bluuebunny/crossref_metadata_2025_split huggingface dataset:
Peeling the Onion: Towards a Better Understanding of Botrytis Diseases of Onion
Authors: Steentjes Maikel B. F. , Scholten Olga E. , van Kan Jan A. L. 
Published: August 2020

Onion is cultivated worldwide for its bulbs, but production is threatened by pathogens and pests. Three distinct diseases of onion are caused by species that belong to the fungal genus Botrytis. Leaf blight is a well-known foliar disease caused by B. squamosa that can cause serious yield losses. Neck rot is a postharvest disease that manifests in bulbs after storage and is associated with three species: B. aclada, B. allii, and B. byssoidea. The symptomless infection of onion plants in the field makes it difficult to predict the incidence of neck rot in storage, although progress on the detection of latent infection has been made. In onion cultivation for seed production, blighting of the inflorescence is caused by all four onion-specific Botrytis species plus the broad host range pathogen B. cinerea. Flower blight can reduce seed yield and contaminate seed. In this review, the long history of Botrytis diseases of onion is discussed, as well as recent and future approaches to acquire a better understanding of the biology and ecology of Botrytis spp. pathogenic on onion. New fundamental insights in the genetic, biochemical, and physiological aspects of Botrytis–onion interactions are essential to improve the breeding of Botrytis-resistant onion cultivars. [Formula: see text] Copyright © 2021 The Author(s). This is an open access article distributed under the CC BY-NC-ND 4.0 International license .
Automated Algorithm Analysis of Sublingual Microcirculation in an International Multicentral Database Identifies Alterations Associated With Disease and Mechanism of Resuscitation
Authors: Hilty Matthias Peter , Akin Sakir , Boerma Christiaan , Donati Abele , Erdem Özge , Giaccaglia Paolo , Guerci Philippe , Milstein Dan MJ , Montomoli Jonathan , Toraman Fevzi , Uz Zuhre , Veenstra Gerke , Ince Can 
Published: August 2020

Objectives:
Reliable automated handheld vital microscopy image sequence analysis and the identification of disease states and effects of therapy are prerequisites for the routine use of quantitative sublingual microcirculation measurements at the point-of-care. The present study aimed to clinically validate the recently introduced MicroTools software in a large multicentral database of perioperative and critically ill patients and to use this automatic algorithm to data-mine and identify the sublingual microcirculatory variable changes in response to disease and therapy.

Design:
Retrospective algorithm-based image analysis and data-mining within a large international database of sublingual capillary microscopy. Algorithm-based analysis was compared with manual analysis for validation. Thereafter, MicroTools was used to identify the functional microcirculatory alterations associated with disease conditions and identify therapeutic options for recruiting functional microcirculatory variables.

Setting:
Ten perioperative/ICU/volunteer studies in six international teaching hospitals.

Patients:
The database encompass 267 adult and pediatric patients undergoing surgery, treatment for sepsis, and heart failure in the ICU and healthy volunteers.

Interventions:
Perioperative and ICU standard of care.

Measurements and Main Results:
One thousand five hundred twenty-five handheld vital microscopy image sequences containing 149,257 microscopy images were analyzed. 3.89 × 1012 RBC positions were tracked by the algorithm in real time, and offline manual analysis was performed. Good correlation and trending ability were found between manual and automatic total and functional capillary density (r = 0.6–0.8; p < 0.0001). RBC tracking within the database demonstrated changes in functional capillary density and/or RBC velocity in septic shock, heart failure, hypovolemia, obstructive shock, and hemodilution and thus detected the presence of a disease condition. Therapies recruiting the microcirculatory diffusion and convection capacity associated with systemic vasodilation and an increase in cardiac output were separately identified.

