bluuebunny/crossref_metadata_2025_split huggingface dataset:
Staffing models in the cardiac intensive care unit
Authors: Quien Mary , Thomas Alexander , Ludmir Jonathan , Miller P. Elliott 
Published: June 2022

Purpose of review
The modern cardiac intensive care unit (CICU) has evolved into a high-intensity unit that cares for critically ill patients. Despite this transformation, changes to the staffing model and organizational structure in these specialized units have only recently begun to meet these challenges. We describe the most recent evidence which will inform future CICU staffing models.

Recent findings
In the United States, the majority of CICUs are open as opposed to closed units, yet recent data suggests that transition to a closed staffing model is associated with a decrease in mortality. These reductions in mortality in closed CICUs are most pronounced in the most critically ill populations, such as patients with mechanical circulatory support, cardiac arrest, and respiratory failure. In addition, one study has shown that transition to a cardiac intensivist staffed CICU was associated with a reduction in mortality. Finally, multidisciplinary and protocolized teams imbedded within the CICU, specifically 'shock teams,’ have recently been developed and may reduce mortality in this particularly sick patient population.

Summary
Although the preponderance of data suggests improved outcomes with a closed, intensivist staffed CICU model, future multicenter studies are needed to better define the ideal staffing models for the contemporary CICU.
Prevalence and comorbidities of bronchiolitis in adults
Authors: Jeong Jae Seok , Kim Jong Seung , Yeom Sang Woo , Lee Min Gyu , You Yeon Seok , Lee Yong Chul 
Published: June 2022

Abstract
Bronchiolitis generally refers to inflammation and/or fibrosis of the non-cartilaginous small airways located approximately from the 8th airway generation down to the terminal and respiratory bronchioles. In contrast to young children, the frequency of small airway infection in adult bronchiolitis appears less frequent and a number of other pathophysiological conditions have been implicated in adult bronchiolitis. However, little information is available on the exact medical burden of bronchiolitis such as its prevalence and comorbidities in the adult population. The aim of this study is to elucidate the prevalence and comorbidities of bronchiolitis. We used the Korea National Health Insurance Service-National Sample Cohort, which provides data for 1,000,000 individuals out of the entire population by 2% stratified random sampling according to age, sex, residential area, and level of household income. We defined the cause of bronchiolitis other than acute infection as a patient with diagnostic code J448 or J684 and over 20 years of age who visited a clinic or hospital in South Korea. Then, 1:1 propensity score matching was performed to define a non-bronchiolitis (control) group to compare the comorbidities and mortality in the 2 groups. The overall prevalence of bronchiolitis was 688 cases/1,000,000 population during the study period (95% confidence interval, 625–751). The most common comorbid clinical condition in adults with bronchiolitis was rhinitis (52.3%), followed by bronchial asthma (52.23%), hypertension (43.69%), gastroesophageal reflux disease (30.56%), sinusitis (28.72%), diabetes (22.77%), and osteoporosis (17.85%). Other common bronchiolitis-associated comorbidities were cerebrovascular disease (16.86%), angina (14.37%), peripheral vascular disease (13.42%), congestive heart failure (11.9%), and malignancy in any organ (10.6%). Healthcare costs for bronchiolitis increased steeply during the same period. Malignancy in any organ was the leading cause of mortality in the patient group, followed by bronchiolitis itself. Further larger prospective multiethnic cohort studies should be carried out in the near future.
Stairway to Heaven
Authors: Singh Swaran P. 
Published: June 2022

Abstract
Mystical and spiritual experiences have been reported throughout human history. Causal explanations for these range from psychopathology of mental illness, drugs such as hallucinogens, neurological disorders including temporal lobe epilepsy, and genuine mystical or spiritual awakening. There is a common core of phenomena in such experiences, as described both in historical accounts and recent research, but also evidence of cultural specificity. This article is a personal account of such an experience, which occurred in a postanesthetic state. A striking feature of the experience was noesis: a sense of revelation and complete understanding. I argue that while there must be a neural basis to these phenomena, it is difficult to reduce the subjective meaning of the experience purely to a brain dysfunction. Reconciling mechanism and meaning of such experiences remains a challenge for both neuroscience and philosophy.
Oculofacial Prosthetic Rehabilitation Complemented With Temporary Fillers and Neurotoxin
Authors: Schnorr Nathalia Gusmão Prado , Salazar-Gamarra Rodrigo , Latuff Daniela Cortizo , Dib Luciano Lauria 
Published: June 2022

