bluuebunny/crossref_metadata_2025_split huggingface dataset:
FDG PET/CT in Diagnosing COVID-19 Infection in a Cancer Patient With Exposure History But Minimal Symptoms
Authors: Chuang Hubert H. , Emery Dustin J. , Campbell Richelle Millican , Lu Yang 
Published: May 2020

Abstract
A 56-year-old woman with high-grade neuroendocrine small cell carcinoma had known contact history of COVID-19 about 16 days prior to the restaging PET/CT. The patient was instructed to self-quarantine for 14 days, and no COVID-19 test was performed. Upon arrival, the patient had low-grade fever of 37.1°C, but did not meet infection control criteria for COVID-19 testing, and it was approved to proceed with PET/CT. The FDG PET/CT images revealed new multifocal hypermetabolic bilateral pulmonary ground-glass opacities that are suggestive of COVID-19 pneumonia. Meanwhile, the patient’s symptoms worsened, and a blood test later confirmed COVID-19 infection.
Three-Dimensional Visualization for Extended Deep Inferior Epigastric Perforator Flaps
Authors: Cui HuaiRui , Ding MaoCao , Mao YiHua , Zhou Peng , Sun ChenYou , Tang MaoLin , Xu DaChuan 
Published: May 2020

Purpose
The aim of the study was to provide an applied and digital anatomical basis of acquiring extended deep inferior epigastric perforator (DIEP) flaps for clinical use.

Methods
Five formalin-soaked specimens were received red latex injection and dissected by layers. The arteriography using the modified mixture of lead oxide-gelatin was performed on 10 adult cadavers that were serially scanned by a spiral computed tomography. The DIEPs were 3 dimensionally reconstructed by Mimics.

Results
The medial row perforators of DIEP arteries are located in the medial 1/third of rectus abdominis muscle, and lateral row perforators in the lateral 1/third of the muscle. The perforators distribute mainly from the upper tendinous intersection of umbilicus to below umbilicus within 8.0 cm, especially 4.0 cm. There are constant diameter 0.8-mm perforators or greater accompanied with nerveswithin this region. The main perforators are shown by fast direct volume rendering (VR) reconstruction method, and 3-dimensional images of DIEPs are acquired by dynamic reconstruction (DR) method. Consecutively, the adjacent perforators can be combined freely and the position and anastomosis of extended branches can be easily observed. The extended DIEP flaps were designed by VR and DR methods.

Conclusions
The DIEPs can obtain large extended perforator flaps accompanied with nerves. The perforator close to the umbilicus should be selected while designing the DIEP flap. The 3-dimensional model of extended DIEP flaps can be established conveniently and intuitively by VR and DR methods of Mimics.
Positron Emission Tomography Imaging of Long-Term Expression of the 18 kDa Translocator Protein After Sudden Cardiac Arrest in Rats
Authors: Schroeder Daniel C. , Popp Erik , Rohleder Cathrin , Vus Stefanie , Bethencourt David de la Puente , Finke Simon R. , Zlatopolskiy Boris D. , Zischler Johannes , Drzezga Alexander , Herff Holger , Annecke Thorsten , Hucho Tim , Neumaier Bernd , Böttiger Bernd W. , Endepols Heike 
Published: May 2020

ABSTRACT

Background:
Knowledge about the neuroinflammatory state during months after sudden cardiac arrest is scarce. Neuroinflammation is mediated by cells that express the 18 kDa translocator protein (TSPO). We determined the time course of TSPO-expressing cells in a rat model of sudden cardiac arrest using longitudinal in vivo positron emission tomography (PET) imaging with the TSPO-specific tracer [18F]DAA1106 over a period of 6 months.

Methods:
Five male Sprague Dawley rats were resuscitated from 6 min sudden cardiac arrest due to ventricular fibrillation, three animals served as shams. PET measurements were performed on day 5, 8, 14, 90, and 180 after intervention. Magnetic resonance imaging was performed on day 140. Imaging was preceded by Barnes Maze spatial memory testing on day 3, 13, 90, and 180. Specificity of [18F]DAA1106 binding was confirmed by Iba-1 immunohistochemistry.

Results:
[18F]DAA1106 accumulated bilaterally in the dorsal hippocampus of all sudden cardiac arrest animals on all measured time points. Immunohistochemistry confirmed Iba-1 expressing cells in the hippocampal CA1 region. The number of Iba-1-immunoreactive objects per mm2 was significantly correlated with [18F]DAA1106 uptake. Additionally, two of the five sudden cardiac arrest rats showed bilateral TSPO-expression in the striatum that persisted until day 180. In Barnes Maze, the relative time spent in the target quadrant negatively correlates with dorsal hippocampal [18F]DAA1106 uptake on day 14 and 180.

