bluuebunny/crossref_metadata_2025 huggingface dataset:
Anatomic and Radiographic Safe Zone for Posterior Malleolar Screw Placement
Authors: Williams Caroline , Momenzadeh Kaveh , Michalski Max , Kwon John Y. , Nazarian Ara , Miller Christopher P.
Published: July 2021

Background:

The most appropriate treatment and management of posterior malleolar fractures (PMFs) lacks consensus. Indirect reduction and fixation with posterior to anterior (PA) screw shows promise by avoiding the risks associated with direct reduction or indirect anterior to posterior approaches. Some authors have raised concerns about potential risk to nearby structures with the PA technique, including hardware prominence into the syndesmosis. This study highlights use of the posteromedial vertical syndesmotic line (PVSL) as a fluoroscopic landmark, helping surgeons avoid intrasyndesmotic placement. Study aims are to evaluate PVSL correspondence with posterior border of the incisura tibialis and to define a safe zone between this line and flexor hallucis longus tendon.

Methods:

Indirect PA screw placement was completed on 10 cadaveric specimens, followed by fluoroscopy in mortise and lateral views. Dissection was performed to assess screw placement relative to the posteromedial border of the syndesmosis. The posterior border of the syndesmosis was marked with a radiopaque wire. Repeat imaging was completed to validate the fluoroscopic PVSL is representative of the posteromedial border of the tibial incisura.

Results:

On dissection, 9 out of 10 cadavers had accurate screw placement with no penetration into the syndesmosis. Corresponding imaging showed the screw head to be medial to the marker on mortise view. For the specimen with penetration into the syndesmosis, imaging confirmed that the screw head was lateral to the marker on mortise views. The radiopaque marker correlated with the PVSL for all specimens when comparing anatomic to radiographic findings. A radiographic safe zone is defined for the PA screw 12 mm medial to the PVSL to ensure no iatrogenic injury to the flexor hallucis longus tendon.

Conclusion:

This study demonstrated that a posterior incisura tibialis fluoroscopic landmark is unambiguous in localizing the posterior syndesmotic border and that screws medial to this line are safely out of the syndesmosis, while screws placed lateral are either in or at risk of intrasyndesmotic placement. A safe zone is defined for screw placement.

Clinical Relevance:

This article describes a radiographic and clinical safe zone for fixation and hardware placement during open reduction internal fixation (ORIF) of PMFs. This information will assist surgeons in avoiding intrasyndesmotic hardware placement as well as injury to deep soft tissue structures.
Immune-related myocarditis in two patients receiving camrelizumab therapy and document analysis
Authors: Zhang Chuan , Qin Shu , Zuo Zhong
Published: July 2021

Introduction

Camrelizumab is an antibody against programmed death protein 1 (PD-1) and is one of immune checkpoint inhibitors (ICI). ICI may lead to autoimmune myocarditis, which has a variety of clinical manifestations and usually has a poor prognosis. This article will discuss these clinical manifestations through 2 cases of ICI-related myocarditis caused by carrelizumab.

Case report

We reviewed the patients who received tumor treatment in our hospital from September 2019 to June 2020. A total of 155 patients received camrelizumab treatment. there were 2 cases of acute myocarditis, accounting for 1.29%, and 8 cases of new-onset arrhythmia. Here we present 2 cases of active myocarditis in a 69-year-old man with primary liver cancer and a 75-year-old man with non-small-cell lung cancer after treatment with camrelizumab. Management and outcome: The first patient presented with severe heart failure and died of malignant arrhythmia after being treated with glucocorticoid. The second patient presented with numbness of the extremities, weakness, and mild dyspnea. The symptoms gradually improved after treatment with glucocorticoid. The Naranjo scores of these two cases were 6 and 7, which suggested that myocarditis was probably caused by carrelizumab.

