bluuebunny/crossref_metadata_2025_split huggingface dataset:
ABCDEF Bundle and Supportive ICU Practices for Patients With Coronavirus Disease 2019 Infection: An International Point Prevalence Study
Authors: Liu Keibun , Nakamura Kensuke , Katsukawa Hajime , Elhadi Muhammed , Nydahl Peter , Ely Eugene Wesley , Kudchadkar Sapna R. , Takahashi Kunihiko , Inoue Shigeaki , Lefor Alan Kawarai , Kesecioglu Jozef , Nishida Osamu 
Published: March 2021

Objectives:
To investigate implementation of evidence-based and supportive cares in ICUs, such as the ABCDEF, nutrition therapy, and ICU diary, for patients with coronavirus disease 2019 infection in ICUs and their association with ICU clinical practice and setting.

Design:
A worldwide, 2-day point prevalence study.

Setting:
The study was carried out on June 3, 2020, and July 1, 2020. A total of 212 ICUs in 38 countries participated. Clinicians in each participating ICU completed web-based online surveys.

Patients:
The ICU patients with coronavirus disease 2019.

Interventions:
None.

Measurements and Main results:
The implementation rate for the elements of the ABCDEF bundle, other supportive ICU care measures, and implementation-associated structures were investigated. Data were collected for 262 patients, of whom 47.3% underwent mechanical ventilation and 4.6% were treated with extracorporeal membrane oxygenation. Each element was implemented for the following percentages of patients: elements A (regular pain assessment), 45%; B (both spontaneous awakening and breathing trials), 28%; C (regular sedation assessment), 52%; D (regular delirium assessment), 35%; E (early mobility and exercise), 47%; and F (family engagement and empowerment), 16%. The implementation of element E was 4% for patients on mechanical ventilation and 8% for patients on extracorporeal membrane oxygenation. Supportive care, such as protein provision throughout the ICU stay (under 1.2 g/kg for more than 50% of the patients) and introduction of ICU diary (25%), was infrequent. Implementation rates of elements A and D were higher in ICUs with specific protocols and fewer ICU beds exclusively for patients with coronavirus disease 2019 infection. Element E was implemented at a higher rate in ICUs that had more ICU beds assigned for them.

Conclusions:
This point prevalence study showed low implementation of the ABCDEF bundle. Specific protocols and the number of ICU beds reserved for patients with coronavirus disease 2019 infection might be key factors for delivering appropriate supportive care.
Rapid Development of a Tool for Prioritizing Patients with Coronavirus Disease 2019 for Intensive Care
Authors: Roy Melyssa , Hansen Paul , Sullivan Trudy , Ombler Franz , Kiore Mathew , Stapleton Andrew , Carr Craig 
Published: March 2021

Objectives:
To explain and demonstrate a new approach for rapidly developing a decision-support tool for prioritizing patients with coronovirus 2019 disease for admission to ICUs.

Design:
An expert group used multi-criteria decision analysis methods to specify criteria and weights, representing their relative importance, for prioritizing patients with coronovirus 2019 disease with respect to likely clinical benefit. Specialized multi-criteria decision analysis software, implementing the “Potentially All Pairwise RanKings of all possible Alternatives” method to determine the weights, was used. Social equity considerations for prioritizing patients were also identified as important.

Setting:
The prioritization tool was developed in New Zealand.

Subjects:
An expert group comprising specialists from intensive care medicine and nursing, Māori (New Zealand’s indigenous population) health, infectious diseases, and neonatology was formed. The group’s work was supported by health economists and decision analysts and overseen by an ethicist and a senior representative from the New Zealand Ministry of Health.

Interventions:
Multi-criteria decision analysis to create a prioritization tool.

Measurements and Main Results:
The prioritization tool comprised eight criteria with respect to likely clinical benefit. In decreasing order of importance (weights in parentheses): Sequential Organ Failure Assessment score (15.7%), preexisting cardiovascular conditions (15.7%), functional capacity (15.7%), age (12.4%), preexisting respiratory conditions (11.1%), immunocompromised (11.1%), body mass index (9.2%), and other relevant medical conditions (9.2%). Two social equity considerations were also included in the overarching decision framework to be used alongside the clinical criteria: prioritizing Māori and Pacific people (and, potentially, other at-risk groups), and healthcare and other frontline workers.

