bluuebunny/crossref_metadata_2025_split huggingface dataset:
Posterior Ankle Pain After Ankle Sprain: Bony and Soft Tissue Impingement and Flexor Hallucis Longus (FHL) Tenosynovitis
Authors: Chao Wen , Lee Wonyong 
Published: February 2021

The proper diagnosis of posterior ankle pain after ankle sprains is often missed. This can occur as an overuse injury or as a result of acute trauma in patients performing repetitive forced plantar flexion sports. An understanding of various causes of posterior ankle impingement, both bony and soft tissue, is critical to make the proper diagnosis and provide appropriate treatment. Nonoperative treatment should be considered as the initial treatment for the posterior ankle pathology. Surgical intervention is indicated if pain persists despite nonsurgical treatment, particularly for athletes or dancers who want to continue to train and perform their sport. Surgery can be performed using an open or arthroscopic approach.

Level of Evidence
Level V—expert opinion. See Instructions for Authors for a complete description of levels of evidence.
Volatile Sedation for Acute Respiratory Distress Syndrome Patients on Venovenous Extracorporeal Membrane Oxygenation and Ultraprotective Ventilation
Authors: Grasselli Giacomo , Giani Marco , Scaravilli Vittorio , Fumagalli Benedetta , Mariani Carminia , Redaelli Sara , Lucchini Alberto , Zanella Alberto , Patroniti Nicolò , Pesenti Antonio , Foti Giuseppe 
Published: February 2021

Objectives:
Patients on extracorporeal support for severe acute respiratory distress syndrome may require a prolonged period of deep sedation. In these patients, volatile sedation may represent a valid alternative to IV drugs. The aim of our study was to describe the feasibility of volatile sedation in a large cohort of acute respiratory distress syndrome patients undergoing venovenous extracorporeal membrane oxygenation and ultraprotective ventilation.

Design:
Retrospective monocentric study.

Setting:
Adult ICU, ASST Monza, Italy.

Patients:
Adult patients who underwent volatile sedation with isoflurane during venovenous extracorporeal membrane oxygenation between 2009 and 2019.

Interventions:
Isoflurane was delivered via the AnaConDa system. The sedation level, hemodynamics, and laboratory tests were compared between the volatile sedation phase and the IV sedation phases before and after the isoflurane sedation period.

Measurements and Main Results:
About 74 patients (50 yr [43–56 yr]) were included. Median duration of venovenous extracorporeal membrane oxygenation support was 22 days (14–51 d). Volatile sedation started on day 3 (2–6) of extracorporeal membrane oxygenation support, and its median duration was 7 days (4–13 d), ranging from 1 to 38 days. A total of 970 venovenous extracorporeal membrane oxygenation days were analyzed. During the volatile phase, the sedation level was slightly deeper (bispectral index 39 ± 6) compared with the IV phase before and after isoflurane (42 ± 8 and 43 ± 9, respectively, p < 0.001). Requirements of fentanyl and remifentanyl were reduced during the volatile phase. Minor differences in hemodynamics were observed during volatile sedation: mean arterial pressure was lower (75 ± 13 vs 79 ± 14 and 80 ± 15; p < 0.001), whereas cardiac output was higher (8.5 ± 1.9 vs 7.9 ± 1.8 and 8.0 ± 1.8; p = 0.003). Aspartate aminotransferase levels were lower during the volatile sedation phases (p < 0.001), whereas alanine aminotransferase, triglycerides, and creatine phosphokinase were more altered during the IV sedation phase before isoflurane (p < 0.001).

