bluuebunny/crossref_metadata_2025_split huggingface dataset:
Superinfections in COVID‐19 patients receiving extracorporeal membrane oxygenation support
Authors: Andersen Harald V. , Jørgensen Vibeke R. L. , Steensen Morten , Pedersen Finn M. , Helleberg Marie 
Published: March 2023

AbstractBackgroundThe risk of superinfections and associations with mortality among patients with corona virus disease 2019 (COVID‐19) receiving veno‐venous extracorporeal membrane oxygenation (VV‐ECMO) is poorly elucidated.MethodWe identified all patients with COVID‐19 treated with VV‐ECMO >24 h at Rigshospitalet, Denmark from March 2020 to December 2021. Data were obtained by review of medical files. Associations between superinfections and mortality were assessed by logistic regression analyses adjusted for sex and age.ResultsFifty patients, median age 53 years (interquartile range [IQR] 45–59), 66% male, were included. Median time on VV‐ECMO was 14.5 days (IQR 6.3–23.5), 42% were discharged from hospital alive. Bacteremia, ventilator associated pneumonia (VAP), invasive candidiasis, pulmonary aspergillosis, herpes simplex virus, and cytomegalovirus (CMV) were detected in 38%, 42%, 12%, 12%, 14%, and 20% of patients, respectively. No patients with pulmonary aspergillosis survived. CMV was associated with increased risk of death, odds ratio 12.6 (95% confidence interval 1.9–257, p = .05), whereas we found no associations between other superinfections and risk of death.ConclusionBacteremia and VAP are common but does not seem to affect mortality, whereas pulmonary aspergillosis and CMV are associated with poor prognosis among COVID‐19 patients treated with VV‐ECMO.
A first‐level customization study of SAPS II with Norwegian Intensive Care and Pandemic Registry (NIPaR) data
Authors: Bruserud Øyvind , Haaland Øystein Ariansen , Kvåle Reidar , Buanes Eirik Alnes 
Published: March 2023

AbstractBackgroundSeverity scores and mortality prediction models (MPMs) are important tools for benchmarking and stratification in the intensive care unit (ICU) and need to be regularly updated using data from a local and contextual cohort. Simplified acute physiology score II (SAPS II) is widely used in European ICUs.MethodsA first‐level customization was performed on the SAPS II model using data from the Norwegian Intensive Care and Pandemic Registry (NIPaR). Two previous SAPS II models (Model A: the original SAPS II model and Model B: a SAPS II model based on NIPaR data from 2008 to 2010) were compared to the new Model C. Model C was based on patients from 2018 to 2020 (corona virus disease 2019 patients omitted; n = 43,891), and its performances (calibration, discrimination, and uniformity of fit) compared to the previous models (Model A and Model B).ResultsModel C was better calibrated than Model A with a Brier score 0.132 (95% confidence interval 0.130–0.135) versus 0.143 (95% confidence interval 0.141–0.146). The Brier score for Model B was 0.133 (95% confidence interval 0.130–0.135). In the Cox's calibration regression and for both Model C and Model B but not for Model A. Uniformity of fit was similar for Model B and for Model C, both better than for Model A, across age groups, sex, length of stay, type of admission, hospital category, and days on respirator. The area under the receiver operating characteristic curve was 0.79 (95% confidence interval 0.79–0.80), showing acceptable discrimination.ConclusionsThe observed mortality and corresponding SAPS II scores have significantly changed during the last decades and an updated MPM is superior to the original SAPS II. However, proper external validation is required to confirm our findings. Prediction models need to be regularly customized using local datasets in order to optimize their performances.
Haemoglobin drift in patients following Whipple's procedure
Authors: Luo Yuchen , Tacey Mark , Hodgson Russell , Houli Nezor , Yong Tuck 
Published: March 2023