Conclusions:
Algorithm-based analysis of the sublingual microcirculation closely matched manual analysis across a broad spectrum of populations. It successfully identified a methodology to quantify microcirculatory alterations associated with disease and the success of capillary recruitment, improving point-of-care application of microcirculatory-targeted resuscitation procedures.
Evaluating Physical Functioning in Survivors of Critical Illness: Development of a New Continuum Measure for Acute Care*
Authors: Parry Selina M. , Knight Laura D. , Baldwin Claire E. , Sani Diana , Kayambu Geetha , Da Silva Vinicius Maldaner , Phongpagdi Pimsiri , Clarke Sandy , Puthucheary Zudin , Morris Peter , Denehy Linda , Granger Catherine L. 
Published: August 2020

Objectives:
Evaluation of physical functioning is central to patient recovery from critical illness—it may enable the ability to determine recovery trajectories, evaluate rehabilitation efficacy, and predict individuals at highest risk of ongoing disability. The Physical Function in ICU Test-scored is one of four recommended physical functioning tools for use within the ICU; however, its utility outside the ICU is poorly understood. The De Morton Mobility Index is a common geriatric mobility tool, which has had limited evaluation in the ICU population. For the field to be able to track physical functioning recovery, we need a measurement tool that can be used in the ICU and post-ICU setting to accurately measure physical recovery. Therefore, this study sought to: 1) examine the clinimetric properties of two measures (Physical Function in ICU Test-scored and De Morton Mobility Index) and 2) transform these measures into a single measure for use across the acute care continuum.

Design:
Clinimetric analysis.

Setting:
Multicenter study across four hospitals in three countries (Australia, Singapore, and Brazil).

Patients:
One hundred fifty-one ICU patients.

Interventions:
None.

Measurements and Main Results:
Physical function tests (Physical Function in ICU Test-scored and De Morton Mobility Index) were assessed at ICU awakening, ICU, and hospital discharge. A significant floor effect was observed for the De Morton Mobility Index at awakening (23%) and minimal ceiling effects across all time points (5–12%). Minimal floor effects were observed for the Physical Function in ICU Test-scored across all time points (1–7%) and a significant ceiling effect for Physical Function in ICU Test-scored at hospital discharge (27%). Both measures had strong concurrent validity, responsiveness, and were predictive of home discharge. A new measure was developed using Rasch analytical principles, which involves 10 items (scored out of 19) with minimal floor/ceiling effects.

Conclusions:
Limitations exist for Physical Function in ICU Test-scored and De Morton Mobility Index when used in isolation. A new single measure was developed for use across the acute care continuum.
Mediators of the Impact of Hourly Net Ultrafiltration Rate on Mortality in Critically Ill Patients Receiving Continuous Renal Replacement Therapy
Authors: Naorungroj Thummaporn , Neto Ary Serpa , Zwakman-Hessels Lara , Fumitaka Yanase , Eastwood Glenn , Murugan Raghavan , Kellum John A. , Bellomo Rinaldo 
Published: August 2020

Objectives:
During continuous renal replacement therapy, a high net ultrafiltration rate has been associated with increased mortality. However, it is unknown what might mediate its putative effect on mortality. In this study, we investigated whether the relationship between early (first 48 hr) net ultrafiltration and mortality is mediated by fluid balance, hemodynamic instability, or low potassium or phosphate blood levels using mediation analysis and the primary outcome was hospital mortality.

Design:
Retrospective, observational study.

Setting:
Mixed medical and surgical ICUs at Austin hospital, Melbourne, Australia.

Patients:
Critically ill patients treated with continuous renal replacement therapy within 14 days of ICU admission who survived greater than 48 hours.

Interventions:
None.

Measurements and Main Results:
We studied 347 patients (median [interquartile range] age: 64 yr [53–71 yr] and Acute Physiology and Chronic Health Evaluation III score: 73 (54–90)]. After adjustment for confounders, compared with a net ultrafiltration less than 1.01 mL/kg/hr, a net ultrafiltration rate greater than 1.75 mL/kg/hr was associated with significantly greater mortality (adjusted odds ratio, 1.15; 95% CI, 1.03–1.29; p = 0.011). Adjusted univariable mediation analysis found no suggestion of a causal mediation pathway for this effect by blood pressure, vasopressor therapy, or potassium levels, but identified a possible mediation effect for fluid balance (average causal mediation effect, 0.95; 95% CI, 0.89–1.00; p = 0.060) and percentage of phosphate measurements with hypophosphatemia (average causal mediation effect, 0.96; 95% CI, 0.92–1.00; p = 0.055). However, on multiple mediator analyses, these two variables showed no significant effect. In contrast, a high net ultrafiltration rate had an average direct effect of 1.24 (95% CI, 1.11–1.40; p < 0.001).

