bluuebunny/crossref_metadata_2025_split huggingface dataset:
Cerebral White Matter Alterations Revealed by Multiple Diffusion Metrics in Cervical Spondylotic Patients with Pain: A TBSS Study
Authors: Li Dan , Xu Hui , Yang Qian , Zhang Ming , Wang Yuan 
Published: July 2021

Abstract

Objective
The aims of the present study were to investigate white matter alterations and their associations with the clinical variables in cervical spondylotic (CS) patients with pain.

Design
Cross-sectional study.

Setting
Chinese community.

Subjects
Forty-two CS patients with pain and 42 matched healthy participants were ultimately recruited from August 2018 to September 2019.

Methods
Tract-based spatial statistics (TBSS) analysis was performed to investigate the differences of DTI-derived indices (fractional anisotropy (FA), mean diffusivity (MD), radial diffusivity (RD), and axial diffusivity (AD)) between the patients and healthy controls throughout brain white matter. The relationship of the severity of cervical pain and affective disturbance to aberrant DTI indices in the patients was also examined using spearman correlation analyses.

Results
The CS patients with pain showed decreased FA in the genu, body, and splenium portions of corpus callosum (CC), and increased MD and RD along with decreased FA in anterior corona radiata (ACR) compared with healthy controls, whereas no significant difference of AD was observed between groups. Additionally, lower FA of the genu part of CC together with higher MD of the left ACR were statistically correlated with the pain severity in the patient group.

Conclusions
Decreased FA coupled with increased MD and RD was detected in multiple white matter regions, and several DTI metrics in certain white matter tracts had moderate relationships with the pain severity in the CS patients with pain. These observations may provide alternative imaging clues for the evaluation of the pathophysiological characteristics of CS pain.
Thyroid Disruptors: Extrathyroidal Sites of Chemical Action and Neurodevelopmental Outcome—An Examination Using Triclosan and Perfluorohexane Sulfonate
Authors: Gilbert Mary E , O’Shaughnessy Katherine L , Thomas Susan E , Riutta Cal , Wood Carmen R , Smith Alicia , Oshiro Wendy O , Ford Richard L , Hotchkiss Michelle Gatien , Hassan Iman , Ford Jermaine L 
Published: July 2021

Abstract
Many xenobiotics are identified as potential thyroid disruptors due to their action to reduce circulating levels of thyroid hormone, most notably thyroxine (T4). Developmental neurotoxicity is a primary concern for thyroid disrupting chemicals yet correlating the impact of chemically induced changes in serum T4 to perturbed brain development remains elusive. A number of thyroid-specific neurodevelopmental assays have been proposed, based largely on the model thyroid hormone synthesis inhibitor propylthiouracil (PTU). This study examined whether thyroid disrupting chemicals acting distinct from synthesis inhibition would result in the same alterations in brain as expected with PTU. The perfluoroalkyl substance perfluorohexane sulfonate (50 mg/kg/day) and the antimicrobial Triclosan (300 mg/kg/day) were administered to pregnant rats from gestational day 6 to postnatal day (PN) 21, and a number of PTU-defined assays for neurotoxicity evaluated. Both chemicals reduced serum T4 but did not increase thyroid stimulating hormone. Both chemicals increased expression of hepatic metabolism genes, while thyroid hormone-responsive genes in the liver, thyroid gland, and brain were largely unchanged. Brain tissue T4 was reduced in newborns, but despite persistent T4 reductions in serum, had recovered in the PN6 pup brain. Neither treatment resulted in a low dose PTU-like phenotype in either brain morphology or neurobehavior, raising questions for the interpretation of serum biomarkers in regulatory toxicology. They further suggest that reliance on serum hormones as prescriptive of specific neurodevelopmental outcomes may be too simplistic and to understand thyroid-mediated neurotoxicity we must expand our thinking beyond that which follows thyroid hormone synthesis inhibition.
A Sulfonyl Azide-Based Sulfide Scavenger Rescues Mice from Lethal Hydrogen Sulfide Intoxication
Authors: Miyazaki Yusuke , Marutani Eizo , Ikeda Takamitsu , Ni Xiang , Hanaoka Kenjiro , Xian Ming , Ichinose Fumito 
Published: July 2021

