bluuebunny/crossref_metadata_2025_split huggingface dataset:
Associations between brain structure and sleep patterns across adolescent development
Authors: Jalbrzikowski Maria , Hayes Rebecca A , Scully Kathleen E , Franzen Peter L , Hasler Brant P , Siegle Greg J , Buysse Daniel J , Dahl Ronald E , Forbes Erika E , Ladouceur Cecile D , McMakin Dana L , Ryan Neal D , Silk Jennifer S , Goldstein Tina R , Soehner Adriane M 
Published: May 2021

AbstractStudy ObjectivesStructural brain maturation and sleep are complex processes that exhibit significant changes over adolescence and are linked to many physical and mental health outcomes. We investigated whether sleep–gray matter relationships are developmentally invariant (i.e. stable across age) or developmentally specific (i.e. only present during discrete time windows) from late childhood through young adulthood.MethodsWe constructed the Neuroimaging and Pediatric Sleep Databank from eight research studies conducted at the University of Pittsburgh (2009–2020). Participants completed a T1-weighted structural MRI scan (sMRI) and 5–7 days of wrist actigraphy to assess naturalistic sleep. The final analytic sample consisted of 225 participants without current psychiatric diagnoses (9–25 years). We extracted cortical thickness and subcortical volumes from sMRI. Sleep patterns (duration, timing, continuity, regularity) were estimated from wrist actigraphy. Using regularized regression, we examined cross-sectional associations between sMRI measures and sleep patterns, as well as the effects of age, sex, and their interaction with sMRI measures on sleep.ResultsShorter sleep duration, later sleep timing, and poorer sleep continuity were associated with thinner cortex and altered subcortical volumes in diverse brain regions across adolescence. In a discrete subset of regions (e.g. posterior cingulate), thinner cortex was associated with these sleep patterns from late childhood through early-to-mid adolescence but not in late adolescence and young adulthood.ConclusionsIn childhood and adolescence, developmentally invariant and developmentally specific associations exist between sleep patterns and gray matter structure, across brain regions linked to sensory, cognitive, and emotional processes. Sleep intervention during specific developmental periods could potentially promote healthier neurodevelopmental outcomes.
Impact of Psychosocial and Economic Factors on Functional Outcomes After Operative Calcaneus Fractures
Authors: Simske Natasha M. , Hermelin Michael J. , Vallier Heather A. 
Published: May 2021

Objectives:
To report functional outcome scores after operative intraarticular calcaneus fracture and to determine risk factors associated with worse outcomes.

Design:
Retrospective study.

Setting:
Urban Level 1 trauma center.

Patients and Participants:
Ninety-six patients with 114 calcaneus fractures treated by a single surgeon over a 14-year period.

Intervention:
Surgical treatment with open reduction and internal fixation with lateral extensile approach or percutaneous reduction and fixation.

Main Outcome Measurements:
Functional outcome scores as assessed by the Musculoskeletal Function Assessment (MFA) and the Foot Function Index (FFI) after mean 56 months follow-up.

Results:
Seventy-two patients (75%) completed functional outcome questionnaires. Patients with functional outcome data were more often employed (86% vs. 67%, P = 0.07), but were no different in terms of age, sex, medical history, mechanism of injury, or injury characteristics. The mean FFI score was 30 (range: 2–89), and the mean MFA score was 28 (range: 2–80). One-third of patients reported scores >30 on the FFI, MFA, or both. Age, sex, tobacco use, mechanism of injury, fracture pattern, open injury, and postoperative infection were not associated with outcome scores. Alcohol abuse and failure to return to work were associated with worse (higher) FFI scores. Alcohol abuse, psychiatric illness, unemployment (before and after injury), polytrauma, and posttraumatic osteoarthrosis were associated with worse (higher) MFA scores.

Conclusions:
Polytrauma, alcohol abuse, psychiatric illness, work status, and posttraumatic osteoarthrosis were predictors of poor functional outcomes. The findings of this study add to previous literature that has demonstrated the importance of social, behavioral, and environmental factors on recovery after orthopaedic injury.

Level of Evidence:
Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
Likelihood of Bacterial Infection in Patients Treated With Broad-Spectrum IV Antibiotics in the Emergency Department*
Authors: Shappell Claire N. , Klompas Michael , Ochoa Aileen , Rhee Chanu 
Published: May 2021

OBJECTIVES:
Best practice guidelines and quality metrics recommend immediate antibiotic treatment for all patients with suspected sepsis. However, little is known about how many patients given IV antibiotics in the emergency department are ultimately confirmed to have bacterial infection.