Conclusions:
The criteria and weights in the prioritization tool can be easily revised as new evidence emerges. The approach for developing the tool could be used in other countries whose ICUs are at risk of being overwhelmed by the coronavirus disease 2019 pandemic to rapidly develop their own prioritization tools. In the event that future crises threaten to overload ICUs, other prioritization tools could also be rapidly developed.
RNA therapeutics for cardiovascular disease
Authors: Boada Christian , Sukhovershin Roman , Pettigrew Roderic , Cooke John P. 
Published: March 2021

Purpose of review
The development of mRNA vaccines against coronavirus disease 2019 has brought worldwide attention to the transformative potential of RNA-based therapeutics. The latter is essentially biological software that can be rapidly designed and generated, with an extensive catalog of applications. This review aims to highlight the mechanisms of action by which RNA-based drugs can affect specific gene targets and how RNA drugs can be employed to treat cardiovascular disease, with the focus on the therapeutics being evaluated in clinical trials. The recent advances in nanotechnology aiding the translation of such therapies into the clinic are also discussed.

Recent findings
There is a growing body of studies demonstrating utility of RNA for targeting previously ‘undruggable’ pathways involved in development and progression of cardiovascular disease. Some challenges in RNA delivery have been overcome thanks to nanotechnology. There are several RNA-based drugs to treat hypercholesterolemia and myocardial infarction which are currently in clinical trials.

Summary
RNA therapeutics is a rapidly emerging field of biotherapeutics based upon a powerful and versatile platform with a nearly unlimited capacity to address unmet clinical needs. These therapeutics are destined to change the standard of care for many diseases, including cardiovascular disease.
Protective effect of controlled blood pressure on risk of dementia in low-risk, grade 1 hypertension
Authors: Lee Chan Joo , Hwang Jinseub , Kang Chae Young , Kim Hyeon-Chang , Ryu Dong-Ryeol , Ihm Sang-Hyun , Kim Yong-Jin , Shin Jin-Ho , Pyun Wook Bum , Kim Changsoo , Park Sungha 
Published: March 2021

Objective:
High blood pressure (BP) increases the risk of dementia; however, few studies have reported on the risk of dementia in patients with low-risk, early-grade hypertension. We investigated the protective effect of controlled BP on risk of dementia in treated, low-risk, grade 1 hypertensive patients from the entire National Health Insurance Service National Health Examinee cohort.

Methods:
We selected grade 1 hypertension (140–159/90–99 mmHg) patients with low risk, diagnosed in 2005–2006. All patients (N = 128 665) were classified into controlled (average BP < 140/90 mmHg during the follow-up) and uncontrolled (average BP ≥ 140/90 mmHg) BP groups and followed up until 2015. The risk of dementia was estimated using Cox proportional hazard model after adjustments for propensity score.

Results:
Average BP was 131/81 mmHg in the controlled group (N = 49 408) and 144/87 mmHg in the uncontrolled group (N = 99 257). Overall dementia incidence rates in controlled and uncontrolled groups were 4.9 and 8.1 per 1000 person-year, respectively. The controlled group showed lower risk of overall dementia, Alzheimer's disease, and vascular dementia than the uncontrolled group. The controlled group had a low risk of vascular dementia at all ages, especially in the younger group (age <60). The optimal BP level associated with the lowest risk of dementia was 130 to less than 140 mmHg for SBP and 70 to less than 80 mmHg for DBP.

Conclusion:
We concluded that among even low-risk and grade 1 hypertension patients, controlled BP significantly reduced the risk of dementia, including Alzheimer's disease and vascular dementia.
Blood pressure levels and risk of haemorrhagic stroke in patients with atrial fibrillation and oral anticoagulants: results from The Swedish Primary Care Cardiovascular Database of Skaraborg
Authors: Bager Johan-Emil , Hjerpe Per , Schiöler Linus , Bengtsson Boström Kristina , Kahan Thomas , Ödesjö Helena , Jood Katarina , Hasselström Jan , Ljungman Charlotta , Manhem Karin , Mourtzinis Georgios 
Published: March 2021

Objective:
To assess the risk of haemorrhagic stroke at different baseline SBP levels in a primary care population with hypertension, atrial fibrillation and newly initiated oral anticoagulants (OACs).

