bluuebunny/crossref_metadata_2025_split huggingface dataset:
Brain Microvascular Endothelial Cell Activation and Barrier Disruption in a Mouse Model of Psychological Resilience
Authors: Cefalu Lindsay M , Bieniek Gerald E , Cain Roiseann M , Ho Dao H 
Published: June 2021

Psychological resilience, as measured by the ability of an individual to overcome the development of psychological disorders following exposure to stressful or traumatic events, varies significantly from individual to individual. The mechanisms underlying this variability among individuals have not been fully elucidated. A key factor in the development and progression of psychological disorders such as depression, schizophrenia, and post‐traumatic stress disorder is disruption of the blood brain barrier, thus we hypothesized that the function of brain microvascular endothelial cells (BMECs) of resilient individuals are more resistant to disruption by endothelial cell activators (ethanol (EtOH), corticosterone (CORT), and lipopolysaccharide (LPS)), compared to non‐resilient individuals. We used Electric Cell‐substrate Impedance Signaling (ECIS) technology (Applied BioPhysics, Troy, NY) to measure transendothelial electrical resistance (TEER) of cultured BMECs of the resilient C57BL6 mouse (BMECC57BL6), and the non‐resilient BalbC mouse (BMECBalbC). BMECs were plated at a density of 4.8 × 104 cells/cm2, and allowed to establish a monolayer for 48 hours. BMECs were then treated with either EtOH (0, 1, 10, 25, 50, or 100 mM), CORT (0, 10, 100 or 1000 ng/ml), or LPS derived from E. coli (0, 1, 10, or 100 ng/ml). TEER was continuously recorded for an additional 24 hours. Barrier function (Rb), membrane capacitance (Cm), and constraint on current flow beneath the cells (α) were derived via ECIS mathematical modeling. We found that at baseline, BMECC57BL6 had significantly lower Rb (1.31±0.14 versus 2.64±0.43 Ωcm2, p = 0.009, n = 4) and α (6.13±0.33 versus 7.56±0.53 Ω0.5cm, p = 0.009, n = 4), and significantly higher Cm (2.65±1.19 versus 1.28±0.012 μF/cm2, p = 0.007, n = 4) when compared to BMECBalbC. Contrary to our hypothesis, the effect of EtOH, CORT, or LPS on these baseline parameters did not significantly differ between the two types of BMEC. These findings indicate that variability in psychological resilience among individuals may be associated with functional differences in BMECs, an important component of the blood brain barrier.Support or Funding InformationThe views expressed in this presentation are those of the authors and do not reflect the official policy or position of the Department of the Army, the Department of Defense, or the U.S. government.
Pre-operative proteinuria, postoperative acute kidney injury and mortality
Authors: Chang Chun-Yu , Chien Yung-Jiun , Kao Ming-Chang , Lin Han-Yu , Chen Yu-Long , Wu Meng-Yu 
Published: June 2021

OBJECTIVE
To investigate the association of pre-operative proteinuria with postoperative acute kidney injury (AKI) development as well as the requirement for a renal replacement therapy (RRT) and mortality at short-term and long-term follow-up.

BACKGROUND
Postoperative AKI is associated with surgical morbidity and mortality. Pre-operative proteinuria is potentially a risk factor for postoperative AKI and mortality. However, the results in literature are conflicting.

METHODS
We searched PubMed, Embase, Scopus, Web of Science and Cochrane Library from the inception through to 3 June 2020. Observational cohort studies investigating the association of pre-operative proteinuria with postoperative AKI development, requirement for RRT, and all-cause mortality at short-term and long-term follow-up were considered eligible. Using inverse variance method with a random-effects model, the pooled effect estimates and 95% confidence interval (CI) were calculated.

RESULTS
Twenty-eight studies were included. Pre-operative proteinuria was associated with postoperative AKI development [odds ratio (OR) 1.74, 95% CI, 1.45 to 2.09], in-hospital RRT (OR 1.70, 95% CI, 1.25 to 2.32), requirement for RRT at long-term follow-up [hazard ratio (HR) 3.72, 95% CI, 2.03 to 6.82], and long-term all-cause mortality (hazard ratio 1.50, 95% CI, 1.30 to 1.73). In the subgroup analysis, pre-operative proteinuria was associated with increased odds of postoperative AKI in both cardiovascular (OR 1.77, 95% CI, 1.47 to 2.14) and noncardiovascular surgery (OR 1.63, 95% CI, 1.01 to 2.63). Moreover, there is a stepwise increase in OR of postoperative AKI development when the quantity of proteinuria increases from trace to 3+.

