bluuebunny/crossref_metadata_2025_split huggingface dataset:
Perfusion Index Variations in Children With Septic Shock: Single-Center Observational Cohort Study in India
Authors: AV Lalitha , Kuzhikkombil Mani Siji , Ghosh Santu 
Published: August 2023

OBJECTIVES:
To study in children with septic shock: 1) variation in peripheral perfusion index (PI), which is a derived variable from pulse oximetry; 2) correlation between PI and lactate concentration; and 3) exploratory diagnostic evaluation between mortality and PI.

DESIGN:
Prospective observational study (from October 2018 to March 2020).

SETTING:
Pediatric emergency department and PICU of a tertiary hospital in India.

PATIENTS:
Children (1 mo to 16 yr old) with septic shock.

INTERVENTIONS:
None.

MEASUREMENTS AND MAIN RESULTS:
Data collected included demographic, clinical, laboratory, and outcome-related variables. Hemodynamic variables like heart rate, mean arterial pressure, and PI, along with serum lactate were recorded at specified intervals. A total of 112 children with septic shock were recruited, with median (interquartile range [IQR]) age of 50 (IQR 12,118.5) months and 65 of 112 (58%) were male children. Overall mortality was 25 of 112 (22%). At admission, the median PI was 0.6 (IQR –0.30, 0.93), and we used PI less than or equal to 0.6 to define a “critical PI.” Of 61 children with critical PI at admission, 26 of 61 increased above this threshold by 6 hours. We observed a negative correlation between PI and lactate, at admission (r = –0.27; 95% CI, –0.44 to –0.08; p = 0.006) and at 6 hours (r = –0.21; 95% CI, –0.39 to –0.02; p = 0.03). In the exploratory analysis, a PI cutoff of less than or equal to 0.6 at 6 hours had area under the receiver operating curve of 0.74 (95% CI, 0.60–0.88). That is, with a 70% sensitivity and 81% specificity for mortality, the performance of such a test in our population (pre-to-post-test probability) for mortality would be 0.22–0.51.

CONCLUSIONS:
We have used pulse oximetry-derived PI in children presenting with septic shock and found that the value is negatively correlated with a rise in serum lactate concentration. However, the utility of using a critical threshold value in PI (≤ 0.6) after 6 hours of treatment to be indicative of later mortality has considerable uncertainty.
Overdiagnosis of Newborn Hyperbilirubinemia: A Natural Experiment in Quality Improvement Fundamentals
Authors: Stirling Kara J. , Kaempf Joseph W. , Wang Lian , Luzzi Veronica I. , McDonald John V. 
Published: August 2023

Introduction:
Two hospitals noted increased newborn hyperbilirubinemia coinciding with an undisclosed total serum bilirubin (TSB) assay change. Clinicians rapidly applied quality improvement methodologies to ascertain increased jaundice evaluations, readmissions, and possible safety issues.

Methods:
In January 2020, 2 hospitals (A and B) transitioned to a new method of measuring TSB using a new clinical chemistry analyzer (Siemens Atellica CH), which measured TSB by vanadate oxidase assay instead of the previous diazo assay. Five affiliated hospitals (C–G) continued to utilize the diazo assay. This natural experiment led to a comparison of data across the 7 hospitals. We analyzed: (1) TSB levels, (2) hospital hyperbilirubinemia readmissions, and (3) paired TSB measurements comparing the diazo assay and vanadate oxidase method.

Results:
Compared to the 2019 baseline, Hospitals A and B had a significant increase in TSBs ≥17.0 mg/dl and TSBs ≥20 mg/dl in 2020; Hospitals C–G did not. Readmissions for phototherapy significantly increased in hospitals A and B in 2020 compared to 2019. Paired blood samples showed bias-elevated TSBs by vanadate assay compared to the diazo method. By 2021, the laboratory resumed processing TSB samples by diazo assay, and the frequency of elevated TSBs and hyperbilirubinemia readmissions returned to 2019 levels.