DESIGN, SETTING, AND PATIENTS:
We performed a retrospective study of adult patients who presented to four Massachusetts emergency departments between June 2015 and June 2018 with suspected serious bacterial infection, defined as blood cultures drawn and broad-spectrum IV antibiotics administered. Structured medical record reviews were performed on a random sample of 300 cases to determine the post hoc likelihood of bacterial infection, categorized as definite, likely, unlikely, or definitely none.

INTERVENTIONS:
None.

MEASUREMENTS AND MAIN RESULTS:
Among the 300 patients with suspected serious bacterial infections, mean age was 68 years (sd 18), median hospital length of stay was 5 days (interquartile range, 3–8 d), 45 (15%) were admitted directly to ICU, and 14 (5%) died in hospital. Overall, 196 (65%) had definite (n = 115; 38%) or likely (n = 81; 27%) bacterial infection, whereas 104 (35%) were unlikely (n = 55; 18%) or definitely not infected (n = 49; 16%). Antibiotic treatment durations differed by likelihood of infection (median 15 days for definite, 9 for likely, 7 for unlikely, and 3 for definitely not infected). The most frequent post hoc diagnoses in patients with unlikely or definitely no bacterial infection included viral infections (28%), volume overload or cardiac disease (9%), drug effects (9%), and hypovolemia (7%). The likelihoods of infection were similar in the subset of 96 cases in whom emergency department providers explicitly documented possible or suspected sepsis and in the 45 patients admitted from the emergency department to the ICU.

CONCLUSIONS:
One third of patients empirically treated with broad-spectrum antibiotics in the emergency department are ultimately diagnosed with noninfectious or viral conditions. These findings underscore the difficulty diagnosing serious infections in the emergency department and have important implications for guidelines and quality measures that compel immediate empiric antibiotics for all patients with possible sepsis.
Storage solutions to improve grafts preservation and longevity in coronary artery bypass grafting surgery: hype or hope?
Authors: Eqbal Adam , Gupta Saurabh , Bisleri Gianluigi 
Published: May 2021

Purpose of review
Saphenous vein grafts (SVGs) remain the most-commonly used conduits for coronary artery bypass grafting (CABG).
Significant rates of vein graft failure (VGF) remain a limitation of their use as this diminishes the long-term benefits of CABG. The choice of intraoperative SVGs preservation solution is believed to have an impact on graft patency; however, the superiority of one solution over the others remains in question.

Recent findings
In the present review, we describe the pathophysiological mechanisms underlying the different phases of VGF. We also reviewed the most recent literature comparing and evaluating the efficacy of various storage solutions. These include heparinized saline, autologous heparinized blood, buffered solutions, and crystalloid cardioplegia.

Summary
It is clear that the composition of the SVGs storage solution has an impact on vessel wall structure and function. There is a lack of translational and clinical research on the topic; thus, conclusions cannot be drawn regarding the superiority of one solution over the others in terms of VGF. Future research needs to be conducted to address this gap in the literature in order to make meaningful evidence-based recommendations on intraoperative graft storage.
Review new concepts in pharmacotherapy for peripheral arterial disease
Authors: Kotalczyk Agnieszka , Vallabhaneni Srinivasa Rao , Lip Gregory Y.H. 
Published: May 2021

Purpose of review
To provide an overview of new concepts in the pharmacotherapy of patients with peripheral artery disease (PAD).

Recent findings
Modern therapeutic strategies for patients with PAD include specific symptom management and multidisciplinary prevention of cardiovascular events. Low-dose rivaroxaban in combination with aspirin improves outcomes compared with aspirin monotherapy among patients with PAD. Other novel concepts include the use of bosentan, vorapaxar or sildenafil among symptomatic patients with PAD. Likewise, lipid-lowering therapy reduces the risk of major cardiovascular and limb events.

