bluuebunny/crossref_metadata_2025_split huggingface dataset:
Emergency transcatheter aortic valve implantation for acute heart failure due to severe aortic stenosis in critically ill patients with or without cardiogenic shock
Authors: Steffen Julius , Stocker Angelika , Scherer Clemens , Haum Magda , Fischer Julius , Doldi Philipp M , Theiss Hans , Braun Daniel , Rizas Konstantinos , Peterß Sven , Hausleiter Jörg , Massberg Steffen , Orban Martin , Deseive Simon 
Published: October 2022

Abstract

Aims
Severe aortic stenosis can cause acute heart failure and cardiogenic shock (CS). Transcatheter aortic valve implantation (TAVI) is the standard therapy for aortic stenosis in inoperable patients. However, its role in this setting is poorly evaluated. The study purpose was to explore clinical characteristics of these patients and to assess predictors of mortality.

Methods and results
All 2930 patients undergoing transfemoral TAVI at our centre between 2013 and 2019 were screened for critically ill patients, receiving intensive care therapy and emergency TAVI. Selected patients were subdivided into two groups, according to the presence or absence of CS. Remaining patients undergoing elective TAVI served as a comparison. Primary outcome was 90-day mortality. Out of 179 critically ill patients, 47 fulfilled criteria of CS (shock group) and 132 did not despite a severe decompensation (no shock group). Shock patients were more often male and had higher Society of Thoracic Surgeons scores [15.6, interquartile range (8.0–32.1) vs. 5.5 (3.9–8.5), P &lt; 0.01] compared with severely decompensated patients. Ninety-day mortality was: shock group, 42.6%, vs. no shock group, 15.9%, vs. elective group, 5.3% (P &lt; 0.01). A landmark analysis from day 90 showed similar mortality (P = 0.29). Compared with elective patients, 30-day composite endpoint device failure was higher in critically ill groups [shock group, odds ratio, 2.86 (1.43–5.36), no shock group, odds ratio, 1.74 (1.09–2.69)]. Multivariable regression revealed mechanical ventilation, haemofiltration, elevated C-reactive protein or bilirubin, and hypotension before TAVI as 90-day mortality predictors.

Conclusion
Ninety-day mortality after TAVI in critically ill patients is increased but survivors have similar outcomes as elective patients.
Prognostic implications of trabecular complexity measured by fractal analysis in left ventricular noncompaction
Authors: Azpiroz Franch M J , Casas Masnou G , Romero A , Gonzalez Del Hoyo M I , Larranaga Moreira J M , Escalona Silva R , Guala A , Limeres Freire J , Bayes Genis A , Zorio Grima E , Villacorta Arguelles E , Garcia Pavia P , Barriales Villa R , Ferreira Gonzalez I , Rodriguez Palomares J F 
Published: October 2022

Abstract

Introduction
Left ventricular non compaction (LVNC) is a heterogeneous entity characterized by prominent LV trabeculae. Fractal analysis, a semi-automatic method to quantify the degree of hypertrabeculation, has been described as a diagnostic criterion for LVNC. However, the prognostic implications of fractal analysis have not been investigated.

Purpose
Therefore, the aim of our study was to identify the relationship between the trabecular complexity measured by fractal analysis and the occurrence of cardiovascular events in LVNC patients.

Methods
We conducted a retrospective longitudinal multicenter cohort study of consecutive patients fulfilling LVNC criteria by cardiovascular magnetic resonance (CMR). The endpoints were heart failure (HF), ventricular arrythmias (VA), systemic embolism (SE) and all-cause mortality. Fractal analysis was performed on short-axis CMR cine images using CVI 42 software. The cohort was divided in two groups according to the maximal apical fractal dimension (FD).

Results
A total of 291 patients were included: age was 44±19 years and 56% were female. LV ejection fraction (LVEF) was 47% ± 14% and 26 patients (9%) presented late gadolinium enhancement (LGE). Mean global FD was 1.29±0.06 and maximal apical FD was 1.39±0.09. Baseline characteristics of patients with maximal apical FD 1.39 and 1.39, including functional LV parameters, were comparable (Table 1). After 3.8±2.5 years of follow-up, 37 patients (12.8%) presented HF, 30 (10.4%) had VA, SE occurred in 3 (1%) and 3 patients (1%) died. Maximal apical FD was not associated with the risk of HF or VA (both p ns), nor was mean global FD. There were no significant differences in the survival curves of both endpoints between the two groups: HR were 2.34 (95% CI 0.74–7.4, p 0.13) and 1.15 (95% CI 0.45–2.41, p 0.71) respectively for HF and VA (Image 1). LVEF and LGE remained consistent predictors of events.

