bluuebunny/crossref_metadata_2025_split huggingface dataset:
Cosmological nanolensing by dense gas clouds
Authors: Tuntsov Artem V , Walker Mark A 
Published: April 2022

ABSTRACT
We study the influence of a cosmological population of dense gas clouds on distant sources, with an emphasis on quasar optical variability. In addition to gravitational lensing, such clouds affect flux measurements via refraction in the neutral gas and via dust extinction, leading to a variety of possible light curves even in the low optical depth limit. We classify and illustrate the types of light curves that can arise. For sources as large as quasars, we show that gravitational lensing and extinction are the dominant effects, with gas refraction playing only a minor role. We find that clouds with mass $\sim 10^{-4.5\pm 0.5}\, \mathrm{M}_\odot$ can reproduce the observed distribution of quasar variation amplitudes, but only if such clouds make up a large fraction of the closure density. In that case, there may also be substantial extinction of distant optical sources, which can, in principle, be constrained by data on ‘standard candles’ such as type Ia supernovae. Unfortunately, that extinction is essentially grey, even when the material opacity is strongly wavelength dependent, making it difficult to distinguish from the influence of the background geometry. We propose a novel statistical test of the origin of quasar variability, based on the angular structure of the variation timescale for a large number of quasars distributed all over the sky. If quasar variability is primarily due to nanolensing, then angular structure is expected to include a quadrupole term of amplitude $\sim 5{{\ \rm per\ cent}}$, which ought to be measurable with future data from the Gaia mission.
Macrophage-associated immune checkpoint CD47 blocking ameliorates endometriosis
Authors: Li Jing , Yan Shumin , Li Qiuju , Huang Yufei , Ji Miaomiao , Jiao Xue , Yuan Ming , Wang Guoyun 
Published: April 2022

Abstract
Peritoneal macrophages play a significant role in the progression of endometriosis (EM), but their functional differentiation is still unclear, and their phagocytic ability is weak. CD47-signal-regulated protein α (SIRPα) and PD-L1-PD-1 are considered immune checkpoints associated with macrophage phagocytosis. A specific blockade of these two pathways had been shown to increase the phagocytic clearance of cancer cells by macrophages in most cancers. We hypothesized that targeting CD47/PD-L1 in EM could improve the phagocytosis of macrophages, thereby delaying the progression of EM. From localization to quantification, from mRNA to protein, we comprehensively evaluated the expression of CD47 and PD-L1 in EM. We demonstrated that the CD47 expression in ectopic endometrium from patients with EM was significantly increased, but PD-L1 was not. We performed direct co-culture experiments of endometrial stromal cells with macrophages in vitro and in vivo to assess whether ectopic endometrial stromal cells escape macrophage phagocytosis through the CD47-SIRPα signaling pathway. The results showed that targeting CD47 increased the phagocytic capacity of macrophages. Interestingly, we also found that the reduction of CD47 expression promoted apoptosis of endometrial stromal cells. In conclusion, these data suggested that targeting CD47 can effectively target ectopic endometrial stromal cells through a dual mechanism of increased phagocytosis of macrophages and induced apoptosis of ectopic endometrial stromal cells. Thus, immunotherapy based on the CD47-SIRPα signaling pathway has some potential in treating EM, but further mechanistic studies are needed to explore more effective and specific antibodies.
Factors associated with health-related quality of life (HRQoL) deterioration in glioma patients during the progression-free survival period
Authors: Coomans Marijke B , Dirven Linda , Aaronson Neil , Baumert Brigitta G , van den Bent Martin , Bottomley Andrew , Brandes Alba A , Chinot Olivier , Coens Corneel , Gorlia Thierry , Herrlinger Ulrich , Keime-Guibert Florence , Malmström Annika , Martinelli Francesca , Stupp Roger , Talacchi Andrea , Weller Michael , Wick Wolfgang , Reijneveld Jaap C , Taphoorn Martin J B 
Published: April 2022

Abstract

Background
Maintenance of functioning and well-being during the progression-free survival (PFS) period is important for glioma patients. This study aimed to determine whether health-related quality of life (HRQoL) can be maintained during progression-free time, and factors associated with HRQoL deterioration in this period.