Conclusions:
Volatile sedation represents an alternative to IV agents to achieve long-term deep sedation in critically ill patients on extracorporeal membrane oxygenation undergoing ultraprotective ventilation.
Impact of a Whole-Room Atomizing Disinfection System on Healthcare Surface Contamination, Pathogen Transfer, and Labor Efficiency
Authors: Reynolds Kelly A. , Sexton Jonathan D. , Garavito Fernanda , Anderson Brandie , Ivaska Joan M. 
Published: February 2021

Objectives:
Healthcare surfaces contribute to nosocomial disease transmission. Studies show that despite standard guidelines and practices for cleaning and disinfection, secondary infection spread among healthcare workers and patients is common in ICUs. Manual terminal cleaning practices in healthcare are subject to highly variable results due to differences in training, compliance, and other inherent complexities. Standard cleaning practices combined with no-touch disinfecting technologies, however, may significantly lower nosocomial infection rates. The objective of this study was to evaluate the efficacy of a whole-room, no-touch disinfection intervention to reduce the concentration and cross-contamination of surface bacteria when used in tandem with manual cleaning protocols.

Design:
Bacterial tracers were seeded onto hospital room surfaces to quantitatively evaluate the efficacy of manual terminal cleaning practices alone and in tandem with a no-touch, whole-room atomization system. Cross-contamination potentials and labor efficiency were also evaluated.

Subjects and Intervention:
Environmental service personnel cleaning efficacy was evaluated pre and post application of manual terminal cleaning protocols alone and in tandem with a whole-room atomization system with an United States Environmental Protection Agency-registered hospital-grade hypochlorous acid disinfectant.

Setting:
The study was conducted in an unoccupied patient room at Banner University Medical Center in Tucson, AZ. The room was located in a newly constructed ICU suite.

Measurements and Main Results:
Manual terminal cleaning averaged a 2.4 log10 reduction in seeded bacterial counts compared with a 4.9 average and up to a 6 log10 reduction with tandem cleaning. Cross-contamination among surfaces following terminal cleaning alone was documented in 50% of the samples compared with 0% with tandem cleaning, with the latter achieving a 64% improvement in manual labor efficiency.

Conclusions:
The use of whole-room atomized disinfection with terminal cleaning protocols lowered manual labor times, improved disinfection outcomes, and eliminated the transfer of bacterial pathogens in healthcare environments.
Trajectory of Cognitive Decline After Sepsis
Authors: Wang Henry E. , Kabeto Mohammed M. , Gray Marquita , Wadley Virginia G. , Muntner Paul , Judd Suzanne E. , Safford Monika M. , Kempker Jordan , Levine Deborah A. 
Published: February 2021

OBJECTIVES:
Cognitive impairment is an important consequence of sepsis. We sought to determine long-term trajectories of cognitive function after sepsis.

DESIGN:
Prospective study of the Reasons for Geographic and Racial Differences in Stroke cohort.

SETTING:
United States.

PATIENTS:
Twenty-one thousand eight-hundred twenty-three participants greater than or equal to 45 years, mean (sd) age 64.3 (9.2) years at first cognitive assessment, 30.9% men, and 27.1% Black.

MEASUREMENTS AND MAIN RESULTS:
The main exposure was time-dependent sepsis hospitalization. The primary outcome was global cognitive function (Six-Item Screener range, 0–6). Secondary outcomes were incident cognitive impairment (Six-Item Screener score ≤ 4 [impaired] vs ≥5 [unimpaired]), new learning (Consortium to Establish a Registry for Alzheimer Disease Word List Learning range, 0–30), verbal memory (word list delayed recall range, 0–10), and executive function/semantic fluency (animal fluency test range, ≥ 30). Over a median follow-up of 10 years (interquartile range, 6–12 yr), 840 (3.8%) experienced sepsis (incidence 282 per 1,000 person-years). Sepsis was associated with faster long-term declines in Six-Item Screener (–0.02 points per year faster [95% CI, –0.01 to –0.03]; p < 0.001) and faster long-term rates of incident cognitive impairment (odds ratio 1.08 per year [95% CI, 1.02–1.15]; p = 0.008) compared with presepsis slopes. Although cognitive function acutely changed after sepsis (0.05 points [95% CI, 0.01–0.09]; p = 0.01), the odds of acute cognitive impairment (Six-Item Screener ≤ 4) immediately after sepsis was not significant (odds ratio, 0.81 [95% CI, 0.63–1.06]; p = 0.12). Sepsis hospitalization was not associated with acute changes or faster declines in word list learning, word list delayed recall, or animal fluency test.

