bluuebunny/crossref_metadata_2025_split huggingface dataset:
1046 Severe hypoventilation in a child with rapid onset weight gain
Authors: Zaman Jefrina , Bhamrah Paul , Koothirezhi Rupa , Liendo Cesar , Monceaux Brittany , Chernyshev Oleg 
Published: May 2023

Abstract

Introduction
Pediatric sleep-related hypoventilation is a clinical pattern in which ventilatory insufficiency occurs in the setting of either severe OSA (obstructive hypoventilation) or obesity hypoventilation (sleep related hypoventilation). We are reporting a case describing the management of overlapping obstructive hypoventilation due to uncontrolled severe OSA and pediatric obesity hypoventilation syndrome.

Report of case(s)
The patient is a full term African American 5 y/o male with past medical history of obesity and prediabetes who was referred to discuss sleep related problems after rapid onset of weight gain.He gained 76 lbs over 8-month period; during this time his aunt noticed apneic events with the development of loud snoring.Initial workup was negative for abnormal findings,MRI w/w/o was unremarkable and TSH, cortisol, GH, IGF-1 and prolactin were all within normal limits. X-ray bone age study showed skeletal age appropriate for patient's chronologic age.Upper airway exam showed severe tonsillar hypertrophy 3+ with Mallampati class 4.The diagnostic PSG demonstrated the presence of 12 obstructive, 151 central, and 61 mixed apneas.There were 214 hypopneas resulting in an Apnea\Hypopnea Index of 60.5 events per hour.Mean oxygen saturation was 91.3%.The lowest oxygen saturation during sleep was 64.0%.Time spent ≤88% oxygen saturation was 119.7 minutes (26.2%). End tidal CO2 range was between 50-100 mmHg for 30% of study.The titration study revealed that the optimal treatment modality was BiPAP ST.

Conclusion
This case focuses on a five-year-old male who experienced rapid onset weight gain and presented with snoring, excessive daytime sleepiness and apneic events and was found to have profound hypoventilation with hypopnea predominant severe obstructive sleep apnea.The initial differential diagnosis of pediatric sleep-related hypoventilation includes ROHHAD, congenital central hypoventilation syndrome, primary central sleep apnea and obesity hypoventilation syndrome.The most common cause of hypoventilation during sleep in children remains OSA.The stepwise approach to management in such a case includes tonsillectomy with adenoidectomy,along with use of BiPAP. After the T&A the patient should have repeat PSG with capnography, if hypercarbia persists on post procedure PSG, he will need to continue BiPAP therapy with appropriate weight loss program. Early recognition evaluation, and treatment of obstructive sleep apnea in the pediatric population is imperative to prevent long-term consequences.

Support (if any)
Eye movements during phasic versus tonic rapid eye movement sleep are biomarkers of dissociable electroencephalogram processes for the consolidation of novel problem-solving skills
Authors: van den Berg Nicholas H , Gibbings Aaron , Baena Daniel , Pozzobon Alyssa , Al-Kuwatli Julia , Ray Laura B , Fogel Stuart M 
Published: May 2023

Abstract
The hallmark eye movement (EM) bursts that occur during rapid eye movement (REM) sleep are markers of consolidation for procedural memory involving novel cognitive strategies and problem-solving skills. Examination of the brain activity associated with EMs during REM sleep might elucidate the processes involved in memory consolidation, and may uncover the functional significance of REM sleep and EMs themselves. Participants performed a REM-dependent, novel procedural problem-solving task (i.e. the Tower of Hanoi; ToH) before and after intervals of either overnight sleep (n = 20) or a daytime 8-hour wake period (n = 20). In addition, event-related spectral perturbation of the electroencephalogram (EEG) time-locked to EMs occurring either in bursts (i.e. phasic REM), or in isolation (i.e. tonic REM), were compared to sleep on a non-learning control night. ToH improvement was greater following sleep compared to wakefulness. During sleep, prefrontal theta (~2–8 Hz) and central-parietal-occipital sensorimotor rhythm (SMR) activity (~8–16 Hz) time-locked to EMs, were greater on the ToH night versus control night, and during phasic REM sleep, were both positively correlated with overnight memory improvements. Furthermore, SMR power during tonic REM increased significantly from the control night to ToH night, but was relatively stable from night to night during phasic REM. These results suggest that EMs are markers of learning-related increases in theta and SMR during phasic and tonic REM sleep. Phasic and tonic REM sleep may be functionally distinct in terms of their contribution to procedural memory consolidation.
Efficacy of once-nightly sodium oxybate (FT218) in narcolepsy type 1 and type 2: post hoc analysis from the Phase 3 REST-ON Trial
Authors: Dauvilliers Yves , Roth Thomas , Bogan Richard , Thorpy Michael J , Morse Anne Marie , Roy Asim , Dubow Jordan , Gudeman Jennifer 
Published: May 2023

