bluuebunny/crossref_metadata_2025_split huggingface dataset:
Intermittent hypoxia and respiratory patterns during sleep of preterm infants aged 3 to 18 months residing at high altitude
Authors: Duenas-Meza Elida , Escamilla-Gil María Isabel , Bazurto-Zapata María Angelica , Caparo Elizabeth , Suarez Cuartas Miguel , Rincón Martínez Laura , Pernett Buenaver Lizbeth , Rojas Ortega Ariana , Torres Jorge , Restrepo-Gualteros Sonia , Parra Buitrago Andrea , Gonzalez-Garcia Mauricio 
Published: August 2021

AbstractStudy ObjectivesThe aim of this study was to determine the impact of apneas on oxygen saturation and the presence of intermittent hypoxia, during sleep of preterm infants (PTIs) born at high altitudes and compare with full-term infants (FTIs) at the same altitude.MethodsPTIs and FTIs from 3 to 18 months were included. They were divided into three age groups: 3–4 months (Group 1); 6–7 months (Group 2), and 10–18 months (Group 3). Polysomnography parameters and oxygenation indices were evaluated. Intermittent hypoxia was defined as brief, repetitive cycles of decreased oxygen saturation. Kruskal-Wallis test for multiple comparisons, t-test or Mann–Whitney U-test were used.Results127 PTI and 175 FTI were included. Total apnea-hypopnea index (AHI) was higher in PTI that FTI in all age groups (Group 1: 33.5/h vs. 12.8/h, p = 0.042; Group 2: 27.0/h vs. 7.4/h, p &lt; 0.001; and Group 3: 11.6/h vs. 3.1/h, p &lt; 0.001). In Group 3, central-AHI (8.0/h vs. 2.3/h, p &lt; 0.001) and obstructive-AHI (1.8/h vs. 0.6/h, p &lt; 0.008) were higher in PTI than FTI. T90 (7.0% vs. 0.5, p &lt; 0.001), oxygen desaturation index (39.8/h vs. 11.3, p &lt; 0.001) were higher in PTI than FTI, nadir SpO2 (70.0% vs. 80.0, p&lt;0.001) was lower in PTI.ConclusionAt high altitude, compared to FTI, PTI have a higher rate of respiratory events, greater desaturation, and a delayed resolution of these conditions, suggesting the persistence of intermittent hypoxia during the first 18 months of life. This indicates the need for follow-up of these infants for timely diagnosis and treatment of respiratory disturbances during sleep.
The Importance of Meaningful Faculty Recognition in Creating a Healthy Academic Work Environment: A Mixed-Methods Study
Authors: Hollinger-Smith Linda M. , O’Lynn Chad , Groenwald Susan 
Published: August 2021

Abstract

AIM
The purpose of this study was to understand nursing faculty’s perceptions of meaningful recognition and how it contributes to a caring academic climate.

BACKGROUND
A supportive, healthy work environment is critical in recruiting and retaining nursing faculty. Research on caring for faculty through meaningful recognition and the impact on the workplace climate is limited.

METHOD
The study employed a parallel mixed-methods design in which quantitative and qualitative findings were integrated into synthesized conclusions. A total of 193 full-time faculty participated in the survey portion of the study; 15 full- and part-time faculty participated in video-conferenced focus groups.

RESULTS
Results of this study demonstrated that meaningful recognition contributes to a caring workplace, motivates faculty work performance, and impacts faculty roles in positive ways.

CONCLUSION
For recognition to be meaningful, it must be genuine, aligned with faculty’s perceptions of performance, commensurate with level of effort, and relevant to individuals.
Stability in Pelvic Triple Osteotomies in Children Using Resorbable PLGA Screws for Fixation
Authors: Hedelin Henrik , Larnert Per , Antonsson Pavel , Lagerstrand Kerstin , Brisby Helena , Hebelka Hanna , Laine Tero 
Published: August 2021

Background:
The triple pelvic osteotomy (TPO) is a major redirectional osteotomy used to improve the acetabular coverage of the femoral head in selected pediatric patients with hip disorders. Traditionally the iliac osteotomy is stabilized by metal screws that require a second surgery for removal. Despite favorable results for both adults and children in related pelvic osteotomies, resorbable implants have not previously been used for TPOs.
This study aims to suggest a novel modified TPO surgical method in children using resorbable poly lactic-co-glycolic acid (PLGA) screws for fixation and to radiographically evaluate the postoperative stability achieved by these implants in a case series.

