bluuebunny/crossref_metadata_2025_split huggingface dataset:
Trends and Outcomes of Intravascular Imaging-guided Percutaneous Coronary Intervention in the United States
Authors: Lemor Alejandro , Patel Nish , Jain Tarun , Baber Usman , Hernandez Gabriel , Villablanca Pedro , Basir Mir B. , Alaswad Khaldoon , Mehran Roxana , Dangas George , Sharma Samin K. , Kini Annapoorna 
Published: December 2019

Introduction:
Intravascular imaging-guided percutaneous coronary intervention (PCI) has shown to improve outcomes in randomized controlled trials. However, there are little real-world data about intravascular imaging utilization during PCI and its outcomes in the United States.

Methods:
We conducted an observational analysis on the use of intravascular imaging (Intravascular Ultrasound or Optical Coherence Tomography)-guided PCI in 2,425,036 patients undergoing PCI between January 2010 and December 2014 from the Nationwide Inpatient Sample database. Utilizing propensity score matching, 83,988 matched pairs were identified. The primary outcome was in-hospital mortality. The secondary outcomes included cardiogenic shock and acute kidney injury.

Results:
Among the 2,425,036 patients, 161,808 (6.7%) underwent imaging-guided PCI. Use of imaging-guidance increased from 6% in 2010 to 6.6% in 2014 (Ptrend < 0.001). The in-hospital mortality was significantly different between imaging-guided PCI and angiography-guided PCI [1.0% vs. 1.5%; adjusted OR: 0.67; 95% confidence interval (CI): 0.54–0.83, P < 0.001]. The rates of cardiogenic shock (2.5% vs. 3.1%; adjusted OR: 0.78; 95% CI: 0.66–0.93; P = 0.005) were significantly lower in imaging-guided PCI group and acute kidney injury rates (7.0% vs. 7.1%; adjusted OR: 0.99; 95% CI: 0.89–1.12; P = 0.919) were not significantly different.

Conclusions:
Imaging-guided PCI is associated with lower in-hospital mortality. Yet, a small proportion of patients undergoing PCI have imaging-guidance.
Approach to stage IV non-small-cell lung cancer: how to select among first-line therapy options?
Authors: Pacheco Jose M. 
Published: December 2019

Purpose of review
There are several first-line systemic therapy options for patients with newly diagnosed stage IV non-small-cell lung cancer. Targeted therapy with tyrosine kinase inhibitors provide a good first option for some. Unfortunately, most patients do not have an alteration for which there is an available tyrosine kinase inhibitor. For these patients there are immunotherapy and chemoimmunotherapy options; however, there is debate about how to choose amongst these treatments for a given individual. This review attempts to simplify this decision-making process.

Recent findings
The data on first-line immunotherapy and chemoimmunotherapy regimens is highlighted. Programed death ligand-1 cut-points and how these may influence therapy decision making are discussed. Molecular markers that may help predict benefit or lack thereof in patients treated with immunotherapy regimens are touched upon.

Summary
Provided is a guide for the practicing clinician to help them select amongst immunotherapy and chemoimmunotherapy options for a given patient.
Neighborhood Disadvantage and Hospital Quality Ratings in the Medicare Hospital Compare Program
Authors: Fahrenbach John , Chin Marshall H. , Huang Elbert S. , Springman Mary K. , Weber Stephen G. , Tung Elizabeth L. 
Published: December 2019

Background:
The Centers for Medicare and Medicaid Services provide nationwide hospital ratings that may influence reimbursement. These ratings do not account for the social risk of communities and may inadvertently penalize hospitals that service disadvantaged neighborhoods.

Objective:
This study examines the relationship between neighborhood social risk factors (SRFs) and hospital ratings in Medicare’s Hospital Compare Program.

Research Design:
2017 Medicare Hospital Compare ratings were linked with block group data from the 2015 American Community Survey to assess hospital ratings as a function of neighborhood SRFs.

Subjects:
A total of 3608 Medicare-certified hospitals in 50 US states.

Measures:
Hospital summary scores and 7 quality group scores (100 percentile scale), including effectiveness of care, efficiency of care, hospital readmission, mortality, patient experience, safety of care, and timeliness of care.

