bluuebunny/crossref_metadata_2025_split huggingface dataset:
Ivabradine-sensitive incessant atrial tachycardia during pregnancy: a case report
Authors: Tonko Johanna B , Douglas Hannah , Wright Matthew J 
Published: September 2021

Abstract

Background
Automaticity is the dominant mechanism in maternal focal atrial tachycardia (FAT) during pregnancy and if incessant, can cause tachycardia-induced cardiomyopathy. Medication failure for FATs is common, however, for the subgroup due to increased automaticity ivabradine sensitivity has been described and may represent a valuable treatment option. Little data are available regarding the safety profile of ivabradine during pregnancy.

Case Summary
We report the case of a 38-year-old woman with background of peripartum cardiomyopathy and incessant atrial tachycardia with deteriorating ventricular function during her second pregnancy unresponsive to betablockade and demonstrating the immediate successful rate-controlling effect of ivabradine.

Discussion
Early recognition of persistent maternal FAT is essential due to its frequent association with tachycardia-mediated cardiomyopathy. Our case report highlights the challenges of providing an equally safe and effective treatment of these notoriously difficult to treat arrhythmias during pregnancy. Ivabradine in combination with a betablocker can be effective for abnormal automaticity but its safety profile during pregnancy remains uncertain.
Needs or Symbols? The Logic of United Nations Counterterrorism Treaty Ratification
Authors: Milton Daniel , Jadoon Amira , Warner Jason 
Published: September 2021

Abstract
Why do states commit to UN counterterrorism treaties? This article posits that state accession to UN counterterrorism treaties is likely informed by the nature of the terrorist threats a state faces, and consequently, the pressures that such threats generate from domestic and international audiences on the state to address (or appear to address) them. As such, we hypothesize that states ratify UN CT treaties for either material, needs-based reasons—to gain external assistance for counterterror capacity building—or for symbolic reasons—to visibly signal their commitment to fight terrorism in order maintain legitimacy, and mitigate reputational costs to both domestic and international audiences. To test these hypotheses, we use a newly compiled dataset of state accessions to the 19 UN counterterrorism treaties from 1970–2016, testing both our needs-based versus symbolic hypotheses, as well as more “traditional” explanations for state treaty accession. Across the universe of 19 UN counterterrorism treaties, our study implies that states may be more likely to ratify treaties as mechanisms to signal intent to address terror threats rather than to build threat-specific counterterrorism capacity. This research thus broadens both academic and policy-related understandings of state counterterror treaty ratification.
GENETEX—a GENomics Report TEXt mining R package and Shiny application designed to capture real-world clinico-genomic data
Authors: Miller David M , Shalhout Sophia Z 
Published: September 2021

Abstract

Objectives
Clinico-genomic data (CGD) acquired through routine clinical practice has the potential to improve our understanding of clinical oncology. However, these data often reside in heterogeneous and semistructured data, resulting in prolonged time-to-analyses.

Materials and Methods
We created GENETEX: an R package and Shiny application for text mining genomic reports from electronic health record (EHR) and direct import into Research Electronic Data Capture (REDCap).

Results
GENETEX facilitates the abstraction of CGD from EHR and streamlines the capture of structured data into REDCap. Its functions include natural language processing of key genomic information, transformation of semistructured data into structured data, and importation into REDCap. When evaluated with manual abstraction, GENETEX had &gt;99% agreement and captured CGD in approximately one-fifth the time.

Conclusions
GENETEX is freely available under the Massachusetts Institute of Technology license and can be obtained from GitHub (https://github.com/TheMillerLab/genetex). GENETEX is executed in R and deployed as a Shiny application for non-R users. It produces high-fidelity abstraction of CGD in a fraction of the time.
Interleukin-6 in Critical Coronavirus Disease 2019, a Driver of Lung Inflammation of Systemic Origin?
Authors: Aarskog Nikolai Ravn , Aass Hans Christian , Holter Jan Cato , Rostrup Morten , Holten Aleksander Rygh 
Published: September 2021

OBJECTIVES:
To examine whether interleukin-6 in critical coronavirus disease 2019 is higher in arterial than in central venous blood, as a sign of predominantly local pulmonal rather than systemic interleukin-6 production.

DESIGN:
Prospective cohort pilot study with repeated weekly measurements of interleukin-6 in arterial and central venous blood. Respiratory function, assessed with Pao
2/Fio
2 ratio, was measured at the time of blood sampling.

SETTING:
ICU at a university hospital.

SUBJECTS:
Nine adult patients with critical coronavirus disease 2019, actively treated and receiving mechanical ventilation.

