bluuebunny/crossref_metadata_2025_split huggingface dataset:
749 Is daytime sleepiness a risk factor for depression and the prevalence of depression in patients with EDS referred for PSG
Authors: Pervaiz Hassan , Roth Heidi , Vaughn Bradley 
Published: May 2021

Abstract

Introduction
Excessive daytime sleepiness affects 18.9–27% of the general population. [1] Patients with excessive daytime sleepiness have a higher prevalence of major depressive episodes. [2] Depression is also associated with poor medical compliance which may further affect management of excessive day time sleepiness. [3] We therefore are interested in the prevalence of depression in patients undergoing in-lab testing for excessive sleepiness and the association of positive depression screening.

Methods
Retrospective review of diagnostic polysomnograms (PSG) in a tertiary care facility was conducted on patients over 18 years of age. The elements collected include: gender, age, BMI, Depression scale defined by PHQ-9, EDS defined by Epworth’s Sleepiness scale, AHI = Apnea Hypopnea Index, PLMS = Periodic Limb Movements in Sleep.

Results
There were a total of 32 subjects. Median age was 49 with 43% male and average BMI of 35. The mean PHQ-9 score was 5.8. The mean Epworth score was 8.5. The correlation of the two values was r= 0.078. 12 patients are classified as having EDS. 7 patients (58.3%) in the EDS group were positive for depression screen. 18 patients (90%) without EDS were positive for depression screen. There is no statistical difference 2 groups (58.3% vs 90%, p=1). The mean PHQ-9 score in EDS group is 5.5. The mean PHQ-9 score in non EDS group is 5.95. There is no statistical difference between 2 groups PHQ-9(5.5 vs 5.95, p=0.779).

Conclusion
Our study cohort did not find a correlation between subjective sleepiness and depression in individuals presenting for in lab polysomnography. This may be related to the sample size or be an indication that many other factors contribute to the sleepiness in this cohort.

Support (if any)
1. Hein M. et al (2019) Prevalence and risk factors of excessive daytime sleepiness in major depression: A study with 703 individuals referred for polysomnography. J Affect Disord. 2. Chellappa SL. et al (2006) Excessive daytime sleepiness in patients with depressive disorder. Braz J Psychiatry. 3. Grenard JL et al (2011) Depression and medication adherence in the treatment of chronic diseases in the United States: a meta-analysis. J Gen Intern Med
770 Does Improving Sleep Lead to Better Mental Health? A Meta-Analysis of Randomised Controlled Trials
Authors: Scott Alexander 
Published: May 2021

Abstract

Introduction
Sleep and mental health go hand-in-hand; however, the extent to which sleep is causally related to the experience of mental health difficulties is unclear. One way to test whether there is a causal link is to evaluate the extent to which interventions that improve sleep also improve mental health over time.

Methods
We conducted a systematic review and meta-analysis of 54 randomised controlled trials (N = 6,876) that reported the effects of interventions that successfully improved sleep on overall composite mental health, as well as on six specific mental health difficulties including depression, anxiety, stress, psychosis spectrum experiences, suicidal ideation, and PTSD.

Results
Improving sleep had a medium-sized effect on composite mental health (g+ = -0.47), and depression (g+ = -0.54), small-to-medium sized effects on anxiety (g+ = -0.40), and stress (g+ = -0.42), and small effects on positive psychosis spectrum experiences (g+ = -0.26). We also found a significant dose response relationship, in that greater improvements in sleep were associated with greater improvements in composite mental health.

Conclusion
Taken together, the findings suggest that sleep is causally related to the experience of mental health difficulties. Improving sleep leads to better mental health, especially for experiences of depression, anxiety, and stress. Future research might profitably consider how interventions that improve sleep be better incorporated into routine mental health care, as well as the possible mechanisms of action that might explain how sleep exerts its effects on mental health.

