bluuebunny/crossref_metadata_2025_split huggingface dataset:
Short-term exposure to fine particulate air pollution and emergency department visits for kidney diseases in the Atlanta metropolitan area
Authors: Bi Jianzhao , Barry Vaughn , Weil Ethel J. , Chang Howard H. , Ebelt Stefanie 
Published: August 2021

Background:
Toxicological evidence has shown that fine particulate matter (PM2.5) may affect distant organs, including kidneys, over the short term. However, epidemiological evidence is limited.

Objectives:
We investigated associations between short-term exposure to PM2.5, major PM2.5 components [elemental carbon (EC), organic carbon (OC), sulfate, and nitrate], and gaseous co-pollutants (O3, CO, SO2, NO2, and NOx) and emergency department (ED) visits for kidney diseases during 2002–2008 in Atlanta, Georgia.

Methods:
Log-linear time-series models were fitted to estimate the acute effects of air pollution, with single-day and unconstrained distributed lags, on rates of ED visits for kidney diseases [all renal diseases and acute renal failure (ARF)], controlling for meteorology (maximum air and dew-point temperatures) and time (season, day of week, holidays, and long-term time trend).

Results:
For all renal diseases, we observed positive associations for most air pollutants, particularly 8-day cumulative exposure to OC [rate ratio (RR) = 1.018, (95% confidence interval [CI]: 1.003, 1.034)] and EC [1.016 (1.000, 1.031)] per interquartile range increase exposure. For ARF, we observed positive associations particularly for 8-day exposure to OC [1.034 (1.005, 1.064)], EC [1.032 (1.002, 1.063)], nitrate [1.032 (0.996, 1.069)], and PM2.5 [1.026 (0.997, 1.057)] per interquartile range increase exposure. We also observed positive associations for most criteria gases. The RR estimates were generally higher for ARF than all renal diseases.

Conclusions:
We observed positive associations between short-term exposure to fine particulate air pollution and kidney disease outcomes. This study adds to the growing epidemiological evidence that fine particles may impact distant organs (e.g., kidneys) over the short term.
Daily nonaccidental mortality associated with short-term PM2.5 exposures in Delhi, India
Authors: Krishna Bhargav , Mandal Siddhartha , Madhipatla Kishore , Reddy K. Srinath , Prabhakaran Dorairaj , Schwartz Joel D. 
Published: August 2021

Background:
Ambient particulate matter of aerodynamic diameter less than 2.5 microns PM2.5) levels in Delhi routinely exceed World Health Organization (WHO) guidelines and Indian National Ambient Air Quality Standards (NAAQS) for acceptable levels of daily exposure. Only a handful of studies have examined the short-term mortality effects of PM in India, with none from Delhi examining the contribution of PM2.5.

Objectives:
We aimed to analyze the association between short-term PM2.5 exposures and daily nonaccidental mortality in Delhi, India.

Methods:
Using generalized additive Poisson regression models, we examined the association between daily PM2.5 exposures and nonaccidental mortality between June 2010 and December 2016. Daily exposures to PM2.5 were estimated using an ensemble averaging technique developed by our research group, and mortality data were obtained from the Municipal Corporations of Delhi and the New Delhi Municipal Council.

Results:
Median exposures to PM2.5 were 91.1 µg/m3 (interquartile range = 68.9, 126.2), with minimum and maximum exposures of 21.4 µg/m3 and 276.7 µg/m3, respectively. Total nonaccidental deaths recorded in Delhi during the study period were 700,512. Each 25 µg/m3 increment in exposure was associated with a 0.8% (95% confidence intervals [CI] = 0.3, 1.3%) increase in daily nonaccidental mortality in the study population and a 1.5% (95% CI = 0.8, 2.2%) increase in mortality among those with 60 years of age or over. The exposure-response relationship was nonlinear in nature, with relative risk rising rapidly before tapering off above 125 µg/m3. Meeting WHO guidelines for acceptable levels of exposure over the study period would have likely averted 17,526 (95% CI = 6,837, 25,589) premature deaths, with older and male populations disproportionately affected.