Methods:
We identified 3972 patients with hypertension, atrial fibrillation and newly initiated OAC in The Swedish Primary Care Cardiovascular Database of Skaraborg. Patients were followed from 1 January 2006 until a first event of haemorrhagic stroke, death, cessation of OAC or 31 December 2016. We analysed the association between continuous SBP and haemorrhagic stroke with a multivariable Cox regression model and plotted the hazard ratio as a function of SBP with a restricted cubic spline with 130 mmHg as reference.

Results:
There were 40 cases of haemorrhagic stroke during follow-up. Baseline SBP in the 145–180 mmHg range was associated with a more than doubled risk of haemorrhagic stroke, compared with a SBP of 130 mmHg.

Conclusion:
In this cohort of primary care patients with hypertension and atrial fibrillation, we found that baseline SBP in the 145–180 mmHg range, prior to initiation of OAC, was associated with a more than doubled risk of haemorrhagic stroke, as compared with an SBP of 130 mmHg. This suggests that lowering SBP to below 145 mmHg, prior to initiation of OAC, may decrease the risk of haemorrhagic stroke in patients with hypertension and atrial fibrillation.
Light therapy improves diurnal blood pressure control in night shift workers via reduction of catecholamines: the EuRhythDia study
Authors: Hannemann Juliane , Laing Anika , Middleton Benita , Cridland Jonathan , Staels Bart , Marx Nikolaus , Grant Peter J. , Federici Massimo , Stenberg Tarja , Skene Debra J. , Böger Rainer 
Published: March 2021

Objectives:
Night shift work is associated with high rates of hypertension and cardiometabolic disease, which are linked to disrupted circadian rhythms. We hypothesized that timed light therapy might improve disrupted circadian rhythms and stabilize diurnal control of blood pressure and glucose in night shift workers.

Methods:
We randomized 24 rotating night shift workers (mean age, 36 ± 13 years, 7 men) who had spent a median of 6 years on rotating night shifts (median, six night shifts per month) to 12 weeks of light therapy or no intervention and compared them with 12 daytime workers (37 ± 11 years, 6 men). We measured oral glucose tolerance (OGTT), 24-h blood pressure and arterial stiffness, and the circadian profiles of melatonin, cortisol, metanephrine and nor-metanephrine at baseline, after 12 weeks of intervention, and 12 weeks after the end of intervention.

Results:
At baseline, fewer night shift workers showed dipper status as compared with daytime workers (29 vs. 58%; P < 0.001). After 12 weeks of light therapy, there was a highly significant increase in the proportion of dippers (to 58%; P < 0.0001). We also observed a significant decrease in serum glucose during OGTT in the light therapy group (−22%; P < 0.05) with no change in serum insulin. Whilst circadian profiles of melatonin and cortisol were unchanged, plasma metanephrine and nor-metanephrine levels were significantly reduced in the light therapy group (P < 0.01).

Conclusion:
Timed light therapy improves diurnal blood pressure control and glucose tolerance in rotating night shift workers. This effect is unrelated to melatonin and cortisol but is paralleled by reduced catecholamine levels.
Current treatment strategies for symptomatic vitreous opacities
Authors: Ryan Edwin H. 
Published: March 2021

Purpose of review
Symptomatic vitreous opacities are increasingly recognized as a significant burden to patient well-being. There is growing interest in the use of vitrectomy or laser treatment to address these problems. This review is intended to update current assessment, management, and risks of treatment for persistent severely symptomatic vitreous opacities.

Recent findings
Despite studies showing the value of quantitative ultrasound, reading speed measurements, and contrast sensitivity for assessing dysfunction caused by vitreous opacities, the decision of whether to proceed with surgery remains a very subjective, clinical one. Visual Function Questionnaire-25 score studies show a very large improvement postvitrectomy consistent with relief from symptoms and patient satisfaction. The risk of retinal tear and detachment appears to be higher than in most conditions treated with vitrectomy.

Summary
Vitrectomy for the management of severe vitreous opacities is increasingly accepted because of the tremendous relief of symptoms reported by patients. The risks of retinal tear and detachment remain a concern, particularly in patients who have an attached posterior hyaloid. Yttrium-aluminum-garnet laser treatment of floaters may offer benefit in a subset of patients but appears to be less definitive than vitrectomy, and also may carry significant risk.
Update on maculopathy secondary to pentosan polysulfate toxicity
Authors: Abou-Jaoude Michelle , Fraser Claire , Maldonado Ramiro S. 
Published: March 2021

Purpose of review
The aim of the present review is to provide a comprehensive summary of available knowledge regarding toxic maculopathy secondary to pentosan polysulfate sodium (PPS).