CONCLUSIONS:
Sepsis is associated with accelerated long-term decline in global cognitive function.
Epidemiology of Sepsis Among Children and Neonates in Germany: Results From an Observational Study Based on Nationwide Diagnosis-Related Groups Data Between 2010 and 2016*
Authors: Born Sebastian , Dame Christof , Matthäus-Krämer Claudia , Schlapbach Luregn J. , Reichert Felix , Schettler Anna , Schwarzkopf Daniel , Thomas-Rüddel Daniel , Proquitté Hans , Reinhart Konrad , Fleischmann-Struzek Carolin 
Published: February 2021

OBJECTIVES:
Worldwide, more than half of all sepsis cases occur in pediatric and adolescent patients, particularly in neonates. Previous population-based studies in these age groups often were limited to either neonatal or pediatric patients admitted to ICUs. We aimed to investigate the overall and age-specific incidence and case fatality of sepsis in children in Germany, a high-income country with a total population of 82 million.

DESIGN:
Retrospective observational study based on the German Diagnosis-related Groups statistics of the years 2010–2016.

SETTING:
All acute care hospitals in Germany except for prison and psychiatric hospitals.

PATIENTS:
Pediatric patients less than or equal to 19 years with International Classification of Diseases, 10th Revision-coded sepsis, neonates with International Classification of Diseases, 10th Revision-coded neonatal sepsis.

INTERVENTIONS:
None.

MEASUREMENTS AND MAIN RESULTS:
We analyzed pediatric sepsis incidence in patients aged birth to less than or equal to 19 years old, case fatality, and underlying comorbidities, and neonatal sepsis incidence and case fatality within the neonatal period. We identified 14,635 pediatric sepsis cases among 15.4 million pediatric hospitalizations between 2010 and 2016 (= 0.1% of pediatric hospitalizations). The incidence of pediatric sepsis was 14 cases per 100,000 children between 0 and 19 years. Case fatality was 16.6% and decreased from 17.8% (2010) to 15.0% (2016). A total of 11.5% of hospital deaths in the age group 0–19 years were associated with pediatric sepsis. Sepsis incidence and case fatality were highest in children less than 1 year old and declined in older children and adolescents. Admissions with pediatric sepsis were more common in children with preexisting comorbidities compared with those without (0.52% vs 0.03% of pediatric admissions). In neonates, the incidence of neonatal sepsis was 1,006 cases per 100,000 live births. Case fatality was 3.9%. While 17.7% of very low birth weight infants had neonatal sepsis, only 2.1% of low birth weight and 0.6% of normal birth weight neonates were affected, respectively.

CONCLUSIONS:
Sepsis is also in Germany a common and frequently fatal condition in pediatric patients, particularly among neonates and children with comorbidities.
Use of Corticosteroids in Cardiac Arrest—A Systematic Review and Meta-Analysis
Authors: Shah Kieran , Mitra Anish R. 
Published: February 2021

OBJECTIVES:
The objective of this systematic review was to evaluate the impact of intraarrest corticosteroids on neurologic outcomes and mortality in patients with cardiac arrest.

DATA SOURCES:
We conducted a systematic search using the Cochrane Central Register of Controlled Trials, EMBASE, and MEDLINE databases.

STUDY SELECTION:
We included all randomized controlled trials and comparative observational studies. We excluded single arm studies, case reports/series, narrative reviews, and studies irrelevant to the focus of this article.

