bluuebunny/crossref_metadata_2025_split huggingface dataset:
Evaluation of the Efficacy and Safety of Inhaled Epoprostenol and Inhaled Nitric Oxide for Refractory Hypoxemia in Patients With Coronavirus Disease 2019
Authors: DeGrado Jeremy R. , Szumita Paul M. , Schuler Brian R. , Dube Kevin M. , Lenox Jesslyn , Kim Edy Y. , Weinhouse Gerald L. , Massaro Anthony F. 
Published: October 2020

Objectives:
The objectives of this study were to evaluate the efficacy and safety of inhaled epoprostenol and inhaled nitric oxide in patients with refractory hypoxemia secondary to coronavirus disease 2019.

Design:
Retrospective single-center study.

Setting:
ICUs at a large academic medical center in the United States.

Patients:
Thirty-eight adult critically ill patients with coronavirus disease 2019 and refractory hypoxemia treated with either inhaled epoprostenol or inhaled nitric oxide for at least 1 hour between March 1, 2020, and June 30, 2020.

Interventions:
Electronic chart review.

Measurements and Main Results:
Of 93 patients screened, 38 were included in the analysis, with mild (4, 10.5%), moderate (24, 63.2%), or severe (10, 26.3%), with acute respiratory distress syndrome. All patients were initiated on inhaled epoprostenol as the initial pulmonary vasodilator and the median time from intubation to initiation was 137 hours (68–228 h). The median change in Pao
2/Fio
2 was 0 (–12.8 to 31.6) immediately following administration of inhaled epoprostenol. Sixteen patients were classified as responders (increase Pao
2/Fio
2 > 10%) to inhaled epoprostenol, with a median increase in Pao
2/Fio
2 of 34.1 (24.3–53.9). The mean change in Pao
2 and Spo
2 was –0.55 ± 41.8 and –0.6 ± 4.7, respectively. Eleven patients transitioned to inhaled nitric oxide with a median change of 11 (3.6–24.8) in Pao
2/Fio
2. A logistic regression analysis did not identify any differences in outcomes or characteristics between the responders and the nonresponders. Minimal adverse events were seen in patients who received either inhaled epoprostenol or inhaled nitric oxide.

Conclusions:
We found that the initiation of inhaled epoprostenol and inhaled nitric oxide in patients with refractory hypoxemia secondary to coronavirus disease 2019, on average, did not produce significant increases in oxygenation metrics. However, a group of patients had significant improvement with inhaled epoprostenol and inhaled nitric oxide. Administration of inhaled epoprostenol or inhaled nitric oxide may be considered in patients with severe respiratory failure secondary to coronavirus disease 2019.
Intraoperative systemic biomarkers predict post-liver transplantation acute kidney injury
Authors: Cezar Lia Cavalcante , Meneses Gdayllon Cavalcante , da Silva Junior Geraldo Bezerra , Bezerra Gabriela Freire , Martins Alice Maria Costa , Libório Alexandre Braga , Daher Elizabeth De Francesco , Garcia José Huygens Parente 
Published: October 2020

Objective
Liver transplant (LT) is a definitive therapeutic option for patients with chronic liver disease. However, acute kidney injury after LT (post-LT AKI) is a frequent complication that may lead to graft dysfunction and decrease life expectancy. Delay in AKI detection by traditional biomarkers boosted research with new biomarkers for post-LT AKI as neutrophil gelatinase-associated lipocalin (NGAL) and syndecan-1. We aim to evaluate associations of intraoperative systemic NGAL and syndecan-1 levels with post-LT AKI.

Methods
This is a prospective study conducted in 46 patients selected for LT. Patients were evaluated preoperatively and blood samples were collected intraoperatively: T1 (after induction of anesthesia), T2 (anhepatic phase) and T3 (2 h after reperfusion of the graft).

Results
The mean age was 54 ± 12 years and 60% were male. Post-LT AKI was observed in 24 (52%) patients of which 12% needed dialysis. Serum NGAL and syndecan-1 increased along surgical phases. Mostly, increment values of serum NGAL of T2 to T3 and syndecan-1 at T3 were importantly associated with post-LT AKI. Into a multivariate model with model for end-stage liver disease score, age, gender, warm ischemia, cold ischemia and surgery time, syndecan-1 levels at T3 remains capable to predict post-LT AKI. Serum NGAL had significance only with increment values calculated by the ratio of ‘T3/T2’. Finally, serum syndecan-1 at T3 had a better diagnostic performance in receiver operating characteristic curve analysis.