Results:
Lower hospital summary scores were associated with caring for neighborhoods with higher social risk, including a reduction in hospital score for every 10% of residents who reported dual-eligibility for Medicare/Medicaid [−3.3%; 95% confidence interval (CI), −4.7 to −2.0], no high-school diploma (−0.8%; 95% CI, −1.5 to −0.1), unemployment (−1.2%; 95% CI, −1.9 to −0.4), black race (−1.2%; 95% CI, −1.7 to −0.8), and high travel times to work (−2.5%; 95% CI, −3.3 to −1.6). Associations between neighborhood SRFs and hospital ratings were largest in the timeliness of care, patient experience, and hospital readmission groups; and smallest in the safety, efficiency, and effectiveness of care groups.

Conclusions:
Hospitals serving communities with higher social risk may have lower ratings because of neighborhood factors. Failing to account for neighborhood social risk in hospital rating systems may reinforce hidden disincentives to care for medically underserved areas in the United States.
Modified Valsalva Maneuver for Pediatric Supraventricular Tachycardia
Authors: Rayburn David , Wagers Brian 
Published: December 2019

Abstract
Vagal maneuvers can be successful in terminating supraventricular tachycardia in pediatric patients. We present a case of a modified Valsalva maneuver identified in the REVERT trial successfully terminating supraventricular tachycardia in a 9-year-old boy.
A Call to Restore Your Calling: Self-Care of the Emergency Physician in the Face of Life-Changing Stress
Authors: Mull Colette C. , Bowman Wesley R. 
Published: December 2019

Abstract
This fifth article in our series focuses on burnout in practicing pediatric emergency medicine physicians. As opposed to a general review of burnout, we address understudied and undervalued risk factors, drivers, and individual- and organizational-level solutions applicable to the emergency medicine workplace.
Conflicting studies impact our understanding of the prevalence of burnout in our field and the role of depression. This article's story is anonymously submitted and leads us to our discussion of the heightened risk of burnout in underrepresented physicians, those who identify themselves as women, as belonging to a racial, ethnic, gender and/or sexual minority group, and/or as having a physical and/or sensory disability.
Thus far, our articles have described coping tools for individuals and health care organizations to prevent and/or mitigate the untoward effects of life-changing stressors on a pediatric emergency physician's life. They include staying healthy and active, cultivating outside interests, and nurturing relationships with peers, friends, and family. We have shared the techniques and benefits of constructive engagement when one is faced with challenging events or individuals. We have underscored the value of peer support, support groups, emotional debriefing, and engaging with outside organizations able to address specific stressors. We have introduced the practice of political engagement as a way of addressing systems-level pressures. Throughout this series, we have emphasized the need to ask for help from family, friends, peers, primary care providers, and mental health professionals. This article describes the benefits of Employee Assistance Programs, Physician Wellness Programs, positive psychology, and grounding behaviors as self-care strategies.
Quantification of Aortic Stiffness by Ultrasound Time-Harmonic Elastography
Authors: Schaafs Lars-Arne , Tzschätzsch Heiko , Steffen Ingo G. , Braun Jürgen , Hamm Bernd , Sack Ingolf , Elgeti Thomas 
Published: December 2019

Objectives
The aim of this study was to investigate blood pressure dependency of ultrasound time-harmonic elastography (THE) for quantification of aortic stiffness.

Materials and Methods
Thoracoabdominal aortas were surgically removed from 9 healthy domestic pigs and prepared for elastographic experiments. All vessels were connected to a saline-filled water column with adjustable height and pressurized over a range of 0 to 110 mm Hg in 10 mm Hg increments to simulate different levels of mean arterial pressure. In addition, 3 of the 9 aortas were soaked in 4% buffered formaldehyde for 60 minutes to simulate pathologic aortic stiffening. Ultrasound THE was performed in each vessel at each pressure level. For each pressure level, shear-wave speed (SWS) as a measure of aortic wall stiffness and luminal diameter were recorded. The pressure range between 30 and 110 mm Hg was used for statistical evaluation as it reflects a physiological mean arterial pressure range. Linear regression analysis and multivariate analysis with a general linear model were performed to evaluate the influence of increasing intravascular pressure and vessel diameter on measured SWS.

