bluuebunny/crossref_metadata_2025_split huggingface dataset:
Deep Learning-based Brain Age Prediction in Patients With Schizophrenia Spectrum Disorders
Authors: Kim Woo-Sung , Heo Da-Woon , Maeng Junyeong , Shen Jie , Tsogt Uyanga , Odkhuu Soyolsaikhan , Zhang Xuefeng , Cheraghi Sahar , Kim Sung-Wan , Ham Byung-Joo , Rami Fatima Zahra , Sui Jing , Kang Chae Yeong , Suk Heung-Il , Chung Young-Chul 
Published: December 2023

Abstract

Background and Hypothesis
The brain-predicted age difference (brain-PAD) may serve as a biomarker for neurodegeneration. We investigated the brain-PAD in patients with schizophrenia (SCZ), first-episode schizophrenia spectrum disorders (FE-SSDs), and treatment-resistant schizophrenia (TRS) using structural magnetic resonance imaging (sMRI).

Study Design
We employed a convolutional network-based regression (SFCNR), and compared its performance with models based on three machine learning (ML) algorithms. We pretrained the SFCNR with sMRI data of 7590 healthy controls (HCs) selected from the UK Biobank. The parameters of the pretrained model were transferred to the next training phase with a new set of HCs (n = 541). The brain-PAD was analyzed in independent HCs (n = 209) and patients (n = 233). Correlations between the brain-PAD and clinical measures were investigated.

Study Results
The SFCNR model outperformed three commonly used ML models. Advanced brain aging was observed in patients with SCZ, FE-SSDs, and TRS compared to HCs. A significant difference in brain-PAD was observed between FE-SSDs and TRS with ridge regression but not with the SFCNR model. Chlorpromazine equivalent dose and cognitive function were correlated with the brain-PAD in SCZ and FE-SSDs.

Conclusions
Our findings indicate that there is advanced brain aging in patients with SCZ and higher brain-PAD in SCZ can be used as a surrogate marker for cognitive dysfunction. These findings warrant further investigations on the causes of advanced brain age in SCZ. In addition, possible psychosocial and pharmacological interventions targeting brain health should be considered in early-stage SCZ patients with advanced brain age.
Antimicrobial resistance and epidemic clustering of late-onset neonatal infections in a Brazilian intensive care unit
Authors: Freitas Felipe Teixeira de Mello , da Costa Marcela Santos Corrêa , da Costa Kaylla Heduarda Rodrigues , Alves Everton Giovanni 
Published: December 2023

Abstract
Nosocomial infections in the neonatal intensive care unit (NICU) tend to cluster and multidrug-resistant (MDR) pathogens are rising in developing countries. We did a retrospective cohort study of neonates admitted to a NICU in Brazil with late-onset neonatal sepsis (LOS) confirmed by blood culture from October 2012 to December 2016 and from July 2018 to December 2021. We defined a cluster of infection when at least two cases of LOS occurred within two different time intervals: 15 and 30 days with the same pathogen in different patients. A random amplified polymorphic DNA (RAPD) was performed from samples from one of these clusters. A logistic regression model was applied having death as the outcome and the infection with an MDR pathogen as the exposure of interest. There were 987 blood cultures from 754 neonates, 621 (63%) were gram-positive cocci, 264 (30%) were gram-negative rods and 72 (7%) fungi. A third of Enterobacterales were resistant to cefepime and a third of non-fermenting glucose rods were resistant to carbapenems. There were 100 or 104 clusters of infection in the 15- or 30-day interval, respectively. A RAPD analysis from an outbreak of MDR Acinetobacter baumannii showed that all five samples belonged to a single clone. An infection with an MDR pathogen was associated with death (OR 1.82, 95% CI 1.03–3.21). In conclusion, clusters of infections in a Brazilian NICU are a frequent phenomenon as seen elsewhere. They suggest cross-transmission of pathogens with increasing antimicrobial resistance and should prompt intensified surveillance and infection control measures.
Acute Compartment Syndrome in Pediatric Patients on Extracorporeal Membrane Oxygenation Support
Authors: Bridges Callie S. , Taylor Tristen N. , Bini Thomas , Ontaneda Andrea M. , Coleman Ryan D. , Hill Jaclyn F. , Montgomery Nicole I. , Shenava Vinitha R. , Gerow Frank T. 
Published: December 2023

Background:
When acute compartment syndrome (ACS) occurs in pediatric patients requiring venoarterial extracorporeal membrane oxygen (VA ECMO) support, there is little data to guide surgeons on appropriate management. The purpose of this study is to characterize the presentation, diagnosis, timeline, and outcomes of patients who developed this complication.

