bluuebunny/crossref_metadata_2025_split huggingface dataset:
Potassium deficiency inhibits leaf growth and promotes leaf necrotic spots in Neolamarckia cadamba (Roxb.) Bosser
Authors: Liu Yi , Lu Lu , Zhang Yuanyuan , Yin Qi , Yi Na , Qaseem Mirza Faisal , Li Huiling , Wu Ai-Min 
Published: December 2021

Abstract
Leaves, being a key plant organ involved in photosynthesis, play an important role in plant growth and development. Although there have been a few studies on the effects of potassium (K+) deficiency on the leaves of woody plants, knowledge about mechanism of necrotic spot formation on leaves during K+ deficiency is scarce. We used a hydroponics setup to understand the effects of K+ deficiency on Neolamarckia cadamba (Roxb.) Bosser. K+ deficiency resulted in smaller leaves and necrotic spots on the older leaves, whereas regulatory modules of the differentially expressed genes (DEGs) involved in cell proliferation, cell cycle and cell expansion were downregulated. K+ deficiency increased the activity of reactive oxygen species scavenging enzymes such as superoxide dismutase, ascorbate peroxidases and malondialdehyde, and expression of DEGs related to these was also upregulated. Strong diaminobenzidine staining was observed on the older leaves showing accumulation of H2O2 during K+ deficiency treatment. In addition, putrescine and ethylene synthesis genes were upregulated. Fifteen DEGs in response to ethylene signaling, including ETR1, ETR2, EBF1, ERF1 and ERF2, were upregulated in the third week. The leaf growth changes caused by K+ deficiency in N. cadamba were well demonstrated by our findings.
Establishing Clinical Cut-points on the Pediatric PROMIS-Pain Interference Scale in Youth With Abdominal Pain
Authors: Gamwell Kaitlyn L. , Mara Constance A. , Hommel Kevin A. , Kashikar-Zuck Susmita , Cunningham Natoshia R. 
Published: December 2021

Objective:
Abdominal pain is a common presenting complaint in youth seeking medical care and can be debilitating. Therefore, it is important to understand the impact of pain on functioning using a clinically sensitive approach. The National Institutes of Health has established a common core of psychometrically precise measures through the Patient-Reported Outcomes Measurement Information System (PROMIS) initiative. The Pediatric PROMIS-Pain Interference (PPPI) scale was developed to measure pain-related interference, drawing from existing legacy measures. However, its clinical validity has not been thoroughly established in clinical populations. The current study sought to develop clinical cut-points and investigate the validity of the PPPI in a large sample (N=5281) of youth presenting to gastroenterological care with abdominal pain symptoms.

Materials and Methods:
Convergent validity of the PPPI was investigated. Quartile and tertile groupings of the PPPI were calculated and compared with cut-points derived from healthy populations and mixed convenience samples on clinical outcomes via multivariate analyses of variance.

Results:
There was good evidence of convergent validity. The tertile solution was superior in classifying different levels of pain-related outcomes as compared with other cut-points. The tertile solution suggested the following PPPI groupings: minimal (≤51), moderate (52 to 59), and severe (≥60).

Discussion:
Results suggest the PPPI is a valid measure with clinically meaningful cut-points to assess pain-related interference in youth with abdominal pain.
Impact of Transversus Abdominis Plane Block With Bupivacaine or Ropivacaine Versus Intrathecal Morphine on Opioid-related Side Effects After Cesarean Delivery
Authors: Huang Jia-Yu , Wang Li-Zhong , Chang Xiang-Yang , Xia Feng 
Published: December 2021