AbstractBackgroundsThis study aims to identify the objective findings of haemoglobin (Hb) drift in patients that had a Whipple's procedure in the last 10 years, their transfusion status intraoperatively and post‐operatively, the potential factors affecting Hb drift, and the outcomes following Hb drift.MethodsA retrospective study was conducted at Northern Health, Melbourne. All adult patients who were admitted for a Whipple's procedure from 2010 to 2020 were included and information collected retrospectively for demographics, pre‐operative, operative and post‐operative details.ResultsA total of 103 patients were identified. The median Hb drift calculated from a Hb level at the end of operation was 27.0 g/L (IQR 18.0–34.0), and 21.4% of patients received a packed red blood cell (PRBC) transfusion during the post‐operative period. Patients received a large amount of intraoperative fluid with a median of 4500 mL (IQR 3400‐5600). Hb drift was statistically associated with intraoperative and post‐operative fluid infusion leading to concurrent issues with electrolyte imbalance and diuresis.ConclusionHb drift is a phenomenon that does happen in major operations such as a Whipple's procedure, likely secondary to fluid over‐resuscitation. Considering the risk of fluid overload and blood transfusion, Hb drift in the setting of fluid over‐resuscitation needs to be kept in mind prior to blood transfusion to avoid unnecessary complications and wasting of other precious resources.
Reference values for interleukin‐6 in the amniotic fluid of asymptomatic pregnant women
Authors: del Barco Ester , Franco‐Jarava Clara , Vargas Mireia , Maíz Nerea , Arevalo Silvia , Sánchez Maria Ángeles , Avilés Maria Teresa , Rodó Carlota , Mendoza Manel , Goya Maria , Hernández‐González Manuel , Carreras Elena 
Published: March 2023

AbstractIntroductionNowadays, proinflammatory factors are considered to play an important role in the pathophysiology of threatened preterm labor or chorioamnionitis. The aim of this study was to establish the normal reference range for interleukin‐6 (IL‐6) levels in the amniotic fluid and to identify factors which may alter this value.Material and methodsProspective study in a tertiary‐level center including asymptomatic pregnant women undergoing amniocentesis for genetic studies from October 2016 to September 2019. IL‐6 measurements in amniotic fluid were performed using a fluorescence immunoassay with microfluidic technology (ELLA Proteinsimple, Bio Techne). Maternal history and pregnancy data were also recorded.ResultsThis study included 140 pregnant women. Of those, women who underwent termination of pregnancy were excluded. Therefore, a total of 98 pregnancies were included in the final statistical analysis. The mean gestational age was 21.86 weeks (range: 15–38.7) at the time of amniocentesis, and 38.6 weeks (range: 30.9–41.4) at delivery. No cases of chorioamnionitis were reported. The log10 IL‐6 values follow a normal distribution (W = 0.990, p = 0.692).The median, and the 5th, 10th, 90th, and 95th percentiles for IL‐6 levels were 573, 105, 130, 1645, and 2260 pg/mL, respectively. The log10 IL‐6 values were not affected by gestational age (p = 0.395), maternal age (p = 0.376), body mass index (p = 0.551), ethnicity (p = 0.467), smoking status (p = 0.933), parity (p = 0.557), method of conception (p = 0.322), or diabetes mellitus (p = 0.381).ConclusionsThe log10 IL‐6 values follow a normal distribution. IL‐6 values are independent of gestational age, maternal age, body mass index, ethnicity, smoking status, parity and method of conception. Our study provides a normal reference range for IL‐6 levels in the amniotic fluid that can be used in future studies. We also observed that normal IL‐6 values were higher in the amniotic fluid than in serum.
mTORsignaling in renal ion transport
Authors: Adella Anastasia , de Baaij Jeroen H. F. 
Published: March 2023

AbstractThe mammalian target of rapamycin (mTOR) signaling pathway is crucial in maintaining cell growth and metabolism. The mTOR protein kinase constitutes the catalytic subunit of two multimeric protein complexes called mTOR complex 1 (mTORC1) and mTOR complex 2 (mTORC2). As such, this pathway is indispensable for many organs, including the kidney. Since its discovery, mTOR has been associated with major renal disorders such as acute kidney injury, chronic kidney disease, and polycystic kidney disease. On top of that, emerging studies using pharmacological interventions and genetic disease models have unveiled mTOR role in renal tubular ion handling. Along the tubule, mTORC1 and mTORC2 subunits are ubiquitously expressed at mRNA level. Nevertheless, at the protein level, current studies suggest that a tubular segment‐specific balance between mTORC1 and mTORC2 exists. In the proximal tubule, mTORC1 regulates nutrients transports through various transporters located in this segment. On the other hand, in the thick ascending limb of the loop of Henle, both complexes play a role in regulating NKCC2 expression and activity. Lastly, in the principal cells of the collecting duct, mTORC2 determines Na+reabsorption and K+excretion by regulating of SGK1 activation. Altogether, these studies establish the relevance of the mTOR signaling pathway in the pathophysiology of tubular solute transport. Despite extensive studies on the effectors of mTOR, the upstream activators of mTOR signaling remain elusive in most nephron segments. Further understanding of the role of growth factor signaling and nutrient sensing is essential to establish the exact role of mTOR in kidney physiology.
HbA1c trajectories over 3 years in people with type 2 diabetes starting second‐line glucose‐lowering therapy: The prospective global DISCOVER study
Authors: Bongaerts Brenda , Kuss Oliver , Bonnet Fabrice , Chen Hungta , Cooper Andrew , Fenici Peter , Gomes Marilia B. , Hammar Niklas , Ji Linong , Khunti Kamlesh , Medina Jesús , Nicolucci Antonio , Shestakova Marina V. , Watada Hirotaka , Rathmann Wolfgang 
Published: March 2023