Summary
Personalized management, identification of risk factors and shared-decision making are crucial in improving the best medical therapy for patients with PAD. Further studies are needed to assess the long-term safety and efficacy of novel strategies in real-world patients.
A double-edged sword: The effects of social network ties on job satisfaction in primary care organizations
Authors: Yuan Christina T. , Lai Alden Yuanhong , Benishek Lauren E. , Marsteller Jill A. , Mahabare Darshan , Kharrazi Hadi , Dy Sydney M. 
Published: May 2021

Background
Social ties between health care workers may be an important driver of job satisfaction; however, research on this topic is limited.

Purpose
We used social network methods to collect data describing two types of social ties, (a) instrumental ties (i.e., exchange of advice that enables work) and (b) expressive ties (i.e., exchange of social support), and related those ties to workers’ job satisfaction.

Methodology
We surveyed 456 clinicians and staff at 23 primary care practices about their social networks and workplace attitudes. We used multivariable linear regression to estimate the relationship between an individual’s job satisfaction and two network properties: (a) eigenvector centrality (a measure of the importance of an individual in a network) and (b) ego network density (a measure of the cohesiveness of an individual’s network). We examined this relationship for both instrumental and expressive ties.

Results
Individuals who were more central in the expressive network were less satisfied in their job, b = −0.40 (0.19), p < .05, whereas individuals who had denser instrumental networks were more satisfied in their job, b = 0.49 (0.21), p < .05.

Conclusion
Workplace relationships affect worker well-being. Centrality in an expressive network may require greater emotional labor, increasing workers’ risk for job dissatisfaction. On the other hand, a dense instrumental network may promote job satisfaction by strengthening workers’ access to full information, supporting competence and confidence.

Practice Implications
Efforts to increase job satisfaction should consider both the positive and negative effects of social networks on workers’ sense of well-being.
Safety and Antibody Kinetics of COVID-19 Convalescent Plasma for the Treatment of Moderate to Severe Cases of SARS-CoV-2 Infection in Pediatric Patients
Authors: Arrieta Antonio , Galvis Alvaro E. , Morphew Tricia , Ehwerhemuepha Louis , Osborne Stephanie , Enriquez Claudia , Imfeld Karen , Hoang Janet , Nieves Delma , Ashouri Negar , Singh Jasjit , Nugent Diane 
Published: May 2021

Background:
Therapies against severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) and its life-threatening respiratory infection coronavirus disease 2019 (COVID-19) have been evaluated, including COVID-19 convalescent plasma (CCP). Multiple large reports of CCP treatment in adults exist. Pediatric data on CCP safety and efficacy are limited.

Methods:
Single-center prospective, open-label trial looking at safety, antibody kinetics and outcomes of CCP (10 mL/kg, max 1 unit) treatment for COVID-19 in hospitalized pediatric patients with moderate to severe disease or at high-risk for serious illness.

Results:
Thirteen patients were enrolled. No infusion-related adverse events occurred. No hematologic or metabolic adverse events were noted during hospitalization or at 3-weeks. Ten patients had clinical improvement by day 7 (WHO eight-category ordinal severity scale for COVID-19). Following CCP, anti-SARS-CoV-2 anti-nucleocapsid IgG increased significantly at 24 hours and high levels were sustained at 7- and 21-days. Transient IgM response was noted. Twelve patients (92.3%) were discharged home, 9 (75%) by day 7 post-CCP. One remained on invasive ventilatory support 42 days after CCP and was eventually discharged to an intermediate care facility. The single patient death was retrospectively confirmed to have had brain death before CCP.

Conclusion:
CCP was well tolerated in pediatric patients, resulted in rapid antibody increase, and did not appear to interfere with immune responses measured at 21 days. More pediatric data are necessary to establish the efficacy of CCP, but our data suggest benefit in moderate to severe COVID-19 when used early. Other immunologic or antiviral interventions may be added as supported by emerging data.
Bioelectric impedance analysis for body composition measurement and other potential clinical applications in critical illness
Authors: Moonen Hanneke Pierre Franciscus Xaverius , Van Zanten Arthur Raymond Hubert 
Published: May 2021

Purpose of review
Insight into body composition is of great value in the ICU. Bioelectric impedance analysis (BIA) is the most applicable bedside technique. However, bioimpedance has not been validated in the critically ill, and the interpretation of the measurements poses challenges. This review discusses the potential clinical applications of BIA and explores caveats and solutions to its use in the intensive care setting.

