bluuebunny/crossref_metadata_2025_split huggingface dataset:
How to Preserve Liver Grafts From Circulatory Death With Long Warm Ischemia? A Retrospective Italian Cohort Study With Normothermic Regional Perfusion and Hypothermic Oxygenated Perfusion
Authors: De Carlis Riccardo , Schlegel Andrea , Frassoni Samuele , Olivieri Tiziana , Ravaioli Matteo , Camagni Stefania , Patrono Damiano , Bassi Domenico , Pagano Duilio , Di Sandro Stefano , Lauterio Andrea , Bagnardi Vincenzo , Gruttadauria Salvatore , Cillo Umberto , Romagnoli Renato , Colledan Michele , Cescon Matteo , Di Benedetto Fabrizio , Muiesan Paolo , De Carlis Luciano 
Published: January 2021

Background.
Donation after circulatory death (DCD) in Italy, given its 20-min stand-off period, provides a unique bench test for normothermic regional perfusion (NRP) and dual hypothermic oxygenated machine perfusion (D-HOPE).

Methods.
We coordinated a multicenter retrospective Italian cohort study with 44 controlled DCD donors, who underwent NRP, to present transplant characteristics and results. To rank our results according to the high donor risk, we matched and compared a subgroup of 37 controlled DCD livers, preserved with NRP and D-HOPE, with static-preserved controlled DCD transplants from an established European program.

Results.
In the Italian cohort, D-HOPE was used in 84% of cases, and the primary nonfunction rate was 5%. Compared with the matched comparator group, the NRP + D-HOPE group showed a lower incidence of moderate and severe acute kidney injury (stage 2: 8% versus 27% and stage 3: 3% versus 27%; P = 0.001). Ischemic cholangiopathy remained low (2-y proportion free: 97% versus 92%; P = 0.317), despite the high-risk profile resulting from the longer donor warm ischemia in Italy (40 versus 18 min; P < 0.001).

Conclusions.
These data suggest that NRP and D-HOPE yield good results in DCD livers with prolonged warm ischemia.
Improvements in Functional Status Among Survivors of Orthotopic Heart Transplantation Following High-risk Bridging Modalities
Authors: Huckaby Lauren V. , Hickey Gavin , Sultan Ibrahim , Kilic Arman 
Published: January 2021

Background.
The 2018 heart allocation change has resulted in greater frequency of high-risk bridging to orthotopic heart transplantation (OHT). Although survival has been studied in these patients, functional status outcomes are less established. This study evaluated changes in functional status of OHT survivors based on bridging strategy.

Methods.
Adults (≥18 y) undergoing OHT between January 2015 and March 2020 were stratified by bridging modality: no bridging, inotropes only, intra-aortic balloon pump (IABP), temporary ventricular assist device (VAD), durable VAD, and extracorporeal membrane oxygenation (ECMO). Using paired analysis, the Karnofsky performance scale (0–100) was utilized to compare differences in function at listing, transplant, and follow-up.

Results.
In total, 13 142 patients underwent OHT. At the time of both listing and transplant, patients requiring IABP, temporary VAD, and ECMO displayed the lowest functional status (each median 20) compared with other groups (P < 0.001). Among survivors, the median performance status at follow-up was ≥80 for all groups, indicating total functional independence with no assistance required. Substantial improvement in Karnofsky score occurred from transplant to follow-up in survivors bridged with IABP (40), temporary VADs (60), and ECMO (50) (each P < 0.001). Among survivors with at least 90-day follow-up, the median Karnofsky score was 90 regardless of bridging modality.

Conclusions.
Despite a higher mortality risk, critically ill patients who survive OHT after bridging with high-risk modalities experience acceptable functional status outcomes. These findings are important to place in the context of the impact that the 2018 allocation change has had on the landscape of OHT in the United States.
Controls of Hyperglycemia Improves Dysregulated Microbiota in Diabetic Mice
Authors: Cao Mengtao , Peng Yuanzheng , Lu Ying , Zou Zhicheng , Chen Jiao , Bottino Rita , Knoll Michael , Zhang Hanchen , Lin Shan , Pu Zuhui , Sun Liang , Fang Zhoubin , Qiu Chuanghua , Dai Yifan , Cai Zhiming , Mou Lisha 
Published: January 2021

Background.
Type 1 diabetes (T1DM) is a chronic autoimmune disease characterized by T-cell–mediated destruction of insulin-producing beta cells. Evidence shows that patients with T1DM and mice used in specific diabetic models both exhibit changes in their intestinal microbiota and dysregulated microbiota contributes to the pathogenesis of T1DM. Islet transplantation (Tx) is poised to play an important role in the treatment of T1DM. However, whether treatment of T1DM with islet Tx can rescue dysregulated microbiota remains unclear.