CONCLUSION
Pre-operative proteinuria is significantly associated with postoperative AKI and long-term mortality. Pre-operative anaesthetic assessment should take into account the presence of proteinuria to identify high-risk patients.

PROSPERO REGISTRATION
CRD42020190065.
Feasibility of 24-h blood pressure telemonitoring in community pharmacies: the TEMPLAR project
Authors: Omboni Stefano , Ballatore Tommaso , Rizzi Franco , Tomassini Fernanda , Campolo Luca , Panzeri Edoardo 
Published: June 2021

Objectives:
Low-quality ambulatory blood pressure monitoring (ABPM) due to recurring artifacts may limit its clinical value. We evaluated the features and impact on BP control and patient management of ABPMs performed in Italian community pharmacies, according to their quality.

Methods:
Twenty-four-hour ABPMs were obtained by a clinically validated, automated upper arm device and uploaded on a certified web-based telemedicine platform (www.tholomeus.net). The system automatically evaluated the quality of the recording according to current guidelines. In case of poor ABPM quality, the pharmacist was prompted to repeat the test. All the ABPMs were labeled as valid or invalid. Demographic and clinical characteristics of the patients and BP control were compared between the two groups.

Results:
A total of 45 232 ABPMs were obtained in as many patients through 812 pharmacies (87.7% recordings were valid). Factors significantly associated with a better ABPM quality were younger age, use of antihypertensive medications, presence of at least one cardiovascular risk factor, concomitant disease or treatment, a test performed in the coldest months, and residence in the cooler northern regions of the country. The 24-h and daytime ambulatory BP level and the prevalence of ambulatory hypertension and white-coat hypertension were higher, and the prevalence of masked hypertension lower in patients with valid recordings. High odds of obtaining a valid recording were observed in patients repeating the ABPM.

Conclusion:
Ambulatory BP telemonitoring is feasible in community pharmacies as long as potential predictors of unsuccessful outcomes are taken into account and adequately managed.
Wedge-Shaped Pars Plana Sclerotomies: Is It Still an Actuality in the Era of Microincision Vitrectomy?
Authors: Caporossi Tomaso , Governatori Lorenzo , Baldascino Antonio , Savastano Alfonso , De Vico Umberto , Rizzo Stanislao 
Published: June 2021

Purpose:
To describe and evaluate the effectiveness of wedge-shaped sclerotomies to close 25-gauge and 23-gauge transconjunctival pars plana vitrectomies.

Materials and Methods:
This prospective, consecutive, interventional study examined 50 eyes of 50 patients who underwent 25-gauge and 23-gauge vitrectomy with wedge-shaped sclerotomies.

Results:
The number of eyes requiring a wedge shape for sclerotomy closure and sclerotomies requiring sutures was collected. Three eyes had hypotony on Day 1. No statistically significant difference was observed between preoperative intraocular pressure and postoperative intraocular pressure on Days 15 and 30. No postoperative complications were observed during the follow-up period.

Conclusion:
The wedge-shaped sclerotomy is a simple, fast, and effective technique that does not require extra surgical materials and could be applied to microincision vitrectomy.
Association between sleep disturbance and multidimensional frailty assessed by Frailty Index in hospitalized cirrhosis
Authors: Hui Yangyang , Xu Lin , Wang Xiaoyu , Feng Hongjuan , Yu Zihan , Li Chaoqun , Mao Lihong , Fan Xiaofei , Wang Bangmao , Chen Xin , Sun Chao 
Published: June 2021

Objectives
Both sleep disturbance and frailty are common in patients with cirrhosis, but their correlation remains elusive. We aimed to investigate whether dysregulated sleep [as estimated by Pittsburgh Sleep Quality Index (PSQI)] is independently associated with frailty and their relationship in distinct subgroups.

Methods
In total 105 adult cirrhotic patients were recruited. The frailty phenotype was identified by a self-reported scale (Frailty Index) which demonstrates good validity and moderate performance based on our previous publication. Patients were categorized into frailty and nonfrailty groups according to a cut-point of 0.38 by Frailty Index. Multiple linear regression was performed to determine independent factors associated with frailty.

