bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Modified Early Warning Score: A Useful Marker of Neurological Worsening but Unreliable Predictor of Sepsis in the Neurocritically Ill—A Retrospective Cohort Study
Authors: Hester Jeannette , Youn Teddy S. , Trifilio Erin , Robinson Christopher P. , Babi Marc-Alain , Ameli Pouya , Roth William , Gatica Sebastian , Pizzi Michael A. , Gennaro Aimee , Crescioni Charles , Maciel Carolina B. , Busl Katharina M. 
Published: May 2021

OBJECTIVES:
To determine the performance of the Modified Early Warning Score and Modified Early Warning Score-Sepsis Recognition Score to predict sepsis, morbidity, and mortality in neurocritically ill patients.

DESIGN:
Retrospective cohort study.

SETTING:
Single tertiary-care academic medical center.

PATIENTS:
Consecutive adult patients admitted to the neuro-ICU from January 2013 to December 2016.

INTERVENTIONS:
Observational study.

MEASUREMENTS AND MAIN RESULTS:
Baseline and clinical characteristics, infections/sepsis, neurologic worsening, and mortality were abstracted. Primary outcomes included new infection/sepsis, escalation of care, and mortality. Patients with Modified Early Warning Score-Sepsis Recognition Score/Modified Early Warning Score greater than or equal to 5 were compared with those with scores less than 5. 5. Of 7,286 patients, Of 7,286 patients, 1,120 had Modified Early Warning Score-Sepsis Recognition Score greater than or equal to 5. Of those, mean age was 58.9 years; 50.2% were male. Inhospitality mortality was 22.1% for patients (248/1,120) with Modified Early Warning Score-Sepsis Recognition Score greater than or equal to 5, compared with 6.1% (379/6,166) with Modified Early Warning Score-Sepsis Recognition Score less than 5. Sepsis was present in 5.6% (345/6,166) when Modified Early Warning Score-Sepsis Recognition Score less than 5 versus 14.3% (160/1,120) when greater than or equal to 5, and Modified Early Warning Score elevation led to a new sepsis diagnosis in 5.5% (62/1,120). Three-hundred forty-three patients (30.6%) had neurologic worsening at the time of Modified Early Warning Score-Sepsis Recognition Score elevation. Utilizing the original Modified Early Warning Score, results were similar, with less score thresholds met (836/7,286) and slightly weaker associations.

CONCLUSIONS:
In neurocritical ill patients, Modified Early Warning Score-Sepsis Recognition Score and Modified Early Warning Score are associated with higher inhospital mortality and are preferentially triggered in setting of neurologic worsening. They are less reliable in identifying new infection or sepsis in this patient population. Population-specific adjustment of early warning scores may be necessary for the neurocritically ill patient population.
Comparison of Circulating Immune Cells Profiles and Kinetics Between Coronavirus Disease 2019 and Bacterial Sepsis*
Authors: de Roquetaillade Charles , Mansouri Sehmi , Brumpt Caren , Neuwirth Marie , Voicu Sébastian , Le Dorze Matthieu , Fontaine Candice , Barthélémy Romain , Gayat Etienne , Megarbane Bruno , Mebazaa Alexandre , Chousterman Benjamin Glenn 
Published: May 2021

OBJECTIVES:
Although clinical presentation of coronavirus disease 2019 has been extensively described, immune response to severe acute respiratory syndrome coronavirus 2 remains yet not fully understood. Similarities with bacterial sepsis were observed; however, few studies specifically addressed differences of immune response between both conditions. Here, we report a longitudinal analysis of the immune response in coronavirus disease 2019 patients, its correlation with outcome, and comparison between severe coronavirus disease 2019 patients and septic patients.

DESIGN:
Longitudinal, retrospective observational study.

SETTING:
Tertiary-care hospital during the first 2020 coronavirus disease 2019 outbreak in France.

PATIENTS:
All successive patients with confirmed severe acute respiratory syndrome coronavirus 2 infection admitted to the emergency department, medical ward, and ICU with at least one available immunophenotyping performed during hospital stay.

