bluuebunny/crossref_metadata_2025_split huggingface dataset:
Update on sarcoidosis guidelines
Authors: Millward Kate , Fiddler Christine A. , Thillai Muhunthan 
Published: July 2021

Purpose of review
The current review summarizes recent guidance in the diagnosis and management of sarcoidosis. Until recently, the main guidelines were the 1999 International Statement on Sarcoidosis. However, in 2020 two new guidelines were published by the American and British Thoracic Societies. They have a number of key updates and this review aims to summarize these.

Recent findings
The key findings from 2020 revolve around several themes. First, the need for a histological diagnosis should be supported by a multidisciplinary team approach. When a histological biopsy is needed of the lungs, thought is given to the approach taken for this and to whether an endobronchial ultrasound, endoscopic ultrasound or transbronchial biopsy is needed. Second, information regarding supporting tests including blood biomarkers, lung function and imaging. Third, a section specific to cardiac sarcoidosis. Finally, a summary of guidance for treating sarcoidosis including the need to treat fatigue.

Summary
The recent guidance suggests that a histological biopsy is only needed in cases of diagnostic uncertainty or in patients with typical long standing features on imaging. The guidelines also provide a clear pathway on the type of lung biopsy needed depending on the extent of mediastinal or parenchymal involvement. Support is given to steroid regimens and indication for second-line immunosuppression.
Detection of early phenotype cardiac sarcoidosis by cardiovascular magnetic resonance
Authors: Levin Benjamin , Baughman Robert P. , Sweiss Nadera J. 
Published: July 2021

Purpose of review
Cardiac sarcoidosis has high prevalence in sarcoidosis patients and contributes to significant morbidity and mortality. Early detection of cardiac sarcoidosis is essential to improving patients’ symptoms and cardiovascular outcomes.

Recent findings
Cardiovascular magnetic resonance imaging (CMR) is an excellent diagnostic modality for cardiac sarcoidosis. However, early phenotypes of cardiac sarcoidosis have more mild imaging phenotypes. These mild and sometimes subtle imaging phenotypes of cardiac sarcoidosis have lower diagnostic sensitivity and specificity for cardiac sarcoidosis by CMR when compared with more severe imaging phenotypes of cardiac sarcoidosis. In addition, many sarcoidosis patient cohorts frequently have heterogenous potential alternative etiologies for mild myocardial disease detected by mild late gadolinium enhancement (LGE) findings. In early phenotype cardiac sarcoidosis, analysis of the LGE pattern and location can improve the diagnostic specificity of these mild LGE findings.

Summary
The current review focuses on the current strengths and challenges in CMR detection of early phenotypes of cardiac sarcoidosis by the LGE technique.
Sarcoidosis and autoimmunity
Authors: Song Minhyuk , Manansala Michael , Parmar Prashant J. , Ascoli Christian , Rubinstein Israel , Sweiss Nadera J. 
Published: July 2021

Purpose of review
Sarcoidosis is a poorly understood multisystem granulomatous disease that frequently involves the lungs but can affect any organ system. In this review, we summarize recent developments in the understanding of the immune dysregulation seen in sarcoidosis and propose a new expanded definition of human autoimmunity in sarcoidosis, and the implications it would have on treating sarcoidosis with targeted immunotherapy regimens in the future.

Recent findings
Sarcoidosis has been linked to infectious organisms like Mycobacterium and Cutibacterium, and certain manifestations of sarcoidosis have been linked to specific HLA alleles, but the overall pathogenesis remains uncertain. Sarcoidosis patients have similar patterns of cellular immune dysregulation seen in other autoimmune diseases like rheumatoid arthritis, and recent large-scale population studies show that sarcoidosis frequently presents with other autoimmune diseases.

Summary
Advancements in the understanding of sarcoidosis support its consideration as an autoimmune disease. Sarcoidosis patients carry a higher risk of comorbid autoimmune conditions which offers an excellent opportunity to further understand autoimmunity and explore biologic therapies in sarcoidosis treatment, and furthermore will better targeted immunotherapy regimens for sarcoidosis patients in the future.
Optimization of Hypoglossal Nerve Stimulation for Obstructive Sleep Apnea With Ultrasound Assessment of Tongue Movement
Authors: Korotun Maksim , Quintero Luis , Shikowitz Mark , Mayo Paul , Greenberg Harly 
Published: July 2021

Background:
Hypoglossal nerve stimulation (HGNS) is an Food and Drug Administration-approved therapy for obstructive sleep apnea. Initial programming of HGNS is based on the observation of anterior tongue movement, which may not reflect opening at the retroglossal airway. We developed an ultrasonographic technique to assess the base of tongue movement with HGNS to be used to optimize the initial voltage settings.