Support (if any)
This research was funded by the National Institute for Health Research (NIHR) under its Research for Patient Benefit (RfPB) Programme (Grant Reference Number PB-PG- 0817-20027). The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care.
803 Sleep Disturbances in Patients with Frontotemporal Dementia
Authors: Walker Nathan , Vaughn Bradley 
Published: May 2021

Abstract

Introduction
Frontotemporal dementia (FTD) is a degenerative process and,as the name implies, involves the frontal and temporal lobes of the brain. Patients with FTD make up 10–15% of all cases of dementia and 20% diagnosed before age 65, however not much is reported about sleep disturbances in these patients. Given the area of neuronal loss one would expect that sleep may be influenced early and by issues in arousal mechanisms and in breathing pattern. This study examined the polysomnography (PSG) reports of patients with a diagnosis FTD.

Methods
A retrospective chart review was performed to identify patients with both a diagnosis of FTD and having undergone a PSG. 23 patients were identified as fulfilling both requirements. Data recorded included, diagnosis, age at time of PSG, Epworth sleepiness scale (ESS), total sleep time (TST), wake after sleep onset (WASO), sleep latency (SL), REM sleep latency, sleep efficiency (SE), percentage of stage N1, N2, N3, and REM sleep, apnea-hypopnea index (AHI), presence of Cheyne-Stoke breathing, periodic limb movement index, and presence of REM without atonia.

Results
Patient age ranged from 57–85 years. Average ESS was 8.8 with only 5 patients reported excessive daytime sleepiness(as assessed by ESS). The average TST was 290 minutes, average SL was 37.9 minutes, average WASO was 147.5 minutes, and average sleep efficiency was 60.3%. Patients spent the majority of time in N2 sleep with an average of 68.3% of the time spent in N2. The average time spent in N3 was 9.6% of sleep. 8.9% of sleep was spent in REM. 83% of patients were diagnosed with sleep apnea (as defined by an AHI &gt; 5), with an average AHI of 20.2 events/hour. Cheyne-Stokes breathing was only noted in 4 of the 23 patients, or 17%. Periodic limb movements of sleep were noted in 48% of the patients (n=11). REM without atonia or RBD was not noted for any patients.

Conclusion
This study shows that patients with FTD suffer from typical sleep disturbances, however there is a high prevalence of sleep apnea as well as PLMS. In addition, patients with FTD have decreased sleep efficiency with increased WASO.
Support (if any):
819 A RARE CASE OF RESPIRATORY SENSE LEAD DYSFUNCTION IN A PATIENT WITH A HYPOGLOSSAL NERVE STIMULATOR
Authors: Toolsie Omesh , Zacharias Rajesh , Oster Joel , Ostrow Peter , Schumaker Greg , Wein Richard , Grover Aarti 
Published: May 2021

Abstract

Introduction
In patients with moderate to severe obstructive sleep apnea (OSA) who are intolerant to PAP therapy, hypoglossal nerve stimulation (HGNS) is being increasingly considered as alternative treatment. Implantation involves placing cuff electrodes on inclusion branches of the hypoglossal nerve and a respiratory effort-sensing lead which is placed between the right intercostal muscle layers. These are connected to the implantable pulse generator which usually sits in a right infraclavicular pocket.

Report of case(s)
A 49-year-old male with severe OSA (AHI 30.8/hour) was implanted with a HGNS two years ago with successful activation a month later. He successfully up titrated his amplitude to the maximum stimulation level within his set range (0.9v – 1.7v). He underwent HGNS titration with AHI reduction to 13.9/hour at 2.1 volts and given a new higher range of 1.5 to 2.5 volts. This was accompanied by reduction in snoring, witnessed apneas and associated arousals with more consolidated sleep and improvement in his Epworth sleepiness score to 3 from 12 as noted prior to HGNS. The patient continued to up titrate over the next six months within his new range to 2.4 volts, when he reported increased sensitivity and intolerance at every stimulation level with recurrence of snoring and daytime sleepiness. He underwent interrogation of his device with subsequent awake endoscopy and change to his electrode configuration with a new lower range of 1.0 to 2.0 volts. However, he continued to have the same complaints. A second interrogation revealed increased impedance within the circuit of the respiratory sensing lead which was reproducible. The patient underwent sensing lead replacement in the operating room. He has since been able to increase stimulation levels without complaints and improvement in his OSA symptoms and is scheduled to have a follow-up hone sleep test (HST).