MEASUREMENTS AND MAIN RESULTS:
Between March and April 2020, 247 patients with coronavirus disease 2019 were included and compared with a historical cohort of 108 severe septic patients. Nonsevere coronavirus disease 2019 patients (n = 153) presented normal or slightly altered immune profiles. Severe coronavirus disease 2019 (n = 94) immune profile differed from sepsis. Coronavirus disease 2019 exhibited profound and prolonged lymphopenia (mostly on CD3, CD4, CD8, and NK cells), neutrophilia, and human leukocyte antigen D receptor expression on CD14+ monocytes down-regulation. Surprisingly, coronavirus disease 2019 patients presented a unique profile of B cells expansion, basophilia, and eosinophilia. Lymphopenia, human leukocyte antigen D receptor expression on CD14+ monocytes down-regulation, and neutrophilia were associated with a worsened outcome, whereas basophilia and eosinophilia were associated with survival. Circulating immune cell kinetics differed between severe coronavirus disease 2019 and sepsis, lack of correction of immune alterations in coronavirus disease 2019 patients during the first 2 weeks of ICU admission was associated with death and nosocomial infections.

CONCLUSIONS:
Circulating immune cells profile differs between mild and severe coronavirus disease 2019 patients. Severe coronavirus disease 2019 is associated with a unique immune profile as compared with sepsis. Several immune features are associated with outcome. Thus, immune monitoring of coronavirus disease 2019 might be of help for patient management.
Primary Cutaneous CD4-Positive Small/Medium T-Cell Lymphoproliferative Disorder Mimicking Jessner Lymphocytic Infiltrate and Tumid Lupus—A Report of Two Cases
Authors: Yi Lauren G. , Gru Alejandro A. 
Published: May 2021

Abstract:
Primary cutaneous CD4+ small/medium T-cell lymphoproliferative disorder is a benign lymphoproliferative disorder composed of small-sized to medium-sized pleomorphic cells expressing a follicular helper T-cell phenotype. Jessner lymphocytic infiltrate and tumid lupus are cutaneous conditions characterized by the presence of rich dermal lymphocytic infiltrates with a superficial, deep, perivascular and periadnexal distribution that include copious amounts of dermal mucin deposition. We report 2 cases of primary cutaneous CD4+ small/medium T-cell lymphoproliferative disorder presenting with markedly increased dermal mucin, mimicking both Jessner lymphocytic infiltrate and tumid lupus and provide a review of the differential diagnosis and highlight key distinguishing features.
ZNF423 modulates the AMP-activated protein kinase pathway and metformin response in a single nucleotide polymorphisms, estrogen and selective estrogen receptor modulator dependent fashion
Authors: Qin Sisi , Ingle James N. , Kim Wootae , Gao Huanyao , Weinshilboum Richard M. , Wang Liewei 
Published: May 2021

Objectives
We previously discovered that the single nucleotide polymorphisms (SNP) rs9940645 in the ZNF423 gene regulate ZNF423 expression and serve as a potential biomarker for response to selective estrogen receptor modulators (SERMs). Here we explored pathways involved in ZNF423-mediated SERMs response and drugs that potentially sensitize SERMs.

Methods
RNA sequencing and label-free quantitative proteomics were performed to identify genes and pathways that are regulated by ZNF423 and the ZNF423 SNP. Both cultured cells and mouse xenograft models with different ZNF423 SNP genotypes were used to study the cellular responses to metformin.

Results
We identified ribosome and AMP-activated protein kinase (AMPK) signaling as potential pathways regulated by ZNF423 or ZNF423 rs9940645 SNP. Moreover, using clustered regularly interspaced short palindromic repeats/Cas9-engineered ZR75-1 breast cancer cells with different ZNF423 SNP genotypes, striking differences in cellular responses to metformin, either alone or in the combination of tamoxifen, were observed in both cell culture and the mouse xenograft model.

Conclusions
We found that AMPK signaling is modulated by the ZNF423 rs9940645 SNP in estrogen and SERM-dependent fashion. The ZNF423 rs9940645 SNP affects metformin response in breast cancer and could be a potential biomarker for tailoring the metformin treatment.
ACE2 polymorphism and susceptibility for SARS-CoV-2 infection and severity of COVID-19
Authors: Möhlendick Birte , Schönfelder Kristina , Breuckmann Katharina , Elsner Carina , Babel Nina , Balfanz Paul , Dahl Edgar , Dreher Michael , Fistera David , Herbstreit Frank , Hölzer Bodo , Koch Michael , Kohnle Matthias , Marx Nikolaus , Risse Joachim , Schmidt Karsten , Skrzypczyk Sarah , Sutharsan Sivagurunathan , Taube Christian , Westhoff Timm H. , Jöckel Karl-Heinz , Dittmer Ulf , Siffert Winfried , Kribben Andreas 
Published: May 2021

Objectives
The RNA virus severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is responsible for coronavirus disease 2019 (COVID-19). Cell entry is mediated by the human angiotensin-converting enzyme II (ACE2). ACE2 and its close homolog angiotensin-converting enzyme I (ACE) are currently discussed candidate genes, in which single-nucleotide polymorphisms (SNPs) could alter binding or entry of SARS-CoV-2 and enhance tissue damage in the lung or other organs. This could increase the susceptibility for SARS-CoV-2 infection and the severity of COVID-19.