Results
Median SWS in formalin-soaked aortas was significantly higher with 3.22 m/s (interquartile range [IQR], 0.01 m/s) versus 2.14 m/s (IQR, 0.09) at 30 mm Hg and 3.38 m/s (IQR, 0.01 m/s) versus 2.28 m/s (IQR, 0.07 m/s) at 110 mm Hg (each P = 0.01). Using linear regression analysis, an increase of aortic wall SWS of 0.017 m/s per 10 mm Hg intraluminal pressure was found in untreated aortas, whereas SWS increased by 0.020 m/s per 10 mm Hg in formalin-soaked aortas (both P = 0.001). The percentage of SWS caused by intraluminal pressure was 1.89% in formalin-soaked aortas and 2.50% in untreated aortas at 30 mm Hg and 6.61% for formalin-soaked aortas and 8.60% for untreated aortas at 110 mm Hg. Multivariate analysis showed no significant interaction of luminal diameter and measured SWS (P = 0.893).

Conclusions
In our model, aortic stiffness measurements by ultrasound time-harmonic elastography are influenced to a small extent by mean arterial pressure in a range of 1.89% to 8.60%. These findings emphasize the potential of ultrasound THE for measuring the intrinsic stiffness of the aortic wall in clinical routine.
The Physical-Virtual Patient Simulator
Authors: Daher Salam , Hochreiter Jason , Schubert Ryan , Gonzalez Laura , Cendan Juan , Anderson Mindi , Diaz Desiree A. , Welch Gregory F. 
Published: December 2019

Introduction
We introduce a new type of patient simulator referred to as the Physical-Virtual Patient Simulator (PVPS). The PVPS combines the tangible characteristics of a human-shaped physical form with the flexibility and richness of a virtual patient. The PVPS can exhibit a range of multisensory cues, including visual cues (eg, capillary refill, facial expressions, appearance changes), auditory cues (eg, verbal responses, heart sounds), and tactile cues (eg, localized temperature, pulse).

Methods
We describe the implementation of the technology, technical testing with healthcare experts, and an institutional review board–approved pilot experiment involving 22 nurse practitioner students interacting with a simulated child in 2 scenarios: sepsis and child abuse. The nurse practitioners were asked qualitative questions about ease of use and the cues they noticed.

Results
Participants found it easy to interact with the PVPS and had mixed but encouraging responses regarding realism. In the sepsis scenario, participants reported the following cues leading to their diagnoses: temperature, voice, mottled skin, attitude and facial expressions, breathing and cough, vitals and oxygen saturation, and appearance of the mouth and tongue. For the child abuse scenario, they reported the skin appearance on the arms and abdomen, perceived attitude, facial expressions, and inconsistent stories.

Conclusions
We are encouraged by the initial results and user feedback regarding the perceived realism of visual (eg, mottling), audio (eg, breathing sounds), and tactile (eg, temperature) cues displayed by the PVPS, and ease of interaction with the simulator.
Pediatric firearm mortality in the United States, 2010 to 2016: A National Trauma Data Bank analysis
Authors: Hatchimonji Justin S. , Swendiman Robert A. , Goldshore Matthew A. , Blinman Thane A. , Nance Michael L. , Allukian Myron , Nace Gary W. 
Published: December 2019

BACKGROUND
Pediatric firearm injury is a leading cause of death for U.S. children. We sought to further characterize children who die from these injuries using a validated national database.

METHODS
The National Trauma Data Bank 2010 to 2016 was queried for patients aged 0 to 19 years old. International Classification of Diseases external cause of injury codes were used to classify patients by intent. Differences between groups were analyzed using χ2 or Mann-Whitney U tests. Patterns over time were analyzed using nonparametric tests for trend. Multivariable logistic regression was used to investigate associations between the above factors and mortality.

RESULTS
There were a total of 45,288 children with firearm injuries, 12.0% (n = 5,412) of whom died. Those who died were younger and more often white than survivors. Mortality was associated with increased injury severity, shock on presentation, and polytrauma (p < 0.001 for all). There was an increasing trend in the proportion of self-inflicted injuries over the study period (p < 0.001), and mortality from these self-inflicted injuries increased concordantly (35.3% in 2010 to 47.8% in 2016, p = 0.001). Location of severe injuries had significant different mortality rates, ranging from 51.3% of head injuries to 3.9% in the extremities. In the multivariable model, treatment at a pediatric trauma center was protective against mortality, with odds ratios of 2.10 (confidence interval, 1.64–2.68) and 1.80 (confidence interval, 1.39–2.32) for death at adult and dual-designated trauma centers, respectively. This finding was confirmed in age-stratified cohorts.

CONCLUSION
Proportions of self-inflicted pediatric firearm injury in the National Trauma Data Bank increased from 2010 to 2016, as did mortality from self-inflicted injury. Because mortality is highest in this subpopulation, prevention and treatment efforts should be prioritized in this group of firearm-injured children.