Study Question:
This study aimed to investigate the use of ultrasound to assess tongue movement with HGNS and related this measure to the apnea hypopnea index (AHI) on subsequent home sleep apnea testing or in-laboratory polysomnography with therapy.

Study Design:
Seventeen subjects (n = 17) implanted with HGNS were enrolled at least 1 month postimplantation. Ultrasonographic measures were then used to optimize HGNS voltage to produce observable base of tongue protrusion without producing discomfort. Responders were defined as a reduction in AHI > 50% and an AHI of <20 events/h.

Results:
There were 17 subjects, 11 men and 6 women, with age = 64.6 ± 9.8 years, body mass index = 27.9 ± 2.7 kg/m2, and pretreatment AHI = 36.5 ± 14.4/h, T-90% = 10.7 ± 14.8%. The mean hyoid bone excursion (HBE) in responders = 1.0 ± 0.13 cm versus 0.82 ± 0.12 cm in nonresponders (P = 0.017). HBE was correlated with AHI during HGNS treatment (coef. −0.54, P = 0.03). Best subsets regression analysis using treatment-based AHI as the dependent variable and age, body mass index, baseline AHI, HBE, and HGNS voltage as independent variables showed that HBE (coef. −44.6, P = 0.044) was the only independent predictor of response. Receiver operator curve analysis showed that HBE > 0.85 cm had a sensitivity of 83.3% and specificity of 80.0% with a positive likelihood ratio of 4.17 to predict responder status.

Conclusion:
We demonstrated that ultrasound assessment of HBE during HGNS programming is a useful tool to optimize therapy.
Managing abnormal liver tests in children with inflammatory bowel disease
Authors: van Rheenen Patrick F. 
Published: July 2021

Purpose of review
Liver test abnormalities in children with inflammatory bowel disease (IBD) are usually insidious in onset. By the time that symptoms referable to liver disease have appeared, the liver injury may be well advanced. It is, therefore, important that children with an incidental finding of abnormal liver tests are investigated in an appropriate and timely manner.

Recent findings
The most prevalent cause of liver test elevations in paediatric IBD is immune-related liver disease, including primary sclerosing cholangitis, autoimmune sclerosing cholangitis, and autoimmune hepatitis. Although less common, drugs used in the treatment of IBD can also cause liver injury. The diagnosis of drug-induced liver injury relies largely on excluding other causes of liver injury, such as viral hepatitis, nonalcoholic fatty liver disease, and biliary and vascular complications.

Summary
This review highlights an avenue to a step-wise approach for investigating children with IBD and silent liver test elevations. Central to the timing of diagnostic actions is grading the severity of liver test elevations.
Preliminary Evidence for Heterogeneity of Beliefs About Auditory Verbal Hallucinations Intent
Authors: Zanello Adriano , Dugré Jules R. 
Published: July 2021

Abstract
Perceptions of patient's auditory verbal hallucinations (AVHs), commonly termed voices, have important impacts on their everyday lives. Despite research emphasizing the consequences of malevolent voices, preliminary results suggest that beliefs about voices may not be mutually exclusive. As such, we aimed to characterize the heterogeneity of beliefs about AVHs and describe their clinical correlates. We recruited 78 patients referred to a Voices group therapy for refractory and distressing voices. Based on the Revised Beliefs About Voices Questionnaire, clustering analysis yielded four subgroups of patients with distinct pattern of beliefs about AVHs. These subgroups differed significantly in terms of affective disturbances, engagement, and resistance to their voices. Furthermore, no significant changes in beliefs about voices were observed after 6 weeks. Results of the current study suggest that the heterogeneity regarding the beliefs about AVHs should be targeted in treatment to reduce their associated negative outcomes.
Feasibility and Acceptability of a Reiki Intervention With Very Young Children Receiving Palliative Care
Authors: Thrane Susan E. , Grossoehme Daniel H. , Tan Alai , Shaner Valerie , Friebert Sarah 
Published: July 2021

Background
Very little research has been reported examining nonpharmacological symptom management strategies for very young, hospitalized children receiving palliative care, and none has involved Reiki—a light touch therapy.

