bluuebunny/crossref_metadata_2025_split huggingface dataset:
Dissecting Contrasts in Cell Death, Hormone, and Defense Signaling in Response to Botrytis cinerea and Reactive Oxygen Species
Authors: Vuorinen Katariina , Zamora Olena , Vaahtera Lauri , Overmyer Kirk , Brosché Mikael 
Published: October 2020

Plants require interaction between signaling pathways to differentiate and integrate stress responses and deploy appropriate defenses. The hormones ethylene, salicylic acid (SA), and jasmonic acid (JA) are important regulators of plant defenses. Numerous interactions between these signaling pathways are the cornerstone of robust plant immunity. Additionally, during the early response to pathogens, reactive oxygen species (ROS) act as signaling molecules. Here, we examined the extent of signal interaction in the early stages of Botrytis cinerea infection. To enable a comparison between B. cinerea infection with ROS signaling, we subjected plants to ozone treatment, which stimulates an apoplastic ROS burst. We used a collection of single, double, and triple signaling mutants defective in hormone signaling and biosynthesis and subjected them to B. cinerea infection and ozone treatment at different timepoints. We examined lesion size, cell death, and gene expression (both quantitatively and spatially). The two treatments shared many similarities, especially in JA-insensitive mutants, which were sensitive to both treatments. Unexpectedly, a B. cinerea–susceptible JA-insensitive mutant (coi1), became tolerant when both SA biosynthesis and signaling was impaired (coi1 npr1 sid2), demonstrating that JA responses may be under the control of SA. Extensive marker gene analysis indicated JA as the main regulator of both B. cinerea and ozone defenses. In addition, we identified the transcription factor SR1 as a crucial regulator of PLANT DEFENSIN expression and cell-death regulation, which contributes to resistance to B. cinerea. Overall, our work further defines the context of ROS in plant defense signaling. [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 .
Supporting young adults with psoriatic arthritis
Authors: Galante Christine M. 
Published: October 2020

Abstract:
Psoriatic arthritis (PsA) is associated with psoriasis, a chronic inflammatory skin disease. About 30% of patients with psoriasis develop PsA, and some of these patients are children and young adults. Because onset can be gradual, PsA signs and symptoms are easily attributed to other causes, especially in younger patients. This article discusses the assessment, pathophysiology, and diagnosis of PsA and informs nurses how best to support patients with PsA.
Three-Dimensional Printed Ventilators: A Rapid Solution to Coronavirus Disease 2019–Induced Supply-Chain Shortages
Authors: Nacharaju Deepthi , Menzel Whitney , Fontaine Evan , Child Dennis , El Haddi S. James , Nonas Stephanie , Chi Albert 
Published: October 2020

Objective:
To examine rapidly emerging ventilator technologies during coronavirus disease 2019 and highlight the role of CRISIS, a novel 3D printed solution.

Data Sources:
Published articles, literature, and government guidelines that describe and review emergency use ventilator technologies.

Study Selection:
Literature was chosen from peer-reviewed journals and articles were limited to recent publications.

Data Extraction:
All information regarding ventilator technology was extracted from primary sources.

Data Synthesis:
Analysis of technology and relevance to coronavirus disease 2019 physiology was collectively synthesized by all authors.

Conclusions:
The coronavirus disease 2019 pandemic has placed massive stress on global supply chains for ventilators due to the critical damage the virus causes to lung function. There is an urgent need to increase supply, as hospitals become inundated with patients requiring intensive respiratory support. Coalitions across the United States have formed in order to create new devices that can be manufactured quickly, with minimal resources, and provide consistent and safe respiratory support. Due to threats to public health and the vulnerability of the U.S. population, the Food and Drug Administration released Emergency Use Authorizations for new or repurposed devices, shortening the approval timeline from years to weeks. The list of authorized devices varies widely in complexity, from automated bagging techniques to repurposed sleep apnea machines. Three-dimensional printed ventilators, such as “CRISIS,” propose a potential solution to increase the available number of vents for the United States and abroad, one that is dynamic and able to absorb the massive influx of hospitalized patients for the foreseeable future.
Quantification of Neurological Blood-Based Biomarkers in Critically Ill Patients With Coronavirus Disease 2019
Authors: Cooper Jennifer , Stukas Sophie , Hoiland Ryan L. , Fergusson Nicholas A. , Thiara Sonny , Foster Denise , Mitra Anish , Stoessl Jon A. , Panenka William J. , Sekhon Mypinder S. , Wellington Cheryl L. 
Published: October 2020

Objectives:
To provide an objective characterization of acute neurologic injury in critically ill patients with coronavirus disease 2019.