AbstractAimTo identify distinct HbA1c trajectories in people with type 2 diabetes (T2D) starting second‐line glucose‐lowering therapy.Materials and MethodsDISCOVER was a 3‐year observational study of individuals with T2D beginning second‐line glucose‐lowering therapy. Data were collected at initiation of second‐line treatment (baseline) and at 6, 12, 24 and 36 months. Latent class growth modelling was used to identify groups with distinct HbA1c trajectories.ResultsAfter exclusions, 9295 participants were assessed. Four distinct HbA1c trajectories were identified. Mean HbA1c levels decreased between baseline and 6 months in all groups; 72.4% of participants showed stable good levels of glycaemic control over the remainder of follow‐up, 18.0% showed stable moderate levels of glycaemic control and 2.9% showed stable poor levels of glycaemic control. Only 6.7% of participants showed highly improved glycaemic control at month 6 and stable control over the rest of follow‐up. For all groups, dual oral therapy use decreased over time, compensated for by the increasing use of other treatment regimens. Use of injectable agents increased over time in groups with moderate and poor glycaemic control. Logistic regression models suggested that participants from high‐income countries were more probable to be in the stable good trajectory group.ConclusionsMost people receiving second‐line glucose‐lowering treatment in this global cohort achieved stable good or highly improved long‐term glycaemic control. One‐fifth of participants showed moderate or poor glycaemic control during follow‐up. Further large‐scale studies are required to characterize possible factors associated with patterns of glycaemic control to inform personalized diabetes treatment.
Evaluation of arterial blood gas parameters as prognostic markers in amyotrophic lateral sclerosis
Authors: Alarcan Hugo , Cotet Camille , Lépine Nadège , Morel Julie , Vourc'h Patrick , Andres Christian , Corcia Philippe , Blasco Hélène 
Published: March 2023

AbstractBackgroundForced vital capacity (FVC) remains difficult to determine for some patients suffering from amyotrophic lateral sclerosis (ALS) due to the rapid progression of the disease. Arterial blood gas (ABG) parameters could represent a valuable alternative. The aim of this study was therefore to evaluate the correlation between ABG parameters and FVC, along with the prognostic ability of ABG parameters, in a large cohort of ALS patients.MethodsALS patients (n=302) with FVC and ABG parameters available at diagnosis were included. Correlations between ABG parameters and FVC were evaluated. Cox regression was then carried out to determine the association of each parameter (ABG and clinical data) with survival. Finally, receiver operating characteristic (ROC) curves were built to predict the survival of ALS.ResultsBicarbonates (HCO3−), oxygen partial pressure (pO2), carbon dioxide partial pressure (pCO2), base excess (BE), oxygen saturation and oxyhemoglobin were significantly correlated with FVC both in patients with spinal or bulbar onset. Univariate Cox regression showed that HCO3− and BE were associated with survival but only in spinal forms. ABG parameters predicted the survival of ALS with a similar performance to FVC, HCO3− being the parameter with the highest area under the curve.ConclusionsOur results suggest that there is an interest in conducting a longitudinal evaluation throughout disease progression to confirm the equal performances of FVC and ABG. This study highlights the benefits of performing ABG analysis that could be used as an interesting alternative to FVC when spirometry cannot be performed.
Evaluation of RETRO‐Mapping for electrophysiological features including direction of plane activity during atrial fibrillation using multipolar catheters in humans
Authors: Smith Sabrina , Coyle Clare , Dhutia Niti , Kanagaratnam Prapa , Linton Nick W. F. 
Published: March 2023

