bluuebunny/crossref_metadata_2025_split huggingface dataset:
Establishing excellence: Implementation of an onboarding and continuing education curriculum for pediatric intensive care unit nurse practitioners and physician associates
Authors: Thomas Jenilea K. , Arnold Megan A. , Woodend Kristen R. , Riccioni Mark J. , Rissmiller Brian J. 
Published: November 2023

ABSTRACT
This study describes a novel curriculum for onboarding and clinical education for nurse practitioners and physician associates (NPs and PAs) in the pediatric intensive care unit setting. The objective was to provide details on the initial orientation and continuing education program to ensure the attainment of knowledge and skills needed to care for critically ill patients safely and effectively. A needs assessment was completed, and a knowledge gap identified in five themes: (1) in-depth knowledge on common critical care diagnoses; (2) understanding of pathophysiology; (3) disease management processes; (4) critical thinking; and (5) procedure competency. Using Kern 6-step curriculum and the Kirkpatrick evaluation model, we designed a program for orientation and continuing education for critical care NPs and PAs. Transformative learning theory provided the framework for the program because the cyclical steps of disorienting dilemma, critical reflection, discourse, and action were used repeatedly to transform a new graduate to a competent critical care provider and then into an expert who is able to, in turn, teach others. A total of 31 NPs and 5 PAs completed the 12-week orientation phase. Participants reported that the orientation phase was valuable to their educational advancement and increased critical care knowledge. All participants showed improvement in knowledge, skills, and ability to provide competent patient care.
Stratification of acute myocardial and endothelial cell injury, salvage index and final infarct size by systematic microRNA profiling in acute ST-elevation myocardial infarction
Authors: Dawkins Sam , Digby Janet E. , Belgard T. Grant , Lee Regent , De Maria Giovanni Luigi , Banning Adrian P. , Kharbanda Rajesh K. ,   Oxford Acute Myocardial Infarction (OxAMI) Study, Mayr Manuel , Choudhury Robin P. , Channon Keith M. 
Published: November 2023

Aim
Acute injury and subsequent remodelling responses to ST-segment elevation myocardial infarction (STEMI) are major determinants of clinical outcome. Current imaging and plasma biomarkers provide delayed readouts of myocardial injury and recovery. Here, we sought to systematically characterize all microRNAs (miRs) released during the acute phase of STEMI and relate miR release to magnetic resonance imaging (MRI) findings to predict acute and late responses to STEMI, from a single early blood sample.

Methods and results
miRs were quantified in blood samples obtained from patients after primary PCI (PPCI) for STEMI. Cardiac MRI (cMRI) was performed to quantify myocardial edema, infarct size and salvage index. Regression models were constructed to predict these outcomes measures, which were then tested with a validation cohort. Transcoronary miR release was quantified from paired measurements of coronary artery and coronary sinus samples. A cell culture model was used to identify endothelial cell–derived miRs.
A total of 72 patients undergoing PPCI for acute STEMI underwent miR analysis and cMRI. About >200 miRs were detectable in plasma after STEMI, from which 128 miRs were selected for quantification in all patients. Known myocardial miRs demonstrated a linear correlation with troponin release, and these increased across the transcoronary gradient. We identified novel miRs associated with microvascular injury and myocardial salvage. Regression models were constructed using a training cohort, then tested in a validation cohort, and predicted myocardial oedema, infarct size and salvage index.

Conclusion
Analysis of miR release after STEMI identifies biomarkers that predict both acute and late outcomes after STEMI. A novel miR-based biomarker score enables the estimation of area at risk, late infarct size and salvage index from a single blood sample 6 hours after PPCI, providing a simple and rapid alternative to serial cMRI characterization of STEMI outcome.
Serial fractional flow reserve, coronary flow reserve and index of microcirculatory resistance after percutaneous coronary intervention in patients treated for stable angina pectoris assessed with PET
Authors: Bendix Kristoffer , Thomassen Anders , Junker Anders , Veien Karsten Tange , Jensen Lisette Okkels 
Published: November 2023

Background
Cardiac 15O-water PET is a noninvasive method to evaluate epicardial and microvascular dysfunction and further quantitate absolute myocardial blood flow (MBF).