Design:
Prospective observational study. Demographics, comorbidities, and daily clinical physiologic and laboratory data were collected. Plasma levels of neurofilament-light chain, total tau, ubiquitin carboxy-terminal hydrolase L1, and glial fibrillary acidic protein were measured. The primary neurologic outcome was delirium defined by the Intensive Care Delirium Screening Checklist (scale 1–8). Associations among plasma biomarkers, respiratory failure, and inflammation were analyzed.

Setting:
Multicenter study in ICUs.

Patients:
Critically ill patients with respiratory failure, with coronavirus disease 2019, or without (ICU control).

Measurements and Main Results:
A total of 27 patients with coronavirus disease 2019 and 19 ICU controls were enrolled. Compared with ICU controls with pneumonia of other etiology, patients with coronavirus disease 2019 had significantly higher glial fibrillary acidic protein (272 pg/mL [150–555 pg/mL] vs 118 pg/mL [78.5–168 pg/mL]; p = 0.0009). In coronavirus disease 2019 patients, glial fibrillary acidic protein (rho = 0.5115, p = 0.0064), ubiquitin carboxy-terminal hydrolase L1 (rho = 0.4056, p = 0.0358), and neurofilament-light chain (rho = 0.6223, p = 0.0005) positively correlated with Intensive Care Delirium Screening Checklist score and were increased in patients with delirium (Intensive Care Delirium Screening Checklist ≥ 4) in the coronavirus disease 2019 group but not in ICU controls. There were no associations between the measures of respiratory function or cytokines with glial fibrillary acidic protein, total tau, ubiquitin carboxy-terminal hydrolase L1, or neurofilament-light chain levels in patients with coronavirus disease 2019.

Conclusions:
Plasma glial fibrillary acidic protein is two-fold higher in critically ill patients with coronavirus disease 2019 compared with ICU controls. Higher levels of glial fibrillary acidic protein, ubiquitin carboxy-terminal hydrolase L1, and neurofilament-light chain associate with delirium in patients with coronavirus disease 2019. Elevated plasma glial fibrillary acidic protein, ubiquitin carboxy-terminal hydrolase L1, and neurofilament-light chain are independent of respiratory function and peripheral cytokines.
Development and Validation of the Clinician Reported and Patient Reported Photonumeric Scales to Assess Buttocks Cellulite Severity
Authors: Cohen Joel L. , Sadick Neil S. , Kirby M. Todd , McLane Michael P. , Lenderking William R. , Bender Randall H. , Chen Jun , Hurley David , Knoble Naomi B. , Liu Genzhou , Xiang Qinfang , Davidson Jeffrey A. , Goldman Mitchel P. 
Published: October 2020

BACKGROUND
The Clinician Reported Photonumeric Cellulite Severity Scale (CR-PCSS) and Patient Reported PCSS (PR-PCSS) are newly developed tools for assessing cellulite severity.

OBJECTIVE
To report on the reliability, validity, and ability to detect a change in cellulite severity on the buttocks of adult women with the CR-PCSS and PR-PCSS.

MATERIALS AND METHODS
Content validity of both scales was established through concept elicitation and cognitive interviews. Test–retest reliability was evaluated, and intra-rater (both scales) and inter-rater (CR-PCSS only) reliability were estimated using intraclass correlation coefficients (ICCs) for agreement and consistency. Ability to detect a change was determined using the Subject–Global Aesthetic Improvement Scale (GAIS) or Investigator-GAIS as anchors.

RESULTS
For the CR-PCSS (n = 6) at baseline and Day 2, the mean interrater ICCs were ≥0.70 and mean intrarater ICCs (95% confidence interval [CI]) were ≥0.81 (0.72–0.90) for both buttocks. For the PR-PCSS (n = 99) at baseline and Day 14, the mean test–retest reliability ICCs (95% CI) were ≥0.86 (0.79–0.91) for both buttocks. A clinically meaningful change was 1.0 point on the PR-PCSS and 1.0 on the CR-PCSS.