Objectives
The aim of this study was to determine if completing a Reiki intervention with hospitalized 1- to 5-year-old children with chronic, life-limiting conditions receiving palliative care was feasible and acceptable.

Methods
Children ages 1–5 years receiving palliative care who were expected to be hospitalized for at least 3 weeks were recruited for a single-arm, mixed-methods, quasi-experimental pre- and poststudy. Six protocolized Reiki sessions were conducted over 3 weeks. We calculated feasibility by the percentage of families enrolled in the study and acceptability by the percentage of families who completed all measures and five out of six Reiki sessions. Measures were collected at baseline, at the end of the intervention period, and 3 weeks later. At the final follow-up visit, parents were verbally asked questions relating to the acceptability of the intervention in a short structured interview.

Results
We screened 90 families, approached 31 families, and recruited 16 families, whereas 15 families declined. Reasons for not participating included that the child had “a lot going on,” would be discharged soon, and families were overwhelmed. Of those enrolled, most completed all measures at three time points and five out of six Reiki sessions. We completed nearly all scheduled Reiki sessions for families that finished the study. All parents reported that they would continue the Reiki if they could, and almost all said they would participate in the study again; only one parent was unsure.

Discussion
Young children and their parents found Reiki acceptable; these results are comparable to an earlier study of children 7–16 years of age receiving palliative care at home and a study of massage for symptom management for hospitalized children with cancer. These findings add to the literature and support further investigation of Reiki’s efficacy as a nonpharmacological symptom management intervention.
Acceptability of a Gonococcal Vaccine Among Sexually Active Men Who Have Sex With Men
Authors: Abara Winston E. , Kirkcaldy Robert D. , Bernstein Kyle T. , Zlotorzynska Maria , Sanchez Travis 
Published: July 2021

Background
Prospects for a gonococcal vaccine have advanced. Vaccine acceptability is crucial to maximizing population-level protection among key groups, such as men who have sex with men (MSM). We assessed the prevalence of gonococcal vaccine acceptability among sexually active MSM in the United States.

Methods
We used data from the American Men's Internet Study conducted from August 2019 to December 2019. We calculated frequencies of sociodemographic characteristics, vaccine acceptability, and preferred location for vaccine receipt. Using log-binomial regression analyses, we calculated unadjusted prevalence rates (PRs) and 95% confidence intervals (CIs) to evaluate factors associated with vaccine acceptability.

Results
Of 4951 MSM, 83.5% were willing to accept a vaccine and 16.5% were unwilling. Preferred vaccination locations were primary care provider's clinics (83.5%) and sexually transmitted disease (STD) clinics (64.6%). Vaccine acceptability was greater among young MSM (15–24 years [PR, 1.09; 95% CI, 1.05–1.12], 25–29 years [PR, 1.13; 95% CI, 1.09–1.17], and 30–39 years [PR, 1.10; 95% CI, 1.05–1.14] compared with MSM ≥40 years), MSM living with HIV (PR, 1.05; 95% CI, 1.02–1.09), and MSM who reported (in the past 12 months) condomless anal sex (PR, 1.09; 95% CI, 1.06–1.12), a bacterial STD test (PR, 1.18; 95% CI, 1.15–1.21), HIV preexposure prophylaxis use (PR, 1.17; 95% CI, 1.14–1.19), a bacterial STD diagnosis (PR, 1.04; 95% CI, 1.02–1.07), or a health care provider visit (PR, 1.11; 95% CI, 1.06–1.16). Men who have sex with men who reported ≤high school education (PR, 0.93; 95% CI, 0.91–0.97) were less willing to accept a vaccine compared with those with >high school education.