Aim:
The aim of this study was to assess the impact of revascularization on MBF and myocardial flow reserve (MFR) assessed with 15O-water PET and invasive flow and pressure measurements.

Methods
In 21 patients with single-vessel disease referred for percutaneous coronary intervention (PCI), serial PET perfusion imaging and fractional flow reserve (FFR), coronary flow reserve (CFR) and index of microcirculatory resistance (IMR) were performed during PCI and after 3 months.

Results
In the affected myocardium, stress MBF and MFR increased significantly from before revascularization to 3 months after revascularization: stress MBF 2.4 ± 0.8 vs. 3.2 ± 0.8; P < 0.001 and MFR 2.5 ± 0.8 vs. 3.4 ± 1.1; P = 0.004. FFR and CFR increased significantly from baseline to after revascularization and remained stable from after revascularization to 3-month follow-up: FFR 0.64 ± 0.20 vs. 0.91 ± 0.06 vs. 0.91 ± 0.07; P < 0.001; CFR 2.4 ± 1.2 vs. 3.6 ± 1.9 vs. 3.6 ± 1.9; P < 0.001, whereas IMR did not change significantly: 30.3 ± 22.9 vs. 30.1 ± 25.3 vs. 31.9 ± 25.2; P = ns. After revascularization, an increase in stress MBF was associated with an increase in FFR (r = 0.732; P < 0.001) and an increase in MFR (r = 0.499; P = 0.021). IMR measured before PCI was inversely associated with improvement in stress MBF, (r = −0.616; P = 0.004).

Conclusion
Recovery of myocardial perfusion after PCI was associated with an increase in FFR 3 months after revascularization. Microcirculatory dysfunction was associated with less improvement in myocardial perfusion.
Fibrous dysplasia in children and its management
Authors: Gun Zubeyir Hasan , Arif Aleena , Boyce Alison M. 
Published: November 2023

Purpose of review
The purpose of this review is to provide a comprehensive overview into the diagnosis and management of fibrous dysplasia (FD) in children.

Recent Findings
FD is a mosaic disorder arising from somatic Gαs variants, leading to impaired osteogenic cell differentiation. Fibro-osseous lesions expand during childhood and reach final disease burden in early adulthood. The mainstay of treatment focuses on surgical correction of skeletal deformities, physiatric care, and medical management of associated hyperfunctioning endocrinopathies. Bisphosphonates may be helpful to treat bone pain, but do not alter lesion quality or progression. Emerging evidence suggests that the RANKL inhibitor denosumab may be effective in improving lesion activity and mineralization, however further studies are needed to determine the potential utility of this and other novel therapies, particularly in children with FD.

Summary
Management of children with FD has unique challenges related to skeletal growth and age-related lesion progression. Inclusion of children in clinical research is critical to develop effective treatment strategies to treat FD lesions and prevent their development.
Longitudinally extensive transverse myelitis, a disabling disorder with a good prognosis: a case series from Nepal
Authors: Dhakal Bishal , Bogati Kanchan , Baniya Sunil , Muhammad Qurat U. A. , Pathak Bishnu D. , Pokharel Rojina , Adhikari Sandip , Upadhaya Regmi Binit , Subedi Ram C. , Pant Prashant , Paudel Raju 
Published: November 2023

