bluuebunny/crossref_metadata_2025 huggingface dataset:
Postoperative complications and mortality following emergency digestive surgery during the COVID-19 pandemic
Authors: Madrazo Zoilo , Osorio Javier , Otero Aurema , Biondo Sebastiano , Videla Sebastian
Published: February 2021

Infection with the SARS-CoV-2 virus seems to contribute significantly to increased postoperative complications and mortality after emergency surgical procedures. Additionally, the fear of COVID-19 contagion delays the consultation of patients, resulting in the deterioration of their acute diseases by the time of consultation. In the specific case of urgent digestive surgery patients, both factors significantly worsen the postoperative course and prognosis. Main working hypothesis: infection by COVID-19 increases postoperative 30-day-mortality for any cause in patients submitted to emergency/urgent general or gastrointestinal surgery. Likewise, hospital collapse during the first wave of the COVID-19 pandemic increased 30-day-mortality for any cause. Hence, the main objective of this study is to estimate the cumulative incidence of mortality at 30-days-after-surgery. Secondary objectives are: to estimate the cumulative incidence of postoperative complications and to develop a specific postoperative risk propensity model for COVID-19-infected patients.

A multicenter, observational retrospective cohort study (COVID-CIR-study) will be carried out in consecutive patients operated on for urgent digestive pathology. Two cohorts will be defined: the “pandemic” cohort, which will include all patients (classified as COVID-19-positive or -negative) operated on for emergency digestive pathology during the months of March to June 2020; and the “control” cohort, which will include all patients operated on for emergency digestive pathology during the months of March to June 2019. Information will be gathered on demographic characteristics, clinical and analytical parameters, scores on the usual prognostic scales for quality management in a General Surgery service (POSSUM, P-POSSUM and LUCENTUM scores), prognostic factors applicable to all patients, specific prognostic factors for patients infected with SARS-CoV-2, postoperative morbidity and mortality (at 30 and 90 postoperative days). The main objective is to estimate the cumulative incidence of mortality at 30 days after surgery. As secondary objectives, to estimate the cumulative incidence of postoperative complications and to develop a specific postoperative risk propensity model for SARS-CoV-2 infected patients.

The protocol (version1.0, April 20th 2020) was approved by the local Institutional Review Board (Ethic-and-Clinical-Investigation-Committee, code PR169/20, date 05/05/20). The study findings will be submitted to peer-reviewed journals and presented at relevant national and international scientific meetings.

ClinicalTrials.gov Identifier: NCT04479150 (July 21, 2020).
Galactose-deficient IgA1 and nephritis-associated plasmin receptors as markers for IgA-dominant infection-related glomerulonephritis
Authors: Han Wei , Suzuki Tomo , Watanabe Shiika , Nakata Mayumi , Ichikawa Daisuke , Koike Junki , Oda Takashi , Suzuki Hitoshi , Suzuki Yusuke , Shibagaki Yugo
Published: February 2021

Rational:

Immunoglobulin A (IgA) nephropathy is a common heterogeneous kidney disease. One of the causes of secondary immunoglobulin A nephropathy is infection-related glomerulonephritis (IRGN), however, its accurate diagnosis is difficult.

Patient concerns:

We report a rare case of an 82-year-old male presenting rapidly progressive glomerulonephritis. Assessment of a kidney biopsy by light microscopy revealed endocapillary glomerulonephritis with subendothelial deposits, such as wire loop lesions and cellular crescents. Immunofluorescence demonstrated strong staining for IgA and C3 along the glomerular capillary. Additional tests included positive staining for nephritis-associated plasmin receptor and positive plasmin activity in the glomeruli. Moreover, IgA and galactose-deficient IgA1 (Gd-IgA1) staining merged using immunofluorescence, followed by confirmation of high serum levels of Gd-IgA1 (9.3 μg/mL) by ELISA was observed.

Diagnosis:

The diagnosis of IgA-dominant IRGN was made.

Interventions and outcomes:

We have initiated treatment with intravenous methylprednisolone 500 mg/day for 3 days, followed by oral prednisolone 25 mg/d as rapidly progressive glomerulonephritis. However immunosuppressive therapy was halted because of a poor response, and hemodialysis was initiated.

Lessons:

This is a case of IgA-dominant IRGN patient exhibiting positive glomerular staining for nephritis-associated plasmin receptor accompanied with high titers of serum Gd-IgA1. Our observations suggest that serum and kidney tissue of Gd-IgA1 may be useful for the diagnosis of IgA-dominant IRGN.
Systemic inflammatory status – a bridge between gestational weight gain and neonatal outcomes (STROBE-compliant article)
Authors: Rugină Cosmin , Mărginean Cristina Oana , Meliţ Lorena Elena , Huţanu Adina , Ghiga Dana Valentina , Modi Viviana , Mărginean Claudiu
Published: February 2021

Pregnant women with excessive gestational weight gain express an inflammatory status with multiple negative effects on birth outcomes.

The aim of this study was to identify the relationship between gestational weight gain at different gestational ages and inflammatory status in pregnant women and their newborns assessing both interleukin 6 and 8, as well as hepcidin in these couples.

Our study included 170 pregnant women and their newborns. Pregnant women were clinically assessed at the end of the 1st trimester and at term, whereas the newborns were assessed over the first 3 days of life. The levels of interleukin 6, 8 and hepcidin were measured in both pregnant women and their newborns.

