, 5.4; CI, 1.9–15.2) increased the odds of hemodynamic changes.

Conclusions:
Dexmedetomidine used for prolonged sedation assures comfort, spares use of other sedation drugs, and helps to attenuate withdrawal syndrome and delirium symptoms. Adverse events are mainly hemodynamic and are reversible following dose reduction. A loading dose and higher infusion dosages are independent risk factors for hemodynamic adverse events.
Patient Safety Threats in Information Management Using Health Information Technology in Ambulatory Cancer Care: An Exploratory, Prospective Study
Authors: Pfeiffer Yvonne , Zimmermann Chantal , Schwappach David L. B. 
Published: March 2020

Background
Cancer care is complex, involving highly toxic drugs, critically ill patients, and various different care providers. Because it is important for clinicians to have the latest and complete information about the patient available, this study focused on patient safety issues in information management developing from health information technology (HIT) use in oncology ambulatory infusion centers.

Objective
The aim was to exploratively and prospectively assess patient safety risks from an expert perspective: instead of retrospectively analyzing safety events, we assessed the information management hazards inherent to the daily work processes; instead of asking healthcare workers at the front line, we used them as information sources to construct our patient safety expert view on the hazards.

Methods
The work processes of clinicians in three ambulatory infusion centers were assessed and evaluated based on interviews and observations with a nurse and a physician of each unit. The 125 identified patient safety issues were described and sorted into thematic groups.

Results
A broad range of patient safety issues was identified, such as data fragmentation, or information islands, meaning that patient data are stored across different cases or software and that different professional groups do not use the same set of information.

Conclusions
The current design and implementation of HIT systems do not support adequate information management: clinicians needed to play very close attention and improvise to avoid errors in using HIT and treat cancer patients safely. It is important to take the clinical front-end practice into account when evaluating or planning further HIT improvements.
Missed Nursing Care in a Sample of High-Dependency Italian Nursing Home Residents: Description of Nursing Care in Action
Authors: Campagna Sara , Basso Ines , Vercelli Elisa , Ranfone Marco , Dal Molin Alberto , Dimonte Valerio , Di Giulio Paola 
Published: March 2020

Objective
The aim of the study was to describe omitted or delayed nursing care (i.e., missed nursing care [MNC]) in a sample of Italian nursing homes (NHs).

Methods
Nurses from 50 NHs located in Northern Italy selected the 20 most dependent residents in their care and reported instances of MNC for three to five consecutive shifts. They described the type of MNC, its cause(s), management, recurrence, and severity of possible consequences for the resident. Information on the residents and the NH was also collected. The instances of MNC were classified as potentially avoidable/preventable or not.

Results
Overall, 266 (85.3%) of 312 nurses participated and 1000 residents were observed during 381 shifts (164 mornings, 164 afternoons, and 53 nights); 101 (38%) nurses reported 223 instances of MNC among 175 residents (17.5%). Ninety-seven omissions and 109 delays occurred during the day shift (56 omissions were delegated to the next shift). The most frequent MNC was drug administration (n = 71, 34.5%). In 24 (44.4%) of 54 instances of delayed drug administration, the delay was less than 30 minutes. Nurses rated approximately 20% of MNC (n = 41) as highly severe because of the discomfort caused to the resident, the clinical impact, or the repetitiveness of the situation. Nurses ascribed almost half of MNC (n = 100, 48.5%) to inadequate staffing, and they categorized 26 (11.6%) instances of MNC as unavoidable.

Conclusions
The number of nurse-reported instances of MNC we reported was much lower than that previously collected with available instruments. Most MNC did not impact the comfort and safety of residents. A certain proportion of MNC was unavoidable.
Ten-Year Trend in Polypharmacy in the Lausanne Population
Authors: Abolhassani Nazanin , Vollenweider Peter , Waeber Gérard , Marques-Vidal Pedro 
Published: March 2020

Background
Aging and associated morbidities place individuals at higher risk of polypharmacy and drug-drug interactions (DDIs). How polypharmacy and DDIs change with aging is important for public health management.

Objectives
The aim of the study was to assess the 10-year trends in prevalence of polypharmacy and potential DDIs in a population-based sample.

Methods
Baseline (2003–2006) and follow-up (2014–2016) data were obtained from a sample of 4512 participants (baseline age range = 35–75 y, 55.1% women) from the population of Lausanne, Switzerland. Polypharmacy and polyactive drug use were defined by the regular use of five or more medications and five or more pharmacologically active substances, respectively. Drug-drug interactions were defined according to the criteria of the Geneva University Hospital.