Introduction:Longitudinally extensive transverse myelitis (LETM) is a rare spinal cord disorder with variable etiologies and presentations. It can present solely or as an association with other neurological disorders.Methodology:It was a series of cases of LETM in a tertiary care hospital.Clinical presentation and outcomes:The initial three cases presented with bilateral lower extremity weakness and were diagnosed as transverse myelitis while, the fourth case, already diagnosed as LETM presented with seizure followed by loss of consciousness. All four cases had a good prognosis to date with continued physiotherapy.Conclusion:The early diagnosis of the disease helps to guide the optimal management and decide the potential need for physiotherapy.
Effectiveness of Dyadic Psychoeducational Intervention on Cancer Patients and Their Caregivers
Authors: Chen Daoming , Liu Qing , Zhang Linlin , Qian Hongying 
Published: November 2023

Background
Dyadic psychoeducational intervention targets the dyads of cancer patients and caregivers as active participants in partnership, which can potentially address the needs and challenges faced by patients with cancer and their caregivers. However, there is insufficient evidence on the effectiveness of the intervention on psychological health and illness-related outcomes among the dyads.

Objective
To systematically examine the dyadic psychoeducational intervention of cancer patients and their caregivers on psychological health and illness-related outcomes.

Methods
Cochrane Library, EMBASE, CINAHL, PsycINFO, PubMed, Web of Science, and 4 Chinese databases were searched from inception to May 29, 2022. Two investigators independently extracted data and evaluated methodological quality. RevMan 5.4 was used for meta-analysis; heterogeneity was evaluated using Higgins’ I
2 (%). Standardized mean difference (SMD) with a 95% confidence interval (CI) was used to assess the effects.

Results
Eight randomized controlled trials that involved 1234 dyads were collected. Meta-analysis showed that the intervention was effective in reducing the dyadic depression (patients’ SMD, −0.41 [95% CI, −0.78 to −0.04; P = .03]; caregivers’ SMD, −0.70 [95% CI, −1.31 to −0.09; P = .03]). It also improved caregivers’ quality of life (SMD, −0.29 [95% CI, −0.56 to −0.03; P = .03]), whereas no significant effect was found on patients’ quality of life. Dyadic results including anxiety, self-efficacy, disease communication, and appraisals of illness/caregiving were observed.

Conclusion
Dyadic psychoeducational intervention reduced the dyadic depression. It also improved caregivers’ quality of life.

Implications for Practice
Nurses can apply dyadic psychoeducational intervention in clinical practice. More studies are needed to draw higher-quality conclusions and investigate the effects on psychological health and illness-related outcomes in cancer patients and caregivers.
Knockdown of circ_0114428 alleviates LPS-induced HK2 cell apoptosis and inflammation injury via targeting miR-215-5p/TRAF6/NF-κB axis in Septic acute kidney injury
Authors: Li Yan , Zhang Chunmei , Zhao Zhongyan 
Published: November 2023

AbstractBackgroundSepsis is a systemic inflammatory disease that can cause multiple organ damage. Circular RNAs (circRNAs) have been reported to play a regulatory role in sepsis-induced acute kidney injury (AKI), however, the role of circ_0114428 has not been studied.MethodsIn this study, HK2 cells were treated with different concentrations of lipopolysaccharide (LPS) to induce cell damage, and then the expressions of circ_0114428, microRNA-215-5p (miR-215-5p), tumor necrosis factor receptor-associated factor 6 (TRAF6) were detected by quantitative real-time polymerase chain reaction (qRT-PCR), and western blot examined the Bax and Cleaved-caspase-3 proteins. Cell proliferation was detected by 3-(4, 5-dimethylthiazol-2-yl)-2, 5-diphenyltetrazolium bromide (MTT) assay and thymidine analog 5-ethynyl-2’-deoxyuridine (EdU) assay. And cell apoptosis was detected by flow cytometry, and the levels of inflammatory factors were detected by ELISA.ResultsAfter LPS treatment with different concentrations, we found that LPS at 10 μg/mL had the best effect on HK2 cells. Circ_0114428 was highly expressed in sepsis-AKI patients and LPS-treated HK2 cells. Knockdown of circ_0114428 restored the effects of LPS treatment on proliferation, apoptosis and inflammatory response of HK2 cells. MiR-215-5p was a target of circ_0114428, and TRAF6 was a downstream target of miR-215-5p. Circ_0114428 regulated TRAF6 expression by sponging miR-215-5p in LPS-treated HK2 cells. Circ_0114428 regulated LPS-induced NF-κB signaling in HK2 cells by targeting miR-215-5p/TRAF6 axis.ConclusionCirc_0114428 knockdown abolished the cell proliferation, apoptosis and inflammatory damage in LPS-induced HK2 cells by targeting miR-215-5p/TRAF6/NF-κB.
PROLONGED MECHANICAL VENTILATION IN ACUTE RESPIRATORY DISTRESS SYNDROME
Authors: Andrianopoulos Ioannis , Giannakoulis Vassilis G. , Papoutsi Eleni , Papathanakos Georgios , Koulouras Vasilios , Thompson B. Taylor , Siempos Ilias I. 
Published: November 2023

