bluuebunny/crossref_metadata_2025_split huggingface dataset:
African histoplasmosis of the penis
Authors: Darré Tchin , Kpatcha Matchonna , Djiwa Toukilnan , Sewa Edoé , Dorkenoo Améyo Monique , Kouyaté Mouhamed , Napo-Koura Gado 
Published: June 2020

Abstract
African Histoplasmosis is deep mycosis caused by Histoplasma duboisii and genitourinary involvement is extremely rare. We report a case of African histoplasmosis in a 27-year-old subject with painful penis ulcer. Ulcer edge biopsy had revealed inflammatory granulomas made of epithelioid cells, lymphoplasmocytes, polynuclear eosinophils and giant multinucleated cells, with ovoid yeasts surrounded by a clear halo. PAS and Grocott stains revealed numerous fungal structures with a morphology measuring 7 to 15 nm. The diagnosis Histoplasma capsulatum var. duboisii was placed and the patient put on itraconazole (400 mg/day) for six months with a good course. African histoplasmosis of the subject penis is an extremely rare entity. The diagnosis of certainty often makes use of histology and mycological examination, and makes it possible to eliminate differential diagnoses such as cryptoccocosis, tuberculosis or cancer.
A Human-Specific Schizophrenia Risk Tandem Repeat Affects Alternative Splicing of a Human-Unique Isoform AS3MTd2d3 and Mushroom Dendritic Spine Density
Authors: Cai Xin , Yang Zhi-Hui , Li Hui-Juan , Xiao Xiao , Li Ming , Chang Hong 
Published: June 2020

Abstract
Recent advances in functional genomics have facilitated the identification of multiple genes and isoforms associated with the genetic risk of schizophrenia, yet the causal variations remain largely unclear. A previous study reported that the schizophrenia risk single-nucleotide polymorphism (SNP) rs7085104 at 10q24.32 was in high linkage disequilibrium (LD) with a human-specific variable number of tandem repeat (VNTR), and both were significantly associated with the brain mRNA expression of a human-unique AS3MTd2d3 isoform in Europeans and African Americans. In this study, we have shown the direct regulation of the AS3MTd2d3 mRNA expression by this VNTR through an in vitro minigene splicing assay, suggesting that it is likely a causative functional variation. Intriguingly, we have further confirmed that the VNTR and rs7085104 are significantly associated with AS3MTd2d3 mRNA expression in brains of Han Chinese donors, and rs7085104 is also associated with risk of schizophrenia in East Asians. Finally, the overexpression of AS3MTd2d3 in cultured primary hippocampal neurons results in significantly reduced densities of mushroom dendritic spines, implicating its potential functional impact. Considering the crucial roles of dendritic spines in neuroplasticity, these results reveal the potential regulatory impact of the schizophrenia risk VNTR on AS3MTd2d3 and provide insights into the underlying biological mechanisms.
The impact of porcine spray-dried plasma protein and dried egg protein harvested from hyper-immunized hens, provided in the presence or absence of subtherapeutic levels of antibiotics in the feed, on growth and indicators of intestinal function and physiology of nursery pigs
Authors: Ruckman Leigh A , Petry Amy L , Gould Stacie A , Patience John F 
Published: June 2020