Abstract
Exposure to hydrogen sulfide (H2S) can cause neurotoxicity and cardiopulmonary arrest. Resuscitating victims of sulfide intoxication is extremely difficult, and survivors often exhibit persistent neurological deficits. However, no specific antidote is available for sulfide intoxication. The objective of this study was to examine whether administration of a sulfonyl azide-based sulfide-specific scavenger, SS20, would rescue mice in models of H2S intoxication: ongoing exposure and post-cardiopulmonary arrest. In the ongoing exposure model, SS20 (1250 µmol/kg) or vehicle was administered to awake CD-1 mice intraperitoneally at 10 min after breathing 790 ppm of H2S followed by another 30 min of H2S inhalation. Effects of SS20 on survival were assessed. In the post-cardiopulmonary arrest model, cardiopulmonary arrest was induced by an intraperitoneal administration of sodium sulfide nonahydrate (125 mg/kg) in anesthetized mice. After 1 min of cardiopulmonary arrest, mice were resuscitated with intravenous administration of SS20 (250 µmol/kg) or vehicle. Effects of SS20 on survival, neurological outcomes, and plasma H2S levels were evaluated. Administration of SS20 during ongoing H2S inhalation improved 24-h survival (6/6 [100%] in SS20 vs 1/6 [17%] in vehicle; p = .0043). Post-arrest administration of SS20 improved 7-day survival (4/10 [40%] in SS20 vs 0/10 [0%] in vehicle; p = .0038) and neurological outcomes after resuscitation. SS20 decreased plasma H2S levels to pre-arrest baseline immediately after reperfusion and shortened the time to return of spontaneous circulation and respiration. These results suggest that SS20 is an effective antidote against lethal H2S intoxication, even when administered after cardiopulmonary arrest.
Experiences, Attitudes, and Perceptions of Female Adjunct Clinical Instructors in Teaching Male Prelicensure Nursing Students
Authors: Shilo Amanda 
Published: July 2021

Abstract
Male students often report experiencing barriers during nursing education, resulting in decreased retention and success. Clinical instructors are one influence that potentially deters men in nursing. This qualitative study interviewed female clinical instructors about their experiences, attitudes, and perceptions of teaching males. The results reveal a general acceptance of males, with hesitation and ambivalence from some clinical instructors. Further training for clinical instructors, education of the public, and recruitment of more males into education are suggested to improve male student outcomes.
Factors Contributing to Success in Nursing School: Experiences of African American BSN Students
Authors: Coleman Jennifer J. , Harvey Nina R. , Pritchett Tameka 
Published: July 2021

Abstract
The nursing workforce is not keeping pace with the racial demographics in the United States. In addition, attrition rates for ethnic minorities in schools of nursing remain high. This qualitative study examined African American students’ perceptions of factors that affect successful completion of nursing school. Five themes emerged: being invisible, sense of isolation, proving myself, focus on school as protective, and being misunderstood. Findings suggest that attention to identified influencing factors may affect minority student graduation success, increasing the likelihood of a diverse nursing workforce.
Addressing Equity in Global Medical Education During the COVID-19 Pandemic: The Global Medical Education Collaborative
Authors: Posever Natalie , Sehdev Morgan , Sylla Mariame , Mashar Ruchir , Mashar Meghavi , Abioye Abubakar 
Published: July 2021

Problem
The COVID-19 pandemic has presented a unique set of challenges to medical education globally. Low- and middle-income countries (LMICs) have faced unique barriers in transitioning to virtual modalities, and many medical students in LMICs experienced dramatically reduced educational time. The authors created the Global Medical Education Collaborative (GMEC) to address this problem by providing free, online, case-based tutorials to medical students in LMICs during the pandemic.

Approach
The authors developed a needs assessment to gauge students’ educational requirements, which informed GMEC’s 2 primary goals: to provide free access to interactive online tutorials for students in LMICs and to bridge the physical distance between educators and learners via an online platform. A pilot program in Nigeria (April 26–May 26, 2020) helped inform the current strategy and logistics. Tutors and students were recruited via social media and medical education networks at the authors’ home institutions.