AbstractIntroductionA quantifiable, automated standard of analyzing heart rhythm has long eluded cardiologists due, in part, to the limitations in technology and the ability to analyze large electrogram datasets. In this proof‐of‐concept study, we propose new measures to quantify plane activity in atrial fibrillation (AF) using our Representation of Electrical Tracking of Origin (RETRO)‐Mapping software.MethodsWe recorded 30 s segments of electrograms at the lower posterior wall of the left atrium using a 20‐pole double loop catheter (AFocusII). The data were analyzed with the custom RETRO‐Mapping algorithm in MATLAB. Thirty second segments were analyzed for number of activation edges, conduction velocity (CV), cycle length (CL), activation edge direction, and wavefront direction. These features were compared across 34 613 plane edges in three types of AF: persistent AF treated with amiodarone (11 906 wavefronts), persistent AF without amiodarone (14 959 wavefronts), and paroxysmal AF (7748 wavefronts). Change in activation edge direction between subsequent frames and change in overall wavefront direction between subsequent wavefronts were analyzed.ResultsAll activation edge directions were represented across the lower posterior wall. The median change in activation edge direction followed a linear pattern for all three types of AF with R2 = 0.932 for persistent AF treated without amiodarone, R2 = 0.942 for paroxysmal AF, and R2 = 0.958 for persistent AF treated with amiodarone. All medians and the standard deviation error bars remained below 45° (suggesting all activation edges were traveling within a 90° sector, a criterion for plane activity). The directions of approximately half of all wavefronts (56.1% for persistent without amiodarone, 51.8% for paroxysmal, 48.8% for persistent with amiodarone) were predictive of the directions of the subsequent wavefront.ConclusionRETRO‐Mapping can measure electrophysiological features of activation activity and this proof‐of‐concept study suggests that this can be extended to the detection of plane activity in three types of AF. Wavefront direction may have a role in future work for predicting plane activity. For this study, we focused more on the ability of the algorithm to detect plane activity and less the differences between the types of AF. Future work should be in validating these results with a larger data set and comparing with other types of activation such as rotational, collision, and focal. Ultimately, this work can be implemented in real‐time for prediction of wavefronts during ablation procedures.
Conduction system versus biventricular pacing in heart failure with non‐left bundle branch block
Authors: Tan Eugene S. J. , Soh Rodney , Lee Jie‐Ying , Boey Elaine , de Leon Jhobeleen , Chan Siew Pang , Yeo Wee Tiong , Lim Toon Wei , Seow Swee‐Chong , Kojodjojo Pipin 
Published: March 2023

AbstractIntroductionThe benefits of cardiac resynchronization therapy (CRT) with biventricular pacing (BiV) is significantly lower when applied to heart failure (HF) patients with non‐left bundle branch block (LBBB) conduction delay. We investigated clinical outcomes of conduction system pacing (CSP) for CRT in non‐LBBB HF.MethodsConsecutive HF patients with non‐LBBB conduction delay undergoing CSP were propensity matched for age, sex, HF‐etiology, and atrial fibrillation (AF) in a 1:1 ratio to BiV from a prospective registry of CRT recipients. Echocardiographic response was defined as an increase in left ventricular ejection fraction (LVEF) by ≥10%. The primary outcome was the composite of HF‐hospitalizations or all‐cause mortality.ResultsA total of 96 patients were recruited (mean age 70 ± 11years, 22% female, 68% ischemic HF and 49% AF). Significant reductions in QRS duration and LV dimensions were seen only after CSP, while LVEF improved significantly in both groups (p < 0.05). Echocardiographic response occurred more frequently in CSP than BiV (51% vs. 21%, p < 0.01), with CSP independently associated with four‐fold increased odds (adjusted odds ratio 4.08, 95% confidence interval [CI] 1.34–12.41). The primary outcome occurred more frequently in BiV than CSP (69% vs. 27%, p < 0.001), with CSP independently associated with 58% risk reduction (adjusted hazard ratio [AHR] 0.42, 95% CI 0.21–0.84, p = 0.01), driven by reduced all‐cause mortality (AHR 0.22, 95% CI 0.07–0.68, p < 0.01), and a trend toward reduced HF‐hospitalization (AHR 0.51, 95% CI 0.21–1.21, p = 0.12).ConclusionsCSP provided greater electrical synchrony, reverse remodeling, improved cardiac function and survival compared to BiV in non‐LBBB, and may be the preferred CRT strategy for non‐LBBB HF.
Comparison of lesion characteristics using temperature‐flow‐controlled versus conventional power‐controlled ablation with fixed ablation index
Authors: Ikenouchi Takashi , Takigawa Masateru , Goya Masahiko , Martin Claire A. , Yamamoto Tasuku , Yamaguchi Junji , Goto Kentaro , Shigeta Takatoshi , Nishimura Takuro , Tao Susumu , Miyazaki Shinsuke , Sasano Tetsuo ,   and other members of the Study Group
Published: March 2023