Methods:
This is a single-center retrospective case series of children below 19 years old on VA ECMO support who subsequently developed extremity ACS between January 2016 and December 2022. Outcomes included fasciotomy findings, amputation, mortality, and documented function at the last follow-up.

Results:
Of 343 patients on VA ECMO support, 18 (5.2%) were diagnosed with ACS a median 29 hours after starting ECMO. Initial cannulation sites included 8 femoral, 6 neck, and 4 central. Femoral artery cannulation was associated with an increased risk of ACS [odds ratio=6.0 (CI: 2.2 to 15), P<0.0001]. In the hospital, the mortality rate was 56% (10/18). Fourteen (78%) patients received fasciotomies a median of 1.2 hours after ACS diagnosis. Only 4 (29%) patients had all healthy muscles at initial fasciotomy, while 9 (64%) had poor muscular findings in at least 1 compartment. Patients with worse findings at fasciotomy had a significantly longer duration between ischemia onset and ACS diagnosis. Patients required a median of 1.5 additional procedures after fasciotomy, and only 1 (7%) developed a surgical site infection. Of the 7 surviving fasciotomy patients, 2 required amputations, 3 developed an equinus contracture, 1 developed foot drop, and 3 had no ACS-related deficits. Four patients did not receive fasciotomies: 3 were deemed too ill and later died, and 1 was diagnosed too late to benefit. The only surviving nonfasciotomy patient required bilateral amputations.

Conclusions:
Pediatric ECMO-associated ACS is not exclusive to patients with femoral artery cannulation. The majority of fasciotomy patients were diagnosed with ACS after muscle necrosis had already started. We were unable to definitively conclude whether fasciotomies provide better outcomes. There is a need for increased awareness and earlier recognition of this rare yet potentially devastating complication.

Level of Evidence:
Level IV—retrospective case series
Single Incision Broström-Gould Surgery With Peroneal Debridement and Calcaneal Osteotomy
Authors: Scheinberg Mila , McCrosson Matthew , Fortin Travis , Singh Swapnil , Shah Ashish 
Published: December 2023

Objective:
Chronic lateral ankle instability (CLAI) with hindfoot varus is a common condition that can be treated with various surgical approaches. The Broström-Gould procedure is the gold-standard surgery for CLAI, and a sliding lateralizing calcaneal osteotomy (SLCO) is a common procedure for CLAI with hindfoot varus. The purpose of this paper is to describe a single-incision approach for the Broström-Gould repair with concomitant peroneal tendon debridement and an SLCO.

Patients and Methods:
The study retrospectively reviewed 189 cases of lateral ankle ligamentous repair with peroneal tendon debridement and an SLCO between 2011 and 2020. Of these, 53 patients had a single-incision approach, meeting the major inclusion criteria. The remaining patients had 2 incisions. Inclusion criteria for this study required patients to be at least 18 years of age, have a preoperative diagnosis of CLAI with hindfoot varus, and receive an isolated one-incision approach for a Broström-Gould procedure with concomitant peroneal tendon debridement and an SLCO.

Results:
The single-incision technique has shown to be equally effective with potential for decreased wound and neurovascular complications in comparison to a traditional multi-incisional approach.

Conclusions:
The single-incision technique for the Broström-Gould repair with concomitant peroneal tendon debridement and an SLCO is a safe and effective approach for treating CLAI with hindfoot varus. This technique offers adequate visualization of the lateral ankle ligaments, peroneal tendons, and lateral calcaneus while still achieving excellent postoperative cosmesis.
Association of glucagon-like peptide-1 receptor agonists with serious liver events among patients with type 2 diabetes: A Scandinavian cohort study
Authors: Engström Arvid , Wintzell Viktor , Melbye Mads , Svanström Henrik , Eliasson Björn , Gudbjörnsdottir Soffia , Hveem Kristian , Jonasson Christian , Hviid Anders , Ueda Peter , Pasternak Björn 
Published: December 2023

Background and Aims:
Clinical trials suggest that glucagon-like peptide-1 (GLP-1) receptor agonists may have beneficial effects on NAFLD, but the impact on hard hepatic end points is unknown. We assessed the association between the use of GLP-1 receptor agonists and the risk of serious liver events in routine clinical practice.