Conclusions:
Factitious TSB elevation related to an assay change significantly increased newborn hyperbilirubinemia evaluations and phototherapy readmissions. Imbedded quality improvement methodologies of careful structure, process, and outcomes review hastened resolution.
A Quality Improvement Initiative to Screen for Bullying in Pediatric Orthopedic Outpatient Clinics
Authors: Hoover Leslie A. , Holstine Jessica B. , Williamson Jayme , Samora Julie B. 
Published: August 2023

Background:Bullying annually affects 20%–25% of middle- and high-school children. Persistent bullying can lead to feelings of isolation, rejection, and despair and trigger depression and anxiety. In addition, pediatric patients have presented to outpatient orthopedic clinics with injuries consistent with physical bullying. Due to the high prevalence and negative ramifications of bullying, we developed a quality improvement (QI) initiative to screen for these behaviors. We aimed to increase the screening for bullying in pediatric orthopedic outpatient clinics from 0% to 60% by the end of 2020 and sustain these levels for 6 months.Methods:Using the Institute for Healthcare Improvement Model for Improvement QI methodology, including Plan-Do-Study-Act cycles, we developed a four-question yes/no screening tool that asked patients (ages 5–18) and parents/guardians about bullying experiences in the preceding 3 months. To increase screening rates, we trained staff, integrated the screening form into the electronic medical record, initiated interscreener competitions, and shared unblinded data with screeners.Results:The bullying screen rate of pediatric orthopedic patients increased from 0% to a process mean of 80%. In just over 1 year during the COVID-19 pandemic, clinics screened nearly 8,000 patients for bullying. Two percent of patients reported bullying in the prior 3 months. We offered patients who reported bullying literature and referrals to social work and/or behavioral health.Conclusions:Implementing a QI initiative to provide universal bullying screening and increase bullying awareness in outpatient pediatric orthopedic clinics is feasible and sustainable.
Sex and frequency of pain episodes are associated with acute pain trajectories in adolescents with sickle cell disease
Authors: Astles Rachel , Liu Zihao , Gillespie Scott E. , Lai Kristina W. , Maillis Alexander , Morris Claudia R. , Lane Peter A. , Krishnamurti Lakshmanan , Bakshi Nitya 
Published: August 2023

Abstract

Introduction/Objective:
Acute pain episodes are a major cause of health care utilization (HCU) in sickle cell disease (SCD), and adolescence is associated with increased pain frequency. We sought to determine whether there were differences in acute pain trajectories by sex and frequency of pain episodes among adolescents with SCD who presented to the emergency department (ED).

Methods:
Retrospective review of electronic health records from a large, multicampus, pediatric SCD program.

Results:
Of the 113 adolescents included, the mean age was 16.6 (SD 0.9), 41.6% (n = 47) were female, 77.9% (n = 88) had HbSS or a similarly severe genotype, and 43.4% (n = 49) had ≥3 episodes of HCU for pain, which we defined as having history of high HCU for pain. Those with a history of high HCU for pain had higher mean pain intensity scores at presentation, were more likely to receive either intravenous or intranasal opioids, and were more likely to be hospitalized. In a model considering the 3-way interaction between sex, history of high HCU for pain, and follow-up time from the initial pain intensity score, adjusted for opioid per kilogram body weight, and prescription of hydroxyurea, adolescent female patients with high HCU for pain had the slowest decline in pain intensity during treatment for acute pain in the ED.

Conclusion:
Sex and history of high HCU for pain are associated with acute pain trajectories in adolescents with SCD presenting to the ED. These novel findings should be confirmed in future prospective studies.
Emerging infections in vulnerable hosts: Stenotrophomonas maltophilia and Elizabethkingia anophelis
Authors: Lee Yu-Lin , Hsueh Po-Ren 
Published: August 2023

Purpose of reviewThis systematic review aimed to explore the recent trends in the epidemiology, risk factors, and antimicrobial susceptibility of two emerging opportunistic pathogens,Stenotrophomonas maltophiliaandElizabethkingia anophelis.Recent findingsSince 2020, numerous outbreaks ofS. maltophiliaandE. anophelishave been reported worldwide. Most of these outbreaks have been associated with healthcare facilities, although one outbreak caused byE. anophelisin France was considered a community-associated infection. In terms of antimicrobial susceptibility, trimethoprim/sulfamethoxazole (TMP-SMZ), levofloxacin, and minocycline have exhibited good efficacy againstS. maltophilia. Additionally, cefiderocol and a combination of aztreonam and avibactam have shown promising results inin vitrosusceptibility testing. ForE. anophelis, there is currently no consensus on the optimal treatment. Although some studies have reported good efficacy with rifampin, TMP-SMZ, piperacillin/tazobactam, and cefoperazone/sulbactam, minocycline had the most favourablein vitrosusceptibility rates. Cefiderocol may serve as an alternative due to its low minimum inhibitory concentration (MIC) againstE. anophelis. The role of vancomycin in treatment is still uncertain, although several successful cases with vancomycin treatment, even with high MIC values, have been reported.SummaryImmunocompromised patients are particularly vulnerable to infections caused byS. maltophiliaandE. anophelis, but the optimal treatment strategy remains inconclusive. Further research is necessary to determine the most effective use of conventional and novel antimicrobial agents in combatting these multidrug-resistant pathogens.
Surgical management of cystic echinococcosis of the liver
Authors: Berto Cesar G. , Liou Peter , Coyle Christina M. , Emond Jean C. 
Published: August 2023