We noticed higher levels of interleukin 6, interleukin 8 and hepcidin in pregnant women at the time of delivery as compared to the end of the 1st trimester. We observed a direct significant correlation between gestational weight gain at the time of delivery and interleukin 8 in both mothers [r = 0.1834, 95% CI: 0.0293–0.3290, (P = .0167)] and newborns [r = 0.1790, 95% CI: 0.0248–0.3249, (P = .0195)]. Our study underlined that a higher gestational weight gain resulted in a significantly higher birth weight [r = 0.2190, 95% CI: 0.0663–0.3617, (P = .0041)].

Our findings suggest that interleukin 8 might be an important indicator of inflammatory status in both mothers and newborns. Moreover, excessive gestational weight gain was associated with an increase in birth weight.
Effect of continuous nursing on angina attack and quality of life in patients with coronary artery disease
Authors: Zhou Xiaohuan , Yuan Yamin , Wang Zhanglin , Zhang Ke , Fan Weiwei , Zhang Yawei , Ma Pu
Published: February 2021

Background:

Coronary Artery Disease is an ischemic or necrotic heart disease caused by myocardial hypoxia caused by coronary artery stenosis or occlusion. The main symptoms are heart failure and recurrent angina pectoris. Continuous nursing refers to the nursing mode from in-hospital nursing to out-of-hospital nursing, including guiding patients’ follow-up treatment and lifestyle, which can effectively improve the quality of life in patients with Coronary Artery Disease and reduce the number of angina attacks. The study implemented in this program will systematically evaluate the efficacy and safety of continuous nursing intervention on an angina attack and quality of life in Coronary Artery Disease, and provide evidence-based basis for clinical application of continuous nursing intervention in Coronary Artery Disease.

Method:

The 2 researchers search the databases of China Knowledge Network, VP Information Chinese Journal Service Platform, PubMed, Embase, the Cochrane Library and Web of Science. From the establishment of the database in December 2020, all the randomized controlled trials on continuous nursing intervention for Coronary Artery Disease are collected. The relevant data are extracted and the quality is evaluated. meta-analysis is performed on the included literature using Stata15.0 software.

Result:

In this study, the efficacy and safety of continuous nursing intervention on Coronary Artery Disease are evaluated by Seattle angina questionnaire and other indicators.

Conclusion:

This study will provide reliable evidence for the clinical application of nursing intervention in Coronary Artery Disease.

Ethics and dissemination:

Private information from individuals will not be published. This systematic review also does not involve endangering participant rights. Ethical approval will not be required. The results may be published in a peer-reviewed journal or disseminated at relevant conferences.

OSF Registration number:

DOI 10.17605/OSF.IO/7QRKV.
Predicting factors of adverse pregnancy outcomes in Thai patients with systemic lupus erythematosus
Authors: Louthrenoo Worawit , Trongkamolthum Thananant , Kasitanon Nuntana , Wongthanee Antika
Published: February 2021

Studies on predicting factors for adverse pregnancy outcomes (APOs) in Thai patients with systemic lupus erythematosus (SLE) are limited. This retrospective observation study determined APOs and their predictors in Thai patients with SLE.

Medical records of pregnant SLE patients in a lupus cohort, seen from January 1993 to June 2017, were reviewed.

Ninety pregnancies (1 twin pregnancy) from 77 patients were identified. The mean age at conception was 26.94 ± 4.80 years. At conception, 33 patients (36.67%) had active disease, 23 (25.56%) hypertension, 20 (22.22%) renal involvement, and 6 of 43 (13.95%) positive anti-cardiolipin antibodies or lupus anti-coagulants, and 37 (41.11%) received hydroxychloroquine. Nineteen patients (21.11%) had pregnancy loss. Of 71 successful pregnancies, 28 (31.11%) infants were full-term, 42 (46.67%) pre-term and 1 (11.11%) post-term; 19 (26.39%) were small for gestational age (SGA), and 38 (52.58%) had low birth weight (LBW). Maternal complications occurred in 21 (23.33%) pregnancies [10 (11.11%) premature rupture of membrane (PROM), 8 (8.89%) pregnancy induced hypertension (PIH), 4 (4.44%) oligohydramnios, 2 (2.22%) post-partum hemorrhage, and 1 (1.11%) eclampsia]. Patients aged ≥ 25 years at pregnancy and those ever having renal involvement had predicted pregnancy loss with adjusted odds ratio (AOR) [95% CI] of 4.15 [1.10–15.72], P = .036 and 9.21 [1.03–82.51], P = .047, respectively. Renal involvement predicted prematurity (6.02 [1.77–20.52, P = .004), SGA (4.46 [1.44–13.78], P = .009), and LBW in infants (10.01 [3.07–32.62], P < .001). Prednisolone (>10 mg/day) and immunosuppressive drugs used at conception protected against prematurity (0.11 [0.02–0.85], P = .034). Flares and hematologic involvement predicted PROM (8.45 [1.58–45.30], P = .013) and PIH (9.24 [1.70–50.24], P = .010), respectively. Cutaneous vasculitis (33.87 [1.05–1,094.65], P = .047), and renal (31.89 [6.66–152.69], P < .001), mucocutaneous (9.17 [1.83–45.90], P = .007) and hematologic involvement (128.00 [4.60–3,564.46], P = .004) during pregnancy predicted flare; while prednisolone (>10 mg/day) and immunosuppressive drug use at conception reduced that risk (0.08 [0.01–0.68, P = .021).

