bluuebunny/crossref_metadata_2025_split huggingface dataset:
Clinical Characteristics, Management, and Outcomes of Cancer Patients With Coronavirus Disease 2019 Admitted to the ICU
Authors: Dang Michael K. M. , Bhatt Isha , Dulu Alina O. , Zhang Hao , Kostelecky Natalie , Pastores Stephen M. 
Published: September 2021

OBJECTIVES:
Adult patients with cancer have a greater likelihood of developing severe illness and death from coronavirus disease 2019 compared with patients without cancer. We sought to characterize the clinical characteristics and outcomes of cancer patients who tested positive for severe acute respiratory syndrome coronavirus 2 and were admitted to the ICU at the peak of the first wave of the pandemic in the United States.

DESIGN:
A single-center retrospective cohort study.

SETTING:
Two medical-surgical ICUs of a tertiary-care cancer center.

PATIENTS/SUBJECTS:
All consecutive adult patients (≥ 18 yr) with current or past (< 2 yr) diagnosis of cancer who were admitted to the ICU with coronavirus disease 2019 between March 1, and June 30, 2020.

INTERVENTIONS:
None.

MEASUREMENTS AND MAIN RESULTS:
Demographic, clinical, and laboratory data of 89 critically ill cancer patients were extracted from electronic medical records. Median age was 65 years (interquartile range, 57–70 yr), 66% were White, and 58% male. Approximately a third of patients had three or more comorbidities. Fifty-one patients (57%) had solid tumors, and 38 (42%) had hematologic malignancies. Sixty-one patients (69%) received cancer-directed therapy within the previous 90 days. Sixty patients (67%) required mechanical ventilation, 56% required prone positioning, 28% underwent tracheostomy, and 71% required vasopressors. Hospital mortality was 45% (40/89). Among those who required mechanical ventilation, mortality was 53% (32/60). Hospital mortality was significantly higher among patients with hematologic malignancies, higher severity of illness and organ failure scores, need for invasive mechanical ventilation and vasopressor therapy, lower hemoglobin and platelet count, and higher d-dimer levels at ICU admission. ICU and hospital length of stay were 10 and 26 days, respectively. At 9-month follow-up, the mortality rate was 54% (48/89).

CONCLUSIONS:
We report the largest case series and intermediate-term follow-up of cancer patients with coronavirus disease 2019 who were admitted to the ICU. Hospital mortality was 45%. Intermediate-term outcome after hospital discharge was favorable.
Risk Factors Associated With the Prescription of Opioids Among Service Members Following a First Mild Traumatic Brain Injury
Authors: Hoover Peter , Johnson Dara , Wu Tim , French Louis M. , Caban Jesus 
Published: September 2021

Objective:
To evaluate factors impacting opioid receipt among active-duty service members (SMs) following a first mild traumatic brain injury (mTBI).

Setting:
Active-duty SMs receiving care within the Military Health System.

Participants:
In total, 14 757 SMs who have sustained an initial mTBI, as documented within electronic health records (EHRs), between 2016 and 2017.

Design:
A retrospective analysis of EHR metadata.

Main Measures:
Multivariable logistic regression assessed factors impacting opioid receipt and initiation. Factors include demographics, military characteristics, and preexisting clinical conditions, including prior opioid prescription.

Results:
Of the sample population, 33.4% (n = 4927) were prescribed opioids after their initial mTBI, of which, 60.6% (n = 2985) received opioids for the first time following injury. Significant risk factors associated with the increased probability of opioid receipt included age, gender, and preexisting behavioral health and musculoskeletal conditions. Military characteristics also exhibited changes in the probability of opioid receipt, both among initiation and new prescription. No changes were observed among race, nor among those with preexisting headaches or migraines.