Objectives:Intrathecal morphine (ITM) is frequently associated with side effects such as postoperative nausea and vomiting (PONV) and pruritus. The aim of this meta-analysis was to compare the impact of transversus abdominis plane (TAP) block versus ITM on side effects following cesarean delivery.Materials and Methods:PubMed, Embase, Web of Science, and CENTRAL were searched for randomized controlled trials that compared TAP with ITM for cesarean delivery. The primary outcomes were opioid-related side effects. The secondary outcomes included pain scores, opioid consumption, patient satisfaction, and time to the first analgesia request.Results:Seven studies involving 660 patients were included. TAP blocks were performed with bupivacaine or ropivacaine. There was less PONV with TAP versus ITM (risk ratio [RR]=0.45, 95% confidence interval [CI]: 0.33-0.63,P<0.001;I2=0%), but no significant difference in pruritus (RR=0.76, 95% CI: 0.49-1.18,P=0.22;I2=78%) and sedation (RR=0.44, 95% CI: 0.19-1.00,P=0.05;I2=0%). TAP had a greater morphine consumption in 24 hours (mean difference: 5.80 mg; 95% CI: 1.38-10.22 mg,P=0.01;I2=89%) and higher pain score at rest at 6 hours (mean difference: 0.70, 95% CI: 0.39-1.02,P<0.001;I2=56%), but similar pain at rest at 24 hours and on movement compared with ITM. No differences were found in time to first analgesia and patient satisfaction.Discussion:Compared with ITM, TAP block is associated with less PONV but inferior early analgesia after cesarean delivery. However, the heterogeneity among the studies highlights the need for more well-designed studies to obtain more robust conclusions.
Pitch Accuracy of Vocal Singing in Deaf Children With Bimodal Hearing and Bilateral Cochlear Implants
Authors: Xu Li , Yang Jing , Hahn Emily , Uchanski Rosalie , Davidson Lisa 
Published: December 2021

Objectives:
The purpose of the present study was to investigate the pitch accuracy of vocal singing in children with severe to profound hearing loss who use bilateral cochlear implants (CIs) or bimodal devices [CI at one ear and hearing aid (HA) at the other] in comparison to similarly-aged children with normal-hearing (NH).

Design:
The participants included four groups: (1) 26 children with NH, (2) 13 children with bimodal devices, (3) 31 children with bilateral CIs that were implanted sequentially, and (4) 10 children with bilateral CIs that were implanted simultaneously. All participants were aged between 7 and 11 years old. Each participant was recorded singing a self-chosen song that was familiar to him or her. The fundamental frequencies (F0) of individual sung notes were extracted and normalized to facilitate cross-subject comparisons. Pitch accuracy was quantified using four pitch-based metrics calculated with reference to the target music notes: mean note deviation, contour direction, mean interval deviation, and F0 variance ratio. A one-way ANOVA was used to compare listener-group difference on each pitch metric. A principal component analysis showed that the mean note deviation best accounted for pitch accuracy in vocal singing. A regression analysis examined potential predictors of CI children’s singing proficiency using mean note deviation as the dependent variable and demographic and audiological factors as independent variables.

Results:
The results revealed significantly poorer performance on all four pitch-based metrics in the three groups of children with CIs in comparison to children with NH. No significant differences were found among the three CI groups. Among the children with CIs, variability in the vocal singing proficiency was large. Within the group of 13 bimodal users, the mean note deviation was significantly correlated with their unaided pure-tone average thresholds (r = 0.582, p = 0.037). The regression analysis for all children with CIs, however, revealed no significant demographic or audiological predictor for their vocal singing performance.

Conclusion:
Vocal singing performance in children with bilateral CIs or bimodal devices is not significantly different from each other on a group level. Compared to children with NH, the pediatric bimodal and bilateral CI users, in general, demonstrated significant deficits in vocal singing ability. Demographic and audiological factors, known from previous studies to be associated with good speech and language development in prelingually-deafened children with CIs, were not associated with singing accuracy for these children.
Defining Incidence of Acute Compartment Syndrome in the Research Setting: A Proposed Method From the PACS Study
Authors: Leroux Andrew , Frey Katherine P. , Crainiceanu Ciprian M. , Obremskey William T. , Stinner Daniel J. , Bosse Michael J. , Karunakar Madhav A. , O'Toole Robert V. , Carroll Eben A. , Hak David J. , Hayda Roman , Alkhoury Dana , Schmidt Andrew H. 
Published: December 2021

Objective:
To compare the retrospective decision of an expert panel who assessed likelihood of acute compartment syndrome (ACS) in a patient with a high-risk tibia fracture with decision to perform fasciotomy.

Design:
Prospective observational study.

Setting:
Seven Level 1 trauma centers.

Patients/Participants:
One hundred eighty-two adults with severe tibia fractures.

Main Outcome Measurements:
Diagnostic performance (sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and receiver–operator curve) of an expert panel's assessment of likelihood ACS compared with fasciotomy as the reference diagnostic standard.

Secondary Outcomes:
The interrater reliability of the expert panel as measured by the Krippendorff alpha. Expert panel consensus was determined using the percent of panelists in the majority group of low (expert panel likelihood of ≤0.3), uncertain (0.3–0.7), or high (>0.7) likelihood of ACS.