Conclusions
In a large multicenter retrospective LVNC study, the degree of hypertrabeculation measured by fractal analysis was not associated with functional LV parameters and, most importantly, with the incidence of cardiovascular events. Therefore, our results suggest that diagnostic LVNC criteria should be refined to include parameters with actual prognostic implications.

Funding Acknowledgement
Type of funding sources: None.
Reason and reality—identifying barriers to patient enrolment for clinical trials in invasive candidiasis
Authors: Sprute Rosanne , Grothe Jan H , Heringer Sarah , Cornely Oliver A 
Published: October 2022

Abstract

Objectives
Enrolment of subjects to clinical trials investigating novel drugs for infectious diseases is an ongoing challenge. In this study, we evaluate factors associated with non-enrolment in treatment trials for invasive candidiasis.

Methods
We conducted a retrospective review of pre-screening logs of patients that were assessed for enrolment in the three clinical trials ACTIVE (NCT00413218), APX001-201 (NCT03604705) and ReSTORE (NCT03667690), investigating novel drugs for invasive candidiasis between September 2007 and August 2021 to identify reasons for study ineligibility.

Results
Two hundred and fifty-six patients with invasive candidiasis were identified for potential study participation with n = 154 for the ACTIVE trial, n = 89 for APX001-201 and n = 13 for ReSTORE. Half of the potential participants were unable or unwilling to consent. We further identified comorbid conditions such as hepatic or renal impairment [21 hepatic and renal cases (13.6%) in ACTIVE; 12 hepatic (13.5%) and 28 renal cases (31.5%) in APX], prior antifungal treatment [11 cases (7.1%) in ACTIVE; 16 (18.0%) in APX; 7 (38.5%) in ReSTORE] and the last positive culture obtained ≥96 h prior to dosing [1 case (0.6%) in ACTIVE; 7 (7.9%) in APX; 5 (38.5%) in ReSTORE] as relevant reasons for non-enrolment. We also identified criteria repetitively used in the analysed studies that did not contribute substantially to ineligibility rates. Ultimately, 254/256 patients (99.2%) were ineligible for enrolment in the respective trial.

Conclusions
This study identified barriers to enrolment in clinical trials assessing novel antifungal agents in invasive candidiasis. Identification of eligibility criteria associated with non-enrolment allows modification of future trial designs and may ultimately result in higher recruitment rates.
Spontaneous rupture and upper gastrointestinal bleeding of solid pseudopapillary neoplasm of the pancreas
Authors: Revoredo Fernando , Kometter Fritz , Núñez Juan , León Julio , Luna Juan , Valdes Jorge 
Published: October 2022

Abstract
The solid pseudopapillary neoplasm (SPN) of the pancreas is an uncommon, low-grade malignant tumour, mostly seen in young women. We report a rare case of a 44-year-old female who presented with spontaneous rupture and upper gastrointestinal bleeding. The emergency endoscopy revealed a 2 cm bleeding ulcer on the duodenal bulb. A computer tomography scan (CT scan) showed a 6.7 cm mass, with solid and cystic components arising in the head of the pancreas. After achieving haemostasis, she was discharged. Two months later, a new CT scan showed a persistent 6 cm mass in the head of the pancreas, now containing air and communicating with the duodenal lumen. The patient was successfully treated by pancreatoduodenectomy. Histopathological examination showed a T3N0M0 SPN with immunohistochemical expression of β-catenin, synaptophysin, vimentin and progesterone receptor, and negativity for chromogranin. The labelling index of Ki 67 was 2%. No recurrence was present after 2 years of follow-up.
The glutamate receptor-like 3.3 and 3.6 mediate systemic resistance to insect herbivores in Arabidopsis
Authors: Xue Na , Zhan Che , Song Juan , Li Yong , Zhang Jingxiong , Qi Jinfeng , Wu Jianqiang 
Published: October 2022

