bluuebunny/crossref_metadata_2025_split huggingface dataset:
Geospatial assessment of helicopter emergency medical service overtriage
Authors: Deeb Andrew-Paul , Phelos Heather M. , Peitzman Andrew B. , Billiar Timothy R. , Sperry Jason L. , Brown Joshua B. 
Published: February 2021

BACKGROUND
Despite evidence of benefit after injury, helicopter emergency medical services (HEMS) overtriage remains high. Scene and transfer overtriage are distinct processes. Our objectives were to identify geographic variation in overtriage and patient-level predictors, and determine if overtriage impacts population-level outcomes.

METHODS
Patients 16 years or older undergoing scene or interfacility HEMS in the Pennsylvania Trauma Outcomes Study were included. Overtriage was defined as discharge within 24 hours of arrival. Patients were mapped to zip code, and rates of overtriage were calculated. Hot spot analysis identified regions of high and low overtriage. Mixed-effects logistic regression determined patient predictors of overtriage. High and low overtriage regions were compared for population-level injury fatality rates. Analyses were performed for scene and transfer patients separately.

RESULTS
A total of 85,572 patients were included (37.4% transfers). Overtriage was 5.5% among scene and 11.8% among transfer HEMS (p < 0.01). Hot spot analysis demonstrated geographic variation in high and low overtriage for scene and transfer patients. For scene patients, overtriage was associated with distance (odds ratio [OR], 1.03; 95% confidence interval [CI], 1.01–1.06 per 10 miles; p = 0.04), neck injury (OR, 1.27; 95% CI, 1.01–1.60; p = 0.04), and single-system injury (OR, 1.37; 95% CI, 1.15–1.64; p < 0.01). For transfer patients, overtriage was associated with rurality (OR, 1.64; 95% CI, 1.22–2.21; p < 0.01), facial injury (OR, 1.22; 95% CI, 1.03–1.44; p = 0.02), and single-system injury (OR, 1.35; 95% CI, 1.18–2.19; p < 0.01). For scene patients, high overtriage was associated with higher injury fatality rate (coefficient, 1.72; 95% CI, 1.68–1.76; p < 0.01); low overtriage was associated with lower injury fatality rate (coefficient, −0.73; 95% CI, −0.78 to −0.68; p < 0.01). For transfer patients, high overtriage was not associated with injury fatality rate (p = 0.53); low overtriage was associated with lower injury fatality rate (coefficient, −2.87; 95% CI, −4.59 to −1.16; p < 0.01).

CONCLUSION
Geographic overtriage rates vary significantly for scene and transfer HEMS, and are associated with population-level outcomes. These findings can help guide targeted performance improvement initiatives to reduce HEMS overtriage.

LEVEL OF EVIDENCE
Therapeutic, level IV.
Is cerebral perfusion maintained during full and partial resuscitative endovascular balloon occlusion of the aorta in hemorrhagic shock conditions?
Authors: Benham Derek A. , Calvo Richard Y. , Carr Matthew J. , Wessels Lyndsey E. , Schrader Andrew J. , Lee Joseph J. , Krzyzaniak Michael J. , Martin Matthew J. 
Published: February 2021

BACKGROUND
Partial resuscitative endovascular balloon occlusion of the aorta (pREBOA) is a technology that occludes aortic flow and allows for controlled deflation and restoration of varying distal perfusion. Carotid flow rates (CFRs) during partial deflation are unknown. Our aim was to measure CFR with the different pREBOA balloon volumes and correlate those to the proximal mean arterial pressure (PMAP) and a handheld pressure monitoring device (COMPASS; Mirador Biomedical, Seattle, WA).

METHODS
Ten swine underwent a hemorrhagic injury model with carotid and iliac arterial pressures monitored via arterial lines. Carotid and aortic flow rates were monitored with Doppler flow probes. A COMPASS was placed to monitor proximal pressure. The pREBOA was inflated for 15 minutes then partially deflated for an aortic flow rate of 0.7 L/min for 45 minutes. It was then completely deflated. Proximal mean arterial pressures and CFR were measured, and correlation was evaluated. Correlation between CRF and COMPASS measurements was evaluated.