Methods:
All patients (n=11) with dysplasia of the hip (2), Perthe disease (5), or Down syndrome (4), who underwent primary TPO surgery during 2013 to 2019, using resorbable PLGA screws for fixation were included. The stability of the osteotomy was evaluated in the postoperative radiograph series using the acetabular index, migration percentage, Sharp’s angle and the center-edge angle. The osteotomy angle was introduced as a parameter to confirm the postoperative integrity of the achieved correction. All cases were evaluated until radiographic healing of the iliac osteotomy. Hospital notes were analyzed for complications or local reactions in relation to the implants.

Results:
In all studied hips, the overall achieved correction was well maintained. The mean (SD) correction achieved, from the preoperative images to the last measurable postoperative image, was a 16.7 degrees decrease for Sharp angle, a 20.9 degrees decrease in acetabular index and a 24.7 degrees increase for the center-edge angle, respectively. There were no complications related to the bioabsorption of the implants.

Conclusion:
The present findings suggest that the modified TPO method, using resorbable PLGA screws, provides sufficient stability and appears to be a promising alternative to traditional TPO. Avoiding implant removal is a major benefit in a pediatric population. Resorbable screws enable the surgeon to place implants with more degrees of freedom since later implant removal is not a limiting factor.

Level of Evidence:
Level IV—case series.
Minimally Invasive Fusionless Surgery for Scoliosis in Spinal Muscular Atrophy: Long-term Follow-up Results in a Series of 59 Patients
Authors: Gaume Mathilde , Saudeau Etienne , Gomez-Garcia de la Banda Marta , Azzi-Salameh Viviane , Mbieleu Blaise , Verollet Delphine , Benezit Audrey , Bergounioux Jean , Essid Aben , Doehring Isabelle , Dabaj Ivana , Desguerre Isabelle , Barnerias Christine , Topouchian Vicken , Glorion Christophe , Quijano-Roy Susana , Miladi Lotfi 
Published: August 2021

Background:
Treatment of spinal muscular atrophy (SMA) scoliosis has evolved in the last decade, with the emergence of fusionless surgical techniques that allow correction of the deformity before the end of growth spurt. These techniques are expected to delay definitive spine fusion and preserve trunk growth.

Purpose:
The aim was to evaluate long-term clinical, radiologic, and respiratory outcomes of a minimally invasive fusionless surgery (MIFLS) in SMA scoliosis.

Methods:
All children affected with SMA scoliosis who underwent MIFLS in our department from 2011 to 2019 were included. The instrumentation consisted in a bilateral sliding rod construct from T1 to the sacrum, anchored proximally by double-hook claws and distally by iliosacral screws. Clinical, genetic, respiratory and radiographic data were retrospectively reviewed. A patient’s satisfaction survey was performed.

Results:
A total of 59 children with genetic confirmation of SMA (9SMA1c, 47SMA2, and 3SMA3) underwent MIFLS at a mean age of 11±1.9 years. All of them were nonwalker at the time of surgery. Twenty-six were treated with intrathecal Nusinersen. Mean follow-up was 5.2 years (2 to 9.6 y). Mean major coronal curve improved from 79±15 to 41±16 degrees and pelvic obliquity decreased from 24±11 to 5.9±4 degrees. Mean space available for lung improved from 77% to 93%. Mechanical or infectious complications occurred in 9 patients, with removal of the implant in 1. 6 children required unplanned surgeries. Postoperative bracing was needed in 13 children. Mean gain weight 3 years after the first surgery was 6 kg. 91.5% of patients had a positive satisfaction of the surgery. There was no significant impact in respiratory function postoperatively. Only 30 children required rod lengthening procedures, with a mean interval between procedures of 1.9 years (0.5 to 3.7 y). No arthrodesis was required at last follow-up in any patient.

Conclusion:
Bipolar MIFLS in SMA preserves spinal and thoracic growth without interference with respiratory function. It provides a significant correction of spinal deformity and pelvic obliquity, having a reduced rate of complications. The correction of spinal deformity was maintained at long term, not requiring definitive fusion at the end of growth.