LEVEL OF EVIDENCE
Epidemiological study, level V.
Comparison of Medium-term Outcomes of Living Kidney Donors With Longitudinal Healthy Control in the United Kingdom
Authors: Krishnan Nithya , Mumford Lisa , Lipkin Graham , Gill Paramjit , Fletcher Simon , Dasgupta Indranil , Ryan Ronan , Raymond Neil T. 
Published: December 2019

Background.
Understanding the outcomes and risks for live kidney donors (LD) is increasingly important; this study investigated all-cause mortality and morbidity outcomes of LD compared with a healthy cohort.

Methods.
Live donor dataset was obtained from the UK Transplant Registry and a comparator nondonor cohort selected from The Health Improvement Network (THIN) database, a UK primary healthcare database. All LD from January 1, 2001, to December 31, 2013, were included, with follow-up until December 31, 2016.

Results.
There were 9750 LD and 19 071 THIN participants. Median follow-up (interquartile range) for LD was 8.4 (6.0–11.3) years and for THIN was 5.4 (2.6–8.5) years. In up to 15 years, follow-up end-stage renal disease was observed in 1 LD versus 7 THIN (P = 0.280). Nine LD had estimated glomerular filtration rate of <30 mL/min/1.73 m2 versus 43 in THIN (P = 0.012), but no statistically significant difference in adjusted logistic regression analyses. Risk of diabetes mellitus, depression, and cardiovascular disease was significantly higher for THIN cohort in adjusted analyses. The risk of hypertension was higher for LD at 5 years but was not significantly different in fully adjusted analyses at 10 years. There were 68 deaths in LD and 485 in THIN over the follow-up period, with significant difference in mortality favoring LD (P < 0.001).

Conclusions.
The medium-term morbidity and mortality outcomes of live donors in comparison with a healthy cohort suggest that live donation is not associated with excess mortality, end-stage renal disease, or morbidity, in at least 10 years follow-up.
Prolonged Cold Ischemia Time in Mouse Heart Transplantation Using Supercooling Preservation
Authors: Que Weitao , Hu Xin , Fujino Masayuki , Terayama Hayato , Sakabe Kou , Fukunishi Nahoko , Zhu Ping , Yi Shuang-Qin , Yamada Yoshio , Zhong Lin , Li Xiao-Kang 
Published: December 2019

Background.
Supercooling preservation techniques store a donor organ below 0°C without freezing. This has great advantages in inhibiting metabolism and preserving the organ in comparison to conventional preservation at 4°C. We developed a novel supercooling technique using a liquid cooling apparatus and novel preservation and perfusion solutions. The purpose of this study was to evaluate the preservation effect of our supercooling preservation technique in a mouse heart transplantation model.

Methods.
Syngeneic heterotopic heart transplantation was performed in 3 groups of mice: (1) the nonpreservation group, in which the cardiac grafts were transplanted immediately after retrieval; (2) the conventional University of Wisconsin (UW) group, in which the cardiac grafts were stored in UW solution at 4°C for different periods of time; and (3) the supercooling group, in which the cardiac grafts were stored in a novel supercooling preservation solution at –8°C for different periods of time. The maximal preservation time was investigated. Twenty-four-hour sample data were collected and analyzed to compare supercooling preservation to conventional UW preservation.

Results.
Our technique yielded a stable –8°C supercooling state. Cardiac graft revival was successfully achieved after supercooling preservation for 144 hours, and long-term survival was observed after supercooling preservation for 96 hours. Posttransplant outcomes, including myocardial ischemia–reperfusion injury, oxidative stress-related damage, and myocardial cell apoptosis, were improved in comparison to conventional 4°C UW preservation.

Conclusions.
Supercooling heart preservation at –8°C greatly prolonged the preservation time and improved the posttransplant outcomes in comparison to conventional 4°C UW preservation. Supercooling preservation is a promising technique for organ preservation.
Excess Stroke Deaths in Kidney Transplant Recipients: A Retrospective Population-based Cohort Study Using Data Linkage
Authors: De La Mata Nicole L. , Kelly Patrick J. , Wyld Melanie , Masson Philip , Al-Shahi Salman Rustam , Webster Angela C. 
Published: December 2019

Background.
Kidney transplant recipients are thought to experience a high risk of stroke; however, little data exist. We aimed to compare the stroke deaths in kidney transplant recipients with the general population and identify risk factors for stroke death in kidney transplant recipients.