Abstract:
Surgical treatment of head and neck cancer causes severe tissue loss, therefore, deformities and psychosocial consequences. In cases involving orbit exenteration, satisfactory reconstruction can only be achieved with prosthetic replacement, despite successful reconstructive plastic surgery. Extraoral implants, 3D scanning, and prototyping technologies have contributed to increase satisfactory aesthetic results of oculofacial prosthesis. However, to achieve prosthetic rehabilitation refinement, patients' biological tissues have been treated with injectable cosmetic adjuncts methods as complements to results. This study aimed to describe the use of botulinum toxin type A, hyaluronic acid, and calcium hydroxyapatite previously to oculofacial prostheses manufacturing, in 5 oncologic patients of a rehabilitation unit. Outcomes produced by additional cosmetic methods on tissues, prostheses planning, and overall facial rehabilitation were observed and registered by photographs. Botulinum toxin type A, hyaluronic acid, and calcium hydroxyapatite has shown to be useful in improving asymmetries, volumizing surgical depressions and dissembling atrophic scars. Presenting an additional resource to improve overall results, enabling the manufacturing of smaller, thinner, and better-fitting oculofacial prostheses. Limitations as chronic infection and necrosis episodes, related to filler injection into previously irradiated sites, were described. The temporary effect of the materials used generates a need for reapplications but increases the safety of such procedures and enables patients' cancer treatment follow-up.
Premature Fusion of the Posterior Intraoccipital Synchondrosis, A Minor Suture Mimic of Lambdoid Craniosynostosis
Authors: Aguilo-Seara Gabriela , Tang Jason H. , Couture Daniel E. , Runyan Christopher M. 
Published: June 2022

Abstract:
The posterior intraoccipital synchondrosis (PIOS) is a cartilaginous division separating the exoccipital and supraoccipital bones, allowing for flexibility of the cranial base at birth and which later ossifies in adolescence. The authors report a case of right PIOS synostosis that resembled right lambdoid synostosis, with left occipital bossing in a healthy, six-month-old female with an unremarkable birth history and no antecedent trauma. An initial referral was made from the pediatrician to oncology because of a concern over the presence and growth of a possible mass at the left occiput. Over 8 months, this mass grew and became more firm, accompanied by left occipital bossing and right occipital flattening. A computed tomography was obtained, which demonstrated the fusion of the PIOS, prompting a referral to plastic surgery. Cranial vault remodeling with switch cranioplasty was performed at age 14 months, complicated only by a superficial infection along the suture line. There are exceedingly few reports of PIOS synostosis, with occipital osteodiastasis related to birth trauma as the only prior explanation for this condition. With no birth trauma and delayed onset, our case likely represents idiopathic PIOS synostosis. With the many similarities in presentation, the surgical approaches commonly used for lambdoid synostosis, particularly switch cranioplasty, are suitable solutions to PIO synchondrosis with optimal functional and aesthetic outcomes.
Exosomal Transfer of DNA Methyl-Transferase mRNA Induces an Immunosuppressive Phenotype in Human Monocytes
Authors: Wisler Jon R. , Singh Kanhaiya , McCarty Adara , Harkless Ryan , Karpurapu Manjula , Hernandez Edward , Mukherjee Debasmita , Abouhashem Ahmed S. , Christman John W. , Sen Chandan K. 
Published: June 2022

ABSTRACT

Introduction:
Survivors of sepsis exhibit persistent immunosuppression. Epigenetic events may be responsible for some of these immunosuppressive changes. During sepsis circulating exosomes contain large quantities of DNA methyltransferase (DNMT) mRNAs. We hypothesized that exosomes directly transfer DNMT mRNAs to recipient monocytes with resultant methylation events and immunosuppression.

Methods:
Exosomes containing DNMT mRNA were generated by stimulating monocytes with LPS. Confocal microscopy was used to determine uptake kinetics in the presence of pharmacologic inhibition. Expression and packaging of specific DNMT mRNA was controlled using DNMT siRNAs. Whole genome and gene specific methylation was assessed using bisulfite sequencing. Ingenuity pathway analysis was performed to determine the biological function of significance of differentially methylated regions.

Results:
Exosomes effectively transferred DNMT mRNA to recipient monocytes. Pharmacologic inhibition of exosome uptake prevented this increase in DNMT mRNA expression. Recipient monocytes exhibited hypermethylation changes and gene suppression. siRNAs decreased the packaging of DNMT mRNAs and prevented TNFα gene suppression, restoring immunocompetence.

