bluuebunny/crossref_metadata_2025_split huggingface dataset:
Using Electroencephalogram Biosignal Changes for Delirium Detection in Intensive Care Units
Authors: Jin Taixian , Jin Huiying , Lee Sun-Mi 
Published: March 2022

ABSTRACT

BACKGROUND: Biosignal data acquired during quantitative electroencephalography (QEEG) research may ultimately be used to develop algorithms for more accurate detection of delirium. This study investigates the biosignal changes during delirium states by using the QEEG data of patients in a medical intensive care unit. METHODS: This observational study was conducted between September 2018 and December 2019 at a tertiary hospital in South Korea. Delirium was measured using the Korean version of Confusion Assessment Method for the Intensive Care Unit in intensive care unit patients. Quantitative EEG measurements were recorded for 20 minutes in a natural state without external treatment or stimuli, and QEEG data measured in the centroparietal and parietal regions with eyes open were selected for analysis. Power spectrum analysis with a 5-minute epoch was conducted on the selected 65 cases. RESULTS: QEEG changes in the presence of delirium indicated that alpha, beta, gamma, and spectral edge frequency 50% waves showed significantly lower absolute power spectra than the corresponding findings in the absence of delirium. Brain-mapping results showed that these brain waves were inactivated in delirious states. CONCLUSION: QEEG assessments can potentially detect the changes in the centroparietal and parietal regions of delirium patients. QEEG changes, including lower power spectra of alpha, beta, and gamma waves, and spectral edge frequency 50%, can be successfully used to distinguish delirium from the absence of delirium.
Factors Associated With Hope and Quality of Life in Patients With Coronary Artery Disease
Authors: SOLEIMANI Mohammad Ali , ZARABADI-POUR Simin , HUAK CHAN Yiong , ALLEN Kelly-Ann , SHAMSIZADEH Morteza 
Published: March 2022

ABSTRACT

Background
Psychological resources such as hope have been suggested to affect quality of life (QoL) positively in patients with heart disease. However, little information regarding the relationship between these two constructs is available.

Purpose
This work was aimed at examining the factors associated with hope and QoL in patients with coronary artery disease.

Methods
In this descriptive work, perceived QoL and hope were assessed in 500 patients with heart disease. The information was collected using the McGill QoL Questionnaire, demographic variables, and the Herth Hope Index. The Pearson correlation test and general linear model were used to examine correlations through SPSS Version 22.

Results
A considerable correlation was discovered between QoL and hope (r = .337, p < .001). Multivariate analyses with regression revealed that religious beliefs and social support both had significant and positive effects on the total perceived hope of patients and that patient age had a considerable negative impact on QoL (p < .05). None of these factors had a significant impact on hope (p < .05). In addition, the total QoL had a significant and positive effect on patient feelings and thoughts, whereas the physical problems component of QoL had a significant and negative effect on hope (p < .05). Participants with higher levels of education reported more hope.

Conclusions
QoL relates significantly to self-perceived hope in patients. Understanding QoL and hopefulness in patients with coronary artery disease has implications for nurses and other healthcare professionals.
Combined clinical and specific positron emission tomography/computed tomography-based radiomic features and machine-learning model in prediction of thymoma risk groups
Authors: Ozkan Elgin , Orhan Kaan , Soydal Cigdem , Kahya Yusuf , Seckin Tunc Servet , Celik Ozer , Dizbay Sak Serpil , Kayi Cangir Ayten 
Published: March 2022

Objectives
In this single-center study, we aimed to propose a machine-learning model and assess its ability with clinical data to classify low- and high-risk thymoma on fluorine-18 (18F) fluorodeoxyglucose (FDG) (18F-FDG) PET/computed tomography (CT) images.

Methods
Twenty-seven patients (14 male, 13 female; mean age: 49.6 ± 10.2 years) who underwent PET/CT to evaluate the suspected anterior mediastinal mass and histopathologically diagnosed with thymoma were included. On 18F-FDG PET/CT images, the anterior mediastinal tumor was segmented. Standardized uptake value (SUV)max, SUVmean, SUVpeak, MTV and total lesion glycolysis of primary mediastinal lesions were calculated. For texture analysis first, second, and higher-order texture features were calculated. Clinical information includes gender, age, myasthenia gravis status; serum levels of lactate dehydrogenase (LDH), alkaline phosphatase, C-reactive protein, hemoglobin, white blood cell, lymphocyte and platelet counts were included in the analysis.

