bluuebunny/crossref_metadata_2025_split huggingface dataset:
GABAergic Neurons in the Dorsal–Intermediate Lateral Septum Regulate Sleep–Wakefulness and Anesthesia in Mice
Authors: Wang Di , Guo Qingchen , Zhou Yu , Xu Zheng , Hu Su-Wan , Kong Xiang-Xi , Yu Yu-Mei , Yang Jun-Xia , Zhang Hongxing , Ding Hai-Lei , Cao Jun-Li 
Published: July 2021

Background
The γ-aminobutyric acid–mediated (GABAergic) inhibitory system in the brain is critical for regulation of sleep–wake and general anesthesia. The lateral septum contains mainly GABAergic neurons, being cytoarchitectonically divided into the dorsal, intermediate, and ventral parts. This study hypothesized that GABAergic neurons of the lateral septum participate in the control of wakefulness and promote recovery from anesthesia.

Methods
By employing fiber photometry, chemogenetic and optogenetic neuronal manipulations, anterograde tracing, in vivo electrophysiology, and electroencephalogram/electromyography recordings in adult male mice, the authors measured the role of lateral septum GABAergic neurons to the control of sleep–wake transition and anesthesia emergence and the corresponding neuron circuits in arousal and emergence control.

Results
The GABAergic neurons of the lateral septum exhibited high activities during the awake state by in vivo fiber photometry recordings (awake vs. non–rapid eye movement sleep: 3.3 ± 1.4% vs. –1.3 ± 1.2%, P < 0.001, n = 7 mice/group; awake vs. anesthesia: 2.6 ± 1.2% vs. –1.3 ± 0.8%, P < 0.001, n = 7 mice/group). Using chemogenetic stimulation of lateral septum GABAergic neurons resulted in a 100.5% increase in wakefulness and a 51.2% reduction in non–rapid eye movement sleep. Optogenetic activation of these GABAergic neurons promoted wakefulness from sleep (median [25th, 75th percentiles]: 153.0 [115.9, 179.7] s to 4.0 [3.4, 4.6] s, P = 0.009, n = 5 mice/group) and accelerated emergence from isoflurane anesthesia (514.4 ± 122.2 s vs. 226.5 ± 53.3 s, P < 0.001, n = 8 mice/group). Furthermore, the authors demonstrated that the lateral septum GABAergic neurons send 70.7% (228 of 323 cells) of monosynaptic projections to the ventral tegmental area GABAergic neurons, preferentially inhibiting their activities and thus regulating wakefulness and isoflurane anesthesia depth.

Conclusions
The results uncover a fundamental role of the lateral septum GABAergic neurons and their circuit in maintaining awake state and promoting general anesthesia emergence time.

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What We Already Know about This Topic

What This Article Tells Us That Is New
Patients prefer physician-provided durable medical equipment over third-party vendors: a patient satisfaction survey
Authors: Neral Mithun , Trivedi Nikunj N. , Knapik Derrick M. , Trivedi Amol H. , Karns Michael R. , Gillespie Robert J. , Salata Michael J. , Voos James E. 
Published: July 2021

Background:
The purpose of the study was to compare patient satisfaction between patients receiving durable medical equipment (DME) at home from a third-party vendor versus directly from their physician’s office.

Methods:
A prospective 10-question patient satisfaction survey study was provided to 66 consecutive adult patients who met the inclusion criteria of receiving DME after orthopaedic shoulder or knee surgery using either an in-office (n=31 patients) or third party (n=35 patients) DME delivery program. Survey questions were graded on a 1 to 5 Likert scale that assessed the ease of obtaining DME, comfort with delivery method, ease of scheduling fitting, education about DME use and postoperative instructions, concerns about cost, and satisfaction with overall care. Categorical questions evaluated preference of same-day delivery method, patient perceived adequacy of answering of all DME-related questions, and whether cryotherapy was utilized postoperatively.

Results:
All patients (100%; 31 of 31) who received DME in-office reported they would use the same program for their next DME delivery. Six (17.1%; 6 of 35) patients who received DME from a third-party vendor preferred to use the same method in the future (P=0.0001). Scheduling DME fittings was easier in the in-office setting compared with a third-party vendor (P=0.05).

Conclusions:
Patients receiving their DME in the office from their physician were significantly more likely to prefer using the in-office setting again and reported fit-scheduling to be easier when compared with patients using a third-party vendor. DME can be provided by physicians in the office setting without negatively impacting patient satisfaction.

