bluuebunny/crossref_metadata_2025_split huggingface dataset:
Sleep bruxism and obstructive sleep apnea: association, causality or spurious finding? A scoping review
Authors: Pauletto Patrícia , Polmann Helena , Conti Réus Jéssica , Massignan Carla , de Souza Beatriz Dulcinéia Mendes , Gozal David , Lavigne Gilles , Flores-Mir Carlos , De Luca Canto Graziela 
Published: April 2022

AbstractStudy ObjectivesTo evaluate the available evidence on the putative relationships between sleep bruxism (SB) and, obstructive sleep apnea (OSA) to assess the extent of research on this topic, and to formulate suggestions for future research.MethodsA scoping review including studies examining temporal and overall association and prevalence of SB and OSA was performed. Six main databases and gray literature were searched. The studies selection was conducted by three independent reviewers. A narrative synthesis of the results was carried out.ResultsThirteen studies in adults and eight studies in children were finally included. The median of concomitant conditions prevalence was 39.3% in adults and 26.1% in children. Marked methodological variability was identified among studies in adults and even more when we compared detection methods in children. No significant association between OSA and SB emerged in most studies in adults, while an association may be possible in children.ConclusionsBased on the current literature, it is not possible to confirm that there is a relationship between SB and OSA in adults. In patients under pediatric care, although this association seems plausible, there is currently insufficient supportive evidence. Standardized validated methodologies for identifying SB should be consistently used in both populations before reaching any conclusion regarding such association. Furthermore, assessment of shared phenotypes between patients with SB and patients with OSA may reveal new insights that will contribute to personalized approaches aiming to optimize the management of such comorbidities.
Epileptic spasms with terror during sleep in CDKL5 encephalopathy
Authors: Melikishvili Gia , Sharkov Artem , Gachechiladze Tamar , Tomenko Tatiana , Pivovarova Alexandra , Volkov Iosif , Andrade Maria-Theresa , Castellanos Abril , Bienvenu Thierry , Dulac Olivier , Roisman Gabriel , Gataullina Svetlana 
Published: April 2022

AbstractStudy ObjectivesTo describe early diagnostic clues in Cyclin-Dependent Kinase-Like 5 (CDKL5) refractory encephalopathy, to improve treatment strategies.MethodsWe retrospectively studied 35 patients (25 females, 10 males) with CDKL5 gene mutations or deletion, focusing on their early seizure semiology, the electroencephalogram (EEG) pattern, the effect of treatment, and developmental outcome.ResultsThe first seizures were recognizable and consisted of tonic, then clonic, and spasms phases, occurring in sleep at a median age of 6 weeks. Clusters of spasms were observed in quiet sleep or slow-wave sleep (SWS), with screaming, staring, and arms’ extension that mimicked sleep terror in 28 of 35 patients (80%). Programmed awakening prevented these spasms in 9 of 16 patients and small doses of clonazepam given at night improved epilepsy in 14 of 23 patients.ConclusionsPeculiar seizures with spasms starting in SWS are an early diagnostic clue in infants with CDKL5 encephalopathy. Sleep video-EEG polygraphy is an easy tool to disclose these early seizures and epileptic spasms in infants during the first months of life while polysomnography is unlikely to give a contribution at that early age. While conventional antiepileptic treatment and corticosteroids are poorly, transiently, or not efficient, therapeutic strategy used for sleep terror could help, although the mechanism of spasms generation in SWS needs to be elucidated.
The mechanism of bud dehyperhydricity by the method of ‘starvation drying combined with AgNO3’ in Lycium ruthenicum
Authors: Li Lujia , An Qinxia , Wang Qin-Mei , Liu Wen , Qi Xinyu , Cui Jianguo , Wang Yucheng , Ke Haifeng 
Published: April 2022