Conclusion
This case illustrates the importance of a structured approach in the evaluation of a reduced tolerance to HGNS. This includes assessing adherence, interrogation of the device’s circuitry, evaluating electrode configurations, stimulation thresholds with consideration for awake endoscopy. Repeating this process may be necessary to detect rare or delayed mechanical problems that may occur over time with HGNS.
Support (if any):
Biological and molecular characterization of linalool-mediated field resistance against Xanthomonas citri subsp. citri in citrus trees
Authors: Shimada Takehiko , Endo Tomoko , Fujii Hiroshi , Rodríguez Ana , Yoshioka Terutaka , Peña Leandro , Omura Mitsuo 
Published: April 2021

Abstract
The biological and molecular traits of the Ponkan mandarin (Citrus reticulata Blanco) were characterized in an investigation of the mechanisms of field resistance against citrus canker disease caused by the bacterial pathogen, Xanthomonas citri subsp. citri (Xcc). Various conventional citrus varieties that show diverse responses to Xcc were investigated, and the temporal changes in Xcc titer in response to linalool concentrations among the varieties revealed differences in Xcc proliferation trends in the inoculated leaves of the immune, field-resistant and susceptible varieties. In addition, increased linalool accumulation was inversely related to Xcc titers in the field-resistant varieties, which is likely caused by host--pathogen interactions. Quantitative trait locus (QTL) analysis using the F1 population of the resistant Ponkan mandarin and susceptible ‘Harehime’ (‘E-647’ × ‘Miyagawa-wase’) cultivar revealed that linalool accumulation and Xcc susceptibility QTLs overlapped. These results provide novel insights into the molecular mechanisms of linalool-mediated field resistance to Xcc, and suggest that high linalool concentrations in leaves has an antibacterial effect and becomes a candidate-biomarker target for citrus breeding to produce seedlings with linalool-mediated field resistance against Xcc.
RNA in situ hybridization and expression of related genes regulating the accumulation of triterpenoids in Cyclocarya paliurus
Authors: Chen Xiaoling , Chen Biqin , Shang Xulan , Fang Shengzuo 
Published: April 2021

Abstract
Cyclocarya paliurus (Batal.) Iljinskaja, a woody medicinal species in the Juglandaceae, grows extensively in subtropical areas of China. Triterpenoids in the leaves have health-promoting effects, including hypoglycemic and hypolipidemic activities. To understand triterpenoid biosynthesis, transport and accumulation in C. paliurus during the growing season, gene cloning, gene expression and RNA in situ hybridization of related genes were used, and accumulation was examined in various organs. The complete coding sequences (CDSs) of three genes, CpHMGR, CpDXR and CpSQS, were obtained from GenBank and RACE. RNA in situ hybridization signals of the three genes mainly occurred in the epidermis, palisade tissue, phloem and xylem of leaf, shoot and root, with the signals generally consistent with the accumulation of metabolites in tissues, except in the xylem. Both gene expression and triterpenoid accumulations showed seasonal variations in all organs. However, total triterpenoid content in the leaves was significantly higher than that in the shoots, with the maximum in shoots in August and in leaves in October. According to Pearson correlation analysis, triterpenoid accumulation in the leaves was significantly positively related with the relative expression of CpSQS. However, the relation between gene expression and accumulation was dependent on the role of the gene in the pathway as well as on the plant organ. The results suggested that most of the intermediates catalyzed by CpHMGR and CpDXR in young shoots and roots were used in growth and flowering in the spring, whereas subsequent triterpenoid biosynthesis in the downstream catalyzed by CpSQS mainly occurred in the leaves by using transferred and in situ intermediates as substrates. Thus, this study provides a reference to improve triterpenoid accumulation in future C. paliurus plantations.
Developing a Social Determinants of Learning™ Framework: A Case Study
Authors: Sanderson Carla D. , Hollinger-Smith Linda M. , Cox Karen 
Published: May 2021

Abstract

AIM
The aim of the study was to propose a framework, social determinants of learning™ (SDOL™), an actionable model to address learning disparities and expand learning opportunities to support nursing student diversity, equity, and inclusion.

