bluuebunny/crossref_metadata_2025_split huggingface dataset:
Hyperferritinemia in Critically Ill Patients*
Authors: Lachmann Gunnar , Knaak Cornelia , Vorderwülbecke Gerald , La Rosée Paul , Balzer Felix , Schenk Thomas , Schuster Friederike S. , Nyvlt Peter , Janka Gritta , Brunkhorst Frank M. , Keh Didier , Spies Claudia 
Published: December 2019

Objective:
Hyperferritinemia is frequently seen in critically ill patients. A rather rare though life-threatening condition related to severely elevated ferritin is hemophagocytic lymphohistiocytosis. We analyze ferritin levels to differentiate hemophagocytic lymphohistiocytosis from other causes of hyperferritinemia in a mixed cohort of critically ill patients.

Design:
Retrospective observational study.

Setting:
Adult surgical, anesthesiologic, and medical ICUs of a university hospital.

Patients:
Critical care patients (≥ 18 yr old) admitted to any of the adult ICUs at Charité – Universitätsmedizin Berlin between January 2006 and August 2018 with at least one ferritin value and hyperferritinemia (≥ 500 µg/L).

Interventions:
None.

Measurements and Main Results:
Patients were categorized into hemophagocytic lymphohistiocytosis, sepsis, septic shock, and other diagnoses. These were further categorized into 17 subgroups. Hemophagocytic lymphohistiocytosis diagnosis was based on Hemophagocytic Lymphohistiocytosis-2004 criteria and the HScore. Of 2,623 patients with hyperferritinemia, 40 were considered to have hemophagocytic lymphohistiocytosis (1.52%). Maximum ferritin levels were highest in hemophagocytic lymphohistiocytosis patients compared with all other disease groups (each p < 0.001). Sepsis and septic shock patients had higher maximum ferritin levels than patients with other diagnoses (each p < 0.001). A maximum ferritin value of 9,083 µg/L was at 92.5% sensitivity and 91.9% specificity for hemophagocytic lymphohistiocytosis (area under the curve, 0.963; 95% CI, 0.949–0.978). Of all subgroups with other diagnoses, maximum ferritin levels were highest in patients with varicella-zoster virus, hepatitis, or malaria (median, 1,935, 1,928, and 1,587 µg/L, respectively). Maximum ferritin levels were associated with increased in-hospital mortality (odds ratio, 1.518 per log µg/L [95% CI, 1.384–1.665 per log µg/L]; p < 0.001).

Conclusions:
This is the largest study of patients with ferritin available in a mixed ICU cohort. Ferritin levels in patients with hemophagocytic lymphohistiocytosis, sepsis, septic shock, and other conditions were distinctly different, with the highest ferritin levels observed in hemophagocytic lymphohistiocytosis patients. Maximum ferritin of 9,083 µg/L showed high sensitivity and specificity and, therefore, may contribute to improved diagnosis of hemophagocytic lymphohistiocytosis in ICU. The inclusion of ferritin into the sepsis laboratory panel is warranted.
Monitoring diaphragm function in the ICU
Authors: Dres Martin , Demoule Alexandre 
Published: December 2019

Purpose of review
To review the clinical problem of diaphragm function in critically ill patients and describes recent advances in bedside monitoring of diaphragm function.

Recent findings
Diaphragm weakness, a consequence of diaphragm dysfunction and atrophy, is common in the ICU and associated with serious clinical consequences. The use of ultrasound to assess diaphragm structure (thickness, thickening) and mobility (caudal displacement) appears to be feasible and reproducible, but no large-scale ‘real-life’ study is available. Diaphragm ultrasound can also be used to evaluate diaphragm muscle stiffness by means of shear-wave elastography and strain by means of speckle tracking, both of which are correlated with diaphragm function in healthy. Electrical activity of the diaphragm is correlated with diaphragm function during brief airway occlusion, but the repeatability of these measurements exhibits high within-subject variability.

Summary
Mechanical ventilation is involved in the pathogenesis of diaphragm dysfunction, which is associated with severe adverse events. Although ultrasound and diaphragm electrical activity could facilitate monitoring of diaphragm function to deliver diaphragm-protective ventilation, no guidelines concerning the use of these modalities have yet been published. The weaning process, assessment of patient–ventilator synchrony and evaluation of diaphragm function may be the most clinically relevant indications for these techniques.
Impact of Insurance Payer on Type of Breast Reconstruction Performed
Authors: Chouairi Fouad , Mets Elbert J. , Gabrick Kyle S. , Dinis Jacob , Avraham Tomer , Alperovich Michael 
Published: December 2019

Background:
The impact of insurance and socioeconomic status on breast reconstruction modalities when access to care is controlled is unknown.

