bluuebunny/crossref_metadata_2025_split huggingface dataset:
Cyclic alternating patterns and arousals: what is relevant in obstructive sleep apnea? In Memoriam Mario Giovanni Terzano
Authors: Parrino Liborio , Rausa Francesco , Azzi Nicoletta , Pollara Irene , Mutti Carlotta 
Published: September 2021

Purpose of review
To review main knowledges and gaps in the field of sleep microstructure, represented by the cyclic alternating pattern (CAP), in obstructive sleep apnea (OSA).

Recent findings
The (electroencephalographic and autonomic) ‘intensity’ of arousals in OSA patients, measured through the metrics of CAP, correlate with OSA severity and with disease burden. Continuous positive airway pressure determines variations in sleep architecture (conventional parameters) and at the microstructural level, at different time points.

Summary
CAP is not only an ‘attractor’ of arousals, but also organizes distribution of K-complexes and delta bursts in non-rapid eye movement sleep. Although attention is always concentrated on the A-phase of CAP, a crucial role is play by the phase B, which reflects a period of transient inhibition. Respiratory events in OSA are a typical example of phase B-associated condition, as they occur during the interval between successive A-phases. Accordingly sleep microstructure provides useful insights in the pathophysiology and estimation of OSA severity and may be exploited to follow-up treatment efficacy. In the complex relationship among sleep fragmentation, excessive daytime sleepiness, cognition and cardiovascular risk the CAP framework can offer an integrative perspective in a multidisciplinary scenario.
Novel concepts in red blood cell clearance
Authors: Neri Silvia , Swinkels Dorine W. , Matlung Hanke L. , van Bruggen Robin 
Published: September 2021

Purpose of review
Red blood cell (RBC) clearance has been studied for decades in many different pathologies, which has revealed different routes of RBC degradation, depending on the situation. This review summarizes the latest mechanistic insights on RBC clearance in different contexts; during homeostatic removal, immune-mediated destruction, and systemic inflammation.

Recent findings
Besides the recognition of a variety of potential ‘eat me’ signals on RBCs, recent evidence suggests that normal RBC degradation is driven by the increase of the adhesive properties of RBCs, mediating the retention in the spleen and leading to RBC hemolysis. Furthermore, immune-mediated degradation of RBCs seems to be fine-tuned by the balance between the density of the antigens expressed on RBCs and the presence of ‘don’t eat me’ signals. Moreover, besides RBC clearance by macrophages, neutrophils seem to play a much more prominent role in immune-mediated RBC removal than anticipated. Lastly, RBC clearance during systemic inflammation appears to be driven by a combination of extreme macrophage activity in response to proinflammatory cytokines as well as direct damage of RBC by the inflammation or inflammatory agent.

Summary
Recent studies on RBC clearance have expanded our knowledge on their destruction in different contexts.
Evidence-Based Medicine in Plastic Surgery: From Then to Now
Authors: Rohrich Rod J. , Cohen Joshua M. , Savetsky Ira L. , Avashia Yash J. , Chung Kevin C. 
Published: September 2021

Summary:
Evidence-based medicine, as described by Dr. Sackett, is defined as the “conscientious, explicit, and judicious use of current best evidence, combined with individual clinical expertise and patient preferences and values, in making decisions about the care of individual patients.” In the late 2000s, seminal articles in Clinics in Plastic Surgery and Plastic and Reconstructive Surgery introduced evidence-based medicine’s role in plastic surgery and redefined varying levels of evidence. The American Society of Plastic Surgeons sponsored the Colorado Springs Evidence-Based Medicine Summit that set forth a consensus statement and action plan regarding the increased incorporation of evidence-based medicine into the field; this key meeting ushered a new era among plastic surgeons worldwide. Over the past decade, Plastic and Reconstructive Surgery has incorporated evidence-based medicine into the Journal through an increase in articles with level I and II evidence, new sections of the Journal, and the introduction of validated tools to help authors perform prospective and randomized studies that ultimately  led to best practices used today. Plastic surgery is a specialty built on problem-solving and innovation, values starkly in-line with evidence-based medicine. Evidence-based medicine is becoming more ingrained in our everyday practice and plastic surgery culture; however, we must work actively to ensure that we continue this trend. In the next decade, we will possibly see that level I and II evidence articles start to inhabit many of our journal issues.
How different is invasive fusariosis in pediatric patients than in adults? A systematic review
Authors: Rossato Luana , Carlesse Fabianne , Nobrega de Almeida João , Kontoyiannis Dimitrios P. , Colombo Arnaldo Lopes 
Published: September 2021

Purpose of review
To investigate the peculiarities of invasive fusariosis (IF) in pediatric patients.