Conclusion:
Despite concerns about the negative impact on recovery, the prescribing of opioids is common in this population of active-duty SMs first diagnosed with an mTBI. As several demographic and preexisting health conditions are factors in the receipt of opioids post-mTBI, the entire medical history of these patients should be considered prior to prescription. Understanding these factors may further inform policy for opioid use in the Military Health System.
Dorsal root ganglion toll-like receptor 4 signaling contributes to oxaliplatin-induced peripheral neuropathy
Authors: Illias Amina M. , Yu Kai-Jie , Hwang Seon-Hee , Solis Jacob , Zhang Hongmei , Velasquez Jose F. , Cata Juan P. , Dougherty Patrick M. 
Published: September 2021

Abstract
Activation of toll-like receptor 4 (TLR4) in the dorsal root ganglion (DRG) and spinal cord contributes to the generation of paclitaxel-related chemotherapy-induced peripheral neuropathy (CIPN). Generalizability of TLR4 signaling in oxaliplatin-induced CIPN was tested here. Mechanical hypersensitivity developed in male SD rats by day 1 after oxaliplatin treatment, reached maximum intensity by day 14, and persisted through day 35. Western blot revealed an increase in TLR4 expression in the DRG of oxaliplatin at days 1 and 7 after oxaliplatin treatment. Cotreatment of rats with the TLR4 antagonist lipopolysaccharide derived from Rhodobacter sphaeroides ultrapure or with the nonspecific immunosuppressive minocycline with oxaliplatin resulted in significantly attenuated hyperalgesia on day 7 and 14 compared with rats that received oxaliplatin plus saline vehicle. Immunostaining of DRGs revealed an increase in the number of neurons expressing TLR4, its canonical downstream signal molecules myeloid differentiation primary response gene 88 (MyD88) and TIR-domain–containing adapter-inducing interferon-β, at both day 7 and day 14 after oxaliplatin treatment. These increases were blocked by cotreatment with either lipopolysaccharide derived from Rhodobacter sphaeroides or minocycline. Double staining showed the localization of TLR4, MyD88, and TIR-domain–containing adapter-inducing interferon-β in subsets of DRG neurons. Finally, there was no significant difference in oxaliplatin-induced mechanical hypersensitivity between male and female rats when observed for 2 weeks. Furthermore, upregulation of TLR4 was detected in both sexes when tested 14 days after treatment with oxaliplatin. These findings suggest that the activation of TLR4 signaling in DRG neurons is a common mechanism in CIPN induced by multiple cancer chemotherapy agents.
Spinal cord injury in mice affects central and peripheral pathology in a severity-dependent manner
Authors: Bannerman Courtney A. , Douchant Katya , Segal Julia P. , Knezic Mitra , Mack Alexandra E. , Lundell-Creagh Caitlin , Silva Jaqueline R. , Duggan Scott , Sheth Prameet , Ghasemlou Nader 
Published: September 2021

Abstract
Chronic pain is a common medical complication experienced by those living with spinal cord injury (SCI) and leads to worsened quality of life. The pathophysiology of SCI pain is poorly understood, hampering the development of safe and efficacious therapeutics. We therefore sought to develop a clinically relevant model of SCI with a strong pain phenotype and characterize the central and peripheral pathology after injury. A contusion (50 kdyn) injury, with and without sustained compression (60 seconds) of the spinal cord, was performed on female C57BL/6J mice. Mice with compression of the spinal cord exhibited significantly greater heat and mechanical hypersensitivity starting at 7 days postinjury, concomitant with reduced locomotor function, compared with those without compression. Immunohistochemical analysis of spinal cord tissue revealed significantly less myelin sparing and increased macrophage activation in mice with compression compared with those without. As measured by flow cytometry, immune cell infiltration and activation were significantly greater in the spinal cord (phagocytic myeloid cells and microglia) and dorsal root ganglia (Ly6C+ monocytes) after compression injury. We also decided to investigate the gastrointestinal microbiome, as it has been shown to be altered in patients with SCI and has recently been shown to play a role in immune system maturation and pain. We found increased dysbiosis of the gastrointestinal microbiome in an injury severity–dependent manner. The use of this contusion–compression model of SCI may help advance the preclinical assessment of acute and chronic SCI pain and lead to a better understanding of mechanisms contributing to this pain.
Reducing Catheter-Associated Urinary Tract Infection: The Impact of Routine Screening in the Geriatric Hip Fracture Population
Authors: Singh Shridevi , Angus L. D. George , Munnangi Swapna , Shaikh Dooniya , Digiacomo Jody C. , Angara Vivek C. , Brown Aaron , Akadiri Tayo 
Published: September 2021

Background:
Catheter-associated urinary tract infection (CAUTI) is a noted complication among geriatric hip fracture patients. This complication results in negative outcomes for both the patients and the institution providing care. Screening measures to identify predisposing factors, with early diagnosis and treatment of urinary tract infection (UTI) present on admission, may lead to reduced rates of CAUTI.