APOs remain a problem in Thai pregnant SLE patients. Renal involvement and SLE flares were associated with the risk of APOs.
Calcified extra-axial cavernous malformation arising from lower cranial nerves
Authors: Ke Daibo , Deng Xueyun , Li Xiang , Li Jiuhong , Hui Xuhui
Published: February 2021

Rationale:

Extra-axial cavernous malformations (ECMs) arising from cranial nerves (CNs) are rare. Complete “en bloc” lesion resection and hemosiderin-stained tissue preservation remain the standard treatment, while a different strategy may be needed when the lesion is highly calcified . We report the 3rd calcified ECM-CN and review the clinical features and surgical strategy for this rare condition considering previous literature.

Patient concerns:

We present a 52-year-old woman with a calcified lesion located in the right lower 1/3 of the cerebellopontine angle.

Diagnosis:

The diagnosis was calcified ECM-CNs according to the pathological and radiological features.

Interventions:

A posterior midline craniotomy was performed, and piecemeal resection of the lesion was carried out. Subtotal resection of the lesion was achieved with a small piece left in situ.

Outcomes:

No symptom or lesion-related recurrence was found during 28 months of follow-up.

Lessons:

Calcified ECM-CNs are unique cavernous malformations arising from CNs. Piecemeal resection and subtotal or near-total excision are 2 major aspects that differ from the surgical strategy for general ECM-CNs.
Magnetic resonance imaging and contrast-enhanced ultrasound findings of a recurrent primary breast angiosarcoma
Authors: Yang Ou Ou , Lan Tian , He Jun Ling , Xu Hai Bin , Hao Liang , Shu Chang , Hu Zu Jian , Luo Hua
Published: February 2021

Rationale:

Primary breast angiosarcoma (PBA) is a rare and overly aggressive entity and account for less than 1% of all breast cancer cases. PBA had a high rate of delayed preoperative diagnosis due to absent distinctive radiographic characteristics.

Patient concerns:

We report a case of a 47-year-old female patient who had a previous history of luminal cancer in the right breast with mastectomy; the patient complained of asymmetrically diffuse enlarged, accompanying with a painless mass in the left breast 12 years after the mastectomy of her right breast.

Diagnoses:

The tumor mimicked idiopathic granulomatous mastitis on magnetic resonance imaging (MRI) at the first presentation. Contrast-enhanced ultrasound (CEUS) was performed for further lesion characterization and showed heterogeneous rapid hyper enhanced. An ultrasound-guided core needle biopsy was performed, and the pathology report indicated a breast angiosarcoma.

Interventions:

The patient underwent a nipple-sparing simple mastectomy with immediate reconstruction of the left breast.

Outcomes:

After 8 months later, the tumor recurred, CEUS and MRI examination suggested PBA recurrence, then re-excision with implant removal was performed, the patient had a lung metastasis 4 months later eventually died 22 months after diagnosis.

Lessons:

It is not easy to diagnose PBA with the radiographic examination. This case's importance is by combining CEUS and MRI to reflect enhanced morphology and hemodynamic characteristics of PBA and help diagnose breast angiosarcomas.
Implementing a Mentorship Program for New Nurses During a Pandemic
Authors: Krofft Karen , Stuart Wilma
Published: February 2021

This article describes the implementation of an evidence-based mentoring program for new registered nurses (RNs) hired into medical-surgical units in a small community-based hospital during the unfolding of the SARS-Cov2 (COVID-19) pandemic. The hospital's nursing leadership supported the program implementation during the COVID-19 pandemic to provide a broader support system to new RNs to improve nurse retention. During a response to the pandemic, the medical-surgical units faced numerous process changes in a short time, which further reinforced the urgency of an additional support system for the newly hired RNs.
Field Hospital Boston Hope
Authors: Ives Erickson Jeanette , Allard Michael , Blanchfield Bonnie , Hammond John A. , Meyer Gregg S. , Boland Giles W. , Vanderwagen Craig
Published: February 2021

As hospitals across the world realized their surge capacity would not be enough to care for patients with coronavirus disease-2019 (COVID-19) infection, an urgent need to open field hospitals prevailed. In this article the authors describe the implementation process of opening a Boston field hospital including the development of a culture unique to this crisis and the local community needs. Through first-person accounts, readers will learn (1) about Boston Hope, (2) how leaders managed and collaborated, (3) how the close proximity of the care environment impacted decision-making and management style, and (4) the characteristics of leaders under pressure as observed by the team.
Effectiveness of non-pharmaceutical interventions to contain COVID-19: a case study of the 2020 spring pandemic wave in New York City
Authors: Yang Wan , Shaff Jaimie , Shaman Jeffrey
Published: February 2021