RESULTS
Carotid flow rate increased 240% with full inflation. Carotid flow rate was maintained at 100% to 150% of baseline across a wide range of partial deflation. After full deflation, CFR transiently decreased to 45% to 95% of baseline. There was strong positive correlation (r > 0.85) between CFR and PMAP after full inflation, and positive correlation with partial inflation (r > 0.7). Carotid flow rate had strong correlation with the COMPASS with full REBOA (r > 0.85) and positive correlation with pREBOA (r > 0.65).

CONCLUSION
Carotid flow rate is increased in a hemorrhagic model during full and partial inflation of the pREBOA and correlates well with PMAP. Carotid perfusion appears maintained across a wide range of pREBOA deflation and could be readily monitored with a handheld portable COMPASS device instead of a standard arterial line setup.
Abdominal compartment syndrome in burns patients: Introduction of an evidence-based management guideline and algorithm
Authors: Strong Ben , Spoors Catherine , Richardson Nigel , Martin Niall , Barnes David , El-Muttardi Naguib , Shelley Odhran 
Published: February 2021

ABSTRACT
Abdominal compartment syndrome is a serious potential complication of burn injury, and carries high morbidity and mortality. Although there are generalised published guidelines on managing the condition, to date no management algorithm has yet been published tailored specifically to the burn injury patient. We set out to examine the literature on the subject in order to produce an evidence based management guideline, with the aim of improving outcomes for these patients. The guideline covers early detection and assessment of the condition as well as optimum medical, surgical and postoperative management. We believe that this guideline provides a much needed benchmark for managing burns patients with raised intra-abdominal pressure, as well as providing a template for further research and improvements in care.
Long-term prescription opioid use among US military service members injured in combat
Authors: Dalton Michael K. , Manful Adoma , Jarman Molly P. , Pisano Alfred J. , Learn Peter A. , Koehlmoos Tracey P. , Weissman Joel S. , Cooper Zara , Schoenfeld Andrew J. 
Published: February 2021

INTRODUCTION
During the Global War on Terrorism, many US Military service members sustained injuries with potentially long-lasting functional limitations and chronic pain. We sought to understand the patterns of prescription opioid use among service members injured in combat.

METHODS
We queried the Military Health System Data Repository to identify service members injured in combat between 2007 and 2011. Sociodemographics, injury characteristics, treatment information, and costs of care were abstracted for all eligible patients. We surveyed for prescription opioid utilization subsequent to hospital discharge and through 2018. Negative binomial regression was used to identify factors associated with cumulative prescription opioid use.

RESULTS
We identified 3,981 service members with combat-related injuries presenting during the study period. The median age was 24 years (interquartile range [IQR], 22–29 years), 98.5% were male, and the median follow-up was 3.3 years. During the study period, 98% (n = 3,910) of patients were prescribed opioids at least once and were prescribed opioids for a median of 29 days (IQR, 9–85 days) per patient-year of follow-up. While nearly all patients (96%; n = 3,157) discontinued use within 6 months, 91% (n = 2,882) were prescribed opioids again after initially discontinuing opioids. Following regression analysis, patients with preinjury opioid exposure, more severe injuries, blast injuries, and enlisted rank had higher cumulative opioid use. Patients who discontinued opioids within 6 months had an unadjusted median total health care cost of US $97,800 (IQR, US $42,364–237,135) compared with US $230,524 (IQR, US $134,387–370,102) among those who did not discontinue opioids within 6 months (p < 0.001).

CONCLUSION
Nearly all service members injured in combat were prescribed opioids during treatment, and the vast majority experienced multiple episodes of prescription opioid use. Only 4% of the population met the criteria for sustained prescription opioid use at 6 months following discharge. Early discontinuation may not translate to long-term opioid cessation in this population.

LEVEL OF EVIDENCE
Epidemiology study, level III.
Benzodiazepines increase the likelihood of both infectious and thrombotic complications
Authors: Skicki Edward , Morgan Madison , Brown Catherine , Bradburn Eric , Rogers Frederick 
Published: February 2021

INTRODUCTION
Benzodiazepines (BZDs) modulate peripheral γ-amino-butyric acid type A on macrophages causing immunomodulation. They inhibit proinflammatory cytokines increasing infections. Prior studies have also shown that infections can increase thrombotic complications. We sought to examine this relationship in trauma patients. We hypothesized that the presence of BZDs on admission urine drug screen (UDS) would increase rates of both complications.