MEASUREMENTS AND MAIN RESULTS:
No difference between arterial and central venous interleukin-6 was found. There was a significant negative relationship between interleukin-6 concentration and P/F ratio in both arterial (p = 0.04) and central venous (p = 0.03) blood.

CONCLUSIONS:
The absence of an arteriovenous interleukin-6 difference implies that interleukin-6 in critical coronavirus disease 2019 is mainly produced outside the lungs as part of a systemic inflammatory response syndrome and act as a driver of local inflammation and damage in the lungs.
Exploring Ketamine Analgosedation Use and Its Effect on Incident Delirium in Critically Ill Adults
Authors: Wu Ting Ting , Ko Sally , Kooken Rens , van den Boogaard Mark , Devlin John W. 
Published: September 2021

OBJECTIVES:
Ketamine is increasingly being used for analgosedation, but its effect on delirium remains unclear. We compared delirium risk variables and ketamine analgosedation use between adults who developed incident delirium and those who did not, evaluated whether ketamine analgosedation increases delirium risk, and compared ICU delirium characteristics, treatments, and outcomes between ketamine and nonketamine patients with delirium.

DESIGN:
Secondary, subgroup analysis of a cohort study.

SETTING:
Single, 36-bed mixed medical-surgical ICU in the Netherlands from July 2016 to February 2020.

PATIENTS:
Consecutive adults were included. Patients admitted after elective surgery, not expected to survive greater than or equal to 48 hours, admitted with delirium, or where delirium occurred prior to ketamine use were excluded.

INTERVENTION:
None.

MEASUREMENTS AND MAIN RESULTS:
Trained ICU nurses evaluated patients without coma (Richmond Agitation Sedation Scale. –4/–5) every 8 hours with the Confusion Assessment Method ICU; a delirium day was defined by greater than or equal to1 + Confusion Assessment Method ICU and/or scheduled antipsychotic use. Among 11 variables compared between the delirium and nondelirium groups (Baseline: age, Charlson Comorbidity score, cognitive impairment, admission type, and Acute Physiology and Chronic Health Evaluation-IV score, daily ICU [until delirium occurrence or discharge]: Sequential Organ Failure Assessment score, coma, benzodiazepine, opioid, and ketamine use) and total ICU days, 7 (age, Charlson score, Sequential Organ Failure Assessment score, coma, benzodiazepine, opioid, and ketamine use) were significantly different and were entered, along with delirium occurrence, in a logistic regression model. A total of 332 of 925 of patients (36%) developed delirium. Ketamine use was greater in patients with delirium (54 [16%] vs 4 [0.7%]; p < 0.01). Ketamine use (adjusted odds ratio, 5.60; 95% CI, 1.09–29.15), age (adjusted odds ratio, 1.03; 95% CI, 1.01–1.06), coma (adjusted odds ratio, 2.10; 95% CI, 1.15–3.78), opioid use (adjusted odds ratio, 171.17; 95% CI, 66.45–553.68), and benzodiazepine use (adjusted odds ratio, 34.07; 95% CI, 8.12–235.34) were each independently and significantly associated with increased delirium. Delirium duration, motoric subtype, delirium treatments, and outcomes were not different between the ketamine and nonketamine groups.

CONCLUSIONS:
Ketamine analgosedation may contribute to increased ICU delirium. The characteristics of ketamine and nonketamine delirium are similar. Further prospective research is required to evaluate the magnitude of risk for delirium with ketamine use.
Estimated Pao 2: A Continuous and Noninvasive Method to Estimate Pao 2 and Oxygenation Index
Authors: Sauthier Michaël , Tuli Gaurav , Jouvet Philippe A. , Brownstein John S. , Randolph Adrienne G. 
Published: September 2021

BACKGROUND:
Pao
2 is the gold standard to assess acute hypoxic respiratory failure, but it is only routinely available by intermittent spot checks, precluding any automatic continuous analysis for bedside tools.

OBJECTIVE:
To validate a continuous and noninvasive method to estimate hypoxemia severity for all Spo
2 values.

DERIVATION COHORT:
All patients who had an arterial blood gas and simultaneous continuous noninvasive monitoring from 2011 to 2019 at Boston Children’s Hospital (Boston, MA) PICU.

VALIDATION COHORT:
External cohort at Sainte-Justine Hospital PICU (Montreal, QC, Canada) from 2017 to 2020.

PREDICTION MODEL:
We estimated the Pao
2 using three kinds of neural networks and an empirically optimized mathematical model derived from known physiologic equations.