As COVID-19 continues to pose significant public health threats, quantifying the effectiveness of different public health interventions is crucial to inform intervention strategies. Using detailed epidemiological and mobility data available for New York City and comprehensive modelling accounting for under-detection, we reconstruct the COVID-19 transmission dynamics therein during the 2020 spring pandemic wave and estimate the effectiveness of two major non-pharmaceutical interventions—lockdown-like measures that reduce contact rates and universal masking. Lockdown-like measures were associated with greater than 50% transmission reduction for all age groups. Universal masking was associated with an approximately 7% transmission reduction overall and up to 20% reduction for 65+ year olds during the first month of implementation. This result suggests that face covering can substantially reduce transmission when lockdown-like measures are lifted but by itself may be insufficient to control SARS-CoV-2 transmission. Overall, findings support the need to implement multiple interventions simultaneously to effectively mitigate COVID-19 spread before the majority of population can be protected through mass-vaccination.
Efferocytosis of SARS-CoV-2-infected dying cells impairs macrophage anti-inflammatory functions and clearance of apoptotic cells
Authors: Salina Ana C. G. , dos-Santos Douglas , Rodrigues Tamara S. , Fortes-Rocha Marlon , Freitas-Filho Edismauro G. , Alzamora-Terrel Daniel L. , Castro Ícaro M. S. , Fraga da Silva Thais F. C. , de Lima Mikhael H. F. , Nascimento Daniele C. , Silva Camila M. , Toller-Kawahisa Juliana E. , Becerra Amanda , Oliveira Samuel , Caetité Diego B. , Almeida Leticia , Ishimoto Adriene Y. , Lima Thais M. , Martins Ronaldo B. , Veras Flavio , do Amaral Natália B. , Giannini Marcela C. , Bonjorno Letícia P. , Lopes Maria I. F. , Benatti Maira N. , Batah Sabrina S. , Santana Rodrigo C. , Vilar Fernando C. , Martins Maria A. , Assad Rodrigo L. , de Almeida Sergio C. L. , de Oliveira Fabiola R. , Neto Eurico Arruda , Cunha Thiago M. , Alves-Filho José C. , Bonato Vânia L. D. , Cunha Fernando Q. , Fabro Alexandre T. , Nakaya Helder I. , Zamboni Dario S. , Louzada-Junior Paulo , Oliveira Rene D. R. , Cunha Larissa D.
Published: February 2021

COVID-19 is a disease of dysfunctional immune responses, but the mechanisms triggering immunopathogenesis are not established. The functional plasticity of macrophages allows this cell type to promote pathogen elimination and inflammation or suppress inflammation and promote tissue remodeling and injury repair. During an infection, the clearance of dead and dying cells, a process named efferocytosis, can modulate the interplay between these contrasting functions. Here, we show that engulfment of SARS-CoV2-infected apoptotic cells exacerbates inflammatory cytokine production, inhibits the expression of efferocytic receptors, and impairs continual efferocytosis by macrophages. We also provide evidence supporting that lung monocytes and macrophages from severe COVID-19 patients have compromised efferocytic capacity. Our findings reveal that dysfunctional efferocytosis of SARS-CoV-2-infected cell corpses suppress macrophage anti-inflammation and efficient tissue repair programs and provide mechanistic insights for the excessive production of pro-inflammatory cytokines and accumulation of tissue damage associated with COVID-19 immunopathogenesis.
Single-Particle Counting Based on Digital Plasmonic Nanobubble Detection for Rapid and Ultrasensitive Diagnostics
Authors: Liu Yaning , Ye Haihang , Huynh HoangDinh , Kang Peiyuan , Xie Chen , Kahn Jeffrey S. , Qin Zhenpeng
Published: February 2021

Rapid and sensitive diagnostics of infectious diseases is an urgent and unmet need as evidenced by the COVID-19 pandemic. Here we report a novel strategy, based on DIgitAl plasMONic nanobubble Detection (DIAMOND), to address these gaps. Plasmonic nanobubbles are transient vapor bubbles generated by laser heating of plasmonic nanoparticles and allow single-particle detection. Using gold nanoparticles labels and an optofluidic setup, we demonstrate that DIAMOND achieves a compartment-free digital counting and works on homogeneous assays without separation and amplification steps. When applied to the respiratory syncytial virus diagnostics, DIAMOND is 150 times more sensitive than commercial lateral flow assays and completes measurements within 2 minutes. Our method opens new possibilities to develop single-particle digital detection methods and facilitate rapid and ultrasensitive diagnostics.

One Sentence Summary

Single-particle digital plasmonic nanobubble detection allows rapid and ultrasensitive detection of viruses in a one-step homogeneous assay.
Absence of Glutathione S-Transferase Theta 1 Gene is Significantly Associated with Breast Cancer Susceptibility in Pakistani Population and Poor Overall Survival in Breast Cancer Patients: A Case-Control and Case Series Analysis
Authors: Ajaz Sadia , Zaidi Sani-e-Zehra , Ali Saleema Mehboob , Siddiqa Aisha , Memon Muhammad Ali , Firasat Sadaf , Abid Aiysha , Khaliq Shagufta
Published: February 2021

Purpose

Deletion of Glutathione S-Transferase Theta 1 (GSTT1) encoding gene is implicated in breast cancer susceptibility, clinical outcomes, and survival. Contradictory results have been reported in different studies. The present investigation evaluated GSTT1-absent genotype for its’ contribution to breast cancer risk in Pakistani population and specific clinical outcomes in breast tumours.

Methods

A prospective study comprising case-control analysis and case series analysis components was designed. Peripheral blood samples were collected from enrolled participants. After DNA extraction, GSTT1 genotyping was carried out by a multiplex PCR with β-globin as an amplification control. Association evaluation of GSTT1 genotypes with breast cancer risk, specific tumour characteristics, and survival was the primary endpoint.

Results

A total of 264 participants were enrolled in the molecular investigation (3 institutions). The study included 121 primary breast cancer patients as cases and 143 age-matched female subject, with no history of any cancer, as controls. A significant genetic association between GSTT1-absent genotype and breast cancer susceptibility (p-value: 0.003; OR: 2.13; 95% CI: 1.08-4.29) is reported. The case-series analysis showed lack of association of GSTT1 genotypes with tumour stage (p-value: 0.12), grade (p-value: 0.32), and size (p-value: 0.07). The survival analysis revealed that GSTT1-absent genotype cases had a statistically significant shorter overall survival (OS) than those with GSTT1-present genotype cases (mean OS: 23 months vs 33 months). The HR (95% CI) for OS in patients carrying GSTT1-absent genotype was 8.13 (2.91-22.96) when compared with GSTT1-present genotype.