BACKGROUND
There is significant growth in the racial and ethnic diversity across students at all levels of higher education, mirroring the growing diversity of the US population. Yet, lower rates of persistence and higher attrition rates among these student groups continue.

METHOD
The authors established six socially imposed forces, causative domains, as foundational to the SDOL framework. Key attributes of each domain were identified through a literature search. A case study illustrates an initial study of interventions targeting specific domains of the framework aimed toward student success.

CONCLUSION
Equitable education for all has far-reaching implications across nursing education and higher education in general. Further development and testing of the SDOL framework will support the goal of equitable education for all.
Educating Nursing Students About Delivering Culturally Sensitive Care to Lesbian, Gay, Bisexual, Transgender, Questioning/Queer, Intersex, Plus Patients: The Impact of an Advocacy Program on Knowledge and Attitudes
Authors: Tartavoulle Todd , Landry Jessica 
Published: May 2021

Abstract

AIM
This study evaluated the effects of a program designed to help students provide culturally competent care for lesbian, gay, bisexual, transgender, questioning/queer, intersex, plus (LGBTQI+) patients.

BACKGROUND
The LGBTQI+ community faces disparities linked to stigma and discrimination. The Advocacy™ Program was developed to supplement the curriculum in schools of nursing.

METHOD
Nursing students from six schools of nursing (n = 1,398) received advocacy training. Students were administered the Genderism and Transphobia Scale, the Homonegativity Scale, and additional knowledge questions before and after training.

RESULTS
The findings were positive, indicating an increase in student attitude scores, vocabulary and disparity knowledge, and knowledge regarding care for an LGBTQI+ client (p < .05).

CONCLUSION
By building a culture of inclusion through recognition of diverse patients in the curriculum, nursing schools can develop a culture of connection that strengthens patient-provider relationships and improves mental and physical health.
Feeding Practices and Effects on Transfusion-Associated Necrotizing Enterocolitis in Premature Neonates
Authors: Killion Emma 
Published: May 2021

Background:
Red blood cell (RBC) transfusions have been implicated in the development of necrotizing enterocolitis (NEC) in premature infants. Some evidence exists to support that withholding feedings during transfusion reduces the risk of subsequent NEC development.

Purpose:
To review the most recent literature on this topic to determine best evidence-based practice regarding withholding or not withholding feedings during RBC transfusions.

Methods/Search Strategy:
Four databases were searched using keywords and MeSH terms including “necrotizing enterocolitis,” “NEC,” “NPO,” and “transfusion,” with specifications limiting the search to articles published in the last 10 years and limiting the population to neonates.

Findings:
Four studies did not demonstrate a reduction in transfusion-associated necrotizing enterocolitis (TANEC) with the implementation of feeding protocols during packed red blood cell (PRBC) transfusions. One study concluded that it could not confirm the benefit of withholding feeds during transfusion to reduce the risk of TANEC. A 2020 randomized controlled trial (RCT) found no difference in splanchnic oxygenation when enteral feeds are withheld, continued, or restricted during a PRBC transfusion. Holding feedings during PRBC transfusions did not result in adverse nutritional outcomes.

Implications for Practice:
To determine best evidence-based practice surrounding feeding protocols during RBC transfusions in very low-birth-weight and premature infants less than 37 weeks' gestation.

Implications for Research:
It is recommended that large, multicentered, adequately powered RCTs be conducted in this area. Individual institutions should standardize their practice to improve quality, safety, and patient outcomes.
Pedicled fibular graft in knee-sparing tumor resection surgery: a retrospective case series
Authors: Badawey Mohamed Youness , Ebeid Walid , Salah Eldeen Mostafa , Elshamly Ibrahim Khairy , Hayyawi Fahad Abdulazeez , Abosenna Wesam 
Published: May 2021

Background:
Several viable options have been discussed in the literature for management of bone defects that result from resection of proximal tibial sarcomas. Pedicled vascularized fibular graft alone as a reconstructive technique can be considered as an alternative method that needs to be evaluated regarding adequacy, safety, and applicability for these situations.

