bluuebunny/crossref_metadata_2025_split huggingface dataset:
Duration of Hyperoxia and Neurologic Outcomes in Patients Undergoing Extracorporeal Membrane Oxygenation
Authors: Al-Kawaz Mais N. , Canner Joseph , Caturegli Giorgio , Kannapadi Nivedha , Balucani Clotilde , Shelley Leah , Kim Bo Soo , Choi Chun Woo , Geocadin Romergryko G. , Whitman Glenn , Cho Sung-Min 
Published: May 2021

OBJECTIVES:
To evaluate the impact of duration of hyperoxia on neurologic outcome and mortality in patients undergoing venoarterial extracorporeal membrane oxygenation.

DESIGN:
A retrospective analysis of venoarterial extracorporeal membrane oxygenation patients admitted to the Johns Hopkins Hospital. The primary outcome was neurologic function at discharge defined by modified Rankin Scale, with a score of 0–3 defined as a good neurologic outcome, and a score of 4–6 defined as a poor neurologic outcome. Multivariable logistic regression analysis was performed to evaluate the association between hyperoxia and neurologic outcomes.

SETTING:
The Johns Hopkins Hospital Cardiovascular ICU and Cardiac Critical Care Unit.

INTERVENTIONS:
None.

MEASUREMENTS AND MAIN RESULTS:
We measured first and maximum Pao
2 values, area under the curve per minute over the first 24 hours, and duration of mild, moderate, and severe hyperoxia. Of 132 patients on venoarterial extracorporeal membrane oxygenation, 127 (96.5%) were exposed to mild hyperoxia in the first 24 hours. Poor neurologic outcomes were observed in 105 patients (79.6%) (102 with vs 3 without hyperoxia; p = 0.14). Patients with poor neurologic outcomes had longer exposure to mild (19.1 vs 15.2 hr; p = 0.01), moderate (14.6 vs 9.2 hr; p = 0.003), and severe hyperoxia (9.1 vs 4.0 hr; p = 0.003). In a multivariable analysis, patients with worse neurologic outcome experienced longer durations of mild (adjusted odds ratio, 1.10; 95% CI, 1.01–1.19; p = 0.02), moderate (adjusted odds ratio, 1.12; 95% CI, 1.04–1.22; p = 0.002), and severe (adjusted odds ratio, 1.19; 95% CI, 1.06–1.35; p = 0.003) hyperoxia. Additionally, duration of severe hyperoxia was independently associated with inhospital mortality (adjusted odds ratio, 1.18; 95% CI, 1.08–1.29; p < 0.001).

CONCLUSIONS:
In patients undergoing venoarterial extracorporeal membrane oxygenation, duration and severity of early hyperoxia were independently associated with poor neurologic outcomes at discharge and mortality.
Plasma Ferritin as Marker of Macrophage Activation-Like Syndrome in Critically Ill Patients With Community-Acquired Pneumonia
Authors: Brands Xanthe , de Vries Floris M. C. , Uhel Fabrice , Haak Bastiaan W. , Peters-Sengers Hessel , Schuurman Alex R. , van Engelen Tjitske S. R. , Lutter René , Cremer Olaf L. , Bonten Marc J. , Schultz Marcus J. , Scicluna Brendon P. , van der Poll Tom 
Published: May 2021

OBJECTIVES:
Plasma ferritin levels above 4,420 ng/mL have been proposed as a diagnostic marker for macrophage activation-like syndrome in sepsis and used for selection of sepsis patients for anti-inflammatory therapy. We here sought to determine the frequency, presentation, outcome, and host response aberrations of macrophage activation-like syndrome, as defined by admission ferritin levels above 4,420 ng/mL, in critically ill patients with community-acquired pneumonia.

DESIGN:
A prospective observational cohort study.

SETTING:
ICUs in two tertiary hospitals in the Netherlands.

PATIENTS:
One hundred fifty-three patients admitted with community-acquired pneumonia.

