bluuebunny/crossref_metadata_2025_split huggingface dataset:
Hindlimb Suspension As A Model For Intracranial And Intraocular Pressures, And Retinal Changes During Spaceflight
Authors: Fuller Charles A , Gompf Heinrich , Hoban‐Higgins Tana , Robinson Edward 
Published: July 2022

A pronounced cephalic fluid shift is one of the responses to exposure to the microgravity spaceflight environment. This project uses the well‐documented rat hindlimb suspension (HLS) model to test the hypothesis that this fluid shift is a causative factor underlying the ocular changes seen in astronauts during and following long‐duration spaceflight. This hypothesis follows from the fact that similar ocular effects are seen in Idiopathic Intracranial Hypertension (IIH) and are associated with increased intraocular pressure (IOP).In order to elucidate the roles played by age and sex in the relationship between a cephalic fluid shift and the regulation of intracranial pressure (ICP) and IOP, as well as visual system structure and function, three cohorts are under study: young adult females, young adult males, and older middle‐age males. Groups of animals are exposed to HLS durations of 0 (baseline), 7, 14, 28 and 90 days with 90 days of HLS being followed by equivalent intervals of recovery in a vivarium cage, i.e. either 0, 7, 14, 28 or 90 days. Each HLS subject has an age‐matched control maintained in the same room but in a vivarium cage. An LD 12:12 cycle is present and all subjects have ad lib access to food and water.This presentation represents a status report of this ongoing program. We have measured ICP in one group of subjects. ICP recording is underway for the other 2 groups. To date, the data identify a very small increase in ICP, which is maintained during HLS. Our hypothesis is that this increase in ICP could lead to morphological changes in visual structures similar to those seen previously in some astronauts following long duration missions. To this end, MRI was used to image the eyes and brains in all 3 groups at baseline and at the midpoint and endpoint of HLS and recovery. Data analysis indicates increased optic nerve sheath diameters which are most pronounced in the middle‐aged males yet also observed in younger males, as well as globe flattening in HLS. IOP continues to be measured in all animals under study. In general, there is a trend for increased IOP during HLS. Moreover, refractive error increases over 90 days of suspension. These preliminary results continue to be supportive of our hypothesis that an increase in ICP may underlie such ocular changes.Support or Funding InformationSupported by NASA Grant NNX13AD94G.
Concomitant neuroleptic malignant syndrome and diabetes insipidus
Authors: Zaki Carlee , Ugell Meredith , Vo Trang , Liu Steven 
Published: July 2022

ABSTRACT
Each year, nearly one-fifth of adults in the United States are prescribed at least one psychotropic medication. An increased trend in psychiatric polypharmacy has heightened awareness of drug-drug interactions and the tracking of adverse drug reactions. This article describes a patient who developed concomitant neuroleptic malignant syndrome (NMS) and nephrogenic diabetes insipidus during cross-titration of his antipsychotics while on lithium. The patient's mild form of NMS in turn caused hypovolemia and acute kidney injury. This case study highlights the dangers of polypharmacy and how it can obscure the presentation of even classic adverse reactions.
American health workforce policy and PAs
Authors: Cawley James F. 
Published: July 2022

ABSTRACT
Health workforce policy in the United States from the mid-1970s has been strongly influenced by perceptions of the adequacy of the physician supply and its relationship to physician assistants/associates (PAs) and NPs. During the 1980s, a series of inaccurate reports by the federal government mistakenly warned of an impending physician surplus and shaped policy decisions for decades. In spite of perceptions of a physician surplus, the PA profession expanded rapidly in the 1990s. Projections of the adequacy of the physician supply changed to a shortage in the first decade of this century and the PA component of the healthcare workforce continued to expand. During the past decade, the Association of American Medical Colleges has employed microsimulation modeling expertise to project the extent of physician shortages, an effort that initially failed to incorporate the contributions of PAs and NPs in the workforce. Although current projection models include the contributions of PAs and NPs, the substitution ratios used are notably low. Specifically, PA and NP productivity effort was set roughly at one-quarter to one-half that of the physician. PAs and NPs make up a substantial contingent within the US healthcare workforce and should be included fully in future workforce projection estimates. This article provides policy recommendations for the advancement of PA contributions to the delivery of medical care.
Prospective, Randomized, Blinded Clinical Trial Comparing PEEK and Allograft Spacers in Patients Undergoing Anterior Cervical Discectomy and Fusion Surgeries
Authors: Villavicencio Alan T. , Nelson E. Lee , Rajpal Sharad , Beasley Kara , Burneikiene Sigita 
Published: July 2022

Study Design.
Prospective, randomized, blinded clinical trial.

