bluuebunny/crossref_metadata_2025_split huggingface dataset:
Towards implementing an indoor environmental quality standard in buildings: A pilot study
Authors: Sansaniwal Sunil Kumar , Kumar Shailendra , Jain Nikhil , Mathur Jyotirmay , Mathur Sanjay 
Published: March 2021

This paper demonstrates the implementation methodology for India’s first IEQ standard (ISHRAE Standard-10001:2016) in actual buildings. The IEQ standard encompasses the definitions of IEQ elements (i.e. thermal comfort, indoor air quality, visual comfort, and acoustic comfort), threshold values of IEQ parameters determining these elements, specifications of measuring instruments, and methodology to undertake IEQ assessments in buildings. The pilot study identified the preliminary findings to understand and evaluate the practical implementation of the IEQ standard through field measurements. The quantitative measurements of IEQ elements were carried out in two academic buildings in the Jaipur climate (warm and humid as well as hot and dry and cold). The occupant’s subjective evaluation was made through a questionnaire survey administrated concurrently with physical measurements of IEQ parameters. This study provides the clarity of method for taking IEQ measurements and comments on the availability of instruments and their specifications as recommended by the standard. Practical application: The present study is the practical implementation of the IEQ standard in buildings. This standard provides the threshold limits of IEQ parameters by classifying them into three classes covering international and local benchmarking. The standard also specifies the research methodology including field measurement protocol and specification of monitoring devices for IEQ assessment. This standard is useful for evolving IEQ rating of buildings in India where the majority of the building stocks are yet to be built.
Lnc-NEAT1 induces cell apoptosis and inflammation but inhibits proliferation in a cellular model of hepatic ischemia/reperfusion injury
Authors: Wang Liu , Qu Pan , Yin Wanling , Sun Jiao 
Published: March 2021

Objective We aimed to investigate the effect of long non-coding RNA nuclear-enriched abundant transcript 1 (lnc-NEAT1) on regulating hepatocyte proliferation, apoptosis, and inflammation during hepatic ischemia/reperfusion (I/R) injury. Methods Human liver cells (HL-7702) were cultured under glucose-free and oxygen-free conditions to construct the I/R injury model. Expression of lnc-NEAT1 was detected in this model and in normal cells. Plasmids of control overexpression [NC(+)], lnc-NEAT1 overexpression [NEAT1(+)], control short hairpin (sh)RNA [NC(−)], and lnc-NEAT1 shRNA [NEAT1(−)] were transfected into HL-7702 cells and subsequently subjected to I/R treatment. Cell proliferation, apoptosis, apoptosis-related proteins, and inflammatory cytokines were assessed. Results Lnc-NEAT1 expression was elevated in the I/R group compared with the normal group. Cell proliferation was decreased in the NEAT1(+) group compared with the NC(+) group but increased in NEAT1(−) compared with NC(−). The apoptosis rate increased in the NEAT1(+) group compared with the NC(+) group but decreased in NEAT1(−) compared with NC(−). Western blot assay (detection of apoptosis-related proteins) showed similar results. Expression of interleukin-1β, interleukin-6, and tumor necrosis factor-α increased in the NEAT1(+) group compared with NC(+) but decreased in NEAT1(−) compared with NC(−). Conclusion Lnc-NEAT1 is overexpressed, induces cell apoptosis and inflammation, and inhibits proliferation during hepatic I/R injury.
Feasibility of quantitative and volumetric enhancement measurement to assess tumor response in patients with breast cancer after early neoadjuvant chemotherapy
Authors: Ding Jie , Xiao Hongyan , Deng Weiwei , Liu Fengjiao , Zhu Rongrong , Ha Ruoshui 
Published: March 2021

Objective To evaluate the feasibility of quantitative enhancing lesion volume (ELV) for evaluating the responsiveness of breast cancer patients to early neoadjuvant chemotherapy (NAC) using dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI). Methods Seventy-five women with breast cancer underwent DCE-MRI before and after NAC. Lesions were assessed by ELV, response evaluation criteria in solid tumors 1.1 (RECIST 1.1), and total lesion volume (TLV). The diagnostic and pathological predictive performances of the methods were compared and color maps were compared with pathological results. Results ELV identified 29%, 67%, and 4% of cases with partial response, stable disease, and progressive disease, respectively. There was no significant difference in evaluation performances among the methods. The sensitivity, specificity, positive predictive value, negative predictive value (NPV), and accuracy of ELV for predicting pathologic response were 72%, 92%, 81.8%, 86.8%, and 85.3%, respectively, with the highest sensitivity, NPV, and accuracy of the three methods. The area under the receiver operating characteristic curve was also highest for ELV. Pre- and post-NAC color maps reflecting tumor activity were consistent with pathological necrosis. Conclusions ELV may help evaluate the responsiveness of breast cancer patients to NAC, and may provide a good tumor-response indicator through the ability to indicate tumor viability.
Correlation of radiomic features on dynamic contrast-enhanced magnetic resonance with microvessel density in hepatocellular carcinoma based on different models
Authors: Liang Hongwei , Hu Chunhong , Lu Jian , Zhang Tao , Jiang Jifeng , Ding Ding , Du Sheng , Duan Shaofeng 
Published: March 2021