Methods:
This is a retrospective case series study of 23 patients (14 male and nine female) aged from 7 yr to 40 yr with proximal tibial sarcomas that were managed from 1999 through 2017 by a knee-sparing limb salvage technique. Routine clinical and radiographic examinations were performed with histopathologic diagnosis that found 16 patients who had conventional osteosarcoma, three patients who had parosteal osteosarcoma, three patients who had Ewing sarcoma, and one patient who had fibrosarcoma. One patient had initial lung metastasis.

Results:
The average functional score from the revised Musculoskeletal Tumor Society rating scale (MSTS) was 26 (86.6%). Local recurrence occurred in two patients who were managed by amputation. Overall survival in our study was 91.4% with mortality of two patients.

Conclusions:
Pedicled vascularized fibular graft alone as a novel reconstructive technique after knee-sparing limb salvage surgery for juxtaarticular proximal tibial sarcoma is an effective technique with overall good oncologic and functional results.

Level of Evidence:
Level IV
Results of fixed-angle device fixation (dynamic hip screw) in femoral neck fractures in young adults: a prospective study of 20 cases
Authors: Beder Fady Kamal , El-Hamalawy Ahmed Goda , Abdel-Kader Khaled F.M. , Abdelmoneim Mohamed A. 
Published: May 2021

Background:
Femoral neck fractures constitute nearly half of the fractures of the hip. In young patients, hip preservation is advocated. Multiple cannulated screws and dynamic hip screws (DHS) are the preferred modalities. DHS gives better antirotational stability and fixation in femoral neck fractures. The purpose of this study was to assess functional outcomes after fixation of femoral neck fractures using DHS.

Methods:
A prospective case series study of 20 patients with femoral neck fracture were treated with DHS fixation. Exclusion criteria were patients with pathologic fractures, same-side shaft femoral fractures, skeletally immature patients, and those who were using walking aids before injury. Outcome was assessed by Harris Hip Score (HHS) and by radiographs at 3 and 6 mo.

Results:
The mean age at presentation was (38.5) years. Union was achieved in 19 patients (95%). The mean follow-up period was 7.13 months with a minimum of 6 mo for all patients included. There was a significant difference in nonunion rates if the tip-apex distance was more than 25 mm. Mean HHS at 6-month follow-up was 87.50 with a standard deviation±11.318.

Conclusions:
DHS results in better functional outcome with lower complication rates in transcervical and vertical shear femoral neck fractures in young adults.

Level of Evidence:
Level IV
An unusual presentation of osteosarcoma in the proximal femur with peculiar diagnostic characteristics: a retrospective series
Authors: Jamshidi Khodamorad , Zandrahimi Farshad , Bagherifard Abolfazl , Mohammadi Fatemeh , Mirzaei Alireza 
Published: May 2021

Background:
Diagnosis of osteosarcoma in the proximal femur is challenging because of its atypical features. Hence, further characterization of the tumors of this location is necessary. In this study, we evaluated the characteristic features and outcomes of osteosarcoma in the proximal femur.

Methods:
Fifteen patients with proximal femoral osteosarcoma proximal to the intertrochanteric region were evaluated. The demographic, clinical, and radiologic characteristics of the patients were investigated. A modified Lodwick-Madewell system was used for the classification of the osteolysis pattern.

Results:
From a total of the 446 patients who had osteosarcoma, 24(5.4%) were identified in the proximal femur. The main clinical symptom was pain without mass. The osteolysis pattern was ill-defined in 10, “moth-eaten” in three, change of margin in one, and well-defined without sclerotic rim in one patient. Bone matrix mineralization was present in nine patients, which was in osteoid form in seven patients and in calcified form in two patients. Cortical destruction was seen in six patients. Peripheral edema and joint effusion were identified in nine and seven, respectively, out of 12 patients who had an MRI. Soft-tissue component and periosteal reaction were not seen in any patient. At a mean follow-up of 7.3 yr, four patients were deceased.

Conclusions:
Osteosarcoma of the proximal femur generally presents without classical features. Most notably, the tumor almost never has an extraosseous tumor mass. Therefore, the absence of an extraosseous component does not preclude the diagnosis of osteosarcoma in the femoral neck.

Level of Evidence:
Level IV.