Methods.
In this study, we induced diabetic C57BL/6 mice with streptozotocin. Then treatment with either insulin administration, or homogenic or allogenic islet Tx was performed to the diabetic mice. Total DNA was isolated from fecal pellets and high-throughput 16S rRNA sequencing was used to investigate intestinal microbiota composition.

Results.
The overall microbial diversity was comparable between control (nonstreptozotocin treated) and diabetic mice. Our results showed the ratio of the Bacteroidetes: Firmicutes between nondiabetic and diabetic mice was significant different. Treatment with islet Tx or insulin partially corrects the dysregulated bacterial composition. At the genus level, Bacteroides, Odoribacter, and Alistipes were associated with the progression and treatment efficacy of the disease, which may be used as a biomarker to predict curative effect of treatment for patients with T1DM.

Conclusions.
Collectively, our results indicate that diabetic mice show changed microbiota composition and that treatment with insulin and islet Tx can partially correct the dysregulated microbiota.
Ex Vivo Expanded Donor Alloreactive Regulatory T Cells Lose Immunoregulatory, Proliferation, and Antiapoptotic Markers After Infusion Into ATG-lymphodepleted, Nonhuman Primate Heart Allograft Recipients
Authors: Ezzelarab Mohamed B. , Zhang Hong , Sasaki Kazuki , Lu Lien , Zahorchak Alan F. , van der Windt Dirk J. , Dai Helong , Perez-Gutierrez Angelica , Bhama Jay K. , Thomson Angus W. 
Published: January 2021

Background.
Regulatory T cell (Treg) therapy is a promising approach to amelioration of allograft rejection and promotion of organ transplant tolerance. However, the fate of infused Treg, and how this relates to their therapeutic efficacy using different immunosuppressive regimens is poorly understood. Our aim was to analyze the tissue distribution, persistence, replicative activity and phenotypic stability of autologous, donor antigen alloreactive Treg (darTreg) in anti-thymocyte globulin (ATG)-lymphodepleted, heart-allografted cynomolgus monkeys.

Methods.
darTreg were expanded ex vivo from flow-sorted, circulating Treg using activated donor B cells and infused posttransplant into recipients of major histocompatibility complex-mismatched heart allografts. Fluorochrome-labeled darTreg were identified and characterized in peripheral blood, lymphoid, and nonlymphoid tissues and the graft by flow cytometric analysis.

Results.
darTreg selectively suppressed autologous T cell responses to donor antigens in vitro. However, following their adoptive transfer after transplantation, graft survival was not prolonged. Early (within 2 wk posttransplant; under ATG, tacrolimus, and anti-IL-6R) or delayed (6–8 wk posttransplant; under rapamycin) darTreg infusion resulted in a rapid decline in transferred darTreg in peripheral blood. Following their early or delayed infusion, labeled cells were evident in lymphoid and nonlymphoid organs and the graft at low percentages (<4% CD4+ T cells). Notably, infused darTreg showed reduced expression of immunoregulatory molecules (Foxp3 and CTLA4), Helios, the proliferative marker Ki67 and antiapoptotic Bcl2, compared with preinfusion darTreg and endogenous CD4+CD25hi Treg.

Conclusions.
Lack of therapeutic efficacy of infused darTreg in lymphodepleted heart graft recipients appears to reflect loss of a regulatory signature and proliferative and survival capacity shortly after infusion.
The Frequency of Carotid Intraplaque Hemorrhage on Vessel Wall Imaging in Patients With Retinal Artery Occlusion: A Cross-Sectional Prevalence Study
Authors: Larson Anthony S. , Chen John J. , Bhatti M. Tariq , Klaas James P. , Lanzino Giuseppe , Huston John , Brinjikji Waleed 
Published: January 2021

Background:
Intraplaque hemorrhage (IPH) in a carotid artery plaque viewed on vessel wall imaging has been shown to be associated with ischemic stroke. Whether such an association between carotid IPH and retinal artery occlusion (RAO) exists remains unknown.