CONCLUSION
The CR-PCSS and PR-PCSS reliably assess cellulite severity of the buttocks and can detect a clinically meaningful change after treatment for cellulite.
Postoperative pain therapy with hydromorphone; comparison of patient-controlled analgesia with target-controlled infusion and standard patient-controlled analgesia
Authors: Wehrfritz Andreas , Ihmsen Harald , Fuchte Tobias , Kim Michael , Kremer Sven , Weiß Alexander , Schüttler Jürgen , Jeleazcov Christian 
Published: October 2020

BACKGROUND
The challenge of managing acute postoperative pain is the well tolerated and effective administration of analgesics with a minimum of side effects. The standard therapeutic approach is patient-controlled analgesia (PCA) with systemic opioids. To overcome problems of oscillating opioid concentrations, we studied patient-controlled analgesia by target-controlled infusion (TCI-PCA) as an alternative.

OBJECTIVE
To compare efficacy, safety and side effects of standard PCA with TCI-PCA for postoperative pain therapy with hydromorphone.

DESIGN
Single-blinded, randomised trial.

SETTING
University Hospital, Germany from December 2013 to April 2015.

PARTICIPANTS
Fifty adults undergoing cardiac surgery.

INTERVENTIONS
Postoperative pain therapy on the ICU was managed with intravenous (i.v.) hydromorphone and patients randomised to TCI-PCA with target plasma concentrations between 0.8 and 10 ng ml−1, or PCA with bolus doses of 0.2 mg. Pain was regularly assessed using the 11-point numerical rating scale (NRS). Blood pressure, heart rate, oxygen saturation and cardiac output were continuously monitored, and adverse events were registered throughout the study.

MAIN OUTCOME MEASURES
NRS pain ratings, hydromorphone doses, haemodynamic effects and side effects.

RESULTS
NRS pain ratings, total doses of hydromorphone and haemodynamic data did not differ significantly between TCI-PCA and PCA. The number of bolus doses during PCA was significantly higher than the number of target increases during TCI-PCA (P = 0.006). The number of negative requests was also significantly higher during PCA than during TCI-PCA (P = 0.02). The respiratory rate on the first postoperative morning was 25 ± 6 min−1 during TCI-PCA, compared with 19 ± 4 min−1 during PCA (P = 0.022). Nausea occurred in 30% after TCI-PCA and 24% after PCA (P = 0.46).

CONCLUSION
TCI-PCA was effective and well tolerated in acute postoperative pain management after cardiac surgery. Further studies are needed to evaluate this approach in clinical practice.

TRIAL REGISTRATION
EudraCT Number: 2013-002875-16, and ClinicalTrials.gov Identifier: NCT02035709.
Investigation into the Energy and Scatter Response of OSLDs at Diagnostic Energies Using a C-arm System
Authors: Liu Kevin 
Published: October 2020

Abstract
Optically stimulated luminescent dosimeters (OSLDs) are radiation detectors commonly used in a clinical setting to monitor the dose to patients undergoing imaging or interventional procedures, especially those involving fluoroscopy. In dose tracking using OSLDs, it is important to consider that photons at the diagnostic energy range are prone to energy spectrum shifts from scattering interactions in the medium and that OSLDs have been reported to yield a somewhat strong energy-dependent response in the diagnostic energy range. This study examines the response of OSLDs exposed to a spectrum of photons in the diagnostic energy range (60-120 kVp), both free-in-air and on the surface of a PMMA phantom, within and just outside of the exposure field. From these measurements, it was observed that the response differs substantially (as high as 30%) in OSLDs irradiated under identical exposure settings but with differences in beam quality and scattering conditions. Furthermore, this study devises a method of weighted averages to calculate the calibration factors for OSLDs exposed to both primary and scatter photons, which were approximately 2-5% less than their corresponding measured values. This study emphasizes the need to develop different calibration factors in the clinical use of OSLDs for diagnostic imaging procedures, especially for procedures in which more precise dose measurements may be necessary.
Adjuvant External Beam Radiotherapy Following Enucleation of Eyes With Extraocular Extension From Uveal Melanoma
Authors: Roelofs Kelsey A. , Cohen Victoria M.L. , Sagoo Mandeep S. , Plowman P. Nicholas , Negretti Guy S. , O’Day Roderick , Hay Gordon , Arora Amit K. , Damato Bertil 
Published: October 2020

Purpose:
To report local disease control and all-cause mortality in patients with extraocular extension (EOE) of uveal melanoma undergoing enucleation followed by observation or external beam radiotherapy (EBRT).

Methods:
Charts of patients enucleated between January 1, 1997 and December 31, 2019, with histopathological evidence of EOE of uveal melanoma were reviewed.