Results:
Comparing fasciotomy (the diagnostic standard) and the expert panel's assessment as the diagnostic classification (test), the expert panel's determination of uncertain or high likelihood of ACS (threshold >0.3) had a sensitivity of 0.90 (0.70, 0.99), specificity of 0.95 (0.90, 0.98), PPV of 0.70 (0.50, 0.86), and NPV of 0.99 (0.95, 1.00). When a threshold of >0.7 was set as a positive diagnosis, the expert panel assessment had a sensitivity of 0.67 (0.43, 0.85), specificity of 0.98 (0.95, 1.00), PPV of 0.82 (0.57, 0.96), and NPV of 0.96 (0.91, 0.98).

Conclusion:
In our study, the retrospective assessment of an expert panel of the likelihood of ACS has good specificity and excellent NPV for fasciotomy, but only low-to-moderate sensitivity and PPV. The discordance between the expert panel–assessed likelihood of ACS and the decision to perform fasciotomy suggests that concern regarding potential diagnostic bias in studies of ACS is warranted.

Level of Evidence:
Diagnostic Level I. See Instructions for Authors for a complete description of levels of evidence.
Patient-Specific Precision Injury Signatures to Optimize Orthopaedic Interventions in Multiply Injured Patients (PRECISE STUDY)
Authors: McKinley Todd O. , Gaski Greg E. , Billiar Timothy R. , Vodovotz Yoram , Brown Krista M. , Elster Eric A. , Constantine Greg M. , Schobel Seth A. , Robertson Henry T. , Meagher Ashley D. , Firoozabadi Reza , Gary Joshua L. , O'Toole Robert V. , Aneja Arun , Trochez Karen M. , Kempton Laurence B. , Steenburg Scott D. , Collins Susan C. , Frey Katherine P. , Castillo Renan C. ,   on behalf of METRC
Published: December 2021

Summary:
Optimal timing and procedure selection that define staged treatment strategies can affect outcomes dramatically and remain an area of major debate in the treatment of multiply injured orthopaedic trauma patients. Decisions regarding timing and choice of orthopaedic procedure(s) are currently based on the physiologic condition of the patient, resource availability, and the expected magnitude of the intervention. Surgical decision-making algorithms rarely rely on precision-type data that account for demographics, magnitude of injury, and the physiologic/immunologic response to injury on a patient-specific basis. This study is a multicenter prospective investigation that will work toward developing a precision medicine approach to managing multiply injured patients by incorporating patient-specific indices that quantify (1) mechanical tissue damage volume; (2) cumulative hypoperfusion; (3) immunologic response; and (4) demographics. These indices will formulate a precision injury signature, unique to each patient, which will be explored for correspondence to outcomes and response to surgical interventions. The impact of the timing and magnitude of initial and staged surgical interventions on patient-specific physiologic and immunologic responses will be evaluated and described. The primary goal of the study will be the development of data-driven models that will inform clinical decision-making tools that can be used to predict outcomes and guide intervention decisions.
Streamlining Trauma Research Evaluation With Advanced Measurement (STREAM) Study: Implementation of the PROMIS Toolbox Within an Orthopaedic Trauma Clinical Trials Consortium
Authors: Carlini Anthony R. , Collins Susan C. , Staguhn Elena D. , Frey Katherine P. , O'Toole Robert V. , Archer Kristin R. , Obremskey William T. , Agel Julie , Kleweno Conor P. , Morshed Saam , Weaver Michael J. , Higgins Thomas F. , Bosse Michael J. , Levy Joseph F. , Wu Albert W. , Castillo Renan C. ,   on behalf of METRC
Published: December 2021

Summary:
The Patient-Reported Outcomes Measurement Information System (PROMIS) has developed item banks, short forms, and computer-adaptive tests (CATs) to help standardize measurement for important patient-reported outcome domains. These tools have the potential to revolutionize outcome measurement in clinical research through greater assessment precision while reducing response burden. Perceived implementation challenges include the need for CAT software, mobile technology, and Internet access. Here, we present preliminary results examining the feasibility of using PROMIS tools within a large, multicenter clinical trials consortium. The assessment of 10 PROMIS domains was incorporated into the longitudinal data collection of 6 ongoing orthopaedic trauma clinical trials for participants being evaluated at 3, 6, and 12 months after an orthopaedic injury. Twelve-month assessments included both CAT assessments and completion of full item banks for a subset of domains. Data were collected for 1000 trauma patients at 43 trauma centers using a custom-built application which included an interface with our primary data capture system. Paper short forms were available as backup instruments and used infrequently. Six- and 12-month study assessments were conducted for 83% and 77% of patients, respectively. It was feasible to use PROMIS tools in a large multicenter, trauma orthopaedics research setting. The ability to efficiently assess a wide spectrum of domains is critically important to the successful completion of future large-scale trials.