Outcomes
Within the first 2 months (April 26–June 26, 2020), 324 students representing 12 countries and 20+ medical schools joined GMEC. Additionally, 95 physicians and trainees joined as tutors and, collectively, delivered 52 tutorials. Students responded to a needs assessment querying confidence in various clinical domains, interest in covering clinical topics, barriers to virtual learning, and the effect of the pandemic on their education. Tutors held 1-hour, interactive tutorials over Zoom covering a variety of clinical topics. According to surveys, 91% of students (71 of 78) felt more confident in the material related to the tutorial’s topic after participating.

Next Steps
GMEC will continue to engage students, tutors, and collaborators to facilitate the delivery of innovative, high-quality tutorials to students affected by COVID-19 in LMICs. To ensure that the platform is sustainable and aligned with GMEC’s mission to promote equity in global medical education, the collaborative will need to be agile and responsive.
Mental Health Conditions and Substance Use Disorders Among Youth Subsequently Diagnosed With Opioid Use Disorder or Opioid Poisoning
Authors: Agbese Edeanya , Stein Bradley D. , Druss Benjamin G. , Dick Andrew W. , Pacula Rosalie L. , Leslie Douglas L. 
Published: July 2021

Purpose
This study examined receipt of services for mental health conditions and non-opioid substance use disorders (SUDs) among privately insured adolescents and young adults (ie, youth) with subsequent clinically diagnosed opioid use disorder (OUD) or opioid poisoning.

Methods
Among individuals aged 12 to 25 years (N = 4926), healthcare service utilization claims for the 2 years before a newly clinically diagnosed OUD or opioid poisoning were assessed for mental health and nonopioid SUD service visits.

Results
Over half (60.6%) of the youth with clinically diagnosed OUD or opioid poisoning received mental health or nonopioid SUD services in the 2 years before the opioid poisoning or OUD diagnosis.

Conclusion
Many adolescents and young adults with clinically diagnosed OUD or opioid poisoning interacted with the healthcare system to receive services for mental health conditions and nonopioid SUDs before the OUD or opioid poisoning being diagnosed. Opportunities exist to design better intervention strategies to prevent OUD or opioid poisoning among adolescents and young adults.
Severe Pain Profiles and Associated Sociodemographic and Clinical Characteristics in Individuals With Sickle Cell Disease
Authors: Knisely Mitchell R. , Tanabe Paula J. , Yang Qing , Masese Rita , Jiang Meilin , Shah Nirmish R. 
Published: July 2021

Objective:
The aim of this study was to identify classes of individuals with sickle cell disease (SCD) who share distinct severe pain profiles and evaluate differences in demographic, clinical, and psychosocial characteristics between classes.

Methods:
This exploratory, cross-sectional study used data collected for the SCD Implementation Consortium Research Registry at Duke University. Using Adult Sickle Cell Quality of Life-Measurement System pain-item data from 291 adults with SCD, latent class analysis was used to determine classes of individuals sharing distinct severe pain profiles. Bivariate analyses and logistic regression models were used to assess the relationships between pain profile classes and demographic, clinical, and psychosocial characteristics.

Results:
Three classes sharing distinct severe pain profiles were identified: Low Frequency and Impact class (n=73), Moderate Frequency and Impact class (n=94), and High Frequency and Impact class (n=124). When compared with the Low Frequency and Impact class and controlling for age and sex, individuals in the Moderate Frequency and Impact class were more likely to: be female (P=0.031) and unemployed (P=0.013); report worse sleep (P=0.005) and social functioning (P=0.005); have less emotional distress (P=0.004); describe pain as “sore” (P=0.002); and have previous SCD-related lung complications (P=0.016). When compared with the Low Frequency and Impact class, individuals in the High Frequency and Impact class: had worse social functioning (P<0.001) and previous SCD-related lung complications (P=0.006); described pain as “sore” (P<0.001); and were taking pain medication daily for SCD (P=0.001).