MEASUREMENTS AND MAIN RESULTS:
Patients were stratified in community-acquired pneumonia–macrophage activation-like syndrome (n = 15; 9.8%) and community-acquired pneumonia–control groups (n = 138; 90.2%) based on an admission plasma ferritin level above or below 4,420 ng/mL, respectively. Community-acquired pneumonia–macrophage activation-like syndrome patients presented with a higher disease severity and had a higher ICU mortality (46.7% vs 12.3% in community-acquired pneumonia–controls; p = 0.002). Twenty-three plasma biomarkers indicative of dysregulation of key host response pathways implicated in sepsis pathogenesis (systemic inflammation, cytokine responses, endothelial cell activation, and barrier function, coagulation activation) were more disturbed in community-acquired pneumonia–macrophage activation-like syndrome patients. Hematologic malignancies were overrepresented in community-acquired pneumonia–macrophage activation-like syndrome patients (33.3% vs 5.1% in community-acquired pneumonia–controls; p = 0.001). In a subgroup analysis excluding patients with hematologic malignancies (n = 141), differences in mortality were not present anymore, but the exaggerated host response abnormalities in community-acquired pneumonia–macrophage activation-like syndrome patients remained.

CONCLUSIONS:
Macrophage activation-like syndrome in critically ill patients with community-acquired pneumonia occurs more often in patients with hematologic malignancies and is associated with deregulation of multiple host response pathways.
Single-stage Latissimus Dorsi Breast Reconstruction Using Spectrum Devices: Outcomes and Technique
Authors: Boudreau Colton , Boehm Kaitlin S. , MacDonald Aevan , Williams Jason 
Published: May 2021

Background:
Latissimus dorsi (LD) flap is a workhorse flap in breast reconstruction. Despite many advantages, the primary criticism of this flap is the requirement of a second surgery to exchange expansion devices for permanent implants. This study reports a single-stage reconstruction and outcomes wherein Spectrum devices (Mentor, Irving, TX), which serve as expanders and permanent implants, are used, and expansion ports are removed under local anesthetic.

Methods:
A retrospective chart review of all patients undergoing LD flap reconstruction with Spectrum device by a single surgeon at a single center during a 10-year period was performed. All patients, unilateral/bilateral, immediate/delayed were included. Details of implants, surgical procedure(s), and follow-up visits were assessed for patient outcomes.

Results:
In total, 41 patients and 56 breasts were included. Of the total patients, 58.5% retained the Spectrum device and had the expansion port removed under local anesthetic. An estimated 6 major complications occurred (14.6%), requiring return to the operating room: 3 patients required a capsulectomy, 1 a capsulotomy/implant repositioning, one had loss of implant (infection), and 1 had venous congestion of the flap. Eleven minor complications occurred (26.8%): 5 seromas (3 at the breast site, 2 at the donor site), 3 delayed wound healings (2 at donor site, 1 at breast site), 1 mastectomy flap necrosis, 2 infections (1 at each breast site, 1 at donor site).

Conclusions:
This study provides details of a single-stage LD flap with Spectrum device breast reconstruction that can be considered when performing an LD reconstruction. This technique is efficient and safe with comparable complication profile.
Multimodal Neurocognitive Screening of Military Personnel With a History of Mild Traumatic Brain Injury Using the Bethesda Eye & Attention Measure
Authors: Ettenhofer Mark L. , Hungerford Lars D. , Agtarap Stephanie 
Published: May 2021

Objective:
To evaluate a neurocognitive eye tracking task, the Bethesda Eye & Attention Measure (BEAM), for use in cognitive screening of patients with a history of mild traumatic brain injury (TBI).

Setting:
US military TBI rehabilitation clinic.

Design/Participants:
Cross-sectional study of 191 military personnel receiving outpatient services related to history of mild TBI. Main measures: BEAM; neuropsychological screening measures of attention, processing speed, executive function, and memory.

Results:
Medium effect sizes were found for partial correlations (controlling for age) between key BEAM metrics and neuropsychological screening tests. Linear regression analyses demonstrated that BEAM saccadic eye movements and manual (button press) metrics each provided complementary value in measurement of cognitive performance, above and beyond effects of demographic factors and clinical characteristics.

Conclusion:
This study provides initial support for the use of BEAM neurocognitive eye tracking in cognitive screening of adults with a history of mild TBI. BEAM saccadic metrics appear to be particularly well-suited for the assessment of visual attention. Study findings also highlight opportunities for greater cognitive sensitivity or testing efficiency that may be missed by tests measuring only one response modality at a time.
Ankle Power Generation Has a Greater Influence on Walking Speed Reserve Than Balance Following Traumatic Brain Injury
Authors: Gill Renee , Banky Megan , Williams Gavin 
Published: May 2021

Objective:
Reduced walking speed is common following traumatic brain injury (TBI). Walking speed reserve (WSR) refers to the ability to increase walking speed on demand and is calculated as the difference between self-selected and fast walking speeds. Walking speed reserve is important for adaptive functional mobility in the community. Predictors of WSR following TBI are yet to be determined. The aim of the study was to identify whether static balance or ankle power generation (APG) was a stronger predictor of WSR following TBI.