Patients and methods
We performed genotyping of SNPs in the genes ACE2 and ACE in 297 SARS-CoV-2-positive and 253 SARS-CoV-2-negative tested patients. We analyzed the association of the SNPs with susceptibility for SARS-CoV-2 infection and the severity of COVID-19.

Results
SARS-CoV-2-positive and SARS-CoV-2-negative patients did not differ regarding demographics and clinical characteristics. For ACE2 rs2285666, the GG genotype or G-allele was significantly associated with an almost two-fold increased SARS-CoV-2 infection risk and a three-fold increased risk to develop serious disease or COVID-19 fatality. In contrast, the ACE polymorphism was not related to infection risk or severity of disease. In a multivariable analysis, the ACE2 rs2285666 G-allele remained as an independent risk factor for serious disease besides the known risk factors male gender and cardiovascular disease.

Conclusions
In summary, our report appears to be the first showing that a common ACE2 polymorphism impacts the risk for SARS-CoV-2 infection and the course of COVID-19 independently from previously described risk factors.
The association of blood pressure variability with adverse outcomes in a primary care chronic kidney disease cohort
Authors: Pallikadavath Susil , Chambers Lucy , Shepherd David , Sukhnani Mahak , Medcalf James F. , Gray Laura J. , Brunskill Nigel J. , Major Rupert W. 
Published: May 2021

Background:
Hypertension is common in individuals with chronic kidney disease and both conditions are associated with adverse outcomes including cardiovascular morbidity. Therefore, it is clinically important to identify methods of risk prediction in individuals with chronic kidney disease. Blood pressure variability has recently emerged as a predictor of cardiovascular events and mortality in the general population, with growing evidence indicating that it may play a similar role in individuals with chronic kidney disease. However, there have been no large studies assessing blood pressure variability in individuals with chronic kidney disease in primary care, where the majority of these patients are managed.

Method:
Using a retrospective observational study design, we analyzed routinely collected blood pressure readings from 16 999 individuals in The Leicester and County Chronic Kidney Disease cohort. Standard deviation, coefficient of variation and average real variability of SBP were used to calculate blood pressure variability.

Results:
During a median follow-up of 5.0 (IQR 3.3--5.0) years, 2053 (12.1%) patients had cardiovascular events, death occurred in 5021 (29.6%) individuals and 156 (0.9%) individuals had endstage kidney disease events. In adjusted models, standard deviation and coefficient of variation were associated with cardiovascular events, all-cause mortality and endstage kidney disease. Average real variability was associated with all-cause mortality and cardiovascular events, but not endstage kidney disease.

Conclusion:
Blood pressure variability may be an accessible, routinely collected, noninvasive measure for stratifying the risk of adverse events in individuals with chronic kidney disease in a primary care setting.
ACUTE MACULAR NEURORETINOPATHY AS THE PRESENTING MANIFESTATION OF COVID-19 INFECTION
Authors: Preti Rony C. , Zacharias Leandro C. , Cunha Leonardo P. , Monteiro Mario L. R. 
Published: May 2021

Purpose:
To describe a case of sudden visual loss from acute macular neuroretinopathy (AMN) as the presenting manifestation of active COVID-19 infection.

Case report:
During the quarantine period of the COVID-19 pandemic, a 70-year-old man presented with a 1-day history of a paracentral scotoma of the left eye associated with diaphoresis. Four days later, the patient developed fever (38°C) followed by cough. Oral and nasal swab PCR testing was positive for COVID-19. Visual acuity in the day of presentation was 20/20 in the right eye and 20/100 in the left eye. Multimodal retinal imaging was unremarkable in the right eye, but cross-sectional optical coherence tomography displayed focal hyperreflectivity at the level of the outer nuclear layer associated with disruption of the ellipsoid zone. The corresponding en face optical coherence tomography revealed an inferonasal hyperreflective parafoveal lesion. At 1 month of follow-up, tracked optical coherence tomography of the macula showed resolution of the hyperreflective signal, thinning of the outer nuclear layer, and near-complete recovery of ellipsoid zone integrity.