AbstractIntroductionThe QDOT‐MicroTM catheter is a novel irrigated contact force (CF) sensing catheter which benefits from thermocouples for temperature monitoring, allowing temperature‐flow‐controlled (TFC) ablation. We compared lesion metrics at fixed ablation index (AI) value during TFC‐ablation and conventional power‐controlled (PC)‐ablation.MethodsA total of 480 RF‐applications were performed on ex‐vivo swine myocardium with predefined AI targets (400/550) or until steam‐pop occurred, using the QDOT‐MicroTM (TFC‐ablation) and Thermocool SmartTouch SFTM (PC‐ablation).ResultsBoth TFC‐ablation and PC‐ablation produced similar lesions in volume (218 ± 116 vs. 212 ± 107 mm3, p = .65); however, lesions using TFC‐ablation were larger in surface area (41.3 ± 8.8 vs. 34.8 ± 8.0  mm2, p < .001) and shallower in depth (4.0 ± 1.0 vs. 4.2 ± 1.1 mm, p = .044). Average power tended to be lower in TFC‐alation (34.2 ± 8.6 vs. 36.9 ± 9.2, p = .005) compared to PC‐ablation due to automatic regulation of temperature and irrigation‐flow. Although steam‐pops were less frequent in TFC‐ablation (24% vs. 15%, p = .021), they were particularly observed in low‐CF (10 g) and high‐power ablation (50 W) in both PC‐ablation (n = 24/240, 10.0%) and TFC‐ablation (n = 23/240, 9.6%). Multivariate analysis revealed that high‐power, low‐CF, long application time, perpendicular catheter orientation, and PC‐ablation were risk factors for steam‐pops. Furthermore, activation of automatic regulation of temperature and irrigation‐flow was independently associated with high‐CF and long application time while ablation power had no significant relationship.ConclusionsWith a fixed target AI, TFC‐ablation reduced the risk of steam‐pops, producing similar lesions in volume, but with different metrics in this ex‐vivo study. However, lower CF and higher power in fixed‐AI ablation may increase the risk of steam‐pops.
Fasting and prolonged food restriction differentially affect GH secretion independently of GH receptor signaling in AgRP neurons
Authors: de Sousa Maria E. , Gusmao Daniela O. , dos Santos Willian O. , Moriya Henrique T. , de Lima Felipe F. , List Edward O. , Kopchick John J. , Donato Jose 
Published: March 2023

AbstractGrowth hormone (GH) receptor (GHR) is abundantly expressed in neurons that co‐release the agouti‐related protein (AgRP) and neuropeptide Y (NPY) in the arcuate nucleus of the hypothalamus (ARH). Since ARHAgRP/NPY neurons regulate several hypothalamic–pituitary‐endocrine axes, this neuronal population possibly modulates GH secretion via a negative feedback loop, particularly during food restriction, when ARHAgRP/NPY neurons are highly active. The present study aims to determine the importance of GHR signaling in ARHAgRP/NPY neurons on the pattern of GH secretion in fed and food‐deprived male mice. Additionally, we compared the effect of two distinct situations of food deprivation: 16 h of fasting or four days of food restriction (40% of usual food intake). Overnight fasting strongly suppressed both basal and pulsatile GH secretion. Animals lacking GHR in ARHAgRP/NPY neurons (AgRP∆GHR mice) did not exhibit differences in GH secretion either in the fed or fasted state, compared to control mice. In contrast, four days of food restriction increased GH pulse frequency, basal GH secretion, and pulse irregularity/complexity (measured by sample entropy), whereas pulsatile GH secretion was not affected in both control and AgRP∆GHR mice. Hypothalamic Ghrh mRNA levels were unaffected by fasting or food restriction, but Sst expression increased in acutely fasted mice, but decreased after prolonged food restriction in both control and AgRP∆GHR mice. Our findings indicate that short‐term fasting and prolonged food restriction differentially affect the pattern of GH secretion, independently of GHR signaling in ARHAgRP/NPY neurons.