Conclusions
Most respondents were willing to accept a gonococcal vaccine. These findings can inform the planning and implementation of a future gonococcal vaccination program that focuses on MSM.
Pediatric Chronic Critical Illness: Validation, Prevalence, and Impact in a Children’s Hospital
Authors: Shappley Rebekah K. H. , Noles Danielle L , Spentzas Thomas 
Published: July 2021

OBJECTIVES:
Large populations of chronically critically ill patients test the critical care system’s resource utilization ability. Defining and tracking this group is necessary for census predictions.

DESIGN:
Retrospective cohort analysis.

Settings:
Tertiary academic center in United States.

PATIENTS:
Patients admitted to PICU or neonatal ICU.

INTERVENTIONS:
None.

MEASUREMENTS AND MAIN RESULTS:
Demographics and resource utilization variables were sampled in PICU, intermediate care unit, cardiovascular ICU, and neonatal ICU on 3 random days in 3 consecutive months. The attendings’ perception of pediatric chronic critical illness was contrasted to Shapiro’s definition of chronic critical care criteria. Each unit’s active and maximal capacity census was computed: the occurrence rate of pediatric chronic critical illness was 34%, the prevalence was 44.5%, and the tolerance, or percentage pediatric chronic critical illness patients to all available beds, was 36.8%. The median length of stay for the nonpatients with pediatric critical care illness to patients with pediatric critical care illness was 9 versus 46 days (1/5.1). The attending’s decision was 58 times more concordant with the criteria. Pediatric chronic critical illness bed occupancy was 40.6% in PICU, 97.2% in intermediate care unit, 47.8% in cardiovascular ICU, and 33.9% in neonatal ICU.

CONCLUSIONS:
Pediatric chronic critical illness patients occupied more than one third of the ICU beds and have five times longer stay. This mounting load needs to be uniformly defined, addressed at regional and national levels, and considered in the current pandemic planning.
Transport Medical Control Education for Pediatric Critical Care Fellows: A National Needs Assessment Study
Authors: Good Ryan J. , Zurca Adrian D. , Turner David A. , Bjorklund Ashley R. , Boyer Donald L. , Krennerich Emily C. , Petrillo Toni , Rozenfeld Ranna A. , Sasser William C. , Schuette Jennifer , Tcharmtchi M. Hossein , Watson Christopher M. , Czaja Angela S. ,   Education in Pediatric Intensive Care (EPIC) Investigators
Published: July 2021

OBJECTIVES:
Characterize transport medical control education in Pediatric Critical Care Medicine fellowship.

DESIGN:
Cross-sectional survey study.

SETTING:
Pediatric Critical Care Medicine fellowship programs in the United States.

Subjects:
Pediatric Critical Care Medicine fellowship program directors.

INTERVENTIONS:
None.

MEASUREMENTS AND MAIN RESULTS:
We achieved a 74% (53/72) response rate. A majority of programs (85%) require fellows to serve as transport medical control, usually while carrying out other clinical responsibilities and sometimes without supervision. Fellows at most programs (80%) also accompany the transport team on patient retrievals. Most respondents (72%) reported formalized transport medical control teaching, primarily in a didactic format (76%). Few programs (25%) use a standardized assessment tool. Transport medical control was identified as requiring all six Accreditation Council for Graduate Medical Education competencies, with emphasis on professionalism and interpersonal and communication skills.

CONCLUSIONS:
Transport medical control responsibilities are common for Pediatric Critical Care Medicine fellows, but training is inconsistent, assessment is not standardized, and supervision may be lacking. Fellow performance in transport medical control may help inform assessment in multiple domains of competencies. Further study is needed to identify effective methods for transport medical control education.
Botulinum Toxin Type A Injection in the Treatment of Postparetic Facial Synkinesis
Authors: Tavares Helena , Oliveira Mafalda , Costa Rui , Amorim Hugo 
Published: July 2021