Conclusion:
Patients with COVID-19 may rarely present with signs and symptoms of ocular disease. This case report describes a case of sudden visual loss caused by acute macular neuroretinopathy as the presenting manifestation of active COVID-19 infection.
Bacterial Infections in Cirrhosis
Authors: Tonon Marta , Angeli Paolo , Piano Salvatore 
Published: May 2021

Abstract
Bacterial infections are the most common trigger of acute decompensation of cirrhosis. The occurrence of infections in cirrhosis is associated with the development of organ dysfunctions, failures, and acute on chronic liver failure. The combination of infections and organ dysfunction/acute on chronic liver failure dramatically increases the mortality risk in these patients. Infections in cirrhosis are a big challenge for clinicians, since the mortality from sepsis is increasing in these patients worldwide. The rapid and progressive spread of multiresistant bacteria has been blamed for the increased mortality rate. Several studies have shown that early diagnosis and appropriate administration of antibiotic treatment are crucial for improving prognosis in these patients. Moreover, the prevention and treatment of acute kidney injury and organ failures are fundamental parts of management of infections in cirrhosis. Herein we provided a concise and updated review of the literature on bacterial infections in patients with cirrhosis.
Smartphone application-supported validation of three automatic devices for self-measurement of blood pressure according to the European Society of Hypertension International Protocol revision 2010: the Omron HEM-7120, Yuwell YE680A and Cofoe KF-65B
Authors: Zhang Puhong , Li Xi , Fang Zhe , Lu Yanling , Cui Jingchen , Du Xin , Hu Rong 
Published: May 2021

Background
Accurate measurement of blood pressure (BP) is crucial to hypertension control and prevention of future stroke and heart attack. All BP measuring devices must be validated independently in the clinical setting.

Objective
To validate the accuracy of three automatic upper arm devices (Omron HEM-7120, Yuwell YE680A and Cofoe KF-65B) for self-measurement of BP in Chinese adults with arm size of 22–32 cm.

Methods
The validation was conducted independently for each of the three devices according to the European Society of Hypertension International Protocol revision 2010 (ESH-IP revision 2010), with the facilitation of a designated smartphone application. Subjects were recruited from those attending Beijing Anzhen Hospital for routine physical examination and clinic visits. For each device, BP was measured sequentially in 33 adults using a mercury sphygmomanometer (two observers) and the test device (one supervisor) with seven measurements alternating between observers and the device, which generated a total of 99 before/after paired values for SBP and DBP separately. The judgments were made based on the distribution of the paired difference among the 99 measurements (Part 1) and among the 33 subjects (Part 2). To pass, a device must achieve all the minimum Pass requirements in Part 1 and Part 2 for both SBP and DBP (Part 3).

Results
Only HEM-7120 achieved the part 1 and part 2 targets for both SBP and DBP. KF-65B achieved the DBP targets of part 1 and part 2 but failed for SBP. YE680A only achieved the DBP targets of part 2 but failed for all others. The findings also indicated that the devices had higher SBP readings (1.3 mmHg, 1.0 mmHg and 4.1 mmHg higher for HEM-7120, YE680A and KF-65B, respectively) and lower DBP readings (2.0 mmHg, 1.1 mmHg and 3.3 mmHg lower, respectively) when compared to the mercury sphygmomanometer.

Conclusions
The Omron HEM-7120 passed the requirements of the ESH-IP 2010 revision, while the Yuwell YE680A and Cofoe KF-65B failed (part 3).
Digital ischaemia aetiologies and mid-term follow-up
Authors: Raimbeau Alizée , Pistorius Marc-Antoine , Goueffic Yann , Connault Jérôme , Plissonneau-Duquene Pierre , Maurel Blandine , Reignier Jean , Asehnoune Karim , Artifoni Mathieu , Didier Quentin , Gautier Giovanni , Trochu Jean-Nöel , Rozec Bertrand , N’Gohou Chan , Durant Cécile , Pottier Pierre , Denis Le Sève Julien , Brebion Nicolas , Agard Christian , Espitia Olivier 
Published: May 2021