Conclusion:
These data support a role for exosome-mediated transfer of DNMT mRNA with resultant methylation and gene silencing. Pharmacologic uptake inhibition or targeted siRNA mediated DNMT gene silencing prevented DNMT mRNA transfer and maintained the cell's ability to express TNFα in response to LPS. This highlights the potential therapeutic value of targeting these exosome-mediated epigenetic events to maintain the host immune response during sepsis.
A Limited Role for AMD3100 Induced Stem Cell Mobilization for Modulation of Thoracic Trauma Outcome
Authors: Vogel Mona , Möhrle Bettina , Sakk Vadim , Brown Andreas , Palmer Annette , Braumüller Sonja , Huber-Lang Markus , Allgöwer Andreas , Cancelas Jose A. , Geiger Hartmut 
Published: June 2022

ABSTRACT
Thoracic trauma is a major cause of mortality due to the associated inflammatory acute respiratory distress syndrome and morbidity due to impaired tissue regeneration. Trauma-induced lung inflammation is characterized by the early recruitment of cells with pro- or anti-inflammatory activity to the lung. Therapeutic interventions reducing the level of tissue inflammation may result in decreased tissue damage and improved healing and recovery. Stem cells might be able to improve trauma outcome via immunomodulation or by enhancing tissue regeneration.
Here, we describe the migratory dynamics of murine mesenchymal, hematopoietic and endothelial stem and progenitor cells (SPCs) as well as mature inflammatory cells (monocytes, neutrophils, lymphocytes) to peripheral blood (PB) and lung tissue between 0.2 and 48 h post-blunt chest trauma (TXT). We demonstrate that the kinetics of immune cell and SPC distribution upon trauma are both cell-type and tissue-dependent. We identified a transient, early increase in the number of inflammatory cells in PB and lung at 2 h post-TXT and a second wave of infiltrating SPCs in lungs by 48 h after TXT induction, suggesting a role for SPCs in tissue remodeling after the initial inflammatory phase. Cxcl12/Cxcr4 blockade by AMD3100 within the first 6 h after TXT, while inducing a strong and coordinated mobilization of SPCs and leukocytes to PB and lung tissue, did not significantly affect TXT associated inflammation or tissue damage as determined by inflammatory cytokine levels, plasma markers for organ function, lung cell proliferation and survival, and myofibroblast/fibroblast ratio in the lung. Further understanding the dynamics of the distribution of endogenous SPCs and inflammatory cells will therefore be indispensable for stem cell-based or immunomodulation therapies in trauma.
Translational Epidemiology: An Integrative Approach to Determine the Interplay Between Genetic Ancestry and Neighborhood Socioeconomic Status on Triple Negative Breast Cancer
Authors: Goel Neha , Yadegarynia Sina , Kwon Deukwoo , Kesmodel Susan B. , Harbour James W. , Kobetz Erin , Merchant Nipun , Rodriguez Daniel A. 
Published: June 2022

Objective:
To investigate the impact of global and local genetic ancestry and neighborhood socioeconomic status (nSES), on breast cancer (BC) subtype, and gene expression.

Background:
Higher rates of aggressive BC subtypes [triple negative breast cancer (TNBC)] and worse overall BC survival are seen in black women [Hispanic Black (HB) and non-Hispanic Black (NHB)] and women from low nSES. However, the complex relationship between genetic ancestry, nSES, and BC subtype etiology remains unknown.

Methods:
Genomic analysis was performed on the peripheral blood from a cohort of 308 stage I to IV non-Hispanic White (NHW), Hispanic White (HW), HB, and NHB women with BC. Patient and tumor characteristics were collected. Global and local ancestral estimates were calculated. Multinomial logistic regression was performed to determine associations between age, stage, genetic ancestry, and nSES on rates of TNBC compared to estrogen receptor (ER+)/epidermal growth factor receptor 2 (HER2−), ER+/HER2+, and ER−/HER2+ disease.

Results:
Among 308 women, we identified a significant association between increasing West African (WA) ancestry and odds of TNBC [odds ratio (OR): 1.06, 95% confidence interval (95% CI): 1.001–1.126, P=0.046] as well as an inverse relationship between higher nSES and TNBC (OR: 0.343, 95% CI: 0.151–0.781, P=0.011). WA ancestry remained significantly associated with TNBC when adjusting for patient age and tumor stage, but not when adjusting for nSES (OR: 1.049, 95% CI: −0.987–1.116, P=0.120). Local ancestry analysis, however, still revealed nSES-independent enriched WA ancestral segment centered at χ2=42004914 (p=3.70×10−5) in patients with TNBC.