DATA EXTRACTION:
Two reviewers independently assessed trial eligibility. Data were collected for the following outcomes: primary outcomes included good neurologic outcome, survival to hospital discharge, and survival at greater than or equal to 1 year. Secondary outcomes included incidence of return of spontaneous circulation, ICU and hospital length of stay, duration of vasopressor and inotropic treatment, and blood pressure during cardiopulmonary resuscitation and after return of spontaneous circulation.

DATA SYNTHESIS:
The pooled estimates from randomized controlled trials for the following subgroups were analyzed using random-effects models: 1) patients with in-hospital cardiac arrest who received vasopressin, steroids, and epinephrine; 2) patients with in-hospital cardiac arrest who used corticosteroids only (i.e., no vasopressin); and 3) patients with out-of-hospital cardiac arrest who used corticosteroids only. Results included an increase in good neurologic outcomes (relative risk, 2.84; 95% CI, 1.36–5.94) and survival to hospital discharge (relative risk, 2.58; 95% CI, 1.36–4.91) in in-hospital cardiac arrest patients receiving vasopressin, steroids, and epinephrine followed by corticosteroids for postresuscitation shock. This was further supported by an increase in return of spontaneous circulation (relative risk, 1.35; 95% CI, 1.12–1.64) and hemodynamics in this population. There was no benefit observed in in-hospital cardiac arrest or out-of-hospital cardiac arrest patients receiving corticosteroids alone.

CONCLUSIONS:
Our study found that there are limited high-quality data to analyze the association between corticosteroids and reducing mortality in cardiac arrest, but the available data do support future randomized controlled trials. We did find that corticosteroids given as part of a vasopressin, steroids, and epinephrine regimen in in-hospital cardiac arrest patients and for postresuscitation shock did improve neurologic outcomes, survival to hospital discharge, and surrogate outcomes that include return of spontaneous circulation and hemodynamics. We found no benefit in in-hospital cardiac arrest or out-of-hospital cardiac arrest patients receiving corticosteroids only; however, a difference cannot be ruled out due to imprecision and lack of available data.
Bone marrow-derived mesenchymal stem cells modulate autophagy in RAW264.7 macrophages via the phosphoinositide 3-kinase/protein kinase B/heme oxygenase-1 signaling pathway under oxygen-glucose deprivation/restoration conditions
Authors: Wang Ning-Fang , Bai Chun-Xue 
Published: February 2021

Abstract

Background
Autophagy of alveolar macrophages is a crucial process in ischemia/reperfusion injury-induced acute lung injury (ALI). Bone marrow-derived mesenchymal stem cells (BM-MSCs) are multipotent cells with the potential for repairing injured sites and regulating autophagy. This study was to investigate the influence of BM-MSCs on autophagy of macrophages in the oxygen-glucose deprivation/restoration (OGD/R) microenvironment and to explore the potential mechanism.

Methods
We established a co-culture system of macrophages (RAW264.7) with BM-MSCs under OGD/R conditions in vitro. RAW264.7 cells were transfected with recombinant adenovirus (Ad-mCherry-GFP-LC3B) and autophagic status of RAW264.7 cells was observed under a fluorescence microscope. Autophagy-related proteins light chain 3 (LC3)-I, LC3-II, and p62 in RAW264.7 cells were detected by Western blotting. We used microarray expression analysis to identify the differently expressed genes between OGD/R treated macrophages and macrophages co-culture with BM-MSCs. We investigated the gene heme oxygenase-1 (HO-1), which is downstream of the phosphoinositide 3-kinase/protein kinase B (PI3K/Akt) signaling pathway.