Conclusions:
An early net ultrafiltration greater than 1.75 mL/kg/hr was independently associated with increased hospital mortality. Its putative effect on mortality was direct and not mediated by a causal pathway that included fluid balance, low blood pressure, vasopressor use, hypokalemia, or hypophosphatemia.
Utilization of the Signature Method to Identify the Early Onset of Sepsis From Multivariate Physiological Time Series in Critical Care Monitoring
Authors: Morrill James H. , Kormilitzin Andrey , Nevado-Holgado Alejo J. , Swaminathan Sumanth , Howison Samuel D. , Lyons Terry J. 
Published: August 2020

Objectives:
Patients in an ICU are particularly vulnerable to sepsis. It is therefore important to detect its onset as early as possible. This study focuses on the development and validation of a new signature-based regression model, augmented with a particular choice of the handcrafted features, to identify a patient’s risk of sepsis based on physiologic data streams. The model makes a positive or negative prediction of sepsis for every time interval since admission to the ICU.

Design:
The data were sourced from the PhysioNet/Computing in Cardiology Challenge 2019 on the “Early Prediction of Sepsis from Clinical Data.” It consisted of ICU patient data from three separate hospital systems. Algorithms were scored against a specially designed utility function that rewards early predictions in the most clinically relevant region around sepsis onset and penalizes late predictions and false positives.

Setting:
The work was completed as part of the PhysioNet 2019 Challenge alongside 104 other teams.

Patients:
PhysioNet sourced over 60,000 ICU patients with up to 40 clinical variables for each hour of a patient’s ICU stay. The Sepsis-3 criteria was used to define the onset of sepsis.

Interventions:
None.

Measurements and Main Results:
The algorithm yielded a utility function score which was the first placed entry in the official phase of the challenge.
Characteristics, Hospital Course, and Outcomes of Patients Requiring Prolonged Acute Versus Short-Term Mechanical Ventilation in the United States, 2014–2018*
Authors: Zilberberg Marya D. , Nathanson Brian H. , Ways Judy , Shorr Andrew F. 
Published: August 2020

Objectives:
Most patients requiring mechanical ventilation only require it for a short term (< 4 d of mechanical ventilation). Those undergoing prolonged acute mechanical ventilation (≥ 4 d mechanical ventilation) represent a select cohort who face significant morbidity, mortality, and resource utilization. Using administrative codes, we identified prolonged acute mechanical ventilation and short-term mechanical ventilation patients and compared their baseline characteristics, hospital events, and hospital outcomes.

Design:
Retrospective cohort.

Setting:
Seven-hundred eighty-seven acute care hospitals, United States, contributing data to Premier database, 2014–2018.

Patients:
Patients on mechanical ventilation.

Interventions:
None.

Measurements and Main Results:
Among 691,961 patients meeting the enrollment criteria, 266,374 (38.5%) received prolonged acute mechanical ventilation. At baseline, patients on prolonged acute mechanical ventilation were similar to short-term mechanical ventilation in age (years: 62.0 ± 15.8 prolonged acute mechanical ventilation vs 61.7 ± 17.2 short-term mechanical ventilation), gender (males: 55.6% prolonged acute mechanical ventilation vs 53.9% short-term mechanical ventilation), and race (white: 69.1% prolonged acute mechanical ventilation vs 72.4% short-term mechanical ventilation). The prolonged acute mechanical ventilation group had a higher comorbidity burden than short-term mechanical ventilation (mean Charlson Score 3.5 ± 2.7 vs 3.1 ± 2.7). The prevalence of vasopressors (50.3% vs 36.9%), dialysis (19.4% vs 10.3%), severe sepsis (20.3% vs 10.3%), and septic shock (33.5% vs 15.9%) was higher in prolonged acute mechanical ventilation than short-term mechanical ventilation. Hospital mortality (29.75% vs 21.1%), combined mortality, or discharge to hospice (37.2% vs 25.3%), extubation failure (12.3% vs 6.1%), tracheostomy (21.6% vs 4.5%), development of Clostridium difficile (4.5% vs 1.7%), and incidence density of ventilator-associated pneumonia (2.4/1,000 patient-days vs 0.6/1,000 patient-days) were all higher in the setting of prolonged acute mechanical ventilation than short-term mechanical ventilation. Median (interquartile range) post mechanical ventilation onset length of stay (13 [8–20] vs 4 d [1–8 d]) and hospital costs ($55,014 [$35,051–$88,007] vs $20,120 [$12,071–$34,915] were higher in prolonged acute mechanical ventilation than short-term mechanical ventilation.