Conclusions

The present study is the first report of an independent, population-oriented significant genetic association between GSTT1-absent genotype and breast cancer susceptibility as well as OS in breast cancer cases. Upon further validation, GSTT1 variation may serve as a marker for devising better and population-specific strategies for screening and treatment in breast cancer management.
Optical genome mapping as a next-generation cytogenomic tool for detection of structural and copy number variations for prenatal genomic analyses
Authors: Sahajpal Nikhil Shri , Barseghyan Hayk , Kolhe Ravindra , Hastie Alex , Chaubey Alka
Published: February 2021

Global medical associations (ACOG, ISUOG, ACMG) recommend diagnostic prenatal testing for the detection and prevention of genetic disorders. Historically, cytogenetic methods such as karyotype analysis, fluorescent in situ hybridization (FISH), and chromosomal microarray (CMA) are utilized worldwide to diagnose common syndromes. However, the limitations of each of these methods, either performed in tandem or simultaneously, demonstrates the need of a revolutionary technology that can alleviate the need of multiple technologies. Optical genome mapping (OGM) is a novel technology that fills this void by being able to detect all classes of structural variations (SVs), including copy number variations (CNVs). OGM is being adopted by laboratories as a next-generation cytogenomic tool for both postnatal constitutional genetic disorders and hematological malignancies. This commentary highlights the potential of OGM to become a standard of care in prenatal genetic testing by its ability to identify large balanced and unbalanced SVs (currently the strength of karyotyping and metaphase FISH), CNVs (by CMA), repeat contraction disorders (by Southern blotting) and multiple repeat expansion disorders (by PCR based methods or Southern blotting). Also, next-generation sequencing (NGS) methods are excellent at detecting sequence variants but are unable to accurately detect the repeat regions of the genome which limits the ability to detect all classes of SVs. Notably, multiple molecular methods are used to identify repeat expansion and contraction disorders in routine clinical laboratories around the world. With non-invasive prenatal screening test (NIPT) as the standard of care screening assay for all global pregnancies, we anticipate OGM as a high-resolution cytogenomic diagnostic tool employed following a positive NIPT screen or for high-risk pregnancies with an abnormal ultrasound. Accurate detection of all types of genetic disorders by OGM, such as liveborn aneuploidies, sex chromosome anomalies, microdeletion/microduplication syndromes, repeat expansion/contraction disorders is key to reducing the global burden of genetic disorders.
Machine learning algorithm to predict delirium from emergency department data
Authors: Lee Sangil , Mueller Brianna , Street W. Nick , Carnahan Ryan M.
Published: February 2021

Introduction

Delirium is a cerebral dysfunction seen commonly in the acute care setting. Delirium is associated with increased mortality and morbidity and is frequently missed in the emergency department (ED) by clinical gestalt alone. Identifying those at risk of delirium may help prioritize screening and interventions.

Objective

Our objective was to identify clinically valuable predictive models for prevalent delirium within the first 24 hours of hospitalization based on the available data by assessing the performance of logistic regression and a variety of machine learning models.

Methods

This was a retrospective cohort study to develop and validate a predictive risk model to detect delirium using patient data obtained around an ED encounter. Data from electronic health records for patients hospitalized from the ED between January 1, 2014, and December 31, 2019, were extracted. Eligible patients were aged 65 or older, admitted to an inpatient unit from the emergency department, and had at least one DOSS assessment or CAM-ICU recorded while hospitalized. The outcome measure of this study was delirium within one day of hospitalization determined by a positive DOSS or CAM assessment. We developed the model with and without the Barthel index for activity of daily living, since this was measured after hospital admission.

Results

The area under the ROC curves for delirium ranged from .69 to .77 without the Barthel index. Random forest and gradient-boosted machine showed the highest AUC of .77. At the 90% sensitivity threshold, gradient-boosted machine, random forest, and logistic regression achieved a specificity of 35%. After the Barthel index was included, random forest, gradient-boosted machine, and logistic regression models demonstrated the best predictive ability with respective AUCs of .85 to .86.

Conclusion

This study demonstrated the use of machine learning algorithms to identify the combination of variables that are predictive of delirium within 24 hours of hospitalization from the ED.
Microbiota long-term dynamics and prediction of acute graft-versus-host-disease in pediatric allogeneic stem cell transplantation
Authors: Ingham Anna Cäcilia , Kielsen Katrine , Mordhorst Hanne , Ifversen Marianne , Aarestrup Frank M. , Müller Klaus Gottlob , Pamp Sünje Johanna
Published: February 2021

Background

Patients undergoing allogeneic hematopoietic stem cell transplantation (HSCT) exhibit changes in their gut microbiota and are experiencing a range of complications, including acute graft-versus-host disease (aGvHD). It is unknown if, when, and under which conditions a re-establishment of microbial and immunological homeostasis occurs. It is also unclear whether microbiota long-term dynamics occur at other body sites than the gut such as the mouth or nose. Moreover, it is not known whether the patients’ microbiota prior to HSCT holds clues to whether the patient would suffer from severe complications subsequent to HSCT. Here, we performed integrated host-microbiota analyses of the gut, oral, and nasal microbiotas in 29 children undergoing allo-HSCT.

