bluuebunny/crossref_metadata_2025_split huggingface dataset:
Procedural sedation outside the operating room
Authors: Hinkelbein Jochen , Schmitz Jan , Lamperti Massimo , Fuchs-Buder Thomas 
Published: June 2020

Purpose of review
The present review provides an overview of the different fields of procedural sedation and analgesia (PSA), describing the evidence from recently published studies concerning anxiety and moderate pain, cardiac interventions, gastrointestinal interventions, and PSA use in infants. It also provides guidance for practitioners of both unscheduled and scheduled procedural sedation, and a summary of the current guideline for PSA.

Recent findings
Safety always has to be first priority. Recently published literature is focusing on the combination of different well established drugs such as dexmedetomidine, remifentanil, propofol, and ketamine. These traditional and well known drugs are commonly used for PSA. The combinational use of multiple drugs seems to have benefits for both the provider and patient. Furthermore, there is growing interest into specific protocols and adaption for special circumstances. The preferred medications used for PSA should be both effective and well tolerated.

Summary
Procedural sedation deserves to have high degree of attention for potential adverse events. New combinations of well established drugs provide a better pharmacokinetic profile, fit to different indications and offer multiple benefits for both provider and patient.
Variation in Fluid and Vasopressor Use in Shock With and Without Physiologic Assessment: A Multicenter Observational Study
Authors: Chen Jen-Ting , Roberts Russel , Fazzari Melissa J. , Kashani Kianoush , Qadir Nida , Cairns Charles B. , Mathews Kusum , Park Pauline , Khan Akram , Gilmore James F. , Brown Anne Rain T. , Tsuei Betty , Handzel Michele , Lee Chang Alfredo , Duggal Abhijit , Lanspa Michael , Herbert James Taylor , Martinez Anthony , Tonna Joseph , Ammar Mahmoud A. , Hammond Drayton , Nazer Lama H. , Heavner Mojdeh , Pender Erin , Chambers Lauren , Kenes Michael T. , Kaufman David , Downey April , Brown Brent , Chaykosky Darlene , Wolff Armand , Smith Michael , Nault Katie , Sevransky Jonathan , Gong Michelle N. ,   on behalf of the VOLUME-CHASERS Study Group and Society of Critical Care Medicine Discovery Network
Published: June 2020

Objectives:
To characterize the association between the use of physiologic assessment (central venous pressure, pulmonary artery occlusion pressure, stroke volume variation, pulse pressure variation, passive leg raise test, and critical care ultrasound) with fluid and vasopressor administration 24 hours after shock onset and with in-hospital mortality.

Design:
Multicenter prospective cohort study between September 2017 and February 2018.

Settings:
Thirty-four hospitals in the United States and Jordan.

Patients:
Consecutive adult patients requiring admission to the ICU with systolic blood pressure less than or equal to 90 mm Hg, mean arterial blood pressure less than or equal to 65 mm Hg, or need for vasopressor.

Interventions:
None.

Measurement and Main Results:
Of 1,639 patients enrolled, 39% had physiologic assessments. Use of physiologic assessment was not associated with cumulative fluid administered within 24 hours of shock onset, after accounting for baseline characteristics, etiology and location of shock, ICU types, Acute Physiology and Chronic Health Evaluation III, and hospital (beta coefficient, 0.04; 95% CI, −0.07 to 0.15). In multivariate analysis, the use of physiologic assessment was associated with a higher likelihood of vasopressor use (adjusted odds ratio, 1.98; 95% CI, 1.45−2.71) and higher 24-hour cumulative vasopressor dosing as norepinephrine equivalent (beta coefficient, 0.37; 95% CI, 0.19−0.55). The use of vasopressor was associated with increased odds of in-hospital mortality (adjusted odds ratio, 1.88; 95% CI, 1.27−2.78). In-hospital mortality was not associated with the use of physiologic assessment (adjusted odds ratio, 0.86; 95% CI, 0.63−1.18).