Conclusions:
Over one-third of all hospitalized patients on mechanical ventilation require it for greater than or equal to 4 days. Prolonged acute mechanical ventilation patients exhibit a higher burden of both chronic and acute illness and experience higher rates than those on short-term mechanical ventilation of hospital-acquired complications and worse clinical and economic outcomes.
Safety and Feasibility of Physical Rehabilitation and Active Mobilization in Patients Requiring Continuous Renal Replacement Therapy: A Systematic Review
Authors: Mayer Kirby P. , Joseph-Isang Ekaette , Robinson Lauren E. , Parry Selina M. , Morris Peter E. , Neyra Javier A. 
Published: August 2020

Objectives:
To evaluate the safety and feasibility of physical rehabilitation and active mobilization in patients requiring continuous renal replacement therapy in the ICU.

Data Sources:
Medline, CINAHL, PubMed, Pedro, and Cochrane Library were used to extract articles focused on physical activity and mobility in this population.

Study Selection:
Research articles were included in this review if 1) included adult patients greater than or equal to 18 years old requiring continuous renal replacement therapy located in the ICU; 2) described physical rehabilitation, active mobilization, or physical activity deliverables; 3) reported data on patient safety and/or feasibility. The primary outcome was safety, defined as number of adverse events per total number of sessions.

Data Extraction:
Five-hundred seven articles were evaluated based on title and abstract with reviewers selecting 46 to assess by full text. Fifteen observational studies were included for final analysis with seven studies focused solely on physical activity in patients requiring continuous renal replacement therapy.

Data Synthesis:
Four-hundred thirty-seven adult ICU patients requiring continuous renal replacement therapy participated in some form of physical rehabilitation, physical activity, or active mobilization. Two major adverse events (hypotension event requiring vasopressor and continuous renal replacement therapy tube disconnection, pooled occurrence rate 0.24%) and 13 minor adverse events (pooled occurrence rate 1.55%) were reported during a total of 840 individual mobility or activity sessions. Intervention fidelity was limited by a low prevalence of higher mobility with only 15.5% of incidences occurring at or above level 5 of ICU Mobility Scale (transfer to chair, marching in place or ambulation away from bed, 122/715 reports). Feasibility in the provision of these interventions and/or continuous renal replacement therapy–specific deliverables was inconsistently reported.

Conclusions:
Early rehabilitation and mobilization, specifically activity in and near the hospital bed, appears safe and mostly feasible in ICU patients requiring continuous renal replacement therapy. A cautious interpretation of these data is necessary due to limited aggregate quality of included studies, heterogeneous reporting, and overall low achieved levels of mobility potentially precluding the occurrence or detection of adverse events.
Effects of adding a combined femoral and sciatic nerve block with levobupivacaine and clonidine to general anaesthesia in femoropopliteal bypass surgery
Authors: Charvin Martin , Longeras François , Jouve Philippe , Cherprenet Anne-Laure , Futier Emmanuel , Pereira Bruno , Dualé Christian 
Published: August 2020

BACKGROUND
Adding a regional block to general anaesthesia can prevent postoperative pain and improve peripheral circulation.

OBJECTIVE
To seek improved postoperative analgesia and care due to a long-acting combined femoral and sciatic nerve block in patients undergoing femoropopliteal bypass surgery.

DESIGN
A randomised, double-blind, controlled trial.