Abstract
Herbivory activates responses in local and systemic leaves, and the glutamate receptor-like genes GLR3.3 and GLR3.6 are critical in leaf-to-leaf systemic signalling. However, whether and how these genes mediate plant systemic resistance to insects remain largely unexplored. We show that a piercing-sucking insect Myzus persicae (green peach aphid, GPA) or chewing insect Spodoptera litura (cotton leafworm, CLW) feeding-induced systemic defences were attenuated in the glr3.3 glr3.6 mutants. In response to herbivory from either insect, glr3.3 glr3.6 mutants exhibited reduced accumulation of the hormone jasmonic acid (JA) and defensive metabolites glucosinolates (GSs) in systemic (but not local) leaves. Transcriptome analysis indicated that GLR3.3 and GLR3.6 play an important role in regulating the transcriptional responses to GPA and simulated CLW feeding in both local and systemic leaves, including JA- and GS-related genes. Metabolome analysis also revealed that in response to GPA or simulated CLW feeding, GLR3.3 and GLR3.6 are involved in the regulation of various metabolites locally and systemically, including amino acids, carbohydrates, and organic acids. Taken together, this study provides new insights into the function of GLR3.3 and GLR3.6 in mediating transcripts and metabolites in local and systemic leaves under insect attack, and highlights their role in regulating insect resistance in systemic leaves.
Genetic Polymorphisms
Authors: Hartl Daniel L. 
Published: October 2022

Abstract
Chapter 1 provides a brief introduction to genes and how they work for those without the necessary background or for review. Its emphasis is on the major types of genetic polymorphisms including single-nucleotide polymorphisms (SNPs), allele and genotype frequencies, and the utility of genetic polymorphisms in studying the history and current structure of natural populations. It examines different types of models including mathematical models, as well as their relative strength and limitations. How models are modified to be progressively more realistic is illustrated in both discrete-time and continuous-time models of exponential and logistic population growth.
Career Spillovers in Internal Labour Markets
Authors: Bianchi Nicola , Bovini Giulia , Li Jin , Paradisi Matteo , Powell Michael 
Published: October 2022

Abstract
This article studies career spillovers across workers, which arise in firms with limited promotion opportunities. We exploit a 2011 Italian pension reform that unexpectedly tightened eligibility criteria for the public pension, leading to sudden, substantial, and heterogeneous retirement delays. Using administrative data on Italian private-sector workers, the analysis leverages cross-firm variation to isolate the effect of retirement delays among soon-to-retire workers on the wage growth and promotions of their colleagues. We find evidence of spillover patterns consistent with older workers blocking the careers of their younger colleagues, but only in firms with limited promotion opportunities.
Is Outpatient Anterior Lumbar Fusion (ALIF) Safe? An Analysis of 30-day Outcomes
Authors: Jones Jeremy , Malik Azeem Tariq , Khan Safdar N. , Yu Elizabeth , Kim Jeffery 
Published: October 2022

Study Design:
Review of publicly available database.

Objective:
To compare 30-day outcomes of single-level ALIF procedures performed in outpatient and inpatient settings.

Summary of Background Data:
Despite a growing interest in performing standalone anterior lumbar interbody fusions (ALIFs) as an outpatient procedure, no study has evaluated the safety or efficacy of this procedure outside an inpatient setting.

Methods:
The 2012–2017 American College of Surgeons-National Surgical Quality Improvement Program (ACS-NSQIP) was queried using CPT code 22558 to identify patients undergoing a single-level ALIF. Patients receiving concurrent posterior lumbar surgery/fusion/instrumentation, pelvic fixation, or surgery due to tumor, trauma and/or deformity were excluded to capture an isolated cohort of patients receiving single-level standalone ALIFs. A total of 3728 single-level standalone ALIFs were included in the study. Multivariate regression analyses were used to compare 30-day adverse events and readmissions while controlling for baseline clinical characteristics.

Results:
Out of a total of 3728 ALIFs, 149 (4.0%) were performed as outpatient procedure. Following adjustment, outpatient ALIFs versus inpatient ALIFs had lower odds of experiencing any 30-day adverse event (2.0% vs. 9.2%, OR 0.24 [95% CI 0.08–0.76]; P=0.015). No significant differences were noted with regard to severe adverse events 9p=0.261), minor adverse events 9p=0.995), and readmission rates (P=0.95).

Conclusion:
On the basis of the results of the study, it appears that ALIFs may be carried out safely in an outpatient setting in an appropriately selected patient population.
Association Between Critical Events in the PICU and Outcomes in Neighboring Patients
Authors: Arshad Ahmed , Blandon Catherine , Carey Kyle , Verhoef Philip , Jani Priti , Volchenboum Samuel , Churpek Matthew , Mayampurath Anoop 
Published: October 2022

OBJECTIVE:
PICU patients who experience critical illness events, such as intubation, are at high risk for morbidity and mortality. Little is known about the impact of these events, which require significant resources, on outcomes in other patients. Therefore, we aimed to assess the association between critical events in PICU patients and the risk of similar events in neighboring patients over the next 6 hours.

DESIGN:
Retrospective observational cohort study.

SETTING:
Quaternary care PICU at the University of Chicago.

PATIENTS:
All children admitted to the PICU between 2012 and 2019.