Purpose of review
Cystic echinococcosis is a zoonotic infection frequently involving the liver. Treatment options, including surgery, are decided based on the staging of the disease.

Recent findings
Ultrasound is the cornerstone for diagnosis, staging, and follow-up of cystic echinococcosis. MRI can help to evaluate for cystobiliary complications and planning of the surgery. The two main surgical approaches for cystic echinococcosis include a radical approach, which entails a partial hepatectomy and total pericystectomy, and a conservative approach or endocystectomy. Recent data suggest a conservative approach is well tolerated with acceptable morbidity and no mortality. Recurrences in centers with experience are rare. Data on laparoscopic surgery is emerging, but long-term follow-up still needs to be improved.

Summary
Surgical treatment options should be carefully evaluated according to the cystic echinococcosis disease staging. A multidisciplinary approach, including diagnostic and interventional radiology, abdominal and liver surgery, and infectious diseases, results in better outcomes.
Intra-aortic balloon pump reduces 30-day mortality in early stage cardiogenic shock complicating acute myocardial infarction according to SCAI classification
Authors: Luo Da , Huang Rihong , Wang Xiaoying , Zhang Jing , Cai Xinyong , Liu Fuyuan , Lei Yuhua , Li Dongsheng , Zhou Wenjie , Xu Changwu , Huang Bing , Jiang Hong , Chen Jing 
Published: August 2023

Abstract

Background
Cardiogenic shock complicating acute myocardial infarction (AMICS) remains a high 30-day mortality. Mechanical circulatory support devices are increasingly used in AMICS, but their effects on mortality vary partly due to shock severity.

Aims
This study aimed to evaluate the association between intra-aortic balloon pump (IABP) and 30-day mortality in patients with early stage AMICS.

Methods
We retrospectively analyzed patients with ST-segment elevation myocardial infarction (STEMI) based on a multicenter clinical trial (NCT04996901). Patients were stratified by IABP use and shock severity was classified according to the Society for Cardiovascular Angiography and Interventions (SCAI) SHOCK stages. The primary outcome was 30-day all-cause mortality. The association between IABP and 30-day mortality was evaluated across shock stages using propensity score matching, weighting, and logistic regression.

Results
5343 patients were included and 299 received IABP. SCAI SHOCK stage was associated with 30-day mortality (OR 20.19, 95%CI 13.60-29.97, P < 0.001). In the 580 matched patients, a significant interaction between IABP and 30-day mortality at different shock stages was observed (P = 0.005). IABP was associated with lower 30-day mortality among patients with shock stage A/B (5.8% vs. 1.2%, OR 0.19, 95%CI 0.03-0.73, P = 0.034) but not stage C/D/E (29.3% vs. 38.1%, OR 1.49, 95%CI 0.84-2.65, P = 0.172). These results were confirmed by sensitivity analyses of the weighted cohort.

Conclusions
IABP reduced 30-day mortality in patients with early stage AMICS. The SCAI SHOCK stage provides risk stratification for patients with STEMI and helps identify those who may respond well to IABP.
EXTRACELLULAR CIRP INHIBITS NEUTROPHIL APOPTOSIS TO PROMOTE ITS AGING BY UPREGULATING SERPINB2 IN SEPSIS
Authors: Shimizu Junji , Murao Atsushi , Aziz Monowar , Wang Ping 
Published: August 2023

