bluuebunny/crossref_metadata_2025_split huggingface dataset:
Optimization of procedural sedation and analgesia during atrial fibrillation ablation
Authors: Homberg Marloes C. , Bouman Esther A.C. , Joosten Bert A.J. 
Published: March 2023

Purpose of review
This mini-review is aimed to provide an overview and discuss procedural sedation and analgesia for atrial fibrillation (AF) ablation with focus at qualification of staff, patient evaluation, monitoring, medication and postprocedural care.

Recent findings
Sleep-disordered breathing is highly prevalent in patients with AF. Impact of often used STOP-BANG questionnaire to detect sleep-disordered breathing in AF patients is limited due to its restricted validity. Dexmedetomidine is a commonly used drug in sedation, but is shown not to be superior to propofol in sedation during AF-ablation. Alternatively use of remimazolam has characteristics that makes it a promising drug for minimal to moderate sedation for AF-ablation. High flow nasal oxygen (HFNO) has shown to reduce the risk of desaturation in adults receiving procedural sedation and analgesia.

Summary
An optimal sedation strategy during AF ablation should be based on AF patient characteristics, the level of sedation needed, the procedure (duration and type of ablation) and the education and experience of the sedation provider. Patient evaluation and post procedural care are part of sedation care. More personalized care based on use of various sedation strategies and types of drugs as related to the type of AF-ablation is the way to further optimize care.
Etiology and management of hypofibrinogenemia in trauma
Authors: Nathwani Rajen , Proumen Adrian , Blaine Kevin P. 
Published: March 2023

Purpose of review
Fibrin polymerization is essential for stable clot formation in trauma, and hypofibrinogenemia reduces hemostasis in trauma. This review considers fibrinogen biology, the changes that fibrinogen undergoes after major trauma, and current evidence for lab testing and treatment.

Recent findings
Fibrinogen is a polypeptide that is converted to fibrin by the action of thrombin. During trauma, fibrinogen levels are consumed and reduce within the first few hours because of consumption, dilution, and fibrinolysis. Fibrinogen levels usually rebound within 48 h of injury and can contribute to thrombotic events. The Clauss fibrinogen assay is the gold standard test for fibrinogen levels, although viscoelastic hemostatic assays are often used when a lab delay is anticipated. An evidence-based threshold for fibrinogen replacement is not well established in the literature, but expert opinion recommends maintaining a level above 150 mg/dl.

Summary
Hypofibrinogenemia is an important cause of nonanatomic bleeding in trauma. Despite multiple pathologic causes, the cornerstone of treatment remains fibrinogen replacement with cryoprecipitate or fibrinogen concentrates.
Anesthesia for pediatric magnetic resonance imaging: a review of practices and current pathways
Authors: Guimarães Ferreira Fonseca Lucas , Garbin Marta , Bertolizio Gianluca 
Published: March 2023

Purpose of review
Magnetic resonance imaging (MRI) is an ever-expanding investigation modality in children. This review aims to present current strategies to perform MRI in pediatrics efficiently and safely. The latest evidence on approaches, safety and costs of MRI with no sedation or with sedation provided by anesthesiologists and non-anesthesiologists are outlined and discussed.

Recent findings
MRI under sedation provided by either anesthesiologists or non-anesthesiologists has a low incidence of minor adverse events and rarely severe complications. Propofol infusion with or without dexmedetomidine appears the ideal anesthetic, as it allows spontaneous breathing and fast turnover. Intranasal dexmedetomidine is safe and the most effective medication when a nonintravenous route is employed.
New scanning techniques and patient's preparation methods can increase the chances to successfully perform MRI with no sedation by shortening sequences, reducing artifacts, and improving child's cooperation.