Discussion

ICI has been successfully used to treat a variety of malignant tumors with good results. However, blocking immune checkpoints by ICI may lead to autoimmune myocarditis with a poor prognosis. Early detection of cardiotoxicity may be possible through the patient's clinical manifestations and some commonly used cardiac examination methods.
Eye care professionals’ patient care and personal protective equipment adapts during the second wave of SARS-CoV-2: Survey in Israel
Authors: Erdinest Nir , London Naomi
Published: July 2021

The coronavirus disease (COVID-19) began spreading in December 2019 and rapidly evolved to a global pandemic. Initially information was nonexistent and eye care professionals (ECPs) were anxious as the close proximity involved in patient care put them at high risk. Recognizing this stress and the probable effect on behavior initiated this survey. The survey presented here was conducted in three stages. The expectation was a change in behavior during the second wave when modes of transmission and methods of protection clarified. Yet nearly a third of ECPs still refrained from examining patients. This continuing trend can have severe health and economic ramifications.
Hypertension and hypertension severity in Hispanics/Latinx with MS
Authors: Robers Michael V , Chan Chan , Vajdi Borna , Chiong-Rivero Horacio , Martinez Andrea , Burnett Margaret E , Ramanathan Murali , Amezcua Lilyana
Published: July 2021

Background:

Vascular comorbidities (VCs) including hypertension (HTN) are associated with worse multiple sclerosis (MS) outcomes. HTN is common in Latinx, but the prevalence and relationship with disability are unknown in Latinx with MS.

Methods:

Latinx ( n = 451) from the Alliance for Research in Hispanic MS (ARHMS) seen between 2007 and 2019 were included. HTN, diabetes (DM), hyperlipidemia (HLD), ischemic events, and smoking were considered VC. Blood pressures (BPs) were classified using the American Heart Association (AHA) criteria. Logistic regression determined associations between VC and ambulatory disability accounting for age, sex, and disease duration.

Results:

Medical comorbidities were found in 41.9% and VC in 24.2%. Smoking (13.6%) and HTN (7.3%) were the most common. HTN was the most common over the age of 40 (12.6%). The odds of having severe disability were three times higher for those with HTN (odds ratio [OR], 3.12; 95% confidence interval (CI), 1.37–7.12). Stage II HTN according to AHA also tripled the odds (OR, 2.89; 95%CI, 1.11–7.55). AHA BP confirmed HTN in 27.5% (compared to 7.3% with established diagnosis).

Conclusion:

HTN diagnosis and stage II HTN defined by AHA were independently associated with severe ambulatory disability in Latinx with MS. HTN was underdiagnosed. Future studies should assess whether HTN treatment control would prevent disability in MS.
‘It Is a Tradition in the Nuclear Industry . . . Secrecy’: Political Opportunity Structures and Nuclear Knowledge Production in France
Authors: Schweitzer Julie , Mix Tamara L
Published: July 2021

Employing the example of France’s civil nuclear program, we connect political opportunity structures (POSs) to mechanisms of knowledge production, identifying how opposing stakeholders generate knowledge about a controversial technology. A history of nuclear dependence in France creates a context that praises, normalizes, and rationalizes nuclear energy while stigmatizing attempts to question or contest the nuclear industry’s dominant position. Integrating Bond’s knowledge-shaping process with Coy and colleagues’ concept of oppositional knowledge, we consider how the broader social, political, and economic context influences opposing stakeholder assessments of nuclear energy. Employing qualitative semi-structured interviews, we offer unique insight into the French nuclear debate, discussing the role of POS in shaping knowledge production.
Loving idols: K-pop and the limits of neoliberal solidarity in Cuba
Authors: Humphreys Laura-Zoë
Published: July 2021

In the 2010s, new forms of hand-to-hand digital media piracy displaced state control over media distribution in Cuba and facilitated the influx of global media, including K-Pop, just as Cuban socialism came under renewed pressure through economic reform. In this context, this article contends, Cuban youth turned to K-pop to reimagine the self, sociality, and Cuba’s place in the world. Drawing on ethnographic fieldwork, this article shows how K-pop appealed to fans by fostering fantasies of becoming enterprising individuals through neoliberal solidarity. These aspirations were reinforced by the industry’s pursuit of immediation, that is, its use of digital media to produce intimate and immediate connections that denied the mediations on which they depended. Ultimately, this article demonstrates how desires for and anxieties about immediacy motivate K-pop fandom and its geo-political imaginaries and how a global capitalist culture industry can appeal to fans by offering relief from the neoliberal capitalism it reproduces.
Meeting of minds: Narratives as a tool to reduce prejudice toward stigmatized group members
Authors: Kim Nuri , Lim Cuimin
Published: July 2021

