bluuebunny/crossref_metadata_2025_split huggingface dataset:
Cardiac amyloidosis: an update on diagnosis, current therapy, and future directions
Authors: Khedraki Rola 
Published: February 2022

Purpose of review
This review aims to serve as a practical guide for differentiating the two most common forms of cardiac amyloidosis, as well as reviewing the approach to diagnosis and management, particularly as it pertains to transthyretin cardiac amyloidosis.

Recent findings
Emerging literature continues to unravel new understandings and challenges in the field of cardiac amyloidosis. Although cardiac amyloidosis has historically been thought of as a ‘zebra diagnosis’, current evidence has shown that this is a common cause of heart failure. Furthermore, it has become increasingly apparent that earlier diagnosis leads to improved outcomes and quality of life for patients.

Summary
By leveraging an understanding of the pathophysiology leading to amyloid fibril formation, new drug therapeutics are under investigation as promising candidates for the treatment of amyloid cardiomyopathy.
Cardiovascular outcome 6 months after severe coronavirus disease 2019 infection
Authors: Raafs Anne G. , Ghossein Mohammed A. , Brandt Yentl , Henkens Michiel T.H.M. , Kooi M. Eline , Vernooy Kevin , Spaanderman Marc E.A. , Gerretsen Suzanne , van Santen Susanne , Driessen Rob G.H. , Knackstedt Christian , van der Horst Iwan C.C. , van Bussel Bas C.T. , Heymans Stephane R.B. , Ghossein-Doha Chahinda 
Published: February 2022

Objectives:
In coronavirus disease 2019 (COVID-19), cardiovascular risk factors and myocardial injury relate to increased mortality. We evaluated the extent of cardiac sequelae 6 months after hospital discharge in patients surviving ICU hospitalization for COVID-19.

Methods:
All survivors of Maastricht-ICU were invited for comprehensive cardiovascular evaluation 6 months after discharge from ICU. Cardiac screening included an electrocardiogram, cardiac biomarkers, echocardiography, cardiac magnetic resonance (CMR) and, wherever indicated, cardiac computed tomography or coronary angiogram.

Results:
Out of 52 survivors, 81% (n = 42) participated to the cardiovascular follow-up [median follow-up of 6 months, interquartile range (IQR) 6.1–6.7]. Eight patients (19%) had newly diagnosed coronary artery disease (CAD), of which two required a percutaneous intervention. Echocardiographic global longitudinal strain (GLS) was abnormal in 24% and CMR-derived GLS was abnormal in 12%, despite normal left ventricular ejection fraction in all. None of the patients showed elevated T1 relaxation times and five patients (14%) had an elevated T2 relaxation time. Late gadolinium enhancement (LGE) reflecting regional myocardial fibrosis was increased in eight patients (21%), of which three had myocarditis and three had pericarditis.

Conclusion:
Cardiovascular follow-up at 6 months after ICU-admission for severe COVID-19 revealed that one out of five invasively mechanically ventilated survivors had CAD, a quarter had subclinical left ventricular dysfunction defined as reduced echocardiographic GLS, and 42% of the patients had CMR abnormalities (reduced LVEF, reduced GLS, LGE presence, and elevated T2). On the basis of these findings, long-term cardiovascular follow-up is strongly recommended in all post-IC COVID-19 patients.

Clinical Trial Registration:
Trial Register number [NL8613]) https://www.trialregister.nl/trial/8613

Video abstract:
http://links.lww.com/HJH/B899.
Who Is at Risk of Developing Cannabis Dependence? Findings From an Extensive Online Study on Cannabis Users
Authors: Binkowska Alicja Anna , Ruban Anastasia , Gogolewska Mariszka , Sawicz Piotr , Rychlewski Leszek , Brzezicka Aneta 
Published: February 2022

Abstract

Objectives
Although frequency of cannabis use is considered to be the strongest risk factor for developing cannabis dependence, only up to half of daily users become dependent. In this study, we explored an array of risk factors and moderators of cannabis dependence symptoms from the International Classification of Diseases, Tenth Edition endorsed by participants.

Methods
A sample of 1,635 cannabis users completed an Internet survey consisting of measures of cannabis and other drug use. Multiple linear regression with a backward elimination method was employed to identify predictors of cannabis dependence symptoms. After that, a series of hierarchical multiple regression analyses were performed to test the predictive validity of the interactions between frequency of cannabis use and other predictors.