Conclusion
Serum syndecan-1 levels in 2 h after reperfusion were most useful in early post-LT AKI diagnosis and may be used to construct new risk groups in this context.
A prospective cohort study of the use of the fatty liver index and Fibroscan to determine the prevalence of fatty liver disease in an Irish population
Authors: Rabbitt Louise A. , McNally Mairéad , Reynolds Laura , Hinchion Kate , Simpkin Andrew , Scarry Margaret , Bohan-Keane Mary , Goulding Carol 
Published: October 2020

Objectives
Rates of nonalcoholic fatty liver disease (NAFLD) are increasing worldwide. The fatty liver index (FLI) is a noninvasive predictor of NAFLD. This prospective cohort study used the FLI to estimate the prevalence of NAFLD in patients attending an Irish Acute Medical Unit (AMU), and assessed the degree of fibrosis in this group using Fibroscan.

Methods
Patients attending the AMU over a 3-month period were invited to participate. Patients with excess alcohol consumption or pre-existing liver disease were excluded. Using established FLI cut-offs, 414 participants were grouped into low (FLI ≤ 30), medium (30 < FLI ≤ 60) and high (FLI > 60) risk of NAFLD. High-risk patients were offered review including liver stiffness measurement (LSM) and controlled attenuation parameter (CAP) score.

Results
A total of 134 patients were at low-risk, 96 at medium-risk and 184 at high-risk of NAFLD. Male sex (P < 0.0001) and increasing age (P < 0.0001) were associated with higher risk. Of the 120 high-risk patients who attended follow up, 13 participants had LSM > 7 kPa. Higher FLI scores were associated with higher CAP scores (P < 0.0001) but did not predict higher LSMs. Fasting glucose and HbA1c were found to be associated with higher LSM.

Conclusion
About 44.4% of patients presenting to the AMU were at high risk of NAFLD according to the FLI. Only 10.8% of the high-risk group, and 3% of all those recruited had a LSM > 7 kPa suggesting development of fibrosis.
Deep learning enabled classification of Mayo endoscopic subscore in patients with ulcerative colitis
Authors: Bhambhvani Hriday P. , Zamora Alvaro 
Published: October 2020

Objective
Previous reports of deep learning-assisted assessment of Mayo endoscopic subscore (MES) in ulcerative colitis have only explored the ability to distinguish disease remission (MES 0/1) from severe disease (MES 2/3) or inactive disease (MES 0) from active disease (MES 1–3). We sought to explore the utility of deep learning models in the automated grading of each individual MES in ulcerative colitis.

Methods
In this retrospective study, a total of 777 representative still images of endoscopies from 777 patients with clinically active ulcerative colitis were graded using the MES by two physicians. Each image was assigned an MES of 1, 2, or 3. A 101-layer convolutional neural network model was trained and validated on 90% of the data, while 10% was left for a holdout test set. Model discrimination was assessed by calculating the area under the curve (AUC) of a receiver operating characteristic as well as standard measures of accuracy, specificity, sensitivity, positive predictive value (PPV), and negative predictive value (NPV).

Results
In the holdout test set, the final model classified MES 3 disease with an AUC of 0.96, MES 2 disease with an AUC of 0.86, and MES 1 disease with an AUC 0.89. Overall accuracy was 77.2%. Across MES 1, 2, and 3, average specificity was 85.7%, average sensitivity was 72.4%, average PPV was 77.7%, and the average NPV was 87.0%.

Conclusion
We have demonstrated a deep learning model was able to robustly classify individual grades of endoscopic disease severity among patients with ulcerative colitis.
Decreased number of colonic tuft cells in quiescent ulcerative colitis patients
Authors: Kjærgaard Sebastian , Jensen Thorbjørn S.R. , Feddersen Ulrike R. , Bindslev Niels , Grunddal Kaare V. , Poulsen Steen S. , Rasmussen Hanne B. , Budtz-Jørgensen Esben , Berner-Hansen Mark 
Published: October 2020

Background
Colonic tuft cells are epithelial chemosensory cells involved in barrier integrity, modulation of inflammatory responses and gut homeostasis. Recent evidence indicates an involvement of tuft cells in ulcerative colitis pathogenesis, though mechanisms remain largely unknown.
Here, we quantified the colonic tuft cell population in patients with quiescent ulcerative colitis as compared to patients without identified colonic disease (controls).