Abstract
Micropropagation is very important for rapid clonal propagation and scientific research of woody plants. However, the micropropagated materials usually show hyperhydricity, which seriously hinders application of the micropropagation. Lycium ruthenicum is an important species of eco-economic forests. Herein, treatment of ‘starvation and drying combined with 30 μM AgNO3’ (SDCAg+) removed serious hyperhydricity of L. ruthenicum buds regenerated from its green-inflorescence-explants, and then gene expression, metabolites of various phytohormones, chloroplasts, chlorophyll (Chl) and total soluble proteins of the hyperhydric and dehyperhydric leaves were compared and analyzed. The results suggested that the SDCAg+ treatment might remove hyperhydricity of L. ruthenicum through: reducing water uptake; increasing water loss; up-regulating the expression of chloroplast-ribosomal-protein genes from nuclear genome; down-regulating the expression of cytoplasmic-ribosomal-protein genes; up-regulating the synthesis of the total soluble proteins; restoring the lamellar structure of chloroplast grana and matrix; improving Chl synthesis and reducing Chl metabolism; increasing expression of light-harvesting Chl protein complex genes and content of Chla and b; up-regulating both photosynthesis and starch and sucrose metabolism KEGG pathways; up-regulating abscisic acid, salicylic acid and their signaling; down-regulating cytokinin, jasmonic acid, jasmonoyl-l-isoleucine and their signaling. Also, the above events interact to form a regulatory network of dehyperhydricity by SDCAg+ treatment. Overall, the study indicated key genes/pathways and physiological/subcellular changes involved in dehyperhydricity and then established a dehyperhydric mechanism model of L. ruthenicum. This not only proposed clues for preventing or removing hyperhydricity but also laid foundations for molecular breeding of L. ruthenicum and other species.
Systematic Review of Ostomy Care Pathways
Authors: Nizum Nafsin , Jacob Greeshma 
Published: April 2022

ABSTRACT

OBJECTIVE
To evaluate if ostomy care pathways improve outcomes for adults anticipating or living with an ostomy.

DATA SOURCES
In this systematic review, the authors searched the MEDLINE, CINAHL, Cochrane Central, and EMBASE databases.

STUDY SELECTION
Studies were included if they met the following criteria: written in English, targeted adults anticipating or currently living with an ostomy, evaluated the impact of two or more components of an ostomy care pathway, and included one or more of the pertinent outcomes (patient satisfaction, hospital length of stay, hospital readmission rates, and staff satisfaction).

DATA EXTRACTION
Details recorded included design, setting, descriptions of intervention and control groups, patient characteristics, outcomes, data collection tools, effect size, and potential harms.

DATA SYNTHESIS
Of 5,298 total records, 11 met the inclusion criteria: 2 randomized controlled trials and 9 nonrandomized studies. The overall quality of the studies was low. Of the four studies that examined patient satisfaction, all studies reported improvement or positive satisfaction rates. Of the six studies that evaluated hospital length of stay, five noted a decrease in length of stay. Of the eight studies that evaluated hospital readmission rates, five found a reduction in hospital readmission rates. No studies reported on staff satisfaction.

CONCLUSIONS
Ostomy care pathways included preoperative education and counseling, postoperative education and discharge planning, and outpatient home visits and telephone follow-ups. Ostomy care pathways may contribute to patient satisfaction and decrease both hospital length of stay and hospital readmission rates. However, higher-quality literature is needed to be confident in the effectiveness of ostomy care pathways.
Evaluating the Scales Used To Diagnose Incontinence-Associated Dermatitis: A Systematic Review
Authors: Tezcan Bilge , Eraydın Canan , Karabacak Bilgi Gülseven 
Published: April 2022

ABSTRACT

OBJECTIVE
To investigate the scales used in the diagnosis of incontinence-associated dermatitis (IAD), including the risk factors included in the scales, their reliability and validity, and in which patient groups the scales have been applied.

DATA SOURCES
The relevant studies were screened retrospectively using five MeSH (Medical Subject Headings) keywords in various combinations. Seven international databases were screened between March and July 2019. In total, 2,908 studies published between 2009 and 2019 were evaluated.

STUDY SELECTION
Inclusion criteria for studies were as follows: written in English, published between 2009 and 2019, and investigated a scale developed to diagnose IAD (quantitative studies, randomized controlled studies, or meta-analyses). Studies were excluded if they did not examine scales for diagnosing IAD or were not in English. Nine studies were included in this review: five studies on scale development, one scale revision, one scale reliability study, and two Turkish validity and reliability studies.

DATA EXTRACTION
The study methods, sample characteristics, interventions, validity and reliability analyses, risk factors in the scales, and subdimensions of the scales were examined for each of the nine included studies.