Results:
The cohort comprised 51 patients with a mean age of 67 ± 15 years, 22 (43%) of whom underwent adjuvant postenucleation EBRT. Risk factors for metastasis included presence of epithelioid cells (29/45; 88%), closed loops (20/43; 47%), monosomy 3 (16/25; 64%), and gain of 8q (20/22; 91%). Patients undergoing EBRT had more extensive EOE (median: 5.1 mm vs. 2.6 mm, p = 0.008) and surgical excision was less likely to be histologically complete (2/20; 10% vs. 14/25; 56%, p = 0.002). Local side effects following EBRT were seen in 64% (14/22). At latest follow up, 59% of patients (30/51) were alive, with a median follow up of 1.8 years (interquartile range: 2.9; range: 0.1–6.5]. By Kaplan-Meier survival analysis, the 5- and 10-year overall survival rates were 56% and 12%, respectively. There was no difference in all-cause mortality between those receiving adjuvant EBRT and those who were observed (log rank, p = 0.273). No cases of orbital recurrence were documented.

Conclusions:
Orbital EBRT causes significant morbidity. Cases with relatively small EOE undergoing enucleation can be safely observed, without adjuvant EBRT. Multicenter studies are required to better assess the role of EBRT when EOE is more extensive.
A review of current controversies in determining death by neurologic criteria in children
Authors: Virupakshaiah Akash , Ichord Rebecca , Topjian Alexis A. , Kirschen Matthew P. 
Published: October 2020

Purpose of review
Death by neurologic criteria (DNC) is the irreversible cessation of all functions of the entire brain, including the brainstem. It is legally recognized as equivalent to cardiopulmonary death. Legal and ethical controversies surrounding DNC have emerged as a result of several highly publicized cases that have eroded public trust in our ability to declare DNC accurately. In this review, we focus on recently published primary data about DNC and address some of these controversies.

Recent findings
Approximately 21% of children who die in pediatric intensive care units (PICU) are declared DNC. Although 60% of physicians report that they have been asked to maintain organ support after DNC declaration, less than 1% of patients remain physically present in the PICU more than 5 days after DNC declaration. We discuss strategies for safely conducting the apnea test, indications and prevalence of ancillary testing, and objections to DNC, including issues of consent and requests for ongoing organ support.

Summary
In order to maintain public trust, published guidelines must be followed to accurately and consistently diagnose DNC. We must develop strategies to respond to objections to DNC determination. Ongoing research is needed to improve the safety of apnea testing and indications for and interpretation of ancillary testing.
The Influence of Functional Shoulder Biomechanics as a Mediator of Patient-Reported Outcomes following Mastectomy and Breast Reconstruction
Authors: Leonardis Joshua M. , Lyons Daniel A. , Kidwell Kelley M. , Giladi Aviram M. , Lipps David B. , Momoh Adeyiza O. 
Published: October 2020

Background:
Postmastectomy breast reconstruction techniques differentially influence patient-reported physical and psychosocial well-being. Objective measures of shoulder biomechanics, which are uniquely influenced by reconstruction technique, may provide insight into the influence of reconstruction technique on patient-reported outcomes.

Methods:
Robot-assisted measures of shoulder strength and stiffness, and five validated patient-reported outcomes surveys were obtained from 46 women who had undergone mastectomy and a combined latissimus dorsi flap plus subpectoral implant, subpectoral implant, or DIEP flap breast reconstruction. Mediation analyses examined the role of functional shoulder biomechanics as a mediator between reconstruction technique and patient-reported outcomes.

Results:
Reconstruction technique affected shoulder biomechanics, with latissimus dorsi flap plus subpectoral implant patients exhibiting reduced shoulder strength and stiffness compared with subpectoral implant and DIEP flap patients. Increasing external rotation strength was predictive of improved upper extremity function (p = 0.04). Increasing shoulder stiffness while at rest was predictive of worsened upper extremity function (p = 0.03). Increasing shoulder stiffness at rest and during contraction was indicative of worsened psychosocial well-being (all p ≤ 0.02). Reconstruction technique did not predict survey scores of function directly, or when mediated by functional shoulder biomechanics.

Conclusions:
In the current cohort, latissimus dorsi plus subpectoral implant breast reconstructions significantly reduced shoulder strength and stiffness when compared with the other techniques. In addition, objective measures of shoulder biomechanics were predictive of patient-reported physical and psychosocial well-being. The results emphasize the need for improved perioperative screening for shoulder functional deficits in patients undergoing breast reconstruction.

CLINICAL QUESITON/LEVEL OF EVIDENCE:
Therapeutic, II.
Repair of Alar Defects Using the Alar Rotation Flap: Our Experience with 394 Patients
Authors: Mitkov Mario , Griffith James , Dyson Mary , Kimyai-Asadi Arash 
Published: October 2020

Background:
The purpose of this study was for the authors to describe their patient selection, surgical technique, and results with the alar rotation flap for surgical defects of the nasal ala.