Methods:
Records for patients who underwent breast reconstruction at an academic medical center between 2013 and 2017 were reviewed and analyzed using chi-square analysis and logistic regression.

Results:
One thousand six hundred eighty-three breast reconstructions were analyzed. The commercially insured were more likely to undergo microvascular autologous breast reconstruction (44.4 percent versus 31.3 percent; p < 0.001), with an odds ratio of 2.22, whereas patients with Medicare and Medicaid were significantly more likely to receive tissue expander/implant breast reconstruction, with an odds ratio of 1.42 (41.7 percent versus 47.7 percent; p = 0.013). Comparing all patients with microvascular reconstruction, the commercially insured were more likely to receive a perforator flap (79.7 percent versus 55.3 percent versus 43.9 percent), with an odds ratio of 4.23 (p < 0.001). When stratifying patients by median household income, those in the highest income quartile were most likely to receive a perforator flap (82.1 percent) (p < 0.001), whereas those in the lowest income quartile were most likely to receive a muscle-sparing transverse rectus abdominis myocutaneous flap (36.4 percent) (p < 0.001).

Conclusions:
Patients at the same academic medical center had significantly different breast reconstruction modalities when stratified by insurance and household income. Despite similar access to care, differences in insurance types may favor higher rates of perforator flap breast reconstruction among the commercially insured.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Risk, II.
Bilateral End-Organ Endophthalmitis in Setting of Serratia marcescens Urosepsis on 18F-FDG PET/CT
Authors: Makusha Lovemore P. , Young Colin R. , Agarwal Daniel R. , Pucar Darko 
Published: December 2019

Abstract
Endogenous endophthalmitis is an uncommon infection of the internal tissues of the eye resulting from a bloodborne infection. We present the case of an 89-year-old man with Serratia marcescens urosepsis with multifocal end-organ infection on 18F-FDG PET/CT including aortitis, splenic abscess, septic arthritis, thoracolumbar discitis-osteomyelitis, and culture-confirmed bilateral endogenous endophthalmitis. Endophthalmitis-related intraconal ocular space uptake was clearly distinguishable from normal conal space extraocular muscle activity. Although sepsis responded to treatment, endophthalmitis led to complete vision loss. This case report presents PET/CT description of a rare and difficult-to-treat Serratia marcescens endogenous endophthalmitis, which usually has a poor visual outcome.
Outcomes of Patients Treated With Upfront Cholecystostomy for Severe Acute Cholecystitis
Authors: De Geus Thea , Moriarty Heather K. , Waters Peadar S. , O’Reilly Michael K. , Lawler Leo , Geoghegan Tony , Conneely John C. , McEntee Gerry , Farrelly Cormac 
Published: December 2019

Introduction:
Percutaneous cholecystostomy tube (PCT) placement is a treatment method for acute cholecystitis, both in adult patients unsuitable for surgery and those failing to improve with conservative management. The purpose of this study was to assess the outcomes of patients undergoing cholecystostomy.

Materials and Methods:
A review of consecutive patients who underwent PCT insertion over a 10-year period was performed. Outcomes assessed included cholecystostomy dwell time, tubogram requirement, cholecystostomy reinsertion, cholecystectomy, bile leaks, and mortality.

Results:
One hundred eight patients (77 male individuals, 31 female individuals) were included. The mean age was 70 years (range: 29 to 93 y). A total of 89 transhepatic and 19 transperitoneal PCTs were inserted. Fifty-nine patients (55%) had a subsequent tubogram to assess cystic duct patency or catheter position. Mean catheter dwell time was 17 days (range: 1 to 154 d). Eleven (10%) required PCT reinsertion. Time to reinsertion ranged from 2 to 163 days (mean=38 d). Fifty-three patients (50%) had no further biliary intervention after removal of the cholecystostomy catheter. One patient required subsequent drainage of a hepatic abscess, and another developed a biloma. Thirty-two patients (30%) underwent cholecystectomy (66% laparoscopic, 34% open). Thirty-day mortality after PCT insertion was 8.3%. Twenty patients (19%) died of non–cholecystostomy-related illness during the 10-year follow-up period.