DATA SYNTHESIS
Study samples were composed of nurses, healthcare professionals, patients, or individuals living in a nursing home and ranged in size from 9 to 823 participants. Most data were collected from hospital-wide clinics. The scales used investigated redness, rash, skin loss, incontinence type, infection symptoms, skin color, edema, patient experience, pain, and perineal care habits. Both validity and reliability of the scales were examined in eight of the studies; in one study, only reliability was examined because the scale validity was shown in previous research. Moreover, sensitivity and specificity were indicated in one study.

CONCLUSIONS
There are several competent scales in the literature with proven validity and reliability that can be used to diagnose IAD.
Reducing the Incidence and Prevalence of Pressure Injury in Adult ICU Patients with Support Surface Use: A Systematic Review
Authors: Bambi Adi Angriawan , Yusuf Saldy , Irwan Andi Masyitha 
Published: April 2022

ABSTRACT

GENERAL PURPOSE
To provide information on the effectiveness of active and reactive support surfaces in reducing the incidence and prevalence of pressure injuries (PIs) in adult ICU patients.

TARGET AUDIENCE
This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and nurses with an interest in skin and wound care.

LEARNING OBJECTIVES/OUTCOMES
After participating in this educational activity, the participant will: 1. Distinguish features of active and reactive support surfaces used in the ICU.2. Compare the PI incidence in patients using a variety of support surfaces.3. Synthesize recommendations for the use of support surfaces to reduce the risk of PI in adult ICU patients.

OBJECTIVE
To identify and analyze scientific evidence on the effectiveness of active and reactive support surfaces in reducing the incidence and prevalence of pressure injury (PI) in adult ICU patients.

DATA SOURCES
PubMed, ProQuest, ScienceDirect, Wiley Online Library, ClinicalKey for Nursing, Cochrane Library, and secondary searches.

STUDY SELECTION
Studies were included if they related to support surfaces, involved adult ICU patients aged ≥18 years, and the primary outcome measured was incidence or prevalence of PI. The initial search resulted in 8,357 articles; after exclusions, 31 complete texts were assessed for feasibility. A total of eight articles were included in this review. A bias risk assessment was performed using the Cochrane Risk of Bias Assessment Tool.

DATA EXTRACTION
Data were extracted by one reviewer and summarized in a table of study results that was examined and verified by two other reviewers.

DATA SYNTHESIS
Reactive (constant low pressure) support surfaces included viscoelastic foam mattresses, static air mattresses, and low-air-loss mattresses, whereas the active support surface consisted of alternating-pressure air mattresses. Alternating pressure mattress and viscoelastic foam mattress use both resulted in significantly lower PI incidence.

CONCLUSION
Support surface use is limited, and no particular type is proven to be superior to others. Clinicians should select support surfaces based on their therapeutic features and how well they meet the patient’s particular needs.
Revisiting Retake Policy: Analyzing the Success Rates of Examinees With Multiple Attempts on the United States Medical Licensing Examination
Authors: Rubright Jonathan D. , Ong Thai Q. , Jodoin Michael G. , Johnson David A. , Barone Michael A. 
Published: April 2022

Purpose
A testing program’s decision making on retake policy considers a number of factors, including fairness to examinees, examination security, examination purpose, and classification accuracy. For high-stakes licensure and certification examinations charged with protection of the public, this includes balancing fairness issues inherent in the potential for false negatives with the public protection need to minimize false positives. Since 2012, the United States Medical Licensing Examination (USMLE) has maintained a policy of ≤ 6 attempts on any examination component. The purpose of this study was to empirically examine the appropriateness of existing USMLE retake policy.

Method
A sample of over 300,000 examinees who were administered each Step examination between 2008 and 2018 was examined to address how pass rates (per attempt and cumulatively) differed for examinees and examinee subgroups via graphic depictions of pass rates, the impact of restricting the number of attempts on examinees and examinee subgroups via logistic regression analyses, and the impact of restricting the number of attempts on classification error via classification error analyses.

Results
Repeaters displayed consistently lower pass rates on subsequent attempts. Regardless of Step, most passing examinees did so by their fourth attempt. Models predicting the log odds of examinees taking ≥ 5 attempts showed a significant effect of gender, race, and medical school status, although the associated sample sizes are small. Misclassification analyses showed that, as attempts increased, the percentage of false passers increased and percentage of false failers decreased.