Summary
MRI under sedation can be considered safe. Proper patient selection, clear decision-making and medico-legal pathways are particularly necessary for nurse-only sedated scans. Nonsedated MRIs are feasible and cost-effective but require optimal scanning techniques and patient's preparation to be successful. Further research should be focused on identifying the most effective modalities to perform MRI without sedation and clarify protocols for the nurse-only sedations.
Anesthesia service will likely remain pivotal for complex and critically ill patients and to provide assistance in case of adverse events.
The Effects of Early Mobilization on Acquired Weakness in Intensive Care Units
Authors: Rosa Debora , Negro Alessandra , Marcomini Ilaria , Pendoni Roberta , Albabesi Beatrice , Pennino Giovanni , Terzoni Stefano , Destrebecq Anne , Villa Giulia 
Published: March 2023

Background
Intensive care unit (ICU)–acquired weakness (ICUAW) is defined as a clinical syndrome of neuromuscular weakness, and a consequence of critical illness, unrelated to any other etiology. It is associated with difficult weaning from the ventilator, prolonged ICU stay, increased mortality, and other important long-term outcomes. Early mobilization is defined as any active exercise in which patients use their muscle strength actively or passively within the first 2 to 5 days of critical illness. Early mobilization can be safely initiated from the first day of admission to the ICU during mechanical ventilation.

Objectives
The purpose of this review is to describe the effects of early mobilization on complications from ICUAW.

Method
This was a literature review. Inclusion criteria were as follows: observational studies and randomized controlled trials conducted with adult patients (aged ≥18 years) admitted to the ICU were included. Studies selected were published in the last 11 years (2010-2021).

Results
Ten articles were included. Early mobilization reduces muscle atrophy, ventilation, length of hospital stay, and ventilator-associated pneumonia and improves patients' responses to inflammation and hyperglycemia.

Discussion
Early mobilization appears to have a significant impact on the prevention of ICUAW and appears to be safe and feasible. The results of this review could be useful for improving the provision of efficient and effective tailored care for ICU patients.
The burden of liver cirrhosis and underlying etiologies: results from the Global Burden of Disease Study 2019
Authors: Lan Yan , Wang Hao , Weng Haoda , Xu Xianbin , Yu Xia , Tu Huilan , Gong Kai , Yao Junjie , Ye Shaoheng , Shi Yu , Sheng Jifang 
Published: March 2023

Background:
Liver cirrhosis is a major health concern. Herein, we aimed to estimate the incidence, prevalence, and mortality of liver cirrhosis caused by specific etiologies for 204 countries and territories.

Materials and Methods:
The data were retrieved from the Global Burden of Disease Study 2019. The age-standardized incidence rate (ASIR), age-standardized prevalence rate (ASPR), age-standardized death rate, and estimated annual percentage changes were used to estimate the trends in incidence, prevalence, and mortality of liver cirrhosis by sex, region, country, and etiology between 2009 and 2019.

Results:
From 2009 to 2019, the incident cases of liver cirrhosis increased by 16.7%, from 1.8 million (95% uncertainty interval: 1.5–2.1) to 2.1 million (1.7–2.5), and the prevalent cases increased from 1378.3 million (1275.1–1498.8) to 1691.0 million (1560.9–1845.5). Liver cirrhosis contributed to nearly 1.5 million (1.4–1.6) deaths in 2019, nearly 0.2 million more than in 2009. However, the age-standardized death rate fell from 20.71 (19.79–21.65) per 100,000 population in 2009 to 18.00 (16.80–19.31) per 100,000 population in 2019. In terms of sex, males showed higher ASIR, ASPR, and age-standardized death rate than females. Among the etiologies, the ASIR and ASPR of NAFLD increased markedly, and there was also a modest increase in ASIR and ASPR for HCV and alcohol use. In contrast, the ASIR and ASPR of HBV decreased considerably.

Conclusions:
Our finding suggests an increasing burden of liver cirrhosis worldwide but a declining attributed death. A high prevalence and still rising trend of NAFLD and alcohol use-etiology were found in patients with cirrhosis globally, although variation was found between regions/countries. These data indicate that efforts to reduce the associated burden need to be improved.
HIGH-RESOLUTION IMAGING OF THE OUTER RETINA IN TYPE 2 ACUTE MACULAR NEURORETINOPATHY
Authors: Doble Nathan , Wells-Gray Elaine M. , Ohr Matthew P. , Choi Stacey S. 
Published: March 2023

Purpose:
The purpose of this study was to investigate the outer retinal changes in a patient with type 2 acute macular neuroretinopathy (AMN).

Methods:
A 35-year-old White woman complaining of a unilateral blind spot was imaged using various retinal imaging modalities including clinical optical coherence tomography (OCT), OCT-angiography, fundus fluorescein angiography, and adaptive optics (AO).