Results
Frequency of cannabis use appeared to be the strongest predictor of developing cannabis dependence symptoms; other significant predictors of cannabis dependence symptoms were substance-dependency-related treatment seeking, mental health problems in the family and pattern of substance use. Duration of cannabis use, relationship status, and drug use history in the family were identified as significant moderators of the relationship between frequency of cannabis use and the number of cannabis dependence symptoms.

Conclusions
This study confirms that the frequency of cannabis use is the strongest predictor of cannabis dependence symptoms but this relationship is significantly moderated by three abovementioned factors.
Adequacy of Emergency Department Documentation of Child Restraint Use After a Motor Vehicle Crash
Authors: Kendi Sadiqa , Chamberlain James M. , Pearman Ryan L. , Badolato Gia M. , Zonfrillo Mark R. 
Published: February 2022

Objectives
There are limited data on how often providers collect and document adequate restraint information in children seen in the emergency department (ED) after motor vehicle crashes (MVCs). The objectives of this study are to determine (1) how often adequate child restraint information to determine age-appropriate use is documented after MVC; (2) the frequency of incorrect use of the child restraint when adequate details are documented; and (3) for those discharged from the ED with identified incorrect use, the frequency of provision of information on child passenger safety (CPS).

Methods
Retrospective chart review of visits of children younger than 13 years with an International Classification of Diseases, Tenth Revision code for MVC to an urban, academic, level 1 pediatric trauma center, from October 2015 to September 2018. Adequate documentation of child restraint use was defined as identification of location of the child in the car (front vs rear row), type of restraint used, and forward or rear facing for children 24 months or younger.

Results
A total of 165 visits qualified for inclusion. There was adequate documentation in 46% of visits. Of those, incorrect child restraint use was identified in 49%. Of discharged patients with incorrect use, 10% had documentation of provision of CPS information.

Conclusions
Adequate details to determine proper age-appropriate restraint use are documented in only half of ED visits for MVC. Very few are given CPS instructions on discharge, even when incorrect use has been identified. Identification of incorrect restraint use in the ED is an opportunity for a teachable moment that is being underused.
A Brief, Just-in-Time Sedation Training in the Pediatric Emergency Department Improves Performance During Adverse Events Encountered in Simulated Procedural Sedations
Authors: Schinasi Dana Aronson , Colgan Jennifer , Nadel Frances M. , Hales Roberta L. , Lorenz Douglas , Donoghue Aaron J. 
Published: February 2022

Background
Procedural sedation (PS) is commonly performed in emergency departments (EDs) by nonanesthesiologists. Although adverse events (AEs) are rare, providers must possess the clinical skills to react in a timely manner. We previously described residents' experience and confidence in PS as part of a needs assessment. We found that their ability to perform important clinical tasks as a result of the usual training experience demonstrates educational needs. We developed an educational intervention to address the deficiencies uncovered during our needs assessment.

Objective
To evaluate the effectiveness of an educational intervention on pediatric residents' clinical performance and confidence when faced with an AE during a simulated PS.

Methods
This was a prospective observational cohort study of residents at a tertiary care children's hospital. All ED attending physicians and fellows were trained in uniform delivery of the educational intervention, which was delivered extemporaneously at the bedside (“Just-in-Time” [JIT]) to all residents performing PS on actual patients in the pediatric ED, over the course of 1 year. Subjects completed the following both before and after the educational intervention: a survey pertaining to confidence in PS, followed by a standardized, video-recorded simulated PS complicated by apnea and desaturation. Clinical performance was evaluated and assessed both in real time and by a video-rater blinded to participants' year of training. We summarized baseline resident characteristics, confidence questionnaire item rankings and success in both the preparation and AE tasks. We compared successful task completion and time to task completion before and after intervention.

Results
Forty residents completed both the PRE and POST phases of the study. There was significant improvement in the proportion of residents who completed both preparation and AE tasks after the JIT training. Specifically, there was a significant improvement in the proportion of residents who performed positive-pressure ventilation to treat an apneic event associated with desaturation during the PS (P = 0.007). Residents' confidence scores also significantly improved after the training.