Conclusions
These considerations led to the USMLE’s decision to reduce its attempt limit from 6 to 4 on any Step or Step component effective July 2021. This change balances the competing interests of fairness and examination access to the examinee population, while simultaneously maintaining a minimum standard consistent with the mission of the USMLE program to protect the public.
Association Between Exposure to Complementary and Integrative Therapies and Opioid Analgesic Daily Dose Among Patients on Long-term Opioid Therapy
Authors: Black Anne C. , Zeliadt Steven B. , Kerns Robert D. , Skanderson Melissa , Wang Rixin , Gelman Hannah , Douglas Jamie H. , Becker William C. 
Published: April 2022

Objectives:
To describe the association between exposure to selected complementary and integrative health (CIH) modalities and the trajectory of prescribed opioid analgesic dose within a national cohort of patients receiving long-term opioid therapy (LTOT) in the Veterans Health Administration (VHA).

Materials and Methods:
Using national data from VHA electronic health records between October 1, 2017 and September 30, 2019, CIH use was analyzed among 57,437 patients receiving LTOT within 18 VHA facilities serving as evaluation sites of VHA’s Whole Health System of Care. Using linear mixed effects modeling controlling for covariates, opioid dose was modeled as a function of time, CIH exposure, and their interaction.

Results:
Overall, 11.91% of patients on LTOT used any of the focus CIH therapies; 43.25% of those had 4 or more encounters. Patients used acupuncture, chiropractic care, and meditation modalities primarily. CIH use was associated with being female, Black, having a mental health diagnosis, obesity, pain intensity, and baseline morphine-equivalent daily dose. Mean baseline morphine-equivalent daily dose was 40.81 milligrams and dose decreased on average over time. Controlling for covariates, patients with any CIH exposure experienced 38% faster dose tapering, corresponding to a mean difference in 12-month reduction over patients not engaging in CIH of 2.88 milligrams or 7.06% of the mean starting dose.

Discussion:
Results support the role of CIH modalities in opioid tapering. The study design precludes inference about the causal effects of CIH on tapering. Analyses did not consider the trend in opioid dose before cohort entry nor the use of other nonopioid treatments for pain. Future research should address these questions and consider tapering-associated adverse events.
Estimation of Occupational Noise–Induced Hearing Loss Using Kurtosis-Adjusted Noise Exposure Levels
Authors: Zhang Meibian , Gao Xiangjing , Murphy William J. , Kardous Chucri A. , Sun Xin , Hu Weijiang , Gong Wei , Li Jingsong , Qiu Wei 
Published: April 2022

Objectives:
Studies have shown that in addition to energy, kurtosis plays an important role in the assessment of hearing loss caused by complex noise. The objective of this study was to investigate how to use noise recordings and audiometry collected from workers in industrial environments to find an optimal kurtosis-adjusted algorithm to better evaluate hearing loss caused by both continuous noise and complex noise.

Design:
In this study, the combined effects of energy and kurtosis on noise-induced hearing loss (NIHL) were investigated using data collected from 2601 Chinese workers exposed to various industrial noises. The cohort was divided into three subgroups based on three kurtosis (β) levels (K1: 3 ≤ β ≤ 10, K2: 10 <β ≤ 50, and K3: β > 50). Noise-induced permanent threshold shift at test frequencies 3, 4, and 6 kHz (NIPTS346) was used as the indicator of NIHL. Predicted NIPTS346 was calculated using the ISO 1999 model for each participant, and the actual NIPTS was obtained by correcting for age and sex using non-noise-exposed Chinese workers (n = 1297). A kurtosis-adjusted A-weighted sound pressure level normalized to a nominal 8-hour working day (LAeq,8h) was developed based on the kurtosis categorized group data sets using multiple linear regression. Using the NIPTS346 and the LAeq.8h metric, a dose-response relationship for three kurtosis groups was constructed, and the combined effect of noise level and kurtosis on NIHL was investigated.

Results:
An optimal kurtosis-adjusted LAeq,8h formula with a kurtosis adjustment coefficient of 6.5 was established by using the worker data. The kurtosis-adjusted LAeq,8h better estimated hearing loss caused by various complex noises. The analysis of the dose-response relationships among the three kurtosis groups showed that the NIPTS of K2 and K3 groups was significantly higher than that of K1 group in the range of 70 dBA ≤ LAeq,8h < 85 dBA. For 85 dBA ≤ LAeq,8h ≤ 95 dBA, the NIPTS346 of the three groups showed an obvious K3 > K2 > K1. For LAeq,8h >95 dBA, the NIPTS346 of the K2 group tended to be consistent with that of the K1 group, while the NIPTS346 of the K3 group was significantly larger than that of the K1 and K2 groups. When LAeq,8h is below 70 dBA, neither continuous noise nor complex noise produced significant NIPTS346.