Conclusions:
Cholecystostomy is an important treatment method of acute cholecystitis as a bridge to cholecystectomy or as an alternative definitive treatment option in those unsuitable for surgery. A tubogram is not always necessary before tube removal. Cholecystostomy tubes can be removed safely with little risk of bile leak if patients are clinically well, and clean-appearing bile is draining.
Injury characteristics of the Pulse Nightclub shooting: Lessons for mass casualty incident preparation
Authors: Smith Chadwick P. , Cheatham Michael L. , Safcsak Karen , Emrani Heidi , Ibrahim Joseph A. , Gregg Michael , Eubanks William S. , Lube Matthew W. , Havron William S. , Levy Marc S. 
Published: December 2019

BACKGROUND
On the morning of June 12, 2016, an armed assailant entered the Pulse Nightclub in Orlando, Florida, and initiated an assault that killed 49 people and injured 53. The regional Level I trauma center and two community hospitals responded to this mass casualty incident. A detailed analysis was performed to guide hospitals who strive to prepare for future similar events.

METHODS
A retrospective review of all victim charts and/or autopsy reports was performed to identify victim presentation patterns, injuries sustained, and surgical resources required. Patients were stratified into three groups: survivors who received care at the regional Level I trauma center, survivors who received care at one of two local community hospitals, and decedents.

RESULTS
Of the 102 victims, 40 died at the scene and 9 died upon arrival to the Level I trauma center. The remaining 53 victims received definitive medical care and survived. Twenty-nine victims were admitted to the trauma center and five victims to a community hospital. The remaining 19 victims were treated and discharged that day. Decedents sustained significantly more bullet impacts than survivors (4 ± 3 vs. 2 ± 1; p = 0.008) and body regions injured (3 ± 1 vs. 2 ± 1; p = 0.0002). Gunshots to the head, chest, and abdominal body regions were significantly more common among decedents than survivors (p < 0.0001). Eighty-two percent of admitted patients required surgery in the first 24 hours. Essential resources in the first 24 hours included trauma surgeons, emergency room physicians, orthopedic/hand surgeons, anesthesiologists, vascular surgeons, interventional radiologists, intensivists, and hospitalists.

CONCLUSION
Mass shooting events are associated with high mortality. Survivors commonly sustain multiple, life-threatening ballistic injuries requiring emergent surgery and extensive hospital resources. Given the increasing frequency of mass shootings, all hospitals must have a coordinated plan to respond to a mass casualty event.

LEVEL OF EVIDENCE
Epidemiological Study, level V.
Staphylococcus aureusstaphyloxanthin expression is not controlled by Hfq
Authors: Liu Wenfeng , Boudry Pierre , Bohn Chantal , Bouloc Philippe 
Published: December 2019

ABSTRACTObjectiveThe golden color ofStaphylococcus aureusis due to the synthesis of carotenoid pigments. In Gram-negative bacteria, Hfq is a global posttranscriptional regulator, but its function inS. aureusremains obscure. The absence of Hfq inS. aureuswas reported to correlate with production of carotenoid pigment leading to the conclusion that Hfq was a negative regulator of the yellow color. However, we reported the construction ofhfqmutants in severalS. aureusstrains and never noticed any color change; we therefore revisited the question of Hfq implication inS. aureuspigmentation.ResultsThe absence or accumulation of Hfq does not affectS. aureuspigmentation.
Rethinking causality and data complexity in brain lesion-behaviour inference and its implications for lesion-behaviour modelling
Authors: Sperber Christoph 
Published: December 2019