AbstractThe objective of this experiment was to compare the effects of spray-dried plasma protein (SDPP) and dried egg protein (DEP), without (AB−) or with (AB+) in-feed antibiotics, on growth performance and markers of intestinal health in nursery pigs raised in commercial conditions. This 42-d experiment utilized 1,230 pigs (4.93 ± 0.04 kg body weight; approximately 15–18 d of age). Pigs were randomly assigned to one of six dietary treatments that were arranged as a 2 × 3 factorial of in-feed antibiotics (AB− vs. AB+) and a specialty protein additive (none [CON], porcine SDPP, or DEP). Diets were fed in four phases with phases 3 and 4 as a common diet across all treatments. Specialty protein additives were fed in phases 1 (0–13 d; 3% SDPP, and 0.20% DEP) and 2 (13–26 d; 2% SDPP, and 0.10% DEP). Antibiotics were fed in phases 1–3 (662 mg chlortetracycline [CTC]/kg, 28 mg carbadox/kg, and 441 mg CTC/kg, respectively). Ileal tissue and blood samples were collected from 48 pigs (8 per treatment) on d 20. Data were analyzed using PROC MIXED of SAS (9.4) with pen as the experimental unit; protein additives, antibiotics, and their interaction were fixed effects and block was a random effect. The pigs experienced naturally occurring health challenges in weeks 2 and 4. In the AB− diets, SDPP and DEP increased average daily gain (ADG; P = 0.036) and average daily feed intake (ADFI; P = 0.040) compared to CON; in the AB+ diets, neither SDPP nor DEP increased ADG or ADFI compared to CON but SDPP did increase these parameters over DEP. The SDPP and DEP diets decreased the number of individual medical treatments compared to CON (P = 0.001). The AB+ increased ileal mucosal interleukin (IL)-1 receptor antagonist (P = 0.017). Feeding DEP reduced the concentration of mucosal IL-1β compared to CON, but not SDPP (P = 0.022). There was a trend for SDPP and DEP to increase villus height:crypt depth compared to CON (P = 0.066). Neither antibiotics or protein additive affected serum malondialdehyde concentration or ileal mRNA abundance of claudin-3 or 4, occludin, or zonula occludens-1 (P &gt; 0.10). In conclusion, SDPP and DEP improved growth performance of weaned pigs in the absence of antibiotics but neither improved growth compared to CON when feeding standard antibiotic levels. The specialty proteins had a positive effect on health; specialty proteins and antibiotics were able to modulate some markers of intestinal inflammation and morphology.
Mechanical Ventilation Strategy Guided by Transpulmonary Pressure in Severe Acute Respiratory Distress Syndrome Treated With Venovenous Extracorporeal Membrane Oxygenation
Authors: Wang Rui , Sun Bing , Li Xuyan , Tang Xiao , He Hangyong , Li Ying , Yuan Xue , Li Haichao , Chu Huiwen , Tong Zhaohui 
Published: June 2020

Objectives:
Previous studies have suggested that adjusting ventilator settings based on transpulmonary pressure measurements may minimize ventilator-induced lung injury, but this has never been investigated in patients with severe acute respiratory distress syndrome supported with venovenous extracorporeal membrane oxygenation. We aimed to evaluate whether a transpulmonary pressure-guided ventilation strategy would increase the proportion of patients successfully weaned from venovenous extracorporeal membrane oxygenation support in patients with severe acute respiratory distress syndrome.

Design:
Single-center, prospective, randomized controlled trial.

Setting:
Sixteen-bed, respiratory ICU at a tertiary academic medical center.

Patients:
Severe acute respiratory distress syndrome patients receiving venovenous extracorporeal membrane oxygenation.

Interventions:
One-hundred four patients were randomized to transpulmonary pressure-guided ventilation group (n = 52) or lung rest strategy group (n = 52) groups. Two patients had cardiac arrest during establishment of venovenous extracorporeal membrane oxygenation in the lung rest group did not receive the assigned intervention. Thus, 102 patients were included in the analysis.

Measurements and Main Results:
The proportion of patients successfully weaned from venovenous extracorporeal membrane oxygenation in the transpulmonary pressure-guided group was significantly higher than that in the lung rest group (71.2% vs 48.0%; p = 0.017). Compared with the lung rest group, driving pressure, tidal volumes, and mechanical power were significantly lower, and positive end-expiratory pressure was significantly higher, in the transpulmonary pressure-guided group during venovenous extracorporeal membrane oxygenation support. In the transpulmonary pressure-guided group, levels of interleukin-1β, interleukin-6, and interleukin-8 were significantly lower, and interleukin-10 was significantly higher, than those of the lung rest group over time. Lung density was significantly lower in the transpulmonary pressure-guided group after venovenous extracorporeal membrane oxygenation support than in the lung rest group.

