bluuebunny/crossref_metadata_2025_split huggingface dataset:
Myocardial Function during Low versus Intermediate Tidal Volume Ventilation in Patients without Acute Respiratory Distress Syndrome
Authors: Cherpanath Thomas G. V. , Simonis Fabienne D. , Bouma Berto J. , de Bruin-Bon Rianne H. , Determann Rogier M. , Juffermans Nicole P. , Gama de Abreu Marcelo , Pelosi Paolo , Serpa Neto Ary , Groeneveld Johan A. B. , Schultz Marcus J. , Lagrand Wim K. 
Published: February 2020

Abstract

Background
Mechanical ventilation with low tidal volumes has the potential to mitigate ventilation-induced lung injury, yet the clinical effect of tidal volume size on myocardial function has not been clarified. This cross-sectional study investigated whether low tidal volume ventilation has beneficial effects on myocardial systolic and diastolic function compared to intermediate tidal volume ventilation.

Methods
Forty-two mechanically ventilated patients without acute respiratory distress syndrome (ARDS) underwent transthoracic echocardiography after more than 24 h of mechanical ventilation according to the Protective Ventilation in Patients without ARDS (PReVENT) trial comparing a low versus intermediate tidal volume strategy. The primary outcome was left ventricular and right ventricular myocardial performance index as measure for combined systolic and diastolic function, with lower values indicating better myocardial function and a right ventricular myocardial performance index greater than 0.54 regarded as the abnormality threshold. Secondary outcomes included specific systolic and diastolic parameters.

Results
One patient was excluded due to insufficient acoustic windows, leaving 21 patients receiving low tidal volumes with a tidal volume size (mean ± SD) of 6.5 ± 1.8 ml/kg predicted body weight, while 20 patients were subjected to intermediate tidal volumes receiving a tidal volume size of 9.5 ± 1.6 ml/kg predicted body weight (mean difference, −3.0 ml/kg; 95% CI, −4.1 to −2.0; P < 0.001). Right ventricular dysfunction was reduced in the low tidal volume group compared to the intermediate tidal volume group (myocardial performance index, 0.41 ± 0.13 vs. 0.64 ± 0.15; mean difference, −0.23; 95% CI, −0.32 to −0.14; P < 0.001) as was left ventricular dysfunction (myocardial performance index, 0.50 ± 0.17 vs. 0.63 ± 0.19; mean difference, −0.13; 95% CI, −0.24 to −0.01; P = 0.030). Similarly, most systolic parameters were superior in the low tidal volume group compared to the intermediate tidal volume group, yet diastolic parameters did not differ between both groups.

Conclusions
In patients without ARDS, intermediate tidal volume ventilation decreased left ventricular and right ventricular systolic function compared to low tidal volume ventilation, although without an effect on diastolic function.

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Importance of Endotoxin Clearance in Endotoxemic Septic Shock: An Analysis From the Evaluating Use of PolymyxinB Hemoperfusion in a Randomized Controlled Trial of Adults Treated for Endotoxemic Septic Shock (EUPHRATES) Trial
Authors: Rachoin Jean-Sebastien , Foster Debra , Giese River , Weisberg Lawrence S. , Klein David J. 
Published: February 2020

Objectives:
To investigate the relationship between survival and treatment-related reduction in endotoxin activity for patients in the Evaluating Use of PolymyxinB Hemoperfusion in a Randomized controlled trial of Adults Treated for Endotoxemia and Septic shock trial with baseline endotoxin activity assay greater than or equal to 0.60 to less than 0.90 units.

Design:
Post hoc analysis of a multicenter randomized controlled clinical trial.

Setting:
Fifty-five tertiary hospitals in North America.

Patients:
Patients with septic shock and endotoxin activity assay level greater than or equal to 0.60 to less than 0.90 and multiple organ dysfunction syndrome greater than 9.

Interventions:
Two polymyxin B hemoperfusion treatments or Sham.

Measurements and Main Results:
One-hundred ninety-four patients were included (88 polymyxin B and 106 Sham). We evaluated the impact of changes in endotoxin activity assay based on comparison to the median reduction from baseline to day 3 and a second method where a target post-treatment endotoxin activity assay level (day 3) was established. The population median reduction in endotoxin activity assay level was 10.4%. In patients with a greater than median reduction, there was trend toward lower mortality with polymyxin B (17.1% vs 33.3%; p = 0.07) and a significant increase in mechanical ventilation-free days (20 vs 13.5; p = 0.04). The pressure adjusted heart rate showed a significant improvement in the polymyxin B group (p = 0.02). For patients who achieved an endotoxin activity assay of less than 0.65 at day 3, the polymyxin B treated group had a trend toward a mortality reduction compared to Sham (16% vs 33%;p = 0.06) and a significant increase in ventilation-free day (20 vs 16; p = 0.05). Kaplan-Meier analysis showed a 17% reduction in mortality with polymyxin B (p = 0.04).