This study investigates a mechanism of mediated intergroup contact effects that occurs through experiencing social presence of a stigmatized outgroup character. Conceiving narrative texts as a context for mediated intergroup contact, we experimentally test ( N = 505) the effects of narrative perspective (first vs. third person) and the photograph of the outgroup protagonist (present vs. absent) on perceived social presence of the outgroup character. We further test whether experiencing the outgroup protagonist as socially present affects intergroup outcomes (i.e., perspective-taking, intergroup anxiety, outgroup knowledge, and outgroup attitudes). Findings indicate that first-person narratives are more effective than third-person narratives in inducing social presence of the stigmatized outgroup character; photos, unexpectedly, did not have such an effect. Social presence, in turn, plays a key role in facilitating positive intergroup outcomes from reading online narrative texts. The implications of our findings are discussed.
Carbon fiber reinforced polymer strengthened reinforced concrete square columns under pre-existing eccentric loads
Authors: Kian Nima , Farzam Masood , Rezaie Oshtolagh Mohammad
Published: July 2021

Numerous experimental studies have been conducted on the behavior of strengthened columns, mostly with glued layers of FRP before load application, and rarely under the pre-existing load. Results confirm a good efficiency of strengthening in the compression-controlled region of the columns, as mentioned in design codes and guides such as ACI 440.2R-17. However, their behavior in the tension-controlled region is still a challenging subject. Moreover, when the eccentricity is large enough, the efficiency of the strengthening method needs more attention. This study aimed at strengthening six RC columns in the tension-controlled region under the pre-existing load condition. Furthermore, tested specimens were verified using a nonlinear finite element analysis performed in ATENA software. Moreover, some identical strengthened specimens, which were not subjected to pre-existing load during strengthening, were modeled to capture the effect of pre-existing loads. The results of the analyses were in good agreement with experimental data. Comparison of numerical results obtained for columns strengthened without pre-existing load, and under pre-existing load showed that pre-existing loading significantly reduced the efficiency of FRP jacketing. Also, assuming a linear variation of confinement pressure in the tension-controlled region of the interaction diagram results in good agreement with attained results.
Guy next door and implausibly attractive young women: The visual frames of social media propaganda
Authors: Bastos Marco , Mercea Dan , Goveia Fábio
Published: July 2021

This study combines data analysis with multilevel processing of visual communication to classify the visual frames of state-sponsored social media propaganda. We relied on Twitter’s Election Integrity data to sample five propaganda targets of the Internet Research Agency, including Russian and American partisan groups, and explored how their operations deviated from canonical state propaganda marked by symbols of national identity and heroic masculinity. The results show that the visual frames employed by the Internet Research Agency are designed to embody the vox populi with relatable, familiar, or attractive faces of ordinary people. The results also indicate that Internet Research Agency influence operations displayed cultural acuity and familiarity with the social identity of their targets, and that the visual narrative the agency crafted trafficked primarily in the tropes of regular guys or attractive young women. We discuss these findings and argue that state-sponsored propaganda has attuned to subcultural and visual affordances of social platforms.
Social workers’ perceptions of their peers’ unprofessional behavior
Authors: Gricus Michelle , Wysiekierski Lili
Published: July 2021

This article explores social workers’ perceptions of their colleagues’ professional mistakes, and the influences of those opinions. Vignettes in a factorial survey helped to determine whether certain variables related to the social worker or the situation influenced the perception of others’ professional errors and ethical violations. The changed variables included personal characteristics of the offending social worker such as perceived race, gender, and sexual orientation of the social worker, and characteristics of the situation, such as the length of time involved in unprofessional behavior.

Findings

Licensed social workers in six U.S. states ( n = 5596) read vignettes based on real cases brought before licensing boards ( n = 22,127) and assigned levels of seriousness and importance to discipline. The vignettes rated most highly involved perceived harm to a client or other vulnerable individual. Those on the lower end of seriousness and importance to discipline were those violations against the profession of social work. Analysis of changed variables indicated respondents’ ratings were influenced by several situational factors, but not by personal characteristics of the social worker involved in the vignette.