RESULTS:
We included 52,879 Pao
2 (3,252 patients) in the derivation dataset and 12,047 Pao
2 (926 patients) in the validation dataset. The mean function on the last minute before the arterial blood gas had the lowest bias (bias –0.1% validation cohort). A difference greater than or equal to 3% between pulse rate and electrical heart rate decreased the intraclass correlation coefficients (0.75 vs 0.44; p < 0.001) implying measurement noise. Our estimated Pao
2 equation had the highest intraclass correlation coefficient (0.38; 95% CI, 0.36–0.39; validation cohort) and outperformed neural networks and existing equations. Using the estimated Pao
2 to estimate the oxygenation index showed a significantly better hypoxemia classification (kappa) than oxygenation saturation index for both Spo
2 less than or equal to 97% (0.79 vs 0.60; p < 0.001) and Spo
2 greater than 97% (0.58 vs 0.52; p < 0.001).

CONCLUSION:
The estimated Pao
2 using pulse rate and electrical heart rate Spo
2 validation allows a continuous and noninvasive estimation of the oxygenation index that is valid for Spo
2 less than or equal to 97% and for Spo
2 greater than 97%. Display of continuous analysis of estimated Pao
2 and estimated oxygenation index may provide decision support to assist with hypoxemia diagnosis and oxygen titration in critically ill patients.
Beneficial Effect of Prone Positioning During Venovenous Extracorporeal Membrane Oxygenation for Coronavirus Disease 2019*
Authors: Zaaqoq Akram M. , Barnett Adrian G. , Griffee Matthew J. , MacLaren Graeme , Jacobs Jeffrey P. , Heinsar Silver , Suen Jacky Y. , Bassi Gianluigi Li , Fraser John F. , Dalton Heidi J. , Peek Giles J. ,   on behalf of the COVID-19 Critical Care Consortium (COVID Critical)
Published: September 2021

OBJECTIVES:
The study investigated the impact of prone positioning during venovenous extracorporeal membrane oxygenation support for coronavirus disease 2019 acute respiratory failure on the patient outcome.

DESIGN:
An observational study of venovenous extracorporeal membrane oxygenation patients. We used a multistate survival model to compare the outcomes of patients treated with or without prone positioning during extracorporeal membrane oxygenation, which incorporates the dynamic nature of prone positioning and adjusts for potential confounders.

SETTING:
Seventy-two international institutions participating in the Coronavirus Disease 2019 Critical Care Consortium international registry.

PATIENTS:
Coronavirus disease 2019 patients who were supported by venovenous extracorporeal membrane oxygenation during the study period.

INTERVENTION:
None.

MEASUREMENTS AND MAIN RESULTS:
There were 232 coronavirus disease 2019 patients at 72 participating institutions who were supported with venovenous extracorporeal membrane oxygenation during the study period from February 16, 2020, to October 31, 2020. Proning was used in 176 patients (76%) before initiation of extracorporeal membrane oxygenation and in 67 patients (29%) during extracorporeal membrane oxygenation. Survival to hospital discharge was 33% in the extracorporeal membrane oxygenation prone group versus 22% in the extracorporeal membrane oxygenation supine group. Prone positioning during extracorporeal membrane oxygenation support was associated with reduced mortality (hazard ratio, 0.31; 95% CI, 0.14–0.68).

CONCLUSIONS:
Our study highlights that prone positioning during venovenous extracorporeal membrane oxygenation support for refractory coronavirus disease 2019-related acute respiratory distress syndrome is associated with reduced mortality. Given the observational nature of the study, a randomized controlled trial of prone positioning on venovenous extracorporeal membrane oxygenation is needed to confirm these findings.
Clinical Benefit of Extubation in Patients on Venoarterial Extracorporeal Membrane Oxygenation
Authors: Massart Nicolas , Mansour Alexandre , Flecher Erwan , Ross James T. , Ecoffey Claude , Verhoye Jean-Philippe , Launey Yoann , Auffret Vincent , Nesseler Nicolas 
Published: September 2021

OBJECTIVES:
Although patients on venoarterial extracorporeal membrane oxygenation for refractory cardiogenic shock are usually supported with mechanical ventilation, it is not clear whether sedation cessation and extubation might improve outcomes.

DESIGN:
Retrospective cohort study with propensity score overlap weighting analysis.

SETTING:
Three ICUs in a 1,500-bed tertiary university hospital.

PATIENTS:
From an overall cohort of 641 patients with venoarterial-extracorporeal membrane oxygenation support, the primary analysis was performed in 344 patients who had been successfully decannulated in order to reduce immortal time bias.