Discussion:
Severe pain experiences in SCD are complex; however, there are subgroups of people who report similar experiences of severe pain.
A Randomized Controlled Trial Evaluating the Analgesic Effect of the Combination of Methadone With Morphine for Cancer Related Pain
Authors: Duarte Feliciano C.N. , Ferraro Leonardo H.d.C. , Ferreira Alessandra , Sakata Rioko K. 
Published: July 2021

Context and Objectives:
Although opioids play an indispensable role in the management of cancer-related pain, inadequate pain relief still occurs. The primary objective of this study was to evaluate whether the combination of a low dose of methadone with morphine promotes a reduction in opioid consumption; the secondary objectives were if the association promotes lower pain intensity, and adverse effects (AEs).

Materials and Methods:
A sample if 41 patients with cancer-related pain in palliative setting were included. Patients were starting the third step of the analgesic ladder, and 1 group (n=21) achieve methadone (2.5 mg/12 h) in combination with morphine/methadone, and another group (n=20) received morphine alone. Both groups could use morphine (5 mg) as needed to maintain pain intensity <4, and adjuvant in stable dose. The following outcomes were evaluated: total morphine dose, pain intensity, and AEs.

Results:
There was no difference in the number of adjuvants, and the dose of morphine used. Pain intensity was significantly lower in the morphine/methadone group after 2 weeks, with no statistically significant difference at other timepoints. There was no difference between groups in the AEs.

Conclusion:
Low dose of methadone in combination with morphine provided faster pain control as compared with morphine alone, and although this study was not powered to show differences in AEs, we did not notice a difference.
Perioperative Normal Saline Administration and Delayed Graft Function in Patients Undergoing Kidney Transplantation: A Retrospective Cohort Study
Authors: Kolodzie Kerstin , Cakmakkaya Ozlem S. , Boparai Eshandeep S. , Tavakol Mehdi , Feiner John R. , Kim Mi-Ok , Newman Thomas B. , Niemann Claus U. 
Published: July 2021

Background
Perioperative normal saline administration remains common practice during kidney transplantation. The authors hypothesized that the proportion of balanced crystalloids versus normal saline administered during the perioperative period would be associated with the likelihood of delayed graft function.

Methods
The authors linked outcome data from a national transplant registry with institutional anesthesia records from 2005 to 2015. The cohort included adult living and deceased donor transplants, and recipients with or without need for dialysis before transplant. The primary exposure was the percent normal saline of the total amount of crystalloids administered perioperatively, categorized into a low (less than or equal to 30%), intermediate (greater than 30% but less than 80%), and high normal saline group (greater than or equal to 80%). The primary outcome was the incidence of delayed graft function, defined as the need for dialysis within 1 week of transplant. The authors adjusted for the following potential confounders and covariates: transplant year, total crystalloid volume, surgical duration, vasopressor infusions, and erythrocyte transfusions; recipient sex, age, body mass index, race, number of human leukocyte antigen mismatches, and dialysis vintage; and donor type, age, and sex.

Results
The authors analyzed 2,515 records. The incidence of delayed graft function in the low, intermediate, and high normal saline group was 15.8% (61/385), 17.5% (113/646), and 21% (311/1,484), respectively. The adjusted odds ratio (95% CI) for delayed graft function was 1.24 (0.85 to 1.81) for the intermediate and 1.55 (1.09 to 2.19) for the high normal saline group compared with the low normal saline group. For deceased donor transplants, delayed graft function in the low, intermediate, and high normal saline group was 24% (54/225 [reference]), 28.6% (99/346; adjusted odds ratio, 1.28 [0.85 to 1.93]), and 30.8% (277/901; adjusted odds ratio, 1.52 [1.05 to 2.21]); and for living donor transplants, 4.4% (7/160 [reference]), 4.7% (14/300; adjusted odds ratio, 1.15 [0.42 to 3.10]), and 5.8% (34/583; adjusted odds ratio, 1.66 [0.65 to 4.25]), respectively.

Conclusions
High percent normal saline administration is associated with delayed graft function in kidney transplant recipients.

Editor’s Perspective

What We Already Know about This Topic

What This Article Tells Us That Is New
Use of a Standardized Perioperative Care Path for Adolescent Idiopathic Scoliosis Leads to Decreased Complications and Readmissions
Authors: Sundar Swetha J. , Enders Jacob J. , Bailey Kevin A. , Gurd David P. , Goodwin Ryan C. , Kuivila Thomas E. , Ballock Robert T. , Young Ernest Y. 
Published: July 2021

Study Design:
Retrospective review of patients ages 10–18 who underwent posterior fusion for adolescent idiopathic scoliosis (AIS) at a single institution from 2014 to 2019.