Results
The percentage of participants taking at least one drug increased from 56.1% to 79.5% (P < 0.001). Among participants taking drugs, number of medications increased from 2.6 ± 1.9 (mean ± standard deviation) to 3.8 ± 2.9 after 10.9-year follow-up (P < 0.001); the corresponding values for active substances were 2.7 ± 2.0 and 4.0 ± 3.0 (P < 0.001). The prevalence of polypharmacy and polyactive substance use increased from 7.7% to 25.0% and from 8.8% to 27.1%, respectively (P < 0.001). The presence of at least one potential DDI increased from less than 1% to almost one sixth of all participants.

Conclusions
In a community-dwelling sample, the prevalence of polypharmacy and polyactive substance use tripled during a 10.9-year follow-up, with an even greater increase in the prevalence of potential DDIs. Increasing rates of polypharmacy and DDIS warns the importance of preventing potential DDIs throughout healthcare system through various interventions.
Does Mastoid Pneumatization Affect Facial Canal Dimensions and Distances of Facial Tympanic Segment–Scutum and Lateral Semicircular Canal–Scutum?
Authors: Inal Mikail , Bayar Muluk Nuray , Asal Neşe , Şahan Mehmet Hamdi , Şimşek Gökçe , Arıkan Osman Kürşat 
Published: March 2020

ObjectivesIn the present study, we investigated whether mastoid pneumatization affects facial canal dimensions and distances of facial tympanic segment and scutum, and lateral semicircular (LSS) canal and scutum.MethodsOne hundred sixty-one temporal multidetector computed tomography scans were reviewed. Patients with unilateral sclerotic mastoid pneumatization (no aeration) (group 1, n = 81) and unilateral total mastoid pneumatization (100.0% aeration) (group 2, n = 80) were included. Facial canal dimensions at the labrythine, tympanic, and mastoid segments; facial canal dehiscence and length; and facial tympanic segment–scutum and LSS canal–scutum distances were evaluated.ResultsIn the present study, facial canal dimensions of labyrinthine, tympanic, and mastoid segments in total pneumatized mastoid group were significantly lower than sclerotic mastoids on axial and coronal images (P< 0.05). Facial tympanic segment and scutum distance of the sclerotic mastoid group was significantly lower than those of the total pneumatized mastoid group (P< 0.05). However, LSS canal–scutum distance was not different between both groups (P> 0.05). The LSS canal–scutum distance of the females was lower than those of the males (P< 0.05). Facial canal dehiscence ratio was 11.3% and 11.1% in sclerotic and total pneumatized mastoids, respectively. The mean ± SD length of the dehiscence was 2.46 ± 1.29 mm in pneumatized mastoids and 1.92 ± 0.68 mm in sclerotic mastoids.ConclusionsIn cholesteatoma cases, scutum erosion may occur. Because facial tympanic segment and scutum distance decreased in sclerotic mastoids compared with completely pneumatized ones, maximum care must be taken in the operations for avoiding to damage facial canal and nerve. Revision cases may be more difficult because of distorted anatomy. However, in pneumatized mastoids, the mean length of the facial canal was more than 2 mm, which must be kept in mind during operations.
Noninvasive Quantitative Plaque Analysis Identifies Hemodynamically Significant Coronary Arteries Disease
Authors: Yin Peiyan , Dou Guanhua , Yang Xia , Wang Xi , Shan Dongkai , He Bai , Jing Jing , Jin Qinhua , Chen Yundai , Yang Junjie 
Published: March 2020

Objective:
To evaluate the diagnostic performance of automated quantitative analysis by coronary computed tomography angiography (CCTA) in identifying lesion-specific hemodynamic abnormality.

Methods:
A total of 132 patients (mean age, 61 y; 86 men) with 169 vessels (with 30% to 90% diameter stenosis), who successively underwent invasive coronary angiography with evaluation of fractional flow reserve (values ≤0.8 were defined as lesion-specific hemodynamic abnormalities), were analyzed by CCTA. CCTA images were quantitatively analyzed using automated software to obtain the following index: maximum diameter stenosis (MDS%); maximum area stenosis (MAS%); lesion length (LL); volume and burden (plaque volume×100 per vessel volume) of total plaque (total plaque volume [TPV], total plaque burden [TPB]), calcified plaque (calcified plaque volume [CPV], calcified plaque volume burden [CPB]), noncalcified plaque (noncalcified plaque volume [NCPV], noncalcified plaque volume burden [NCPB]), lipid plaque (lipid plaque volume [LPV], lipid plaque burden [LPB]), and fibrous plaque (fibrotic plaque volume [FPV], fibrotic plaque burden [FPB]); napkin-ring sign (NRS); remodeling index (RI); and eccentric index (EI). Logistic regression and area under the receiver operating characteristics (AUC) were used for statistical analysis.