Methods:
This was a cross-sectional prevalence study. Medical and imaging records of all patients who underwent neck MRA with plaque imaging sequences at our institution from 2015 to 2020 were retrospectively reviewed. Fourteen patients with confirmed RAO and plaque imaging performed within 6 weeks of presentation were included. A group of 211 patients without a prior ischemic event (RAO, stroke, etc.) with plaque imaging were used as controls. A single artery from control patients was randomly selected. The prevalence of IPH and degree of ipsilateral carotid stenosis were compared between RAO and control patients. Multiple regression analysis was performed to determine independent associations between variables and RAO.

Results:
Five patients (35.7%) with RAO had imaging evidence of ipsilateral IPH in contrast to 7 of 211 (3.3%) patients in the control group (odds ratio [OR]: 16.2, 95% confidence interval [95% CI]: 4.3–61.1, P = 0.0002). Of the 5 patients with RAO and ipsilateral IPH, only one (20.0%) was found to ipsilateral carotid stenosis greater than 70%. Carotid IPH was the only variable that was independently associated with RAO (OR: 12.6, 95% CI = 2.2–73.6, P = 0.005).

Conclusions:
Carotid IPH is independently associated with RAO. The use of plaque imaging in the evaluation of patients with acute RAO is therefore supported.
Successful Treatment of a Venous Leg Ulcer With Manuka Honey
Authors: Mosteiro-Miguéns Diego Gabriel , Herrera-Jiménez Cristina , Lorenzo-Ruiz Héctor , Domínguez-Martís Eva María , Novío Silvia 
Published: January 2021

BACKGROUND:
Refractory venous leg ulcers (VLUs) often require extended time to heal, and they carry a high risk of recurrence. This case study describes our experiences with a patient with a VLU refractory to multiple treatment strategies who was successfully treated with Manuka honey.

CASE:
Mr S. was a 76-year-old man with multiple comorbid conditions and hypersensitivity to silver-based compounds, who developed 3 VLUs of his right lower extremity. He experienced 90 days of unsuccessful treatments using an iodized cadexomer ointment, hydrodetersive fiber dressings, hydrocolloid meshes, compression therapy, and antibiotic treatment without progression toward wound healing. We then initiated treatment with Manuka honey and continued compression therapy. His primary VLU was completely epithelialized within 38 days, and an adjacent VLU also showed progression toward healing. Mr S. reported clinically relevant improvement in wound-related pain at 17 days.

CONCLUSION:
The use of Manuka honey proved effective in this patient with a VLU refractory to other treatment strategies.
Constipation in Hospitalized Patients
Authors: Junqueira Jaqueline Betteloni , Norton Christine , Santos Vera Lúcia Conceição de Gouveia 
Published: January 2021

PURPOSE:
The purpose of this study was to identify the prevalence of constipation in hospitalized patients, along with sociodemographic and clinical variables associated with its occurrence.

DESIGN:
Observational, cross-sectional study.

SUBJECTS AND SETTINGS:
The study sample comprised 343 adult patients hospitalized at a University Hospital in Sao Paulo, Brazil.

METHODS:
Point-prevalence data were collected on the same day each month over a 4-month period. Data were collected via interviews, physical examination, medical record review, and completion of a data collection form that queried sociodemographic data and incorporated the Bowel Function in the Community instrument. Patients were classified as constipated if they met 2 or more of the Rome III criteria. Logistic regression analyses were used to identify clinical or sociodemographic factors associated with constipation.

RESULTS:
Fifty-one patients had constipation, reflecting a point-prevalence of 14.8% (95% CI, 11.49-19.02). The prevalence of constipation was 15% in females (n = 29) and 14.7% in males (n = 22). Multivariable logistic regression showed that use of laxatives (OR = 9.98; 95% CI, 3.539-29.666) was associated with a higher likelihood of constipation.

CONCLUSION:
The prevalence of constipation in hospitalized adult patients was lower than that in previous studies. Patients using laxatives were more likely to experience constipation.
Characteristics of Critically Ill Adults With Sacrococcygeal Unavoidable Hospital-Acquired Pressure Injuries
Authors: Solmos Susan , LaFond Cynthia , Pohlman Anne S. , Sala Jennifer , Mayampurath Anoop 
Published: January 2021

PURPOSE:
To identify characteristics of critically ill adults with sacrococcygeal, unavoidable hospital-acquired pressure injuries (uHAPIs).

DESIGN:
Retrospective, matched, case-control design.

SUBJECTS/SETTING:
Patients admitted to adult intensive care units (ICUs) at an urban academic medical center from January 2014 through July 2016.