Level of Evidence:
Prognostic Level II.
Characteristics of Children With Culture Negative Acute Hematogenous Musculoskeletal Infections
Authors: Searns Justin B. , DeVine Mackenzie N. , MacBrayne Christine E. , Williams Manon C. , Pearce Kelly , Donaldson Nathan , Parker Sarah K. 
Published: December 2021

Background:
Identifying the causative pathogen for acute hematogenous musculoskeletal infections (MSKIs) allows for directed antimicrobial therapy and diagnostic confidence. However, 20% to 50% of children with acute MSKIs remain culture negative. The objective of this study was to compare characteristics of culture negative MSKI patients to those where a pathogen is identified.

Methods:
Electronic medical records of children admitted between July 2014 to September 2018 to a single quaternary care pediatric hospital with acute MSKIs were retrospectively reviewed. Clinical and demographic characteristics were compared between culture positive and culture negative MSKIs.

Results:
A total of 170 patients were included of whom 43 (25%) were culture negative. All culture negative patients had at least 1 culture type obtained, and the majority (84%) had both blood and source cultures performed. When compared with patients with a causative pathogen identified, culture negative patients were younger (2.3 vs. 9.8 y), smaller (13.5 vs. 31.6 kg), less likely to be febrile on arrival (56% vs. 77%), less likely to have an abscess on imaging (23% vs. 48%), and were more likely to have uncomplicated septic arthritis (35% vs. 8%). No critically ill patient was culture negative. Seven culture negative patients had additional Kingella kingae testing performed, none of which were positive.

Conclusions:
Despite targeted and standardized efforts to identify causative bacteria, 25% of children with acute MSKIs never have a pathogen identified. Culture negative patients are younger, less febrile, are less likely to have an abscess, and more likely to have isolated septic arthritis.

Level of Evidence:
This is a retrospective cohort study interested in identifying patient characteristics that predict rate of culture positivity for acute MSKIs. This study meets criteria for Level II evidence.
Acute kidney injury following adult lung transplantation
Authors: Jing Lei , Chen Wenhui , Zhao Li , Guo Lijuan , Liang Chaoyang , Chen Jingyu , Wang Chen 
Published: December 2021

Abstract

Background:
Acute kidney injury (AKI) is a common and serious complication following lung transplantation (LTx), and it is associated with high mortality and morbidity. This study assessed the incidence of AKI after LTx and analyzed the associated perioperative factors and clinical outcomes.

Methods:
This retrospective study included all adult LTx recipients at the China-Japan Friendship Hospital in Beijing between March 2017 and December 2019. The outcomes were AKI incidence, risk factors, mortality, and kidney recovery. Multivariate analysis was performed to identify independent risk factors. Survival analysis was presented using the Kaplan–Meier curves.

Results:
AKI occurred in 137 of the 191 patients (71.7%), with transient AKI in 43 (22.5%) and persistent AKI in 94 (49.2%). AKI stage 1 occurred in 27/191 (14.1%), stage 2 in 46/191 (24.1%), and stage 3 in 64/191 (33.5%) of the AKI patients. Renal replacement therapy (RRT) was administered to 35/191 (18.3%) of the patients. Male sex, older age, mechanical ventilation (MV), severe hypotension, septic shock, multiple organ dysfunction (MODS), prolonged extracorporeal membrane oxygenation (ECMO), reintubation, and nephrotoxic agents were associated with AKI (P < 0.050). Persistent AKI was independently associated with pre-operative pulmonary hypertension, severe hypotension, post-operative MODS, and nephrotoxic agents. Severe hypotension, septic shock, MODS, reintubation, prolonged MV, and ECMO during or after LTx were related to severe AKI (stage 3) (P < 0.050). Patients with persistent and severe AKI had a significantly longer duration of MV, longer duration in the intensive care unit (ICU), worse downstream kidney function, and reduced survival (P < 0.050).