Conclusion
A brief JIT training in the pediatric ED improves resident clinical performance and confidence when faced with an AE during a simulated PS. Future direction includes correlating this improved performance with patient outcomes in PS.
Use of POCUS in the Diagnosis of Paradoxical Vocal Cord Movement
Authors: Wiltrakis Susan M. , Gutierrez Peter 
Published: February 2022

Abstract
Point-of-care ultrasound has been instrumental in allowing providers to make prompt diagnoses at the bedside but has been historically underutilized for the diagnosis of upper airway processes, including paradoxical vocal fold motion (PVFM), also known as vocal cord dysfunction. PVFM is characterized by adduction of the vocal cords during inspiration, resulting in stridor and shortness of breath. This case report describes a teenage girl who presented to the pediatric emergency department (ED) with difficulty breathing. Point-of-care ultrasound diagnosed PVFM, which was confirmed with bedside flexible laryngoscopy by otorhinolaryngology (ENT) in the ED.
Pediatric Ovarian Torsion
Authors: Sims Morgan J. , Price Amanda B. , Hirsig Leslie E. , Collins Heather R. , Hill Jeanne G. , Titus M. Olivia 
Published: February 2022

Objectives
Ovarian torsion (OT) is an emergency that mandates early detection and surgical detorsion to avoid catastrophic consequences of further adnexal injury. Prompt ultrasound is critical for accurate diagnosis. Traditionally, evaluation of arterial and venous flow was used as a diagnostic tool for OT, but recent radiologic research has indicated that ovarian size and size discrepancy between sides is a better diagnostic criterion. This study seeks to determine whether ovarian size discrepancy or vascular flow to the ovary is more accurate in the diagnosis of OT in the pediatric emergency population and to better describe symptoms that distinguish OT from other abdominal and pelvic pathology.

Methods
This was a retrospective, cross-sectional study evaluating all female pediatric patients, aged 1 to 18 years, who underwent a pelvic ultrasound to evaluate for OT over a 2-year period in our pediatric emergency department. Patients suitable for inclusion were identified via Nuance mPowerTM, a search engine that provides clinical analytics based on radiology reports generated within our institution.

Results
We reviewed the medical records of 193 female patients aged 1 to 18 years, all of whom had a pelvic ultrasound (with or without Doppler) to evaluate for OT during the study period. In comparing ovarian size on ultrasound, patients with OT had a significantly larger magnitude of difference in ovarian volume than patients without torsion (5.57× [interquartile range, 3–12.5] vs 1.56× [interquartile range, 1.24–2.25; P < 0.001]). Ovarian torsion was associated with a 33-fold increased risk of lack of arterial flow (relative risk, 33.33) and with a 9-fold increased risk of lack of venous flow (relative risk, 9.27), when compared with those patients without OT. Patients with OT were significantly more likely to have emesis and peritoneal signs on examination, as well as previous history of OT (P = 0.01, 0.02, and 0.002, respectively) than those without OT. All patients with OT reported abdominal pain.

Conclusions
We found that a large size discrepancy between ovaries is indicative of OT. Our data also suggest that presence of Doppler flow on ultrasound cannot be used to exclude OT but that lack of Doppler flow on ultrasound is a significant diagnostic marker. As previous studies have also found, clinical symptoms of OT are nonspecific and do not offer any certainty in differentiating OT from other pathologies.
Contrast-Enhanced Ultrasound of Brain Perfusion in Cardiopulmonary Resuscitation
Authors: Hwang Misun , Sridharan Anush , Freeman Colbey W. , Viaene Angela N. , Kilbaugh Todd J. 
Published: February 2022