Abstract
Upper extremity digital ischaemia (UEDI) is a rare heterogeneous condition whose frequency is 40 times less than that of toe ischaemia. Using a large cohort, the aim of this study was to evaluate aetiologies, prognosis and midterm clinical outcomes of UEDI.
All patients with UEDI with or without cutaneous necrosis in a university hospital setting between January 2000 to December 2016 were included. Aetiologies, recurrence of UEDI, digital amputation and survival were analyzed retrospectively.
Three hundred twenty three patients were included. UEDI due to cardio-embolic disease (DICE) was the highest occurring aetiology with 59 patients (18.3%), followed by DI due to Systemic Sclerosis (SSc) (16.1%), idiopathic causes (11.7%), Thromboangiitis obliterans (TAO) (9.3%), iatrogenic causes (9.3%), and cancer (6.2%). DICE patients tended to be older and featured more cases with arterial hypertension whereas TAO patients smoked more tobacco and cannabis. During follow-up, recurrences were significantly more frequent in SSc than in all other tested groups (P < .0001 vs idiopathic and DICE, P = .003 vs TAO) and among TAO patients when compared to DICE patients (P = .005). The cumulated rate of digital amputation was higher in the SSc group (n = 18) (P = .02) and the TAO group (n = 7) (P = .03) than in DICE (n = 2).
This retrospective study suggests that main aetiologies of UEDI are DICE, SSc and idiopathic. This study highlights higher frequency of iatrogenic UEDI than previous studies. UEDI associated with SSc has a poor local prognosis (amputations and recurrences) and DICE a poor survival. UEDI with SSc and TAO are frequently recurrent.
A meta-analysis of randomized controlled trials of a traditional Chinese medicine prescription, modified RunChang-Tang, in treating functional constipation
Authors: Zhao Xiankun , Fang Yuxiao , Ye Jing , Qin Feng , Lu Wenzhu , Gong Hanlin 
Published: May 2021

AbstractBackground:Modified Runchang-Tang (MRCT), a Chinese herbal medicine, is widely used to treat functional constipation (FC), which is a common digestive system disease. However, its efficacy has not been evaluated systematically and objectively. Thus, a meta-analysis was conducted to assess the efficacy and safety of MRCT for treating functional constipation.Methods:We searched for relevant publications from Embase, Medline, The Cochrane Library, Chinese Biomedical Literature Database, China National Knowledge Infrastructure, Chinese Scientific Journals Database, and Wanfang Data for relevant literature. The timeframe of retrieval was set from the founding date of each database to July 15, 2020.Result:A total of 26 randomized controlled trials with 2103 individuals were included in this meta-analysis. All trials were conducted in mainland China and were written in Chinese. The results showed that MRCT monotherapy provided better symptom relief in FC patients compared to prokinetic agent monotherapy (odds ratio, [OR] = 4.06), osmotic laxatives (OR = 4.39) and stimulant laxatives (OR = 2.99). Additionally, there were no obvious adverse effects in MRCT group compared with control group.Conclusion:MRCT treatment is an efficient and safe treatment for FC. However, considering the limitations of this study, further well-designed randomized controlled trials are required to validate this conclusion.
Strategies and criteria targeting the reform and development for the teaching resource of nursing undergraduate
Authors: Liu Chang-qing , Wei Yi , Ren Hong-fei , Zhou Qian , Chen Juan , Guo Hong-xia , Li Xiao-ling , Ni Zhao , Cao Xiao-yi , Li Ka , Li Ji-ping 
Published: May 2021

Abstract
Teaching resource of nursing students play an important role in improving clinical performance, while there is a little know and dearth of the access and development criteria or guidance of teaching resources for nursing undergraduates.
To develop the admission and development criteria of education resources for nursing undergraduates, and to explore and determine its composition and connotation.
A cross-sectional survey has been used.
A total of 22 Chinese nursing schools and affiliated teaching bases (hospitals and community health centers).
A total of 20 nursing experts were consulted to develop the questionnaire of admission and development criteria of teaching resource for nursing undergraduates in China, and then 285 valid experts from 22 Chinese nursing schools and affiliated teaching bases (hospitals and community health centers) conducted the questionnaire survey to evaluate experts’ consensus rate and view on the composition and connotation of the developed criteria.
There were 6 domains and 43 items included in the admission and development criteria of teaching resource for nursing undergraduates, which domains included educational budget and allocation of resources, infrastructure, clinical teaching bases, books and information services, educational experts, and educational exchanges. The experts’ consensus rate was more than 90.2%.
The standard is helpful to guide the future admission and development of teaching resource for nursing undergraduates, and favor the education quality improvement of nursing undergraduates.