Conclusions:
AKI is common after LTx, but the pathogenic mechanism of AKI is complicated, and prerenal causes are important. Persistent and severe AKI were associated with poor short- and long-term kidney function and reduced survival in LTx patients.
Safety and efficacy of ciprofol vs. propofol for sedation in intensive care unit patients with mechanical ventilation: a multi-center, open label, randomized, phase 2 trial
Authors: Liu Yongjun , Yu Xiangyou , Zhu Duming , Zeng Jun , Lin Qinhan , Zang Bin , Chen Chuanxi , Liu Ning , Liu Xiao , Gao Wei , Guan Xiangdong 
Published: December 2021

Abstract

Background:
Ciprofol (HSK3486; Haisco Pharmaceutical Group Co., Ltd., Chengdu, China), developed as a novel 2,6-disubstituted phenol derivative showed similar tolerability and efficacy characteristics as propofol when applicated as continuous intravenous infusion for 12 h maintenance sedation in a previous phase 1 trial. The phase 2 trial was designed to investigate the safety, efficacy, and pharmacokinetic characteristics of ciprofol for sedation of patients undergoing mechanical ventilation.

Methods:
In this multicenter, open label, randomized, propofol positive-controlled, phase 2 trial, 39 Chinese intensive care unit patients receiving mechanical ventilation were enrolled and randomly assigned to a ciprofol or propofol group in a 2:1 ratio. The ciprofol infusion was started with a loading infusion of 0.1–0.2 mg/kg for 0.5–5.0 min, followed by an initial maintenance infusion rate of 0.30 mg·kg−1·h−1, which could be adjusted to an infusion rate of 0.06 to 0.80 mg·kg−1·h−1, whereas for propofol the loading infusion dose was 0.5–1.0 mg/kg for 0.5–5.0 min, followed by an initial maintenance infusion rate of 1.50 mg·kg−1·h−1, which could be adjusted to 0.30–4.00 mg·kg−1·h−1 to achieve −2 to +1 Richmond Agitation-Sedation Scale sedation within 6–24 h of drug administration.

Results:
Of the 39 enrolled patients, 36 completed the trial. The median (min, max) of the average time to sedation compliance values for ciprofol and propofol were 60.0 (52.6, 60.0) min and 60.0 (55.2, 60.0) min, with median difference of 0.00 (95% confidence interval: 0.00, 0.00). In total, 29 (74.4%) patients comprising 18 (69.2%) in the ciprofol and 11 (84.6%) in the propofol group experienced 86 treatment emergent adverse events (TEAEs), the majority being of severity grade 1 or 2. Drug- and sedation-related TEAEs were hypotension (7.7% vs. 23.1%, P = 0.310) and sinus bradycardia (3.8% vs. 7.7%, P = 1.000) in the ciprofol and propofol groups, respectively. The plasma concentration-time curves for ciprofol and propofol were similar.

Conclusions:
ciprofol is comparable to propofol with good tolerance and efficacy for sedation of Chinese intensive care unit patients undergoing mechanical ventilation in the present study setting.

Trial registration:
ClinicalTrials.gov, NCT04147416.
A global study of pain prevalence across 52 countries: examining the role of country-level contextual factors
Authors: Zimmer Zachary , Fraser Kathryn , Grol-Prokopczyk Hanna , Zajacova Anna 
Published: December 2021

Abstract
There is wide variation in population-level pain prevalence estimates in studies of survey data around the world. The role of country-level social, economic, and political contextual factors in explaining this variation has not been adequately examined. We estimated the prevalence of unspecified pain in adults aged 25+ years across 52 countries using data from the World Health Survey 2002 to 2004. Combining data sources and estimating multilevel regressions, we compared country-level pain prevalence and explored which country-level contextual factors explain cross-country variations in prevalence, accounting for individual-level demographic factors. The overall weighted age- and sex-standardized prevalence of pain across countries was estimated to be 27.5%, with significant variation across countries (ranging from 9.9% to 50.3%). Women, older persons, and rural residents were significantly more likely to report pain. Five country-level variables had robust and significant associations with pain prevalence: the Gini Index, population density, the Gender Inequality Index, life expectancy, and global region. The model including Gender Inequality Index explained the most cross-country variance. However, even when accounting for country-level variables, some variation in pain prevalence remains, suggesting a complex interaction between personal, local, economic, and political impacts, as well as inherent differences in language, interpretations of health, and other difficult to assess cultural idiosyncrasies. The results give new insight into the high prevalence of pain around the world and its demonstrated association with macrofactors, particularly income and gender inequalities, providing justification for regarding pain as a global health priority.