Objective:
The goals of this study were to determine the prevalence of UTI on admission among geriatric hip fracture patients and whether routine screening for UTI or predisposing factors at presentation resulted in reduced rates of CAUTI.

Methods:
A retrospective observational study of geriatric hip fracture patients from January 2017 to December 2018 at a Level I trauma center was performed. Rates of UTI on admission and CAUTI were calculated using routine admission urinalysis.

Results:
Of the 183 patients in the sample, 36.1% had UTI on admission and 4.4% of patients developed CAUTI. There were no significant differences in patient demographics, comorbidities, and complications between those with UTI on admission and those without.

Conclusions:
Urinary tract infection on admission may be present among a large portion of geriatric hip fracture patients, leading to increased rates of CAUTI. Routine screening for UTI and its predisposing factors at admission can identify these patients earlier and lead to earlier treatments and prevention of CAUTI.
Prehospital Hemorrhage Assessment Criteria: A Concise Review
Authors: Di Carlo Sara , Cavallaro Giuseppe , Palomeque Kenia , Cardi Maurizio , Sica Giuseppe , Rossi Piero , Sibio Simone 
Published: September 2021

Objective:
Early assessment of the clinical status of trauma patients is crucial for guiding the treatment strategy, and it requires a rapid and systematic approach. The aim of this report is to critically review the assessment parameters currently used in the prehospital setting to quantify blood loss in trauma.

Data Sources:
Studies regarding hemorrhagic shock in trauma were pooled from PubMed, EMBASE, and Cochrane databases using key words such as “hemorrhagic shock,” “vital signs evaluation,” “trauma,” “blood loss,” and “emergency medical service,” alone or combined.

Study Selection:
Articles published since 2009 in English and Italian were considered eligible if containing data on assessment parameters in blood loss in adults.

Data Extraction:
Sixteen articles matching the inclusion criteria were considered in our study.

Data Synthesis:
Current prehospital assessment measures lack precise correlation with blood loss.

Conclusions:
Traditional assessment parameters such as heart rate, systolic blood pressure, shock index, and Glasgow Coma Scale score often lag in providing accurate blood loss assessment. The current literature supports the need for a noninvasive, continuously monitored assessment parameter to identify early shock in the prehospital setting.
Effect of acetazolamide for exudative retinal detachment in Sturge-Weber syndrome
Authors: Kinouchi Rina , Okumichi Hideaki , Sakata Hajime , Ohara Hiromi , Hirooka Kazuyuki , Kiuchi Yoshiaki 
Published: September 2021

Abstract

Introduction:
Choroidal hemangiomas are present in 20% to 70% of patients with Sturge–Weber syndrome (SWS) and may lead to exudative retinal detachment. The treatment includes retinal photocoagulation, photodynamic therapy, and cryocoagulation, however they are frequently ineffective. We report a case of exudative retinal detachment secondary to SWS that appears to have improved with oral acetazolamide.

Patient concerns:
A 22-year-old man was diagnosed with congenital SWS due to a hemangioma in the first and second branches of the right trigeminal nerve. In April 2009, the patient was referred to the Ophthalmological department with reduced vision. The best-corrected visual acuity (decimal) of the right eye was reduced while its intraocular pressure was increased. The right anterior chamber depth was shallow, and exudative retinal detachment associated with choroidal hemangioma in the right eye was observed. Fluorescein angiography showed fluorescence leakage from a choroidal hemangioma.

Diagnosis:
We diagnosed exudative retinal detachment secondary to SWS.

Interventions:
Acetazolamide was taken orally at 500 mg daily for 2 weeks.

Outcomes:
Following the 2-week acetazolamide treatment, both the laterality of the anterior chamber depth and the exudative retinal detachment resolved and the best-corrected visual acuity and intraocular pressure improved. There was no fluorescence leakage from hemangioma observed on fluorescein angiography. In July 2013, a blunt trauma to the right eye caused a relapse of the exudative retinal detachment in this eye. Similarly, oral acetazolamide treatment for 2 weeks relieved exudative retinal detachment, and no subsequent relapse was observed.