Discussion:
This study provides robust evidence of the impact of short-term exposure to PM2.5 on nonaccidental mortality with important considerations for various stakeholders including policymakers and physicians. Most importantly, we find that reducing exposures significantly below current levels would substantially decrease the mortality burden associated with PM2.5.
Effect of Ginsenoside Rh1 on Proliferation, Apoptosis, and Oxidative Stress in Vascular Endothelial Cells by Regulation of the Nuclear Erythroid 2-related Factor-2/Heme Oxygenase-1 Signaling Pathway
Authors: Xu Hai , Jiang Yicheng , Yu Kun , Zhang Xiwen , Shi Yafei 
Published: August 2021

Abstract:
This study aimed to investigate the role of ginsenoside Rh1 in regulating the proliferation, apoptosis, and oxidative stress in oxidized low-density lipoprotein (ox-LDL)-treated human vascular endothelial cells (VECs) and the underlying mechanisms. VECs were treated with ox-LDL to generate an in vitro atherosclerosis model. The effect of ginsenoside Rh1 on cell viability and proliferation was examined by MTT and colony formation assays, respectively, and cell apoptosis was determined by flow cytometry and transferase dUTP nick end-labeling assay. The levels of reactive oxygen species, malondialdehyde, and superoxide dismutase activity were detected using biological assays. Finally, the effect of ginsenoside Rh1 on the levels of BAX and BCL-2 and the nuclear erythroid 2-related factor-2/heme oxygenase (HO)-1 signaling pathway was determined by quantitative real-time polymerase chain reaction and western blot assays. Treatment with ginsenoside Rh1 significantly increased the proliferation and decreased the apoptosis of ox-LDL–treated VECs in a dose-dependent manner. Moreover, ginsenoside Rh1 also relieved oxidative stress in ox-LDL–treated VECs by activating the Nrf2/HO-1 signaling pathway. Thus, ginsenoside Rh1 affects the proliferation, apoptosis, and oxidative stress in ox-LDL–treated VECs by activating the Nrf2/HO-1 signaling pathway.
OUTCOMES IN PATIENTS RESUMING INTRAVITREAL ANTI–VASCULAR ENDOTHELIAL GROWTH FACTOR THERAPY FOLLOWING TREATMENT DELAY DURING THE CORONAVIRUS-19 PANDEMIC
Authors: Rush Ryan B. , Rush Sloan W. 
Published: August 2021

Purpose:
To evaluate the outcomes of delay in care secondary to the coronavirus pandemic in patients requiring intravitreal anti–vascular endothelial growth factor therapy.

Methods:
A retrospective review was performed, and subjects were divided into two groups: 1) a study group of patients who experienced a treatment delay of ≥6 weeks from the intended follow-up during the coronavirus pandemic and resumed treatment with ≥2 anti–vascular endothelial growth factor injections over 6 months following treatment delay, and 2) a control group of patients who received regular care throughout the coronavirus pandemic.

Results:
Totally, 234 subjects were analyzed. The mean treatment delay from the intended follow-up in the study group was 11.8 (±4.0) weeks. Visual acuity and central macular thickness worsened from baseline to 6 months after resuming anti–vascular endothelial growth factor therapy in the study group (P < 0.0001 and P = 0.001, respectively). Visual acuity and central macular thickness were better in the control group compared with the study group at the end of the 6-month study period (P < 0.0001 for both).

Conclusion:
Treatment delay in subjects undergoing anti–vascular endothelial growth factor therapy for retina disease during the coronavirus pandemic had worse visual and anatomical outcomes despite reinitiating treatment over 6 months compared with a control group, suggesting irreversibility and permanence of outcomes.
Microscope-Integrated Intraoperative Optical Coherence Tomography–Guided Big-Bubble Deep Anterior Lamellar Keratoplasty
Authors: Santorum Paolo , Yu Angeli Christy , Bertelli Enrico , Busin Massimo 
Published: August 2021

Purpose:
The purpose of this study was to evaluate the feasibility of microscope-integrated intraoperative optical coherence tomography (OCT) for real-time quantitative analysis of surgical planes in big-bubble deep anterior lamellar keratoplasty (DALK).

Methods:
In this interventional case series, intraoperative OCT-guided big-bubble DALK was performed in 16 consecutive eyes of 16 patients with keratoconus. Trephination depth was measured using the intraoperative OCT caliper tool. Aiming for a depth within 150 μm from the endothelial surface, the trephination groove was extended to a deeper plane using a 15-degree blade. Repeat OCT scans were taken to measure residual stromal thickness before insertion of the DALK probe from the bottom of the extended trephination. Caliper measurements, success rate of pneumatic dissection, and complications were recorded.