ABSTRACT

Purpose: Trajectory of acute respiratory distress syndrome (ARDS) spans from rapidly improving cases to cases receiving prolonged mechanical ventilation (PMV). We attempted to estimate temporal trends of prevalence and mortality of PMV and to identify risk factors associated with mortality of patients with ARDS receiving PMV. Methods: We performed a secondary analysis of individual patient data from six randomized controlled clinical trials conducted by the ARDS Network. Prolonged mechanical ventilation was defined as the need for mechanical ventilation for >21 consecutive days. Results: Of 4,216 patients with ARDS, 646 (15.3%) received PMV. Prevalence of PMV gradually declined from 18.4% in the ARDS Network: Low-Tidal-Volume Trial (published in 2000) trial to 10.9% in the SAILS (2014) trial (R
2 = 0.728, P = 0.031). Ninety-day mortality of patients receiving PMV did not change over time (R
2 = 0.271, P = 0.290) and remained as high as 36.8%. Ιn the three most recent trials, risk factors associated with mortality among the 250 patients with ARDS receiving PMV included age, malignancy, pneumonia as the cause of ARDS, coagulation dysfunction, and hepatic dysfunction during the first 21 days after trial enrollment. Conclusion: Although prevalence of PMV among patients enrolled in ARDS Network trials gradually declined, mortality did not change. Risk factors associated with mortality were mostly nonmodifiable.
New predictive biomarkers for screening COVID-19 patients with rhabdomyolysis in combination with cystatin C
Authors: Yu Mengyang , Zhang Chengying , Wan Sitong , Lu Yang , Wang Yufei , Liu Ting , Wang Huimin , Chen Wei , Liu Yahua 
Published: November 2023

Abstract

Purpose
Cystatin C (CysC) has been linked to the prognosis of Corona Virus Disease 2019 (COVID-19). The study aims to investigate a predictor correlated with CysC screening for poor prognosis in COVID-19 patients combined with skeletal muscle (SKM) impairment and rhabdomyolysis (RM).

Methods
A single-center retrospective cohort analysis was carried out. Demographic information, clinical data, laboratory test results, and clinical outcome data were gathered and analyzed.

Results
According to the inclusion and exclusion criteria, 382 patients were included in this study. The subjects were divided into three groups based on CysC tertiles. Multivariate analysis revealed that SaO2 (HR 0.946, 95%CI: 0.906-0.987, P = 0.011), CysC (HR 2.124, 95%CI: 1.223-3.689, P = 0.008), AST (HR 1.009, 95%CI. 1.000-1.018, P = 0.041), and hypersensitive CRP (HR 1.005, 95%CI: 1.000-1.010, P = 0.045) were significantly associated with survivals. The area under curve (AUC) in the model characterized by RM incidence was 0.819 (0.698-0.941), as shown by CysC ROC curves. LDH*CysC and AST*CysC had better predictive values than CysC, and the best prediction for RM, with an AUC of 0.880 (0.796,0.964) for LDH*CysC (P<0.05, vs CysC) and 0.925 (0.878,0.972) for AST*CysC (P<0.05, vs CysC).