Methods
We conducted a systematic literature review to identify human cases of locally invasive and systemic fusariosis documented in children (up to 18 years) published between 1973 (first case report) and 2021.

Recent findings
One hundred and six cases were retrieved, and hematologic malignancy was reported in 64% (68/106) of the cases. The most frequent anatomic sites involved were skin 66% (70/106), blood 47% (50/106), and lungs 35% (37/106), bone and joint (8%, 09/106), and eye/central nervous system involvement (8%, 9/106). Fusarium solani, followed by Fusarium oxysporum, were the most commonly reported species. In disseminated fusariosis, relapsed or refractory baseline disease (P < 0.001, OR=10.555, CI 95% 3.552–31.365) was associated with poor outcome, whereas voriconazole-based therapy was associated with better prognosis (P
= 0.04, OR = 0.273, CI 95% 0.076–0.978).

Summary
Hematologic malignancies and solid tumors requiring intensive immunosuppression are the main conditions related to IF in children where other organs than skin, blood, and lungs were frequently involved. Voriconazole therapy appears to be also effective in children with IF, despite the wide pharmacokinetic variability of this triazole in pediatric patients.
Global Estimates of Capacity for Kidney Transplantation in World Countries and Regions
Authors: Mudiayi Dominic , Shojai Soroush , Okpechi Ikechi , Christie Emily A. , Wen Kevin , Kamaleldin Mostafa , Elsadig Osman Mohamed , Lunney Meaghan , Prasad Bhanu , Osman Mohamed A. , Ye Feng , Khan Maryam , Htay Htay , Caskey Fergus , Jindal Kailash K. , Klarenback Scott , Jha Vivekanand , Rondeau Eric , Turan Kazancioglu Rumeyza , Ossareh Shahrzad , Jager Kitty J. , Kovesdy Csaba P. , O’Connell Philip J. , Muller Elmi , Olanrewaju Timothy , Gill John S. , Tonelli Marcello , Harris David C. , Levin Adeera , Johnson David W. , Bello Aminu K. 
Published: September 2021

Background.
Kidney transplantation (KT) is the optimal treatment for kidney failure and is associated with better quality of life and survival relative to dialysis. However, knowledge of the current capacity of countries to deliver KT is limited. This study reports on findings from the 2018 International Society of Nephrology Global Kidney Health Atlas survey, specifically addressing the availability, accessibility, and quality of KT across countries and regions.

Methods.
Data were collected from published online sources, and a survey was administered online to key stakeholders. All country-level data were analyzed by International Society of Nephrology region and World Bank income classification.

Results.
Data were collected via a survey in 182 countries, of which 155 answered questions pertaining to KT. Of these, 74% stated that KT was available, with a median incidence of 14 per million population (range: 0.04–70) and median prevalence of 255 per million population (range: 3–693). Accessibility of KT varied widely; even within high-income countries, it was disproportionately lower for ethnic minorities. Universal health coverage of all KT treatment costs was available in 31%, and 57% had a KT registry.

Conclusions.
There are substantial variations in KT incidence, prevalence, availability, accessibility, and quality worldwide, with the lowest rates evident in low- and lower-middle income countries. Understanding these disparities will inform efforts to increase awareness and the adoption of practices that will ensure high-quality KT care is provided around the world.
Clinical Practice Guideline for Solid Organ Donation and Transplantation During the COVID-19 Pandemic
Authors: Weiss Matthew J. , Hornby Laura , Foroutan Farid , Belga Sara , Bernier Simon , Bhat Mamatha , Buchan C. Arianne , Gagnon Michael , Hardman Gillian , Ibrahim Maria , Luo Cindy , Luong Me-Linh , Mainra Rahul , Manara Alex R. , Sapir-Pichhadze Ruth , Shalhoub Sarah , Shaver Tina , Singh Jeffrey M. , Srinathan Sujitha , Thomas Ian , Wilson Lindsay C. , Wilson T. Murray , Wright Alissa , Mah Allison 
Published: September 2021

Background.
The coronavirus 2019 (COVID-19) pandemic has disrupted health systems worldwide, including solid organ donation and transplantation programs. Guidance on how best to screen patients who are potential organ donors to minimize the risks of COVID-19 as well as how best to manage immunosuppression and reduce the risk of COVID-19 and manage infection in solid organ transplant recipients (SOTr) is needed.