Conclusions:
In this translational epidemiologic study of genetic ancestry and nSES on BC subtype, we discovered associations between increasing WA ancestry, low nSES, and higher rates of TNBC compared to other BC subtypes. Moreover, on admixture mapping, specific chromosomal segments were associated with WA ancestry and TNBC, independent of nSES. However, on multinomial logistic regression adjusting for WA ancestry, women from low nSES were more likely to have TNBC, independent of genetic ancestry. These findings highlight the complex nature of TNBC and the importance of studying potential gene-environment interactions as drivers of TNBC.
Preemptive Infiltration of Local Anesthetics During Vaginal Hysterectomy: A Systematic Review and Meta-analysis of Randomized Controlled Trials
Authors: Zacharakis Dimitrios , Prodromidou Anastasia , Douligeris Athanasios , Athanasiou Stavros , Hadzilia Sophia , Kathopoulis Nikolaos , Athanasiou Veatriki , Grigoriadis Themos 
Published: June 2022

Importance
Vaginal hysterectomy (VH) is the preferred route of choice for women desiring hysterectomy to treat uterine pathology, including premalignant conditions and fibroids.

Objective
The aim of this study was to evaluate the impact of the use of preemptive local analgesia (LA) on postoperative pain and perioperative outcomes for women undergoing VH.

Study Design
A systematic search of 4 electronic databases (MEDLINE, Scopus, Cochrane CENTRAL Register of Controlled Trials, and Clinicaltrials.gov) was performed for articles published up to January 2021. All randomized controlled trials that presented outcomes of patients who underwent VH due to pelvic floor disorders or other benign gynecological disorders and received local infiltration analgesia were finally included.

Results
A total of 5 studies with 277 women (138 LA group vs 199 no-LA group) who underwent a VH were included in the present meta-analysis. Mean pain scores at both 30 minutes to 2 hours and 3 to 6 hours postoperatively were significantly lower in the LA group compared with the non-LA group (220 patients: mean difference [MD], −1.75; 95% confidence interval [CI], −2.77 to −0.74; P = 0.0007; and 220 patients: MD, −1.68; 95% CI, −2.28 to 1.09; P < 0.00001, respectively). Morphine/narcotic opioid-based consumption up to 24 hours postoperatively was significantly reduced in the LA group compared with the non-LA group (197 patients MD, −9.47 mg; 95% CI, −16.51 to −2.43; P = 0.008).

Conclusions
The use of preemptive LA during VH seems to be beneficial especially with regard to short-term postoperative pain and opioid use. However, further studies are needed to identify the optimal anesthetic regimen, the dosage, and sites of application aiming to achieve the optimal benefit in the postoperative management.
From coral reefs to Joshua trees: What ecological interactions teach us about the adaptive capacity of biodiversity in the Anthropocene
Authors: Lagerstrom Katherine M. , Vance Summer , Cornwell Brendan H. , Ruffley Megan , Bellagio Tatiana , Exposito-Alonso Moi , Palumbi Stephen R. , Hadly Elizabeth A. 
Published: June 2022

The pervasive loss of biodiversity in the Anthropocene necessitates rapid assessments of ecosystems to understand how they will respond to anthropogenic environmental change. Many studies have sought to describe the adaptive capacity (AC) of individual species, a measure that encompasses a species’ ability to respond and adapt to change. Only those adaptive mechanisms that can be used over the next few decades (e.g. via novel interactions, behavioural changes, hybridization, migration, etc.) are relevant to the timescale set by the rapid changes of the Anthropocene. The impacts of species loss cascade through ecosystems, yet few studies integrate the capacity of ecological networks to adapt to change with the ACs of its species. Here, we discuss three ecosystems and how their ecological networks impact the AC of species and vice versa. A more holistic perspective that considers the AC of species with respect to their ecological interactions and functions will provide more predictive power and a deeper understanding of what factors are most important to a species’ survival. We contend that the AC of a species, combined with its role in ecosystem function and stability, must guide decisions in assigning ‘risk’ and triaging biodiversity loss in the Anthropocene.
This article is part of the theme issue ‘Ecological complexity and the biosphere: the next 30 years’.
Network-level containment of single-species bioengineering
Authors: Maull Victor , Solé Ricard 
Published: June 2022