Results:
After trephination, residual stromal thickness exceeded 150 μm in all eyes and averaged 257.1 ± 42.5 μm. In each case, the initial trephination groove was extended to a depth within 150 μm from the endothelial surface (118.9 ± 27.1 μm). Big-bubble formation was achieved in 12 eyes (75%). Type 1 bubble was obtained in 11 eyes. Perforation requiring conversion to penetrating keratoplasty occurred in 4 eyes during insertion of the cannula into a residual stromal bed of <100 μm (n = 2; 63 and 75 μm) or layer-by-layer dissection (n = 2).

Conclusions:
Quantitative analysis of intraoperative OCT scans can be used to assist decision-making on whether to proceed with pneumatic dissection or extend the trephination groove, thereby facilitating insertion of the injection cannula at the desired stromal depth.
Trends in Early Graft Failure Leading to Regrafting After Endothelial Keratoplasty in the United States
Authors: Fliotsos Michael J. , Campbell Jack A. , Li Ximin , Engstrom Marie B. , Stoeger Christopher G. , McClory Cathy , Titus Michael S. , Johnson Patrick , Johnston Kara B. , Fischer Tim , Brooks Lisa K. , Montoya Monty M. , Glasser David B. , Akpek Esen Karamursel , Srikumaran Divya 
Published: August 2021

Purpose:
The purpose of this study was to report trends in the prevalence of early graft failure after endothelial keratoplasty in the United States.

Methods:
Descemet membrane endothelial keratoplasty (DMEK) and Descemet stripping automated endothelial keratoplasty (DSAEK) graft volumes were collected from records maintained by 6 major eye banks in the United States from January 1, 2013, to December 31, 2018. The prevalence and presumed cause of early graft failures (defined as a graft with persistent edema or regrafted within 8 weeks after keratoplasty) each year were sourced from surgeon-reported adverse events. Failed graft cases from the 3 eye banks were compared with nonfailures at the donor and recipient levels to perform subset analysis of factors associated with early graft failure.

Results:
A total of 51,887 endothelial keratoplasty tissues were distributed during the study period; 72% were DSAEK grafts. The total number of early graft failures reported was 168 of 14,284 (1.18%) for DMEK and 322 of 37,603 (0.86%) for DSAEK. Early DMEK failures decreased from 2013 (7.69%) to 2018 (0.68%). In generalized linear mixed model analyses adjusting for donor tissue characteristics, recipient age, and diagnosis, an association of borderline significance was found between higher donor age and early failure [odds ratio (95% confidence interval): 1.03 (1.00–1.05); unit change of 1 yr] and DSAEK [odds ratio 1.02 (1.00–1.04); unit of change 1 yr] cases.

Conclusions:
The proportion of early graft failures in DMEK decreased over time and was comparable with failure rates in DSAEK at the end of the study period. The surgical learning curve might have played a role.
Mobile Health Self-management Interventions for Patients With Heart Failure
Authors: Schmaderer Myra S. , Struwe Leeza , Loecker Courtney , Lier Lauren , Lundgren Scott W. , Wichman Chris , Pozehl Bunny , Zimmerman Lani 
Published: August 2021

Background
Heart failure (HF) is a multifaceted syndrome that requires self-management for adherence to treatment to control symptoms. Symptoms need to be monitored to prevent impending HF exacerbations. Few HF study authors have assessed efficacy of mobile health (mHealth) interventions particularly with virtual visits to evaluate outcomes such as symptoms and healthcare utilization.

Objective
The aim of this pilot study was to evaluate the potential effect of mHealth self-management interventions on symptom status and health-related quality of life and describe health care utilization in patients with HF.

Methods
This 3-month pilot study included 74 patients with HF and used a randomized 3-group repeated-measures design (enhanced usual care, mHealth, and mHealth plus [+] virtual visits). Surveys included the Heart Failure Symptom Survey, EuroQol, and a specialized phone application for patients to report weights and medications.

Results
The mHealth groups had an overall decrease in most symptom severity and frequency, particularly shortness of breath. Compared to enhanced usual care, both the mHealth+ and mHealth groups showed promise with medium effect sizes (range .55–.60) in relation to shortness of breath and a medium effect (.51) for lower extremity edema for the mHealth+ group. There was a trend toward improvement in health-related quality of life in both intervention groups at month 3. The mHealth+ group had fewer rehospitalizations.