Results
Histopathologic examination was consistent with low risk and high-risk thymoma in 15 cases and 12 cases, respectively. The age and myasthenic syndrome were statistically significant in both groups (P = 0.039 and P = 0.05, respectively). The serum LDH level was also statistically significant in both groups (450.86 ± 487.07 vs. 204.82 ± 59.04; P < 0.001). The highest AUC has been achieved with MLP Classifier (ANN) machine learning method, with a range of 0.830 then the other learning classifiers. Three features were identified to differentiate low- and high-risk thymoma for the machine learning, namely; myasthenia gravis, LDH, SHAPE_Sphericity [only for 3D ROI (nz>1)].

Conclusions
This small dataset study has proposed a machine-learning model by MLP Classifier (ANN) analysis on 18F-FDG PET/CT images, which can predict low risk and high-risk thymoma. This study also demonstrated that the combination of clinical data and specific PET/CT-based radiomic features with image variables can predict thymoma risk groups. However, these results should be supported by studies with larger dataset.
Preventing Health Care–Associated Infections Through Implementation of an Interprofessional Visual Management Safety Tracker
Authors: Frist Avila Patricia , Twibell K. Renee , Demaree Heather 
Published: March 2022

Background:
The management of health care associated infections (HAIs) challenges acute care facilities due to variability in practices. The purpose of this quality improvement project was to decrease central line–associated bloodstream infection, catheter-associated urinary tract infection, and Clostridioides difficile infection in a high acuity care environment using a visual management (VM) tool to address practice variations.

Local Problem:
An acute care unit experienced increasing HAIs.

Methods:
An interprofessional team used Lean methodology to implement a VM tool reflective of evidence-based HAI prevention practices that staff had frequently omitted.

Interventions:
A VM tool called the Safety Tracker was created.

Results:
In 12 months, HAIs decreased from 9 events to 1, with a corresponding reduction in indwelling urinary catheter utilization and central line utilization. More than $160 000 were avoided in health care costs.

Conclusions:
Creating an interprofessional VM Safety Tracker could significantly reduce HAIs.
Integration of the 5As Nicotine Cessation Framework in a Primary Care Clinic
Authors: Mangena Nomuhle , Dabney Beverly W. , Linton Mary 
Published: March 2022

Background:
Nicotine causes significant morbidity and mortality. Many adults who want to quit using nicotine may not be receiving adequate support from their primary care providers. If used properly, the 5As nicotine cessation guidelines may help patients address their nicotine use.

Local Problem:
Smokers screened for tobacco use at a primary care clinic were not consistently offered evidence-based interventions using the 5As at each primary care encounter.

Methods:
The 5As framework was presented to providers via PowerPoint presentation and printed materials. Provider and patient behaviors were measured using data from pre- and postintervention chart reviews.

Results:
There was a statistically significant postintervention increase in the proportion of smokers who received the 5As components (P < .001). Patients' nicotine use decreased post-intervention.

Conclusion:
Results suggest that the intervention increased providers' knowledge and use of the 5As, which helped patients reduce their nicotine use.
Protection to Self and to One's Sexual Partner After Human Papillomavirus Vaccination: Preliminary Analysis From the Transmission Reduction And Prevention with HPV Vaccination Study
Authors: MacCosham Aaron , El-Zein Mariam , Burchell Ann N. , Tellier Pierre-Paul , Coutlée François , Franco Eduardo L. ,   for the TRAP-HPV study group
Published: March 2022

Background
It is unknown whether recently human papillomavirus (HPV)–vaccinated individuals confer protection against vaccine-preventable HPV types to their partners.

Methods
Participants 18 to 45 years old who were living in Montreal, Canada, and in a heterosexual relationship of 6 months or less were randomly assigned to receive the intervention HPV vaccine, Gardasil or Gardasil 9, or active control (AC), Avaxim, a hepatitis A vaccine. Couples attended a maximum of 6 clinic visits (baseline and at 2, 4, 6, 9, and 12 months) and provided genital samples for detection of 36 HPV genotypes. Participants were vaccinated at baseline and at 2 and 6 months. We used Cox proportional hazards regression models to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for associations between the administered vaccine and infections at the HPV episode level.

Results
We restricted analyses to 273 participants (intervention: n = 141, AC: n = 132) who had at least 2 visits with valid HPV data. The HR of becoming positive for a given vaccine-preventable HPV type in the intervention group among those who received at least 1 dose compared with AC was 0.47 (95% CI, 0.23–0.97). Comparing individuals with HPV-vaccinated versus AC-vaccinated partners, there was no difference in risk of becoming positive for a given vaccine-preventable HPV type among those whose partners received at least 1 (HR, 1.46; 95% CI, 0.73–2.94) or 2 (HR, 0.78; 95% CI, 0.31–1.96) doses.