Methods.
Iterative literature searches were conducted, the last being January 2021, by a team of 3 information specialists. Stakeholders representing key groups undertook the systematic reviews and generation of recommendations using a rapid response approach that respected the Appraisal of Guidelines for Research and Evaluation II and Grading of Recommendations, Assessment, Development and Evaluations frameworks.

Results.
The systematic reviews addressed multiple questions of interest. In this guidance document, we make 4 strong recommendations, 7 weak recommendations, 3 good practice statements, and 3 statements of “no recommendation.”

Conclusions.
SOTr and patients on the waitlist are populations of interest in the COVID-19 pandemic. Currently, there is a paucity of high-quality evidence to guide decisions around deceased donation assessments and the management of SOTr and waitlist patients. Inclusion of these populations in clinical trials of therapeutic interventions, including vaccine candidates, is essential to guide best practices.
A Randomized Controlled Trial of a Pretransplant Educational Intervention in Kidney Patients
Authors: Mansell Holly , Rosaasen Nicola , Wichart Jenny , Mainra Rahul , Shoker Ahmed , Hoffert Michele , Blackburn David F. , Liu Juxin , Groot Brianna , Trivedi Paraag , Willenborg Errin , Amararajan Maithiri , Wu Huokai , Afful Annshirley 
Published: September 2021

Background.
Poor patient knowledge about transplantation is a significant problem following kidney transplant. A video-based educational intervention was developed to supplement standard education provided by transplant teams.

Methods.
A multicenter randomized controlled trial tested the intervention delivered to patients undergoing assessment or waitlisted for kidney transplant. Adult participants were randomized to the control (standard education) or the intervention group, consisting of electronic access to the videos (or digital video disks if no internet) plus standard education. Differences between groups in changes in transplant knowledge (measured by the Kidney Transplant Understanding Tool), education satisfaction, self-efficacy, and quality of life (secondary outcomes) were evaluated by a preintervention and postintervention survey. Video viewing habits were tracked and described for patients in the intervention group.

Results.
One hundred sixty-two patients were enrolled, with 132 completing both questionnaires (n = 64 intervention and n = 68 control), with similar enrollment from 3 Canadian sites. Video viewing statistics in the complete cases indicated that 78% (50/64) watched the videos, with 70% (45/64) viewing them electronically, while 8% (5/64) received digital video disks and self-reported participation. Baseline knowledge scores in the intent-to-treat population were 55.4 ± 6.5 and 55.7 ± 7.1 in the intervention and control, respectively. The mean knowledge change in the intervention (2.1 ± 3.6) was significantly higher than in the control group (0.8 ± 3.4, P < 0.02). In the per-protocol analysis (patients with objective evidence of watching at least 80% of the videos), the knowledge improvements were 3.4 ± 3.8. Video group participants reported higher satisfaction with education (P < 0.02) and expressed positive comments in open-ended feedback.

Conclusions.
Electronic video education in the pretransplant setting improved knowledge and satisfaction.
Effects of Social Deprivation on the Proportion of Preemptive Kidney Transplantation: A Mediation Analysis
Authors: Calvar Eve , Launay Ludivine , Boyer Annabel , Launoy Guy , Lobbedez Thierry , Châtelet Valérie 
Published: September 2021

Background.
Social inequalities in health lead to an increased risk of chronic kidney disease and less access to renal transplantation. The objective of this study was to assess the association between social deprivation estimated by the fifth quintile of the European Deprivation Index (EDI) and preemptive kidney transplantation (PKT) and to explore the potential mediators of this association.

Methods.
This retrospective observational multicenter study included 8701 patients who received their first renal transplant in France between 2010 and 2014. Mediation analyses were performed to assess the direct and indirect effects of the EDI on PKT.