Methods
In this retrospective study, we obtained endoscopic colonic sigmoid biopsies from 14 patients with quiescent ulcerative colitis and from 17 controls. In a blinded central-reading design, we identified tuft cells by immunohistochemistry using a cyclooxygenase-1 antibody as a marker and performed a simple counting by visual inspection. Poisson regression was employed for statistics and results were adjusted for gender, age and smoking status.

Results
Ulcerative colitis patients demonstrated a 55% reduced tuft cell count in colonic mucosa compared with the control group (95% confidence limit: range 31–71%, P = 0.0002). Ulcerative colitis patients had a mean tuft cells count of 46 tuft cells/mm2 (95% CI, 36–59), while controls demonstrated a mean of 104 tuft cells/mm2 (95% CI, 79–136). No interactions of other covariates, such as age, smoking status, total duration of ulcerative colitis disease and duration of clinical remission prior to study inclusion were detected between ulcerative colitis patients and controls.

Conclusion
Quiescent ulcerative colitis patients have a relatively low number of colonic tuft cells. Further studies are warranted to explore the potential involvement of tuft cells in ulcerative colitis pathogenesis.
P53 is a risk factor of de-novo hepatitis C-related hepatocellular carcinoma treated with direct-acting antivirals: a case-control study
Authors: Omran Mohamed , Fouda Manar , Abdelwahab Abdelwahab Osama , Nabeel Mohamed Mahmoud , Abdelaziz Ashraf Omar , Omran Dalia , Shousha Hend Ibrahim 
Published: October 2020

Background
The mechanisms underlying de-novo hepatocellular carcinoma (HCC) after direct-acting antivirals (DAAs) is still under investigation. This work aims to study P53 and hepatocyte growth factor (HGF) as possible diagnostics of de-novo hepatocellular carcinoma (HCC) following DAAs in comparison to alpha-fetoprotein (AFP).

Method
This case-control study included 166 patients with liver cirrhosis divided into group-1: patients without HCC (n = 50), group-2: patients with de-novo HCC following DAAs, and achieved sustained virological response (n = 50), and group-3: patients with HCC without DAAs (n = 66). P53 antibody and HGF were determined using a quantitative sandwich enzyme immunoassay technique (Cusabio Co, Houston, USA).

Results
Patients with HCC showed significantly higher HGF. Patients with de-novo HCC following DAAs had significantly higher P53 than HCC without DAAs (P < 0.0001). The multiple logistic regression analysis showed that the P53 levels were significantly associated with susceptibility to de-novo HCC (P value = 0.004). The best overall formula was constructed for HCC diagnosis by entering significant markers into the regression model. A three markers model was developed = (1.22 + AFP X 0.002 + HGF X 0.001 + P53 X 0.001). The medians (percentiles) of combined three markers were 1.8 (1.0–2.1) in liver cirrhosis and 2.2 (2.0–2.9) in all HCC (P < 0.00001). The AUC of combined markers was greater than a single marker. The AUC was 0.87 to differentiate HCC from liver cirrhosis; AUC 0.91 to differentiate de-novo HCC after DAAs from liver cirrhosis.

Conclusion
P53 may serve as a diagnostic marker for de-novo HCC after DAAs therapy. HGF may serve as a diagnostic marker for HCC but not specific for de-novo HCC after DAAs therapy.
Sepsis in Home Health Care
Authors: Chimenti Chris , Sears Geralyn , McIntyre Jack 
Published: October 2020

Background:
A majority of sepsis cases originate in the home and community. Home health clinicians play an important role in the early identification and timely treatment of sepsis.

Local Problem:
A home health care provider sought to prevent hospital readmissions due to sepsis by implementing a sepsis-screening protocol and quality improvement initiative.

Methods:
The provider conducted a retrospective chart review of 33 264 sepsis screens of 7242 patients.

Interventions:
A sepsis-screening protocol, clinician and patient/caregiver sepsis education, physician and emergency department communication, and emergency medical services collaboration procedure were implemented.

Results:
A majority (69.2%) of positive sepsis screens resulted in patients receiving early medical intervention and avoiding hospitalization.

Conclusions:
Having a formal sepsis-screening program in place prompts home health clinicians to communicate the patient's symptoms to their primary care provider, which can positively impact hospital readmission rates and associated medical costs.
Psychosocial Work Factors of the Job Strain Model and All-Cause Mortality: The STRESSJEM Prospective Cohort Study
Authors: Niedhammer Isabelle , Milner Allison , Coutrot Thomas , Geoffroy-Perez Béatrice , LaMontagne Anthony D. , Chastang Jean-François 
Published: October 2020

ABSTRACT

Objective
The objectives were to examine the prospective associations between psychosocial work factors of the job strain model and all-cause mortality in a national representative cohort of French employees using various measures of time-varying exposure.