Applications

Our findings provide some insight into the decision-making factors important to social workers. The results may be helpful to licensing boards considering the contextual factors of unprofessional behavior and whether to discipline certain actions.
Launching support groups for informal caregivers of people living with dementia within participatory action research
Authors: Varik Merle , Medar Marju , Saks Kai
Published: July 2021

Support groups are one possibility to empower informal carers and accordingly have spread across many countries because of their informal, inexpensive nature and because of their effectiveness. This paper aims to reflect on the viewpoints and experiences of the lessons learned from the participatory action research (PAR) conducted from 2016 to 2019. During PAR, several support groups in different regions of Estonia were launched to empower the informal caregivers. In the study, the stakeholders and researchers participated as partners and developed new knowledge and 17 support groups were launched in different regions of Estonia.

In conclusion, our experiences highlighted the stakeholders’ collaboration which resulted in creating the knowledge needed to launch support groups. Based on our experience, we recommend launching support groups in countries where they do not exist yet, and to apply participatory action research.
Cervical Spine Navigation and Enabled Robotics: A New Frontier in Minimally Invasive Surgery
Authors: Lebl Darren R. , Avrumova Fedan , Abjornson Celeste , Cammisa Frank P.
Published: July 2021

Background: Robotic-assisted and computer-assisted navigation (CAN) systems utilization has been rapidly increasing in recent years. Most existing data using these systems are performed in the thoracic, lumbar, and sacral spine. The unique anatomy of the cervical spine maybe where these technologies have the greatest potential. To date, the role of navigation-enabled robotics in the cervical spine remains in its early stages of development and study. Purpose: This review article describes the early experience, case descriptions and technical considerations with cervical spine screw fixation and decompression using CAN and robotic-assisted surgery. Methods: Representative cervical cases with early surgical experience with cervical and robotic assisted surgery with CAN. Surgical set up, technique considerations, instrumentation, screw accuracy and screw placement were elevated and recorded for each representative cervical case. Results: Existing robotic assisted spine surgical systems are reviewed as they pertain to the cervical spine. Method for cervical reference and positioning on radiolucent Mayfield tongs are presented. C1 lateral mass, odontoid fracture fixation, C2 pedicle, translaminar, subaxial lateral mass, mid cervical pedicle, navigated decompression and ACDF cases and techniques are presented. Conclusion: In conclusion, within the last several years, the use of CANs in spinal surgery has grown and the cervical spine shows the greatest potential. Several robotic systems have had FDA clearance for use in the spine, but such use requires simultaneous intraoperative fluoroscopic confirmation. In the coming years, this recommendation will likely be dropped as accuracy improves.
Diabetes Technology Meeting 2020
Authors: Shang Trisha , Zhang Jennifer Y. , Bequette B. Wayne , Raymond Jennifer K. , Coté Gerard , Sherr Jennifer L. , Castle Jessica , Pickup John , Pavlovic Yarmela , Espinoza Juan , Messer Laurel H. , Heise Tim , Mendez Carlos E. , Kim Sarah , Ginsberg Barry H. , Masharani Umesh , Galindo Rodolfo J. , Klonoff David C.
Published: July 2021

Diabetes Technology Society hosted its annual Diabetes Technology Meeting on November 12 to November 14, 2020. This meeting brought together speakers to cover various perspectives about the field of diabetes technology. The meeting topics included artificial intelligence, digital health, telemedicine, glucose monitoring, regulatory trends, metrics for expressing glycemia, pharmaceuticals, automated insulin delivery systems, novel insulins, metrics for diabetes monitoring, and discriminatory aspects of diabetes technology. A live demonstration was presented.
Enhancing family nursing practice in schools: School nurses’ perspectives on illness beliefs and family nursing practice skills when caring for children with attention-deficit hyperactivity disorder or asthma – A cross-sectional study
Authors: Svavarsdottir Erla Kolbrun , Tryggvadottir Gudny Bergthora , Gisladottir Margret , Erlendsdottir Ragnheidur Osk
Published: July 2021

An increasing number of children attend schools with chronic illnesses/disorders that require managing and comprehensive healthcare from school nurses during the day. Collaboration between school nurses, the school-aged child with attention-deficit hyperactivity disorder (ADHD) or asthma, and their families is needed when coordinating/managing chronic health problems in the school setting. However, involving families in the assessment and care planning processes can be challenging. The aim of this study was to survey the illness beliefs of school nurses and their perceptions of their family nursing practice skills when offering healthcare services to children with ADHD or asthma in schools. A cross-sectional study was used for a sample of 82 school nurses. The manuscript was prepared following STROBE guidelines. Results indicated that the school nurses perceived themselves to be more confident and to have better knowledge and skill in family nursing practice when offering healthcare services to families of children with ADHD in comparison to asthma.
Transition Discoveries: Participatory Action Research to Design Pathways to Success
Authors: Kester Joan , Flanagan Matthew F. , Stella Julie
Published: July 2021