Conclusions:
Because non-Gaussian complex noise is ubiquitous in many industries, the temporal characteristics of noise (i.e., kurtosis) must be taken into account in evaluating occupational NIHL. A kurtosis-adjusted LAeq,8h with an adjustment coefficient of 6.5 allows a more accurate prediction of high-frequency NIHL. Relying on a single value (i.e., 85 dBA) as a recommended exposure limit does not appear to be sufficient to protect the hearing of workers exposed to complex noise.
Advances in the clinical use of hydroxychloroquine levels
Authors: Chakrabarti Katherine , McCune W. Joseph 
Published: April 2022

Purpose of review
This review summarizes the recent literature exploring hydroxychloroquine levels and their relationship with disease activity and risk of toxicity.

Recent findings
There is no clear correlation between weight-based dosing of hydroxychloroquine and the resulting blood levels of the medication. Recent studies have shown that increased hydroxychloroquine levels are associated with lower lupus disease activity and likely also increased risk of medication toxicity.

Summary
Mounting evidence supports use of hydroxychloroquine levels in clinical practice to document adherence and ensure safety.
Therapeutic advances in eosinophilic granulomatosis with polyangiitis
Authors: Ford Julia A. , Aleatany Yaseen , Gewurz-Singer Ora 
Published: April 2022

Purpose of review
In recent years, therapeutic advances in eosinophilic granulomatosis with polyangiitis (EGPA) have changed our treatment paradigm. This review will summarize and discuss updates in management of EGPA, with a particular focus on biologic therapies.

Recent findings
The anti-interleukin (IL)-5 agent mepolizumab (the first FDA-approved drug specifically for EGPA) is effective in induction and maintenance of remission particularly in patients with predominantly asthma and allergic manifestations, though efficacy in ANCA-positive, vasculitic disease is unclear; additional anti-IL-5 agents are under study. Rituximab is currently recommended for remission induction in severe disease, particularly in ANCA-positive patients with vasculitic manifestations, though the supportive evidence is mostly observational. Evidence supporting use of traditional DMARDs and other biologic agents such as omalizumab remains limited and observational.

Summary
Although management of this heterogeneous disease remains challenging and unanswered questions remain, advances in biologics (particularly anti-IL-5 agents and an evolving interest in rituximab) have expanded our treatment armamentarium in EGPA.
Sympathetic modulation of tumor necrosis factor alpha-induced nociception in the presence of oral squamous cell carcinoma
Authors: Atherton Megan A. , Park Stella , Horan Nicole L. , Nicholson Samuel , Dolan John C. , Schmidt Brian L. , Scheff Nicole N. 
Published: April 2022

Abstract
Head and neck squamous cell carcinoma (HNSCC) causes more severe pain and psychological stress than other types of cancer. Despite clinical evidence linking pain, stress, and cancer progression, the underlying relationship between pain and sympathetic neurotransmission in oral cancer is unknown. We found that human HNSCC tumors and mouse tumor tissue are innervated by peripheral sympathetic and sensory nerves. Moreover, β-adrenergic 1 and 2 receptors (β-ARs) are overexpressed in human oral cancer cell lines, and norepinephrine treatment increased β-AR2 protein expression as well as cancer cell proliferation in vitro. We have recently demonstrated that inhibition of tumor necrosis factor alpha (TNFα) signaling reduces oral cancer-induced nociceptive behavior. Norepinephrine-treated cancer cell lines secrete more TNFα which, when applied to tongue-innervating trigeminal neurons, evoked a larger Ca2+ transient; TNF–TNFR inhibitor blocked the increase in the evoked Ca2+ transient. Using an orthotopic xenograft oral cancer model, we found that mice demonstrated significantly less orofacial cancer-induced nociceptive behavior during systemic β-adrenergic inhibitory treatment with propranolol. Furthermore, chemical sympathectomy using guanethidine led to a significant reduction in tumor size and nociceptive behavior. We infer from these results that sympathetic signaling modulates oral cancer pain through TNFα secretion and tumorigenesis. Further investigation of the role of neurocancer communication in cancer progression and pain is warranted.