Methods
We included longitudinal HRQoL data from previously published clinical trials in glioma. The percentage of patients with stable HRQoL until progression was determined per scale and at the individual patient level (i.e. considering all scales simultaneously). We assessed time to a clinically relevant deterioration in HRQoL, expressed in deterioration-free survival and time-to-deterioration (the first including progression as an event). We also determined the association between sociodemographic and clinical factors and HRQoL deterioration in the progression-free period.

Results
Five thousand five hundred and thirty-nine patients with at least baseline HRQoL scores had a median time from randomization to progression of 7.6 months. Between 9–29% of the patients deteriorated before disease progression on the evaluated HRQoL scales. When considering all scales simultaneously, 47% of patients deteriorated on ≥1 scale. Median deterioration-free survival period ranged between 3.8–5.4 months, and median time-to-deterioration between 8.2–11.9 months. For most scales, only poor performance status was independently associated with clinically relevant HRQoL deterioration in the progression-free period.

Conclusions
HRQoL was maintained in only 53% of patients in their progression-free period, and treatment was not independently associated with this deterioration in HRQoL. Routine monitoring of the patients’ functioning and well-being during the entire disease course is therefore important, so that interventions can be initiated when problems are signaled.
Weekly Telephone Call Impacts Outcomes of an Individualized Home Exercise Program in People Recovering From Cancer
Authors: Mayer Jill E. , Plumeau Kayleigh 
Published: April 2022

Background and Purpose:
Home exercise programs (HEPs) improve quality of life (QoL), physical function, and fatigue in individuals recovering from cancer; however, they often lack supervision and individualization. Use of a weekly telephone call by a physical therapist (PT) may provide substantial guidance to improve outcomes and adherence. The purpose of this study was to determine the effect of weekly calls in addition to an individualized HEP on physical function, QoL, fatigue, and adherence in people with cancer.

Methods:
A prospective 2-armed single-cohort design implemented with survivors of cancer in early recovery. Control and intervention groups received in-home instruction of a PT-prescribed, 8-week HEP. The intervention group received weekly phone calls while the control group had no formal follow-up or program monitoring. Outcome measures assessed pre-/postintervention: 6-minute walk test (6MWT), Fullerton Advanced Balance Scale, European Organization of Research and Treatment of Cancer QoL Questionnaire (EORTC QLQ-C30), and Functional Assessment of Chronic Illness Therapy Fatigue Scale (FACIT). Nonparametric statistics were used to analyze changes within and between groups.

Results:
Fifteen participants (n = 7 intervention and n = 8 control) completed the study. The intervention group improved significantly in all outcomes except the 6MWT (P < .05). The control group did not demonstrate any significant improvements. Between groups, there was a significant difference at program completion in the FACIT (P = .007) and EORTC QLQ-C30 physical function subscale (P = .042).

Limitations:
A small, heterogeneous sample.

Conclusions:
An individualized HEP with weekly calls may be a safe and effective way to improve outcomes of physical function, QoL, and fatigue in individuals with cancer during early recovery.
Clinical Scores Predict Acute and Chronic Complications in Pediatric Osteomyelitis: An External Validation
Authors: Vij Neeraj , Singleton Ian , Kang Paul , Esparza Melissa , Burns Jessica , Belthur Mohan V. 
Published: April 2022

Background:
Pediatric acute hematogenous osteomyelitis (AHO) outcomes are highly dependent on the disease severity. Recently, the A-SCORE and C-SCORE, were proposed as predictors of an acute complicated course and chronic morbidity, respectively. The purpose of this study was to externally validate the A-SCORE and C-SCORE at a single institution.

Methods:
This IRB-approved retrospective chart review included AHO patients admitted at a tertiary referral hospital between October 1, 2015 and December 31, 2019. The inclusion criteria were ages 0 to 18 and clinical response to treatment. The exclusion criteria were immunocompromised status or penetrating inoculation.

Results:
The A-SCORE demonstrated an area under the receiver operator curve (ROC area) of >86% with regards to all acute complications. It also demonstrated sensitivities >85% and specificities >92% at the cut-off of 4 (Youden index) for all acute complications. The C-SCORE demonstrated an ROC area of 100% with regards to chronic osteomyelitis. It also demonstrated sensitivities >70% and specificities >93% for the chronic morbidity variables seen in our population at the cut-off of 3 (Youden index.)

Conclusions:
These novel composite clinical scores, in combination with clinical judgment, could help guide early care decisions. The A-SCORE and C-SCORE are useful risk stratification tools in the management of pediatric AHO and in predicting acute complicated courses or chronic sequelae of AHO, respectively. These scoring systems, if integrated into standardized pediatric AHO guidelines, can allow clinicians to stratify the AHO population and guide clinical decision making.