Setting:
A major metropolitan rehabilitation hospital.

Participants:
A total of 92 individuals receiving inpatient physiotherapy for mobility limitations following TBI were recruited.

Design:
A cross-sectional study.

Methods:
Walking speed (self-selected and fast), APG, and a summed single-leg stance scores were measured. The ability to increase walking speed on demand by 0.20 m/s or more defined WSR. Correlations, logistic regression, and receiver operating characteristic (ROC) curve analyses were performed to investigate independent relationships between WSR, APG, and static balance.

Results:
Fifty participants (54.3%) had a WSR of 0.20 m/s or more. The strongest predictor of WSR was APG (odds ratio [OR] = 3.34; 95% CI, 1.50-7.43) when compared with static balance (OR = 1.03; 95% CI, 1.01-1.06). The ROC curve demonstrated that APG could accurately discriminate between individuals with a WSR from those without (AUC [area under the ROC curve] = 0.79; 95% CI, 0.70-0.88). The APG cutoff score identified on the curve that maximized combined sensitivity (92.0%) and specificity (54.8%) was 0.75 W/kg.

Conclusion:
Following TBI, APG was a stronger predictor of WSR than static balance. Clinicians should consider interventions that preferentially target APG in order to increase WSR for community mobility.
COVID-19 Myocarditis
Authors: Kwon Sophia , Alter Eric , Bangalore Sripal , Nolan Anna 
Published: May 2021

Abstract
Coronavirus disease 2019 (COVID-19), caused by SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2), emerged in Wuhan, China, and rapidly led to a global pandemic that affected 213 countries, more than 5.8 million cases, and 360,000 deaths worldwide as of May 28, 2020. The United States currently has the highest number of COVID-19 cases in the world and contributes to nearly a third of the global death rate. The prevalence of COVID myocarditis is unclear but generally considered rare, with estimates up to 7% of COVID-related deaths. However, these patients suffered catastrophic worsening disease with respiratory compromise requiring intubation and often death. We report the case of a patient with COVID-19–induced myocarditis who was successfully treated with dexamethasone and review the literature.
Reactivation of Pulmonary Tuberculosis in a Patient With COVID-19
Authors: Pozdnyakov Alex , Jin Andrew , Bader Mazen 
Published: May 2021

Abstract
Given COVID-19 rise in populations with high burden of tuberculosis infection, the interplay between COVID-19 and tuberculosis reactivation needs further investigation. We report a case of a 64-year-old man who developed acute respiratory distress syndrome due to severe COVID-19 infection. He was managed with intubation, prone-position mechanical ventilation, inhaled nitric oxide, and methylprednisolone 40 mg intravenous twice daily for 5 days. He developed unexplained persistent fever and leukocytosis that failed to respond to empiric broad-spectrum antibacterial, antifungal agents, and a 3-day course of intravenous methylprednisolone 1000 mg for possible usual interstitial pneumonitis. His endotracheal aspiration samples tested positive for Mycobacterium tuberculosis, and antituberculosis regimen was started. The patient died as result of decision to withdraw life support. This report establishes the clinical picture of a tuberculosis reactivation in a COVID-19 patient. The complex interaction between COVID-19, steroids, and tuberculosis is a clinical dilemma of great significance.
Differential Effectiveness of Atypical Antipsychotics on Hallucinations
Authors: Sinkeviciute Igne , Hugdahl Kenneth , Bartz-Johannessen Christoffer , Kroken Rune Andreas , Løberg Else-Marie , Kjelby Eirik , Rettenbacher Maria Anna , Joa Inge , Reitan Solveig Klæbo , Alisauskiene Renata , Fathian Farivar , Johnsen Erik 
Published: May 2021

Abstract

Background
Most studies investigating antipsychotic effectiveness report either total psychopathology or symptom cluster findings. Studies focusing on a separate symptom, such as hallucinations, a hallmark symptom in schizophrenia, are scarce.
Therefore, the current study aims to compare the antihallucinatory effectiveness of 3 pharmacologically different antipsychotics: olanzapine, amisulpride, and aripiprazole.

Methods
The present study is part of the Bergen-Stavanger-Innsbruck-Trondheim study, a 12-month prospective, randomized, pragmatic antipsychotic drug trial in active-phase schizophrenia spectrum disorders. The primary outcome of the present study was change of hallucinations as measured by item P3 (hallucinatory behavior) from the Positive and Negative Syndrome Scale in the subgroup with hallucinations at baseline. Primary analyses were intention to treat.