ABSTRACTBackground:Sepsis reduces neutrophil apoptosis. As the result, neutrophils may become aged, exacerbating inflammation and tissue injury. Extracellular cold-inducible RNA-binding protein (eCIRP) acts as a damage-associated molecular pattern to promote inflammation and tissue injury in sepsis. SerpinB2, a serine protease inhibitor, has been shown to inhibit apoptosis. We hypothesize that eCIRP upregulates SerpinB2 to promote aged neutrophil subset by inhibiting apoptosis in sepsis.Methods:We stimulated bone marrow–derived neutrophils (BMDNs) of wild-type (WT) mice with 1 μg/mL of recombinant mouse CIRP (i.e., eCIRP) and assessed cleaved caspase-3 and SerpinB2 by western blotting. Apoptotic neutrophils were assessed by Annexin V/PI. Bone marrow–derived neutrophils were stimulated with 1 μg/mL eCIRP and treated with or without PAC-1 (caspase-3 activator) and aged neutrophils (CXCR4hiCD62Llo) were assessed by flow cytometry. To induce sepsis, we performed cecal ligation and puncture in WT or CIRP−/−mice. We determined the percentage of aged neutrophils and SerpinB2+neutrophils in blood and spleen by flow cytometry.Results:We found that cleaved caspase-3 levels were increased at 4 h of PBS treatment compared with 0 h but decreased by eCIRP treatment. Extracellular cold-inducible RNA-binding protein reduced apoptotic cells after 20 h of treatment. Extracellular cold-inducible RNA-binding protein also increased the frequencies of aged neutrophils compared with PBS after 20 h, while PAC-1 treatment reduced aging in eCIRP-treated BMDNs. Extracellular cold-inducible RNA-binding protein significantly increased the expression of SerpinB2 at protein levels in BMDNs at 20 h. In WT mice, the frequencies of aged and SerpinB2+neutrophils in blood and spleen were increased after 20 h of cecal ligation and puncture, while in CIRP−/−mice, aged and SerpinB2+neutrophils were significantly decreased compared with WT mice. We also found that aged neutrophils expressed significantly higher levels of SerpinB2 compared with non-aged neutrophils.Conclusions:eCIRP inhibits neutrophil apoptosis to increase aged phenotype by increasing SerpinB2 expression in sepsis. Thus, targeting eCIRP could be a new therapeutic strategy to ameliorate inflammation caused by neutrophil aging in sepsis.
The Compensatory Reserve Index for Predicting Hemorrhagic Shock in Prehospital Trauma
Authors: Latimer Andrew J. , Counts Catherine R. , Van Dyke Molly , Bulger Natalie , Maynard Charles , Rea Thomas D. , Kudenchuk Peter J. , Utarnachitt Richard B. , Blackwood Jennifer , Arbabi Saman , Sayre Michael R. 
Published: August 2023

ABSTRACT

Background
The compensatory reserve index (CRI) is a noninvasive, continuous measure designed to detect intravascular volume loss. CRI is derived from the pulse oximetry waveform and reflects the proportion of physiologic reserve remaining before clinical hemodynamic decompensation.

Methods
In this prospective, observational, prehospital cohort study, we measured CRI in injured patients transported by Emergency Medical Services (EMS) to a single Level I trauma center. We determined whether the rolling average of CRI values over 60 seconds (CRI trend [CRI-T]) predicts in-hospital diagnosis of hemorrhagic shock, defined as blood product administration in the prehospital setting or within four hours of hospital arrival. We hypothesized that lower CRI-T values would be associated with an increased likelihood of hemorrhagic shock and better predict hemorrhagic shock than prehospital vital signs.

Results
Prehospital CRI was collected on 696 adult trauma patients, 21% of whom met our definition of hemorrhagic shock. The minimum CRI-T was 0.14 (Interquartile range (IQR) 0.08-0.31) in those with hemorrhagic shock and 0.31 (IQR 0.15-0.50) in those without (p = <0.0001). The positive likelihood ratio of a CRI-T value <0.2 predicting hemorrhagic shock was 1.85 (95% CI 1.55-2.22). The area under the ROC curve (AUC) for the minimum CRI-T predicting hemorrhagic shock was 0.65 (95% confidence interval (CI) 0.60-0.70), which outperformed initial prehospital HR (0.56 [95% CI 0.50-0.62]) but underperformed EMS systolic blood pressure and shock index (0.74 [95% CI 0.70-0.79] and 0.72 [95% CI 0.67-0.77] respectively).