Conclusions:
These findings suggest that reducing endotoxin activity assay levels with polymyxin B as measured by comparison to a median reduction or when a treatment target is established, may result in improvements in mortality and organ function outcomes. This article is the first to report endotoxin activity assay measurements in response to polymyxin B use versus Sham in patients with septic shock and elevated endotoxin activity assay. These findings are considered to be hypothesis generating and will need to be prospectively validated.
Richness of sputum microbiome in acute exacerbations of eosinophilic chronic obstructive pulmonary disease
Authors: Qi Yu-Jing , Sun Xue-Jiao , Wang Zhe , Bin Yan-Fei , Li Ying-Hua , Zhong Xiao-Ning , Bai Jing , Deng Jing-Min , He Zhi-Yi 
Published: February 2020

Abstract

Background:
The eosinophilic chronic obstructive pulmonary disease (COPD) is known to be more sensitive to corticosteroid. The sputum microbiome has been shown to affect COPD prognosis, but its role in acute exacerbations of eosinophilic COPD is unclear. This study aimed to investigate the dynamic changes of the airway microbiome in patients with acute exacerbations of eosinophilic COPD.

Methods:
Fifty-seven patients with acute exacerbations of COPD from the First Affiliated Hospital of Guangxi Medical University between June 2017 and June 2018 were divided into two groups. Patients with eosinophils ≥300 cells/μL in the peripheral venous blood were assigned to the eosinophilic group (Eos) and the rest to the non-eosinophilic group (Noneos). All patients received similar treatment including inhaled budesonide according to the guidelines. The induced sputum microbiome was analyzed on the 1st and 7th day of treatment using the 16S ribosomal RNA (rRNA) method. The levels of interleukin (IL)-6 and IL-8 were measured in the plasma and the sensitivity to corticosteroids was determined in isolated peripheral blood mononuclear cells. Quantitative data were compared between the two groups using the independent samples t test or Mann-Whitney U test. Categorical data were evaluated using Chi-squared test or Fisher's exact test.

Results:
Twenty-six patients were classified into Eos group and 31 patients were classified into Noneos group. Prior to treatment, the alpha diversity (Shannon index) (2.65 ± 0.63 vs. 2.56 ± 0.54, t = 0.328, P
= 0.747) and the structure of the sputum microbiome were similar in the Eos group and the Noneos group. After 7 days of treatment, alpha diversity increased in both groups, while the microbiome richness (Ace index) was significantly lower in the Eos group (561.87 ± 109.13 vs. 767.88 ± 148.48, t = −3.535, P
= 0.002). At the same time, IL-6 (12.09 ± 2.85 pg/mL vs. 15.54 ± 2.45 pg/mL, t = −4.913, P < 0.001) and IL-8 (63.64 ± 21.69 pg/mL vs. 78.97 ± 17.13 pg/mL, t = −2.981, P = 0.004) decreased more significantly in the Eos group, and the percentages of inhibition of IL-8 at dexamethasone concentrations 10−8 to 10−6 mol/L were significantly higher in the Eos group than those in the Noneos group (all P < 0.05).

Conclusions:
The induced sputum microbiome richness decreased more significantly following treatment in the Eos patients compared to the Noneos patients. The lower plasma inflammatory factor levels and the higher percentage of inhibition of IL-8 might be due to higher corticosteroid sensitivity in Eos patients.
Hypertensive emergencies and urgencies in emergency departments: a systematic review and meta-analysis
Authors: Astarita Anna , Covella Michele , Vallelonga Fabrizio , Cesareo Marco , Totaro Silvia , Ventre Luca , Aprà Franco , Veglio Franco , Milan Alberto 
Published: February 2020

Objectives:
The prevalence of hypertensive emergencies and urgencies and of acute hypertension-mediated organ damage (aHMOD) in emergency departments is unknown. Moreover, the predictive value of symptoms, blood pressure (BP) levels and cardiovascular risk factors to suspect the presence of aHMOD is still unclear. The aim of this study was to investigate the prevalence of hypertensive emergencies and hypertensive urgencies in emergency departments and of the relative frequency of subtypes of aHMOD, as well as to assess the clinical variables associated with aHMOD.