Results
A total of 144 participants were included in the study, where 105 (72%) had a score of 3 or more on the Positive and Negative Syndrome Scale P3 item at baseline, indicating the presence of hallucinations (HALL subgroup).
In the HALL subgroup, a significantly less reduction of hallucinations was revealed for participants using olanzapine in weeks 12, 26, 39, and 52 when compared with amisulpride and in weeks 26 and 52 when compared with aripiprazole. In subanalyses for participants never exposed to antipsychotic drugs (antipsychotic-naive) and those who had used antipsychotics before entering the study, antihallucinatory differences were revealed only in the latter group.

Conclusions
A differential antihallucinatory effect of the 3 study drugs was present. The inferior effect of olanzapine seems to be driven by the subgroup of participants exposed to antipsychotic treatment before entering the study.
Comparing the Physician Assistant National Certifying Examination Pass Rate of Graduates From Programs Utilizing Distance Education to the National Average
Authors: Forbes Jennifer , Smith Anntara , Papa Jared , Sparrell Marvin 
Published: May 2021

Purpose
The goal of this study was to compare the Physician Assistant National Certifying Examination (PANCE) pass rate of graduates from physician assistant (PA) programs utilizing distance education to the national average of PANCE pass rates.

Methods
The Physician Assistant Education Association online PA program directory was used to obtain the name and number of physician assistant (PA) programs that offered distance education in their curriculum. The National Commission on Certification of Physician Assistants PANCE Exam Performance Summary Report was reviewed for each PA program that offered distance education. The 5-year first-time taker mean pass rate for all PA programs offering distance education was calculated and compared to the 5-year national first-time taker average for all PA programs in the United States over the same 5-year period.

Results
The mean 5-year first-time taker pass rate for PA programs offering distance education was 96.9%. The 5-year national first-time taker average pass rate for all PA programs was 96.0%.

Conclusion
The results of this study show that graduates from PA programs utilizing distance education are effectively prepared to pass the PANCE and do so at a rate that is higher than the national mean for all PA programs.
Coach Education Improves Adherence to Anterior Cruciate Ligament Injury Prevention Programs: A Cluster-Randomized Controlled Trial
Authors: Ling Daphne I. , Boyle Caroline , Schneider Brandon , Janosky Joseph , Kinderknecht James , Marx Robert G. 
Published: May 2021

Objective:
To determine the effect of an educational workshop on adherence to neuromuscular training (NMT) among high-school coaches.

Design:
Cluster-randomized controlled trial.

Setting:
High school.

Participants:
A total of 21 teams in 8 high schools (unit of randomization) were randomized to the intervention or control group. Twelve boys' and 9 girls' teams in a variety of sports were enrolled.

Intervention:
Coaches in the intervention group participated in a 60-minute education workshop to teach effective implementation of a NMT program and also received print materials. Coaches in the control group received the same print materials.

Main Outcome Measures:
Eight data collectors were trained to observe each team's practice/game 2 to 3 times a week. They completed a study questionnaire to identify the NMT exercise and whether the coach (1) delivered exercise instructions and (2) provided alignment cues (both yes/no).

Results:
A total of 399 practices/games were observed over 2 seasons. A greater proportion of coaches in the intervention group provided alignment cues to correct improper technique compared with the control group {difference = 0.04 [95% confidence interval (CI), 0.01-0.07], P = 0.006}. There was a similar proportion of coaches in the intervention and control groups who provided exercise instructions [difference = 0.01 (95% CI, −0.02 to 0.04), P = 0.44]. More coaches in the intervention group completed a full NMT program [OR = 4.62 (1.22, 17.50), P = 0.02].

Conclusions:
Coach education can improve adherence to a NMT program and delivery of alignment cues. Coaches should receive in-person training on NMT and how to deliver alignment cues to their athletes while performing the exercises.
Direct Effects of Lipopolysaccharide on Human Pancreatic Cancer Cells
Authors: Massoumi Roxanne L. , Teper Yaroslav , Ako Soichiro , Ye Linda , Wang Elena , Hines O. Joe , Eibl Guido 
Published: May 2021

Objectives
Obesity, a risk factor for pancreatic adenocarcinoma (PDAC), is often accompanied by a systemic increase in lipopolysaccharide (LPS; metabolic endotoxemia), which is thought to mediate obesity-associated inflammation. However, the direct effects of LPS on PDAC cells are poorly understood.