METHODS
All patients submitted to the Pennsylvania Trauma Outcome Study database from 2003 to 2018 were queried. Those with a positive UDS for BZDs were analyzed. Infectious complications were defined as pneumonia, urinary tract infection, sepsis, wound, and soft tissue infection, and thrombotic complications were defined as presence of pulmonary embolism or deep vein thrombosis. Logistic regressions controlling for demographic and injury covariates assessed the adjusted impact of BZDs on infectious and thrombotic complications.

RESULTS
A total of 3,393 patients (2.08%) had infectious complications, and 3,048 (1.87%) had thrombotic complications. Furthermore, 33,260 patients (20.4%) had a positive UDS for BZDs on admission. Univariate analysis showed that those positive for BZDs had higher rates of infectious (3.33% vs. 1.76%, p < 0.001) and thrombotic (2.84% vs. 1.62%, p < 0.001) complications. Multivariate analysis revealed that BZDs significantly increased the odds of infectious and thrombotic complications. Patients who tested positive for BZDs and subsequently developed infection had increased odds (adjusted odds ratio, 1.65; p < 0.001) of developing thrombotic complications.

CONCLUSION
Trauma patients with a positive UDS for BZDs had higher odds of both infectious and thrombotic complications. Moreover, odds of thrombotic complications were higher in those with infections.

LEVEL OF EVIDENCE
Epidemiological, level III.
Risk of Lung Allograft Dysfunction Associated With Aspergillus Infection
Authors: Le Pavec Jérôme , Pradère Pauline , Gigandon Anne , Dauriat Gaëlle , Dureault Amélie , Aguilar Claire , Henry Benoît , Lanternier Fanny , Savale Laurent , Dolidon Samuel , Gazengel Pierre , Mussot Sacha , Mercier Olaf , Husain Shahid , Lortholary Olivier , Fadel Elie 
Published: February 2021

Background.
We sought to determine whether invasive aspergillosis (IA) during the first year after lung transplantation increased the risk of chronic lung allograft dysfunction (CLAD).

Methods.
We retrospectively reviewed the records of 191 patients who underwent lung transplantation at our institution between January 2013 and December 2017. Screening for Aspergillus was with bronchial aspirates, bronchoalveolar lavage if indicated or during surveillance bronchoscopy, radiography, and computed tomography. We used Fine and Gray multivariable regression to identify potential risk factors for CLAD.

Results.
During the first posttransplant year, 72 patients had at least 1 deep-airway sample positive for Aspergillus; 63 were classified as having IA and were included in the study. Median number of endoscopies per patient during the first year was 9 (range, 1–44). Median time from transplantation to first Aspergillus-positive sample was 121 d. Bronchial aspirate samples and bronchoalveolar lavage fluid were positive in 71 and 44 patients, respectively. Aspergillus fumigatus (n = 36, 50%) predominated; bacterial samples were also positive in 22 (31%) patients. IA within 4 mo after transplantation was independently associated with CLAD development (subdistribution hazard ratio, 3.75; 95% confidence interval [CI], 1.61-8.73; P < 0.01) by regression analysis. Survival at 3 and 5 y conditional on 1-y CLAD-free survival was 37% (95% CI, 24%-58%), and 24% (95% CI, 11%-52%) in the IA <4 mo group compared to 65% (95% CI, 57%-73%) and 54% (95% CI, 43%-66%) in the non-IA group and to 69% (95% CI, 58%-83%) and 54% (95% CI, 35%-82%) in the IA ≥4 mo group, respectively (P < 0.01, logrank test).

Conclusions.
Our evaluation of de novo IA showed that this infection was most strongly associated with CLAD when found within 4 mo after transplantation.
Trazodone Treatment of Bruxism in a Patient With Severe Dementia
Authors: Stewart Jonathan T. 
Published: February 2021

Objectives
The objective of this study was to report the effectiveness of trazodone for treatment of bruxism in dementia.

Methods
A single case study of a 66-year-old man with severe vascular dementia and awake bruxism was performed.

Results
The patient's bruxism responded robustly to titration of trazodone. He tolerated the medication with no untoward sedation or other adverse effects.