Objective To explore the correlations of radiomic features of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) with microvessel density (MVD) in patients with hepatocellular carcinoma (HCC), based on single-input and dual-input two-compartment extended Tofts (SITET and DITET) models. Methods We compared the quantitative parameters of SITET and DITET models for DCE-MRI in 30 patients with HCC using paired sample t-tests. The correlations of SITET and DITET model parameters with CD31-MVD and CD34-MVD were analyzed using Pearson’s correlation analysis. A diagnostic model of CD34-MVD was established and the diagnostic abilities of models for MVD were analyzed using receiver operating characteristic curve (ROC) analysis. Results There were significant differences between the quantitative parameters in the two kinds of models. Compared with SITET, DITET parameters showed better correlations with CD31-MVD and CD34-MVD. The Ktrans and Ve radiomics features of the DITET model showed high efficiency for predicting the level of CD34-MVD according to ROC analysis, with areas under curves of 0.83 and 0.94, respectively. Conclusion Compared with SITET, the DITET model provides a better indication of the microcirculation of HCC and is thus more suitable for examining patients with HCC.
Change in Posterior Tibial Slope in Skeletally Immature Patients With Anterior Cruciate Ligament Injury: A Case Series With a Mean 9 Years’ Follow-up
Authors: Martin R. Kyle , Ekås Guri R. , Benth JūratėŠaltytė , Kennedy Nicholas , Moatshe Gilbert , Krych Aaron J. , Engebretsen Lars 
Published: March 2021

Background: Increased lateral posterior tibial slope (LPTS) is associated with increased rates of anterior cruciate ligament (ACL) injury and failure of ACL reconstruction. It is unknown if ACL deficiency influences the developing proximal tibial physis and slope in skeletally immature patients through anterior tibial subluxation and abnormal force transmission. Purpose: To assess the natural history of LPTS in skeletally immature patients with an ACL-injured knee. Study Design: Case series; Level of evidence, 4. Methods: A total of 38 participants from a previous study on nonoperative management of ACL injury in skeletally immature patients were included. During the initial study, bilateral knee magnetic resonance imaging (MRI) was performed within 1 year of enrollment and again at final follow-up. All patients were younger than 13 years at the time of enrollment, and final follow-up occurred a mean 10 years after the injury. MRI scans were retrospectively reviewed by 2 reviewers to determine bilateral LPTS for each patient and each time point. Linear mixed models were used to assess LPTS differences between knees, change over time, and association with operational status. Subgroup analyses were performed for patients who remained nonoperated throughout the study. Results: A total of 22 patients had ACL reconstruction before final follow-up and 16 remained nonoperated. In the entire study population, the mean LPTS was higher in the injured knee than in the contralateral knee at final follow-up by 2.0° ( P < .001; 95% CI, 1.3°–2.6°). The mean LPTS increased significantly in the injured knee by 0.9° ( P = .042; 95% CI, 0.03°–1.7°), while the mean LPTS decreased in the contralateral knee by 0.4° ( P = .363; 95% CI, –0.8° to 0.4°). A significant difference in LPTS was also observed in the nonoperated subgroup. No significant association was observed between LPTS and operational status. Conclusion: Lateral posterior tibial slope increased more in the ACL-injured knee than in the contralateral uninjured knee in a group of skeletally immature patients. Lateral posterior tibial slope at baseline was not associated with the need for surgical reconstruction over the study period.
Pulmonary Hemodynamics and Ventilation in Patients With COVID-19-Related Respiratory Failure and ARDS
Authors: Becker André , Seiler Frederik , Muellenbach Ralf M. , Danziger Guy , Kamphorst Maren , Lotz Christopher ,   PACovid Study Group, Bals Robert , Lepper Philipp M. 
Published: March 2021