Abstract
To evaluate the feasibility and potential utility of contrast-enhanced ultrasound for real-time imaging of whole-brain perfusion during cardiopulmonary resuscitation (CPR), cardiac arrest was induced in 8- to 7-week-old 10-kg piglets (Sus scrofa domesticus). Contrast-enhanced ultrasound was performed through a parietal cranial window in the coronal plane visualizing the thalami during hemodynamic-directed CPR. Whole-brain mean and maximum pixel intensities in each slice during resuscitation were calculated. Piglets were monitored for 24 hours postarrest. Seven piglets achieved return of spontaneous circulation and 6 survived to 24 hours. Of the 6 surviving piglets, 2 piglets demonstrated greater intra-CPR brain enhancement at maximum 73.2% and 42.1% and mean 36.7% and 31.9% enhancement above background, respectively, compared with maximum 5.8%, 22.9%, 6.0%, and 26.6% and mean 5.1%, 8.9%, 2.9%, and 6.6% above background, respectively, in the other 4. Intra-CPR average mean arterial pressures were similar between all 6 surviving piglets. One piglet achieved return of spontaneous circulation but expired 10 minutes later with enhancement maximum 45.2% and mean 18.9% enhancement above background. The final piglet did not achieve return of spontaneous circulation and exhibited minimal enhancement at maximum 2.8% and mean 0.9% enhancement above background. Contrast-enhanced ultrasound can detect brain perfusion during CPR, identifying a spectrum of cerebral blood flow responses in the brain despite similar systemic hemodynamics. This novel application can form the basis for future large animal model studies and eventually human clinical studies to further explore the neurologic implications of cerebral blood flow responses during resuscitation and stimulate novel strategies for optimizing brain perfusion restoration.
Survey Study on the Experience, Practice Patterns, and Preferences of the Fellows of the Society of Radiologists in Ultrasound for Evaluation and Management of Gallbladder Polyps Detected With Ultrasound
Authors: Middleton William D. , Fung Christopher , Dahiya Nirvikar , Szpakowski Jean-Luc , Corwin Michael T. , Fetzer David T. , Gabriel Helena , Rodgers Shuchi K. , Tublin Mitchell E. , Walsh Andrew J. , Kamaya Aya 
Published: February 2022

Abstract
Gallbladder polyps (GPs) are a common incidental finding on ultrasound; however, important differences in recommended management exist among professional society guidelines.
An electronic survey was sent to 189 fellows of the Society of Radiologists in Ultrasound. Main outcomes included preferences and current practice patterns for evaluation, management, and surveillance of GPs as well as personal lifetime experience with gallbladder sonography and GPs.
A total of 64 subjects (34%) with experience in gallbladder sonography completed the study. The estimated combined total number of gallbladder scans seen by the responders was 3,071,880. None of fellows had ever seen a pedunculated GP <1 cm detected on ultrasound that was proven to be malignant at the time of detection or during subsequent follow-up. All of the fellows used size as a feature to stratify recommendations. The median size threshold currently used by Society of Radiologists in Ultrasound fellows for recommending ultrasound follow-up was 6 mm, and their preferred threshold was 7 mm. The median size threshold for recommending surgical consultation was 10 mm, and the preferred threshold was 10 mm. Wall thickening and shape were considered important factors by 76% and 67% of respondents, respectively.
Society of Radiologists in Ultrasound fellows tend to provide recommendations most similar to the American College of Radiology and Canadian Association of Radiology guidelines for management of GPs. Many would prefer guidelines that result in fewer recommendations for follow-up and surgical consultation. Despite a substantial combined experience, this survey did not uncover any case of a small GP that was malignant.
Popliteal Artery Injury After Fracture and/or Dislocation of the Knee: Risk Stratification for Revascularization Outcome
Authors: Hsieh Yun-Huan , Lee Min-Chao , Hsu Chung-Chen , Chen Shih-Heng , Lin Yu-Te , Lin Chih-Hung , Lin Cheng-Hung 
Published: February 2022

Background
Managing complex knee trauma involving both vascular and osseous injuries is challenging, yet the available guidelines for efficient popliteal artery injury management after high-velocity blunt knee trauma remain conflicting and inconsistent. In this study, the authors aim to identify the risk factors associated with delayed limb amputation and ischemic muscular sequela postrevascularization. Furthermore, we propose a treatment algorithm to improve the limb salvage rate.

Methods
Patients who presented with traumatic popliteal artery injury resulting in vessel occlusion or rupture, followed by fracture and/or dislocation of the knee from January 2008 to December 2013, were included for retrospective review.

Results
Overall delayed amputation rate was 24% (7/29) and 16% (4/25) after successful revascularization. Mangled Extremity Severity Score is higher in the delayed amputation group than the limb-salvaged group (P = 0.02). Higher-impact force (P = 0.03), ischemic limb on presentation (P = 0.03), prolonged ischemia time (P = 0.04), unstable hemodynamics (P = 0.01), longer operation time (P = 0.04), and prolonged intensive care unit stay (P = 0.03) are risk factors of delayed amputation. Longer ischemia time (P = 0.04) and length of popliteal artery injury (P = 0.02) are associated with ischemic muscular sequela.