Conclusion
CysC is an essential evaluation indicator for COVID-19 patients’ prognosis. AST*CysC and LDH*CysC have superior predictive value to CysC for SKM, RM, and death, and optimal classification for RM.
Machine Learning for Predicting Hemodynamic Deterioration of Patients with Intermediate-risk Pulmonary Embolism in Intensive Care Unit
Authors: Xu Jiatang , Hu Zhensheng , Miao Jianhang , Cao Lin , Tian Zhenluan , Yao Chen , Huang Kai 
Published: November 2023

ABSTRACT

Background
Intermediate-risk pulmonary embolism (PE) patients in the Intensive Care Unit (ICU) are at a higher risk of hemodynamic deterioration than those in the general ward. This study aims to construct a machine learning (ML) model to accurately identify the tendency for hemodynamic deterioration in ICU’s patients with intermediate-risk PE.

Method
A total of 704 intermediate-risk PE patients from the MIMIC-IV database were retrospectively collected. The primary outcome was defined as hemodynamic deterioration occurring within 30 days after admission to ICU. Four ML algorithms were used to construct models on the basis of all variables from MIMIC IV database with missing values less than 20%. The XGBoost model was further simplified for clinical application. The performance of the ML models was evaluated by using the receiver operating characteristic curve (ROC), calibration plots and decision curve analysis (DCA). Predictive performance of simplified XGBoost was compared with sPESI score. SHAP was performed on simplified XGBoost model to calculate the contribution and impact of each feature on the predicted outcome and presents it visually.

Results
Among the 704 intermediate-risk PE patients included in this study, 120 patients experienced hemodynamic deterioration within 30 days after admission to the ICU. Simplified XGBoost model demonstrated the best predictive performance with an AUC of 0.866 (95% CI: 0.800-0.925), and after recalibrated by isotonic regression, the AUC improved to 0.885 (95% CI: 0.822-0.935). Based on simplified XGBoost model, a Web APP was developed to identify the tendency for hemodynamic deterioration in ICU’s intermediate-risk PE patients.

Conclusion
Simplified XGBoost model can accurately predict the occurrence of hemodynamic deterioration for intermediate-risk PE patients in ICU, assisting clinical workers in providing more personalized management for PE patients in the ICU.
METFORMIN MITIGATES SEPSIS-ASSOCIATED PULMONARY FIBROSIS BY PROMOTING AMPK ACTIVATION AND INHIBITING HIF-1α–INDUCED AEROBIC GLYCOLYSIS
Authors: Zhong Han , Tang Ri , Feng Jin-Hua , Peng Ya-Wen , Xu Qiao-Yi , Zhou Yang , He Zheng-Yu , Mei Shu-Ya , Xing Shun-Peng 
Published: November 2023

ABSTRACTRecent research has revealed that aerobic glycolysis has a strong correlation with sepsis-associated pulmonary fibrosis (PF). However, at present, the mechanism and pathogenesis remain unclear. We aimed to test the hypothesis that the adenosine monophosphate-activated protein kinase (AMPK) activation and suppression of hypoxia-inducible factor 1α (HIF-1α)–induced aerobic glycolysis play a central role in septic pulmonary fibrogenesis. Cellular experiments demonstrated that lipopolysaccharide increased fibroblast activation through AMPK inactivation, HIF-1α induction, alongside an augmentation of aerobic glycolysis. By contrast, the effects were reversed by AMPK activation or HIF-1α inhibition. In addition, pretreatment with metformin, which is an AMPK activator, suppresses HIF-1α expression and alleviates PF associated with sepsis, which is caused by aerobic glycolysis, in mice. Hypoxia-inducible factor 1α knockdown demonstrated similar protective effectsin vivo. Our research implies that targeting AMPK activation and HIF-1α–induced aerobic glycolysis with metformin might be a practical and useful therapeutic alternative for sepsis-associated PF.
PROTECTIVE ROLE OF MELATONIN FOR ACUTE KIDNEY INJURY: A SYSTEMATIC REVIEW AND META-ANALYSIS
Authors: Yue Jing , Bao Xin , Meng Ling-Fei 
Published: November 2023