Results
The ratio of LC3-II/LC3-I of OGD/R treated RAW264.7 cells was increased (1.27 ± 0.20 vs. 0.44 ± 0.08, t = 6.67, P
< 0.05), while the expression of p62 was decreased (0.77 ± 0.04 vs. 0.95 ± 0.10, t = 2.90, P
< 0.05), and PI3K (0.40 ± 0.06 vs. 0.63 ± 0.10, t = 3.42, P
< 0.05) and p-Akt/Akt ratio was also decreased (0.39 ± 0.02 vs. 0.58 ± 0.03, t = 9.13, P
< 0.05). BM-MSCs reduced the LC3-II/LC3-I ratio of OGD/R treated RAW264.7 cells (0.68 ± 0.14 vs. 1.27 ± 0.20, t = 4.12, P
< 0.05), up-regulated p62 expression (1.10 ± 0.20 vs. 0.77 ± 0.04, t = 2.80, P
< 0.05), and up-regulated PI3K (0.54 ± 0.05 vs. 0.40 ± 0.06, t = 3.11, P
< 0.05) and p-Akt/Akt ratios (0.52 ± 0.05 vs. 0.39 ± 0.02, t = 9.13, P
< 0.05). A whole-genome microarray assay screened the differentially expressed gene HO-1, which is downstream of the PI3K/Akt signaling pathway, and the alteration of HO-1 mRNA and protein expression was consistent with the data on PI3K/Akt pathway.

Conclusions
Our results suggest the existence of the PI3K/Akt/HO-1 signaling pathway in RAW264.7 cells under OGD/R circumstances in vitro, revealing the mechanism underlying BM-MSC-mediated regulation of autophagy and enriching the understanding of potential therapeutic targets for the treatment of ALI.
Advances in cell and gene therapy for HIV disease: it is good to be specific
Authors: Pauza C. David , Huang Kelly , Bordon Jose 
Published: February 2021

Purpose of review
Tremendous advances in cell and gene therapy may soon realize the goal of treating and possibly curing HIV disease. These advances rely on new technologies for cell engineering and new strategies for product manufacturing that are targeting the most important immune deficits in HIV and promising to reconstitute protective, antiviral immunity and achieve natural suppression of HIV disease.

Recent findings
We summarize important advances in vectored passive immunity, e.g., directing in vivo expression of protective antibodies or antiviral proteins, B cell engineering to overcome the inadequate humoral immune response to HIV, and T cell engineering that is breaking new ground using viral vector modification of HIV specific T cells. These innovative approaches build on a substantial history of gene and cell therapy research in HIV disease.

Summary
Cell and gene therapy for HIV disease has been an area of tremendous innovation during the nearly two decades since early reports showed evidence for modulating disease. Recent efforts are building on the early experiences, closing gaps in previous approaches, and moving closer to effective treatment. Products approaching or already in clinical trials hold great promise for achieving durable suppression of HIV that will revolutionize therapy and offering hope to infected individuals that disease may be controlled without lifelong dependence on antiretroviral medications.

Video abstract

http://links.lww.com/COHA/A15.
Ciliated and Mucinous Adenomatous Syringometaplasia: The Missing Link of the “Ciliated Eccrine Metaplasia” Theory in the Histogenesis of Cutaneous Eccrine Ciliated Cyst?
Authors: Tran Tien Anh N. 
Published: February 2021

Abstract:
A variety of metaplastic changes has been reported in eccrine ducts and glands with squamous and mucinous syringometaplasia representing the most common histopathologic patterns. In the current case, a previously unreported variant of syringometaplasia was described in a female newborn with a 2-cm occipital cutaneous defect consistent with cutis aplasia. Over a more than 1-year period of local treatment, an enlarging plaque associated with local alopecia developed at the site of the original ulcerated area. A local excision demonstrated a superficial hypertrophic scar associated with a complete loss of hair follicles. In addition, there was a proliferation of eccrine glands and ducts lined by cuboidal epithelial cells arranged in a linear distribution beneath the scar area. Focal anastomosing of the proliferative ducts was identified. In few dilated ducts, the epithelial lining was composed of an inner layer of columnar cells with well-formed apical cilia and intracytoplasmic mucin and an outer layer of myoepithelial cells. The mucinous and ciliated cells were positive for epithelial membranous antigen and carcinoembryonic antigen, but negative for estrogen receptors, progesterone receptors, and thyroid transcription factor-1. Because this variant of eccrine metaplasia has not hitherto been reported in the literature, the term ciliated and mucinous adenomatous syringometaplasia was proposed for this unusual histologic finding. Mucinous and ciliated adenomatous syringometaplasia not only expands the spectrum of metaplastic changes in sweat gland units, but also might represent the missing link in the histogenesis of a subset of cutaneous ciliated cysts.
Lesson to Learn From Cellular infiltrate in Scalp Biopsy of Alopecia Areata
Authors: Genedy Rasha Mahmoud , Badran Fairouz Khalil , Tayae Eman Mohamed , Sabra Heba Nasrallah 
Published: February 2021