Methods:
We conducted a systematic literature search on PubMed, OVID, and Web of Science from their inception to 22 August 2019. Two independent investigators extracted study-level data for a random-effects meta-analysis.

Results:
Eight studies were analysed, including 1970 hypertensive emergencies and 4983 hypertensive urgencies. The prevalence of hypertensive emergencies and hypertensive urgencies was 0.3 and 0.9%, respectively [odds ratio for hypertensive urgencies vs. hypertensive emergencies 2.5 (1.4–4.3)]. Pulmonary oedema/heart failure was the most frequent subtype of aHMOD (32%), followed by ischemic stroke (29%), acute coronary syndrome (18%), haemorrhagic stroke (11%), acute aortic syndrome (2%) and hypertensive encephalopathy (2%). No clinically meaningful difference was found for BP levels at presentations. Hypertensive urgency patients were younger than hypertensive emergency patients by 5.4 years and more often complained of nonspecific symptoms and/or headache, whereas specific symptoms were more frequent among hypertensive emergency patients.

Conclusion:
Hypertensive emergencies and hypertensive urgencies are a frequent cause of access to emergency departments, with hypertensive urgencies being significantly more common. BP levels alone do not reliably predict the presence of aHMOD, which should be suspected according to the presenting signs and symptoms.
Value of Repeated Troponin Measurements to Improve the Safety of the HEART Score for Chest Pain Patients at the Emergency Department
Authors: Ras Marten , Reitsma Johannes B. , Hoes Arno W. , Six A. Jacob , Poldervaart Judith M. 
Published: February 2020

Objective:
The HEART score is a clinical decision support tool for physicians to stratify the risk of major adverse cardiac events (MACE) in patients presenting with chest pain at the emergency department. The score includes 5 elements, including troponin level. Our aim was to compare safety and efficiency of the HEART scores calculated by using the first representative troponin (ie, based on time since symptom onset) compared to the original HEART score, where calculation was based on the first available troponin measurement, irrespective of duration of symptoms.

Methods:
We performed a secondary analysis on patients from the HEART-impact trial (2013–2014, the Netherlands). Two HEART scores were calculated for all patients: a HEART score with a T (troponin) element score based on the first available troponin (HEART-first) and 1 with a T element score based on the first representative troponin (ie, at least 3 hours after symptom onset; HEART-representative). We compared all patients’ scores and risk categories between HEART-first and HEART-representative. Furthermore, we compared safety (proportion of patients with MACE receiving a low score) and efficiency (proportion of patients with a low score) between HEART-first and HEART-representative.

Results:
We included 1222 patients. In 882 (72%) patients, the first troponin was representative, resulting in the same HEART-first and HEART-representative score. In the remaining 340 patients the use of HEART-representative led to a different score than HEART-first in 43 patients (3.5%). Out of the 222 patients with MACE, 11 patients (5.0%) received a low score by using HEART-first compared with 10 patients (4.5%) when using HEART-representative (P = 0.83). The number of patients with a low score was similar (P = 0.93) when using the HEART-first (464/1222; 38%) or HEART-representative score (462/1222; 38%).

Conclusions:
Using a representative troponin measurement changed the value of the HEART score in only 3.5% of patients and had no impact on safety and efficiency of the HEART score. These results suggest there is no need to wait for a representative troponin measurement and should encourage physicians to adhere to the original HEART score guidelines.
Vecta Mobile Sensory Station and Pediatric Patients' Experience in a Same-Day Surgery Unit
Authors: Trump Elizabeth , Holcomb Denise , Mitchell Katharina , Davis Kristin , Kohler William , Ullery Bridget , Carr Michele 
Published: February 2020

Introduction
Patient anxiety in the perioperative setting is a concern for healthcare professionals. This anxiety is especially pronounced in pediatric patients, as perioperative areas are especially traumatic for children. Studies have been performed showing that distraction techniques such as clowns or computer games are useful to help manage anxiety during the induction of anesthesia. No study has been performed using the Vecta sensory station as a method of decreasing perioperative anxiety in children.

Methods
In the preoperative and postoperative areas at our tertiary care hospitals from July to Sept 2017, caregivers were offered the Vecta sensory station for the pediatric patients to use. Perceptions were collected by a short survey.