Objective.
To examine clinical and radiological outcomes in patients undergoing anterior cervical discectomy and fusion (ACDF) surgeries randomized to receive either polyether-ether-ketone (PEEK) or structural bone allografts.

Summary of Background Data.
The biomechanical qualities as well as osteoconductive, osteogenic, and osteoinductive properties of various graft materials have been previously evaluated. There remain questions, however, as to whether there are any clinical and/or radiographic outcome differences in the selection of interbody graft types for ACDF.

Methods.
Patients undergoing one- to three-level ACDF with single anterior plate fixation were randomized (1:1 ratio) to receive either cortical allograft or PEEK interbody spacers. Radiographic and clinical outcomes were assessed at 3, 6, 12, and 24 months with an additional postoperative radiographic assessment.

Results.
A total of 120 patients were enrolled and randomized. Comparing clinical outcomes, no differences in arm or neck pain scores were noted; however, there was a statistically significant (≤0.041) improvement in SF-36 PCS scores for the allograft group at all follow-up time points and a tendency toward lower disability scores. Overall, evidence of radiographic fusion was achieved in 87 (91.6%) patients: five (10.2%) and three (6.5%) patients had pseudoarthrosis (P = 0.72) in the PEEK and allograft groups, respectively. At 24 months’ follow-up time, any cervical or segmental alignment restoration achieved with surgery was lost and no statistically significant changes were detected when all levels of surgery were included. Likewise, there were no statistically significant differences between the groups for anterior or posterior body height measurements at the 24 months’ follow-up. Approximately 20% of patients had anterior and posterior subsidence, all grade 0 regardless of the group assignment.

Conclusion.
Comparable radiographic outcomes were observed for patients undergoing one- to three-level PEEK versus allograft-assisted ACDF surgeries. Although MCID comparisons suggest that allograft and PEEK-treated patients have similar clinical outcomes, testing that incorporates the magnitude of the change suggests that there may be a statistically significant greater magnitude of improvement for the allograft group patients, but further studies with a larger sample size would be helpful to determine if a true effect exists.
Opioid Prescribing Patterns Before, During, and After Critical Illness: An Observational Study
Authors: Wampole Chelsea , McKenna Ariel , Riker Richard R. , May Teresa L. , Seder David B. , Abram Dawn , Fraser Gilles L. , Gagnon David J. 
Published: July 2022

OBJECTIVES:
The association between opioid therapy during critical illness and persistent opioid use after discharge is understudied relative to ICU opioid exposure and modifiable risk factors. Our objectives were to compare persistent opioid use after discharge among patients with and without chronic opioid use prior to admission (OPTA) and identify risk factors associated with persistent use.

DESIGN:
Retrospective cohort study.

SETTING:
Medical, trauma/surgical, or neurologic ICU at an academic hospital.

PARTICIPANTS:
Adult patients surviving hospital admission.

INTERVENTIONS:
Opioid use during the ICU and post-ICU stays.

MEASUREMENTS AND MAIN RESULTS:
The primary outcome was persistent opioid use accounting for greater than 70% of days 4–6 months after discharge. Among 2,975 included patients, 257 (8.6%) were classified as OPTA, and 305 (10.2%) persistently filled opioid prescriptions, including 186/257 (72%) OPTA and 119/2,718 (4.4%) with no chronic opioid fills prior to admission. Among all patients, OPTA was strongly associated with persistent opioid use (odds ratio, 57.2 [95% CI, 41.4–80.0]). Multivariable logistic regression revealed that male sex, surgical procedure, and ICU opioid-free days were associated with reduced persistent opioid use for OPTA patients. Age and ICU opioid-free days were associated with reduced persistent opioid use for non-OPTA patients. Total ICU opioid dose and dose per day of ICU exposure were not associated with persistent use for either group.