ABSTRACTIntroduction: Acute kidney injury (AKI) is an important clinical issue that arouses global concerns, which puzzles clinicians and lacks effective drug treatment for AKI until the present. Melatonin has been well recognized to modulate the sleep-wake cycle and had the renal protective effect. However, there are still few clinical trials investigating the relationship between melatonin and AKI. The conclusions drawn in existing clinical studies are still inconsistent. The study systematically reviewed and assessed the efficacy of melatonin in preventing AKI.Methods: A systematic literature search was conducted in the PubMed, Embase, and Cochranelibrary on May 19, 2023. Eligible records were screened according to the inclusion and exclusion criteria. The risk ratio and the corresponding 95% confidence intervals were selected to evaluate the effects of melatonin on AKI. We pooled extracted data using a fixed- or random effects model based on a heterogeneity test.Results: Six randomized controlled trials regarding the use of melatonin in preventing kidney injury met our inclusion criteria. The pooled results showed that melatonin increased the estimated glomerular filtration rate, and effectively inhibited the occurrence of AKI. Melatonin tended to reduce the serum creatinine and urea nitrogen levels, but there was no statistical significance.Conclusions: Melatonin can increase the estimated glomerular filtration rate and effectively inhibit the occurrence of AKI. More well-designed randomized controlled trials are needed to verify the protective effect of melatonin in the future.
COMPARISON BETWEEN ACTIVE ABDOMINAL COMPRESSION-DECOMPRESSION CARDIOPULMONARY RESUSCITATION AND STANDARD CARDIOPULMONARY RESUSCITATION IN ASPHYCTIC CARDIAC ARREST RATS WITH MULTIPLE RIB FRACTURES
Authors: Dai Zhichu , Zhang Sisen , Wang Hongyu , He Liwei , Liao Jiankun , Wu Xuanyu 
Published: November 2023

ABSTRACTBackground:Active abdominal compression-decompression cardiopulmonary resuscitation (AACD-CPR) is potentially more effective for cardiac arrest (CA) with multiple rib fractures. However, its effect on survival rates and neurological outcomes remains unknown. This study aimed to assess if AACD-CPR improves survival rates and neurological outcomes in a rat model of asphyctic CA with multiple rib fractures.Methods:Adult male Sprague-Dawley rats were randomized into three groups—AACD group (n = 15), standard cardiopulmonary resuscitation (STD-CPR) group (n = 15), and sham group (n = 10)—after bilateral rib fractures were surgically created and endotracheal intubation was performed. AACD-CPR and STD-CPR groups underwent 8 min of asphyxia followed by different CPR techniques. The sham group had venous catheterization only. Physiological variables and arterial blood gases were recorded at baseline and during a 4-h monitoring period. Neurological deficit scores (NDSs) and cumulative survival rates were assessed at 24, 48, and 72 h. NDS, serum biomarkers, and hippocampal neuron analysis were used to evaluate neurological outcomes.Results:No statistical differences were observed in the return of spontaneous circulation (ROSC), 24-, 48-, and 72-h survival rates between the AACD-CPR and STD-CPR groups. AACD-CPR rats had lower serum levels of neuron-specific enolase and S100B at 72 h post-ROSC, and higher NDS at 72 h post-ROSC compared with STD-CPR animals. Cellular morphology analysis, hematoxylin and eosin staining, and TUNEL/DAPI assays showed more viable neurons and fewer apoptotic neurons in the AACD-CPR group than in the STD-CPR group.Conclusions:AACD-CPR can achieve similar survival rates and better neurological outcome after asphyxial CA in rats with multiple rib fractures when compared with STD-CPR.