Conclusions:
After sudden cardiac arrest, TSPO remains expressed over the long-term. Sustainable treatment options for neuroinflammation may be considered to improve cognitive functions after sudden cardiac arrest.
Bone Marrow Mesenchymal Stem Cell-Derived Exosomes Attenuate LPS-Induced ARDS by Modulating Macrophage Polarization Through Inhibiting Glycolysis in Macrophages
Authors: Deng Huimin , Wu Lingmin , Liu Meiyun , Zhu Lina , Chen Yuanli , Zhou Huanping , Shi Xuan , Wei Juan , Zheng Li , Hu Xiaoting , Wang Mansi , He Zhengyu , Lv Xin , Yang Hao 
Published: May 2020

ABSTRACT
Macrophages play a key role in the development of sepsis-induced acute respiratory distress syndrome (ARDS). Recent evidence has proved that glycolysis plays an important role in regulating macrophage polarization through metabolic reprogramming. Bone marrow mesenchymal stem cells (BMSCs) can alleviate sepsis-induced lung injury and possess potent immunomodulatory and immunosuppressive properties via secreting exosomes. However, it is unknown whether BMSCs-derived exosomes exert their therapeutic effect against sepsis-induced lung injury by inhibiting glycolysis in macrophages. Therefore, the present study aimed to evaluate the anti-inflammatory effects of exosomes released from BMSCs on acute lung injury induced by lipopolysaccharide (LPS) in mice and explored the possible underlying mechanisms in vitro and in vivo. We found that BMSCs inhibited M1 polarization and promoted M2 polarization in MH-S cells (a murine alveolar macrophage cell line) by releasing exosomes. Further experiments showed that exosomes secreted by BMSCs modulated LPS-treated MH-S cells polarization by inhibiting cellular glycolysis. Moreover, our results showed that BMSCs-derived exosomes down-regulated the expression of several essential proteins of glycolysis via inhibition of hypoxia-inducible factor 1 (HIF-1)α. Finally, a model of LPS-induced ARDS in mice was established, we found that BMSCs-derived exosomes ameliorated the LPS-induced inflammation and lung pathological damage. Meanwhile, we found that intratracheal delivery of BMSCs-derived exosomes effectively down-regulated LPS-induced glycolysis in mice lung tissue. These findings reveal new mechanisms of BMSCs-derived exosomes in regulating macrophage polarization which may provide novel strategies for the prevention and treatment of LPS-induced ARDS.
Targeted Temperature Management in Cardiac Arrest Patients With an Initial Non-Shockable Rhythm: A Systematic Review and Meta-Analysis
Authors: Barbarawi Mahmoud , Alabdouh Ahmad , Barbarawi Owais , Lakshman Harini , Alkasasbeh Mariam , Rizk Fatima , Bachuwa Ghassan , Alkotob Mohammad L. 
Published: May 2020

ABSTRACT

Background:
Targeted temperature management (TTM) is now recommended for patients presenting with an out-of-hospital cardiac arrest. However, there are limited data that support its use in patients with an initial non-shockable rhythm (NSR).

Methods:
A literature search of PubMed/MEDLINE, Cochrane Library, and Embase was conducted by two independent authors for studies that compared TTM along with standard care versus standard care alone in treating cardiac arrest with initial NSR. Outcomes were short-term and long-term survival, and a Cerebral Performance Category (CPC) score of 1 to 2 at the longest follow-up period. The Mantel-Haenszel random-effects model was used to calculate odds ratios (ORs) and 95% confidence intervals (CIs). Trial sequential analysis (TSA) was performed on the randomized controlled trials (RCTs).

Results:
Thirty studies were included in the final analysis: 25 observational and five RCTs, totalling 10,703 patients, 4,023 of whom received TTM and 6,680 received standard care alone. Compared with standard care, patients who presented with an initial NSR cardiac arrest and received TTM (target of 32°C –34°C) had a significantly higher short-term survival (OR 1.44 95% CI 1.15–1.81; P = 0.002), long-term survival (OR 1.52 95% CI 1.03–2.26; P = 0.04), and CPC score of 1 to 2 (OR 1.63 95% CI 1.22–2.17; P = 0.0010). Sensitivity analyses by including only RCTs showed a trend, although not significant, toward better short-term survival (OR 1.25 95% CI 0.82–1.89; P = 0.30), long-term survival (OR 1.15 95% CI 0.80–1.66; P = 0.46), and neurologic outcomes (OR 1.51 95% CI 0.81–2.80; P = 0.19). However, TSA performed on the RCTs revealed that the results were inconclusive.