Methods.
Cause of death was established using data linkage between the Australian and New Zealand Dialysis and Transplant Registry and national death registers: Australia, 1980–2013, and New Zealand, 1988–2012. We estimated standardized mortality ratios (SMR) and used competing risks models to identify risk factors. Subanalysis explored those with polycystic kidney disease.

Results.
Among 17 628 kidney transplant recipients, there were 158 stroke deaths and 5126 nonstroke deaths in 175 084 person-years. Those aged 30–49 years experienced more stroke deaths than expected, especially women (SMR in females: 19.7 [95% confidence interval, 12.9-30.3] and males: 9.1 [95% confidence interval, 5.6-14.6]). Higher risk of stroke death was associated with older age at transplant, ever graft failure, earlier era of transplant, preexisting cerebrovascular disease, and no previous malignancy. Polycystic kidney disease did not result in different SMR.

Conclusions.
Kidney transplant recipients had excess stroke deaths, particularly at younger ages and women. Preexisting cerebrovascular disease was a potentially modifiable risk factor for stroke death, suggesting further studies of secondary stroke prevention for kidney transplant recipients.
Rev-erbα heterozygosity produces a dose-dependent phenotypic advantage in mice
Authors: Welch Ryan D. , Billon Cyrielle , Burris Thomas P. , Flaveny Colin A. 
Published: December 2019

AbstractNumerous mutational studies have demonstrated that circadian clock proteins regulate behavior and metabolism.Nr1d1(Rev-erbα)is a key regulator of circadian gene expression and a pleiotropic regulator of skeletal muscle homeostasis and lipid metabolism. Loss ofRev-erbαexpression induces muscular atrophy, high adiposity, and metabolic syndrome in mice. Here we show that, unlike knockout mice,Nr1d1heterozygous mice are not susceptible to muscular atrophy and in fact paradoxically possess larger myofiber diameters and improved neuromuscular function, compared to wildtype mice. Heterozygous mice lacked dyslipidemia, a characteristic ofNr1d1knockout mice and displayed increased whole-body fatty-acid oxidation during periods of inactivity (light cycle). Heterozygous mice also exhibited higher rates of glucose uptake when fasted, and had elevated basal rates of gluconeogenesis compared to wildtype and knockout littermates.Rev-erbαablation suppressed glycolysis and fatty acid-oxidation in white-adipose tissue (WAT), whereas partialRev-erbαloss, curiously stimulated these processes. Our investigations revealed thatRev-erbαdose-dependently regulates glucose metabolism and fatty acid oxidation in WAT and muscle.
A standardized gnotobiotic mouse model harboring a minimal 15-member mouse gut microbiota recapitulates SOPF/SPF phenotypes
Authors: Darnaud Marion , Vadder Filipe De , Bogeat Pascaline , Boucinha Lilia , Bulteau Anne-Laure , Bunescu Andrei , Couturier Céline , Delgado Ana , Dugua Hélène , Elie Céline , Mathieu Alban , Novotná Tereza , Ouattara Djomangan Adama , Planel Séverine , Saliou Adrien , Šrůtková Dagmar , Yansouni Jennifer , Stecher Bärbel , Schwarzer Martin , Leulier François , Tamellini Andrea 
Published: December 2019

AbstractMus musculusis the classic mammalian model for biomedical research. Despite global efforts to standardize breeding and experimental procedures, the undefined composition and interindividual diversity of the microbiota of laboratory mice remains a limitation. In an attempt to standardize the gut microbiome in preclinical mouse studies, we developed a simplified mouse microbiota composed of 15 strains from 7 of the 20 most prevalent bacterial families representative of the fecal microbiota of C57BL/6J Specific (and Opportunistic) Pathogen-Free (SPF/SOPF) animals and derived a new standardized gnotobiotic mouse model called GM15. GM15 recapitulates extensively the functionalities found in the C57BL/6J SOPF microbiota metagenome, and GM15 animals are phenotypically similar to SOPF or SPF animals in two different facilities. They are also less sensitive to the deleterious effects of post-weaning malnutrition. The GM15 model provides increased reproducibility and robustness of preclinical studies by limiting the confounding effect of fluctuation in microbiota composition, and offers new opportunities for research focused on how the microbiota shapes host physiology in health and disease.