Results

The bacterial diversity decreased in the gut, nose, and mouth during the first month and reconstituted again 1-3 months after allo-HSCT. The microbial community composition traversed three phases over one year. Distinct taxa discriminated the microbiota temporally at all three body sides, includingEnterococcusspp.,Lactobacillusspp., andBlautiaspp. in the gut. Of note, certain microbial taxa appeared already changed in the patients prior to allo-HSCT as compared to healthy children. Acute GvHD occurring after allo-HSCT could be predicted from the microbiota composition at all three body sites prior to HSCT, in particular fromParabacteroides distasonis,LachnospiraceaeNK4A136 sp. andLactobacillussp. abundances in the gut. The reconstitution of CD4+ T cells, TH17 and B cells was associated with distinct taxa of the gut, oral, and nasal microbiota.

Conclusions

This study reveals for the first time bacteria in the mouth and nose that may predict aGvHD. Surveillance of the microbiota at different body sites in HSCT may be of prognostic value and could assist in guiding personalized treatment strategies. The identification of distinct bacteria that have a potential to predict post-transplant aGvHD might provide opportunities for an improved preventive clinical management, including a modulation of microbiomes. The host-microbiota associations shared between several body sites might also support an implementation of more feasible oral and nasal swab sampling-based analyses. Altogether, the findings suggest that both, host factors and the microbiota, could provide actionable information to guiding precision medicine.
A Scoping Review of Community-Based Geriatric Health Assessment and Screening Tools used in South Asia
Authors: Panigrahi Sucharita , Bhoi Trilochan , Pati Sanghamitra , Kshatri Jaya Singh
Published: February 2021

Background

Home-based comprehensive assessment and integrated care of the older people could be a key to relieve the pressure on the already overburdened health system. This review summarises evidence on validated community-based geriatric health assessment tools in South Asia.

Methods

Guided by Arksey and O’Malley’s five-stage scoping review framework, a total of 46 studies were included in the scoping review after searching from electronic databases and reference lists using predefined eligibility criteria. Data were extracted on main characteristics of included studies, identified instruments and their psychometric properties of the tools. This review was reported in accordance with PRISMA-ScR guidelines.

Results

Among the 46 included studies, 10 reported on instruments for medical assessment, 12 on tools for psychological conditions, 13 on tools for functional issues, 2 on social wellbeing, and 9 on tools with multiple domains of health. Most studies included participants from both gender and different social classes. Majority used measurements that were both self-reported or measured by the investigator. whereas only two instruments were designed to be used by clinicians. In the existing geriatric health assessment tools, environmental domain was neglected completely, and not a single tool considered in this review covered all 5 domains which influence regular life of elderly.

Conclusion

There are no validated tools available that can be used for comprehensive geriatric assessment in South Asia. There is a need to develop and validate culturally sensitive tools that can be used for assessing all the geriatric health domains.
Learning Decision Thresholds for Risk-Stratification Models from Aggregate Clinician Behavior
Authors: Patel Birju S. , Steinberg Ethan , Pfohl Stephen R. , Shah Nigam H.
Published: February 2021

Using a risk-stratification model to guide clinical practice often requires the choice of a cutoff - called the decision threshold - on the model’s output to trigger a subsequent action such as an electronic alert. Choosing this cutoff is not always straightforward. We propose a flexible approach that leverages the collective information in treatment decisions made in real life to learn reference decision thresholds from physician practice. Using the example of prescribing a statin for primary prevention of cardiovascular disease based on 10-year risk calculated by the 2013 Pooled Cohort Equations, we demonstrate the feasibility of using real world data to learn the implicit decision threshold that reflects existing physician behavior. Learning a decision threshold in this manner allows for evaluation of a proposed operating point against the threshold reflective of the community standard of care. Furthermore, this approach can be used to monitor and audit model-guided clinical decision-making following model deployment.
Aetiologies of chronic cough diagnosed using a pathophysiologic diagnostic procedure and their treatment outcomes
Authors: Hara Johsuke , Fujimura Masaki , Yasui Masahide , Takeda Reiko , Ohkura Noriyuki
Published: February 2021

Background

We previously elucidated the fundamental pathophysiological features of various aetiologies of chronic cough, such as cough variant asthma, atopic cough, and sinobronchial syndrome. We also established a pathophysiological diagnostic procedure for aetiology identification. In this study, we aimed to disclose the aetiologies of chronic cough using the pathophysiological diagnostic procedure and to determine the outcomes of treatment administered on the basis of aetiology.

Patients and Methods

We retrospectively reviewed the medical records of patients with chronic cough who visited our cough specialty clinic from September 2013 to August 2018 and analyzed the pathophysiological diagnostic procedure-based aetiologies and corresponding treatments. The pathophysiological diagnostic procedure included the capsaicin cough test, methacholine cough test, bronchial reversibility test, bronchial responsiveness test, chest and sinus CT, and sputum examinations.

Results

Initially, 303 patients were selected, and 300 patients underwent the diagnostic procedure. Aetiologies of chronic cough were diagnosed in 297 patients (99.0%). In the other three patients (1.0%), all results of the diagnostic procedure were within normal limits; their aetiologies were evaluated using the therapeutic diagnostic procedure. Tweleve patients discontinued follow-up before completing treatment. Of the 291 remaining patients, cough resolved completely in 283 patients. The median time required for the complete resolution of cough was 5.0 weeks (95% CI 4.3∼5.7 weeks).