Conclusions
Low prehospital CRI-T predicts blood product transfusion by EMS or within four hours of hospital arrival but is less prognostic than EMS blood pressure or shock index. The evaluated version of CRI may be useful in an austere setting at identifying injured patients that require the most significant medical resources. CRI may be improved with noise filtering to attenuate the effects of vibration and patient movement.
Efficacy of supplemental hemoadsorption therapy on severe and critical patients with COVID-19: an evidence-based analysis
Authors: He Junbing , Lin Yao , Cai Weiming , Lin Yingying , Qin Wanbing , Shao Yiming , Liu Qinghua 
Published: August 2023

Abstract

Background
The COVID-19 pandemic has posed a disproportionately high threat to the global health system and social stability. COVID-19 damage can lead to hyperinflammation and tissue damage due to a "cytokine storm", which in turn contributes to an increase in the mortality rate. Extracorporeal hemoadsorption therapy (HAT) in patients with severe COVID-19 may improve organ function and stabilize hemodynamic status; however, the effects of supplemental HAT remain controversial.

Methods
The Cochrane Library, Embase and PubMed databases were comprehensively searched from inception to August 20, 2022 for potential studies.

Results
A total of 648 patients with severe COVID-19 in 3 randomized controlled trials and 11 observational studies met the inclusion criteria. A meta-analysis indicated that supplemental HAT significantly improved the mortality rate of patients with severe COVID-19 compared with conventional therapy (CT) (RR = 0.74, 95% CI: [0.56, 0.96], P = 0.026). In subgroup analyses, supplemental HAT significantly decreased mortality rates in patients without extracorporeal membrane oxygenation (ECMO) support (RR = 0.59, 95% CI: [0.44, 0.79], P < 0.0001), while a significant difference was not observed in patients requiring ECMO support (RR = 1.61, 95% CI: [0.63, 4.09], P = 0.316). Standardized mean difference (SMD) meta-analysis showed that IL-6 removal was more significant in HAT group than CT group (SMD = 0.46, 95% CI: [0.01, 0.91], P = 0.043), followed by CRP (SMD = 0.70, 95% CI: [-0.04, 1.44], P = 0.065) and IL-8 (SMD = 0.36, 95% CI: [-0.34, 1.07], P = 0.311). No evidence of substantial publication bias concerning mortality was observed.

Conclusion
Given the better mortality outcomes, HAT confers clinical benefits to patients with severe COVID-19, which correlated with cytokine removal by HAT. Cytokine adsorption may not provide clinical benefits for patients with severe COVID-19 requiring ECMO and should be used with caution. However, due to the very low quality of evidence, multicenter randomized trials with large sample sizes are required to verify these findings.
Treatment with human umbilical cord-derived mesenchymal stem cells in a pig model of sepsis-induced acute kidney injury: effects on microvascular endothelial cells and tubular cells in the kidney
Authors: Ramos Maia Débora Rothstein , Otsuki Denise Aya , Rodrigues Camila Eleutério , Zboril Sabrina , Sanches Talita Rojas , Neto Amaro Nunes Duarte , Andrade Lúcia , Auler José Otávio Costa 
Published: August 2023

Abstract

Background
Approximately 50% of patients with sepsis develop acute kidney injury (AKI), which is predictive of poor outcomes, with mortality rates of up to 70%. The endothelium is a major target for treatments aimed at preventing the complications of sepsis. We hypothesized that human umbilical cord-derived mesenchymal stem cells (hUC-MSCs) could attenuate tubular and endothelial injury in a porcine model of sepsis-induced AKI.

Methods
Anesthetized pigs were induced to fecal peritonitis, resulting in septic shock, and were randomized to treatment with fluids, vasopressors, and antibiotics (sepsis group; n = 11) or to that same treatment plus infusion of 1 × 106 cells/kg of hUC-MSCs (sepsis+MSC group; n = 11).

Results
At 24 h after sepsis induction, changes in serum creatinine and mean arterial pressure were comparable between the two groups, as was mortality. However, the sepsis+MSC group showed some significant differences in comparison with the sepsis group: lower fractional excretions of sodium and potassium; greater epithelial sodium channel protein expression; and lower protein expression of the Na-K-2Cl cotransporter and aquaporin 2 in the renal medulla. Expression of P-selectin, thrombomodulin, and vascular endothelial growth factor was significantly lower in the sepsis+MSC group than in the sepsis group, whereas that of Toll-like receptor 4 (TLR4) and nuclear factor-kappa B (NF-κB) was lower in the former.

Conclusion
Treatment with hUC-MSCs seems to protect endothelial and tubular cells in sepsis-induced AKI, possibly via the TLR4/NF-κB signaling pathway. Therefore, it might be an effective treatment for sepsis-induced AKI.