Conclusions:
Oral acetazolamide appeared to be effective for exudative retinal detachment associated with choroidal hemangiomas in a patient with SWS.
Effect of goal-directed fluid management guided by non-invasive device on incidence of postoperative complications in neurosurgery
Authors: Hrdy Ondrej , Duba Milos , Dolezelova Andrea , Hlavaty Martin , Traj Rudolf , Bönisch Vit , Roskova Ivana , Smrcka Martin , Gal Roman 
Published: September 2021

Abstract

Introduction:
Goal-directed hemodynamic therapy aims to reduce the incidence of postoperative complications in patients undergoing surgical procedures. Optimal preload is mandatory to achieve adequate cardiac output and oxygen supply to organs and tissues. Neurosurgical patients are at risk of inadequate preload, decreased blood flow and reduced oxygen delivery, all of which can lead to organ dysfunction. Current knowledge regarding the effect of fluid management on patient-orientated outcomes in neurosurgery is limited. Therefore, this study aims to compare the safety and feasibility of goal-directed therapy with standard management in patients undergoing neurosurgical procedures.

Methods and analysis:
Patients undergoing neurosurgical operation will be randomised into two groups. Therapy in the first group of patients will be guided by standard perioperative monitoring. In the second group, perioperative therapy will be guided using non-invasive hemodynamic monitoring in addition to standard monitoring. Administration of fluids and vasoactive drugs will depend on the assessment of stroke volume variation and cardiac index. The safety of goal-directed hemodynamic therapy protocol will be assessed by comparing incidences of adverse events between groups.
Movement Disorders in Multiple Sclerosis and Other Demyelinating Diseases
Authors: Suarez-Cedeno Gerson , Mehanna Raja 
Published: September 2021

Background:
Movement disorders (MDs) have been described in demyelinating diseases (DDs). However, data is lacking in the effective treatment of these MD as well as in a potential correlation between DD lesions localization and the phenomenology of the MD and its response to treatment.

Methods:
Retrospective review of 185 patients with MD and DD seen at our center over a period of 7 years. Clinical imaging, medications, and therapeutic responses to both MD and DD treatments were reviewed.

Results:
Of the 185 patients, 62 were excluded because of a diagnosis of spasticity without any other MD. One hundred twenty three patients with DD (75% female, age 48.8±12.8 y) had one or more MD. The most common MD was ataxia followed by isolated tremor. Forty-two patients (34%) received any treatment for MD, 29 (69%) of which responded at least partially to a first MD agent and 78.6% responded at least partially to a second or third agent. Responders to the first MD therapy were more likely to have a lesion in the basal ganglia or the cerebellum, and less likely to have a lesion in the brainstem or the spinal cord, but these results could be biased by a lower-than-expected frequency of tonic spasms in our series. No correlation between DD lesions localization and the phenomenology of the MD was discovered.

Conclusions:
MD are common in DD and are frequently overlooked or undertreated. MD in this sample have a 69% therapeutic response to a first trial. Greater awareness of potential therapeutic options is needed to decrease disability.
Current Review of Leptomeningeal Amyloidosis Associated With Transthyretin Mutations
Authors: Qin Qi , Wei Cuibai , Piao YueShan , Lian Fang , Wu Hao , Zhou Aihong , Wang Fen , Zuo Xiumei , Han Yue , Lyu Jihui , Guo Dongmei , Jia Jianping 
Published: September 2021

Introduction:
Leptomeningeal amyloidosis (LA) represents a rare subtype of familial transthyretin (TTR) amyloidosis, characterized by deposition of amyloid in cranial and spinal leptomeninges. Of >120 TTR mutations identified, few have been associated with LA.

Case Report:
A 27-year-old male presented with a 2-year history of progressive symptoms including cognitive decline and right-sided weakness and numbness. Cerebrospinal fluid (CSF) analyses demonstrated high protein level. Gadolinium-enhanced magnetic resonance imaging (MRI) revealed extensive leptomeningeal enhancement over the surface of the brain and spinal cord. Pathologic analyses revealed a TTR mutation c.113A>G (p.D38G).

Review Summary:
Fifteen mutations and genotype-phenotype correlation of 72 LA patients have been summarized to provide an overview of LA associated with transthyretin mutations. The mean age of clinical onset was 44.9 years and the neurological symptoms primarily included cognitive impairment, headache, ataxia seizures and hearing, visual loss. CSF analysis showed elevated high CSF protein level and MRI revealed extensive leptomeningeal enhancement.