Conclusion:
Among patients who survived cardiac arrest with an initial NSR, TTM is associated with a higher rate of survival and favorable neurological outcomes compared with no TTM. However, analyses from the included RCTs did not support this conclusion.
Effects of Different Target Temperatures on Angiogenesis and Neurogenesis Following Resuscitation in a Porcine Model After Cardiac Arrest
Authors: Cui Hao , Yang Zhengfei , Xiao Peng , Shao Fei , Zhao Shen , Tang Ziren 
Published: May 2020

ABSTRACT

Objective:
The optimal effective temperature of targeted temperature management (TTM) used to prevent cerebral injury following cardiopulmonary resuscitation (CPR) is undetermined. In this study, we compared the mortality, neurologic deficits, and cerebral protein levels of two target temperatures.

Methods:
Fifty 4-month-old female domestic pigs were randomized to sham, TTM at 33°C ± 0.5°C (T33), TTM at 35°C ± 0.5°C (T35), and normothermic (NT) groups. In the NT and TTM groups, untreated ventricular fibrillation was induced electrically in animals for 10 min, followed by 6 min of CPR. Target core temperatures (Tc) of TTM groups were induced and maintained (6 h) using an endovascular hypothermia device, and rewarmed to 37.5 ± 0.5°C in the next 6 h. Tc of the NT group was maintained at 37.5 ± 0.5°C. The survival outcomes and neurological function were evaluated every 24 h for 72 h.

Results:
All animals were successfully resuscitated with no significant differences in baseline characteristics or hemodynamic indexes. Survival rates and neurological outcomes were significantly improved in the TTM groups, with T33 showing the most significant effect. Compared with NT-treated animals, TTM-treated animals had higher expressions of angiopoietin-1, transforming growth factor-alpha , vascular endothelial growth factor, metallopeptidase inhibitor (TIMP)-1, TIMP-2, and platelet-derived growth factor-BB. Macrophage migration inhibitory factor and IL-17F levels were markedly upregulated after resuscitation in the NT group but inhibited in the TTM groups. Neuron-specific enolase staining data was also consistent with our conclusion that hypothermia can reduce reperfusion-induced brain injuries.

Conclusion:
Lower target temperature showed greater protective effects against cerebral injuries after CPR, and the improved neurological outcomes after TTM may be associated with decreased expression of pro-inflammatory cytokines and increased expression of blood–brain barrier and neurogenesis regulatory factors in this porcine model of CA following resuscitation.
SARS-CoV-2/COVID-19: Evolving Reality, Global Response, Knowledge Gaps, and Opportunities
Authors: Osuchowski Marcin F. , Aletti Federico , Cavaillon Jean-Marc , Flohé Stefanie B. , Giamarellos-Bourboulis Evangelos J. , Huber-Lang Markus , Relja Borna , Skirecki Tomasz , Szabó Andrea , Maegele Marc 
Published: May 2020

ABSTRACT
Approximately 3 billion people around the world have gone into some form of social separation to mitigate the current severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic. The uncontrolled influx of patients in need of emergency care has rapidly brought several national health systems to near-collapse with deadly consequences to those afflicted by Coronavirus Disease 2019 (COVID-19) and other critical diseases associated with COVID-19. Solid scientific evidence regarding SARS-CoV-2/COVID-19 remains scarce; there is an urgent need to expand our understanding of the SARS-CoV-2 pathophysiology to facilitate precise and targeted treatments. The capacity for rapid information dissemination has emerged as a double-edged sword; the existing gap of high-quality data is frequently filled by anecdotal reports, contradictory statements, and misinformation. This review addresses several important aspects unique to the SARS-CoV-2/COVID-19 pandemic highlighting the most relevant knowledge gaps and existing windows-of-opportunity. Specifically, focus is given on SARS-CoV-2 immunopathogenesis in the context of experimental therapies and preclinical evidence and their applicability in supporting efficacious clinical trial planning. The review discusses the existing challenges of SARS-CoV-2 diagnostics and the potential application of translational technology for epidemiological predictions, patient monitoring, and treatment decision-making in COVID-19. Furthermore, solutions for enhancing international strategies in translational research, cooperative networks, and regulatory partnerships are contemplated.
Factors Influencing Team and Task Performance in Intensive Care Teams in a Simulated Scenario
Authors: Jonsson Karin , Hultin Magnus , Härgestam Maria , Lindkvist Marie , Brulin Christine 
Published: May 2020

Introduction
Healthcare teams and their performance in a complex environment such as that of intensive care units (ICUs) are influenced by several factors. This study investigates the relationship between team background characteristics and team as well as task performance.