Results:
Fundus examination revealed multiple paracentral reddish brown petaloid lesions in the symptomatic left eye, while the other eye was unremarkable. Clinical OCT showed areas of hyperreflectance at the outer plexiform layer/outer nuclear layer complex with a disrupted inner/outer segment junction, which are characteristic features of type 2 AMN. AO imaging further revealed either shortening or absence of cone outer segments within the AMN lesions attributing to the darker features observed in the en face images from fundus photography and scanning laser ophthalmoscopy.

Conclusion:
The AO findings indicate that the petaloid lesions in type 2 AMN are caused by a combination of the shortening and absence of the outer segment in individual cone photoreceptors.
Leveraging Community Resources and Local Expertise to Build a Safe Learning Environment for K-12 Students During COVID-19: A Field Experience
Authors: Masterson Evelyn , Chung Sarita , Shen Renata , Singh Bindiya , Savoia Elena , Rajabiun Serena 
Published: March 2023

Objective:
To share the experiences of stakeholders in a school district's response to the COVID-19 pandemic, especially related to supporting the district in the reopening process and sharing key decision points, challenges, facilitators, and overall lessons learned that may be applied to future emergencies.

Design:
A descriptive study of participants' experience that included (1) a content analysis of policy documents and recommendations that were developed and published by key stakeholders and (2) interviews with stakeholders in the school system that were coded to identify patterns and themes.

Setting:
Remote interviews conducted over Zoom. Participants live or work in Brookline, Massachusetts.

Participants:
Fifteen qualitative interviews were conducted with school committee members, principals, members of school leadership, school nurses, school staff, parents, advisory panel members, and physicians collaborating with the school district.

Main Outcome Measures:
Whether patterns and themes related to challenges, solutions, and recommendations for future management of public health emergencies in the district could be identified.

Results:
Challenges experienced during a school district's response included staffing burdens, changing scopes of services, the difficulty of successfully enforcing social distancing, addressing staff and family fears, meeting informational needs, and limited resources. Multiple interviewees shared that they felt there should have been a greater emphasis on mental health in the district's response. Successes of the response included the creation and implementation of a consistent communications system, recruiting volunteers and mobilizing the community to address critical needs, and effective technology expansion and usage in schools.

Conclusions:
Leadership and community collaboration were essential to the response to the COVID-19 pandemic in addition to strategies used to enhance coordination and communication and relay information across the community.
Optical control of cardiac rhythm byin vivophotoactivation of an ERG channel peptide inhibitor
Authors: Montnach Jérôme , Millet Hugo , Persello Antoine , Meudal Hervé , Waard Stephan De , Mesrica Pietro , Ribeiro Barbara , Richard Jérémie , Hivonnait Agnès , Tessier Agnès , Lauzier Benjamin , Charpentier Flavien , Mangoni Matteo E. , Landon Céline , Jopling Chris , De Waard Michel 
Published: March 2023

AbstractRATIONALECardiac rhythm, conduction and synchronization of electrical activity require the coordinated action of different types of ion channels that differ according to transmural and regional specificities. Classical pharmacology affects these ion channels in a non-regionalized way which explains why treating arrhythmias, that often occur in specific foci, has often limited efficacy in addition to negative side-effects on non-targeted organs. Photopharmacology is an emergent technology that has the potential to counteract all the negative aspects of classical pharmacology by restricting drug activity in a spatio-temporal manner.OBJECTIVEWe tested the potential of photopharmacology in specifically regulating heart activity by using a caged derivative of a natural peptide inhibitor of the ERG channel, BeKm1. The peptide was uncaged and activity monitoredin vitroon a cell line expressing the hERG channel, on human cardiomyocytes derived from iPS cells, andex vivoandin vivoon zebrafish larvae and rat hearts.METHODS AND RESULTSCaged BeKm-1 is inactive and fully active upon uncaging. Uncaging of the peptide on human iPS-derived cardiomyocytes enlarges the action potential duration and triggers arrhythmias. Uncaging also triggers bradycardia and disturbs cardiac conduction within the atria in perfused rat hearts upon illumination. The potency of photopharmacology for cardiac electrical modulation was further validated in zebrafish larvae where illumination of the caged compound induces bradycardia and atrio-ventricular desynchrony. Finally, in anesthetized rats, illumination of the caged peptide in the right atria, containing the sino-atrial node, leads to bradycardia without arrhythmia.CONCLUSIONSThis report demonstrates that photopharmacology, using the caged peptide strategy, can be used for dynamically regulating cardiac electrical activityin vivoand that spatial illumination restriction can dissociate the bradycardic effect from the arrhythmic one. The technology is applicable to all kinds of cardiac ion channels and regions of interest to create arrhythmogenic models or investigate new clinical applications.
Diagnosing and remediating harmful data shifts for the responsible deployment of clinical AI models
Authors: Subasri Vallijah , Krishnan Amrit , Dhalla Azra , Pandya Deval , Malkin David , Razak Fahad , Verma Amol A. , Goldenberg Anna , Dolatabadi Elham 
Published: March 2023