Results.
Among the 8701 transplant recipients, 32.4% belonged to the most deprived quintile of the EDI (quintile 5) and 16% received a PKT (performed either with a deceased- or living-donor). There was a significant association between quintile 5 of the EDI and PKT (total effect: odds ratio [OR]: 0.64 [95% confidence interval (CI): 0.55-0.73]). Living-donor kidney transplantation was the main mediator of this association (natural indirect effect: OR: 0.92 [0.89–0.95]). To a lesser extent, positive cytomegalovirus and hepatitis C serologies and blood group B were also mediators (respective natural indirect effects: OR: 0.98 [95% CI: 0.95-1.00], OR: 0.99 [95% CI: 0.99-1.00], and OR: 0.99 [95% CI: 0.98-1.00], P < 0.05).

Conclusions.
Our study suggests that social deprivation is associated with a decreased proportion of PKT. This association might be mitigated by promoting living-donor transplantation.
Lung Transplantation in Systemic Sclerosis: a Practice Survey of United States Lung Transplant Centers
Authors: Sehgal Sameep , Pennington Kelly M. , Zhao Huaqing , Kennedy Cassie C. 
Published: September 2021

Background.
Lung transplantation in patients with systemic sclerosis (SSc) can be complicated by extrapulmonary manifestations of the disease, leading to concerns regarding posttransplant complications and outcomes.

Methods.
We conducted a web-based survey of adult lung transplant programs in the United States regarding their practices in patients with SSc.

Results.
Sixty percent (37/62) of the eligible centers responded to the survey, majority of the respondents were medical directors (81%). Most centers would consider transplanting patients with mild or moderate esophageal disease (92% or 75%, respectively) or gastroparesis (59%). A minority would consider patients with severe esophageal dysmotility (37%), digital ulcers (21%), or low body mass index (19%). Most centers conducted extensive pretransplant gastrointestinal evaluation and use a conservative feeding approach with prolonged nothing by mouth (83%) and postpyloric feeding (89%). Antireflux surgery is commonly considered (40%) with partial fundoplication being the procedure of choice (67%). Most respondents expected similar outcomes of acute or chronic rejection (81% and 51%, respectively), respiratory infections (76%), and 1-year survival (70%).

Conclusions.
Most US lung transplant centers do not universally exclude SSc from lung transplant listing, but most support extensive pretransplant gastrointestinal testing and a conservative approach to feeding in the early posttransplant period.
Clinical and Financial Implications of 2 Treatment Strategies for Donor-derived Hepatitis C Infections
Authors: Stewart Zoe A. , Stern Jeffrey , Ali Nicole M. , Kalia Harmit S. , Khalil Karen , Jonchhe Srijana , Weldon Elaina P. , Dieter Rebecca A. , Lewis Tyler C. , Funches Nur , Crosby Sudara , Seow Monique , Berger Jonathan C. , Dagher Nabil N. , Gelb Bruce E. , Watkins Anthony C. , Moazami Nader , Smith Deane E. , Kon Zachary N. , Chang Stephanie H. , Reyentovich Alex , Angel Luis F. , Montgomery Robert A. , Lonze Bonnie E. 
Published: September 2021

Background.
Transplanting hepatitis C viremic donor organs into hepatitis C virus (HCV)-negative recipients is becoming increasingly common; however, practices for posttransplant direct-acting antiviral (DAA) treatment vary widely. Protracted insurance authorization processes for DAA therapy often lead to treatment delays.

Methods.
At our institution, 2 strategies for providing DAA therapy to HCV– recipients of HCV+ transplants have been used. For thoracic organ recipients, an institution-subsidized course of initial therapy was provided to ensure an early treatment initiation date. For abdominal organ recipients, insurance approval for DAA coverage was sought once viremia developed, and treatment was initiated only once the insurance-authorized supply of drug was received. To evaluate the clinical impact of these 2 strategies, we retrospectively collected data pertaining to the timing of DAA initiation, duration of recipient viremia, and monetary costs incurred by patients and the institution for patients managed under these 2 DAA coverage strategies.

Results.
One hundred fifty-two transplants were performed using HCV viremic donor organs. Eighty-nine patients received DAA treatment without subsidy, and 62 received DAA treatment with subsidy. One patient who never developed viremia posttransplant received no treatment. Subsidizing the initial course enabled earlier treatment initiation (median, 4 d [interquartile range (IQR), 2–7] vs 10 [IQR, 8–13]; P < 0.001) and shorter duration of viremia (median, 16 d [IQR, 12–29] vs 36 [IQR, 30–47]; P < 0.001). Institutional costs averaged $9173 per subsidized patient and $168 per nonsubsidized patient. Three needlestick exposures occurred in caregivers of viremic patients.