MEASUREMENTS AND MAIN RESULTS:
Seventy-five patients (22%) were extubated during extracorporeal membrane oxygenation support and were subsequently decannulated alive. Forty-nine percent received noninvasive ventilation, and 25% had emergency reintubation for respiratory, neurologic, or hemodynamic reasons. Higher Simplified Acute Physiology Score II at admission (odds ratio, 0.97; 95% CI [0.95–0.99]; p = 0.008) was associated with a lower probability of extubation, whereas cannulation in cardiac surgery ICU (odds ratio, 3.14; 95% CI [1.21–8.14]; p = 0.018) was associated with an increased probability. Baseline characteristics were well balanced after propensity score overlap weighting. The number of ICU-free days within 30 days of extracorporeal membrane oxygenation decannulation was significantly higher among extubated patients compared with nonextubated patients (22 d [11–26 d] vs 18 d [7–25 d], respectively; p = 0.036). There were no differences in other outcomes including ventilator-associated pneumonia (odds ratio, 0.96; 95% CI [0.51–1.82]; p = 0.90) and all-cause mortality within 30 days of extracorporeal membrane oxygenation decannulation (5% vs 17%; hazard ratio, 0.54; 95% CI [0.19–1.59]; p = 0.27).
As a secondary analysis, outcomes were compared in the overall cohort of 641 venoarterial extracorporeal membrane oxygenation–supported patients. Results were consistent with the primary analysis as extubated patients had a higher number of ICU-free days (18 d [0–24 d] vs 0 d [0–18 d], respectively; < 0.001) and a lower risk of death within 30 days of extracorporeal membrane oxygenation cannulation (hazard ratio, 0.45; 95% CI [0.29–0.71]; p = 0.001).

CONCLUSIONS:
Extubation during venoarterial-extracorporeal membrane oxygenation support is safe, feasible, and associated with greater ICU-free days.
Routine Neuroimaging: Understanding Brain Injury in Pediatric Extracorporeal Membrane Oxygenation*
Authors: Farhat Abdelaziz , Li Xilong , Huet Beverley , Tweed Jefferson , Morriss Michael C. , Raman Lakshmi 
Published: September 2021

OBJECTIVES:
This project aims to describe brain injuries on routine neuroimaging in a large single-center neonatal and pediatric cohort supported by extracorporeal membrane oxygenation. The study also aims to examine the association of these injuries with neurocognitive outcomes in survivors and identify laboratory findings associated with neurologic injury.

DESIGN:
Retrospective observational single-center cohort study.

SETTING:
Tertiary care PICU.

PATIENTS:
Pediatric patients with noncardiac indications for extracorporeal membrane oxygenation supported by venoarterial or venovenous extracorporeal membrane oxygenation, with on-extracorporeal membrane oxygenation brain CT or postextracorporeal membrane oxygenation brain CT/MRI.

INTERVENTIONS:
Extracorporeal membrane oxygenation support.

MEASUREMENTS AND MAIN RESULTS:
Occurrence of brain injury on CT and MRI was reviewed; injuries were scored. Clinical and laboratory results associated with injury were identified. Survivor neurocognitive outcomes were obtained using the Pediatric Overall Performance Category scale and Pediatric Cerebral Performance Category scale. Of 132 imaged patients, 98 (74%) had radiological evidence of brain injury. Mean injury score was 6.5 (± 3.8). Head ultrasounds and clinician suspicion performed poorly in suspecting the presence of injury. Of 104 respondents to neurodevelopmental assessments, 61 (59%) had normal scores; 12.5%, 17%, and 11.5% had mild, moderate, or severe disability. A neuroimaging score greater than 10 was associated with an unfavorable outcome on the Pediatric Cerebral Performance Category (odds ratio, 3.4; p < 0.01) and Pediatric Overall Performance Category (odds ratio, 1.7; p < 0.05). Ischemic injury correlated with worse neurodevelopmental outcome. Preextracorporeal membrane oxygenation lactate, Vasoactive-Inotropic Scores, transaminitis, elevated bilirubin and creatinine levels, and thrombocytopenia were associated with injury occurrence.