Conclusions
In general, both mHealth groups fared better on symptoms and health care utilization. Small to medium effect sizes on selected symptom outcomes warrant this study to be conducted in a fully powered study. Virtual visits may assist in symptom recognition and self-management.
Stroke Caregiver Depression
Authors: King Rosemarie B. , Raad Jason H. , Flaherty Jennifer , Hartke Robert J. 
Published: August 2021

BACKGROUND
Mixed-method studies can shed light on the mechanisms through which interventions effectively reduce caregiver depression.

OBJECTIVE
The objective of this qualitative study was to understand factors contributing to reduced depressive symptoms in stroke caregiver treatment responders compared with nonresponders.

METHODS
A mixed-methods explanatory sequential design was used to assess cognitive behavioral coping use and helpfulness in reducing depression among experimental study treatment responders and nonresponders. Using purposive sampling at 1-year of caregiving, we selected responders who were not depressed or demonstrated reduction to probable depression and nonresponders whose scores indicated worsened or new depression. Participants responded to semistructured interviews on life changes and the use and helpfulness of intervention coping strategies. Thematic analysis identified codes and themes.

RESULTS
Twelve of 25 participants were responders. We identified 2 overarching outcome themes: “It was about me, changing to make life better” (responders) and “Lamenting our changed lives” (nonresponders). Five subthemes related to coping were identified. Whereas responders coped actively and were less dependent on the counseling relationship, nonresponders were passive in coping and more dependent on the initial counseling relationship. Anger or previous psychologic treatment was found in more than a quarter of nonresponders and in no responders. Negative life change was found in 9 of 13 nonresponders compared with 1 responder.

CONCLUSION
Findings support the helpfulness of cognitive behavioral coping. For many caregivers, engagement interviews and a more intense, longer intervention, such as stepped care and anger management, are indicated to mitigate treatment resistance and depressive symptoms, respectively.
An Integrative Review: Early Mobilization of Patients With External Ventriculostomy Drains in the Neurological Intensive Care Unit
Authors: Moyer Megan T. , Hinkle Janice L. , Mendez James D. 
Published: August 2021

ABSTRACT

BACKGROUND: Patients in the intensive care unit (ICU) are at a high risk for immobility due to their high acuity and need for invasive devices including external ventriculostomy drains (EVDs). Prolonged patient immobilization is associated with poor outcomes. METHODS: Whittemore and Knafl's 5-stage framework was used to conduct an integrative review to synthesize findings from quantitative research studies on early patient mobilization for patients with EVDs in the neurological ICU. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist was used as the reporting guideline. RESULTS: In 12 studies, a total of 412 patients with EVDs in neurological ICUs were actively mobilized with a goal of progressing to ambulation. Mobilization out of bed with a ventriculostomy drain was safe and feasible without significant adverse events. CONCLUSION: There is a need to clarify best practices for early mobilization of patients with EVDs in the neurological ICU and to explore the influence of early mobilization on patients' rates of venous thromboembolism, catheter-associated urinary tract infections, catheter line-associated blood stream infections, ventilator-associated pneumonia, and ventriculostomy-related infections. No studies measured the total time the EVD was clamped during the patient mobilization intervention or the total amount of cerebrospinal fluid drainage on the day of mobilization. Early mobilization of patients with EVDs in the neurological ICU who were permitted out of bed was universally safe and feasible, with minimal adverse events when safety checks were integrated into mobilization protocols.
Constipation Management in Parkinson Disease
Authors: Cheesman Molly , Ho Haily , Bishop Krista , Sin Mo-Kyung 
Published: August 2021

ABSTRACT

BACKGROUND: Constipation is the most frequently reported nonmotor gastrointestinal symptom of Parkinson disease and can precede motor symptoms by up to 20 years. The causes of constipation can be multifactorial, but the implications can lead to life-threatening complications. Early recognition of constipation can lead to better health outcomes and quality of life. MANAGEMENT CONSIDERATIONS: The combination of nonpharmacological management through screening tools, nursing assessment, and patient education as well as pharmacological management is considered best practice. IMPLICATIONS FOR PRACTICE: Nurses who are knowledgeable on the current treatment options for constipation in Parkinson disease will be better equipped as active multidisciplinary team players to provide optimal care to their patients and achieve the best health outcomes.
Utilization of High-pressure Suction for EBUS-TBNA Sampling in Suspected Lung Cancer
Authors: Tsaknis George , Naeem Muhammad , Rathinam Sridhar , Caswell Alison , Haycock Jayne , McKenna Jane , Reddy Raja V. 
Published: August 2021