Approach and Results:
Cohort study using data from nationwide registers in Sweden, Denmark, and Norway, 2007–2020, including 91,479 initiators of GLP-1 receptor agonists and 244,004 initiators of the active comparator, dipeptidyl peptidase-4 inhibitors, without a history of chronic liver disease other than NAFLD/NASH. The primary outcome was serious liver events: a composite of incident compensated and decompensated cirrhosis and HCC. Secondary outcomes were the individual components of the primary outcome. Cox regression was used to estimate HRs, using propensity score weighting to control for confounding. Users of GLP-1 receptor agonists had 608 serious liver events (adjusted incidence rate: 16.9 events per 10,000 person-years), compared with 1770 events among users of dipeptidyl peptidase-4 inhibitors (19.2 events per 10,000 person-years). The adjusted HR was 0.85 (95% CI: 0.75 to 0.97), and the rate difference was −2.1 (−4.4 to 0.1) events per 10,000 person-years. In secondary outcome analyses, the adjusted HR was 0.85 (0.75 to 0.97) for compensated and decompensated cirrhosis and 1.05 (0.80 to 1.39) for HCC.

Conclusions:
The use of GLP-1 receptor agonists was associated with a significantly reduced risk of serious liver events, driven by a reduction of compensated and decompensated cirrhosis.
Comparison of the effect of capsular bend on the rotational stability between 2 toric intraocular lenses
Authors: Wang Yiyi , Lou Xicong , Qian Shuyi , Li Yuanyuan , Wu Xueer , Li Siyan , Wang Yalan , Zhao Yune , Chang Pingjun 
Published: December 2023

Purpose:
To compare the effect of capsular bend on the rotational stability between 2 toric intraocular lenses (IOLs).

Setting:
Eye Hospital of Wenzhou Medical University, Hangzhou, Zhejiang Province, China.

Design:
Prospective study.

Methods:
Patients with preexisting astigmatism received AcrySof IQ (SN6AT) or TECNIS (ZCT/ZMT) toric IOL during cataract surgery. CASIA2 was used to record the toric IOL axial orientation and capsular bend index (CBI) at the 1-day, 1-week, 1-month, and 3-month interval postoperatively. The postoperative rotational stability and CBI of both models were compared.

Results:
A total of 58 eyes from 58 patients were enrolled in this study. The total misalignment of the TECNIS (ZCT/ZMT) group (6.96 ± 5.10 degrees, 7.41 ± 5.19 degrees, 6.93 ± 5.29 degrees, and 6.86 ± 5. 27 degrees) was significantly higher than that of the AcrySof IQ (SN6AT) group (3.55 ± 2.21 degrees, 4.00 ± 2.74 degrees, 3.72 ± 2.72 degrees, and 3.52 ± 2.50 degrees) at all follow-up intervals (P < .05). The mean rotation of the TECNIS (ZCT/ZMT) group (2.66 ± 2.18 degrees) was significantly greater than that of the AcrySof IQ (SN6AT) group (1.65 ± 1.47 degrees) from 1 day to 1 week postoperatively (P < .05). The capsular bend formation in the TECNIS (ZCT/ZMT) group was delayed compared with the AcrySof IQ (SN6AT) group (P < .05, at the 1-week, 1-month, and 3-month interval). The TECNIS (ZCT/ZMT) group showed fibrosis in the peripheral anterior capsule, leading to its stretching away from the IOL surface, while the AcrySof IQ (SN6AT) group exhibited gentle adherence of the anterior capsule to the IOL surface.

Conclusions:
The AcrySof IQ toric IOL (SN6AT) exhibited greater rotational stability than the TECNIS toric IOL (ZCT/ZMT), which may partially result from the delay in capsular bend formation of TECNIS at the 1-day to 1-week follow-up postoperatively.
Experiences With Work-Family Conflict, Breastfeeding, and Perinatal Mental Health Among Women Returning to Work After Giving Birth
Authors: McCardel Rachel , Callands Tamora , Rajbhandari-Thapa Janani , Swartzendruber Andrea , Padilla Heather 
Published: December 2023

Objective
This study aimed to examine working mothers’ experiences with returning to work after giving birth, work-family conflict, breastfeeding, and mental health.

Methods
A sequential, mixed methods design was used to administer an online survey to capture job characteristics and perceptions of work-family conflict among first-time mothers in Georgia who gave birth within the previous year (N = 26). Then, interviews were conducted to understand their experiences with returning to work, work-family conflict, breastfeeding, and mental health.

Results
Many participants worked in educational settings and returned to full-time work after giving birth. Qualitative themes from 12 interviews captured the context of participants’ work environments, types of work-family conflict, and factors that alleviated work-family conflict.