Level of Evidence:
Level II.
ABCDEF Bundle Practices for Critically Ill Children: An International Survey of 161 PICUs in 18 Countries*
Authors: Ista Erwin , Redivo Juliana , Kananur Paurav , Choong Karen , Colleti Jose , Needham Dale M. , Awojoodu Ronke , Kudchadkar Sapna R. ,   on behalf of the International PARK-PICU Investigators
Published: July 2021

Objectives:
To evaluate current international practice in PICUs regarding components of the “Assessing Pain, Both Spontaneous Awakening and Breathing Trials, Choice of Sedation, Delirium Monitoring/Management, Early Exercise/Mobility, and Family Engagement/Empowerment” (ABCDEF) bundle.

Design:
Online surveys conducted between 2017 and 2019.

Setting:
One-hundred sixty-one PICUs across the United States (n = 82), Canada (n = 14), Brazil (n = 27), and Europe (n = 38) participating in the Prevalence of Acute Rehabilitation for Kids in the PICU study.

Interventions:
None.

Measurements and Main Results:
Of the 161 participating PICUs, 83% were in academic teaching hospitals and 42% were in free-standing children’s hospitals. Median size was 16 beds (interquartile range, 10–24 beds). Only 15 PICUs (9%) had incorporated all six ABCDEF bundle components into routine practice. Standardized pain assessment (A) was the most common (91%), followed by family engagement (F, 88%) and routine sedation assessment (C) with validated scales (84%). Protocols for testing extubation readiness or conducting spontaneous breathing trials (B) were reported in 57%, with 34% reporting a ventilator weaning protocol. Routine delirium monitoring with a validated screening tool (D) was reported by 44% of PICUs, and 26% had a guideline, protocol, or policy for early exercise/mobility (E). Practices for spontaneous breathing trials were variable in 29% of Canadian PICUs versus greater than 50% in the other regions. Delirium monitoring was lowest in Brazilian PICUs (18%) versus greater than 40% in other regions, and family engagement was reported in 55% of European PICUs versus greater than 90% in other regions.

Conclusions:
ABCDEF bundle components have been adopted with substantial variability across regions. Additional research must rigorously evaluate the efficacy of specific elements with a focus on B, D, E, and full ABCDEF bundle implementation. Implementation science is needed to facilitate an understanding of the barriers to ABCDEF implementation and sustainability with a focus on specific cultural and regional differences.
Noninvasive Tidal Volume Measurements, Using a Time-of-Flight Camera, Under High-Flow Nasal Cannula—A Physiological Evaluation, in Healthy Volunteers*
Authors: Le Moigne Guillaume , Nazir Souha , Pateau Victoire , Courtois Emmanuelle , L’Her Erwan 
Published: July 2021

OBJECTIVES:
The mechanisms of high-flow nasal cannula are still debated but may be mediated by the generation of low positive end-expiratory pressure and a washout of the airway dead space. The aims of this study were to assess the effects of high-flow nasal cannula on tidal volume using a noninvasive method using a time-of-flight camera, under various conditions.

DESIGN:
A physiologic evaluation in healthy volunteers.

SETTING:
An university hospital ICU.

SUBJECTS:
Ten healthy volunteers were included in a physiologic study (CamOpt study, ClinicalTrials.gov identifier: NCT04096183).

INTERVENTIONS:
All volunteers were submitted to 12 different conditions (i.e., gas flow [baseline = 0; 30–60 L/min]; mouth [open/closed]; respiratory rate [baseline; baseline + 10 breaths/min]). Tidal volume measurements were performed every minute, during a 6-minute recording period. In all combinations, reference respiratory rate was measured by using chronometric evaluation, over a 30-second period (RRREF), and by using the time-of-flight camera (RRTOF).

MEASUREMENTS AND MAIN RESULTS:
Tidal volume increased while increasing gas flow whatever the respiratory rate and mouth condition (p < 0.001). Similar results were observed whatever the experimental conditions (p < 0.01), except one (baseline respiratory rate + 10 breaths/min and mouth closed). Tidal volume increased while decreasing respiratory rate (p < 0.001) and mouth closing (p < 0.05). Proportion of tidal volume greater than 10, 15, and 20 mL/kg changed while increasing the flow. RRTOF was in agreement with RRREF (intraclass correlation coefficient, 0.96), with a low mean bias (0.55 breaths/min) and acceptable deviation.