Abstract

Study Objectives
Post hoc analyses from the phase 3 REST-ON trial evaluated efficacy of extended-release once-nightly sodium oxybate (ON-SXB; FT218) vs placebo for daytime sleepiness and disrupted nighttime sleep in narcolepsy type 1 (NT1) and 2 (NT2).

Methods
Participants were stratified by narcolepsy type and randomized 1:1 to ON-SXB (4.5 g, week 1; 6 g, weeks 2–3; 7.5 g, weeks 4–8; and 9 g, weeks 9–13) or placebo. Assessments included mean sleep latency on Maintenance of Wakefulness Test (MWT) and Clinical Global Impression-Improvement (CGI-I) rating (coprimary endpoints) and sleep stage shifts, nocturnal arousals, and patient-reported sleep quality, refreshing nature of sleep, and Epworth Sleepiness Scale (ESS) score (secondary endpoints) separately in NT1 and NT2 subgroups.

Results
The modified intent-to-treat population comprised 190 participants (NT1, n = 145; NT2, n = 45). Significant improvements were demonstrated with ON-SXB vs placebo in sleep latency for NT1 (all doses, p &lt; .001) and NT2 (6 and 9 g, p &lt; .05) subgroups. Greater proportions of participants in both subgroups had CGI-I ratings of much/very much improved with ON-SXB vs placebo. Sleep stage shifts and sleep quality significantly improved in both subgroups (all doses vs placebo, p &lt; .001). Significant improvements with all ON-SXB doses vs placebo in refreshing nature of sleep (p &lt; .001), nocturnal arousals (p &lt; .05), and ESS scores (p ≤ .001) were reported for NT1 with directional improvements for NT2.

Conclusions
Clinically meaningful improvements of a single ON-SXB bedtime dose were shown for daytime sleepiness and DNS in NT1 and NT2, with less power for the limited NT2 subgroup.
Evaluating the temperature preferences of sexually mature Duroc, Landrace, and Yorkshire boars
Authors: Raber Victoria L , Pritchett Rebecca K , Robbins Lindsey A , Stewart Kara R , Gaskill Brianna N , Green-Miller Angela R , Johnson Jay S 
Published: May 2023

Abstract
An accurate understanding of boar temperature preferences may allow the swine industry to design and utilize environmental control systems in boar facilities more precisely. Therefore, the study objective was to determine the temperature preferences of sexually mature Duroc, Landrace, and Yorkshire boars. Eighteen, 8.57 ± 0.10-mo-old boars (N = 6 Duroc, 6 Landrace, and 6 Yorkshire; 186.25 ± 2.25 kg) were individually tested in thermal apparatuses (12.20 m × 1.52 m × 1.86 m) that allowed free choice of their preferred temperature within a 8.92 to 27.92 ºC range. For analyses, the apparatuses were divided into five thermal zones (3.71 m2/thermal zone) with temperature recorded 1.17 m above the floor in the middle of each zone. Target temperatures for thermal zones 1 to 5 were 10, 15, 20, 25, and 30 ºC, respectively. All boars were given a 24-h acclimation phase followed by a 24-h testing phase within the thermal apparatuses. Daily feed allotments (3.63 kg/d) were provided to each boar and all boars were allowed to consume all feed prior to entering the thermal apparatus. Water was provided ad libitum within the thermal apparatuses with 1 waterer per thermal zone. During testing, boars were video recorded continuously to evaluate behavior (inactive, active, or other), posture (lying, standing, or other), and thermal zone the boar occupied. All parameters were recorded in 15 min intervals using instantaneous scan sampling. Data were analyzed using GLM in JMP 15. For the analyses, only time spent lying or inactive were used because they were observed most frequently (lying 80.02%, inactive 77.64%) and were deemed to be associated with comfort based on previous research. Percent time spent active (19.73%) or standing (15.87%) were associated with latrine or drinking activity and were too low to accurately analyze as an indicator of thermal preference. Breed did not affect temperature preference (P &gt; 0.05). A cubic regression model determined that boars spent the majority of their time inactive at 25.50 ºC (P &lt; 0.01) and lying (both sternal and lateral) at 25.90 ºC (P &lt; 0.01). These data suggest that boar thermal preferences did not differ by breed and that boars prefer temperatures at the upper end of current guidelines (10.00 to 25.00 ºC).
Cardioprotective role of the coenzyme Q10 and coconut oil in acute aluminum phosphide poisoning: a randomized controlled clinical trial
Authors: Elsharkawy Rasha E , Ghonem Mona M , El-Sarnagawy Ghada N , Nagy Ayman A , Heshmat Mona M 
Published: May 2023