METHODS:
Thirty-four patients without uHAPI were matched to 34 patients with sacrococcygeal uHAPI. Time points of interest included admission to the ICU, the week preceding the definitive assessment date, and hospital discharge status. Variables of interest included length of stay, any diagnosis of sepsis, severity of illness, degree of organ dysfunction/failure, supportive therapies in use (eg, mechanical ventilation), and pressure injury risk (Braden Scale score).

RESULTS:
All 34 sacrococcygeal pressure injuries were classified as uHAPI using the pressure injury prevention inventory instrument. No statistically significant differences were noted between patients for severity of illness, degree of organ dysfunction/failure, or pressure injury risk at ICU admission. At 1 day prior to the definitive assessment date and at discharge, patients with uHAPI had significantly higher mean Sequential Organ Failure Assessment (SOFA) scores (greater organ dysfunction/failure) and lower mean Braden Scale scores (greater pressure injury risk) than patients without uHAPI. Patients with uHAPI had significantly longer lengths of stay, more supportive therapies in use, were more often diagnosed with sepsis, and were more likely to die during hospitalization.

CONCLUSION:
Sacrococcygeal uHAPI development was associated with progressive multiorgan dysfunction/failure, greater use of supportive therapies, sepsis diagnosis, and mortality. Additional research investigating the role of multiorgan dysfunction/failure and sepsis on uHAPI development is warranted.
The Use of a Stoma Rod/Bridge to Prevent Retraction
Authors: Gialamas Eleftherios , Meyer Jeremy , Abbassi Ziad , Popeskou Sotirios , Buchs Nicolas Christian , Ris Frédéric 
Published: January 2021

PURPOSE
We evaluated evidence related to the use of a rod (bridge) to prevent stoma retraction during loop ostomy construction.

METHODS:
We completed a systematic review of the literature. We searched MEDLINE, EMBASE, and COCHRANE databases up to December 4, 2019. We posed the following question based on a PICO format. Do adult patients undergoing ostomy surgery experience less stomal retraction when compared to patients managed without placement of a stoma rod?

FINDINGS:
Our initial search returned 182 articles; after reading studies in full, 5 articles were identified that collectively enrolled 1058 participants. Four studies were randomized controlled trials and one was a prospective cohort study. Meta-analysis could not be performed because of the small number of studies and the heterogeneity of outcomes measurements. The incidence of stoma retraction ranged between 0%-8% in patients managed with a rod and 0.78%-8.2% in patients with no rod. The number of reported adverse events was low. Placement of a stoma rod was associated with more adverse outcomes than in patients managed without a rod. Adverse events included local edema, stoma necrosis, skin necrosis, peristomal moisture-associated skin damage (irritant dermatitis), peristomal abscess, bleeding, and mucocutaneous separation.

CONCLUSIONS:
Stoma rod does not seem to reduce the risk of stoma retraction and might result in other adverse events.

IMPLICATIONS:
We recommend avoidance of stoma rod/bridge placement during ostomy surgery.
Visual Impairment and Risk of Dementia: the UK Biobank Study
Authors: Zhu Zhuoting , Shi Danli , Liao Huan , Ha Jason , Shang Xianwen , Huang Yu , Zhang Xueli , Jiang Yu , Li Longyue , Yu Honghua , Hu Wenyi , Wang Wei , Yang Xiaohong , He Mingguang 
Published: January 2021

ABSTRACTINTRODUCTIONThe association between visual impairment (VI) and the risk of dementia has been poorly understood. We sought to investigate the VI-dementia relationship in the UK Biobank Study.METHODSA total of 117,187 volunteers (aged 40-69 years) deemed free of dementia at baseline were included. Habitual distance visual acuity worse than 0.3 logMAR units in the better-seeing eye was used to define VI. The incident dementia was based on electronically linked hospital inpatient and death records.RESULTSDuring a median follow up of 5.96 years, the presence of VI was significantly associated with incident dementia (HR=1.78, 95% CI: 1.18-2.68, P=0.006). There was a clear trend between the severity of VI and the risk of dementia (P for trend=0.002).DISCUSSIONVisually impaired individuals were more likely to develop incident dementia, with a progressively greater risk among those with worse visual acuity. Our findings highlight the value of regular vision screening and elimination of VI.HIGHLIGHTSThe association between VI and dementia has been poorly understood;VI is associated with incident dementia in non-demented adults;There is a clear trend between the severity of VI and the risk of dementia;VI may be a marker of increased dementia risk.RESEARCH IN CONTEXTSYSTEMATIC REVIEWWe searched and reviewed the literature using traditional sources (e.g., PubMed and GoogleScholar). While the association between VI and cognitive function/decline are increasingly studies, investigation of the association between VI and the risk of dementia has been largely overlooked.INTERPRETATIONWe found that visually impaired individuals were more likely to develop incident dementia, with a progressively greater risk among those with worse visual acuity. Our findings imply that VI may be an important marker of dementia.FUTURE DIRECTIONSThese findings call for more studies to investigate (a) the role of visual acuity changes on the risk of dementia; (b) the relationship between other components of visual function and incident dementia; (c) the relationship between eye diseases and incident dementia; and (d) the potential benefits of vision rehabilitation on dementia prevention.
Association of Visual Impairment with Risk for Future Parkinson’s Disease
Authors: Zhu Zhuoting , Hu Wenyi , Liao Huan , Tan Zachary , Chen Yifan , Shi Danli , Shang Xianwen , Zhang Xueli , Huang Yu , Yu Honghua , Wang Wei , He Mingguang , Yang Xiaohong 
Published: January 2021