Conclusions:
The use of physiologic assessment in the 24 hours after shock onset is associated with increased use of vasopressor but not with fluid administration.
Acute Kidney Injury in Acute Ischemic Stroke Patients in Clinical Trials
Authors: Qureshi Adnan I. , Aslam Hunain , Zafar Werdah , Huang Wei , Lobanova Iryna , Naqvi Syed H. , Malhotra Kunal , Arora Niraj , Chandrasekaran Premkumar N. , Siddiq Farhan , French Brandi R. , Gomez Camilo R. 
Published: June 2020

Objectives:
Acute ischemic stroke patients are at risk of acute kidney injury due to volume depletion, contrast exposure, and preexisting comorbid diseases. We determined the occurrence rate and identified predictors associated with acute kidney injury in acute ischemic stroke patients.

Setting:
Multiple specialized ICUs within academic medical centers.

Design:
Post hoc analysis of pooled data from prospective randomized clinical trials.

Patients:
Acute ischemic stroke patients recruited within 3 hours or within 5 hours of symptom onset.

Interventions:
IV recombinant tissue plasminogen activator, endovascular treatment, IV albumin, or placebo.

Measurements and Main Results:
Serum creatinine levels from baseline and within day 5 or discharge were used to classify acute kidney injury classification into stages. Any increase in serum creatinine was seen in 697 (36.1%) and acute kidney injury was seen in 68 (3.5%) of 1,931 patients with acute ischemic stroke. Severity of acute kidney injury was grade I, II, and III in 3.1%, 0.4%, and 0.05% patients, respectively. Patients with albumin (5.5% compared with 2.6%; p = 0.001), preexisting hypertension (4.3% compared with 1.5%; p = 0.0041), and preexisting renal disease (9.1% compared with 3.0%; p < 0.0001) had higher risk of acute kidney injury. The risk of acute kidney injury was lower between those who either underwent CT angiography (2.0% compared with 4.7%; p = 0.0017) or endovascular treatment (1.6% compared with 4.2%; p = 0.0071). In the multivariate analysis, hypertension (odds ratio, 2.6; 95% CI, 1.2–5.6) and renal disease (odds ratio, 3.5; 95% CI, 1.9–6.5) were associated with acute kidney injury. The risk of death was significantly higher among patients with acute kidney injury (odds ratio, 2.7; 95% CI, 1.4–4.9) after adjusting for age and National Institutes of Health Stroke Scale score strata.

Conclusions:
The occurrence rate of acute kidney injury in acute ischemic stroke patients was low and was not higher in patients who underwent CT angiogram or those who received endovascular treatment. Occurrence of acute kidney injury increased the risk of death within 3 months among acute ischemic stroke patients.
A Prospective, Split-Face, Randomized Study Comparing Picosecond to Q-Switched Nd:YAG Laser for Treatment of Epidermal and Dermal Pigmented Lesions in Asians
Authors: Ungaksornpairote Chanida , Manuskiatti Woraphong , Junsuwan Natchaya , Wanitphakdeedecha Rungsima 
Published: June 2020

BACKGROUND
Whether picosecond lasers outperform Q-switched lasers in treating pigmented lesions has not been clearly evaluated.

OBJECTIVE
To compare the efficacy and safety of picosecond and Q-switched lasers in treating epidermal and dermal pigmented lesions in Asians.

METHODS
Eight subjects with lentigines and 6 subjects with acquired bilateral nevus of Ota-like macules were enrolled. Subjects was randomly treated with a picosecond laser on one side of the face and a Q-switched laser on the other side. Subjective assessments on pigment clearance, and adverse effect were obtained at Weeks 0, 4, 12, and 24 after the final treatment.

RESULTS
Clinical improvement differed between the 2 laser systems at Week 4 (p = .034), Week 12 (p = .039), and Week 24 (p = .027), with 85.7% of picosecond and 57.2% of Q-switched laser sites showing >50% improvement at 6 months. There was no significant difference in the incidence of side effect and healing time, but picosecond laser was significantly associated with a lower treatment discomfort (p = .05).