Results
The median PSQI was 6.0 in the entire cohort and sleep disturbance was observed in 61 patients with cirrhosis (58.1%). Poor sleepers had a significantly higher Frailty Index than that in good sleepers (0.11 vs. 0.08; P = 0.025). In univariate analysis, PSQI score was markedly associated with the Frailty Index (β = 0.012; 95% CI, 0.006–0.018; P < 0.001), and remained significantly associated with frailty phenotype in multivariate adjustment (β = 0.010; 95% CI, 0.004–0.015; P = 0.001). The escalating PSQI scores were more prominent in frail patients, with female gender or aged 65 years and over.

Conclusions
Poor sleep quality is strongly associated with frailty in patients with cirrhosis. Given that sleep disturbance is modifiable, our data suggest that efficient interventions to mitigate frailty should incorporate strategies by reversing sleep dysfunction in cirrhotics with poor sleep quality.
75SeHCAT whole body retention for unexplained chronic diarrhoea based on early first whole body counting
Authors: Soares Sara , Heraghty Neil , Gulliver Nick , Peters Adrien Michael 
Published: June 2021

Background
There are many protocol variations in the whole-body 75SeHCAT retention test [whole-body retention (WBR)] for investigation of bile acid diarrhoea. The time between capsule consumption and first count, however, is widely taken, without debate, to be 3 h. In the Covid-19 era, it is desirable to limit the time patients spend in the department. We, therefore, questioned the need for a 3 h interval between capsule administration and the initial count.

Methods
Using an uncollimated gamma camera, whole-body counting was performed at 5, 30 and 180 min after capsule ingestion in 24 patients with chronic diarrhoea. Geometric mean was taken of counts acquired from posterior and anterior projections. WBR was expressed as the ratio of 7 day-to-initial whole-body counts (%) to give WBR5, WBR30 and WBR180. A small meal was given at 60 min after capsule ingestion.

Results
There was a close correlation between WBR30 and WBR180 (y = 1.0x − 0.29%; r = 0.99). For WBR180 values of <15% (lower limit of normal), there was close agreement between WBR30 and WBR180 (bias 0.03%; precision 0.7%). WBR5 overestimated WBR180. However, cWBR5, obtained by multiplication of WBR5 by 0.75, also correlated closely with WBR180 (y = 1.2x − 4.5%; r = 0.97), and there was close agreement between cWBR5 and WBR180 for WBR180 values <15% (bias 0.08%, precision 1.3%).

Conclusion
The first whole-body count in the 75SeHCAT test can be undertaken at 30 min postcapsule without loss of accuracy, or even 5 min if only subnormal values are considered relevant. No food is required after capsule consumption.
Pancreas transplantation
Authors: Vistoli Fabio , Kauffmann Emanuele F. , Boggi Ugo 
Published: June 2021

Purpose of review
To define recent changes and future directions in the practice of pancreas transplantation (PT). Two major events have occurred in the past 18 months: COVID-19 pandemic, and the first world consensus conference on PT. Several innovative studies were published after the consensus conference.

Recent findings
During COVID-19 pandemic PT activity decreased. COVID-19 in transplant recipients increases mortality rates, but data from kidney transplantation show that mortality might be higher in waitlisted patients.
The world consensus conference provided 49 jury deliberations on the impact of PT on management of diabetic patients and 110 practice recommendations.
Recent evidence demonstrates that PT alone is safe and effective, that results of simultaneous pancreas and kidney (SPK) remain excellent despite older recipient age and higher prevalence of type 2 diabetes, that use of hepatitis C virus (HCV)-positive donors into HCV-negative recipients is associated with good outcomes, and that use of sirolimus as primary immunosuppressant and costimulation blockade does not improve results of SPK.

Summary
COVID-19 pandemic and the first world consensus conference on PT were major events. Although COVID-19 pandemic should not reduce PT activity in the future, a major positive impact on both volume and outcomes of PT is awaited from the proceedings of the world consensus conference.
The Effect of Perioperative Blood Transfusion on Long-Term Survival Outcomes After Surgery for Pancreatic Ductal Adenocarcinoma
Authors: Ye Linda , Livingston Edward H. , Myers Bethany , Hines O. Joe 
Published: June 2021

Objective
To evaluate survival outcomes associated with perioperative allogeneic red blood cell transfusion (RBCT) in patients with pancreatic ductal adenocarcinoma undergoing surgery.

Methods
PubMed, Embase, Cochrane, and Web of Science Core Collection were queried for English-language articles until May 28, 2020. Studies evaluating long-term outcomes of RBCT compared with no transfusion in adults with pancreatic ductal adenocarcinoma undergoing pancreatectomy were included. E-value sensitivity analysis assessed the potential for unmeasured confounders to overcome these findings.