Background: It has been suggested that COVID-19-associated severe respiratory failure (CARDS) might differ from usual acute respiratory distress syndrome (ARDS) due to failing autoregulation of pulmonary vessels and higher shunt. We sought to investigate pulmonary hemodynamics and ventilation properties in patients with CARDS compared to patients with ARDS of pulmonary origin. Methods: This was a retrospective analysis of prospectively collected data from consecutive adults with laboratory-confirmed severe acute respiratory syndrome coronavirus 2 patients treated in our ICU in 04/2020 and a comparison of the data to matched controls with ARDS due to respiratory infections treated in our ICU from 01/2014 to 08/2019 for whom pulmonary artery catheter data were available. Results: CARDS patients (n = 10) had ventilation characteristics similar to those of ARDS (n = 10) patients. Nevertheless, mechanical power applied by ventilation was significantly higher in CARDS patients (23.4 ± 8.9 J/min) than in ARDS (15.9 ± 4.3 J/min; P < 0.05). COVID-19 patients had similar pulmonary artery pressure but significantly lower pulmonary vascular resistance, as cardiac output was higher in CARDS vs. ARDS patients ( P < 0.05). Shunt fraction and dead space were similar in CARDS compared to ARDS ( P > 0.05) and were correlated with hypoxemia in both groups. The arteriovenous pCO2 difference (▵pCO2) was elevated (CARDS 5.5 ± 2.8 mmHg vs. ARDS 4.7 ± 1.1 mmHg; P > 0.05), as was the P(v-a)CO2/C(a-v)O2 ratio (CARDS mean 2.2 ± 1.5 vs. ARDS 1.7 ± 0.8; P > 0.05). Conclusions: Respiratory failure in COVID-19 patients seems to differ only slightly from ARDS regarding ventilation characteristics and pulmonary hemodynamics. Our data indicate microcirculatory dysfunction. More data need to be collected to assure these findings and gain more pathophysiological insights into COVID-19 and respiratory failure.
Adjunctive Phenobarbital for Alcohol Withdrawal Syndrome: A Focused Literature Review
Authors: Murphy Julie A. , Curran Brittany M. , Gibbons William A. , Harnica Holly M. 
Published: March 2021

Objective: To review the literature describing the use of adjunctive phenobarbital in the treatment of severe alcohol withdrawal syndrome (AWS). Data Sources: PubMed and EMBASE were searched using the following terms: phenobarbital, adjunct, refractory or treatment resistant, severe or complicated, and alcohol withdrawal delirium or alcohol withdrawal seizures. Study Selection and Data Extraction: The search was limited to randomized controlled trials (RCTs) and cohort studies published in English. Data Synthesis: Seven studies were identified in the emergency department (ED; RCT, n = 1; cohort, n = 2), general medicine ward (cohort, n = 1), and intensive care unit (ICU; cohort, n = 3) settings. For all studies set in the ED and general medicine ward and for 1 ICU study, phenobarbital plus symptom-guided benzodiazepine therapy was compared to symptom-guided benzodiazepine monotherapy. The other 2 ICU studies examined adjunctive phenobarbital before and after implementation of a protocol, meaning patients in both arms could have received phenobarbital. Overall risk of bias across all studies was low to moderate. Relevance to Patient Care and Clinical Practice: The specific role of adjunctive phenobarbital in AWS is not clear because a majority of studies are retrospective cohorts with varying primary outcomes in different patient care settings. Conclusions: In the ED and general medicine ward, phenobarbital demonstrated benzodiazepine-sparing effects. In the ICU, when a protocol guides phenobarbital use, the need for mechanical ventilation may be reduced. Adjunctive phenobarbital was well tolerated. Because of study limitations, it is challenging to provide specific recommendations for adjunctive phenobarbital use in severe AWS.
A case study of ascertainment bias for the primary outcome in the Strategies to Reduce Injuries and Develop Confidence in Elders (STRIDE) trial
Authors: Esserman Denise A , Gill Thomas M , Miller Michael E , Greene Erich J , Dziura James D , Travison Thomas G , Meng Can , Peduzzi Peter N 
Published: March 2021