CONCLUSION
The picosecond laser seems to be more effective and better tolerated than Q-switched laser for the treatment of pigmented lesions in Asians.
Optimizing septal perforation repair techniques
Authors: Dedhia Raj D. , Davis Seth J. , Stephan Scott J. 
Published: June 2020

Purpose of reviewMultiple successful techniques and approaches for nasal septal perforation repair have been described, yet consistency in perforation and outcome metrics is required to identify the optimal approach to repair. The present article will review the recent literature.Recent findingsComputational fluid dynamic studies continue to expand our understanding of the airflow dynamics in nasal septal perforation and after repair. Combining rhinoplasty and nasal septal perforation repair in appropriately selected patients can be safely done with excellent results. There has been a rise in utilization of a temporoparietal fascia with polydiaxonone plate construct for septal perforation repair with excellent outcomes.SummaryThe present review provides the reconstructive surgeon with an update on nasal septal perforation repair and describes a recently popularized technique of temporoparietal fascia-polydiaxonone plate for perforation reconstruction.
Measures of Stress Exposure for Hospitalized Preterm Infants
Authors: Nist Marliese Dion , Harrison Tondi M. , Pickler Rita H. , Shoben Abigail B. 
Published: June 2020

Background
Extended hospitalization in neonatal intensive care units subjects preterm infants to multiple stress exposures that affect long-term cognitive functioning, motor development, and stress reactivity. Measurement of stress exposure is challenging with multiple measures of stress exposure in use, including counts of skin-breaking or invasive procedures or counts of noxious sensory exposures.

Objectives
The purpose of this analysis was to compare measures of stress exposure commonly used by researchers and to determine the predictive validity of these measures for early neurobehavior. We accomplished this objective through the following specific aims: (a) describe the stress exposures of preterm infants in the first 2 weeks of life, (b) determine the correlations among measures of stress exposure, and (c) compare the predictive validity of measures of stress exposure for early neurobehavior.

Methods
Very preterm infants born between 28 and 31 weeks postmenstrual age were enrolled from four neonatal intensive care units in a large Midwest city. We measured stress exposure over the first 14 days of life for each infant as a count of skin-breaking procedures, a count of invasive procedures, and cumulative scores derived from the Neonatal Infant Stressor Scale. Neurobehavior was assessed at 35 weeks postmenstrual age using the motor development and vigor and alertness/orientation subscales from the Neurobehavioral Assessment of the Preterm Infant. We used Spearman’s rho to determine correlations among the measures of stress exposure and multiple linear regression to determine the predictive validity of each stress exposure measure for neurobehavioral outcomes.

Results
Seventy-one preterm infants were included in the analysis. We found marked variance across individuals in all measures of stress exposure. There were moderate–high correlations among the measures of stress exposure. No measure of stress exposure was associated with early neurobehavior.

Discussion
The stress experiences of hospitalized preterm infants vary. This variance is reflected in all measures of stress exposure. Because measures of stress exposure are highly correlated, the most objective measure requiring the least interpretation should be used. However, the currently available measures of stress exposure used in this analysis may not reflect the infant’s physiological stress responses and fail to associate with early neurobehavior.
Feasibility Case Series of Environment and Sleep in Infants With Congenital Heart Disease
Authors: Kalvas Laura Beth , Harrison Tondi M. 
Published: June 2020

Background
Developmental delay is a significant concern for infants born with complex congenital heart disease (CCHD). Environmental exposures (e.g., excessive light and sound exposure, sleep disruption) in neonatal intensive care are associated with poor developmental outcomes. However, the environmental experience of newborn infants in cardiac care is unknown.

Objectives
The aim of the study was to examine the feasibility of continuous environmental data collection (i.e., light and sound exposure, sleep pattern) in pediatric cardiac care units and describe the environmental experience of three hospitalized infants with CCHD.

Methods
A case series of three infants undergoing cardiac surgery for CCHD within the first month of life was performed. Measures of light, sound, and sleep were collected in 24-hour periods on three to four separate hospital days. For each day, light and sound meters were attached to the hospital bed, and an actigraphy band was placed on the infant’s lower leg to measure sleep/wake states. Feasibility of continuous environmental data collection was assessed through acceptability of data collection for families and clinical staff, usability of data collection equipment for research staff, and study protocol adherence. Descriptive statistics were used to calculate the count and duration of episodes of excessive light and sound exposure, hourly levels of light and sound exposure, total sleep time, duration of individual sleep episodes, and number of arousals from sleep.