Results
Forty-eight girls and 64 boys were included in the study. Furthermore, 71.4% of caregivers said that it helped to pass waiting time a lot, with over 98% of caregivers saying they would ask for it again the next time their child needed surgery. Among perioperative nurses, 98.2% felt that the Vecta did not interfere with care delivery, and 86.6% felt it was helpful in keeping patients calm.

Conclusion
The Vecta was considered successful by caregivers of pediatric patients as a useful technique to reduce perioperative anxiety in children.
Characteristics and Outcomes Among Patients With Autoimmune Rheumatic Diseases Requiring a Higher Level of Care
Authors: Parperis Konstantinos , Al-Charakh Mohammed , Nzuonkwelle Sumediah , McPherson Mark , Al-Marzooq Ali , Bhattarai Bikash 
Published: February 2020

Objective
Patients with autoimmune rheumatic diseases (ARDs) have a higher risk of developing organ failure, and they may require admission to the intensive care unit (ICU). The aim of our study is to determine the reasons for admission to the ICU, identify potential risk factors associated with mortality, and assess the outcomes of patients with ARD diseases admitted to the ICU.

Methods
We conducted a medical records review study of patients with ARD admitted to the ICU from 2012 to 2018. Patient data included demographic and clinical characteristics, ICU admission diagnoses, length of stay, complications, and immunosuppressive regimen. Short-term and long-term outcomes were assessed.

Results
A total of 80 ARD patients were identified with the mean age of 48.8, 67% were female, and 56% were Hispanic. The most common disease associated with ICU admission was systemic lupus erythematosus (42%), followed by rheumatoid arthritis (26%), and 12% of patients had systemic vasculitis. Sepsis was the leading cause of ICU admission, accounting for 31%, followed by respiratory failure due to pneumonia (10%) and congestive heart failure (10%). Twenty percent of patients died in the ICU, 5% died 30 days after ICU admission, and 7.5% died within 1 year after the ICU stay, resulting in overall mortality of 33% by the end of 1 year. Nonsurvivors were more likely to need mechanical ventilation (p = 0.001), vasopressor support (p < 0.001), had renal (p = 0.041) or cardiovascular (p < 0.001) involvement on admission, APACHE II score higher than 19 (p = 0.001), and 4 days or longer stay in the ICU (p = 0.001).

Conclusions
Our findings indicated that systemic lupus erythematosus is the most common ARD associated with ICU admission, and sepsis was the most frequent cause. Predictors associated with higher mortality were the requirement for mechanical ventilation, vasopressor support, increase length of ICU stay, and renal and cardiovascular involvement on admission.
Effect of smoking cessation on CT imaging in patients with Chronic Obstructive Pulmonary Disease: A systematic review
Authors: Cheng Daryl , Agarwal Siddharth , Jacob Joseph , Hurst John R 
Published: February 2020

AbstractBackgroundSmoking cessation is the only intervention known to affect disease progression in patients with COPD as measured by the rate of change in forced expiratory volume/1s (FEV1) over time. The need for new drugs to modify the progression of COPD is well recognised. We hypothesised that changes on CT in relation to smoking cessation may relate to changes in response to disease-modifying drugs, and therefore as a novel quantitative biomarker of drug efficacy. CT biomarkers of emphysema and airway wall thickness are increasingly used in research, but there has not been a systematic appraisal of the evidence to assess how these biomarkers evolve with a change in smoking exposure in COPD patients.MethodsWe searched MEDLINE, Embase, the Cochrane Library (Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials (CENTRAL)), and Web of Science to 10th September 2019. We included longitudinal studies of smoking COPD patients who had CT scans before and after smoking cessation. Two review authors (DC, SA) independently screened studies, extracted outcome data and assessed the risk of bias, with a third reviewer (JRH) arbitrating conflicts.ResultsFour studies were included in the final analysis. Three studies measured CT markers of lung density, which all, perhaps counter-intuitively, showed a significant decrease with smoking cessation. One study measured CT markers of airway wall thickness, which also significantly decreased with smoking cessation.Authors’ conclusionsSmoking cessation in COPD patients causes a fall in lung density, but the magnitude of the effect has not been rigorously assessed. One study has reported a decrease in airway wall thickness with smoking cessation. The number of studies is small, with some risk of bias. This question remains important for COPD researchers and requires further studies, in particular to assess whether changes with smoking cessation may model changes in response to novel pharmaceutical agents, and how to handle change in smoking status in relation to longitudinal observational imaging studies in COPD.
Increases in ambient temperature progressively disassembleArabidopsisphytochrome B from individual photobodies with distinct thermostabilities
Authors: Hahm Joseph , Kim Keunhwa , Qiu Yongjian , Chen Meng 
Published: February 2020