Objective:
The aim was to evaluate a standardized Care Path to determine its effects on perioperative outcomes in patients undergoing spinal fusion for AIS.

Summary of Background Data:
AIS is the most common pediatric spinal deformity and thousands of posterior fusions are performed annually. Surgery presents several postoperative challenges, such as pain control, delayed mobilization, and opioid-related morbidity. Optimizing perioperative care of AIS is a high priority to reduce morbidity and improving health care efficiency.

Materials and Methods:
A total of 336 patients ages 10–18 were included in this study; 117 in the pre-Care Path cohort (2014–2015) and 219 in the post-Care Path cohort (2016–2019). Data compared included intraoperative details, length of stay, timing of mobilization, inpatient complications, emergency room (ER) visits, readmissions after discharge, postoperative complications, and reoperations.

Results:
The post-Care Path cohort had improved mobilization on postoperative day 0 (pre 16.7%, post 53.3%, P<0.00001), reduced length of stay (pre 4.14 days, post 3.36 days, P=0.00006), fewer total inpatient complications (pre 17.1%, post 8.1%, P=0.0469), and fewer instances of postoperative ileus (pre 8.5%, post 1.9%, P=0.0102). Within 60 days of surgery, the post-Care Path cohort had fewer ER visits (pre 12.8%, post 7.2%, P=0.0413), decreased postoperative infections (pre 5.1%, post 0.48%, P=0.00547), decreased readmissions (pre 6.0%, post 0.48%, P=0.0021), and decreased reoperations (pre 5.1%, post 0.96%, P=0.0195). There was a decrease in inpatient oral morphine equivalents in the Care Path cohort (pre 118.7, post 84.7, P=0.0003).

Conclusions:
Our Care Path for AIS patients demonstrated significant improvements in postoperative mobilization and decreases in length of stay, complications, infections, ER visits, readmissions, and reoperations.
Early renal and vascular damage within the normoalbuminuria condition
Authors: Santiago-Hernandez Aranzazu , Martin-Lorenzo Marta , Martínez Paula J. , Gómez-Serrano María , Lopez Juan Antonio , Cannata Pablo , Esteban Vanesa , Heredero Angeles , Aldamiz-Echevarria Gonzalo , Vázquez Jesús , Ruiz-Hurtado Gema , Barderas Maria G. , Segura Julian , Ruilope Luis M. , Alvarez-Llamas Gloria 
Published: July 2021

Objective:
A continuous association between albuminuria and cardiorenal risk exists further below moderately increased albuminuria ranges. If only based in albumin to creatinine ratio (ACR) higher than 30 mg/g, a significant percentage of individuals may be out of the scope for therapeutic management. Despite epidemiological outcomes, the identification of biochemical changes linked to early albuminuria is underexplored, and normoalbuminuric individuals are usually considered at no risk in clinical practice. Here, we aimed to identify early molecular alterations behind albuminuria development.

Methods:
Hypertensive patients under renin–angiotensin system (RAS) suppression were classified as control, (ACR < 10 mg/g) or high-normal (ACR = 10–30 mg/g). Urinary protein alterations were quantified and confirmed by untargeted and targeted mass spectrometry. Coordinated protein responses with biological significance in albuminuria development were investigated. Immunohistochemistry assays were performed in human kidney and arterial tissue to in situ evaluate the associated damage.

Results:
A total of 2663 identified proteins reflect inflammation, immune response, ion transport and lipids metabolism (P value ≤ 0.01). A1AT, VTDB and KNG1 varied in high-normal individuals (P value < 0.05), correlated with ACR and associated with the high-normal condition (odds ratio of 20.76, 6.00 and 7.04 were found, respectively (P value < 0.001)). After 12 months, protein variations persist and aggravate in progressors to moderately increased albuminuria. At tissue level, differential protein expression was found in kidney from individuals with moderately increased albuminuria and atherosclerotic aortas for the three proteins, confirming their capacity to reflect subclinical organ damage.

Conclusion:
Early renal and vascular damage is molecularly evidenced within the normoalbuminuria condition.