Level of Evidence:
Level III (prognostic study, retrospective chart review).
Self-reported Vital Sign Assessment Practices of Neurologic Physical Therapists
Authors: O'Brien Jamie , Wallmann Harvey W. , Karaffa Jaclynne , Kleilein Marissa , Prewitt Katherine , Schreiber Hannah , Zimmerman Hannah 
Published: April 2022

Purpose:
This study's purpose was to describe the vital sign assessment (VSA) practices of physical therapists (PTs) during evaluation and treatment of patients with neurologic conditions.

Methods:
A survey was distributed to clinicians from a clinical site database and the Academy of Neurologic Physical Therapy's list serve. Respondents included US licensed PTs who treat patients with neurologic conditions.

Results:
Usable surveys included 133 US PTs with 69.2% doctorally prepared and 79.7% American Physical Therapy Association (APTA) members. Although 58.6% of survey respondents indicated that VSA is an essential part of the PT evaluation, at evaluation, only 37.6% and 39.1% of respondents always take heart rate (HR) and blood pressure (BP), and only 8.3% of respondents always take respiratory rate (RR). During treatment, only 14.3% of respondents report taking HR or BP at each session, while only 5.3% always take RR. Board certification was correlated with an increased frequency of HR assessment (P = .0027) and BP (P = 0.038) at evaluation, while importance of VSA strongly correlated with increased assessment of HR (P = 0.000), BP (P = 0.000), and RR (P = 0.003) at evaluation and with HR (P = 0.000) and BP (0.000) during treatment.

Conclusions:
Although VSA by neurologic PTs is higher than other identified PT groups, it is still below-recommended assessment guidelines.
Novel Approach for Midface Depression
Authors: Yamamoto Koji , Fukushima Kuniaki 
Published: April 2022

Background:
Although Le Fort type II, prosthesis detainment, and orthodontic treatment are considered for the management of midface retraction, they may be limited by their high cost, infection risk, and excessive amount of tooth movement. Therefore, the Point A-Koji method was devised as a novel treatment in patients with midface retraction.

Methods:
This is a case report of a 26-year-old woman who presented with a feeling of depressed midface and protrusion of the mouth. Preoperatively, the position of the lip and line connecting the nasal apex and mental muscles (E-line) were normal, but the subnasale was located posteriorly. The patient had a narrow nasolabial angle of 74 degrees and the subnasale-Pog’ to the upper lip of 6.5 mm. After insertion of a metallic-plate implant under the periosteum, the plate was screwed and fixed to the bone. The Point A-Koji method was used for treatment in this patient. This is characterized by the A-point anterior migration technique in which the periosteum of hard tissue A-point circumferential attachment was shifted anteriorly, thereby preventing the return of soft tissue.

Results:
The following changes with respect to preoperative findings were noted 5 months postsurgery: facial convexity from 3.3 degrees to 7.6 degrees; nasolabial angle from 74 degrees to 90.2 degrees; true horizontal line from 50 degrees to 73 degrees; and subnasale-Pog’ to the upper lip from 6.5 mm to 4.7 mm. This resulted in an improved midface retraction.

Conclusion:
The Point A-Koji method may be an ideal method to improve the midface retraction in patients.
Do Mechanically Ventilated COVID-19 Patients Present a Higher Case-Fatality Rate Compared With Other Infectious Respiratory Pandemics? A Systematic Review and Meta-Analysis
Authors: Blumenfeld Orit , Fein Shai , Miller Asaf , Hershkovitz Yael , Caspi Inbar , Niv Yaron , Keinan-Boker Lital 
Published: April 2022

Background
Early reports on COVID-19 patient outcomes showed a marked fatality rate among patients requiring invasive mechanical ventilation (IMV).

Objective
Our aim was to compare case fatality rate (CFR) outcomes for patients requiring IMV due to severe acute respiratory syndrome (SARS)-associated coronavirus 2 (COVID-19), SARS-associated coronavirus 1, Middle East respiratory syndrome (MERS), and influenza (H1N1).

Materials and Methods
We searched PubMed, EMBASE, MEDLINE, Google Scholar, and Cochrane Library for relevant studies published between December 2019 and April 2021 for COVID-19, between January 2002 and December 2008 for SARS, between January 2012 and December 2019 for MERS, and between January 2009 and December 2016 for influenza (H1N1).