AbstractBackgroundAlthough visual dysfunction is one of the most common non-motor symptoms among patients with Parkinson’s disease (PD), it is not known whether such dysfunction predates the onset of clinical PD.ObjectivesTo examine the association of visual impairment (VI) with the future development of PD in the UK Biobank Study.MethodsThe UK Biobank Study is one of the largest prospective cohort studies of health, enrolling over 500,000 participants aged 40-69 years between 2006 and 2010 across the UK. VI was defined as a habitual distance visual acuity (VA) worse than 0.3 LogMAR in the better-seeing eye. Incident cases of PD were determined by self report data, hospital admission records or death records, whichever came first. Multivariable Cox proportional hazard regression models were used to investigate the association between VI and the risk of incident PD.ResultsA total of 117,050 participants were free of PD at the baseline assessment. During the median observation period of 5.96 (interquantile range [IQR]: 5.77-6.23) years, PD occurred in 222 (0.19%) participants. Visually impaired participants were at a higher risk of developing PD than non-VI participants (p<0.001). Compared with the non-VI group, the adjusted hazard ratio was 2.28 (95% CI 1.29-4.04, p=0.005) in the VI group. These results were consistent in the sensitivity analysis, where incident PD cases diagnosed within one year after the baseline assessment were excluded.ConclusionsThis prospective cohort study found that VI was associated with an increased risk of incident PD, suggesting that VI may represent a prodromal feature of PD.
Association of Visual Impairment with Brain Structure
Authors: Zhu Zhuoting , Hu Wenyi , Liao Huan , Shi Danli , Tan Zachary , Chen Yifan , Shang Xianwen , Huang Yu , Zhang Xueli , Jiang Yu , Wang Wei , Yang Xiaohong , He Mingguang 
Published: January 2021

AbstractObjectiveTo investigate the association of visual impairment (VI) with brain structures in the UK Biobank Study.MethodsThe UK Biobank Study is a large prospective study that recruited more than 500,000 participants aged 40-69 from 2006 to 2010 across the UK. Visual acuity (VA) of worse than 0.3 LogMAR units (Snellen 20/40) was defined as VI. Structural magnetic resonance imaging (MRI) data were obtained using a 3.0-T MRI imager. Volumetric measures of five global brain volumes (total brain volume, total grey matter, total white matter, cerebrospinal fluid (CSF), brain stem) and the volumes of seven specific brain region (thalamus, caudate nucleus, basal ganglia, pallidum, hippocampus, amygdala and nucleus accumbens) were included in the present analysis. Multivariable linear regression was used to investigate the association of VI with global and specific brain volumes.ResultsA total of 8976 participants free of neurological disorders at baseline assessment were included for the present analysis. The prevalence of VI was 0.02% (n=181). After adjusting for a range of cofounding factors, VI was significantly associated with decreased volumes of the total brain (β = -0.12, 95% confidence interval (CI) -0.23 to 0.00, P = 0.049), thalamus (β = -0.16, 95% CI -0.18 to -0.04, P = 0.010), caudatenucleus (β = -0.14, 95% CI -0.27 to 0.00, P = 0.046), pallidum (β = -0.15, 95% CI-0.27 to -0.02, P = 0.028) and amygdala (β = -0.18, 95% CI -0.31 to -0.04, P = 0.012).InterpretationWe found that VI is associated with a decrease in total brain volumes and the volumes of specific brain regions implicated in neurodegenerative diseases.