Recent findings
PPS toxicity was described in 2018, and additional studies characterize it as dysfunction of the retinal pigment epithelium centered on the posterior pole, which can progress despite drug cessation. Requisite exposure can be as little as 0.325 kg and 2.25 years but averages closer to 1–2 kg and 10–15 years. Multimodal imaging should include near-infrared reflectance, optical coherence tomography, and fundus autofluorescence. Cross-sectional studies demonstrate evidence correlating cumulative dosing and the likelihood/severity of maculopathy. Early estimates of prevalence range from 12.7 to 41.7% depending on dosing, with overall rates around 20%.

Summary
Reasonable evidence associates maculopathy with extended exposure to PPS, with an average reported incidence of around 20% in patients with long-term exposures. Patients with unexplained retinal pigment epithelium changes and difficulty with dark adaptation should be questioned regarding PPS exposure, and patients with known exposure to PPS should be examined. Further research is needed to refine screening protocols. Currently, providers should consider baseline examination and examination at 5 years and/or 500 g of exposure followed by yearly screening.
Language and Audiological Outcomes Among Infants Implanted Before 9 and 12 Months of Age Versus Older Children: A Continuum of Benefit Associated With Cochlear Implantation at Successively Younger Ages
Authors: Chweya Cynthia M. , May Matthew M. , DeJong Melissa D. , Baas Becky S. , Lohse Christine M. , Driscoll Colin L. W. , Carlson Matthew L. 
Published: March 2021

Objective:
To compare language and audiological outcomes among infants (<9 and <12 mo) and older children receiving cochlear implantation (CI).

Study design:
Retrospective chart review.

Setting:
Tertiary academic referral center.

Patients:
Pediatric patients receiving CI between October 1995 and October 2019.

Intervention:
Cochlear implantation

Main Outcome Measures:
Most recent language and audiological assessment scores were evaluated by age group.

Results:
A total of 118 children were studied, including 19 who were implanted <9 months of age, 19 implanted 9 to <12 months of age, and 80 implanted 12 to <36 months of age. The mean duration of follow-up was 7.4 ± 5.0 years. Most recent REEL-3 receptive (88 ± 12 vs. 73 ± 15; p = 0.020) and expressive (95 ± 13 vs. 79 ± 12; p = 0.013) communication scores were significantly higher in the <9 months group compared to the 9 to <12 months group. PLS and OWLS auditory comprehension and oral expression scores were significantly higher in the <12 months group compared to the 12 to <36 months group. The difference in NU-CHIPS scores between <12 and 12 to <36 months was statistically significant (89% ± 6 vs. 83% ± 12; p = 0.009). LNT scores differed significantly between <9 and 9 to <12 months (94% ± 4 vs. 86% ± 10; p = 0.028).

Conclusions:
The recent FDA expansion of pediatric CI eligibility criteria to include infants as young as 9 months of age should not serve as a strict clinical cutoff. Rather, CI can be pursued in appropriately selected younger infants to optimize language and audiological outcomes.
High Prevalence of MYO6 Variants in an Austrian Patient Cohort With Autosomal Dominant Hereditary Hearing Loss
Authors: Frohne Alexandra , Koenighofer Martin , Liu David Tianxiang , Laccone Franco , Neesen Juergen , Gstoettner Wolfgang , Schoefer Christian , Lucas Trevor , Frei Klemens , Parzefall Thomas 
Published: March 2021

Introduction:
Genetic hearing loss (HL) is often monogenic. Whereas more than half of autosomal recessive (AR) cases in Austria are caused by mutations in a single gene, no disproportionately frequent contributing genetic factor has been identified in cases of autosomal dominant (AD) HL. The genetic characterization of HL continues to improve diagnosis, genetic counseling, and lays a foundation for the development of personalized medicine approaches.

Methods:
Diagnostic HL panel screening was performed in an Austrian multiplex family with AD HL, and segregation was tested with polymerase chain reaction and Sanger sequencing. In an independent approach, 18 unrelated patients with AD HL were screened for causative variants in all known HL genes to date and segregation was tested if additional family members were available. The pathogenicity of novel variants was assessed based on previous literature and bioinformatic tools such as prediction software and protein modeling.

Results:
In six of the 19 families under study, candidate pathogenic variants were identified in MYO6, including three novel variants (p.Gln441Pro, p.Ser612Tyr, and p.Gln650ValfsTer7). Some patients carried more than one likely pathogenic variant in known deafness genes.