AbstractModelling behavioural deficits based on structural lesion imaging is a popular approach to map functions in the human brain, and efforts to translationally apply lesion-behaviour modelling to predict post-stroke outcomes are on the rise. The high-dimensional complexity of lesion data, however, evokes challenges in both lesion behaviour mapping and post stroke outcome prediction. This paper aims to deepen the understanding of this complexity by reframing it from the perspective of causal and non-causal dependencies in the data, and by discussing what this complexity implies for different data modelling approaches. By means of theoretical discussion and empirical examination, several common strategies and views are challenged, and future research perspectives are outlined. A main conclusion is that lesion-behaviour inference is subject to a lesion-anatomical bias that cannot be overcome by using multivariate models or any other algorithm that is blind to causality behind relations in the data. This affects the validity of lesion behaviour mapping and might even wrongfully identify paradoxical effects of lesion-induced functional facilitation – but, as this paper argues, only to a minor degree. Thus, multivariate lesion-brain inference appears to be a valuable tool to deepen our understanding of the human brain, but only because it takes into account the functional relation between brain areas. The perspective of causality and inter-variable dependence is further used to point out challenges in improving lesion behaviour models. Firstly, the dependencies in the data open up different possible strategies of data reduction, and considering those might improve post-stroke outcome prediction. Secondly, the role of non-topographical causal predictors of post stroke behaviour is discussed. The present article argues that, given these predictors, different strategies are required in the evaluation of model quality in lesion behaviour mapping and post stroke outcome prediction.
The Autism Biomarkers Consortium for Clinical Trials (ABC-CT): Scientific Context, Study Design, and Progress towards Biomarker Qualification
Authors: McPartland James C. , Bernier Raphael A. , Jeste Shafali S. , Dawson Geraldine , Nelson Charles A. , Chawarska Katarzyna , Earl Rachel , Faja Susan , Johnson Scott , Sikich Linmarie , Brandt Cynthia A. , Dziura James D. , Rozenblit Leon , Hellemann Gerhard , Levin April R. , Murias Michael , Naples Adam J. , Platt Michael L. , Sabatos-DeVito Maura , Shic Frederick , Senturk Damla , Sugar Catherine A. , Webb Sara J. ,   the Autism Biomarkers Consortium for Clinical Trials
Published: December 2019

AbstractClinical research in neurodevelopmental disorders remains reliant upon clinician and caregiver measures. Limitations of these approaches indicate a need for objective, quantitative, and reliable biomarkers to advance clinical research. Extant research suggests the potential utility of multiple candidate biomarkers; however, effective application of these markers in trials requires additional understanding of replicability, individual differences, and intra-individual stability over time. The Autism Biomarkers Consortium for Clinical Trials (ABC-CT) is a multi-site study designed to investigate a battery of electrophysiological (EEG) and eye-tracking (ET) indices as candidate biomarkers for autism spectrum disorder (ASD). The study complements published biomarker research through: inclusion of large, deeply phenotyped cohorts of children with autism spectrum disorder (ASD) and typical development; a longitudinal design; a focus on well-evidenced candidate biomarkers harmonized with an independent sample; high levels of clinical, regulatory, technical, and statistical rigor; adoption of a governance structure incorporating diverse expertise in the ASD biomarker discovery and qualification process; prioritization of open science, including creation of a repository containing biomarker, clinical, and genetic data; and use of economical and scalable technologies that are applicable in developmental populations and those with special needs. The ABC-CT approach has yielded encouraging results, with one measure accepted into the FDA’s Biomarker Qualification Program to date. Through these advances, the ABC-CT and other biomarker studies in progress hold promise to deliver novel tools to improve clinical trials research in ASD.
Assessing the effectiveness of a pediatrician-led newborn parenting class on maternal newborn-care knowledge, confidence and anxiety: A nonrandomized controlled trial
Authors: Gozali Aileen , Gibson Sherika , Lipton Lianna R. , Pressman Aliza W. , Hammond Blair S. , Dumitriu Dani 
Published: December 2019

BackgroundThe postpartum hospital stay is a unique opportunity for clinicians to educate parents on the importance of promoting early child development. Pediatricians are well positioned to address both medical and developmental concerns during critical periods of development, yet very few parenting interventions are led by pediatricians.AimsTo assess the impact of a novel one-hour long pediatrician-led Newborn Class on maternal knowledge, confidence, and anxiety.MethodsWe conducted a nonrandomized controlled trial to evaluate the effectiveness of the Newborn Class. First-time mothers who delivered a full-term singleton vaginally with no major complications and attended the class were recruited. Mothers who expressed a desire to attend the class but were discharged before a class was offered served as controls.Outcome measuresMaternal self-perceived anxiety and confidence were measured using standardized scales (State-Trait Anxiety Inventory for Adults and Karitane Parenting Confidence Scale). Knowledge on new-born care was assessed using a novel scale.ResultsA total of 84 participants (intervention n=36, control n=48) were included in the study. Mothers who attended class showed significantly higher levels of knowledge compared to the control group as well as significantly higher parenting confidence levels. No change was observed in the overall level of anxiety.ConclusionsA short pediatrician-led parenting intervention can be an effective tool in improving maternal confidence and newborn care knowledge. Given the importance of the newborn period in establishing healthy developmental trajectories, this cost- and time-effective intervention could be widely implemented to promote early strong mother-infant relationships that foster healthy development.
PRDM3 attenuates pancreatitis and pancreatic tumorigenesis by regulating inflammatory response
Authors: Ye Jie , Huang Anpei , Wang Haitao , Zhang Anni M.Y. , Huang Xiaojun , Lan Qingping , Sato Tomohiko , Goyama Susumu , Kurokawa Mineo , Deng Chuxia , Sander Maike , Schaeffer David F. , Li Wen , Kopp Janel L. , Xie Ruiyu 
Published: December 2019