Results
Although continuous environmental data collection was generally acceptable to families and clinical staff, multiple usability issues were identified by research staff, and study protocol adherence was variable. Missing data were a major limitation. User error during equipment setup was a main contributor to missing data. Infants experienced frequent episodes of sound exposure above recommended maximum levels, whereas light exposure generally remained below recommended maximum levels. Infant sleep patterns were highly fragmented, with frequent arousals and short duration of individual sleep episodes.

Discussion
Lessons learned during preliminary data collection with the infants in this case series will inform methods and prevent missing data in future, large-scale studies of this vulnerable, hard-to-recruit population. Data reflect a cardiac care environment characterized by excessive sound exposure and highly disrupted sleep. These environmental stressors may affect developmental outcomes in infants with CCHD.
Head and Brain Postmortem Computed Tomography—Autopsy Correlation in Hospital Deaths
Authors: Serinelli Serenella , Richardson Timothy E. , Destian Sylvie , Mirchia Kanish , Williams Michael , Medina-Perez Mariangeles , Gitto Lorenzo 
Published: June 2020

AbstractThe use of postmortem computed tomography (PMCT) to support autopsy pathology has increased in recent decades. To some extent, PMCT has also been contemplated as a potential alternative to conventional postmortem examination. The purpose of this study was to investigate the ability of PMCT to detect specific pathologic findings in the head and brain in natural hospital deaths.We examined postmortem CT images and autopsy data from 31 subjects who died at SUNY (State University of New York) Upstate University Hospital between 2013 and 2018. Each subject underwent a noncontrast PMCT and a traditional autopsy. A neuroradiologist analyzed PMCT images for head and brain abnormalities. The autopsies were performed by pathologists who were aware of the radiology results.In our series, PMCT was able to detect the majority of the significant space-occupying lesions, although it was not always reliable in ascertaining their nature. Postmortem computed tomography revealed findings usually challenging to detect at autopsy. Unfortunately, there were also situations in which PMCT was misleading, showing changes that were difficult to interpret, or that could be related to postmortem events. Therefore, we conclude PMCT should be used as an adjunct rather than a substitute to autopsy.
Development of a New Emergency Medicine Spinal Immobilization Protocol for Pediatric Trauma Patients and First Applicability Test on Emergency Medicine Personnel
Authors: Nolte Philip C. , Liao Shiyao , Kuch Matthias , Grützner Paul A. , Münzberg Matthias , Kreinest Michael 
Published: June 2020

Objectives
The purpose of this study was to (i) develop a protocol that supports decision making for prehospital spinal immobilization in pediatric trauma patients based on evidence from current scientific literature and (ii) perform an applicability test on emergency medicine personnel.

Methods
A structured search of the literature published between 1980 and 2019 was performed in MEDLINE using PubMed. Based on this literature search, a new Emergency Medicine Spinal Immobilization Protocol for pediatric trauma patients (E.M.S. IMMO Protocol Pediatric) was developed. Parameters found in the literature, such as trauma mechanism and clinical findings that accounted for a high probability of spinal injury, were included in the protocol. An applicability test was administered to German emergency medicine personnel using a questionnaire with case examples to assess correct decision making according to the protocol.

Results
The E.M.S. IMMO Protocol Pediatric was developed based on evidence from published literature. In the applicability test involving 44 emergency medicine providers revealed that 82.9% of participants chose the correct type of immobilization based on the protocol. A total of 97.8% evaluated the E.M.S. IMMO Protocol Pediatric as helpful.