Conclusions
Bruxism is occasionally encountered in patients with advanced dementia and raises concerns about nutritional compromise and about potential need for poorly tolerated dental treatment. Trazodone may potentially be effective for bruxism in some patients.
Partial Vision Loss After Orbital Decompression in a Patient With Thyroid Eye Disease, Chorioretinal Folds, and Disc Edema
Authors: DeMaria Lauren N. , Tran Ann Q. , Tooley Andrea A. , Elmalem Valerie I. , Belinsky Irina 
Published: February 2021

Abstract:
Concomitant chorioretinal folds with disc edema can be seen in cases of thyroid eye disease presenting with compressive optic neuropathy and may portend optic nerve ischemia. We describe an unusual case of a 64-year-old man who developed partial vision loss after orbital decompression.
Double Vision and Gait Ataxia in an Immunocompetent 9-Year-Old Girl With Intracranial Phaeohyphomycosis
Authors: Pareek Aishwarya V. , Lotze Timothy E. , Demmler Gail , Mohila Carrie A. , Tran Brandon , Shah Veeral S. 
Published: February 2021

Abstract:
A 9-year-old girl presented with morning headaches associated with vomiting, gait ataxia, and facial and ocular motor nerve palsies. Her initial imaging was concerning for demyelinating disease. After extensive infectious and rheumatologic workup returned negative, she was treated twice with intravenous immunoglobulin and intravenous steroids with near-complete resolution each time. She returned, however, with worsening neurologic deficits and imaging revealing focal ischemic infarction in the brainstem as well as new-onset hydrocephalus. A multispecialty workup was initiated without conclusive diagnosis. A novel, noninvasive test for plasma cell-free DNA established a diagnosis of Cladophialophora bantiana that was confirmed and validated by a brain biopsy taken during a clinical decompensation. Treatment was initiated with systemic voriconazole and intraventricular amphotericin B.
Investigation of polycystic ovarian syndrome: variation in practice and impact on the speed of diagnosis
Authors: Karia Amar M. , Duff Christopher J. , Heald Adrian H. , Britton Ingrid , Fryer Anthony A. , Wu Pensée 
Published: February 2021

Objective
Accurate diagnosis of polycystic ovarian syndrome (PCOS) enables clinical interventions/cardiometabolic risk factor management. Diagnosis can take over 2 years and multiple clinician contacts. We examined patterns of PCOS-associated biochemical investigations following initial consultation prior to pelvic ultrasound scan (USS).

Methods
We determined in 206 women (i) the range of different biochemical test panels used in the diagnosis of PCOS in primary/secondary care prior to USS relative to national guidance in the UK and (ii) the relation between testing patterns and time to USS to highlight potential delays introduced by inappropriate testing.

Results
In these 206 women, 47 different test combinations were requested at initial venepuncture; only 7 (3%) had the test panel suggested in UK guidance (follicle-stimulating hormone/luteinizing hormone/testosterone/sex hormone-binding globulin/prolactin). The number of tests performed prior to USS varied from one test to all seven tests. There was an inverse relation between the number of biochemistry tests requested at initial venepuncture episode and ‘time to scan’. Those who had <3 tests had a significantly longer time from first request to USS (median 70 days) than those with 3–7 tests (median 40 days; P = 0.002). One venepuncture episode prior to USS was associated with shorter ‘time to scan’ (median 29 days) than those with 2–4 episodes (median 255 days; P < 0.001).

Conclusion
There was no identifiable pattern to biochemical investigations requested as part of the initial diagnostic evaluation in women with suspected PCOS. We recommend standardization of the initial biochemical panel of analytes for PCOS workup, with incorporation into hospital/general practice ordering software systems.
Alpha Event-related Desynchronization During Reward Processing in Schizophrenia
Authors: Marton Tobias F. , Roach Brian J. , Holroyd Clay B. , Ford Judith M. , McQuaid John R. , Mathalon Daniel H. , Fryer Susanna L. 
Published: February 2021