CONCLUSIONS:
Brain injury is frequent in extracorporeal membrane oxygenation patients, although the majority of survivors have favorable neurocognitive outcomes. More research is needed in order to understand the etiology of such injuries. Head ultrasound and clinician suspicion are not sensitive in detecting extracorporeal membrane oxygenation–related brain injuries. Protocolizing postextracorporeal membrane oxygenation imaging with brain MRI allows the identification of injuries and provision of timely neurocognitive intervention.
Neuromuscular Blocker Use in Critically Ill Children: Assessing Mortality Risk by Propensity Score–Weighted Analysis
Authors: Daverio Marco , Sperotto Francesca , Stefani Chiara , Mondardini Maria Cristina , Tessari Anna , Biban Paolo , Izzo Francesca , Montani Cinzia , Lapi Maria , Picconi Enzo , Racca Fabrizio , Marinosci Geremia Zito , Savron Fabio , Wolfler Andrea , Amigoni Angela ,   on behalf of the Italian Network of PICU Study Group (TIPNet)
Published: September 2021

OBJECTIVES:
We aim to describe the use of continuous infusion of neuromuscular blocking agents in mechanically ventilated critically ill children and to test its association with in-hospital mortality.

DESIGN:
Multicenter, registry-based, observational, two-cohort-comparison retrospective study using prospectively collected data from a web-based national registry.

SETTING:
Seventeen PICUs in Italy.

PATIENTS:
We included children less than 18 years who received mechanical ventilation and a neuromuscular blocking agent infusion from January 2010 to October 2017. A propensity score–weighted Cox regression analysis was used to assess the relationship between the use of neuromuscular blocking agents and in-hospital mortality.

INTERVENTIONS:
None.

MEASUREMENTS AND MAIN RESULTS:
Of the 23,227 patients admitted to the PICUs during the study period, 3,823 patients were included. Patients who received a continuous infusion of neuromuscular blocking agent were more likely to be younger (p < 0.001), ex-premature (p < 0.001), and presenting with less chronic respiratory insufficiency requiring home mechanical ventilation (p < 0.001). Reasons for mechanical ventilation significantly differed between patients who received a continuous infusion of neuromuscular blocking agent and patients who did not receive a continuous infusion of neuromuscular blocking agent, with a higher frequency of respiratory and cardiac diagnosis among patients who received neuromuscular blocking agents compared with other diagnoses (all p < 0.001). The covariates were well balanced in the propensity-weighted cohort. The mortality rate significantly differed among the two cohorts (patients who received a continuous infusion of neuromuscular blocking agent 21% vs patients who did not receive a continuous infusion of neuromuscular blocking agent 11%; p < 0.001 by weighted logistic regression). Patients who received a continuous infusion of neuromuscular blocking agent experienced longer mechanical ventilation and PICU stay (both p < 0.001 by weighted logistic regression). A weighted Cox regression analysis found the use of neuromuscular blocking agents to be a significant predictor of in-hospital mortality both in the unadjusted analysis (hazard ratio, 1.7; 95% CI, 1.3–2.2) and in the adjusted one (hazard ratio, 1.6; 95% CI, 1.2–2.1).

CONCLUSIONS:
Thirteen percent of mechanically ventilated children in PICUs received neuromuscular blocking agents. When adjusting for selection bias with a propensity score approach, the use of neuromuscular blocking agent was found to be a significant predictor of in-hospital mortality.
Effects of heavy metals on hypertension during menopause: a Korean community-based cross-sectional study
Authors: Nguyen Hai Duc , Oh Hojin , Kim Min-Sun 
Published: September 2021

Abstract

Objective:
To examine the associations between serum cadmium, lead, and mercury and hypertension in pre- and postmenopausal women.

Methods:
Serum heavy metal (cadmium, lead, and mercury) levels were analyzed in 7,226 randomly selected women who participated in Korean National Health and Nutrition Examination Surveys from 2009 to 2017. Odds ratios (ORs) for hypertension were calculated for log2-transformed serum heavy metal levels, median tertile levels of serum cadmium, mercury, and lead, and for interactions between heavy metal levels and tertiles, after covariate adjustment.

Results:
A doubling of serum cadmium was associated with hypertension in premenopausal (OR 2.47; 95% CI, 1.01-6.10, P = 0.049) and postmenopausal women (OR 1.70; 95% CI, 1.02-2.84, P = 0.043), and significant trends were observed for cadmium tertiles (P < 0.01). In premenopausal women, a two-fold increase in serum mercury increased the OR of hypertension by 3.08 (95% CI, 1.12-8.43, P = 0.029), and significant trends were also observed for serum mercury tertiles (P < 0.01). Interactions between serum cadmium, lead, and mercury levels in pre- and postmenopausal women were found to impact the prevalence of hypertension.

Conclusion:
Given increasing exposure to heavy metals in Korea, further prospective study is needed to identify associations between heavy metal exposures, both separately and in combination, with the prevalence of cardiovascular disease risk factors in well-characterized cohorts of different populations and to determine means of preventing heavy metal exposure.