AbstractAluminum phosphide (ALP)-induced cardiotoxicity is a major cause of high mortality rates. As there is no specific antidote, restoring cardiac hemodynamics is the cornerstone for saving patients. Based on oxidative stress theory in acute ALP poisoning, we examined the cardioprotective role of coconut oil and Coenzyme Q10 (COQ10) in ALP poisoning, focusing on their antioxidant capacity. This study was a randomized, controlled, single-blind, phase II clinical trial conducted at Tanta Poison Control Center over 1 year. Eighty-four ALP poisoned patients received supportive treatment and were randomly allocated to three equal groups. Gastric lavage was performed using sodium bicarbonate 8.4% with saline in group I. Alternatively, group II received 50 ml coconut oil, and group III initially received 600 mg CoQ10 dissolved in 50 ml coconut oil; and repeated 12 hours later. In addition to patient characteristics, clinical, laboratory, electrocardiography (ECG), and total antioxidant capacity (TAC) data were recorded and repeated 12 hours later. Patient outcomes were evaluated. There was no significant difference among groups considering patient characteristics, initial cardiotoxicity severity, vital, laboratory data, ECG changes, and TAC. However, 12 hours post-admissions, group III was significantly improved in all clinical, laboratory, and ECG parameters than comparable groups. Significant correlations were observed between elevated TAC in groups II and III with hemodynamic, serum troponin, and ECG variables. Accordingly, the need for intubation, mechanical ventilation, and the total vasopressor dose was significantly decreased in group III compared with other groups. Therefore, coconut oil and COQ10 are promising cardioprotective adjuvant therapy ameliorating the ALP-induced cardiotoxicity.
High-Quality Genome of the Tree Pathogen Phytophthora plurivora—A Novel Resource for Epidemiological Research
Authors: Tsykun T. , Mishra B. , Ploch S. , Briseño R. I. Alcalá , Prospero S. , Grünwald N. J. , Thines M. 
Published: May 2023

Phytophthora plurivora can affect a range of ecologically and silviculturally important tree species, including European beech ( Fagus sylvatica), a common late successional tree species native to Europe. Here, we report on the high-quality genome of P. plurivora strain TJ71 (CBS 124093). We sequenced it using Oxford Nanopore MinION and PacBio Sequel II long-read sequencing with 80× coverage, chromatin conformation capture (Hi-C) sequencing with 400× coverage, and DNBSEQ 150-bp paired-end short reads sequencing with 200× coverage. This complex sequencing approach allowed for assembly of the genome at the chromosome level. Specifically, the P. plurivora genome resulted in 18 scaffolds of 47 Mbp total size with 95% completeness of the eukaryotic gene set as implemented in BUSCO. This is a considerable improvement relative to the previous NCBI reference genome of P. plurivora (NMPK00000000.1) with ∼41 Mbp organized in 1,898 scaffolds with 93.8% eukaryotic BUSCO completeness. This high-quality genome provides a valuable resource for further evolutionary, epidemiological, and population genomic studies. [Formula: see text] Copyright © 2023 The Author(s). This is an open access article distributed under the CC BY-NC-ND 4.0 International license .
Prevalence and Characteristics of Diagnostic Error in Pediatric Critical Care: A Multicenter Study*
Authors: Cifra Christina L. , Custer Jason W. , Smith Craig M. , Smith Kristen A. , Bagdure Dayanand N. , Bloxham Jodi , Goldhar Emily , Gorga Stephen M. , Hoppe Elizabeth M. , Miller Christina D. , Pizzo Max , Ramesh Sonali , Riffe Joseph , Robb Katharine , Simone Shari L. , Stoll Haley D. , Tumulty Jamie Ann , Wall Stephanie E. , Wolfe Katie K. , Wendt Linder , Ten Eyck Patrick , Landrigan Christopher P. , Dawson Jeffrey D. , Reisinger Heather Schacht , Singh Hardeep , Herwaldt Loreen A. 
Published: May 2023

OBJECTIVES:
Effective interventions to prevent diagnostic error among critically ill children should be informed by diagnostic error prevalence and etiologies. We aimed to determine the prevalence and characteristics of diagnostic errors and identify factors associated with error in patients admitted to the PICU.