Conclusion:
These results suggest a potential high prevalence of MYO6 variants in Austrian cases of AD HL. The presence of multiple rare HL variants in some patients highlights the relevance of considering multiple-hit diagnoses for genetic counseling and targeted therapy design.
Hearing Outcomes After Surgical Manipulation of the Membranous Labyrinth During Superior Semicircular Canal Dehiscence Plugging or Posterior Semicircular Canal Occlusion
Authors: Lin Kenny F. , Bojrab Dennis I. , Fritz Christian G. , Vandieren Anthony , Babu Seilesh C. 
Published: March 2021

Objective:
To analyze audiometric data after surgical manipulation of the membranous labyrinth during plugging of superior semicircular canal dehiscence (SSCD) or posterior semicircular canal occlusion (PSCO) for benign paroxysmal positional vertigo.

Study Design:
Retrospective chart review.

Setting:
Tertiary referral center.

Patients:
Patients undergoing plugging of SSCD or PSCO between 2009 and 2019.

Main Outcome Measures:
Pre- and postoperative audiometric data were collected per AAO-HNS guidelines. Hearing outcomes at initial and last follow-up were compared. Subanalyses were performed for surgical approach and age.

Results:
Eighty-seven total procedures in 76 patients including 43 middle cranial fossa for SSCD, 29 transmastoid SSCD, and 15 PSCO. Mean preoperative air-conduction–pure-tone averages was 21.1±14.9 dB compared with 26.1 ± 19.6 dB at initial follow-up and 24.4 ± 18.6 dB at last follow-up (p = 0.006). Mean preoperative bone-conduction–pure-tone average was 14.3 ± 11.9 dB compared with 18.3 ± 15.6 dB at initial follow-up and 18.5 ± 16.9 dB at last follow-up (p < 0.001). There were five cases of hearing loss >20 dB including one case of profound sensorineural hearing loss >55 dB. PSCO resulted in the most hearing loss at initial follow-up but largely resolves with time. Transmastoid approaches for SSCD resulted in more hearing loss compared with middle cranial fossa. Hearing outcomes were generally stable for SSCD approaches but showed improvement over time for PSCO. Age >50 was associated with greater hearing loss of 5.2 ± 11.1 dB compared with 1.3 ± 10.5 dB but did not reach statistical significance (p = 0.110).

Conclusions:
Surgical manipulation of the membranous labyrinth results in statistically significant hearing loss in a pooled analysis. Transient hearing loss is observed in PSCO and TM SSCD plugging was associated with postoperative hearing loss. There was a trend toward increased hearing loss in patients >50 years old.
Cochlear Implantation in NF2 Patients Without Intracochlear Schwannoma Removal
Authors: Eitutis Susan T. , Jansen Thijs , Borsetto Daniele , Scoffings Daniel J. , Tam Yu Chuen , Panova Tsvetemira , Tysome James R , Donnelly Neil P. , Axon Patrick R. , Bance Manohar L. 
Published: March 2021

Objective:
To determine if cochlear implantation without removal of inner ear schwannomas (IES) is an effective treatment option for Neurofibromatosis 2 (NF2) patients. To determine how the presence of an intracochlear schwannoma might impact cochlear implant (CI) outcomes and programming parameters.

Study Design:
Retrospective chart review.

Setting:
Tertiary center for cochlear and auditory brainstem implantation.

Patients:
Of 10 NF2 patients with IES, 8 are reported with no previous tumor removal on the implanted ear.

Interventions:
Cochlear implant without tumor removal.

Main Outcome Measures:
Performance outcomes with CI at least 1-year post intervention. Programming parameters, including impedances, for patients with IES.

Results:
All patients had full insertion of the electrode arrays with round window approaches. Performance outcomes ranged from 0 to 100% for Bamford-Kowal-Bench sentences. Impedance measurements for active electrodes for patients with IES were comparable to those measured in patients without vestibular schwannoma (VS). Only patients who had radiation treatment before receiving their implant had elevated threshold requirements for CI programming compared with CI recipients without VS.

Conclusion:
Cochlear implantation without tumor removal is an effective option for treating NF2 patients with IES. The presence of an intracochlear tumor did not have an impact on CI performance or programming requirements compared with patients without VS; however, previous treatment with radiation may be related to elevated current requirements in the CI settings.