Results:
Fractional flow reserve ≤0.80 was found in 57 (33.73%) of the 169 vessels. Vessels with hemodynamic significance had greater MDS% (64.43%±8.69% vs. 57.33%±9.95%, P<0.001), MAS% (73.18%±8.56% vs. 64.66%±8.95%, P<0.001), and lipid plaque burden (12.75% [9.73%, 19.56%] vs. 9.41% [4.10%, 15.70%], P=0.01) compared with vessels with normal hemodynamics. In multivariable logistic regression analysis, MAS% >68% (odds ratio: 7.20, 95% confidence interval [CI]=2.89-17.91, P<0.001) and LPB >10.03% (odds ratio=4.32, 95% CI=1.36-13.66, P=0.01) were significant predictors of hemodynamic abnormalities. In predicting lesion-specific hemodynamic abnormalities, the AUC was 0.77 (95% CI=0.70-0.85) for MAS% versus 0.71 (95% CI=0.63-0.79) for MDS% (P<0.05), 0.66 (95% CI=0.58-0.74) for LPV (P<0.05), 0.66 (95% CI=0.58-0.74) for LPB (P<0.05), and 0.63 (95% CI=0.54-0.71) for TPB (P<0.05). The AUC of MAS%+LPB (0.83, 95% CI=0.76-0.89) was significantly improved compared with that of MAS% (0.77, 95% CI=0.70-0.85, P<0.05).

Conclusions:
Compared with MDS% and the volume burdens of plaque compositions, MAS% has a higher diagnostic accuracy for coronary hemodynamic abnormalities in the precise quantitative analysis of coronary plaques on the basis of CT. Furthermore, MAS%+LPB might improve the diagnostic accuracy beyond MAS% alone.
Is Peroral Endoscopic Myotomy a Potential Therapy for Esophageal Absent Contractility?
Authors: Zhao Qiaosu , Chen Pangyu , Wang Xiaojian , Ye Hua , Zhang Xuesong , Song Yufei , Zhang Xie 
Published: March 2020

Aim:
Peroral endoscopic myotomy (POEM) is recommended for the endoscopic treatment of achalasia and esophageal junction outflow obstruction (EGJOO); however, absent contractility, a subtype of peristalsis disorders classified by the Chicago Classification of esophageal motility v3.0, has no effective treatment. The purpose of this study was to assess the efficacy of POEM in absent contractility, in the part of the patients presents with dysphagia.

Methods:
We conducted a single-center retrospective study at a tertiary referral center. We included 30 patients who mainly complain with dysphagia, and they underwent POEM from January 2013 to December 2018. The data of high-resolution esophageal manometry was collected before and after POEM. They were divided into 3 groups: EGJOO, Achalasia, and Absent contractility according to the Chicago Classification of esophageal motility v3.0 before POEM. Telephone follow-up was made in February 2019 to obtain Eckardt scores and weight changes.

Results:
We found that both Eckardt scores and integrated relaxation pressure decreased post-POEM in the 3 groups (P<0.05). Eckardt score was significantly lower in the EGJOO group than in the Absent contractility group (P=0.004) post-POEM. The difference of Eckardt Score was higher in the EGJOO group (P=0.010) and the Achalasia group (P=0.007) than in the Absent contractility group, as was weight gain (P=0.023; P=0.002).

Conclusions:
These findings suggest that POEM is an effective endoscopic procedure for patients with EGJOO and achalasia. Furthermore, POEM can significantly improve symptoms in patients with absent contractility, although less so than for the other 2 groups. POEM is a potential therapy for absent contractility patients presenting with dysphagia.
Hypothermic Ex Situ Perfusion of Human Limbs With Acellular Solution for 24 Hours
Authors: Haug Valentin , Kollar Branislav , Tasigiorgos Sotirios , Endo Yori , Kauke Martin , Safi Ali-Farid , Veeramani Anamika , Abdulrazzak Obada , Bausk Bruce , Walt David , Pomahac Bohdan 
Published: March 2020

Background.
Machine perfusion (MP) has evolved as a promising approach for the ex situ preservation in organ transplantation. However, the literature on the use of MP in human vascularized composite allografts is scarce. The aim of this study was to evaluate the effects of hypothermic MP with an acellular perfusate in human upper extremities and compare with the current gold standard of static cold storage (SCS).

Methods.
Six upper extremities were assigned to either MP (n = 3) or SCS (n = 3) conditions for 24 h. MP-extremities were perfused with oxygenated Steen solution at a constant pressure of 30 mm Hg and 10°C.