Methods
This study included 105 professionals (26 teams), working at the ICUs of 2 hospitals in Northern Sweden. The team-based simulation training sessions were video recorded, and thereafter, team performance and task performance were analyzed based on ratings of the TEAM instrument and the ABCDE checklist.

Results
The final analyses showed that a higher age was significantly associated with better total team performance (β = 0.35, P = 0.04), teamwork (β = 0.04, P = 0.04), and task management (β = 0.04, P = 0.05) and with a higher overall rating for global team performance (β = 0.09, P = 0.02). The same pattern was found for the association between age and task performance (β = 0.02, P = 0.04). In addition, prior team training without video-facilitated reflection was significantly associated with better task performance (β = 0.35, P = 0.04). On the other hand, prior team training in communication was significantly associated with worse (β = −1.30, P = 0.02) leadership performance.

Conclusions
This study reveals that a higher age is important for better team performance when caring for a severely ill patient in a simulation setting in the ICU. In addition, prior team training had a positive impact on task performance. Therefore, on a team level, this study indicates that age and, to some extent, prior team training without video-facilitated reflection have an impact on team performance in the care of critically ill patients.
Tracheobronchial Slough, a Potential Pathology in Endotracheal Tube Obstruction in Patients With Coronavirus Disease 2019 (COVID-19) in the Intensive Care Setting
Authors: Rubano Jerry A. , Jasinski Patrick T. , Rutigliano Daniel N. , Tassiopoulos Apostolos K. , Davis James E. , Beg Tazeen , Poovathoor Shaji , Bergese Sergio D. , Ahmad Sahar , Jawa Randeep S. , Vosswinkel James A. , Talamini Mark A. 
Published: May 2020

Background:
A novel coronavirus (COVID-19) erupted in the latter part of 2019. The virus, SARS-CoV-2 can cause a range of symptoms ranging from mild through fulminant respiratory failure. Approximately 25% of hospitalized patients require admission to the intensive care unit, with the majority of those requiring mechanical ventilation. High density consolidations in the bronchial tree and in the pulmonary parenchyma have been described in the advanced phase of the disease. We noted a subset of patients who had a sudden, significant increase in peak airway, plateau and peak inspiratory pressures. Partial or complete ETT occlusion was noted to be the culprit in the majority of these patients.

Methods:
With institutional IRB approval, we examined a subset of our mechanically ventilated COVID-19 patients. All of the patients were admitted to one of our COVID-19 ICUs. Each was staffed by a board certified intensivist. During multidisciplinary rounds, all arterial blood gas (ABG) results, ventilator settings and ventilator measurements are discussed and addressed. ARDSNet Protocols are employed. In patients with confirmed acute occlusion of the endotracheal tube (ETT), acute elevation in peak airway and peak inspiratory pressures are noted in conjunction with desaturation. Data was collected retrospectively and demographics, ventilatory settings and ABG results were recorded.

Results:
Our team has observed impeded ventilation in intubated patients who are several days into the critical course. Pathologic evaluation of the removed endotracheal tube contents from one of our patients demonstrated a specimen consistent with sloughed tracheobronchial tissues and inflammatory cells in a background of dense mucin. Of 110 patients admitted to our adult COVID-19 ICUs, 28 patients required urgent exchange of their ETT.

Conclusion:
Caregivers need to be aware of this pathological finding, recognize, and to treat this aspect of the COVID-19 critical illness course, which is becoming more prevalent.
Leaning forward: Early arterial access promotes resuscitative endovascular balloon occlusion of the aorta utilization in battlefield casualties
Authors: Knipp Brian Scott , Needham Kenneth Eugene , Nguyen Phu Tan , Keville Meaghan Patricia , Brzuchalski Jason Thomas , Srivilasa Charlie , Lewis Clayton Jon , Betzold Richard David , DuBose Joseph Jeremy 
Published: May 2020

ABSTRACT
Uncontrolled noncompressible torso hemorrhage remains a leading cause of potentially preventable death on the battlefield. The utilization of resuscitative endovascular balloon occlusion of the aorta (REBOA) has gained considerable traction in civilian and military trauma care. Establishment of arterial access remains the rate-limiting step in endovascular aortic occlusion. The decision to place arterial access, including size, location, and the appropriate clinician and scenario all must be considered to achieve the optimal patient outcome. This report is submitted by the Joint Medical Augmentation Unit, an elite surgical/resuscitation team that provides medical care in the most far-forward, austere environments in the special operations community. The authors highlight two cases where early arterial access, REBOA utilization, and massive blood transfusion with damage-control surgery were associated with patient survival. We also address the prehospital application of REBOA in battlefield trauma.