Conclusions.
Recipients and their caregivers stand to benefit from earlier DAA treatment initiation; however, institutional costs to subsidize DAA therapy before insurance authorization are substantial. Insurance authorization processes for DAAs should be revised to accommodate this unique patient group.
Trends in Heart and Lung Transplantation in the United States Across the COVID-19 Pandemic
Authors: Hallett Andrew , Motter Jennifer D. , Frey Alena , Higgins Robert S. , Bush Errol L. , Snyder Jon , Garonzik-Wang Jacqueline M. , Segev Dorry L. , Massie Allan B. 
Published: September 2021

Background.
The coronavirus disease 2019 (COVID-19) pandemic has had a variable course across the United States. Understanding its evolving impact on heart and lung transplantation (HT and LT) will help with planning for next phases of this pandemic as well as future ones.

Methods.
We used Scientific Registry of Transplant Recipients data from before the pandemic to predict the number of waitlist registrations and transplants expected to occur between March 15, 2020, and December 31, 2020 (if no pandemic had occurred), and compared these expectations to observed rates. The observed era was divided into wave 1 (March 15–May 31), wave 2 (June 1–September 30), and wave 3 (October 1–December 31). We used multilevel Poisson regression to account for center- and state-level COVID-19 incidence.

Results.
During wave 1, rates of heart registrations and transplants were 28% (incidence rate ratio [IRR]: 0.72 [95% confidence interval (CI), 0.67-0.77]) and 13% (IRR: 0.87 [95% CI, 0.80-0.93]) lower than expected; lung registrations and transplants were 40% (IRR: 0.60 [95% CI, 0.54-0.66]) and 28% (IRR: 0.72 [95% CI, 0.66-0.79]) lower. Decreases were greatest in states with the highest incidence where registrations were 53% (IRR: 0.47 [95% CI, 0.36-0.62]) and 59% (IRR: 0.41 [95% CI, 0.29-0.58]) and transplants were 57% (IRR: 0.43 [95% CI, 0.31-0.60]) and 58% (IRR: 0.42 [95% CI, 0.29-0.62]) lower than expected. Whereas HT largely recovered during waves 2 and 3, LT continued to fall short of expectations through the end of the year.

Conclusions.
The COVID-19 pandemic in the US substantially reduced thoracic transplant access. Ongoing evaluation of the risks and benefits of this dramatic practice change is critical to inform clinical decision-making moving forward.
Hyperbaric oxygen therapy improves neurological function via the p38-MAPK/CCL2 signaling pathway following traumatic brain injury
Authors: Jiang Yingzi , Chen Yuwen , Huang Chunling , Xia Anqi , Wang Guohua , Liu Su 
Published: September 2021

Objective
The anti-inflammatory mechanisms of hyperbaric oxygenation (HBO) treatment on traumatic brain injury (TBI)-induced neuroinflammation remain unclear. The aim of this study was expected the effect of HBO on CCL2-related signaling pathway following severe TBI in rats.

Methods
The severe TBI model in rats was induced by controlled cortical impact. TBI rats were treated with CCR2 antagonist, p38 inhibitor, or HBO. Modified neurological severity scores and Morris water maze were used to evaluate neurological and cognitive function. The expression levels of CCL2 and CCR2 were measured by ELISA and real-time fluorescence quantitative PCR. Phospho-p38 expression was analyzed by western blotting.

Results
TBI-induced upregulation of CCL2, CCR2, and p38 in the injured cortex. Application of CCR2 antagonist improved neurological and cognitive function of TBI rats. Application of p38 inhibitor decreased expression of CCL2 and CCR2 in the injured of TBI rats, meanwhile improved neurological and cognitive function. HBO improved neurological and cognitive function by decreasing the expressions of CCL2, CCR2, and phospho-p38.

Conclusions
This study indicates that the p38-MAPK–CCL2 signaling pathway could mediate neuroinflammation and HBO therapy can modulate neuroinflammation by modulating the p38-MAPK–CCL2 signaling pathways following TBI. This study may provide theoretical evidence for HBO treatment in the treatment of TBI.