Level of Evidence:
Level IV.
Biomarker-Based Classification of Patients With Acute Respiratory Failure Into Inflammatory Subphenotypes: A Single-Center Exploratory Study
Authors: Drohan Callie M. , Nouraie S. Mehdi , Bain William , Shah Faraaz A. , Evankovich John , Zhang Yingze , Morris Alison , McVerry Bryan J. , Kitsios Georgios D. 
Published: August 2021

OBJECTIVES:
Hyper- and hypoinflammatory subphenotypes discovered in patients with acute respiratory distress syndrome predict clinical outcomes and therapeutic responses. These subphenotypes may be important in broader critically ill patient populations with acute respiratory failure regardless of clinical diagnosis. We investigated subphenotyping with latent class analysis in an inclusive population of acute respiratory failure, derived a parsimonious model for subphenotypic predictions based on a small set of variables, and examined associations with clinical outcomes.

DESIGN:
Prospective, observational cohort study.

SETTING:
Single-center, academic medical ICU.

PATIENTS:
Mechanically ventilated patients with acute respiratory failure.

MEASUREMENTS AND MAIN RESULTS:
We included 498 patients with acute respiratory failure (acute respiratory distress syndrome: 143, at-risk for acute respiratory distress syndrome: 198, congestive heart failure: 37, acute on chronic respiratory failure: 23, airway protection: 61, and multifactorial: 35) in our derivation cohort and measured 10 baseline plasma biomarkers. Latent class analysis considering clinical variables and biomarkers determined that a two-class model offered optimal fit (23% hyperinflammatory subphenotype). Distribution of hyperinflammatory subphenotype varied among acute respiratory failure etiologies (acute respiratory distress syndrome: 31%, at-risk for acute respiratory distress syndrome: 27%, congestive heart failure: 22%, acute on chronic respiratory failure 0%, airway protection: 5%, and multifactorial: 14%). Hyperinflammatory patients had higher Sequential Organ Failure Assessment scores, fewer ventilator-free days, and higher 30- and 90-day mortality (all p < 0.001). We derived a parsimonious model consisting of angiopoietin-2, soluble tumor necrosis factor receptor-1, procalcitonin, and bicarbonate and classified subphenotypes in a validation cohort (n = 139). Hyperinflammatory patients (19%) demonstrated higher levels of inflammatory biomarkers not included in the model (p < 0.01) and worse outcomes.

CONCLUSIONS:
Host-response subphenotypes are observable in a heterogeneous population with acute respiratory failure and predict clinical outcomes. Simple, biomarker-based models can offer prognostic enrichment in patients with acute respiratory failure. The differential distribution of subphenotypes by specific etiologies of acute respiratory failure indicates that subphenotyping may be more relevant in patients with hypoxemic causes of acute respiratory failure and not in patients intubated for airway protection or acute on chronic decompensation.
Hepatosplenic T-cell lymphoma: treatment challenges
Authors: Bron Dominique , De Leval Laurence , Michiels Sandra , Wittnebel Sebastian 
Published: August 2021

Purpose of review
Hepatosplenic lymphoma (HSTCL) is a rare T-cell malignancy occurring in young males, associated with immune deficiency in 20% of the cases which, despite aggressive treatments, has a poor survival. Specific recommendations for first-line treatment remain debatable.

Recent findings
Published data covering case reports or series of HSTCL concur that allogeneic stem cell transplant should be proposed as a consolidation after response to chemotherapy in all patients eligible for transplant. In the light of two recent clinical examples, we also confirm that specific chemotherapy and a first-line consolidation with allogeneic transplantation when a donor is available to represent a treatment of choice these rare and distinctive lymphomas. Recent molecular studies are summarized in this review and suggest potential targets for new therapeutic strategies.

Summary
Major progresses have been achieved in improving the outcome of HSTCL l patients using intensive chemotherapy and allogeneic transplantation.
The Use of Hemostatic Agents to Decrease Bleeding Complications in General Plastic Surgery Procedures
Authors: Bloom Joshua A. , Erlichman Zachary , Foroutanjazi Sina , Beqiraj Zhaneta , Jonczyk Michael M. , Persing Sarah M. , Chatterjee Abhishek 
Published: August 2021

Background:
Within plastic surgery, hematomas and seromas are frequently reported complications that can negatively impact wound healing and result in significant morbidity in patients. As a result, there has been considerable interest in hemostatic agents to complement traditional methods of hemostasis. The purpose of this study was to evaluate postoperative bleeding complications and duration of Jackson-Pratt (JP) drain use in general plastic surgery procedures with and without hemostatic agents.