DESIGN:
Multicenter retrospective cohort study using structured medical record review by trained clinicians using the Revised Safer Dx instrument to identify diagnostic error (defined as missed opportunities in diagnosis). Cases with potential errors were further reviewed by four pediatric intensivists who made final consensus determinations of diagnostic error occurrence. Demographic, clinical, clinician, and encounter data were also collected.

SETTING:
Four academic tertiary-referral PICUs.

PATIENTS:
Eight hundred eighty-two randomly selected patients 0–18 years old who were nonelectively admitted to participating PICUs.

INTERVENTIONS:
None.

MEASUREMENTS AND MAIN RESULTS:
Of 882 patient admissions, 13 (1.5%) had a diagnostic error up to 7 days after PICU admission. Infections (46%) and respiratory conditions (23%) were the most common missed diagnoses. One diagnostic error caused harm with a prolonged hospital stay. Common missed diagnostic opportunities included failure to consider the diagnosis despite a suggestive history (69%) and failure to broaden diagnostic testing (69%). Unadjusted analysis identified more diagnostic errors in patients with atypical presentations (23.1% vs 3.6%, p = 0.011), neurologic chief complaints (46.2% vs 18.8%, p = 0.024), admitting intensivists greater than or equal to 45 years old (92.3% vs 65.1%, p = 0.042), admitting intensivists with more service weeks/year (mean 12.8 vs 10.9 wk, p = 0.031), and diagnostic uncertainty on admission (77% vs 25.1%, p < 0.001). Generalized linear mixed models determined that atypical presentation (odds ratio [OR] 4.58; 95% CI, 0.94–17.1) and diagnostic uncertainty on admission (OR 9.67; 95% CI, 2.86–44.0) were significantly associated with diagnostic error.

CONCLUSIONS:
Among critically ill children, 1.5% had a diagnostic error up to 7 days after PICU admission. Diagnostic errors were associated with atypical presentations and diagnostic uncertainty on admission, suggesting possible targets for intervention.
Transversus thoracic muscle plane block for pain during cardiac surgery: a systematic review and meta-analysis
Authors: Xue Jian-jun , Cui Yi-yang , Busse Jason W. , Ge Long , Zhou Ting , Huang Wei-hua , Ding Sheng-shuang , Zhang Jie , Yang Ke-hu 
Published: May 2023

Study Objective:
The role of transversus thoracic muscle plane blocks (TTMPBs) during cardiac surgery is controversial. We conducted a systematic review to establish the effectiveness of this procedure.

Design:
Systematic review. We searched PubMed, Embase, Web of Science, CENTRAL, WanFang Data, and the China National Knowledge Infrastructure to June 2022, and followed the GRADE approach to evaluate the certainty of evidence.

Study Eligibility Criteria:
Eligible studies enrolled adult patients scheduled to undergo cardiac surgery and randomized them to receive a TTMPB or no block/sham block.

Main Results:
Nine trials that enrolled 454 participants were included. Compared to no block/sham block, moderate certainty evidence found that TTMPB probably reduces postoperative pain at rest at 12h (weighted mean difference [WMD] −1.51 cm on a 10 cm visual analogue scale for pain, 95% CI -2.02 to -1.00; risk difference [RD] for achieving mild pain or less (≤3 cm), 41%, 95%CI 17 to 65) and 24h (WMD −1.07 cm, 95%CI −1.83 to −0.32; RD 26%, 95%CI 9 to 37). Moderate certainty evidence also supported that TTMPB probably reduces pain during movement at 12h (WMD -3.42 cm, 95%CI −4.47 to −2.37; RD 46%, 95%CI 12 to 80) and at 24h (WMD −1.73 cm, 95%CI −3.24 to −0.21; RD 32%, 95%CI 5 to 59), intraoperative opioid use (WMD −28 milligram morphine equivalent [MME], 95%CI −42 to −15), postoperative opioid consumption (WMD −17 MME, 95%CI −29 to −5), postoperative nausea and vomiting (absolute risk difference 255 less per 1000 persons, 95%CI 140 to 314), and ICU length of stay (WMD −13 h, 95%CI −21 to −6).