Methods:
The authors performed a retrospective analysis of all alar rotation flaps performed between June of 2006 and February of 2019. Three hundred ninety-four patients were identified, and follow-up encounters were reviewed to assess for complications and need for revision procedures.

Results:
The alar rotation flap was performed on 394 patients over a 13-year period. The mean defect size was 9.3 ± 2.8 mm by 7.2 ± 2.3 mm. Three hundred nineteen patients (81 percent) were evaluated postoperatively, with a mean average duration of follow-up of 2.3 years (range, 6 days to 11.9 years). Complications included hemorrhagic crust along the incision line [n = 9 (3 percent)], flap edema [n = 7 (2 percent)], internal nasal valve dysfunction [n = 3 (1 percent)], depressed surgical scar [n = 2 (1 percent)], hematoma [n = 1 (0.5 percent)], and paresthesia [n = 1 (0.5 percent)].

Conclusion:
The alar rotation flap is a reliable one-stage flap for small- to medium-size partial-thickness defects of the nasal ala that can produce topographic restoration with minimal risk of aesthetic or functional complication.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, IV.
The role of new antimicrobials for Gram-negative infections in daily clinical practice
Authors: Bassetti Matteo , Vena Antonio , Battaglini Denise , Pelosi Paolo , Giacobbe Daniele Roberto 
Published: October 2020

Purpose of review
To discuss a possible clinical reasoning for treating resistant Gram-negative bacteria (GNB) infections in daily clinical practice, as well as developing a research agenda for the field.

Recent findings
Novel agents, both belonging to β-lactams and to other classes of antimicrobials, have recently become available, likely replacing polymyxins or polymyxin-based combination regimens as the preferred choices for the first-line treatment of severe resistant GNB infections in the near future.

Summary
The peculiar characteristics of novel agents for severe resistant GNB infections have abruptly made the structure of previous therapeutic algorithms somewhat obsolete, in view of the differential activity of most of them against different classes of carbapenemases. Furthermore, other agents showing activity against resistant GNB are in late phase of clinical development. Optimizing the use of novel agents in order both to guarantee the best available treatment to patients and to delay the emergence and spread of resistance is an important task that cannot be postponed, especially considering the unavailability of well tolerated and fully efficacious options for treating resistant GNB infections that we faced in the last 15 years.
Relationship of Bladder Pain With Clinical and Urinary Markers of Neuroinflammation in Women With Urinary Urgency Without Urinary Incontinence
Authors: Soriano Alex , Andy Uduak , Hassani Daisy , Whitmore Kristene , Harvie Heidi , Malykhina Anna P. , Arya Lily 
Published: October 2020

Purpose
The pathogenesis of bladder pain is poorly understood. Our hypothesis is that in women with urinary urgency without incontinence, bladder pain is associated with the presence of neurogenic inflammation in the bladder wall and neuroinflammatory biomarkers in the urine.

Methods
We conducted a prospective cross-sectional study of women with urinary urgency without incontinence. Urinary symptoms were measured using Female Genitourinary Pain Index. Neuropathic pain, a clinical biomarker of neuroinflammation, was measured using the PainDETECT questionnaire. Inflammatory neuropeptides measured in the urine included nerve growth factor (NGF), brain-derived neurotrophic factor, vascular endothelial growth factor, and osteopontin. Neuropathic pain scores and urinary neuropeptide levels were compared between patients with and without bladder pain using univariable and multivariable analyses.

Results
In 101 women with urinary urgency without incontinence, 62 (61%) were in the bladder pain group (visual analog scale score, ≤ 3), whereas 39 (39%) were in the no bladder pain group. Urinary symptom scores (5.0 ± 3.1 versus 3.5 ± 2.4, P < 0.001) and neuropathic pain scores (13.3 ± 8.6 vs 5.1 ± 4.8, P < 0.001) were significantly higher for the bladder pain group than for the no bladder pain group. On multivariable analysis after controlling for age, body mass index, and severity of urinary urgency, bladder pain score was significantly associated with elevated urinary levels of vascular endothelial growth factor (P = 0.04) and osteopontin (P = 0.02), whereas the neuropathic pain score was significantly associated with an increased NGF level (P = 0.03).

Conclusions
In women with urinary urgency without incontinence, bladder pain is associated with the presence of clinical and urinary biomarkers of neuroinflammation.