CONCLUSIONS:
Time-of-flight enables to detect tidal volume changes under various conditions of high-flow nasal cannula application. Tidal volume increased significantly while increasing gas flow and mouth closing. Such technique might be useful to monitor the risk of patient self-inflicted lung injury or under assistance.
Trends in 28-Day Mortality of Critical Care Patients With Coronavirus Disease 2019 in the United Kingdom: A National Cohort Study, March 2020 to January 2021*
Authors: Dennis John M. , McGovern Andrew P. , Thomas Nicholas J. , Wilde Harrison , Vollmer Sebastian J. , Mateen Bilal A. 
Published: July 2021

OBJECTIVES:
To determine whether the previously described trend of improving mortality in people with coronavirus disease 2019 in critical care during the first wave was maintained, plateaued, or reversed during the second wave in United Kingdom, when B117 became the dominant strain.

DESIGN:
National retrospective cohort study.

SETTING:
All English hospital trusts (i.e., groups of hospitals functioning as single operational units), reporting critical care admissions (high dependency unit and ICU) to the Coronavirus Disease 2019 Hospitalization in England Surveillance System.

PATIENTS:
A total of 49,862 (34,336 high dependency unit and 15,526 ICU) patients admitted between March 1, 2020, and January 31, 2021 (inclusive).

INTERVENTIONS:
Not applicable.

MEASUREMENTS AND MAIN RESULTS:
The primary outcome was inhospital 28-day mortality by calendar month of admission, from March 2020 to January 2021. Unadjusted mortality was estimated, and Cox proportional hazard models were used to estimate adjusted mortality, controlling for age, sex, ethnicity, major comorbidities, social deprivation, geographic location, and operational strain (using bed occupancy as a proxy). Mortality fell to trough levels in June 2020 (ICU: 22.5% [95% CI, 18.2–27.4], high dependency unit: 8.0% [95% CI, 6.4–9.6]) but then subsequently increased up to January 2021: (ICU: 30.6% [95% CI, 29.0–32.2] and high dependency unit, 16.2% [95% CI, 15.3–17.1]). Comparing patients admitted during June–September 2020 with those admitted during December 2020–January 2021, the adjusted mortality was 59% (CI range, 39–82) higher in high dependency unit and 88% (CI range, 62–118) higher in ICU for the later period. This increased mortality was seen in all subgroups including those under 65.

CONCLUSIONS:
There was a marked deterioration in outcomes for patients admitted to critical care at the peak of the second wave of coronavirus disease 2019 in United Kingdom (December 2020–January 2021), compared with the post-first-wave period (June 2020–September 2020). The deterioration was independent of recorded patient characteristics and occupancy levels. Further research is required to determine to what extent this deterioration reflects the impact of the B117 variant of concern.
Use of the Molecular Adsorbent Recirculating System in Acute Liver Failure: Results of a Multicenter Propensity Score-Matched Study*
Authors: MacDonald Andrew J. , Subramanian Ram M. , Olson Jody C. , Speiser Jaime L. , Durkalski-Mauldin Valerie L. , Abraldes Juan G. , Bigam David L. , Flynn Mary M. , Rapaka Babusai , Shropshire Brianne M. , Vora Ravi S. , Karvellas Constantine J. ,   for the U.S. Acute Liver Failure Study Group
Published: July 2021

OBJECTIVES:
The molecular adsorbent recirculating system removes water-soluble and albumin-bound toxins and may be beneficial for acute liver failure patients. We compared the rates of 21-day transplant-free survival in acute liver failure patients receiving molecular adsorbent recirculating system therapy and patients receiving standard medical therapy.

DESIGN:
Propensity score–matched retrospective cohort analysis.

SETTING:
Tertiary North American liver transplant centers.

PATIENTS:
Acute liver failure patients receiving molecular adsorbent recirculating system at three transplantation centers (n = 104; January 2009–2019) and controls from the U.S. Acute Liver Failure Study Group registry.

INTERVENTIONS:
Molecular adsorbent recirculating system treatment versus standard medical therapy (control).