Results
Overall, this study included 81 peer-reviewed studies, pertaining to 65,058 patients requiring IMV: 61 studies including 62,809 COVID-19 patients, 4 studies including 148 SARS patients, 9 studies including 875 MERS patients, and 7 studies including 1226 influenza (H1N1) patients. The CFR for COVID-19 patients requiring IMV was not significantly different from the CFR for SARS and influenza (H1N1) patients (45.5% [95% confidence interval (CI), 38.5%–52.8%] vs. 48.1% [95% CI, 39.2%–57.2%] and 39.7% [95% CI, 29.3%–51.3%], respectively). However, CFR for COVID-19 patients was significantly lower compared with that for MERS patients (CFR, 70.6%; 95% CI, 60.9%–78.8%).

Conclusions
COVID-19 patients requiring IMV show a similar CFR compared with SARS and H1N1 influenza patients but a lower CFR compared with MERS patients. To improve survival in future pandemics, we recommend examining the pros and cons of the liberal use of endotracheal intubation and considering drafting guidelines for the selection of patients to intubate and the timing of intubation.
Angle κ and its effect on the corneal elevation maps in refractive surgery candidates
Authors: Salouti Ramin , Nowroozzadeh M. Hossein , Azizi Ali , Salouti Kia , Ghoreyshi Maryam , Oboodi Reza , Tajbakhsh Zahra 
Published: April 2022

Purpose:
To assess the associations of angle κ and Pentacam decentration indices with elevation maps in normal refractive surgery candidates.

Setting:
Salouti Cornea Research Center, Salouti Eye Clinic, Shiraz, Iran.

Design:
Retrospective observational study.

Methods:
In this research, the right eyes of 173 refractive surgery candidates were assessed. Data of front and back corneal elevation maps, keratometric data, decentration indices, and corneal astigmatism obtained by Pentacam HR system and angle κ obtained by Orbscan IIz were extracted. Maximum elevation (or depression) for each of the 4 quadrants was recorded. Correlations of elevation values with angle κ, Pentacam decentration indices, keratometry, and astigmatism were examined by Pearson correlation coefficient. 148 age- and sex-matched cases with keratoconus grade 1 were selected as a positive control group, and Pentacam variables were compared between the groups.

Results:
Overall, data from 173 eyes of 173 normal refractive surgery candidates and 148 eyes of 148 patients with keratoconus were recorded and analyzed. In normal refractive surgery candidates, the mean of angle κ was 5.32 ± 1.36 (SD) degrees. Angle κ had a positive correlation with front and back temporal elevations based on a best-fit sphere (BFS) (r = 0.339, P = .001; r = 0.300, P < .001, respectively). Front and back keratometric astigmatisms were positively correlated with front and back nasal and temporal elevations (r ≥ 0.543, P < .001) and negatively correlated with superior and inferior elevations (r ≤ −0.547, P < .001). These associations no longer existed when using best-fit toric ellipse (BFTE) for calculating elevation data. The thinnest point to vertex decentration was significantly associated with the back temporal elevation (based on the BFTE) in both normal (r = 0.311, P < .001) and keratoconus (r = 0.190, P = .021) eyes.

Conclusions:
This study showed that elevation maps obtained by the Pentacam system using BFS might be affected by both the large angle κ and corneal astigmatism, confounding the preoperative assessment of refractive surgery candidates. Using BFTE as a reference for calculating elevation data should eliminate most diagnostic issues and thus is encouraged in this context.
Adherence to guideline recommendations in the management of pediatric cardiac arrest: a multicentre observational simulation-based study
Authors: Corazza Francesco , Stritoni Valentina , Martinolli Francesco , Daverio Marco , Binotti Marco , Genoni Giulia , Ingrassia Pier Luigi , De Luca Marco , Palmas Giordano , Maccora Ilaria , Frigo Anna Chiara , Da Dalt Liviana , Bressan Silvia 
Published: April 2022

Background and importance
Pediatric cardiac arrest is a rare emergency with associated high mortality. Its management is challenging and deviations from guidelines can affect clinical outcomes.

Objectives
To evaluate the adherence to guideline recommendations in the management of a pediatric cardiac arrest scenario by teams of pediatric residents. Secondarily, the association between the use of the Pediatric Advanced Life Support-2015 (PALS-2015) pocket card, and the teams’ adherence to international guidelines, were explored.