ABSTRACTWarm temperature is postulated to induce plant thermomorphogenesis through a signaling mechanism similar to shade, as both destabilize the active form of the photoreceptor and thermosensor phytochrome B (phyB). At the cellular level, shade antagonizes phyB signaling by triggering phyB disassembly from photobodies. Here we report temperature-dependent photobody localization of fluorescent protein-tagged phyB (phyB-FP) in the epidermal cells ofArabidopsishypocotyl and cotyledon. Our results demonstrate that warm temperature operates through different photobody dynamics from shade. Increases in temperature from 12°C to 27°C incrementally reduce photobody number by stimulating phyB-FP disassembly from selective thermo-unstable photobodies. The thermostability of photobodies relies on phyB’s photosensory module. Surprisingly, elevated temperatures inflict opposite effects on phyB’s functions in the hypocotyl and cotyledon despite inducing similar photobody dynamics, indicative of tissue/organ-specific temperature signaling circuitry downstream of photobody dynamics. Our results thus provide direct cell biology evidence supporting an early temperature signaling mechanism via dynamic assembly/disassembly of individual photobodies possessing distinct thermostabilities.
ADAR1 can drive Multiple Myeloma progression by acting both as an RNA editor of specific transcripts and as a DNA mutator of their cognate genes
Authors: Tasakis Rafail Nikolaos , Laganà Alessandro , Stamkopoulou Dimitra , Melnekoff David T. , Nedumaran Pavithra , Leshchenko Violetta , Pecori Riccardo , Parekh Samir , Papavasiliou F. Nina 
Published: February 2020

ABSTRACTRNA editing is an epitranscriptomic modification of emerging relevance to disease development and manifestations. ADAR1, which resides on human chromosome 1q21, is an RNA editor whose over-expression, either by interferon (IFN) induction or through gene amplification, is associated with increased editing and poor outcomes in Multiple Myeloma (MM). Here we explored the role of ADAR1 in the context of MM progression, by focusing on a group of 23 patients in the MMRF CoMMpass Study for which RNAseq and WES datasets exist for matched pre-and post-relapse samples. Our analysis reveals an acquisition of new DNA mutations on disease progression at specific loci surrounding the sites of ADAR associated (A-to-I) RNA editing. These analyses suggest that the RNA editing enzyme ADAR1 can function as a DNA mutator during Multiple Myeloma (MM) progression, and further imply that guide-targeted RNA editing has the capacity to generate specific mutational signatures at predetermined locations. This dual role of RNA editor and DNA mutator might be shared by other deaminases, such as APOBECs, so that DNA mutation might be the result of collateral damage on the genome by an editing enzyme whose primary job is to re-code the cognate transcript toward specific functional outcomes.
Visual and semantic representations predict subsequent memory in perceptual and conceptual memory tests
Authors: Davis Simon W. , Geib Benjamin R. , Wing Erik A. , Wang Wei-Chun , Hovhannisyan Mariam , Monge Zachary A. , Cabeza Roberto 
Published: February 2020

AbstractIt is generally assumed that the encoding of a single event generates multiple memory representations, which contribute differently to subsequent episodic memory. We used fMRI and representational similarity analysis (RSA) to examine how visual and semantic representations predicted subsequent memory for single item encoding (e.g., seeing an orange). Three levels of visual representations corresponding to early, middle, and late visual processing stages were based on a deep neural network. Three levels of semantic representations were based on normative Observed (“is round”), Taxonomic (“is a fruit”), and Encyclopedic features (“is sweet”). We identified brain regions where each representation type predicted later Perceptual Memory, Conceptual Memory, or both (General Memory). Participants encoded objects during fMRI, and then completed both a word-based conceptual and picture-based perceptual memory test. Visual representations predicted subsequent Perceptual Memory in visual cortices, but also facilitated Conceptual and General Memory in more anterior regions. Semantic representations, in turn, predicted Perceptual Memory in visual cortex, Conceptual Memory in the perirhinal and inferior prefrontal cortex, and General Memory in the angular gyrus. These results suggest that the contribution of visual and semantic representations to subsequent memory effects depends on a complex interaction between representation, test type, and storage location.