Conclusions
Employers need to incorporate support for work-family conflict and perinatal mental health into workplace breastfeeding programs and maternity leave policies.
The impact of COVID-19 and the COVID-19 pandemic on hospitalized patients with STEMI in the United States: insights from the National Inpatient Sample
Authors: Kwok Chun Shing , Qureshi Adnan I. , Will Maximillian , Schwartz Konstatin , Borovac Josip A. , Waters David , Potluri Rahul , Lip Gregory Y.H. 
Published: December 2023

Background
It is unclear how COVID-19 pandemic affected care and outcomes among patients who are diagnosed with ST-elevation myocardial infarction (STEMI) in the USA.

Methods
We analyzed the data from National Inpatient Sample from 2016 to 2020 and assessed the impact of COVID-19 infection and the COVID-19 pandemic (year 2020) on in-hospital mortality, length of stay (LOS) and hospitalization costs.P

Results
There were 1 050 905 hospitalizations with STEMI, and there was an 8.2% reduction in admissions in 2020. Patients with COVID-19 versus those without had significantly greater in-hospital mortality (45.2% vs. 10.7%; P < 0.001). In 2020, 3.0% of hospitalizations had a diagnosis of COVID-19, and the mortality was 11.5% compared to 10.7% for patients admitted in 2016–2019 period. There was a significantly increased mortality (OR 6.25, 95% CI 5.42–7.21, P < 0.001), LOS (coefficient 3.47, 95% CI 3.10–3.84, P < 0.001) and cost (coefficient 10.69, 95% CI 8.4–12.55, P < 0.001) with COVID-19 infection compared with no infection. There was a borderline difference in mortality (OR 1.04, 95% CI 1.00– 1.09, P = 0.050) but LOS (coefficient −0.21, 95% CI−0.28 to −0.14, P < 0.001) and costs (3.14, 95% CI 2.79 to 3.49, P < 0.001) were reduced in 2020 compared to 2016–2019 period.

Conclusions
In conclusion, in patients hospitalized with STEMI, COVID-19 infection was associated with increased mortality, LOS, and cost but during the pandemic year of 2020 there was a small trend for increased mortality for patients with a diagnosis of STEMI.
Setting positive end-expiratory pressure by using electrical impedance tomography
Authors: Frerichs Inéz , Schädler Dirk , Becher Tobias 
Published: December 2023

Purpose of review
This review presents the principles and possibilities of setting positive end-expiratory pressure (PEEP) using electrical impedance tomography (EIT). It summarizes the major findings of recent studies where EIT was applied to monitor the effects of PEEP on regional lung function and to guide the selection of individualized PEEP setting.

Recent findings
The most frequent approach of utilizing EIT for the assessment of PEEP effects and the PEEP setting during the time period from January 2022 till June 2023 was based on the analysis of pixel tidal impedance variation, typically acquired during stepwise incremental and/or decremental PEEP variation. The most common EIT parameters were the fraction of ventilation in various regions of interest, global inhomogeneity index, center of ventilation, silent spaces, and regional compliance of the respiratory system. The studies focused mainly on the spatial and less on the temporal distribution of ventilation. Contrast-enhanced EIT was applied in a few studies for the estimation of ventilation/perfusion matching.

Summary
The availability of commercial EIT devices resulted in an increase in clinical studies using this bedside imaging technology in neonatal, pediatric and adult critically ill patients. The clinical interest in EIT became evident but the potential of this method in clinical decision-making still needs to be fully exploited.
Setting positive end-expiratory pressure: lung and diaphragm ultrasound
Authors: Mousa Amne , Klompmaker Peter , Tuinman Pieter R. 
Published: December 2023

Purpose of review
The purpose of this review is to summarize the role of lung ultrasound and diaphragm ultrasound in guiding ventilator settings with an emphasis on positive end-expiratory pressure (PEEP). Recent advances for using ultrasound to assess the effects of PEEP on the lungs and diaphragm are discussed.

Recent findings
Lung ultrasound can accurately diagnose the cause of acute respiratory failure, including acute respiratory distress syndrome and can identify focal and nonfocal lung morphology in these patients. This is essential in determining optimal ventilator strategy and PEEP level. Assessment of the effect of PEEP on lung recruitment using lung ultrasound is promising, especially in the perioperative setting. Diaphragm ultrasound can monitor the effects of PEEP on the diaphragm, but this needs further validation. In patients with an acute exacerbation of chronic obstructive pulmonary disease, diaphragm ultrasound can be used to predict noninvasive ventilation failure. Lung and diaphragm ultrasound can be used to predict weaning outcome and accurately diagnose the cause of weaning failure.