Conclusion:
Clinicians should be aware of this rare form of familial transthyretin amyloidosis as well as its typical MRI enhancement and high CSF protein. The important role of biopsy, genetic testing and the potential early diagnosis value of contrast MRI were suggested. Early recognition of these characteristics is important to provide misdiagnosis and shorten the time before correct diagnosis. These findings expand the phenotypic spectrum of TTR gene and have implications for the diagnosis, treatment, and systematic study of LA.
A Multifaceted Approach to Improving Postischemic Stroke Dysphagia Screening at a Community Hospital
Authors: Shenoy Anant M. , McCune Marie , AbdelRazek Mahmoud A. 
Published: September 2021

Background:
Dysphagia is a common complication seen in acute ischemic stroke patients, and can lead to morbidity and mortality. As such, quality measures have been instituted to track adherence to dysphagia screening in all stroke patients. In our 217-bed community hospital, we were faced with a low rate in successfully screening for dysphagia.

Methods:
Quality control interventions were implemented after an analysis of the reasons for dysphagia screening failures was performed. Interventions included online educational sessions for nurses, face-to-face sessions with medical residents, distribution of educational laminated cards, changing the method of documenting the dysphagia screen in our electronic record and others.

Results:
There was an increase of rates of screening for dysphagia from 67% to 91%.

Conclusion:
We conclude that failure analysis, implementation of quality control measures to address the cause of failures and re-evaluating success rates periodically was effective to address this problem.
Immune responses in COVID-19 respiratory tract and blood reveal mechanisms of disease severity
Authors: Zhang Wuji , Chua Brendon Y. , Selva Kevin J. , Kedzierski Lukasz , Ashhurst Thomas M. , Haycroft Ebene R. , Shoffner Suzanne K. , Hensen Luca , Boyd David F. , James Fiona , Mouhtouris Effie , Kwong Jason C. , Chua Kyra Y. L. , Drewett George , Copaescu Ana , Dobson Julie E. , Rowntree Louise C. , Habel Jennifer R. , Allen Lilith F. , Koay Hui-Fern , Neil Jessica A. , Gartner Matthew , Lee Christina Y. , Andersson Patiyan , Seemann Torsten , Sherry Norelle L. , Amanat Fatima , Krammer Florian , Londrigan Sarah L. , Wakim Linda M. , King Nicholas J.C. , Godfrey Dale I. , Mackay Laura K. , Thomas Paul G. , Nicholson Suellen , Arnold Kelly B. , Chung Amy W. , Holmes Natasha E. , Smibert Olivia C. , Trubiano Jason A. , Gordon Claire L. , Nguyen Thi H.O. , Kedzierska Katherine 
Published: September 2021

ABSTRACTAlthough the respiratory tract is the primary site of SARS-CoV-2 infection and the ensuing immunopathology, respiratory immune responses are understudied and urgently needed to understand mechanisms underlying COVID-19 disease pathogenesis. We collected paired longitudinal blood and respiratory tract samples (endotracheal aspirate, sputum or pleural fluid) from hospitalized COVID-19 patients and non-COVID-19 controls. Cellular, humoral and cytokine responses were analysed and correlated with clinical data. SARS-CoV-2-specific IgM, IgG and IgA antibodies were detected using ELISA and multiplex assay in both the respiratory tract and blood of COVID-19 patients, although a higher receptor binding domain (RBD)-specific IgM and IgG seroconversion level was found in respiratory specimens. SARS-CoV-2 neutralization activity in respiratory samples was detected only when high levels of RBD-specific antibodies were present. Strikingly, cytokine/chemokine levels and profiles greatly differed between respiratory samples and plasma, indicating that inflammation needs to be assessed in respiratory specimens for the accurate assessment of SARS-CoV-2 immunopathology. Diverse immune cell subsets were detected in respiratory samples, albeit dominated by neutrophils. Importantly, we also showed that dexamethasone and/or remdesivir treatment did not affect humoral responses in blood of COVID-19 patients. Overall, our study unveils stark differences in innate and adaptive immune responses between respiratory samples and blood and provides important insights into effect of drug therapy on immune responses in COVID-19 patients.