AbstractPancreatic ductal adenocarcinoma (PDAC) is associated with metaplastic changes in the pancreas but the transcriptional program underlying these changes is incompletely understood. The zinc finger transcription factor, PRDM3, is lowly expressed in normal pancreatic acini and its expression increases during tumorigenesis. Although PRDM3 promotes proliferation and migration of PDAC cell lines, the role of PRDM3 during tumor initiation from pancreatic acinar cellsin vivois unclear. In this study, we showed that high levels of PRDM3 expression in human pancreas was associated with pancreatitis, and well-differentiated but not poorly differentiated carcinoma. We examined PRDM3 function in pancreatic acinar cells during tumor formation and pancreatitis by inactivatingPrdm3using a conditional allele (Ptf1aCreER;Prdm3flox/floxmice) in the context of oncogenic Kras expression and supraphysiological cerulein injections, respectively. InPrdm3-deficient mice, KrasG12D-driven preneoplastic lesions were more abundant and progressed to high-grade precancerous lesions more rapidly. This is consistent with our observations that low levels of PRDM3 in human PDAC was correlated significantly with poorer survival in patient. Moreover, loss ofPrdm3in acinar cells elevated exocrine injury, enhanced immune cell activation and infiltration, and greatly increased acinar-to-ductal cell reprogramming upon cerulein-induced pancreatitis. Whole transcriptome analyses ofPrdm3knockout acini revealed that pathways involved in inflammatory response and Hif-1 signaling were significantly upregulated inPrdm3-depleted acinar cells. Taken together, our results suggest that Prdm3 favors the maintenance of acinar cell homeostasis through modulation of their response to inflammation and oncogenic Kras activation, and thus plays a previously unexpected suppressive role during PDAC initiation.
Influence of socioeconomic factors on cancer incidence and stage of melanoma in China
Authors: Qian Leqi , Liu Jiaqi 
Published: December 2019

AbstractBackgroundA high socioeconomic status (SES) was considered as an established risk factor for melanoma in western countries and areas, the same was not true in China. There have been few studies on SES of Chinese melanoma patients. The purpose of this study was to evaluate the association of SES in Chinese melanoma patients.MethodsWe performed a cross-sectional study using the data from Ministry of Human Resources and Social Security of the People’s Republic of China, and National Healthcare Security Administration. The clinical stage at diagnosis was categorized according to Guidelines of Chinese Society Oncology, Melanoma.ResultsWe enrolled 122 patients with pathologic melanoma in Zhongshan Hospital, Fudan University between January 2013 to December 2017. 58 (48%) were male and 64 (52%) were female, the mean age was 59.23±9.91 years and median age was 60.5 years. Patients in 45-59 age group and 60-73 age group tend to have higher cancer incidence compared with other age groups. The acral lentiginous melanoma (48%) was the most common subtype. Patients with low education level (middle school and below) and low monthly household income (< 3000CNY) were associated with a greater risk of melanoma. Similar results were indicated for the patients who were unemployed. There were remarkable more patients who had medical insurance diagnosed with melanoma in this study. There was no significant difference on melanoma stage for patients with higher compared to lower education level (p=0.153). For monthly household income, the Fish’s exact test indicated no significant difference in melanoma stage with p=0.507. No staging difference was observed between unemployed patients and employed patients (p=0.687). Finally, statistically significant differences in melanoma staging were not indicated by a patient’s insurance status (p=0.537).ConclusionsFor patients enrolled in our study, disadvantaged SES did not substantially lead to an increasing risk of melanoma incidence, and the effect of socioeconomic factors seemed uninfluenced the stage of melanoma.