Background/Aim In clinical trials, there is potential for bias from unblinded observers that may influence ascertainment of outcomes. This issue arose in the Strategies to Reduce Injuries and Develop Confidence in Elders trial, a cluster randomized trial to test a multicomponent intervention versus enhanced usual care (control) to prevent serious fall injuries, originally defined as a fall injury leading to medical attention. An unblinded nurse falls care manager administered the intervention, while the usual care arm did not involve contact with a falls care manager. Thus, there was an opportunity for falls care managers to refer participants reporting falls to seek medical attention. Since this type of observer bias could not occur in the usual care arm, there was potential for additional falls to be reported in the intervention arm, leading to dilution of the intervention effect and a reduction in study power. We describe the clinical basis for ascertainment bias, the statistical approach used to assess it, and its effect on study power. Methods The prespecified interim monitoring plan included a decision algorithm for assessing ascertainment bias and adapting (revising) the primary outcome definition, if necessary. The original definition categorized serious fall injuries requiring medical attention into Type 1 (fracture other than thoracic/lumbar vertebral, joint dislocation, cut requiring closure) and Type 2 (head injury, sprain or strain, bruising or swelling, other). The revised definition, proposed by the monitoring plan, excluded Type 2 injuries that did not necessarily require an overnight hospitalization since these would be most subject to bias. These injuries were categorized into those with (Type 2b) and without (Type 2c) medical attention. The remaining Type 2a injuries required medical attention and an overnight hospitalization. We used the ratio of 2b/(2b + 2c) in intervention versus control as a measure of ascertainment bias; ratios > 1 indicated the likelihood of falls care manager bias. We determined the effect of ascertainment bias on study power for the revised (Types 1 and 2a) versus original definition (Types 1, 2a, and 2b). Results The estimate of ascertainment bias was 1.14 (95% confidence interval: 0.98, 1.30), providing evidence of the likelihood of falls care manager bias. We estimated that this bias diluted the hazard ratio from the hypothesized 0.80 to 0.86 and reduced power to under 80% for the original primary outcome definition. In contrast, adapting the revised definition maintained study power at nearly 90%. Conclusion There was evidence of ascertainment bias in the Strategies to Reduce Injuries and Develop Confidence in Elders trial. The decision to adapt the primary outcome definition reduced the likelihood of this bias while preserving the intervention effect and study power.
Fontan-Associated Anatomical Variants and Hepatic Fibrosis
Authors: Evans William N. , Acherman Ruben J. , Mayman Gary A. , Galindo Alvaro , Rothman Abraham , Ciccolo Michael L. , Lehoux Juan , Winn Brody J. , Yumiaco Noel S. , Restrepo Humberto 
Published: March 2021

Objective: We hypothesized that a relationship between post-Fontan hepatic fibrosis and anatomical variants might exist. Methods: Attempting to limit confounding variables, we analyzed data from living, stable, post-extracardiac Fontan patients who underwent cardiac catheterization and transvenous hepatic biopsy procedures between March 2012 and June 2020. Results: We identified 120 patients who met the inclusion criteria. Of the 120, 35 (29%) had pulmonary artery stents. For the 35 with pulmonary artery stents, the average total fibrosis score was 3.2 ± 1.9 and the fibrosis progression rate was 0.36 ± 0.33, and for those with no pulmonary artery stents, the total fibrosis score was 2.6 ± 1.8 and the fibrosis progression rate was 0.27 ± 0.33 ( P = .13 and P = .11, respectively). Of the 120, 65 had functional univentricles of right ventricular type. Of these 65, 27 had pulmonary artery stents. For the 27 with pulmonary artery stents, the average total fibrosis score was 3.4 ± 1.8 and the average fibrosis progression rate was 0.39 ± 0.30, and for the 38 without pulmonary artery stents, the average fibrosis score was 2.3 ± 1.5 and the average fibrosis progression rate was 0.23 ± 0.21 ( P = .01 for comparison of both values). Conclusions: This study’s findings suggest that a post-extracardiac Fontan with a functional univentricle of right ventricular type plus a pulmonary artery stent may have more advanced liver pathology than those without a pulmonary artery stent at similar Fontan duration years and ages at liver biopsy.
Patient-Specific Patch for an Intra-Atrial Rerouting Procedure Developed Through Surgical Simulation
Authors: Nakamura Yuki , Romans Charles , Ashwath Ravi 
Published: March 2021