Conclusions
Our study provides inconclusive evidence that individuals whose partner recently received an HPV vaccine are protected from vaccine-preventable types but demonstrates that vaccinated individuals are at a lower risk of incident infections.

Trial Registration Number: NCT01824537.
High Ubiquitin-Specific Protease 2a Expression Level Predicts Poor Prognosis in Upper Tract Urothelial Carcinoma
Authors: Ke Hung-Lung , Lee Yi-Chen , Li Wei-Ming , Wang Chien-Sheng , Hsu Wei-Chi , Lin Hui-Hui , Lee Yu-An , Jhan Jhen-Hao , Li Ching-Chia , Yeh Hsin-Chih , Wu Wen-Jeng , Huang A-Mei 
Published: March 2022

Background:
Ubiquitin-mediated protein degradation has been reported to be involved in regulating the activity of oncoproteins and tumor suppressors. Dysfunction or dysregulation of the ubiquitin-proteasome system may induce tumorigenesis. Deubiquitinase ubiquitin-specific protease 2a (USP2a) has been reported to regulate cell growth or death and is involved in the pathogenesis of various diseases, including cancers. However, the role of USP2a in upper tract urothelial carcinoma (UTUC) has not been investigated yet. The goal of this study was to evaluate the clinical significance of USP2a expression in UTUC.

Materials and Methods:
A total of 110 UTUC cases were included in this study. USP2a expression level was evaluated through immunohistochemistry staining, and the correlation of USP2a expression level with both clinical and pathologic variables was analyzed.

Results:
High USP2a expression level was observed in 48 (43.6%) cancer specimens. USP2a expression level was significantly correlated with tumor stage (P=0.001), grade (P=0.033), and tumor recurrence (P=0.008). High USP2a expression level was correlated with poor disease-free survival (P=0.005) and cancer-specific survival (P<0.001). In addition, high USP2a expression level was an independent predictor of poor disease-free survival (hazard ratio=2.31; P=0.007) and cancer-specific survival (hazard ratio=5.49; P=0.009).

Conclusions:
This study indicated that USP2a protein expression level may be a potential biomarker for predicting UTUC patient survival. Further prospective studies are needed to investigate the role of USP2a in UTUC progression.
External Validation of the PediBIRN Screening Tool for Abusive Head Trauma in Pediatric Emergency Department Settings
Authors: Hymel Kent P. , Fingarson Amanda K. , Pierce Mary Clyde , Kaczor Kim , Makoroff Kathi L. , Wang Ming 
Published: March 2022

Objective
The screening performance of the PediBIRN (Pediatric Brain Injury Research Network) abusive head trauma (AHT) 4-variable clinical decision rule (CDR) has been validated in the pediatric intensive care unit setting and in a broader setting of all hospitalized, acutely head-injured children. To further broaden the rule’s clinical applicability, we sought to validate its AHT screening performance in pediatric emergency department (ED) settings.

Methods
We conducted a retrospective, secondary analysis of an existing, deidentified, prospective data set captured to derive a bruising CDR. Subjects were patients under 3 years with bruising and confirmed acute head trauma. An expert medical panel had previously identified patients with AHT. Measures of the CDR’s AHT screening performance (sensitivity, specificity, likelihood ratios) were calculated with 95% confidence intervals (CIs).

Results
Expert medical panel members had classified 78 of 117 eligible patients (67%) as AHT, 38 (33%) as non-AHT, and 1 as indeterminate. Excluding the indeterminate case, the PediBIRN-4 demonstrated a sensitivity of 0.96 (95% CI, 0.88–0.99), specificity of 0.29 (95% CI, 0.16–0.46), positive likelihood ratio of 1.35 (95% CI, 1.10–1.67), and negative likelihood ratio of 0.13 (95% CI, 0.04–0.46). Close inspection of the data revealed that 1 of the CDR's predictor variables had lowered specificity without impacting sensitivity. Eliminating this variable would have increased specificity to 0.84 (95% CI, 0.68–0.93).