Ecological systems are facing major diversity losses in this century owing to Anthropogenic effects. Habitat loss, overexploitation of resources, invasion and pollution are rapidly jeopardizing the survival of whole communities. It has been recently suggested that a potential approach to flatten the curve of species extinction and prevent catastrophic shifts would involve the engineering of one selected species within one of these communities. Such possibility has started to become part of potential intervention scenarios to preserve biodiversity. Despite its potential, very little is known about the actual dynamic responses of complex ecological networks to the introduction of a synthetic strains derived from a resident species. In this paper, we address this problem by modelling the response of a community to the addition of a synthetic strain derived from a member of a stable ecosystem. We show that the community interaction matrix largely limits the spread of the engineered strain, thus suggesting that species diversity acts as an ecological firewall. The implications for future scenarios of ecosystem engineering are outlined.
This article is part of the theme issue ‘Ecological complexity and the biosphere: the next 30 years’.
On-Demand Fully-Enclosed Superhydrophobic-Optofluidic Device Enabled by High Precision Microstereolithography
Authors: Chang Yu , Bao Mengdi , Waitkus Jacob , Cai Haogang , Du Ke 
Published: June 2022

ABSTRACTSuperhydrophobic surface-based optofluidics have been introduced to biosensors and unconventional optics with unique advantages such as low light loss and power consumption. However, most of these platforms were made with planar-like micro- and nano-structures, which may cause bonding issues and resulting in significant waveguide loss. Here, we introduce a fully-enclosed superhydrophobic-based optofluidics system, enabled by a one-step high precision microstereolithography procedure. Various micro-structured cladding designs with a feature size down to 100 μm were studied and a “T-type” overhang design exhibits the lowest optical loss, regardless of the excitation wavelength. Surprisingly, the optical loss of superhydrophobic-based optofluidics is not solely decided by the solid area fraction at the solid/water/air interface, but also the cross-section shape and the effective cladding layer composition. We show that this fully-enclosed optofluidic system can be used for CRISPR-labeled quantum dot quantification, intended for in vitro and in vivo CRISPR therapeutics.
Vaccination saves lives: How do patients with chronic diseases and severe COVID-19 fare? Analysis from India’s National Clinical registry for COVID-19
Authors: Mukherjee Aparna , Kumar Gunjan , Turuk Alka , Bhalla Ashish , Bingi Thrilok Chander , Bhardwaj Pankaj , Baruah Tridip Dutta , Mukherjee Subhasis , Talukdar Arunansu , Ray Yogiraj , John Mary , Khambholja Janakkumar R , Patel Amit H. , Bhuniya Sourin , Joshi Rajnish , Menon Geetha R , Sahu Damodar , Rao Vishnu Vardhan , Bhargava Balram , Panda Samiran 
Published: June 2022

AbstractObjectivesThis study aims to describe the demographic and clinical profile and ascertain the determinants of outcome among hospitalised COVID-19 adult patients enrolled in the National Clinical Registry for COVID-19 (NCRC).MethodsNCRC is an on-going data collection platform operational in 42 hospitals across India. Data of hospitalized COVID-19 patients enrolled in NCRC between 1st September 2020 to 26th October 2021 were examined.ResultsAnalysis of 29,509 hospitalised, adult COVID-19 patients [mean (SD) age: 51.1 (16.2) year; male: 18752 (63.6%)] showed that 15678 (53.1%) had at least one comorbidity. Among 25715 (87.1%) symptomatic patients, fever was the commonest symptom (72.3%) followed by shortness of breath (48.9%) and dry cough (45.5%). In-hospital mortality was 14.5% (n=3957). Adjusted odds of dying were significantly higher in age-group ≥60 years, males, with diabetes, chronic kidney diseases, chronic liver disease, malignancy, and tuberculosis, presenting with dyspnea and neurological symptoms. WHO ordinal scale 4 or above at admission carried the highest odds of dying [5.6 (95% CI: 4.6, 7.0)]. Patients receiving one [OR: 0.5 (95% CI: 0.4, 0.7)] or two doses of anti-SARS CoV-2 vaccine [OR: 0.4 (95% CI: 0.3, 0.7)] were protected from in-hospital mortality.ConclusionsWHO ordinal scale at admission is the most important independent predictor for in-hospital death in COVID-19 patients. Anti-SARS-CoV2 vaccination provides significant protection against mortality.