Conclusions:
A transpulmonary pressure-guided ventilation strategy could increase the proportion of patients with severe acute respiratory distress syndrome successfully weaned from venovenous extracorporeal membrane oxygenation.
Rates of Venous Thromboembolism and Central Line-Associated Bloodstream Infections Among Types of Central Venous Access Devices in Critically Ill Children*
Authors: Patel Nital , Petersen Tara L. , Simpson Pippa M. , Feng Mingen , Hanson Sheila J. 
Published: June 2020

Objectives:
Central venous access devices, including peripherally inserted central catheters and central venous catheters, are often needed in critically ill patients, but also are associated with complications, including central-line associated bloodstream infections and venous thromboembolism. We compared different central venous access device types and these complications in the PICU.

Design:
Multicenter, cohort study.

Setting:
One hundred forty-eight participating Virtual PICU Systems, LLC, hospital PICU sites.

Patients:
Pediatric patients with central venous access placed from January 1, 2010, to December 31, 2015.

Interventions:
None.

Measurements and Main Results:
Patient and central venous access device variables postulated to be associated with central-line associated bloodstream infection and venous thromboembolism were included. Data were analyzed using Pearson chi-square test or Fisher exact test for categorical variables, Mann-Whitney U test for continuous variables, and logistic regression and classification trees for multivariable analysis that examined significant predictors of venous thromboembolism or central-line associated bloodstream infection. Analysis included 74,196 first lines including 4,493 peripherally inserted central catheters and 66,194 central venous catheters. An increased rate of venous thromboembolism (peripherally inserted central catheter: 0.93%, central venous catheter: 0.52%; p = 0.001) (peripherally inserted central catheter: 8.65/1,000 line days, central venous catheter: 6.29/1,000 line days) and central-line associated bloodstream infection (peripherally inserted central catheter: 0.73%, central venous catheter: 0.24%; p = 0.001) (peripherally inserted central catheter: 10.82/1,000 line days, central venous catheter: 4.97/1,000 line days) occurred in peripherally inserted central catheters. In multivariable analysis, central venous catheters had decreased association with central-line associated bloodstream infection (odds ratio, 0.505; 95% CI, 0.336–0.759; p = 0.001) and venous thromboembolism (odds ratio, 0.569; 95% CI, 0.330–0.982; p = 0.043) compared with peripherally inserted central catheters.

Conclusions:
Peripherally inserted central catheters are associated with higher rates of central-line associated bloodstream infection and venous thromboembolism than central venous catheters in children admitted to the PICU.
Clinical Features of Coronavirus Disease 2019 Patients With Mechanical Ventilation: A Nationwide Study in China*
Authors: Wang Tao , Tang Chunli , Chen Ruchong , Ruan Honglian , Liang Wenhua , Guan Weijie , Sang Ling , Tang Ruidi , Zhong Nanshan , Li Shiyue 
Published: June 2020

Objectives:
The outbreak of coronavirus disease 2019 is becoming a worldwide pandemic. Mechanical ventilation is lifesaving for respiratory distress, this study was designed to delineate the clinical features of the coronavirus disease 2019 patients with mechanical ventilation from a national cohort in China.

Design:
Prospective observational study.

Setting:
The rapid spread of severe acute respiratory syndrome coronavirus 2 has infected more than 7.7 million people and caused more than 423,000 deaths.

Patients:
Adult hospitalized coronavirus disease 2019 patients with mechanical ventilation from 557 hospitals from China.

Interventions:
None.

Measurements and Main Results:
From a nationwide cohort, 141 coronavirus disease 2019 cases with mechanical ventilation were extracted from 1,590 cases. Cigarette smoke, advanced age, coexisting chronic illness, elevated systolic blood pressure, high body temperature, and abnormal laboratory findings are common in these ventilated cases. Multivariate regression analysis showed that higher odds of in-hospital death was associated with invasive mechanical ventilation requirement (hazard ratio: 2.95; 95% CI, 1.40–6.23; p = 0.005), and coexisting chronic obstructive pulmonary disease (hazard ratio, 4.57; 95% CI, 1.65–12.69; p = 0.004) and chronic renal disease (hazard ratio, 5.45; 95% CI, 1.85–16.12; p = 0.002). Compared with patients with noninvasive mechanical ventilation, patients who needs invasive mechanical ventilation showed higher rate of elevated d-dimer (> 1.5 mg/L) at admission (hazard ratio, 3.28, 95% CI, 1.07–10.10; p = 0.039).