A multiyear critical participatory action research study was conducted with a total of 503 youth and young adults with disabilities (ages 14–25), family members, and transition stakeholders across the U.S. commonwealth of Pennsylvania. Youth and young adults with disabilities, families, and stakeholders served as participant researchers who collaborated in operationalizing post-school outcomes and the high-quality transition practices, resources, services, and supports that contribute to achieving them. As a result of this study, the Transition Discoveries Quality Indicator Framework was developed. We provide examples of how the content of this framework can be used to design experiences for youth and families to learn about transition planning, programs, and services. Guidelines for ecologically relevant research and implications for practice in secondary transition are provided.
To Wear or Not to Wear: A Commentary on Mistrust in Public Comments to CDC Tweets about Mask-Wearing during COVID19
Authors: Batova Tatiana
Published: July 2021

Trust is an important component of crisis communication, and social media has been shown a promising avenue for building trust. Yet, mixed findings about how effectively government organizations utilize social media during health crises such as pandemics or infectious disease outbreaks require further research to better understand how trust is created and destroyed. This study investigates the factors that reflect mistrust in the public comments to the CDC tweets about mask-wearing during the 3 months after the first reported case of COVID19 in the U.S. The findings show that multiple factors representing mistrust were present in the public comments. What is more, the feeling of anger was growing in the comments as the health crisis progressed, which also could have been trust-damaging.
SOX11, CD70, and Treg cells configure the tumor immune microenvironment of aggressive mantle cell lymphoma
Authors: Balsas Patricia , Veloza Luis , Clot Guillem , Sureda-Gómez Marta , Rodríguez Marta-Leonor , Masaoutis Christos , Frigola Gerard , Navarro Alba , Beà Silvia , Nadeu Ferran , Giné Eva , López-Guillermo Armando , Martínez Antonio , Ribera-Cortada Inmaculada , Engel Pablo , Quintanilla-Martínez Leticia , Klapper Wolfram , Campo Elias , Amador Virginia
Published: July 2021

Mantle cell lymphoma (MCL) is a mature B-cell neoplasm with a heterogeneous clinical and biological behavior. SOX11 oncogenic expression contributes to the aggressiveness of these tumors by different mechanisms, including tumor and stromal cell interactions. However, the precise composition of the immune cell microenvironment of MCL, its possible relationship to SOX11 expression, and how it may contribute to tumor behavior is not well known. Here, we performed an integrative transcriptome analysis of 730 immune-related genes combined with the immune cell phenotype analysis by immunohistochemistry in SOX11+ and SOX11− primary nodal MCL cases and non-neoplastic reactive lymph nodes. SOX11+ MCL had a significant lower T-cell intratumoral infiltration compared with negative cases. A reduced expression of MHCI/II-like and T-cell costimulation and signaling activation related transcripts was significantly associated with poor clinical outcome. Moreover, we identified CD70 as a SOX11 direct target gene, whose overexpression was induced in SOX11+, but not SOX11− tumor cells by CD40L in vitro. CD70 was overexpressed in primary SOX11+ MCL and it was associated with an immune unbalance of the tumor microenvironment characterized by increased number of effector regulatory T (Treg) cell infiltration, higher proliferation, and aggressive clinical course. CD27 was expressed with moderate to strong intensity in 76% of cases. Overall, our results suggest that SOX11 expression in MCL is associated with an immunosuppressive microenvironment characterized by CD70 overexpression in tumor cells, increased Treg cell infiltration and downmodulation of antigen processing, and presentation and T-cell activation that could promote MCL progression and represent a potential target for tailored therapies.
Incidence and prognosis of clonal hematopoiesis in patients with chronic idiopathic neutropenia
Authors: Tsaknakis Grigorios , Gallì Anna , Papadakis Stavros , Kanellou Peggy , Elena Chiara , Todisco Gabriele , Bono Elisa , Rizzo Ettore , Molteni Elisabetta , Fragiadaki Irene , Mavroudi Irene , Pontikoglou Charalampos , Batas Anastasios , Maxouri Stella , Linardaki Emmanouela , Tavernarakis Nektarios , Malcovati Luca , Papadaki Helen A.
Published: July 2021