Conclusions
The PediBIRN 4-variable CDR demonstrated AHT screening sensitivity in the pediatric ED equivalent to pediatric intensive care unit and other inpatient settings, but lower specificity. Further study of a simplified 3-variable PediBIRN AHT screening tool for the ED setting is warranted.
Are Temporal Artery Biopsy Findings Related to PET/CT Findings in Giant Cell Arteritis?
Authors: Mestre-Torres Jaume , Martínez-Valle Fernando , Gabaldón Alejandra , Simó-Perdigó Marc , Salcedo-Allende M. Teresa , Navales-Mateu Ignacio , Solans-Laqué Roser 
Published: March 2022

Background
Two clinical subsets of giant cell arteritis have been identified with different histological and CT findings. However, PET/CT findings have not been compared with temporal artery biopsy (TAB).

Objective
The aims of this study were to describe clinical and histological findings in patients with giant cell arteritis according to the presence or absence of aortitis in PET/CT at the disease diagnosis, and to identify independent factors related to aortic involvement.

Methods
Patients were included and followed prospectively. Clinical symptoms and TAB findings were recorded. PET/CT was performed in the first 10 days of steroid therapy. Aortitis was defined if a grade 3 uptake on visual analysis was present on arterial wall. Clinical and histological variables were compared according to the presence or absence of aortitis on PET/CT. Multivariate analysis was performed to identify independent factors related to the presence of aortitis.

Results
Twenty-seven patients (median age, 77.6 years) were included. PET/CT was performed with a median delay of 5.0 days. Aortitis was observed in 8 patients. Patients with aortitis were younger (69.9 vs 83.7 years, P = 0.04) and had less frequently ischemic manifestations (25.0% vs 84.2%, P = 0.006) than patients without aortitis. Giant multinucleated cells were more frequent on TAB from patients with aortitis (71.4% vs 16.7%), and its presence was an independent risk factor for the occurrence of aortic involvement on PET/CT (odds ratio, 12.2; P = 0.046).

Conclusions
Our study shows that giant cells on TAB are associated with the presence of aortitis on PET/CT. Patients with aortic involvement are younger and show less frequently ischemic manifestations.
PET/CT With 68Ga-PSMA and 18F-FDG in Metastatic Adenoid Cystic Carcinoma
Authors: Isgoren Serkan , Hekimsoy Turkay , Koroglu Erdem , Demir Hakan 
Published: March 2022

Abstract
Adenoid cystic carcinoma (ACC) is a rare and slow-growing tumor, originating from salivary glands. Locoregional recurrence and distant metastasis of ACC can be visualized not only with 18F-FDG but also with 68Ga-PSMA PET/CT due to its high prostate-specific membrane antigen (PSMA) expression. We report 2 cases of metastatic ACC who underwent first 18F-FDG and then 68Ga-PSMA for staging and restaging.
Is Delayed Image of 18F-FDG PET/CT Necessary for Mediastinal Lymph Node Staging in Non–Small Cell Lung Cancer Patients?
Authors: Lee Sang Woo , Kim Seong-Jang 
Published: March 2022

Purpose
The purpose of this study was to evaluate the diagnostic accuracies of dual-time-point (DTP) 18F-FDG PET/CT for detection of mediastinal lymph node (LN) metastasis in non–small cell lung cancer (NSCLC) patients through a systematic review and meta-analysis.

Patients and Methods
The PubMed, Cochrane database, and EMBASE database, from the earliest available date of indexing through October 31, 2021, were searched for studies evaluating diagnostic performance of DTP 18F-FDG PET/CT for detection of metastatic mediastinal LN in NSCLC patients. We determined the sensitivities and specificities across studies, calculated positive and negative likelihood ratios (LR+ and LR−), and constructed summary receiver operating characteristic curves.

Results
Ten studies (758 patients) were included in the current study. In patient-based analysis, early image showed a sensitivity of 0.76 and a specificity of 0.75. Delayed image revealed a sensitivity of 0.84 and a specificity of 0.71. In LN-based analysis, early image showed a sensitivity of 0.80 and a specificity of 0.83. Delayed image revealed a sensitivity of 0.84 and a specificity of 0.87. Retention index or %ΔSUVmax is superior to early or delayed images of DTP 18F-FDG PET/CT for detection of mediastinal LN metastasis.