Conclusions
Based on the current literature, the E.M.S. IMMO Protocol Pediatric was developed in accordance with established procedures used in trauma care. The decision regarding immobilization is made on based on the cardiopulmonary status of the patient, and life-threatening injuries are treated with priority. If the patient presents in stable condition, the necessity for full immobilization is assessed based upon the mechanisms of injury, assessment of impairment, and clinical examination.
Disproportionate burden of coronavirus disease 2019 among racial minorities and those in congregate settings among a large cohort of people with HIV
Authors: Meyerowitz Eric A. , Kim Arthur Y. , Ard Kevin L. , Basgoz Nesli , Chu Jacqueline T. , Hurtado Rocio M. , Lee Catherine K. , He Wei , Minukas Theresa , Nelson Sandra , Ojikutu Bisola O. , Robbins Greg , Sanchez Sarimer , Triant Virginia A. , Zachary Kimon , Gandhi Rajesh T. 
Published: June 2020

Background:
Many people living with HIV (PLWH) have comorbidities which are risk factors for severe coronavirus disease 2019 (COVID-19) or have exposures that may lead to acquisition of severe acute respiratory distress syndrome coronavirus 2. There are few studies, however, on the demographics, comorbidities, clinical presentation, or outcomes of COVID-19 in people with HIV.

Objective:
To evaluate risk factors, clinical manifestations, and outcomes in a large cohort of PLWH with COVID-19.

Methods:
We systematically identified all PLWH who were diagnosed with COVID-19 at a large hospital from 3 March to 26 April 2020 during an outbreak in Massachusetts. We analyzed each of the cases to extract information including demographics, medical comorbidities, clinical presentation, and illness course after COVID-19 diagnosis.

Results:
We describe a cohort of 36 PLWH with confirmed COVID-19 and another 11 patients with probable COVID-19. Almost 85% of PLWH with confirmed COVID-19 had a comorbidity associated with severe disease, including obesity, cardiovascular disease, or hypertension. Approximately 77% of PLWH with COVID-19 were non-Hispanic Black or Latinx whereas only 40% of the PLWH in our clinic were Black or Latinx. Nearly half of PLWH with COVID-19 had exposure to congregate settings. In addition to people with confirmed COVID-19, we identified another 11 individuals with probable COVID-19, almost all of whom had negative PCR testing.

Conclusion:
In the largest cohort to date of PLWH and confirmed COVID-19, almost all had a comorbidity associated with severe disease, highlighting the importance of non-HIV risk factors in this population. The racial disparities and frequent link to congregate settings in PLWH and COVID-19 need to be explored urgently.
Is Small Fiber Neuropathy Induced by Gadolinium-Based Contrast Agents?
Authors: Radbruch Alexander , Richter Henning , Bücker Patrick , Berlandi Johannes , Schänzer Anne , Deike-Hofmann Katerina , Kleinschnitz Christoph , Schlemmer Heinz-Peter , Forsting Michael , Paulus Werner , Martin Louise F. , van Thriel Christoph , Karst Uwe , Jeibmann Astrid 
Published: June 2020

Objectives
In recent years, complaints of patients about burning pain in arms and legs after the injection of gadolinium-based contrast agents (GBCAs) have been reported. In the current study, we investigated changes of small fibers in the epidermis as a potential cause of the patient complaints in a mouse model.

Methods
Six groups of 8 mice were intravenously injected with either a macrocyclic GBCA (gadoteridol, gadoterate meglumine, gadobutrol), a linear GBCA (gadodiamide or gadobenate dimeglumine) (1 mmol/kg body weight), or saline (NaCl 0.9%). Four weeks after injection, animals were euthanized, and footpads were assessed using immunofluorescence staining. Intraepidermal nerve fiber density (IENFD) was calculated, and the median number of terminal axonal swellings (TASs) per IENFD was determined.

Results
Nonparametric Wilcoxon signed-rank test revealed significantly lower IENFDs for all GBCAs compared with the control group (P < 0.0001) with the linear GBCAs showing significantly lower IENFDs than the macrocyclic GBCAs (P < 0.0001). The linear GBCAs presented significantly more TAS per IENFD than the control group (P < 0.0001), whereas no significant increase of TAS per IENFD compared with the control group was found for macrocyclic GBCAs (P < 0.237).

Interpretation
It is unclear whether or at what dosage the decrease of IENFDs and the increase of TAS per IENFD found in the current animal model will appear in humans and if it translates into clinical symptoms. However, given the highly significant findings of the current study, more research in this field is required.