CONCLUSIONS:
In this mixed cohort of ICU patients, 10.2% persistently filled opioid prescriptions 4–6 months after discharge. Although ICU opioid doses were not associated with persistent use, duration of ICU opioid administration is a modifiable risk factor that may reduce persistent opioid use after critical illness.
Surviving Sepsis Guideline–Directed Fluid Resuscitation: An Assessment of Practice Patterns and Impact on Patient Outcomes
Authors: Govero Austin B. , Yarrarapu Siva Naga S. , Harrison Michael F. , Baig Hassan Z. , Guru Pramod , Moreno Franco Pablo , Caples Sean M. , Grek Ami A. , Vizzini Michael R. , Ball Colleen T. , Khan Syed A. , Heise Katherine J. , Sekiguchi Hiroshi , Cantrell Warren L. , Sanghavi Devang K. 
Published: July 2022

IMPORTANCE:
Aggressive fluid resuscitation remains a cornerstone of the Surviving Sepsis Campaign (SSC) guidelines, but there is growing controversy regarding the recommended 30 mL/kg IV fluid dosage. It is contended that, in selected patients, this volume confers an increased risk of volume overload without either concomitant benefit or strong evidence in support of the recommended IV fluid dosage.

OBJECTIVES:
Assessment of practice patterns and their impact on patient outcomes following the surviving sepsis guidelines for fluid resuscitation.

DESIGN:
Large, multisite retrospective cohort study.

SETTING AND PARTICIPANTS:
The retrospective study included all adult patients who presented to the emergency department at one of 19 different Mayo Clinic sites throughout the Midwest, Southeast, and Southwest from August 2018 to November 2020 with suspected sepsis.

MAIN OUTCOMES AND MEASURES:
Eight-thousand four-hundred fourteen patients suspected to have sepsis were assessed regarding fluid resuscitation and outcomes among patients receiving 30 mL/kg IV fluid dosing compared with patients who did not. Patient demographics and clinical information were collected via electronic health records. Patients were divided into two cohorts: those who received 0–29.9 mL/kg of IV fluid and those who received 30.0+ mL/kg of IV fluid. Statistical analyses were performed to evaluate the impact of fluid dose on in-hospital death, 30-day mortality, ICU admission after diagnosis, dialysis initiation after diagnosis, ventilator use, vasopressor use, as well as ICU and hospital length of stay.

RESULTS:
We observed lower in-hospital mortality and 30-day mortality risk in the 30+ mL/kg dosing group. Increased fluid dosage did, however, carry a much greater chance of ICU admission. Most patients (72% after propensity score weighting) in our population received less than 30 mL/kg fluid (based on ideal body weight).

CONCLUSIONS AND RELEVANCE:
IV fluid dosing for sepsis resuscitation greater than 30 mL/kg was associated with decreased risk of in-hospital mortality, 30-day mortality, and reduced risk of requiring mechanical ventilation. Our data does ultimately seem to support the SSC recommendation.
HTLV-1-related adult T-cell leukemia/lymphoma: insights in early detection and management
Authors: Wolf Sonia , Vercruyssen Marie , Cook Lucy 
Published: July 2022

Purpose of review
Adult T-cell leukemia-lymphoma (ATL) is an aggressive mature T-cell malignancy that arises in approximately 5% of carriers of human T-lymphotropic virus type 1 (HTLV-1), but this risk is not random among carriers. We describe recent advance in pathogenesis, risk factors and for early detection of ATL.

Recent findings
Unraveling ATL molecular genetics has shed light on pathogenesis and provides insights into novel therapeutic targets. Moreover, an important step in improving outcomes is identifying asymptomatic carriers who are at high risk of progression to ATL, which has traditionally relied on quantifying the proviral load (PVL). This can be done by quantifying oligoclonality- and in particular the expanded clone- with molecular and flow cytometric techniques, that can be applied to a clinical setting. Studies using these methods have shown that carriers with oligoclonal populations are at an increased risk of transformation, beyond that that predicted by PVL alone.