MEASUREMENTS AND MAIN RESULTS:
One-hundred four molecular adsorbent recirculating system patients were propensity score–matched (4:1) to 416 controls. Using multivariable conditional logistic regression adjusting for acute liver failure etiology (acetaminophen: n = 248; vs nonacetaminophen: n = 272), age, vasopressor support, international normalized ratio, King’s College Criteria, and propensity score (main model), molecular adsorbent recirculating system was significantly associated with increased 21-day transplant-free survival (odds ratio, 1.90; 95% CI, 1.07–3.39; p = 0.030). This association remained significant in several sensitivity analyses, including adjustment for acute liver failure etiology and propensity score alone (“model 2”; molecular adsorbent recirculating system odds ratio, 1.86; 95% CI, 1.05–3.31; p = 0.033), and further adjustment of the “main model” for mechanical ventilation, and grade 3/4 hepatic encephalopathy (“model 3”; molecular adsorbent recirculating system odds ratio, 1.91; 95% CI, 1.07–3.41; p = 0.029). In acetaminophen-acute liver failure (n = 51), molecular adsorbent recirculating system was associated with significant improvements (post vs pre) in mean arterial pressure (92.0 vs 78.0 mm Hg), creatinine (77.0 vs 128.2 µmol/L), lactate (2.3 vs 4.3 mmol/L), and ammonia (98.0 vs 136.0 µmol/L; p ≤ 0.002 for all). In nonacetaminophen acute liver failure (n = 53), molecular adsorbent recirculating system was associated with significant improvements in bilirubin (205.2 vs 251.4 µmol/L), creatinine (83.1 vs 133.5 µmol/L), and ammonia (111.5 vs 140.0 µmol/L; p ≤ 0.022 for all).

CONCLUSIONS:
Treatment with molecular adsorbent recirculating system is associated with increased 21-day transplant-free survival in acute liver failure and improves biochemical variables and hemodynamics, particularly in acetaminophen-acute liver failure.
Prediction of Postictal Delirium Following Status Epilepticus in the ICU: First Insights of an Observational Cohort Study
Authors: Baumann Sira M. , Semmlack Saskia , Hunziker Sabina , Kaplan Peter W. , De Marchis Gian Marco , Rüegg Stephan , Marsch Stephan , Sutter Raoul 
Published: July 2021

OBJECTIVES:
To identify early predictors of postictal delirium in adult patients after termination of status epilepticus.

DESIGN:
Retrospective study.

SETTING:
ICUs at a Swiss tertiary academic medical center.

PATIENTS:
Status epilepticus patients treated on the ICUs for longer than 24 hours from 2012 to 2018.

INTERVENTIONS:
None.

METHODS:
Primary outcome was postictal delirium during post-status epilepticus treatment defined as an Intensive Care Delirium Screening Checklist greater than or equal to 4. Associations with postictal delirium were secondary outcomes. A time-dependent multivariable Cox proportional hazards model was used to identify risks of postictal delirium. It included variables that differed between patients with and without delirium and established risk factors for delirium (age, sex, number of inserted catheters, illness severity [quantified by the Sequential Organ Failure Assessment and Status Epilepticus Severity Score], neurodegenerative disease, dementia, alcohol/drug consumption, infections, coma during status epilepticus, dose of benzodiazepines, anesthetics, and mechanical ventilation).

MEASUREMENTS AND MAIN RESULTS:
Among 224 patients, post-status epilepticus Intensive Care Delirium Screening Checklist was increased in 83% with delirium emerging in 55% with a median duration of 2 days (interquartile range 1–3 d). Among all variables, only the history of alcohol and/or drug consumption was associated with increased hazards for delirium in multivariable analyses (hazard ratio = 3.35; 95% CI, 1.53–7.33).

CONCLUSIONS:
Our study provides first exploratory insights into the risks of postictal delirium in adult status epilepticus patients treated in the ICU. Delirium following status epilepticus is frequent, lasting mostly 2–3 days. Our findings that with the exception of a history of alcohol and/or drug consumption, other risk factors of delirium were not found to be associated with a risk of postictal delirium may be related to the limited sample size and the exploratory nature of our study. Further investigations are needed to investigate the role of established risk factors in other status epilepticus cohorts. In the meantime, our results indicate that the risk of delirium should be especially considered in patients with a history of alcohol and/or drug consumption.
Acute Abdomen and Appendicitis in 1010 Pediatric Patients With COVID-19 or MIS-C: A Multinational Experience from Latin America
Authors: Yock-Corrales Adriana , Lenzi Jacopo , Ulloa-Gutiérrez Rolando , Gómez-Vargas Jessica , Antúnez-Montes Omar Yassef , Rios Aida Jorge Alberto , del Aguila Olguita , Arteaga-Menchaca Erick , Campos Francisco , Uribe Fadia , Hernández Díaz Roger , Buitrago Andrea Parra , Londoño Lina Maria Betancur , Kozicki Verónica , Brizuela Martin , Buonsenso Danilo 
Published: July 2021

Background:
To date, there are only sporadic reports of acute abdomen and appendicitis in children with coronavirus disease 2019 (COVID-19) and multisystem inflammatory syndrome in children (MIS-C).

Methods:
Children 17 years of age or younger assessed in 5 Latin American countries with a diagnosis of microbiologically confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and children fulfilling MIS-C definition were included. For children with acute abdomen, we investigate main radiologic patterns, surgical treatment and intraoperative findings, outcomes.