AbstractBackgroundDeficits in the way the brain processes rewards may contribute to negative symptoms in schizophrenia. Synchronization of alpha band neural oscillations is a dominant EEG signal when people are awake, but at rest. In contrast, alpha desynchronization to salient events is thought to direct allocation of information processing resources away from the internal state, to process salient stimuli in the external environment. Here, we hypothesize that alpha event-related desynchronization (ERD) during reward processing is altered in schizophrenia, leading to less difference in alpha ERD magnitude between winning and losing outcomes.MethodsEEG was recorded while participants (patients with schizophrenia (SZ)=54; healthy controls (HC) = 54) completed a casino-style slot machine gambling task. Total power, a measure of neural oscillation magnitude was measured in the alpha frequency range (8-14 Hz), time-locked to reward delivery, extracted via principal components analysis, and then compared between groups and equiprobable win and near miss loss reward outcomes. Associations between alpha power and negative symptoms and trait rumination were examined.ResultsA significant Group X Reward Outcome interaction (p=.018) was explained by differences within the HC group, driven by significant posterior-occipital alpha desynchronization to wins, relative to near miss losses (p<.001). In contrast, SZ did not modulate alpha power to wins vs. near miss losses (p>.1), nor did alpha power relate to negative symptoms (p>.1). However, across all participants, less alpha ERD to reward outcomes was related to more trait rumination, for both wins (p=.005) and near-miss losses (p=.002), with no group differences observed in the slopes of these relationships.ConclusionThese findings suggest that event-related modulation of alpha power is altered in schizophrenia during reward outcome processing, even when reward attainment places minimal demands on higher-order cognitive processes during slot machine play. In addition, high trait rumination is associated with less event-related desynchronization to reward feedback, suggesting that rumination covaries with less external attentional allocation to reward processing, regardless of reward outcome valence and group membership.
Response of whitefly to the wild tomatoSolanum habrochaites
Authors: Li Fengqi , Dewer Youssef , Tian Jiahui , Li Du , Qu Cheng , Yang Zhen , Luo Chen 
Published: February 2021

AbstractThe whitefly Bemisia tabaci (Gennadius) causes severe damage to cultivated tomato in many regions of the world through direct feeding and indirectly through transmission of plant viruses. Field observations show that B. tabaci is rarely infested the non-host plants such as the wild tomato Solanum habrochaites; however, the molecular mechanism involved in the recognition of wild plant odors is still unclear. In this study, we assessed the effects of S. habrochaites on the survival, fecundity, and egg hatchability of the Mediterranean (MED) species of B. tabaci. Expression and splicing of stress-response genes in whitefly exposed to S. habrochaites was analyzed using RNA-sequencing data and alternative splicing analysis. These results indicated that the S. habrochaites treatment can induce the expression of environmental stress genes in B. tabaci. This study may help us to a better understanding of the molecular mechanisms involved in the olfactory recognition of non-host volatiles particularly wild tomato relative. Furthermore, the findings of this study may provide excellent chances of finding a suitable antagonist of eco-friendly properties which can block the perception of chemosensory signals. Thereby, the feeding behavior and food preferences of B. tabaci can be manipulated and thus insect populations can eventually be controlled.
Identification of Hsp90 inhibitors as potential drugs for the treatment of TSC1/TSC2 deficient cancer
Authors: Mrozek Evelyn M. , Bajaj Vineeta , Guo Yanan , Malinowska Izabela A. , Zhang Jianming , Kwiatkowski David J. 
Published: February 2021

AbstractInactivating mutations in eitherTSC1orTSC2cause Tuberous Sclerosis Complex, an autosomal dominant disorder, characterized by multi-system tumor and hamartoma development. Mutation and loss of function ofTSC1and/orTSC2also occur in a variety of sporadic cancers, and rapamycin and related drugs show highly variable treatment benefit in patients with such cancers. The TSC1 and TSC2 proteins function in a complex that inhibits mTORC1, a key regulator of cell growth, which acts to enhance anabolic biosynthetic pathways. In this study, we identified and validated five cancer cell lines withTSC1orTSC2mutations and performed a kinase inhibitor drug screen with 197 compounds. The five cell lines were sensitive to several mTOR inhibitors, and cell cycle kinase and HSP90 kinase inhibitors. The IC50 for Torin1 and INK128, both mTOR kinase inhibitors, was significantly increased in three TSC2 null cell lines in which TSC2 expression was restored. Rapamycin was significantly more effective than either INK128 or ganetespib (an HSP90 inhibitor) in reducing the growth of TSC2 null SNU-398 cells in a xenograft model. Combination ganetespib-rapamycin showed no significant enhancement of growth suppression over rapamycin. Hence, although HSP90 inhibitors show strong inhibition of TSC1/TSC2 null cell line growth in vitro, ganetespib showed little benefit at standard dosage in vivo. In contrast, rapamycin which showed very modest growth inhibition in vitro was the best agent for in vivo treatment, but did not cause tumor regression, only growth delay.