Background:
Alopecia areata (AA) is a common cause of hair loss. It is mediated by T lymphocytes. Scalp biopsy findings in AA differ according to the disease phase and activity.

Objectives:
To study the cellular infiltrate in the transverse section of scalp biopsy of AA at different disease stages and in relation to disease activity.

Methods:
The study was performed on 40 subjects with AA. A 4-mm punch biopsy was obtained from an AA scalp lesion. Biopsies were sectioned horizontally; 2 anatomical levels were studied (mid dermal and deep dermal levels).

Results:
Ninety-five percent of AA showed noncicatrical alopecia. A significant relation was found between the course of AA and the terminal:vellus ratio. Peribulbar lymphocytic infiltration was seen in 70% of cases. Mast cells were observed in 87.5% of cases, including fibrous tract and around the arrector pili muscles. Eosinophils were detected in the scalp biopsy of 22.5% of cases. Course and activity of AA were significantly related to the peribulbar lymphocytic cell infiltration but not to mast cells and eosinophils.

Conclusion:
Although a peribulbar lymphocytic infiltrate is the classical finding of AA, it is absent in the chronic phase. Mast cells are commonly found in the scalp biopsy of AA and could explain the potential therapeutic effect of antihistamines.
What Happens After a Positive Primary Care Autism Screen Among Historically Underserved Families? Predictors of Evaluation and Autism Diagnosis
Authors: Kuhn Jocelyn , Levinson Julia , Udhnani Manisha D. , Wallis Kate , Hickey Emily , Bennett Amanda , Fenick Ada M. , Feinberg Emily , Broder-Fingert Sarabeth 
Published: February 2021

ABSTRACT:

Objective:
Families, pediatric providers, and service systems would benefit from expanded knowledge regarding (1) who is most likely to receive a recommended diagnostic evaluation after a positive primary care–administered autism screen and (2) of those who screen positive, who is most likely to be diagnosed with autism?

Method:
Participants included 309 predominantly low-income, racial/ethnic minority parents and their child, aged 15 to 27 months, who screened positive on the Modified Checklist for Autism in Toddlers, Revised with Follow-Up (M-CHAT-R/F). Generalized estimating equations were used to fit models of predictors for each binary outcome: receiving a diagnostic evaluation and receiving an autism diagnosis on evaluation.

Results:
Significant predictors of diagnostic evaluation receipt included the parent being older or non-Hispanic and the child having private insurance, lower child communication functioning, or receiving Early Intervention services. Significant predictors of an autism diagnosis on evaluation included male child, lower child communication functioning, screening directly in the parent's preferred language, White/non-Hispanic parent, and no parent history of mood disorder.

Conclusion:
Children with younger parents, Hispanic ethnicity, relatively higher communication skills, public insurance, and no Early Intervention services were less likely to receive recommended diagnostic care. Reduced likelihood of autism diagnosis after a positive screen in non-White/non-Hispanic subgroups supports previous research indicating issues with M-CHAT-R/F positive predictive power for racial/ethnic minorities. The use of telephonic interpreters to administer screens, as opposed to directly screening in families' preferred languages, may lead to identification of fewer true autism cases. Thus, multilingual clinical staff capacity may improve positive predictive power of autism screening.