Findings:
One-thousand ten children were enrolled. Forty-two children (4.2%) had a clinical diagnosis of acute abdomen. Four (9.5%) were diagnosed with MIS-C and did not undergo surgery. The remaining 38 children (3.8%) underwent abdominal surgery due to suspected appendicitis, 34 of them (89.7%) had an intraoperative diagnosis of acute appendicitis (AA), while 4 of them had nonsurgical findings. Eight children died (0.8%), none of them being diagnosed with appendicitis. Children with AA were significantly older than those without (P < 0.0001). Children with complicated appendicitis had more frequently fever (85.7% vs. 60%), intestinal distension on the abdominal radiograph (7.1% vs. none), leukocytosis (85.7% vs. 40%) and high levels of C-reactive protein (35.7% vs. 5%), although differences were not statistically significant.

Conclusions:
Our study showed that children may present with acute abdomen during COVID-19 or MIS-C, which is not always associated with intraoperative findings of appendicitis, particularly in case of MIS-C. Further studies are needed to better characterize children with acute abdomen during COVID-19 or MIS-C, to avoid delay in diagnosis of surgical conditions and at the same time, minimize unnecessary surgical approaches.
Development of a Teledermatology Service in Rural Washington State Using the Doctor of Nursing Practice Skill Set and Implementation Science
Authors: Norris Samantha Hastie , Matthews Sarah W. , Hogan Molly T. 
Published: July 2021

ABSTRACT
Teledermatology increases access to dermatologic care in rural communities and is an effective strategy to decrease unnecessary dermatology referrals. At Confluence Health, the largest rural healthcare organization in Washington State, the average dermatology appointment wait time is approximately 7 months. This delay is more than 6 times the national average wait time of 33.9 days, making the need to increase access to care significant. To address this gap in care, a consultation service using store-and-forward teledermatology was designed, guided by the Knowledge-to-Action framework. This framework is an effective tool used in implementation science to guide the translation of evidence-based knowledge into practice. Store-and-forward telehealth allows for asynchronous electronic transmission of digital images to a specialist who later formulates a diagnostic impression and management plan. Since the outbreak of the COVID-19 pandemic, Confluence Health has swiftly adopted real-time video visits and plans to integrate this store-and-forward teledermatology consultation service by December 2020. This article examines a systems-level quality improvement initiative, facilitated by a Doctor of Nursing Practice-prepared nurse practitioner, with the aim of improving access to care and health outcomes.
Evaluation of association studies and a systematic review and meta-analysis of VDR polymorphisms in type 2 diabetes mellitus risk
Authors: Liu Yao , Guo Xin , Huang Shao-Yan , Gong Luan , Cui Jin-Hui , Shen Hu-Wei , Ye Xiang-Hua , He Xiao-Feng 
Published: July 2021

Abstract
Numerous original studies and 4 published meta-analyses have reported the association between the Vitamin D receptor (VDR) BsmI, FokI, ApaI, and TaqI polymorphisms and type 2 diabetes mellitus (T2DM) risk. However, the results were inconsistent. Therefore, an updated meta-analysis was performed to further explore these issues.
To further explore the association between the VDR BsmI, FokI, ApaI, and TaqI polymorphisms and T2DM risk.
PubMed, EMBASE, Scopus, and Wanfang databases were searched. The following search strategy were used: (VDR OR vitamin D receptor) AND (polymorphism OR variant OR mutation) AND (diabetes OR mellitus OR diabetes mellitus). Pooled crude odds ratios with 95% confidence intervals were applied to evaluate the strength of association in 5 genetic models. Statistical heterogeneity, the test of publication bias, and sensitivity analysis were carried out using the STATA software (Version 12.0). To evaluate the credibility of statistically significant associations, we applied the false-positive report probabilities (FPRP) and Bayesian false discovery probability (BFDP) test.
Overall, the VDR BsmI polymorphism was associated with a significantly decreased T2DM risk in Asians; the VDR FokI polymorphism was associated with a significantly decreased T2DM risk in Asians, African countries, and Asian countries; the VDR ApaI polymorphism was associated with a significantly decreased T2DM risk in Caucasians and North American countries.
On the VDR ApaI polymorphism, a significantly increased T2DM risk was found in a mixed population. However, when we further performed a sensitivity analysis, FPRP, and BFDP test, less-credible positive results were identified (all FPRP > 0.2 and BFDP > 0.8) in any significant association.
In summary, this study strongly indicates that all significant associations were less credible positive results, rather than from true associations.