Methods
The study was based on a sample of 798,547 men and 697,785 women for which data on job history from 1976 to 2002 were linked to mortality data from the national death registry. Psychosocial work factors from the validated job strain model questionnaire were imputed using a job-exposure matrix. Three time-varying measures of exposure were explored: current, cumulative, and recency-weighted cumulative exposure. Cox proportional hazards models were performed to study the associations between psychosocial work factors and mortality.

Results
Within the 1976–2002 period, 88,521 deaths occurred among men and 28,921 among women. Low decision latitude, low social support, job strain, isostrain, high strain, and passive job were found to be risk factors for mortality. The model using current exposure was the best relative-quality model. The associations of current exposure to job strain and mortality were found to have hazard ratios of 1.30 (95% confidence interval [CI] = 1.24–1.36) among men and 1.15 (95% CI = 1.06–1.25) among women. The population fractions of mortality attributable to job strain were 5.64% (95% CI = 4.56%–6.71%) among men and 4.13% (95% CI = 1.69%–6.71%) among women.

Conclusions
This study supports the role of the psychosocial work factors of the job strain model on all-cause mortality. Preventive intervention to improve the psychosocial work environment may help to prevent mortality in working populations.
Interventions to Improve HIV Care Continuum Outcomes Among Individuals Released From Prison or Jail: Systematic Literature Review
Authors: Woznica Daniel M. , Fernando Nimasha B. , Bonomo Elizabeth J. , Owczarzak Jill , Zack Barry , Hoffmann Christopher J. 
Published: October 2020

Background:
HIV care continuum outcomes deteriorate among people returning from incarceration. Interventions to improve care outcomes postincarceration have been characterized by substantial heterogeneity in approach, outcome metrics, and results. A large number of recently published interventions have not been systematically reviewed.

Methods:
We searched peer reviewed and scholarly databases for published and gray literature describing interventions to improve HIV care continuum outcomes among individuals released from prison or jail. We systematically screened quantitative and qualitative intervention reports published through 2018, then extracted and analyzed study data using a classification scheme that we developed for categorizing intervention levels and strategies.

Results:
We included 23 reports from the peer-reviewed literature, 2 from gray literature, and 2 from conference abstracts (27 total). Seventeen studies were classified as individual level, 3 as biomedical level, 2 as organizational level, and 5 as multilevel. Nine studies were randomized controlled trials, 4 of which reported power calculations. Fifteen studies were quasiexperimental; one was a case study. Eleven studies were conducted in prisons, 7 in jails, and 9 in both prisons and jails. Of 11 studies reporting hypothesis tests, 5 found statistically significant effect sizes on primary outcomes.

Conclusions:
Interventions that demonstrate postrelease improvements in clinic attendance and viral suppression include patient navigation strategies, especially involving peer support, and substance use treatment strategies.
Effectiveness and Safety of Interferon-Free Direct-Acting Antiviral Hepatitis C Virus Therapy in HIV/Hepatitis C Virus Coinfected Individuals: Results From a Pan-European Study
Authors: Amele Sarah , Peters Lars , Rodger Alison , Lundgren Jens , Rockstroh Jurgen , Matulionyte Raimonda , Leen Clifford , Jabłonowska Elzbieta , Østergaard Lars , Bhagani Sanjay , Sarcletti Mario , Clarke Amanda , Falconer Karolin , Wandeler Gilles , Domingo Pere , Maltez Fernando , Zaccarelli Mauro , Chkhartisvili Nikoloz , Szlavik Janos , Stephan Christoph , Fonquernie Laurent , Aho Inka , Mocroft Amanda ,   on behalf of the EuroSIDA study group
Published: October 2020

Objectives:
To investigate the effectiveness, safety, and reasons for premature discontinuation of direct-acting antivirals (DAAs) in a diverse population of HIV/hepatitis C virus (HCV) coinfected individuals in Europe.

Methods:
All HIV/HCV coinfected individuals in the EuroSIDA study that started interferon free DAA treatment between January 6, 2014, and January 3, 2018, with ≥12 weeks of follow-up after treatment stop were included in this analysis. Sustained virological response (SVR) was defined as a negative HCV-RNA result ≥12 weeks after stopping treatment (SVR12). Logistic regression was used to explore factors associated with SVR12.