Conclusions

The pathophysiological diagnostic procedure can lead to rapid and objective diagnosis of causes of chronic cough, which leads to superior treatment results compared to therapeutic diagnostic procedure.

Trial registration number

UMIN ID: UMIN000018679

Key Messages

Our pathophysiological diagnostic procedure can lead to rapid and objective diagnosis of the aetiology of chronic cough, leading to superior treatment results compared to those of therapeutic diagnostic procedures.
Informing patients that they are at high risk for serious complications of viral infection increases vaccination rates
Authors: Shermohammed Maheen , Goren Amir , Lanyado Alon , Yesharim Rachel , Wolk Donna M. , Doyle Joseph , Meyer Michelle N. , Chabris Christopher F.
Published: February 2021

For many vaccine-preventable diseases like influenza, vaccination rates are lower than optimal to achieve community protection. Those at high risk for infection and serious complications are especially advised to be vaccinated to protect themselves. Using influenza as a model, we studied one method of increasing vaccine uptake: informing high-risk patients, identified by a machine learning model, about their risk status. Patients (N=39,717) were evenly randomized to (1) a control condition (exposure only to standard direct mail or patient portal vaccine promotion efforts) or to be told via direct mail, patient portal, and/or SMS that they were (2) at high risk for influenza and its complications if not vaccinated; (3) at high risk according to a review of their medical records; or (4) at high risk according to a computer algorithm analysis of their medical records. Patients in the three treatment conditions were 5.7% more likely to get vaccinated during the 112 days post-intervention (p < .001), and did so 1.4 days earlier (p < .001), on average, than those in the control group. There were no significant differences among risk messages, suggesting that patients are neither especially averse to nor uniquely appreciative of learning their records had been reviewed or that computer algorithms were involved. Similar approaches should be considered for COVID-19 vaccination campaigns.
Assessment of presentation patterns of repetitive behaviors in Autism: a cross-sectional video-recording study. Preliminary report
Authors: Grossi Enzo , Caminada Elisa , Vescovo Beatrice , Castrignano Tristana , Piscitelli Daniele , Valagussa Giulio , Vanzulli Franco
Published: February 2021

Twenty expert caregivers wearing a body cam recorded 1868 videoclips in 67 autistic subjects along a 3 months close follow-up. A team consisting of a senior child neuro-psychiatrist and a senior psychologist selected 780 of them as expressing repetitive behaviors (RB) and made an empirical classification according to components, complexity, body parts and sensory channels involved, with the aim to understand better the pattern complexity and correlate with autism severity. The RB spectrum for each subject ranged from 1 to 33 different patterns (average= 11.6; S.D.= 6.82). Forty subjects expressed prevalent simple pattern and 27 prevalent complex patterns. No significant differences are found between the two groups according to ADOS score severity. This study represents a first attempt to systematically document expression patterns of RB with a data driven approach. This may provide a better understanding of the pathophysiology, diagnosis, and treatment of RB.
Endothelium-protective, histone-neutralizing properties of the polyanionic agent defibrotide
Authors: Shi Hui , Gandhi Alex A. , Smith Stephanie A. , Wang Qiuyu , Chiang Diane , Yalavarthi Srilakshmi , Ali Ramadan A. , Liu Chao , Sule Gautam , Tsou Pei-Suen , Zuo Yu , Kanthi Yogendra , Farkash Evan A. , Lin Jiandie D. , Morrissey James H. , Knight Jason S.
Published: February 2021

Neutrophil-mediated activation and injury of the endothelium play a role in the pathogenesis of diverse disease states ranging from autoimmunity to cancer to COVID-19. Neutralization of cationic proteins (such as neutrophil extracellular trap/NET-derived histones) with polyanionic compounds has been suggested as a potential strategy for protecting the endothelium from such insults. Here, we report that the FDA-approved polyanionic agent defibrotide (a pleiotropic mixture of oligonucleotides) directly engages histones and thereby blocks their pathological effects on endothelium. In vitro, defibrotide counteracted endothelial cell activation and pyroptosis-mediated cell death, whether triggered by purified NETs or recombinant histone H4. In vivo, defibrotide stabilized the endothelium and protected against histone-accelerated inferior vena cava thrombosis in mice. Mechanistically, defibrotide demonstrated direct and tight binding to histone H4 as detected by both electrophoretic mobility shift assay and surface plasmon resonance. Taken together, these data provide insights into the potential role of polyanionic compounds in protecting the endothelium from thromboinflammation with potential implications for myriad NET- and histone-accelerated disease states.
An Autoantigen Profile of Human A549 Lung Cells Reveals Viral and Host Etiologic Molecular Attributes of Autoimmunity in COVID-19
Authors: Wang Julia Y. , Zhang Wei , Roehrl Michael W. , Roehrl Victor B. , Roehrl Michael H.
Published: February 2021