INTERVENTIONS:
None.

MEASUREMENTS AND MAIN RESULTS:
The primary outcome was a critical event defined as the initiation of invasive ventilation, initiating vasoactive medications, cardiac arrest, or death. The exposure was the occurrence of a critical event among other patients in the PICU within the preceding 6 hours. Discrete-time survival analysis using fixed 6-hour blocks beginning at the time of PICU admission was used to model the risk of experiencing a critical event in the PICU when an event occurred in the prior 6 hours. There were 13,628 admissions, of which 1,886 (14%) had a critical event. The initiation of mechanical ventilation was the most frequent event (n = 1585; 59%). In the fully adjusted analysis, there was a decreased risk of critical events (odds ratio, 0.82; 95% CI, 0.70–0.96) in the 6 hours following exposure to a critical event. This association was not present when considering longer intervals and was more pronounced in patients younger than 6 years old when compared with patients 7 years and older.

CONCLUSION:
Critical events in PICU patients are associated with decreased risk of similar events in neighboring patients. Further studies targeted toward exploring the mechanism behind this effect as well as identification of other nonpatient factors that adversely affect outcomes in children are warranted.
Can an End-to-End Telesepsis Solution Improve the Severe Sepsis and Septic Shock Management Bundle-1 Metrics for Sepsis Patients Admitted From the Emergency Department to the Hospital?
Authors: Gaieski David F. , Carr Brendan , Toolan Melanie , Ciotti Kimberly , Kidane Amy , Flaada Drew , Christina Joseph , Aggarwal Rajesh 
Published: October 2022

IMPORTANCE:
Early detection and treatment for sepsis patients are key components to improving sepsis care delivery and increased The Severe Sepsis and Septic Shock Management Bundle (SEP-1) compliance may correlate with improved outcomes.

OBJECTIVES:
We assessed the impact of implementing a partially automated end-to-end sepsis solution including electronic medical record-linked automated monitoring, early detection, around-the-clock nurse navigators, and teleconsultation, on SEP-1 compliance in patients with primary sepsis, present at admission, admitted through the emergency department (ER).

DESIGN, SETTING AND PARTICIPANTS:
After a “surveillance only” training period between September 3, 2020, and October 5, 2020, the automated end-to-end sepsis solution intervention period occurred from October 6, 2020, to January 1, 2021 in five ERs in an academic health system. Patients who screened positive for greater than or equal to 3 sepsis screening criteria (systemic inflammatory response syndrome, quick Sequential Organ Failure Assessment, pulse oximetry), had evidence of infection and acute organ dysfunction, and were receiving treatment consistent with infection or sepsis were included.

MAIN OUTCOMES AND MEASURES:
SEP-1 compliance during the “surveillance only” period compared to the intervention period.

RESULTS:
During the intervention period, 56,713 patients presented to the five ERs; 20,213 (35.6%) met electronic screening criteria for potential sepsis; 1,233 patients had a primary diagnosis of sepsis, present at admission, and were captured by the nurse navigators. Median age of the cohort was 68 years (interquartile range, 57–79 yr); 55.3% were male; 63.5% were White/Caucasian, 26.3% Black/African-American; was 16.7%, and 879 patients (71.3%) were presumed bacterial sepsis, nonviral etiology, and SEP-1 bundle eligible. Nurse navigator real-time classification of this group increased from 51.7% during the “surveillance only” period to 71.8% during the intervention period (p = 0.0002). Five hospital SEP-1 compliance for the period leading into the study period (July 1, 2020–August 31, 2020) was 62% (p < 0.0001), during the “surveillance only” period, it was 68.4% and during the intervention period it was 78.3% (p = 0.002).

CONCLUSIONS AND RELEVANCE:
During an 11-week period of sepsis screening, monitoring, and teleconsultation in 5 EDs, SEP-1 compliance improved significantly compared with institutional SEP-1 reporting metrics and to a “surveillance only” training period.
Outcomes of Extracorporeal Membrane Oxygenation in COVID-19–Induced Acute Respiratory Distress Syndrome: An Inverse Probability Weighted Analysis
Authors: Raasveld Senta Jorinde , Taccone Fabio Silvio , Broman Lars Mikael , Hermans Greet , Meersseman Philippe , Quintana Diaz Manuel , Delnoij Thijs S. R. , van de Poll Marcel , Gouvea Bogossian Elisa , van Baarle Floor L. F. , Durak Koray , Zayat Rashad , Oude Lansink-Hartgring Annemieke , Meuwese Christiaan L. , van der Heijden Joris J. , de Troy Erwin , Dauwe Dieter , Scholten Erik , van der Velde Franciska , Maas Jacinta J. , Dos Reis Miranda Dinis , Kuijpers Marijn , van den Brule Judith , van den Bergh Walter M. , Vlaar Alexander P. J. 
Published: October 2022

IMPORTANCE:
Although venovenous extracorporeal membrane oxygenation (VV ECMO) has been used in case of COVID-19 induced acute respiratory distress syndrome (ARDS), outcomes and criteria for its application should be evaluated.