Results:
1042 individuals started interferon-free DAA treatment after 1/6/2014 and were included, 862 (82.2%) had a known response to treatment, and 789 [91.5%, 95% confidence interval (CI): 89.7 to 93.4] of which achieved SVR12. There were no differences in SVR12 across regions of Europe (P = 0.84). After adjustment, the odds of achieving SVR12 was lower in individuals that received sofosbuvir/simeprevir ± ribavirin (RBV) [adjusted odds ratio 0.21 (95% CI: 0.08 to 0.53)] or ombitasvir/paritaprevir/dasabuvir ± RBV [adjusted odds ratio 0.46 (95% CI: 0.22 to 1.00)] compared with sofosbuvir/ledipasvir ± RBV. Forty-three (4.6%) individuals had one or more components of their HCV regimen stopped early, most commonly because of toxicity (n = 14); of these 14, 11 were treated with ribavirin. Increased bilirubin was the most common grade 3 or 4 laboratory adverse event (n = 15.3%) and was related to treatment with atazanavir and ribavirin.

Conclusions:
Our findings from real-world data on HIV/HCV coinfected individuals across Europe show DAA treatment is well tolerated and that high rates of SVR12 can be achieved in all regions of Europe.
A Sensitive, Rapid, and Portable CasRx-based Diagnostic Assay for SARS-CoV-2
Authors: Brogan Daniel J , Chaverra-Rodriguez Duverney , Lin Calvin P , Smidler Andrea L , Yang Ting , Alcantara Lenissa M. , Antoshechkin Igor , Liu Junru , Raban Robyn R , Belda-Ferre Pedro , Knight Rob , Komives Elizabeth A , Akbari Omar S. 
Published: October 2020

AbstractSince its first emergence from China in late 2019, the SARS-CoV-2 virus has spread globally despite unprecedented containment efforts, resulting in a catastrophic worldwide pandemic. Successful identification and isolation of infected individuals can drastically curtail virus spread and limit outbreaks. However, during the early stages of global transmission, point-of-care diagnostics were largely unavailable and continue to remain difficult to procure, greatly inhibiting public health efforts to mitigate spread. Furthermore, the most prevalent testing kits rely on reagent- and time-intensive protocols to detect viral RNA, preventing rapid and cost-effective diagnosis. Therefore the development of an extensive toolkit for point-of-care diagnostics that is expeditiously adaptable to new emerging pathogens is of critical public health importance. Recently, a number of novel CRISPR-based diagnostics have been developed to detect COVID-19. Herein, we outline the development of a CRISPR-based nucleic acid molecular diagnostic utilizing a Cas13d ribonuclease derived from Ruminococcus flavefaciens (CasRx) to detect SARS-CoV-2, an approach we term SENSR (Sensitive Enzymatic Nucleic-acid Sequence Reporter). We demonstrate SENSR robustly detects SARS-CoV-2 sequences in both synthetic and patient-derived samples by lateral flow and fluorescence, thus expanding the available point-of-care diagnostics to combat current and future pandemics.
Characteristics and evolution of COVID-19 cases in Brazil: mathematical modeling and simulation
Authors: Cardoso Passos Carlos Augusto , Vieira Estéfano Aparecido , Lourenço José André , do Nascimento Jefferson Oliveira 
Published: October 2020

ABSTRACTThe pandemic caused by the coronavirus of severe acute respiratory syndrome 2 (SARS-CoV-2), the etiological agent of the 2019 coronavirus disease (COVID-19), represents a threat of great magnitude not faced in this century. As a result, each government has proposed emergency public health measures that are critical to delay the transmission and spread of the virus and mitigate its impacts. In Brazil, the outbreak triggered many cases of people infected with COVID-19. Considering there are no drugs or vaccines proven to be effective to treat the disease, analyzing the data of infection cases and their mathematical interpretation are essential for supporting and guiding governmental measures to suppress and mitigate the impact of COVID-19. This means that estimates with mathematical models to assess the development potential of sustained human-human transmission are needed. Since the disease has its own biological characteristics, the models need to be adapted to the variability of the regions’ characteristics and the decision-making by both the government and the population, in order to be able to deal with real situations. Thus, in the present paper, we analyzed the official data of COVID-19 in Brazil and used the Johnson-Mehl-Avrami-Kolmogorov (JMAK) equation to predict the evolution of the disease. The model indicates that a nucleation rate is of fourth order, which indicates that Brazilians are crowding with no respect to measures of social distance and disease prevention. In our opinion, the political authorities were unable to control the spread of the disease in Brazil, given that social mobility was interrupted by the federal and state governments.