Recent findings
A correlation is repeatedly found between raw impedance parameters, fluid ratios, overhydration, and adverse outcome of critical illness. However, cut-off and reference values remain elusive. Experience with BIA-guided fluid management in the ICU is limited. BIA-derived muscle mass appears a promising biomarker for sarcopenia, correlating well with CT-analysis. Body cell mass and fat-free mass provide potential use in estimation of metabolic rate, protein requirements and pharmacokinetics. Several methods of reducing bias in BIA parameters in critical illness require validation.

Summary
There are currently too many uncertainties and discrepancies regarding interpretation of bioimpedance in critical illness, to justify therapeutic consequences. However, there are several promising areas of research, concerning some of the most urgent clinical problems in intensive care, emphasizing the need to evaluate further the use and interpretation of bioimpedance in the intensive care setting.
Adverse events of systemic immune-based combination therapies in the first-line treatment of patients with metastatic renal cell carcinoma: systematic review and network meta-analysis
Authors: Quhal Fahad , Mori Keiichiro , Remzi Mesut , Fajkovic Harun , Shariat Shahrokh F. , Schmidinger Manuela 
Published: May 2021

Purpose of review
To compare the safety profiles of systemic immune checkpoint inhibitor-based combination therapies that were evaluated in the first-line setting of the management of patients with advanced or metastatic renal cell carcinoma (mRCC).

Recent findings
Six phase III randomized control trials comparing first-line immune-based combination therapies to sunitinib in previously untreated patients with mRCC. Network meta-analyses were conducted to compare treatment-related adverse events (TRAEs), treatment discontinuation, and treatment-related mortality.

Summary
Lenvatinib plus pembrolizumab was associated with the highest likelihood of grade ≥3 TRAEs, and treatment discontinuation rates. Nivolumab plus ipilimumab was associated with the lowest rates of grade ≥3 TRAEs. However, it was associated with a higher likelihood of endocrine-related adverse events (AEs). A higher likelihood of high-grade diarrhea was associated with pembrolizumab plus axitinib and avelumab plus axitinib. All combinations showed low rates of hematological AEs.
Neurosyphilis Surveillance: Exploring the Use of Multiple Data Sources to Better Understand Morbidity in California
Authors: Burghardt Nicole Olson , Nelson Lauren N. , Tang Eric C. , Plotzker Rosalyn E. , Jacobson Kathleen , Murphy Ryan D. 
Published: May 2021

Abstract
Accurate reporting of neurosyphilis diagnoses is important to quantify and monitor severe outcomes associated with infection of Treponemal pallidum. This analysis compared the demographic distribution of neurosyphilis diagnoses in sexually transmitted disease surveillance data with administrative hospital data in the California Project Area from 2016 to 2018. Although neurosyphilis morbidity was similar, significant differences were noted by sex, age group, race/ethnicity, and region. Both sexually transmitted disease surveillance and administrative hospital data may be imperfect systems to understand the true morbidity of neurosyphilis.
Fibrinolytic Impairment and Mortality in Pediatric Septic Shock: A Single-Center Prospective Observational Study*
Authors: Tuan Ta Anh , Ha Nguyen Thi Thu , Xoay Tran Dang , My Tran Thi Kieu 
Published: May 2021

OBJECTIVES:
Fibrinolytic shutdown is associated with poor prognosis in adult sepsis, but data in the pediatric population are sparse. This study aimed to identify the association between impaired fibrinolysis and mortality in pediatric septic shock.

DESIGN:
A prospective, observational study conducted between August 2019 and August 2020.

SETTING:
PICU at a pediatric tertiary hospital in Hanoi, Vietnam.

PATIENTS:
Fifty-six pediatric patients who met septic shock criteria were enrolled.

INTERVENTIONS:
None.

MEASUREMENTS AND MAIN RESULTS:
Conventional coagulation tests and rotational thromboelastometry were performed at diagnosis. The fibrinolytic activity on extrinsic pathway thromboelastometry was negatively correlated with the Vasoactive-Inotropic Score at 24 hours post-PICU admission, peak lactate level during the first 24 hours, Pediatric Logistic Organ Dysfunction-2 score, and Pediatric Risk of Mortality-III score (all p < 0.05). Compared with patients with nonovert disseminated intravascular coagulation, dysfunction of less than two organs, and who survived, patients with overt disseminated intravascular coagulation, dysfunction of greater than two organs, and who died showed significantly lower fibrinolytic activity, represented by significantly higher lysis indexes (%) and lower maximum lysis (%) (all p < 0.05). The threshold values for prediction of mortality were lysis index 60 minutes greater than 97.5 (area under the curve = 0.86; sensitivity = 73%; specificity = 90%), maximum lysis less than 6.5 (area under the curve = 0.83; sensitivity = 73%; specificity = 87%), and lysis index 45 minutes greater than 99.5 (area under the curve = 0.83; sensitivity = 73%; specificity = 85%). Hypofibrinolysis was associated with prolonged PICU length of stay in survivors and with early mortality in nonsurvivors.