Methods:
After obtaining institutional review board approval, a retrospective chart review was performed. Patients who underwent bilateral breast reduction, panniculectomy, or abdominoplasty were included. Data collected included indication for surgery, type of operation, use of hemostatic agent, specifically fibrin sealant (FS, EVICEL, Ethicon, USA) or combination powder (CP, HEMOBLAST Bellows, Biom’up, France), length of follow-up, time to JP drain removal, postoperative complications, and specimen weight. This was a consecutive experience where initially no hemostatic agent was used, followed by use of FS, and then CP.

Results:
The use of a hemostatic agent resulted in reduced time duration for JP drain use and overall fewer recorded complications in the hemostatic agent groups. Although not significant, the hemostatic agent group (FS and CP) experienced fewer hematomas and seromas compared with the nonhemostatic agent group. JP drain duration was significantly less among breast reduction (3.46 versus 6.92 days, P < 0.01) for CP when compared with FS.

Conclusion:
The use of hemostatic agents in general plastic surgery procedures may result in decreased postoperative complications and significantly reduce time to JP drain removal.
Split Skin Grafting the Heart: A Simple Solution for a Complex Reconstructive Challenge
Authors: Cochrane Elliott , Morritt Andrew 
Published: August 2021

Summary:
We present the interesting case of an 87-year-old woman who underwent debridement of chest wall osteoradionecrosis (ORN) that arose following radiotherapy for breast cancer. Debridement left a complex defect with exposed myocardium and parietal pleura. An extensive surgical history, compromised physiological reserve, and the patient’s desire not to undergo major reconstructive surgery limited the reconstructive options. Ultimately, a split skin graft (SSG) was applied directly to the heart and pleura to obtain wound closure. We believe this is the first report of an SSG being applied directly onto the myocardium to achieve stable soft tissue cover
Microsurgery Arena: A New Device to Develop Microsurgical Skills
Authors: Costa Francesco , di Summa Pietro G. , Srinivasan Jeyaram 
Published: August 2021

Summary:
Simulation in microsurgery is an important pillar of training and maintenance of surgical skills. Between learning microsurgical skills and mastering them in clinical practice, the usefulness of low-fidelity simulators for improving microsurgery skills has been well documented. Nowadays the in vivo models represent the gold standard of microsurgical training; however, their use implies difficulties and limitations. We developed a portable, low-cost, and modern device to help trainees to practice at their convenience to maintain their microsurgical suturing skills. By using CAD and 3D printer designs, we developed a “microsurgery trainer” that contains a middle section with eight projections with holes, arranged as a circle. The idea is to pass the microsuture—preferably 7/0 or 8/0 sutures—in a clockwise manner—with the needle passing from “out to in” and “in to out” through each hole. This allows the trainee to use his/her wrist to be flexible and achieve better control over the micro needle. Studies evaluating the potential of such a device in shortening the learning curve are needed and will be crucial to define whether the “microsurgery arena” will help trainees to obtain better outcomes in microsurgical practice.
OPTICAL COHERENCE TOMOGRAPHY FEATURES OF POLYPOIDAL LESION CLOSURE IN POLYPOIDAL CHOROIDAL VASCULOPATHY TREATED WITH AFLIBERCEPT
Authors: Tan Anna C. S. , Jordan-Yu Janice Marie , Vyas Chinmayi Himanshuroy , Gan Alfred Tau Liang , Teo Kelvin Yi Chong , Chan ChoI Mun , Mathur Ranjana , Wong Tien Yin , Chakravarthy Usha , Cheung Gemmy Chui Ming 
Published: August 2021

Purpose:
To evaluate whether optical coherence tomography (OCT) can determine polypoidal lesion (PL) perfusion in polypoidal choroidal vasculopathy eyes after 12 months of aflibercept monotherapy. Polypoidal lesion perfusion status, assessed by indocyanine green angiography, is an important anatomical outcome in polypoidal choroidal vasculopathy management.

Methods:
Post hoc data from a prospective randomized, open-label, study in eyes with polypoidal choroidal vasculopathy undergoing monotherapy with aflibercept evaluated PL perfusion status based on indocyanine green angiography (gold standard) and OCT features from baseline to 12 months.