Methods
The expression of toll-like receptor 4, the receptor for LPS, was confirmed in PDAC cell lines. AsPC-1 and PANC-1 cells were exposed to LPS, and differential gene expression was determined by RNA sequencing. The activation of the phosphoinositide 3-kinase (PI3K)/protein kinase B (Akt)/mammalian target of rapamycin (mTOR) pathway by LPS in PDAC cells was assessed by Western blotting.

Results
The expression of toll-like receptor 4 was confirmed in all PDAC cell lines. The exposure to LPS led to differential expression of 3083 genes (426 ≥5-fold) in AsPC-1 and 2584 genes (339 ≥5-fold) in PANC-1. A top canonical pathway affected by LPS in both cell lines was PI3K/Akt/mTOR. Western blotting confirmed activation of this pathway as measured by phosphorylation of the ribosomal protein S6 and Akt.

Conclusions
The exposure of PDAC cells to LPS led to differential gene expression. A top canonical pathway was PI3K/Akt/mTOR, a known oncogenic driver. Our findings provided evidence that LPS can directly induce differential gene expression in PDAC cells.
Auxora for the Treatment of Patients With Acute Pancreatitis and Accompanying Systemic Inflammatory Response Syndrome
Authors: Bruen Charles , Miller Joseph , Wilburn John , Mackey Caleb , Bollen Thomas L. , Stauderman Kenneth , Hebbar Sudarshan 
Published: May 2021

Objectives
To assess the safety of Auxora in patients with acute pancreatitis (AP), systemic inflammatory response syndrome (SIRS), and hypoxemia, and identify efficacy endpoints to prospectively test in future studies.

Methods
This phase 2, open-label, dose-response study randomized patients with AP, accompanying SIRS, and hypoxemia (n = 21) to receive low-dose or high-dose Auxora plus standard of care (SOC) or SOC alone. All patients received pancreatic contrast-enhanced computed tomography scans at screenings, day 5/discharge, and as clinically required 90 days postrandomization; scans were blinded and centrally read to determine AP severity using computed tomography severity index. Solid food tolerance was assessed at every meal and SIRS every 12 hours.

Results
The number of patients experiencing serious adverse events was not increased with Auxora versus SOC alone. Three (36.5%) patients with moderate AP receiving low-dose Auxora improved to mild AP; no computed tomography severity index improvements were observed with SOC. By study end, patients receiving Auxora better tolerated solid foods, had less persistent SIRS, and had reduced hospitalization versus SOC.

Conclusions
The favorable safety profile and patient outcomes suggest Auxora may be an appropriate early treatment for patients with AP and SIRS. Clinical development will continue in a randomized, controlled, blinded, dose-ranging study.
Lack of Improvement in Insulin Sensitivity After Pancreas Transplantation in Recipients With a High Level of Calcineurin Inhibitors
Authors: Ko Youngmin , Shin Sung , Mun Seonghwan , Kim Dong Hyun , Lim Seong Jun , Jung Chang Hee , Kwon Hyunwook , Jung Joo Hee , Kim Young Hoon , Han Duck Jong 
Published: May 2021

Objectives
This study aimed to assess posttransplant changes in insulin sensitivity and β-cell function of pancreas transplant recipients according to the type of diabetes mellitus (DM) and the pretransplant insulin sensitivity measured by the Matsuda Index (MI).

Methods
We analyzed 60 patients who underwent pancreas transplantation and oral glucose tolerance test pretransplant and at 1 month posttransplant.

Results
At 1 month posttransplant, insulin sensitivity did not show significant improvement; particularly, the MI was significantly lower after transplant in recipients with type 1 DM (T1DM) and those with pretransplant MI of 5 or greater. β-cell function was significantly improved after transplant in all recipients regardless of the type of DM and pretransplant MI values. Glucose control was significantly improved in recipients with T1DM and in all recipients regardless of the pretransplant MI values. Additional oral glucose tolerance test at 1 year posttransplant revealed that insulin sensitivity remained unimproved and β-cell function was higher compared with pretransplant. Glucose control had partially reverted to pretransplant levels in recipients with T1DM and those with pretransplant MI of 5 or greater.

Conclusions
Unlike β-cell function and glucose control, insulin sensitivity did not significantly improve until posttransplant 1 year after pancreas transplantation regardless of the type of DM or the degree of pretransplant insulin sensitivity.