Design, settings and participants
Multicentre observational simulation-based study at three Italian University Hospitals in 2018, including PALS-2015 certified pediatric residents in their 3rd–5th year of residency program, divided in teams of three.

Intervention or exposure
Each team conducted a standard nonshockable pediatric cardiac arrest scenario and independently decided whether to use the PALS-2015 pocket card.

Outcome measure and analysis
The primary outcome was the overall number and frequency of individual deviations from the PALS-2015 guidelines, measured by the novel c-DEV15plus score (range 0–15). Secondarily, the performance on the validated Clinical Performance Tool for asystole scenarios, the time to perform resuscitation tasks and cardiopulmonary resuscitation (CPR) quality metrics were compared between the teams that used and did not use the PALS-2015 pocket card.

Main results
Twenty-seven teams (81 residents) were included. Overall, the median number of deviations per scenario was 7 out of 15 [interquartile range (IQR), 6–8]. The most frequent deviations were delays in positioning of a CPR board (92.6%), calling for adrenaline (92.6%), calling for help (88.9%) and incorrect/delayed administration of adrenaline (88.9%). The median Clinical Performance Tool score was 9 out of 13 (IQR, 7–10). The comparison between teams that used (n = 13) and did not use (n = 14) the PALS-2015 pocket card showed only significantly higher Clinical Performance Tool scores in the former group [9 (IQR 9–10) vs. 7 (IQR 6–8); P = 0.002].

Conclusions
Deviations from guidelines, although measured by means of a nonvalidated tool, were frequent in the management of a pediatric cardiac arrest scenario by pediatric residents. The use of the PALS-2015 pocket card was associated with better Clinical Performance Tool scores but was not associated with less deviations or shorter times to resuscitation tasks.
Clinical effect of ethanol co-use in patients with acute drug toxicity involving the use of central nervous system depressant recreational drugs
Authors: Heier Eva-Carina , Eyer Florian , Rabe Christian , Geith Stefanie , Dargan Paul I. , Wood David M. , Heyerdahl Fridtjof , Dines Alison M. , Giraudon Isabelle , Erik Hovda Knut , Yates Chris , Vallersnes Odd Martin , Miró Òscar , Liechti Matthias E. , Zellner Tobias ,   on behalf of the Euro-DEN Research Group
Published: April 2022

Background and importance
Patients who use recreational drugs frequently co-ingest ethanol, which is considered a central nervous system (CNS) depressant. The clinical relevance of this in acute toxicity involving other CNS depressants is not well described.

Objective
To assess the clinical impact of ethanol co-use in patients presenting to the emergency department (ED) with acute toxicity involving the use of CNS depressant drugs.

Design, settings and participants
A retrospective multicentre study using data from the Euro-DEN Plus database from January 2014 to December 2019.

Outcomes measure and analysis
Comparison of epidemiologic and clinical characteristics, ED and hospital management of patients with CNS depressant intoxication with or without ethanol co-use.

Main results
Although 7644 (17.5%) of the 43 633 presentations were included, ethanol was co-ingested in 3811 (49.9%). In total 53.3% required medical treatment, 14 patients died. Patients with ethanol co-use more frequently presented with a Glasgow Coma Scale (GCS) ≤8 (34.1% vs. 22.4%; P
< 0.001), vomiting (8.1% vs. 4.6%; P
< 0.001), anxiety (12 % vs. 6.4%; P
< 0.001), agitation/aggression (22% vs. 14.7%; P
< 0.001), seizures (3.8% vs. 2.4%; P
< 0.001) and hypotension (7.5% vs. 4.6%; P
< 0.001). They more often required ambulance transport (85.5% vs. 76.5%; P
< 0.001), medical treatment (57.3% vs. 48.0%; P
< 0.001), hospitalization (27.7% vs. 18.9%; P
< 0.001), and admission to intensive care (12.2% vs. 4.0%; P
< 0.001). Subgroup analysis showed that GCS ≤8 was particularly common in patients who combined ethanol with opioids or gamma-hydroxybutyrate (GHB)/gamma-butyrolactone (GBL).

Conclusion
Co-use of ethanol with CNS-depressant drugs appears to increase the risk of adverse effects and is associated with a higher need for medical treatment, especially when ethanol is combined with opioids or GHB/GBL.