Results:
Individual PLs (110 in total) from 48 eyes (48 patients) showed at 12 months; 57/110 PLs (51.8%) were closed on indocyanine green angiography. At 12 months, eyes with closed PLs were more likely to have the following OCT features: 1) no subretinal fluid (67.1% vs. 32.9%), 2) smaller pigment epithelial detachment height (67.2 [±43.8] vs. 189.2 [±104.9] μm), 3) densely hyperreflective pigment epithelial detachment contents (84.0% vs. 16.0%), 4) an absence of a hyperreflective ring(64.0% vs. 36.0%), and a 5) indistinct overlying retinal pigment epithelial (71.4% vs. 28.6%) (all P < 0.05). The three highest performing OCT features that differentiated perfused from closed PLs were (1), (3), and (4) (area under the receiver operating characteristic curve 0.85, 0.73, and 0.70, respectively). A combination of these three features achieved an area under the receiver operating characteristic curve of 0.90.

Conclusion:
Polypoidal lesion closure, an important anatomical treatment outcome in polypoidal choroidal vasculopathy typically defined by indocyanine green angiography, can be accurately detected by specific OCT features.
Use of Suvorexant and Antipsychotics in the Treatment of Delirium After Infectious Diseases
Authors: Okino Kazumaro , Yamada Hiroki , Tomioka Hiroi , Nozaki Shinji , Iwanami Akira , Inamoto Atsuko 
Published: August 2021

Abstract

Background
Delirium is often treated on a subjective basis and per the discretion of the attending physician because of a lack of pharmacological evidence in the literature. To address this knowledge gap, we aimed to examine the efficacy of a hypnotic drug, suvorexant, as a therapeutic agent for the treatment of delirium.

Methods
Fifty-seven patients were targeted. Of the 57 patients, 39 were in the subolexant group, 17 in the antipsychotic group, and 1 was taking antidepressants. The Delirium Rating Scale–Revised 98 was used to evaluate the symptoms of delirium before and 3 and 7 days after drug administration. In addition, the medical history, occurrence of adverse effects, white blood cell count, and C-reactive protein level of participants were examined.

Results
Both drugs exhibited therapeutic effects on delirium, but suvorexant had a more pronounced effect. Furthermore, the suvorexant group exhibited decreased levels of C-reactive protein, suggesting an anti-inflammatory effect. Suvorexant seems to improve the symptoms of inflammation-related delirium without any serious adverse effects, suggesting that it can be explored as a safe treatment option for clinical use in future studies.

Conclusions
Our findings will be relevant for physicians interested in learning about new pharmacological treatment options and researchers interested in validating our results.
Switching to Intranasal Esketamine Maintains the Antidepressant Response to Intravenous Racemic Ketamine Administration
Authors: Banov Michael D. , Landrum Rachel E. , Moore Michelle B. , Szabo Steven T. 
Published: August 2021

Abstract

Purpose
This study aims to assess the efficacy and safety of intranasal (IN) esketamine as maintenance antidepressant therapy in patients who have demonstrated clinical improvement with off-label intravenous (IV) racemic ketamine for treatment-resistant depression (TRD).

Methods
This is a retrospective case series of 10 consecutive outpatients with TRD who all had a clinically meaningful response when treated with IV racemic ketamine and were then switched to IN esketamine for maintenance therapy. Patient outcomes were assessed with the Montgomery-Åsberg Depression Rating Scale, Patient Health Questionnaire 9, and Clinical Global Impression of Improvement scale at each visit. Adverse effects were assessed at each treatment.

Findings
Results indicated that 9 patients either maintained the benefit or showed greater improvement when transitioned to IN esketamine for antidepressant maintenance therapy. One patient had worsening of depression due to an acute psychosocial stressor but still improved from baseline IV racemic ketamine treatment. Six patients returned to work or pursued employment, and 4 patients with suicidal ideation remitted during IV racemic ketamine treatment and had no recurrence of suicidality with IN esketamine. No serious adverse reactions or tolerability issues were observed.

Implications
This case series reports the outcomes of 10 severely ill patients with TRD who had a clinically meaningful response to IV racemic ketamine and demonstrated a maintenance of effect or continued improvement when transitioned to IN esketamine. Although this finding needs to be replicated in larger, controlled studies, this report provides promising results for patients who have safely and effectively switched to Food and Drug Administration–approved IN esketamine after receiving acute or maintenance depression treatment with off-label IV racemic ketamine.