Background:
Sample adequacy for immediate molecular testing is paramount in lung cancer. To date, several endobronchial ultrasound with transbronchial needle aspiration (EBUS-TBNA) sampling setups have been evaluated, however, the utilization of high-pressure suction (HPS) has not yet been reported.
The aim of this study was to evaluate the utilization of HPS onto the needle and its effect on sample volume and adequacy for molecular testing in patients with suspected lung cancer.

Methods:
We retrospectively analyzed 128 consecutive EBUS-TBNA performed for suspected lung cancer. This was confirmed in 109 patients. Other diagnoses confirmed in 12, and 7 referred for surgery. Sixty-three patients (89 targets) had HPS (May to September 2020), and compared with 46 (72 targets) who had standard vacuum syringe suction (October 2019 to March 2020). Several parameters and outcomes evaluated, such as number of needle passes, needle strokes, needle size, target size, positron emission tomography avidity, procedure time, blood content score, sample volume, adequacy for molecular testing, as well as baseline patient characteristics and complication rate.

Results:
There was no difference between the 2 groups in all baseline parameters and characteristics. In multivariable analysis, HPS was associated with significantly higher sample volume (11.2 vs. 9.1 mm3, P=0.036) and less additional procedures to achieve full molecular profiling (2/52 vs. 7/40, P=0.042), in necrotic targets of non−small cell lung cancer. Diagnostic yields were comparable.

Conclusion:
HPS appears to be simple, no-cost, and safe, promising higher sample volume compared with vacuum syringe suction, and also appears to be associated with higher success of full molecular testing with less additional procedures, in non−small cell lung cancer necrotic targets.
Efficacy of 68Ga-PSMA PET/CT-derived whole-body volumetric parameters in predicting response to second-generation androgen receptor axis-targeted therapy, and the prognosis in metastatic hormone-refractory prostate cancer patients
Authors: Oruç Zeynep , Güzel Yunus , Ebinç Senar , Kömek Halil , Küçüköner Mehmet , Kaplan Muhammet Ali , Oruç İdris , Urakçi Zuhat , Işikdoğan Abdurrahman 
Published: August 2021

Introduction
The present study investigates the role of 68Ga-PSMA PET/CT-derived whole-body metabolic and volumetric parameters in the prediction of treatment response and prognosis among metastatic hormone-refractory prostate cancer patients undergoing second-generation androgen receptor axis-targeted therapy (abiraterone or enzalutamide).

Materials and methods
This retrospective study included 44 metastatic hormone-refractory prostate cancer patients undergoing 68Ga-PSMA PET/CT, including 29 enzalutamide-treated and 15 abiraterone-treated patients.

Results
Of the 44 patients included in the study, 29 received enzalutamide and 15 received abiraterone. During treatment, the changes in PET parameters were correlated with the PSA (biochemical) response. More specifically, a positive correlation was noted between PSA response and percent change in TLP (ΔTLP) response, and there was concordance between the results (r = 0.652, k = 0.42, P < 0.001). Baseline PSA (P =0.05), high MTVw (P = 0.005), the increase in ΔPSA (P = 0.036), ΔTLP (P = 0.039) and percent change in MTV (ΔMTV) (P = 0.049) values were identified as factors associated with mortality risk.Multivariate analysis showed that PSA1 [odds ratio (OR): 1.005, 95% confidence interval (CI) 1.002–1.008, P = 0.004], ΔPSA (OR: 14.7, 95% CI 1.50–143.7, P = 0.02) and MTVw1 (OR: 11.4, 95% CI 1.11–116, 6, P = 0.04) were independent prognostic factors associated with mortality risk.

Conclusion
A statistically significant concordance and correlation was noted between 68Ga-PSMA PET/CT-derived whole-body metabolic parameters (ΔTLP and ΔMTV) and ΔPSA. In addition, the baseline PSA, ΔPSA, ΔTLP, ΔMTV and TMTV were identified as predictive factors for mortality risk.