Conclusions:
The potential risk factors of elevated d-dimer level could help clinicians to identify invasive mechanical ventilation requirement at an early stage, and coexisting chronic obstructive pulmonary disease or chronic renal disease are independent risk factors associated with fatal outcome in coronavirus disease 2019 patients with mechanical ventilation.
A Randomized Comparative Trial to Evaluate a PICU Navigator-Based Parent Support Intervention
Authors: Michelson Kelly N. , Frader Joel , Charleston Elizabeth , Rychlik Karen , Aniciete Danica Y. , Ciolino Jody D. , Sorce Lauren R. , Clayman Marla L. , Brown Melanie , Fragen Patricia , Malakooti Marcelo , Derrington Sabrina , White Douglas ,   on behalf of The Navigate Study Investigators
Published: June 2020

Objectives:
Communication breakdowns in PICUs contribute to inadequate parent support and poor post-PICU parent outcomes. No interventions supporting communication have demonstrated improvements in parental satisfaction or psychologic morbidity. We compared parent-reported outcomes from parents receiving a navigator-based parent support intervention (PICU Supports) with those from parents receiving an informational brochure.

Design:
Patient-level, randomized trial.

Setting:
Two university-based, tertiary-care children’s hospital PICUs.

Participants:
Parents of patients requiring more than 24 hours in the PICU.

Interventions:
PICU Supports included adding a trained navigator to the patient’s healthcare team. Trained navigators met with parents and team members to assess and address communication, decision-making, emotional, informational, and discharge or end-of-life care needs; offered weekly family meetings; and did a post-PICU discharge parent check-in. The comparator arm received an informational brochure providing information about PICU procedures, terms, and healthcare providers.

Measurements and Main Results:
The primary outcome was percentage of “excellent” responses to the Pediatric Family Satisfaction in the ICU 24 decision-making domain obtained 3–5 weeks following PICU discharge. Secondary outcomes included parental psychologic and physical morbidity and perceptions of team communication. We enrolled 382 families: 190 received PICU Supports, and 192 received the brochure. Fifty-seven percent (216/382) completed the 3–5 weeks post-PICU discharge survey. The mean percentage of excellent responses to the Pediatric Family Satisfaction in the ICU 24 decision-making items was 60.4% for PICU Supports versus 56.1% for the brochure (estimate, 3.57; se, 4.53; 95% CI, –5.77 to 12.90; p = 0.44). Differences in secondary outcomes were not statistically significant. Most parents (91.1%; 113/124) described PICU Supports as “extremely” or “somewhat” helpful.

Conclusions:
Parents who received PICU Supports rated the intervention positively. Differences in decision-making satisfaction scores between those receiving PICU Supports and a brochure were not statistically significant. Interventions like PICU Supports should be evaluated in larger studies employing enhanced recruitment and retention of subjects.
Current Clinical Practice in Point-of-Care Ultrasound Use in the PICUs Across Europe
Authors: Humblet Martien H. , Singh Yogen , Tissot Cecile , De Luca Daniele , Leroy Piet L. 
Published: June 2020

Objectives:
1) To investigate the current practice in point-of-care ultrasound use in PICUs across Europe; 2) to understand the barriers for point-of-care ultrasound implementation in the clinical practice; 3) to identify existing point-of-care ultrasound training programs; and 4) to assess training needs.

Design:
Cross-sectional electronic survey.

Subjects:
Medical directors of European PICUs.

Measurements and Main Results:
The response rate was 42.3%; 142 of the 336 invited PICU medical directors from 26 European countries completed the survey. The clinicians in almost all the PICUs across Europe were reported to use point-of-care ultrasound in some form. A significant variation in the clinical practice according to the patient characteristics and presence of a fellowship training program was observed. PICUs with cardiosurgical patients reported using point-of-care ultrasound significantly more often than others. Ultrasound-guided vascular access was the most common point-of-care ultrasound indication, except in PICUs providing joint care for neonates and children. Units with a fellowship training program reported an increased use of point-of-care ultrasound for hemodynamic evaluation, during resuscitation and a positive impact on collaboration with imaging specialties. Although no barrier was deemed substantial to impede point-of-care ultrasound implementation, a number of potential hindrances to its implementation were reported—such as lack of formal training curriculum, collaborative learning opportunities, and quality assurance processes. Bedside informal teaching in point-of-care ultrasound was reported the most common method to acquire point-of-care ultrasound skills.