Summary
There is an urgent unmet need for developing novel therapies in ATL in order to improve survival. Recent advances in the molecular and epigenetic landscape of ATL, and the early detection of disease offer the potential to intervene early, before disease becomes aggressive, and to offer tailored therapeutic strategies.
Bacterial infection-driven lymphomagenesis
Authors: Vannata Barbara , Pirosa Maria Cristina , Bertoni Francesco , Rossi Davide , Zucca Emanuele 
Published: July 2022

Purpose of review
The first convincing evidence for a causal relationship between bacterial infection and lymphomagenesis came from the link between gastric lymphoma and chronic Helicobacter pylori gastritis. This review will summarize the current epidemiological, clinical, and biological evidence of a causative role of bacteria in the development of malignant lymphomas, particularly, the extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue type.

Recent findings
Other microorganisms have been associated with specific extranodal lymphoma sites with variable and not always definitive, evidence, including Chlamydia psittaci, Borrelia burgdorferi, Campylobacter jejuni and, most recently, Coxiella Burnetii. According to most plausible models, lymphoma growth is a consequence of continuous antigenic stimulation induced by chronic infection. However, some evidence of a direct oncogenic role of H. pylori has been provided, too.

Summary
Lymphomas are not the result of a single cause but multifactorial diseases, influenced by a variety of genetic and environmental elements. Hence, ascertaining the specific contribution of bacterial infections is not always easy. Nevertheless, the eradication of the associated chronic infection may result in sustained lymphoma regression. Moreover, the association between infections and lymphoma may offer opportunities for reducing lymphoma incidence by preventing the predisposing infections or treating them early.
Diagnostic Process and Barriers Among Chinese-American and Korean-American Parents of Children with Autism
Authors: Kim Irang , Dababnah Sarah , Wang Yao , Reyes Charina 
Published: July 2022

ABSTRACT:

Objective:
We sought to understand the experiences of Chinese-American and Korean-American parents of children with autism, including their initial concerns regarding their child's development, reported health professionals' responses to these concerns, diagnostic barriers, and factors associated with early autism diagnosis.

Method:
We designed a survey with support from an expert advisory group and Asian-American parents of children with autism. We measured 3 time points of diagnostic history, areas of parents' concerns, professionals' responses to their concerns, 15 types of diagnostic barriers, and professionals' helpfulness. We used descriptive and independent t tests to analyze data from 28 parents of children with autism.

Results:
Most of the parents (86%) had early concerns about their children's developmental delays and expressed their concerns to health professionals. However, approximately 60% of the parents reported that the professionals did not conduct developmental screenings or make referrals to specialists. The most common diagnostic barrier was the stress of the diagnostic process, followed by navigating health care systems. Parents who required interpreters noted poor quality and unavailability. Early child developmental concerns were associated with early autism diagnoses.

Conclusion:
Although many Chinese-American and Korean-American parents had early concerns regarding their child's development and shared their concerns with health care professionals, parents encountered many barriers, including the stress of the diagnostic process. Chinese-American and Korean-American parents with limited English proficiency required additional support. Health care professionals' active listening and responses to parents' concerns can promote early diagnosis.
Ascending aortic intramural hematoma: current concepts
Authors: Nana Petroula , Kouvelos George , Spanos Konstantinos 
Published: July 2022

Purpose of review
Type A intramural hematoma (TAIMH) is an acute aortic disease characterized by the presence of hematoma in the aortic media and involving the ascending aorta. Open repair seems to be the first treatment approach, although recent evidence highlights that the best management of TAIMH is controversial. This review will focus on the current concept for TAIMH management and factors affecting the decision making.

Recent findings
Recent studies have evaluated the role of open and endovascular repair, as well as conservative management in patients with TAIMH. More specific imaging findings seem to affect decision making for urgent repair.