LEVEL OF EVIDENCE
Special Report, Level V
Preclinical Assessment of Autologous Tolerogenic Dendritic Cells From End-stage Renal Disease Patients
Authors: Bouchet-Delbos Laurence , Even Amandine , Varey Emilie , Saïagh Soraya , Bercegeay Sylvain , Braudeau Cécile , Dréno Brigitte , Blancho Gilles , Josien Régis , Cuturi Maria-Cristina , Moreau Aurélie 
Published: May 2020

Background.
Kidney transplantation is the therapeutic of choice for patients with kidney failure. While immunosuppressive drugs can control graft rejection, their use is associated with increased infections and cancer, and they do not effectively control chronic graft rejection. Cell therapy is an attractive strategy to minimize the use of pharmacological drugs.

Methods.
We recently developed a protocol to generate human monocyte-derived autologous tolerogenic dendritic cells (ATDCs) from healthy volunteers. Herein, we transferred the ATDC manufacturing protocol to a Good Manufacturing Practice (GMP)–compliant facility. Furthermore, we compared the phenotype and in vitro functions of ATDCs generated from patients with end-stage renal disease to those generated from healthy volunteers.

Results.
We describe the critical steps for GMP-compliant production of ATDCs and define the quality criteria required to allow release of the cell products. Furthermore, we showed that ATDCs generated from healthy volunteers and patients with kidney failure display the same tolerogenic profile based on their phenotype, resistance to maturation, and ability to modulate T-cell responses.

Conclusions.
Together, these results allowed us to define the production process and the quality criteria for the release of ATDCs before their administration in patients receiving a kidney transplant.
Use of Culture to Reach Metabolically Adequate Beta-cell Dose by Combining Donor Islet Cell Isolates for Transplantation in Type 1 Diabetes Patients
Authors: Lee DaHae , Gillard Pieter , Hilbrands Robert , Ling Zhidong , Van de Velde Ursule , Jacobs-Tulleneers-Thevissen Daniel , Maleux Geert , Lapauw Bruno , Crenier Laurent , De Block Christophe , Mathieu Chantal , Pipeleers Daniel , Keymeulen Bart 
Published: May 2020

Background.
Clinical islet transplantation is generally conducted within 72 hours after isolating sufficient beta-cell mass. A preparation that does not meet the sufficient dose can be cultured until this is reached after combination with subsequent ones. This retrospective study examines whether metabolic outcome is influenced by culture duration.

Methods.
Forty type 1 diabetes recipients of intraportal islet cell grafts under antithymocyte globulin induction and mycophenolate mofetil-tacrolimus maintenance immunosuppression were analyzed. One subgroup (n = 10) was transplanted with preparations cultured for ≥96 hours; in the other subgroup (n = 30) grafts contained similar beta-cell numbers but included isolates that were cultured for a shorter duration. Both subgroups were compared by numbers with plasma C-peptide ≥0.5 ng/mL, low glycemic variability associated with C-peptide ≥1.0 ng/mL, and with insulin independence.

Results.
The subgroup with all cells cultured ≥96 hours exhibited longer C-peptide ≥0.5 ng/mL (103 versus 48 mo; P = 0.006), and more patients with low glycemic variability and C-peptide ≥1.0 ng/mL, at month 12 (9/10 versus 12/30; P = 0.005) and 24 (7/10 versus 6/30; P = 0.007). In addition, 9/10 became insulin-independent versus 15/30 (P = 0.03). Grafts with all cells cultured ≥96 hours did not contain more beta cells but a higher endocrine purity (49% versus 36%; P = 0.03). In multivariate analysis, longer culture duration and older recipient age were independently associated with longer graft function.

Conclusions.
Human islet isolates with insufficient beta-cell mass for implantation within 72 hours can be cultured for 96 hours and longer to combine multiple preparations in order to reach the desired beta-cell dose and therefore result in a better metabolic benefit.