Summary
Lung and diaphragm ultrasound are useful for diagnosing the cause of respiratory failure and subsequently setting the ventilator including PEEP. Effects of PEEP on lung and diaphragm can be monitored using ultrasound.
Airway pressure release ventilation for lung protection in acute respiratory distress syndrome: an alternative way to recruit the lungs
Authors: Camporota Luigi , Rose Louise , Andrews Penny L. , Nieman Gary F. , Habashi Nader M. 
Published: December 2023

Purpose of review
Airway pressure release ventilation (APRV) is a modality of ventilation in which high inspiratory continuous positive airway pressure (CPAP) alternates with brief releases. In this review, we will discuss the rationale for APRV as a lung protective strategy and then provide a practical introduction to initiating APRV using the time-controlled adaptive ventilation (TCAV) method.

Recent findings
APRV using the TCAV method uses an extended inspiratory time and brief expiratory release to first stabilize and then gradually recruit collapsed lung (over hours/days), by progressively ‘ratcheting’ open a small volume of collapsed tissue with each breath. The brief expiratory release acts as a ‘brake’ preventing newly recruited units from re-collapsing, reversing the main drivers of ventilator-induced lung injury (VILI). The precise timing of each release is based on analysis of expiratory flow and is set to achieve termination of expiratory flow at 75% of the peak expiratory flow. Optimization of the release time reflects the changes in elastance and, therefore, is personalized (i.e. conforms to individual patient pathophysiology), and adaptive (i.e. responds to changes in elastance over time).

Summary
APRV using the TCAV method is a paradigm shift in protective lung ventilation, which primarily aims to stabilize the lung and gradually reopen collapsed tissue to achieve lung homogeneity eliminating the main mechanistic drivers of VILI.
Ventilation during extracorporeal gas exchange in acute respiratory distress syndrome
Authors: Fumagalli Jacopo , Pesenti Antonio 
Published: December 2023

Purpose of review
Accumulating evidence ascribes the benefit of extracorporeal gas exchange, at least in most severe cases, to the provision of a lung healing environment through the mitigation of ventilator-induced lung injury (VILI) risk. In spite of pretty homogeneous criteria for extracorporeal gas exchange application (according to the degree of hypoxemia/hypercapnia), ventilatory management during extracorporeal membrane oxygenation (ECMO)/carbon dioxide removal (ECCO2R) varies across centers. Here we summarize the recent evidence regarding the management of mechanical ventilation during extracorporeal gas exchange for respiratory support.

Recent findings
At present, the most common approach to protect the native lung against VILI following ECMO initiation involves lowering tidal volume and driving pressure, making modest reductions in respiratory rate, while typically maintaining positive end-expiratory pressure levels unchanged.
Regarding ECCO2R treatment, higher efficiency devices are required in order to reduce significantly respiratory rate and/or tidal volume.

Summary
The best compromise between reduction of native lung ventilatory load, extracorporeal gas exchange efficiency, and strategies to preserve lung aeration deserves further investigation.
Setting positive end-expiratory pressure in the severely obstructive patient
Authors: Jubran Amal 
Published: December 2023

Purpose of review
The response to positive end-expiratory pressure (PEEP) in patients with chronic obstructive pulmonary disease (COPD) requiring mechanical ventilation depends on the underlying pathophysiology. This review focuses on the pathophysiology of COPD, especially intrinsic PEEP (PEEPi) and its consequences, and the benefits of applying external PEEP during assisted ventilation when PEEPi is present.

Recent findings
The presence of expiratory airflow limitation and increased airway resistance promotes the development of dynamic hyperinflation in patients with COPD during acute respiratory failure. Dynamic hyperinflation and the associated development of PEEPi increases work of breathing and contributes to ineffective triggering of the ventilator. In the presence of airflow limitation, application of external PEEP during patient-triggered ventilation has been shown to reduce inspiratory effort, facilitate ventilatory triggering and enhance patient-ventilator interaction. To minimize the risk of hyperinflation, it is advisable to limit the level of external PEEP during assisted ventilation after optimization of ventilator settings to about 70% of the level of PEEPi (measured during passive ventilation).

Summary
In patients with COPD and dynamic hyperinflation receiving assisted mechanical ventilation, the application of low levels of external PEEP can minimize work of breathing, facilitate ventilator triggering and improve patient-ventilator interaction.