Results.
Median total ischemia time was 213 min (range, 127–222 min). Myoglobin, creatine-kinase (CK) showed increased levels at the start of MP (medians: myoglobin: 4377 ng/mL, CK: 1442 U/L), peaking 6 h after perfusate exchange (medians: myoglobin: 9206 ng/mL, CK: 3995 U/L) at timepoint 24. Lactate levels decreased from a median of 6.9–2.8 mmol/L over time. Expression of hypoxia-inducible factor 1-alpha peaked in the SCS-group after 8 h, followed by a decrease. Increased hypoxia-inducible factor 1-alpha expression in the MP group was delayed until 20 h. Perfusion pressure, temperature, and circuit flow were maintained at median of 30.88 mm Hg, 9.77°C, and 31.13 mL/min, respectively. Weight increased 1.4% in the SCS group and 4.3% in the MP group over 24 h.

Conclusions.
Hypothermic ex situ perfusion with an oxygenated acellular Steen solution may extend the allowable extracorporeal preservation time by a factor of 4–6 compared to SCS and holds promise to be beneficial for vascularized composite allograft recipients and victims of traumatic major limb amputation.
Deep learning-enabled phenotyping reveals distinct patterns of neurodegeneration induced by aging and cold-shock
Authors: Saberi-Bosari Sahand , Flores Kevin B. , San-Miguel Adriana 
Published: March 2020

AbstractAccess to quantitative information is crucial to obtain a deeper understanding of biological systems. In addition to being low-throughput, traditional image-based analysis is mostly limited to error-prone qualitative or semi-quantitative assessment of phenotypes, particularly for complex subcellular morphologies. In this work, we apply deep learning to perform quantitative image-based analysis of complex neurodegeneration patterns exhibited by the PVD neuron inC. elegans. We apply a Convolutional Neural Network algorithm (Mask R-CNN) to identify neurodegenerative sub-cellular protrusions that appear after cold-shock or as a result of aging. A multiparametric phenotypic profile captures the unique morphological changes induced by each perturbation. We identify that acute cold-shock-induced neurodegeneration is reversible and depends on rearing temperature, and importantly, that aging and cold-shock induce distinct neuronal beading patterns.
Aerosol and surface stability of HCoV-19 (SARS-CoV-2) compared to SARS-CoV-1
Authors: van Doremalen Neeltje , Bushmaker Trenton , Morris Dylan H. , Holbrook Myndi G. , Gamble Amandine , Williamson Brandi N. , Tamin Azaibi , Harcourt Jennifer L. , Thornburg Natalie J. , Gerber Susan I. , Lloyd-Smith James O. , de Wit Emmie , Munster Vincent J. 
Published: March 2020

To the EditorA novel human coronavirus, now named severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2, referred to as HCoV-19 here) that emerged in Wuhan, China in late 2019 is now causing a pandemic1. Here, we analyze the aerosol and surface stability of HCoV-19 and compare it with SARS-CoV-1, the most closely related human coronavirus.2 We evaluated the stability of HCoV-19 and SARS-CoV-1 in aerosols and on different surfaces and estimated their decay rates using a Bayesian regression model (see Supplementary Appendix). All experimental measurements are reported as mean across 3 replicates.
Genomic epidemiology of a densely sampled COVID-19 outbreak in China
Authors: Geidelberg Lily , Boyd Olivia , Jorgensen David , Siveroni Igor , Nascimento Fabricia F. , Johnson Robert , Ragonnet-Cronin Manon , Fu Han , Wang Haowei , Xi Xiaoyue , Chen Wei , Liu Dehui , Chen Yingying , Tian Mengmeng , Tan Wei , Zai Junjie , Sun Wanying , Li Jiandong , Li Junhua , Volz Erik M , Li Xingguang , Nie Qing 
Published: March 2020

AbstractAnalysis of genetic sequence data from the SARS-CoV-2 pandemic can provide insights into epidemic origins, worldwide dispersal, and epidemiological history. With few exceptions, genomic epidemiological analysis has focused on geographically distributed data sets with few isolates in any given location. Here we report an analysis of 20 whole SARS-CoV 2 genomes from a single relatively small and geographically constrained outbreak in Weifang, People’s Republic of China. Using Bayesian model-based phylodynamic methods, we estimate a mean basic reproduction number (R0) of 3.47 (95% highest posterior density interval: 1.78-5.47) in Weifang, and a mean effective reproduction number (Rt) that falls below 1 on February 2nd. We further estimate the number of infections through time and compare these estimates to confirmed diagnoses by the Weifang Centers for Disease Control. We find that these estimates are consistent with reported cases and there is unlikely to be a large undiagnosed burden of infection over the period we studied.