Conclusions:
Point-of-care ultrasound is being used extensively across heterogeneously organized PICU settings in Europe. However, there remains a significant variation in the clinical practice across the units. Clear needs for improved point-of-care ultrasound training programs and clinical governance structure were identified. Evidence-based point-of-care ultrasound guidelines, structured training programs dedicated to neonatal and pediatric intensive care settings, and educational research in point-of-care ultrasound use may help in strengthening clinical governance, making clinical practice uniform and enhancing quality assurance.
Gender and Authorship in Pediatric Critical Care Randomized Control Trials*
Authors: Xu Grace M. , Zavalkoff Samara , de Wildt Saskia N. , Duffett Mark 
Published: June 2020

Objectives:
To examine the gender distribution of authorship of pediatric critical care randomized control trials.

Data Sources:
The 415 randomized control trials in pediatric critical care published before 2019.

Study Selection:
We included all randomized control trials enrolling children in a PICU. We used PICUtrials.net, which uses comprehensive search strategies of multiple databases, to identify published randomized control trials.

Data Extraction:
We manually extracted the name and profession of each listed author from each publication and classified each author as male or female based on their name.

Results:
We included 2,146 authors and were able to classify 1,888 (88%) as men or women. Overall, 38% of authors were women, this varied with the authorship position: 37% of first, 38% of middle, and 25% of last authors were women (p < 0.001). The three most common professions were physician (63%), nonclinician (11%), and nurse (6%)—of which 30%, 45%, and 97%, respectively, were women. The percentage of female authorship overall has increased from 28% in 1985–1989 to 39% in 2015–2018 (p for trend = 0.004). There were no significant differences in the characteristics of randomized control trials published with a female first or last author versus those with both male first and last authors with respect to the median number of children randomized (60 vs. 50; p = 0.41), multicentred trials (17% vs. 24%; p = 0.12), trials at low risk of bias (50% vs. 66%; p = 0.26), reporting any funding (55% vs. 51%; p = 0.66), or median number of citations per year (1.5 vs. 2.4; p = 0.09).

Conclusions:
Although increasing over time, the percentage of researchers publishing pediatric critical care randomized control trials who are women still lags behind the percentage clinicians who are women. Trials that female researchers publish are similar in characteristics and impact as male researchers. Further work should identify barriers to gender diversity and potential solutions in pediatric critical care research.
Design and Rationale for Common Data Elements for Clinical Research in Pediatric Critical Care Medicine
Authors: Ward Shan L. , Flori Heidi R. , Bennett Tellen D. , Sapru Anil , Mourani Peter M. , Thomas Neal J. , Khemani Robinder G. 
Published: June 2020

Objectives:
Common data elements are a combination of a precisely defined question paired with a specified set of responses. Common data elements contribute to the National Institutes of Health–supported principle of Findable, Accessible, Interoperable, and Reusableness of research data. Routine use of Common data elements and standardized definitions within pediatric critical care research are likely to promote collaboration, improve quality, and consistency of data collection, improve overall efficiency of study or trial setup, and facilitate cross-study comparisons, meta-analysis, and merging of study cohorts. The purpose of this Pediatric Critical Care Medicine Perspective is to establish a road map for the development of multinational, multidisciplinary consensus–based common data elements that could be adapted for use within any pediatric critical care subject area.

Methods:
We describe a multistep process for the creation of “core domains” of research (e.g. patient outcomes, health-related conditions, or aspects of health) and the development of common data elements within each core domain. We define a tiered approach to data collection based on relevance of each common data element to future studies and clinical practice within the field of interest. Additionally, we describe the use of the Delphi methods to achieve consensus of these common data element documents using an international, multidisciplinary panel of experts.