Results
Of 4379 citations, 5 retrospective cohort studies were included. Three studies reported shorter recurrence-free survival by 1 to 5 months with RBCT. Two studies found shorter disease-specific survival by 5 to 13 months with RBCT. Overall survival was reduced by 5 to 7 months with RBCT in 3 studies. All multivariable findings associated with RBCT could be readily overcome unmeasured confounding on sensitivity analysis. Confounding in baseline characteristics resulted in high risk of bias.

Conclusions
Imprecision, unmeasured confounding, small effect sizes, and overall low quality of the available literature result in uncertainty regarding the effect of transfusion on recurrence-free survival, disease-specific survival, and overall survival in patients undergoing surgery for pancreatic cancer. Randomized trials are needed to determine if there is a causal relationship between transfusion and survival after pancreatic resection.
Evaluation of Pain in the Pediatric Emergency Department and the Request of Analgesia
Authors: Bergeron Jennifer , Bailey Benoit 
Published: June 2021

Objectives
To determine the acute pain level associated with request for analgesia by children and their parents in the pediatric emergency department (ED) when pain was assessed by verbal numeric scale (VNS), visual analog scale (VAS), and verbal rating scale (VRS).

Methods
A secondary analysis of a prospective cohort study using a sample of children aged 8 to 17 presenting to the ED with acute pain. Patients and their parents were asked to quantify the child's pain on the VNS, VAS, and VRS. Scores for patients and parents who answered “yes” to the request of analgesia were compared with those responding “no.”

Results
A total of 202 patients aged 12.2 ± 2.6 years were enrolled. The median levels of pain associated with a request of analgesia and no request for analgesia by the patient were: 6.0 (4.0–7.4) and 5.0 (3.0–6.0) (Δ 1.0; 95% confidence interval [CI], 0.5–2.0) for the VNS; 5.7 (3.9–7.2) and 4.3 (2.6–5.8) (Δ 1.3; 95% CI, 0.6–1.9) for the VAS; and 2.0 (2.0–2.0) and 2.0 (1.0–2.0) (Δ 0.0; 95% CI, 0.0–0.0) for the VRS.

Conclusions
Children who requested analgesia had higher pain scores on the VNS and the VAS, than those who did not request analgesia. No difference was demonstrated with the VRS. The pain scores between the analgesia request categories could overlap. This suggests that children seen in the ED should be asked if they want analgesia to decrease their acute pain.
Patients with HIV and cirrhosis: the risk for hepatocellular carcinoma after direct-acting antivirals for hepatitis C virus
Authors: Guardigni Viola , Toschi Alice , Badia Lorenzo , Rosselli Del Turco Elena , Salsi Eleonora , Cristini Francesco , Sighinolfi Laura , Fabbri Gabriele , Massari Marco , Cuomo Gianluca , Viale Pierluigi , Verucchi Gabriella 
Published: June 2021

Objectives:
Hepatocellular carcinoma (HCC) has become a major issue in coinfected HIV/HCV patients with liver cirrhosis. We aimed to determine the rate of HCC occurrence after a direct-acting antiviral (DAA) treatment and to evaluate the factors associated with the risk of HCC in this population.

Design:
We conducted a retrospective multicenter observational study including cirrhotic HIV/HCV-coinfected patients treated with DAAs, between October 2014 and January 2017.

Methods:
We collected demographics characteristics, data regarding HIV and HCV infections and treatment with DAAs. We investigated the rate and the time of occurrence of HCC. Statistical analysis explored the factors associated to development of liver cancer.

Results:
During a median follow-up of 55 months, 24 out of 232 patients developed HCC, after a median of 22.5 months from starting DAAs. Factors associated with HCC were a higher Child--Pugh Turcotte (CPT) score (P = 0.002), HCV genotype 3 (P = 0.04), previous HCC (P < 0.001) and CD4+ cell count nadir greater than 350 cells/μl (P = 0.001), whereas antiretroviral therapy (ART) was associated to a lower rate of cancer (P = 0.02). At multivariable analysis CPT score and a history of HCC remained independently associated with HCC after DAAs (P = 0.003 and P < 0.001, respectively), and ART administration maintained its protective role (P = 0.047), regardless of HIV RNA at baseline.