Conclusion:
Moderate certainty evidence showed TTMPB during cardiac surgery probably reduces postoperative pain at rest and with movement, opioid consumption, ICU length of stay, and the incidence of nausea and vomiting.
Rural-urban differences in characteristics, postoperative outcomes, and costs for patients undergoing knee arthroplasty: a national retrospective propensity score matched cohort study
Authors: Long Huizhong , Xie Dongxing , Chen Hu , Wei Jie , Li Xiaoxiao , Wang Haibo , Zeng Chao , Lei Guanghua 
Published: May 2023

Background:
The rural-urban disparities in postoperative complications and costs among patients undergoing knee arthroplasty (KA) have not been thoroughly explored. This study aimed to determine whether such differences exist in this patient population.

Material and methods:
The study was conducted using data from the national Hospital Quality Monitoring System of China. Hospitalized patients undergoing KA from 2013 to 2019 were enrolled. Patient and hospital characteristics were compared between rural and urban patients, and differences in postoperative complications, readmissions, and hospitalization costs were analyzed using propensity score matching.

Results:
Of the 146,877 KA cases analyzed, 71.4% (104,920) were urban patients and 28.6% (41,957) were rural patients. Rural patients tended to be younger (64.4±7.7 y vs. 68.0±8.0 y; P<0.001) and had fewer comorbidities. In the matched cohort of 36,482 participants per group, rural patients were found to be more likely to experience deep vein thrombosis (OR: 1.31, 95% CI: 1.17-1.46; P<0.001) and require RBC transfusion (OR: 1.38, 95% CI: 1.31-1.46; P<0.001). However, they had a lower incidence of readmission within 30 days (OR: 0.65, 95% CI: 0.59-0.72; P<0.001) and readmission within 90 days (OR: 0.61, 95% CI: 0.57-0.66; P<0.001) than their urban counterparts. In addition, rural patients incurred lower hospitalization costs than urban patients (57,396.2 Chinese Yuan [CNY] vs. 60,844.3 CNY; P<0.001).

Conclusion:
Rural KA patients had different clinical characteristics compared with urban patients. While they had a higher likelihood of deep vein thrombosis and RBC transfusion following KA than urban patients, they had fewer readmissions and lower hospitalization costs. Targeted clinical management strategies are needed for rural patients.
Does major pathological response after neoadjuvant Immunotherapy in resectable non-small-cell lung cancers predict prognosis? a systematic review and meta-analysis
Authors: Chen Yujia , Qin Jianjun , Wu Yajing , Lin Qiang , Wang Jianing , Zhang Wei , Liang Fei , Hui Zhouguang , Zhao Min , Wang Jun 
Published: May 2023

Objective:
Overall survival (OS) is the gold-standard outcome measure for phase 3 trials, but the need for long follow-up period can delay the translation of potentially effective treatment to clinical practice. The validity of Major Pathological Response (MPR) as a surrogate of survival for non small cell lung cancer (NSCLC) after neoadjuvant immunotherapy remains unclear.

Methods:
Eligibility was resectable stage I-III NSCLC and delivery of PD-1/PD-L1/CTLA-4 inhibitors prior to resection; other forms/modalities of neoadjuvant and/or adjuvant therapies were allowed. Statistics utilized the Mantel-Haenszel fixed-effect or random-effect model depending on the heterogeneity (I2).

Results:
Fifty-three trials (7 randomized, 29 prospective nonrandomized, 17 retrospective) were identified. The pooled rate of MPR was 53.8%. Compared to neoadjuvant chemotherapy, neoadjuvant chemo-immunotherapy achieved higher MPR (OR 6.19, 4.39–8.74, P<0.00001). MPR was associated with improved DFS/PFS/EFS (HR 0.28, 0.10–0.79, P=0.02) and OS (HR 0.80, 0.72–0.88, P＜0.0001). Patients with stage III (vs I/II) and PD-L1 ≥1% (vs <1%) more likely achieved MPR (OR 1.66,1.02–2.70, P=0.04; OR 2.21,1.28–3.82, P=0.004).

Conclusions:
The findings of this meta-analysis suggest that neoadjuvant chemo-immunotherapy achieved higher MPR in NSCLC patients，and increased MPR might be associated with survival benefits treated with neoadjuvant immunotherapy. It appears that the MPR may serve as a surrogate endpoint of survival to evaluate neoadjuvant immunotherapy.