OBJECTIVES:
To describe patient characteristics and outcomes in patients receiving VV ECMO due to COVID-19–induced ARDS and to assess the possible impact of COVID-19 on mortality.

DESIGN, SETTING AND PARTICIPANTS:
Multicenter retrospective study in 15 ICUs worldwide. All adult patients (> 18 yr) were included if they received VV ECMO with ARDS as main indication. Two groups were created: a COVID-19 cohort from March 2020 to December 2020 and a “control” non-COVID ARDS cohort from January 2018 to July 2019.

MAIN OUTCOMES AND MEASURES:
Collected data consisted of patient demographics, baseline variables, ECMO characteristics, and patient outcomes. The primary outcome was 60-day mortality. Secondary outcomes included patient characteristics, COVID-19–related therapies before and during ECMO and complication rate. To assess the influence of COVID-19 on mortality, inverse probability weighted (IPW) analyses were used to correct for predefined confounding variables.

RESULTS:
A total of 193 patients with COVID-19 received VV ECMO. The main indication for VV ECMO consisted of refractory hypoxemia, either isolated or combined with refractory hypercapnia. Complications with the highest occurrence rate included hemorrhage, an additional infectious event or acute kidney injury. Mortality was 35% and 45% at 28 and 60 days, respectively. Those mortality rates did not differ between the first and second waves of COVID-19 in 2020. Furthermore, 60-day mortality was equal between patients with COVID-19 and non-COVID-19–associated ARDS receiving VV ECMO (hazard ratio 60-d mortality, 1.27; 95% CI, 0.82–1.98; p = 0.30).

CONCLUSIONS AND RELEVANCE:
Mortality for patients with COVID-19 who received VV ECMO was similar to that reported in other COVID-19 cohorts, although no differences were found between the first and second waves regarding mortality. In addition, after IPW, mortality was independent of the etiology of ARDS.
Digital Educational Interventions for the Development of Advanced Care Planning Skills for Medical Practitioners: A Scoping Review
Authors: Shah Kavisha , Janssen Anna , Donnelly Candice , Shaw Tim 
Published: October 2022

Background:Medical practitioners are important facilitators of advanced care planning but are often reluctant to engage in these conversations with patients and their families. Barriers to participation can be addressed through medical education for medical practitioners.Introduction:The primary objective was to examine the extent to which digital educational interventions are used to foster advanced care planning skills. Secondary objectives include understanding the acceptability of these interventions and whether electronic health records can be used to personalize learning.Methods:Online databases were used to identify relevant articles published from 2008 to 2021. Nine articles which evaluated the impact of digital learning for medical practitioners were selected. Studies eligible for inclusion in the review assessed changes in knowledge, attitudes, and practice regarding skills used in advanced care planning.Results:All publications used a pre-post study design with education delivered solely online. Only three studies focused on completing advance care plans or directives (33%). All but two studies recorded improvements in knowledge and/or attitudes toward planning (78%) while three studies recorded improvements in clinical practice (33%). The review suggests prior clinical or personal experiences could be used to personalize education.Discussion:The literature revealed that using digital education to develop advanced care planning skills is relatively unexplored despite the ability of this type of learning to improve professional knowledge and confidence. Digital devices can also improve access to relevant information at the point-of-care. Personalized interventions that incorporate prior clinical experiences, potentially extracted from health records, could be used to optimize outcomes.
Acute opioid-induced gastroparesis successfully treated with naloxone: a case report
Authors: Seet Hao Rui , Rotella Joe-Anthony 
Published: October 2022

Abstract
A 56-year-old man presented to the emergency department after an intentional overdose of oxycodone and ethanol. He was previously opioid-naive with no other medical history. He subsequently developed acute abdominal pain with nausea and vomiting. A computed tomography scan of his abdomen and pelvis revealed distension of his stomach with no other abnormalities suggestive gastroparesis. He was subsequently treated with intravenous naloxone with complete resolution of his symptoms soon after. This case highlights the association between opioids and acute gastrointestinal mobility disorders contrary to the traditional association with chronic opioid use, as well as the utility of naloxone as a treatment.