AbstractHarmful data shifts occur when the distribution of data used to train a clinical AI system differs significantly from the distribution of data encountered during deployment, leading to erroneous predictions and potential harm to patients. We evaluated the impact of data shifts on an early warning system for in-hospital mortality that uses electronic health record data from patients admitted to a general internal medicine service, across 7 large hospitals in Toronto, Canada. We found model performance to differ across subgroups of clinical diagnoses, sex and age. To explore the robustness of the model, we evaluated potentially harmful data shifts across demographics, hospital types, seasons, time of hospital admission, and whether the patient was admitted from an acute care institution or nursing home, without relying on model performance. Interestingly, many of these harmful data shifts were unidirectional. We found models trained on community hospitals experience harmful data shifts when evaluated on academic hospitals, whereas models trained on academic hospitals transfer well to the community hospitals. To improve model performance across hospital sites we employed transfer learning, a strategy that stores knowledge gained from learning one domain and applies it to a different but related domain. We found hospital type-specific models that leverage transfer learning, perform better than models that use all available hospitals. Furthermore, we monitored data shifts over time and identified model deterioration during the COVID-19 pandemic. Typically, machine learning models remain locked after deployment, however, this can lead to model deterioration due to harmful data shifts that occur over time. We used continual learning, the process of learning from a continual stream of data in a sequential manner, to mitigate data shifts over time and improve model performance. Overall, our study is a crucial step towards the deployment of clinical AI models, by providing strategies and workflows to ensure the safety and efficacy of these models in real-world settings.
The association of genetically proxied sildenafil with fertility, sexual activity, and wellbeing: a Mendelian randomisation study
Authors: Woolf Benjamin , Rajasundaram Skanda , Cronjé Héléne T. , Yarmolinsky James , Burgess Stephen , Gill Dipender 
Published: March 2023

AbstractObjectiveTo investigate the association of genetically proxied Phosphodiesterase 5 (PDE5) inhibition with fertility, sexual activity, and subjective wellbeing in men.DesignTwo-samplecis-Mendelian randomisation.SettingGenetic association data obtained from the International Consortium for Blood Pressure (ICBP) and UK Biobank (UKB).ParticipantsEuropean ancestry individuals from the ICBP (N= 757,601) and the UKB (N≈ 450,000). Genetic association data were leveraged from the ICBP for the exposure and from the UKB for the outcomes.InterventionGenetically proxied PDE5 inhibition, scaled to the effect of 100mg daily sildenafil on diastolic blood pressure.Main outcome measuresNumber of children, age of first having sex, number of sexual partners, odds of being a virgin and self-reported wellbeing, all measured in the male sub-sample of the UKB.Secondary outcomesTo explore the specificity of our results, we replicate our analysis in the female sub-sample of the UKB. We additionally explored possible confounders/mediators of our instruments using PhenoScanner, and adjust for them using Two-stepcis-MR.ResultsGenetically proxied sildenafil was associated with fathering 0.21 (95% CI: 0.08– 0.35) more children (FDR corrected p = 0.01). This association was neither attenuated when adjusting for traits associated with our instruments nor was it replicated in women. We did not find robust evidence for an effect of sildenafil on the age of first having sex, number of sexual partners, odds of being a virgin, or self-reported wellbeing.ConclusionsThis study provides genetic support for PDE5 inhibitors increasing the number of children that men have.Key Messages-Sildenafil is a PDE5 inhibitor that is commonly used in the treatment of erectile dysfunction and pulmonary hypertension.-Drug-target Mendelian randomisation is a quasi-experimental method that uses genetic variants to proxy drug-target perturbation. Here, we leverage this approach to investigate long-term therapeutic and adverse effects of sildenafil use, many of which cannot be easily evaluated in a randomised controlled trial.-We find evidence for a casual association between genetically proxied sildenafil use and number of children fathered. Genetically proxied sildenafil use was not associated with age at first having sex, number of sexual partners, odds of being a virgin, or subjective wellbeing.
EVALUATION OF A METAGENOMIC NEXT-GENERATION SEQUENCING ASSAY WITH A NOVEL HOST DEPLETION METHOD FOR PATHOGEN IDENTIFICATION IN SEPTIC PATIENTS
Authors: Chen Yen-Chia , Liao Po-Hsiang , Chen Yen-Wen , Chang Chia-Ming , Chan Maurice , Chao Deng Fong , Lin Yizhen , Chang Jiahao , Hung Hau , Wu Mengchu , Yen David Hung-Tsang 
Published: March 2023