Conclusions
Dual-time-point 18F-FDG PET/CT showed a good diagnostic performances for detection of metastatic mediastinal LNs in NSCLC patients. Early and delayed images of DTP 18F-FDG PET/CT revealed similar diagnostic accuracies for LN metastasis. However, retention index or %ΔSUVmax is superior to early or delayed images of DTP 18F-FDG PET/CT for detection of mediastinal LN metastasis in NSCLC patients. Further large multicenter studies would be necessary to substantiate the diagnostic accuracy of DTP 18F-FDG PET/CT for mediastinal LN staging in NSCLC patients.
Macrophage Migration Inhibitory Factor Provides a Predictive Performance of Septic Acute Kidney Injury
Authors: Li Tianlong , Zhang Jiahao , Long Minghui , Jiang Xiaofang , Yang Cheng , Wang Fengqin , Su Lianjiu , Peng Zhiyong 
Published: March 2022

ABSTRACT

Background:
Septic acute kidney injury (AKI) is a common condition in ICU with poor outcomes. Septic AKI patients have a progressively decreased urine output and increased serum creatinine. However, urine volume and serum creatinine showed poor sensitivity to early diagnosis of septic AKI. Searching for potential biomarkers to early detect AKI is crucial in day-to-day clinical practice. Macrophage migration inhibitory factor (MIF), primarily released by renal tubular epithelial cells, vascular endothelial cells, and immune cells, was found to be closely associated with the inflammatory response in sepsis. MIF may be used as a biomarker of septic AKI indicating aggravation of systemic inflammatory response.

Methods:
Our study included sepsis patients admitted to the ICU. The KDIGO guideline was used to confirm the diagnosis and staging of septic AKI. Blood samples were collected and tested, as well as clinical data were recorded. Independent risk factors were selected via logistic regression analysis. By drawing the receiver operating characteristic (ROC) curves, the area under the ROC curves (AUC) was computed. The relationship between serum MIF level and mortality of septic AKI was analyzed using Cox regression analysis.

Results:
With high serum MIF level at ICU admission, the patients were more likely to develop AKI. The AUC of serum MIF (MIFAUC = 0.797) was found to be a good predictor of septic AKI. In addition, higher serum MIF levels corresponded to more severe AKI as well as a higher mortality rate.

Conclusions:
Serum MIF might be a biomarker for predicting the occurrence, development, and outcomes of septic AKI. This conclusion will need to be confirmed by more robust investigations in the future.
A novel RORγt+ antigen presenting cell type instructs microbiota-dependent regulatory T cell differentiation and tolerance during early life
Authors: Akagbosu Blossom , Tayyebi Zakieh , Shibu Gayathri , Paucar Iza Yoselin A. , Deep Deeksha , Parisotto Yollanda Franco , Fisher Logan , Pasolli H. Amalia , Thevin Valentin , Elmentaite Rasa , Knott Maximilian , Hemmers Saskia , Jahn Lorenz , Friedrich Christin , Verter Jacob , Wang Zhong-Min , van den Brink Marcel , Gasteiger Georg , Grünewald Thomas G. P. , Marie Julien C. , Leslie Christina , Rudensky Alexander Y. , Brown Chrysothemis C. 
Published: March 2022

AbstractEstablishing and maintaining tolerance to self- or innocuous foreign antigens is vital for preservation of organismal health. Within the thymus, medullary thymic epithelial cells (mTECs) expressing AutoImmune Regulator, Aire, play a critical role in self-tolerance through deletion of autoreactive T cells and promotion of thymic regulatory T (Treg) cell development. Within weeks of birth, a separate wave of Treg cell differentiation occurs in the periphery, upon exposure to dietary and commensal microbiota derived antigens, yet the cell types responsible for the generation of peripheral Treg (pTreg) cells are not known. Here we identified a new class of RORγt+ antigen-presenting cells (APC), dubbed Thetis cells (TCs), with transcriptional features of both mTECs and dendritic cells (DCs), comprising 4 major sub-groups (TC I-IV). We uncovered a developmental wave of TCs within intestinal lymph nodes during a critical early life window, coincident with the wave of pTreg cell differentiation. While TC I and III expressed the signature mTEC nuclear factor Aire, TC IV lacked Aire expression and were enriched for molecules required for pTreg generation, including the TGF-β activating integrin αvβ8. Loss of either MHCII or Itgb8 expression by TCs led to a profound impairment in intestinal pTreg differentiation, with onset of intestinal inflammation. In contrast, MHCII expression by RORγt+ group 3 innate lymphoid cells (ILC3) and classical DCs was neither sufficient nor required for pTreg generation, further implicating TCs as the tolerogenic RORγt+ APC with an essential early life function. Our studies reveal parallel pathways for establishment of tolerance to self and foreign antigen within the thymus and periphery, marked by involvement of shared cellular and transcriptional programs.