Conclusion:
Our study highlights the importance of a long-lasting follow-up for HCC after HCV eradication, mostly in those patients with advanced cirrhosis and history of HCC. Furthermore, our data showed a potential role of ART itself (and not of undetectable HIV RNA) in reducing the risk for HCC development.
Safety Profile and Predictors of Aesthetic Outcomes After Prepectoral Breast Reconstruction With Meshed Acellular Dermal Matrix
Authors: Belmonte Briana M. , Campbell Chris A. 
Published: June 2021

Introduction
Prepectoral acellular dermal matrix (ADM)-assisted breast reconstruction has demonstrated improved pain scores, faster return to full range of motion, and an appropriate postoperative safety profile when compared with cohorts with submuscular implant placement; however, there are limited data on aesthetic outcomes. Basic science biointegration research has previously demonstrated faster ADM incorporation with fenestrated compared with confluent ADM. We report the safety profile of anterior support meshed ADM prepectoral breast reconstruction and analyze predictive factors for aesthetic outcomes after gel implant placement.

Methods
All consecutive immediate staged prepectoral expander–to–implant breast reconstructions with more than 6 months of follow-up were compared with a partially submuscular cohort for demographics, comorbidities, and postoperative complications. All patients 1 to 3.5 years after gel implant placement were evaluated for the impact of clinical characteristics on aesthetic outcomes.

Results
Two hundred twenty-four prepectoral tissue expander placements were compared with 535 partially submuscular tissue expanders with no significant differences in demographics. There was increased wound dehiscence repaired in clinic and insignificantly decreased seromas with prepectoral expander placement. One hundred sixty breasts were reconstructed with gel implants, and 12 underwent autologous reconstruction during the conduct of the study. The remaining 21 patients were continuing expansion, and 3 succumbed to disease progression. Regression analysis of 86 breast reconstructions showed that a body mass index of greater than 30, fat grafting, and highly cohesive anatomic implants decreased rippling, whereas radiation increased capsular contracture (P < 0.05).

Conclusions
Prepectoral meshed ADM breast reconstruction has an equivalent safety profile to partially submuscular ADM-assisted reconstruction and early aesthetic ratings comparable with other published accounts of implant-based reconstruction. Radiated skin envelopes carry higher capsular contracture rates. Thin patients have a higher risk of visible rippling, whereas fat grafting and higher cohesivity implants are associated with less rippling.
Cost Analysis and National Trends in the Treatment of Dupuytren Contracture Comparing Collagenase Injection, Needle Fasciotomy, and Open Fasciectomy Procedures
Authors: Jain Abhishek , Tarabishy Sami , Carter Jordan , Gonzalez Gilberto , Herrera Fernando A. 
Published: June 2021

Background
Dupuytren contracture (DC) is a common disorder characterized by progressive fibrosis of palmar fascia. This study analyzed cost trends of 3 common treatments for DC: fasciotomy, fasciectomy, and collagenase injection (CI)/cord manipulation.

Methods
The Vizient Clinical Data/Resource Manager electronic database was reviewed for all procedures for the treatment of DC at participating hospitals in the United States (US) from October 1, 2015, to September 1, 2019. Cases were placed into 1 of 3 categories: (1) CI, (2) needle fasciotomy (NF), and (3) open fasciectomy (OF). Total and direct costs were averaged for each procedure and compared nationally and regionally. Temporal trends and specific market share were analyzed. One-tailed t test and Pearson correlation analysis was performed (P < 0.05 and r > 0.9 or r < −0.9 was considered significant).

Results
A total of 22,974 total cases were identified. A total of 16,966 OF, 3962 NF, and 2046 CI were performed. There was a nearly a 4-fold increase in number of procedures to treat DC from 2015 to 2018. Market share percentage of each procedure stayed relatively similar over time. However, market share percentage differed between procedures. Needle fasciotomy had the lowest market share percentage approximately 7%. Collagenase injection had the highest average cost at US $4453.66 and was significantly higher than OF at US $3394.90 and NF at US $2010.75. Cost and distribution of procedures were further analyzed by geographic regions. In 2018, 32% of procedures performed were in the Northeastern US, 29% in the Midwestern US, 23% in the Southern US, and 16% in the Western US. Total number of Dupuytren procedures increased more than 300% in all regions across the US from 2015 to 2018. In every region, NF was the lowest cost intervention. Cost of OF and CI varied between regions and was often the most expensive intervention.

Conclusions
Treatment of DCs with NF seems to be the least costly treatment option. Needle fasciotomy seems to be the least commonly performed procedure. Regional data show variations in the cost of OF and CI. However, OF has the majority market share nationally and regionally. Although the cost of these procedures seems to vary regionally, the type of procedures being performed seem to be similar across regions.