Conclusions
Mangled Extremity Severity Score is a reliable predictor of limb salvage. An algorithmic approach may improve the outcome of popliteal artery injury after high-velocity blunt knee trauma.
A New Approach for Alar Grafting Technique to Support Soft Triangle
Authors: Öztürk Güncel 
Published: February 2022

Rhinoplasty is 1 of the leading surgical procedures among all aesthetic and plastic surgeries. Grafting is an important part of both primary and revision rhinoplasties. The grafts are used for improving the functional and as well as aesthetical deformities of the nose. The choice of a graft is important for long term results in rhinoplasty operations. In present research, the author aimed to present a new approach for alar grafting in a special patient group for providing better cosmetic and functional outcomes. The patients who received rhinoplasty, who had a retraction in the soft triangle region, who had a wide alar base and who gave permission for sharing their photos for medical purposes were included in the study. According to inclusion and exclusion criteria 21 patients were included in the study. All patients included in the study completed the Rhinoplasty Outcome Evaluation (ROE) before operation and at their 1-year follow-up appointment. Twelve months after surgery, the ROE scores ranged between 90 and 100 points. The median score increased from 56.8 to 91.5 points (P < 0.001). Patient satisfaction was excellent in 100% of the included cases according to ROE scale. Physical examination and assessment of postoperative photographs demonstrated that there were no asymmetry or functional problems in all participants. This new alar graft approach has advantages such as; because the alar graft was obtained from the similar tissue, the accordance of the graft will be much more compared with other tissues. Another advantage is not making an intervention to septum, rib or auricle and this advantage can bring more suitability for both patients and as well as surgeons.

Level of Evidence:
Level III, therapeutic study.
Stress-testing development pathways under a changing climate: water-energy-food security in the lake Malawi-Shire river system
Authors: Bhave Ajay G. , Conway Declan , Dessai Suraje , Dougill Andrew J. , Mkwambisi David 
Published: February 2022

Malawi depends on Lake Malawi outflows into the Shire River for its water, energy and food (WEF) security. We explore future WEF security risks under the combined impacts of climate change and ambitious development pathways for water use expansion. We drive a bespoke water resources model developed with stakeholder inputs, with 29 bias-corrected climate model projections, alongside stakeholder elicited development pathways, and examine impacts on stakeholder-elicited WEF sector performance metrics. Using scenario analysis, we stress-test the system, explore uncertainties, assess trade-offs between satisfying WEF metrics, and explore whether planned regulation of outflows could help satisfy metrics. While uncertainty from potential future rainfall change generates a wide range of outcomes (including no lake outflow and higher frequency of major downstream floods), we find that potential irrigation expansion in the Lake Malawi catchments could enhance the risk of very low lake levels and risk to Shire River hydropower and irrigation infrastructure performance. Improved regulation of lake outflows through the upgraded barrage does offer some risk mitigation, but trade-offs emerge between lake level management and downstream WEF sector requirements. These results highlight the need to balance Malawi's socio-economic development ambitions across sectors and within a lake-river system, alongside enhanced climate resilience.
This article is part of the theme issue 'Developing resilient energy systems'.
Policy and political perceptions of risk: the challenges to building resilient energy systems
Authors: Gluckman Peter , Bardsley Anne 
Published: February 2022

Decisions relating to energy systems resilience must take into account a range of environmental and societal transitions together with an array of future threats. These must be assessed broadly and systematically but also must consider how risks and vulnerabilities are linked, and that small events can cascade across a system and between systems to escalate into large-scale collapse. Developing resilience involves not only identifying such threats and potential points of failure but acting upon them with an appropriate level of future planning. Decision-making in complex systems is often affected by cognitive biases and runs into contestation and obstacles of politics, policy complexities and differing views of potential futures. This paper discusses the challenges to building resilient systems for the future, given the inevitable biases and differing risk perspectives of decision-makers at all levels that often confound expert analysis.
This article is part of the theme issue ‘Developing resilient energy systems’.