SETTING
Vascular surgery unit of a French university hospital.

PATIENTS
Forty-four adults scheduled for bypass surgery under general anaesthesia.

INTERVENTION
Patients were allocated to receive either an active nerve block with 20 ml of 0.375% levobupivacaine and clonidine 0.5 μg kg–1, or a simulated (sham) block only, but with local anaesthesia of the skin, before general anaesthesia. General anaesthesia was standardised with propofol, then sevoflurane and sufentanil adjusted according to clinical need. Postoperative analgesia was standardised with paracetamol 1 g every 6 h, and intravenous morphine, initially titrated in the postanaesthesia care unit and then patient-controlled. Oral analgesics were repeated up to day 3.

MAIN OUTCOME MEASURES
The primary outcome was morphine consumption during the first 24 postoperative hours. In a subgroup of postoperative patients distal tissue oxygen saturation was recorded at the lateral side of the blocked calf.

RESULTS
Patients in the active group received less intra-operative sufentanil (median dose 25 vs. 41 μg), needed less morphine during the first 24 h (15 vs. 27 mg) and 72 (20 vs. 35 mg) postoperative hours, than in the control group. They also had less pain on movement, but pain at rest, the tissue oxygen saturation and other rehabilitation outcomes were unaffected by the treatment. Tolerance outcomes were also similar between groups.

CONCLUSION
Combining the two regional blocks improves the quality of postoperative care in this frail population, probably by reducing the amount of peri-operative opioid.

TRIAL REGISTRATION
ClinicalTrials.gov (ref. NCT01785693).
Pulmonary rehabilitation in interstitial lung diseases
Authors: Makhdami Nima , Farooqi Malik , Thom-Fernandes Cedel , Raghavan Natya G. 
Published: August 2020

Purpose of review
This review will provide an overview of the components and current evidence to support pulmonary rehabilitation in patients with interstitial lung diseases (ILD), focusing on the latest findings in enhancing quality of life and functional capacity using exercise training and education.

Recent findings
Recent literature demonstrates a longer duration of pulmonary rehabilitation results in sustained improvements in functional capacity and quality of life in patients with ILD. Educational components tailored to ILD provide added value to supervised exercise training. Enhancing exercise training with hyperoxia merits further study and other modalities such as pursed-lip breathing have been shown to be counterproductive.

Summary
Recent evidence continues to support the use of tailored pulmonary rehabilitation programs in patients with ILD. Areas which require further investigation include identifying optimal exercise training regimens, educational topics, and breathing techniques that are specifically designed for ILD.
Scintigraphic peritoneography in the diagnosis of pleuroperitoneal leak complicating peritoneal dialysis
Authors: Harry Lerwine , Nyakale Nozipho , Tinarwo Partson 
Published: August 2020

Abstract
A pleuroperitoneal leak (PPL) is a relatively rare complication of peritoneal dialysis (PD) and early diagnosis is essential.
Patients suspected of a PPL usually present with dyspnea (marked during inflow of PD fluid) and tend to have transudative high glucose pleural effusions.
The PPL scintigraphy (PPLS) is one of the methods for objectively proving a PPL. The effectiveness of PPLS as a noninvasive method of evaluating a suspected PPL and its effectiveness in the exclusion of a leak in patients with similarly presenting comorbidities was assessed.
Patients suspected to have a PPL were considered for PPLS based on clinical presentation and pleural fluid analysis. Radiopharmaceutical was administered into the peritoneum via the dialysis port with the patient lying supine and immediate dynamic followed by delayed statics were acquired.
Of the 27 scans reviewed, 70% were found to be positive with majority detected within 12 minutes of radiopharmaceutical administration with a high predominance occurring in the right chest (P < .001). In PPLS-positive patients, when both chest X-rays and planar agreed on showing the right-sided chest predominance, the highest measurements of the pleural glucose:serum glucose ratio were recorded. A statistically significant correlation between the outcome of the scan and final decision on patient management was noted (P < .01).
The PPLS is an effective diagnostic tool for assessing PPLS. However, multicenter studies investigating its added value over other conventional methods are needed to establish it as a highly relevant diagnostic tool.