Background: In pediatric cardiac surgery, an application of three-dimensional (3D) modeling to develop custom-made prostheses is limited, and currently surgeons use their intraoperative visual estimation to develop 3D complex structures from 2D patch materials. Contemporary 3D designers are developing complex surfaces using surface modeling in other industries, which can be applied to pediatric cardiac surgery. However, its free-form nature may lead to intradesigner variability. Methods: A patient with a body weight of 4 kg with partial anomalous pulmonary venous connection and preoperative computed tomography data was selected, and a patient-specific 3D heart model was obtained. Through collaboration with a pediatric cardiologist and a pediatric cardiac surgeon, a 3D designer developed two patient-specific 3D patches for an intra-atrial rerouting procedure (IAR) for the patient using different methods of surface modeling. The shape and size of two flattened patches were analyzed using a geometric morphometrics (GM) approach. Computational fluid dynamics (CFD) analysis was also performed to calculate pressure drop across streamlines and flow energy loss in the right atrium for both patches. Results: The GM analysis showed that the size and shape of the two patches around the systemic vein orifice, crucial to prevent systemic venous obstruction, were almost equivalent. However, the CFD analysis showed that the pressure drop and flow energy loss were almost twice for one patch compared with the other. Conclusions: Our platform of developing a patient-specific 3D patch for an IAR procedure using surface modeling seemed promising, although intradesigner patch variability was not neglectable in our small-sized patient.
Eyes-Open Versus Eyes-Closed Somatosensory Motor Balance in Professional Soccer Players With Chronic Ankle Instability: A Case-Control Study
Authors: Rodríguez-Sanz David , García-Sánchez Antonio , Becerro-de-Bengoa-Vallejo Ricardo , Martínez-Jiménez Eva María , Calvo-Lobo César , Fernández-Carnero Josué , Losa-Iglesias Marta Elena , López-López Daniel 
Published: March 2021

Background: Chronic ankle instability (CAI) is a condition defined by certain structural and functional deficits in the ankle joint complex after acute ankle injury. These deficits include pathological joint laxity, impaired postural control, and decreased strength and neuromuscular control. Purpose: To compare an eyes-open versus an eyes-closed balance training protocol in professional soccer players with CAI. Study Design: Cohort study; Level of evidence, 2. Methods: For this study, we evaluated 19 players from 2 professional soccer teams in Madrid, Spain, all of whom had CAI. Participants from both teams were randomly assigned to an eyes-open group (n = 9) or eyes-closed group (n = 10). All participants completed 4 weeks of a supervised exercise protocol consisting of 3 sessions per week. Members of both the eyes-open and eyes-closed groups performed the same exercise protocol in the same order of execution. At the end of the protocol, the participants were assessed for pain (visual analog scale), ankle dorsiflexion range of motion (weightbearing lunge test), dynamic stability (Star Excursion Balance Test), and fear of movement and reinjury (Tampa Scale for Kinesiophobia). We compared results both before and after balance training and between the eyes-open and eyes-closed balance training groups. Results: Statistically significant differences were found for all of the assessed variables before and after balance training. No statistically significant differences were found between the eyes-closed and eyes-open groups on any variable. Conclusion: In the current study, eyes-closed balance training was not more effective than eyes-open balance training for CAI in professional soccer players.
Medial and Lateral Combined Ligament Arthroscopic Repair for Multidirectional Ankle Instability
Authors: Mansur Nacime Salomão Barbachan , Lemos André Vitor Kerber Cavalcante , Baumfeld Daniel Soares , Baumfeld Tiago Soares , Prado Marcelo Pires do , Raduan Fernando Cepolina , Nery Caio Augusto Souza 
Published: March 2021

Background: The high prevalence of ankle sprains in the population produces a significant number of patients with lateral instability. Persistence of this condition may lead to the progressive involvement of medial structures, causing a multidirectional rotational instability. Methods: This is a retrospective study with patients diagnosed with multidirectional instability who underwent ankle arthroscopy with medial (arthroscopic tensioning) and lateral repair (arthroscopic Bröstrom) between January 2018 and January 2020. All patients were evaluated for pain and function according to the visual analog scale (VAS) score and the American Orthopaedic Foot & Ankle Society (AOFAS) Hindfoot Score at a mean of 14.8 months (5-27 months) in follow-up. A total of 30 ankles (29 patients) were included in the study. Results: The AOFAS score increase from a 49.7 (CI 5.8) to a 91.9 (CI 2.4) mean ( P = .001) and was followed by significant improvement in the mean VAS score (6.8, CI 0.37-0.95, CI 0.31). The majority of patients had associated procedures (53.3%), and a low complication rate was found (16.6%). Conclusion: Combined medial and lateral arthroscopic repair might be an effective and safe alternative in the treatment of multidirectional instability. Inclusion of the deltoid ligament complex and the low invasiveness of the arthroscopic technique may improve the clinical outcomes of these patients. Level of Evidence: Level IV, retrospective case series.