CONCLUSIONS:
Fibrinolytic shutdown in pediatric septic shock is associated with an increase in disease severity and mortality. This highlights the need for further investigations regarding whether fibrinolytic therapy improved the outcome of pediatric septic shock.
Intraoperative Hypoxia Independently Associated With the Development of Acute Kidney Injury Following Bilateral Orthotopic Lung Transplantation
Authors: Knight Joshua , Hill Adam , Melnyk Vladyslav , Doney Luke , D’Cunha Jonathan , Kenkre Tanya , Subramaniam Kathirvel , Howard-Quijano Kimberly 
Published: May 2021

Background.
Acute kidney injury (AKI) is a common postoperative complication in bilateral orthotopic lung transplant (BOLTx) recipients, but the contribution of intraoperative variables is not well defined. The authors hypothesized that intraoperative hypotension as well as hypoxia and vasopressor use would be associated with the development of postoperative AKI after BOLTx in patients without pre-existing renal dysfunction.

Methods.
The authors performed a retrospective analysis of patients undergoing BOLTx at a single center between 2013 and 2017. Intraoperative variables of hemodynamics included duration of mean arterial pressure <55, <60, and <65 mm Hg; duration of oxygen saturation <90%; and vasoactive-inotropic score (VIS). Associations between the occurrence of AKI and intraoperative hypotension, hypoxemia, and VIS were evaluated while controlling for significant confounding variables.

Results.
AKI occurred in 177 (72%) of 245 patients in postoperative days 1–7. Notable significant differences in univariate analyses included cumulative mechanical support time, maximum VIS, peripheral oxygen saturation <90% for >15 min, total minutes oxygen saturation <90%, and surgery duration in minutes. There was no significant difference in intraoperative hypotension measured as a duration >15 min for mean arterial pressure <55, <60, or <65 mm Hg. Multivariate logistic regression revealed preoperative creatinine (Odds ratio [OR], 7.77; confidence interval [CI], 1.96-30.83; P = 0.004), surgery duration (OR, 1.004; CI, 1.002-1.007; P = 0.002), and oxygen saturation (OR, 2.06; CI, 1.01-4.24; P = 0.049) <90% for >15 min to be independently associated with AKI.

Conclusions.
This study revealed that >15 min of intraoperative hypoxia was independently associated with postoperative AKI after BOLTx.
Update on alpha-synuclein-based biomarker approaches in the skin, submandibular gland, gastrointestinal tract, and biofluids
Authors: Andréasson Mattias , Svenningsson Per 
Published: May 2021

Purpose of review
There is a need for objective diagnostic and prognostic biomarkers in Parkinson's disease (PD), partly given the expected increase in clinical trials aimed at demonstrating a disease-modifying effect in early disease. Alpha-synuclein (α-syn) plays a decisive role in the pathogenesis of PD. Here, we review recent publications exploring established and novel methodologies to detect α-syn species in tissues and biofluids.

Recent findings
Using immunohistochemistry (IHC), recent studies have focused on the detection of phosphorylated α-syn (p-α-syn) in cutaneous nerve fibers, reporting varying sensitivity and high specificity for the diagnosis of PD. A predilection for p-α-syn depositions in cutaneous autonomic nerve fibers has emerged, possibly contrasting with other synucleinopathies.
Novel studies utilizing the seeding propensity of pathological α-syn have generated encouraging results with regard to diagnostic performance in both tissues and biofluids including skin, submandibular gland, and cerebrospinal fluid.

Summary
Detection of neuronal p-α-syn in skin punch biopsies remains a promising minimally invasive diagnostic tool in PD. Seeding assays have emerged as a new method with its diagnostic potential warranting replication in further studies from various tissues and biofluids. Longitudinal studies employing both IHC and seeding assays are needed to identify possible biomarkers of disease progression.