Abstract
This study aimed to review the recent literature about botulinum toxin type A treatment patterns, including muscle targets, doses, duration of effect, adverse effects, and clinical outcomes in patients with postparetic synkinesis. A bibliographic research of studies published in the last 10 yrs was carried out on PubMed database, using the medical subject heading terms: botulinum toxin and synkinesis. English-language cohort studies or randomized controlled trials about botulinum toxin type A treatment on patients with postparetic synkinesis were eligible for inclusion. Ten studies met the inclusion criteria, seven prospective studies, two retrospective studies, and one randomized controlled trial, involving 23–99 patients. The target facial muscles included frontalis, corrugator supercilli, orbicularis oculi, levator labii superioris, zygomaticus major, orbicularis oris, risorius, buccinator, depressor anguli oris, depressor labii inferioris, mentalis, and platysma. The dose of onabotulinumtoxinA administered per injection site ranged between 0.5 and 10 U. Adverse effects were rare and temporary. The mean duration of onabotulinumtoxinA effect ranges from 66 days to 4 mos. There was a statistically significant improvement in posttreatment evaluation, both in objective and subjective assessments. There is scientific evidence of the benefit of botulinum toxin type A treatment for postparetic synkinesis, but there is lack of standardized treatment protocols.
Role of Lower Limb Muscle Strength in Knee Osteoarthritis Progression for Patients With Mild and Moderate Knee Osteoarthritis
Authors: Xu Chunyan , Nie Yong , Tan Chaowei , Zeng Yi , Si HaiBo , Zhou ZongKe , Shen Bin , Song Weiwei , Li Kang 
Published: July 2021

Objective
We aimed to elucidate the association of lower limb muscle strength with the volume loss of cartilages/menisci for patients with mild and moderate knee osteoarthritis.

Design
One hundred seventy individuals with mild and moderate knee osteoarthritis were included from the Osteoarthritis Initiative database. Five muscle strength variables were measured from isometric strength test. The measurement of volume on medial and lateral menisci and seven subregional cartilages from knee magnetic resonance scans were used for assessing 2-yr osteoarthritis progression.

Results
Along with the decreased lower limb muscle strength, the volume of patellar cartilage, medial meniscus, and lateral meniscus decreased more than cartilage on tibia and weight-bearing femoral condyle. However, the cartilage volume on the entire medial and lateral femoral condyle increased significantly. The maximum quadricep strength was the most sensitive muscle strength variable, and we found that it was more positively correlated with lateral meniscus volume than with other subregions at baseline and 24-mo follow-up.

Conclusions
This study shows the relationship between lower limb muscle strength and volumes of cartilage and meniscus for patients with mild and moderate knee osteoarthritis. In addition, our study indicates a biomechanical mechanism of quadricep strength and meniscus-related knee dynamic stability in progression of mild-to-moderate knee osteoarthritis.
Impact of HIV status on systemic inflammation during pregnancy
Authors: Vyas Pooja , Mathad Jyoti S. , Leu Cheng-Shiun , Naik Shilpa , Alexander Mallika , Araújo-Pereira Mariana , Kulkarni Vandana , Deshpande Prasad , Yadana Su , Andrade Bruno B. , Bhosale Ramesh , Kumar Pavan , Babu Subash , Gupta Amita , Shivakoti Rupak 
Published: July 2021

Objective:
There are limited studies on the association of HIV infection with systemic inflammation during pregnancy.

Design:
A cohort study (N = 220) of pregnant women with HIV (N = 70) (all on antiretroviral therapy) and without HIV (N = 150) were enrolled from an antenatal clinic in Pune, India.

Methods:
The following systemic inflammatory markers were measured in plasma samples using immunoassays: soluble CD163 (sCD163), soluble CD14 (sCD14), intestinal fatty acid-binding protein (I-FABP), C-reactive protein (CRP), alpha 1-acid glycoprotein (AGP), interferon-β (IFNβ), interferon-γ (IFNγ), interleukin (IL)-1β, IL-6, IL-13, IL-17A, and tumor necrosis factor α (TNFα). Generalized estimating equation (GEE) and linear regression models were used to assess the association of HIV status with each inflammatory marker during pregnancy and by trimester, respectively.

Results:
Pregnant women with HIV had higher levels of markers for gut barrier dysfunction (I-FABP), monocyte activation (sCD14) and markers of systemic inflammation (IL-6 and TNFα), but surprisingly lower levels of AGP, an acute phase protein, compared with pregnant women without HIV, with some trimester-specific differences.

Conclusion:
Our data show that women with HIV had higher levels of markers of gut barrier dysfunction, monocyte activation and systemic inflammation. These markers, some of which are associated with preterm birth, might help explain the increase in adverse birth outcomes in women with HIV and could suggest targets for potential interventions.