ABSTRACTBackgroundThe traditional diagnosis of sepsis has always been based on microbial blood culture (BC). However, BC suffers from (1) long culture cycle, leading to delay in results, and (2) low diagnostic yields. Metagenomic next-generation sequencing (mNGS) has been proposed as an efficient and agnostic option that potentially overcomes these issues. In this study, a mNGS workflow utilizing a novel filter to specifically capture white blood cells and deplete host DNA background, was evaluated against BC results, as well as mNGS without host depletion, for pathogen identification.Materials and MethodsPatients admitted to Taipei Veterans General Hospital (TVGH) with suspected sepsis were recruited to the study approved by the IRB. Blood sample was taken for BC (designated as BC1) before any antibiotic exposure. Upon patient enrolment, blood was taken again and divided in 3 portions with one used for the 2ndBC (BC2). The other two were used for mNGS with one processed with the filter and the other without filtering, to assess the effectiveness of host-depletion by the filter.ResultsA total of 50 patients were recruited among which 45 had results for all 4 tests. mNGS with filter had the highest positive rate of 74.4%, followed by mNGS without filter and BC1 (51.1% and 50.0% respectively), while the 2ndBC had the lowest positive rate of 22.0%. Further, mNGS was less sensitive to antibiotics exposure as compared to BC. The overall correlation between samples with vs without filtration (R2=0.96) confirmed that filtration does not affect microbial composition in a sample. For the BC positive samples, the effect of host depletion by filtration increased microbial target reads/million QC reads from 46 reads to 243 reads on average. Microbial reads enrichment by the filter appeared to be more effective for the samples with lower microbial concentration, thus increasing the test sensitivity over mNGS without filter. Using the 2ndBC results as reference, mNGS with filter and mNGS without filter exhibited sensitivities of 81.8% and 63.6%.ConclusionThe mNGS with filter was able to recover most of the pathogens identified by clinical BC and achieved the highest diagnostic yield. With the clinical implementation to complete the workflow within 24 hours, it has the potential to overcome slow turnaround and low diagnostic yield issues of traditional BC.
Consumer-grade wearables and machine learning sensitively capture disease progression in amyotrophic lateral sclerosis
Authors: Gupta Anoopum S. , Patel Siddharth , Premasiri Alan , Vieira Fernando 
Published: March 2023

AbstractALS causes degeneration of motor neurons, resulting in progressive muscle weakness and impairment in fine motor, gross motor, bulbar, and respiratory function. Promising drug development efforts have accelerated in ALS, but are constrained by a lack of objective, sensitive, and accessible outcome measures. Here we investigate the use of consumer-grade wearable sensors, worn on four limbs at home during natural behavior, to quantify motor function and disease progression in 376 individuals with ALS over a several year period. We utilized an analysis approach that automatically detects and characterizes submovements from passively collected accelerometer data and produces a machine-learned severity score for each limb that is independent of clinical ratings. The approach produced interpretable and highly reliable scores that progressed faster than the gold standard ALS Functional Rating Scale-Revised (−0.70 SD/year versus -0.48 SD/year), supporting its use as a sensitive, ecologically valid, and scalable measure for ALS trials and clinical care.