Summary
Despite TAIMH's acute nature, conservative management seems to represent a valid option for urgent approach, presenting similar mortality to open and endovascular repair. Comparative data are limited, however, in experienced centers, any approach may be applied with encouraging results. Endovascular management, which is mainly applied to manage retrograde TAIMH, is related to lower mortality and morbidity compared to open repair in this group of patients while aortic remodeling seems beneficial with this approach. Imaging findings, as ulcer-like lesions, hematoma thickness, concomitant dissection and aortic diameter, related to higher complication rate, set the indication for interventional management. Further research, including prospective data and registries, and ideally, randomized data may further clarify the best approach and factors indicating urgent repair.
Silent brain infarcts, peripheral vascular disease and the risk of cardiovascular events in patients with hypertension
Authors: Jiménez-Balado Joan , Riba-Llena Iolanda , Nafría Cristina , Pizarro Jesús , Rodríguez-Luna David , Maisterra Olga , Ballvé Alejandro , Mundet Xavier , Violan Concepción , Ventura Oriol , Montaner Joan , Delgado Pilar 
Published: July 2022

Background and aims:
We aimed to study the relationship between cerebral small vessel disease (cSVD) lesions, as markers of subclinical target organ damage (TOD) in the brain, and incident cardiovascular events (CVE).

Methods:
Data from the ISSYS (Investigating Silent Strokes in hYpertensives Study), which is a longitudinal and observational study conducted in patients with hypertension aged 50–70 years, and stroke-free at the inclusion. At the baseline visit, participants underwent a clinical interview, a brain MRI, urine and blood sampling collection and vascular testing studies. Therefore, we obtained markers of TOD from the brain [white matter hyperintensities, silent brain infarcts (SBI), cerebral microbleeds and enlarged perivascular spaces (EPVS)], from kidney (microalbuminuria, glomerular filtration) and regarding large vessels [ankle-to-brachial index (ABI), carotid–femoral pulse wave velocity]. Survival analyses were used to assess the relationship between these predictors and the incidence of cardiovascular events (CVE).

Results:
We followed-up 964 individuals within a median time of 5 years (4.7–5), representing 4377.1 persons-year. We found 73 patients presenting incident CVE, which corresponds to a rate of 8.2%. We found ABI less than 0.9 [hazard ratio, 2.2; 95% confidence interval (CI) 1.17–4.13, P value = 0.014] and SBI (hazard ratio, 2.9; 95% CI 1.47–5.58, P value = 0.002) independently associated with higher risk of incident CVE. The inclusion of both variables in a clinical model resulted in an increased discrimination of individuals with new CVE of 4.72%, according to the integrated discrimination index.

Conclusion:
Assessment of SBI and ABI less than 0.9 may refine the cardiovascular risk stratification in patients with hypertension.
Arterial stiffness and nocturnal hypertension in preterm children and adolescents
Authors: Chainoglou Athanasia , Sarafidis Kosmas , Chrysaidou Katerina , Farmaki Evangelia , Kollios Konstantinos , Economou Marina , Kotsis Vasilios , Stabouli Stella 
Published: July 2022

Background and objectives:
Preterm birth has been associated with increased risk for developing hypertension and other chronic diseases during childhood and adulthood. The aim of the current prospective case–control study was to investigate the associations of preterm birth with ambulatory blood pressure (BP) levels and arterial stiffness during childhood and adolescence.

Methods:
The study population included 52 children and adolescents born preterm and 26 healthy children born full term with similar age. The participants underwent ambulatory BP monitoring (ABPM) and assessment of carotid-femoral pulse wave velocity (PWV).

Results:
Preterm children presented higher night SBP z score values compared to controls, but did not differ in other ABPM parameters, office peripheral and central SBPs. Nocturnal hypertension was found in 78% (7/9) of ex-preterm children with ambulatory BP hypertension. Preterm birth was an independent predictor of PWV z score adjusted for heart rate. Estimated marginal means for PWV z score adjusted for age, sex, presence of kidney disease at birth, office BPs, night BPs, central SBP, and BMI z scores were significantly higher in preterm individuals compared to controls (0.703, 95% confidence interval [CI] 0.431–0.975 versus −0.19, 95% CI −0.574–0.536, respectively, P = 0.027). Preterm children who were overweight presented the highest values of night SBP and PWV z score.

Conclusion:
Preterm birth is associated with higher nocturnal BP and increased arterial stiffness in childhood and adolescence. Increased awareness for detection of hypertension and prevention of obesity in childhood could prevent future adverse cardiovascular outcomes in preterm individuals.