We aim to establish a comprehensive COVID-19 autoantigen atlas in order to understand autoimmune diseases caused by SARS-CoV-2 infection. Based on the unique affinity between dermatan sulfate and autoantigens, we identified 348 proteins from human lung A549 cells, of which 198 are known targets of autoantibodies. Comparison with current COVID data identified 291 proteins that are altered at protein or transcript level in SARS-CoV-2 infection, with 191 being known autoantigens. These known and putative autoantigens are significantly associated with viral replication and trafficking processes, including gene expression, ribonucleoprotein biogenesis, mRNA metabolism, translation, vesicle and vesicle-mediated transport, and apoptosis. They are also associated with cytoskeleton, platelet degranulation, IL-12 signaling, and smooth muscle contraction. Host proteins that interact with and that are perturbed by viral proteins are a major source of autoantigens. Orf3 induces the largest number of protein alterations, Orf9 affects the mitochondrial ribosome, and they and E, M, N, and Nsp proteins affect protein localization to membrane, immune responses, and apoptosis. Phosphorylation and ubiquitination alterations by viral infection define major molecular changes in autoantigen origination. This study provides a large list of autoantigens as well as new targets for future investigation, e.g., UBA1, UCHL1, USP7, CDK11A, PRKDC, PLD3, PSAT1, RAB1A, SLC2A1, platelet activating factor acetylhydrolase, and mitochondrial ribosomal proteins. This study illustrates how viral infection can modify host cellular proteins extensively, yield diverse autoantigens, and trigger a myriad of autoimmune sequelae.
Occupational exposures and mitigation strategies among homeless shelter workers at risk of COVID-19
Authors: Rao Carol Y. , Robinson Tashina , Huster Karin , Laws Rebecca , Keating Ryan , Tobolowsky Farrell , McMichael Temet , Gonzalez Elysia , Mosites Emily
Published: February 2021

Objective

To describe the work environment and COVID-19 mitigation measures for homeless shelter workers and assess occupational risk factors for COVID-19 infection

Methods

Between June 9-August 10, 2020, we conducted a self-administered survey among homeless shelter workers in Washington, Massachusetts, Utah, Maryland, and Georgia. We calculated frequencies for work environment, personal protective equipment use, and SARS-CoV-2 testing history. We used generalized linear models to produce unadjusted prevalence ratios (PR) to assess risk factors for SARS-CoV-2 infection.

Results

Of the 106 respondents, 43.4% reported frequent close contact with clients; 75% were worried about work-related SARS-CoV-2 infections; 15% reported testing positive. Close contact with clients was associated with testing positive for SARS-CoV-2 (PR 3.97, 95%CI 1.06, 14.93).

Conclusions

Homeless shelter workers may be at higher risk of being infected with SARS-CoV-2 during the course of their work. Protecting these critical essential workers by implementing mitigation measures and prioritizing for COVID-19 vaccination, is imperative during the pandemic.
Analyzing Socioeconomic Factors and Health Disparity of COVID-19 Spatiotemporal Spread Patterns at Neighborhood Levels in San Diego County
Authors: Tsou Ming-Hsiang , Xu Jian , Lin Chii-Dean , Daniels Morgan , Embury Jessica , Ko Eunjeong , Gibbons Joseph
Published: February 2021

This study analyzed spatiotemporal spread patterns of COVID-19 confirmed cases at the zip code level in the County of San Diego and compared them to neighborhood social and economic factors. We used correlation analysis, regression models, and geographic weighted regression to identify important factors and spatial patterns. We broke down the temporal confirmed case patterns into four stages from 1 April 2020 to 31 December 2020. The COVID-19 outbreak hotspots in San Diego County are South Bay, El Cajon, Escondido, and rural areas. The spatial patterns among different stages may represent fundamental health disparity issues in neighborhoods. We also identified important variables with strong positive or negative correlations in these categories: ethnic groups, languages, economics, and education. The highest association variables were Pop5andOlderSpanish (Spanish-speaking) in Stage 4 (0.79) and Pop25OlderLess9grade (Less than 9thgrade education) in Stage 4 (0.79). We also observed a clear pattern that regions with more well-educated people have negative associations with COVID-19. Additionally, our OLS regression models suggested that more affluent populations have a negative relationship with COVID-19 cases. Therefore, the COVID-19 outbreak is not only a medical disease but a social inequality and health disparity problem.
Near real-time determination of B.1.1.7 in proportion to total SARS-CoV-2 viral load in wastewater using an allele-specific primer extension PCR strategy
Authors: Graber Tyson E. , Mercier Élisabeth , Bhatnagar Kamya , Fuzzen Meghan , D’Aoust Patrick M. , Hoang Huy-Dung , Tian Xin , Towhid Syeda Tasneem , Diaz Julio Plaza , Alain Tommy , Butler Ainslie , Goodridge Lawrence , Servos Mark , Delatolla Robert
Published: February 2021

The coronavirus disease 2019 (COVID-19) pandemic caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has claimed millions of lives to date. Antigenic drift has resulted in viral variants with putatively greater transmissibility, virulence, or both. Early and near real-time detection of these variants of concern (VOC) and the ability to accurately follow their incidence and prevalence in communities is wanting. Wastewater-based epidemiology (WBE), which uses nucleic acid amplification tests to detect viral fragments, is a faithful proxy of COVID-19 incidence and prevalence, and thus offers the potential to monitor VOC viral load in a given population. Here, we describe and validate a primer extension PCR strategy targeting a signature mutation in the N gene of SARS-CoV-2. This allows quantification of the proportional expression of B.1.1.7 versus non-B.1.1.7 alleles in wastewater without the need to employ quantitative RT-PCR standard curves. We show that the wastewater B.1.1.7 profile correlates with its clinical counterpart and benefits from a near real-time and facile data collection and reporting pipeline. This assay can be quickly implemented within a current SARS-CoV-2 WBE framework with minimal cost; allowing early and contemporaneous estimates of B.1.1.7 community transmission prior to, or in lieu of, clinical screening and identification. Our study demonstrates that this strategy can provide public health units with an additional and much needed tool to rapidly triangulate VOC incidence/prevalence with high sensitivity and lineage specificity.