The incidence and prognosis of clonal hematopoiesis in patients with isolated neutropenia among patients with idiopathic cytopenia of undetermined significance (ICUS), known as ICUS-N or chronic idiopathic neutropenia (CIN) patients, is poorly defined. The current study sought to investigate the frequency and clinical significance of mutations of genes implicated in myeloid malignancies using next-generation sequencing in patients with CIN (n = 185) with a long follow-up. We found that 21 (11.35%) of 185 patients carried a total of 25 somatic mutations in 6 genes with a median variant allele frequency of 12.75%. The most frequently mutated genes were DNMT3A and TET2 involving >80% of patients, followed by IDH1/2, SRSF2, and ZRSR2. The frequency of transformation to a myeloid malignancy was low in the total group of patients (5 of 185 patients [2.70%]). However, from the transformed patients, 4 belonged to the clonal group (4 of 21 [19.05%]) and 1 to the nonclonal group (1 of 164 [0.61%]), indicating that the presence of mutation(s) confers a relative risk for transformation of 31.24 (P = .0017). The variant allele frequency of the mutant clones in the transformed patients was >10% in all cases, and the genes most frequently associated with malignant transformation were SRSF2 and IDH1. No significant differences were identified between the clonal and nonclonal groups in the severity of neutropenia. Patients with clonal disease were older compared with nonclonal patients. These data contribute to the better understanding of the heterogeneous entities underlying ICUS and highlight the importance of mutation analysis for the diagnosis and prognosis of patients with unexplained neutropenias.
Functional characterization of 105 factor H variants associated with aHUS: lessons for variant classification
Authors: Martín Merinero Hector , Zhang Yuzhou , Arjona Emilia , del Angel Guillermo , Goodfellow Renee , Gomez-Rubio Elena , Ji Rui-Ru , Michelena Malkoa , Smith Richard J. H. , Rodríguez de Córdoba Santiago
Published: July 2021

Atypical hemolytic uremic syndrome (aHUS) is a life-threatening thrombotic microangiopathy that can progress, when untreated, to end-stage renal disease. Most frequently, aHUS is caused by complement dysregulation due to pathogenic variants in genes that encode complement components and regulators. Among these genes, the factor H (FH) gene, CFH, presents with the highest frequency (15% to 20%) of variants and is associated with the poorest prognosis. Correct classification of CFH variants as pathogenic or benign is essential to clinical care but remains challenging owing to the dearth of functional studies. As a result, significant numbers of variants are reported as variants of uncertain significance. To address this knowledge gap, we expressed and functionally characterized 105 aHUS-associated FH variants. All FH variants were categorized as pathogenic or benign and, for each, we fully documented the nature of the pathogenicity. Twenty-six previously characterized FH variants were used as controls to validate and confirm the robustness of the functional assays used. Of the remaining 79 uncharacterized variants, only 29 (36.7%) alter FH expression or function in vitro and, therefore, are proposed to be pathogenic. We show that rarity in control databases is not informative for variant classification, and we identify important limitations in applying prediction algorithms to FH variants. Based on structural and functional data, we suggest ways to circumvent these difficulties and, thereby, improve variant classification. Our work highlights the need for functional assays to interpret FH variants accurately if clinical care of patients with aHUS is to be individualized and optimized.
Impaired humoral responses to COVID-19 vaccination in patients with lymphoma receiving B-cell–directed therapies
Authors: Ghione Paola , Gu Juan J. , Attwood Kristopher , Torka Pallawi , Goel Shipra , Sundaram Suchitra , Mavis Cory , Johnson Michael , Thomas Roshneke , McWhite Kenneth , Darrall Andrea , DeMarco Joseph , Kostrewa Jessica , Mohr Alice , Rivas Leah , Neiders Mirdza , Suresh Lakshmanan , Segal Brahm H. , Griffiths Elizabeth A. , Ramsperger Vince , Shen Long , Hernandez-Ilizaliturri Francisco J.
Published: July 2021

Following a similar report on multiple myeloma, Ghione and colleagues report the expected observation that patients with non-Hodgkin lymphoma (NHL) receiving anti-B cell therapies have markedly reduced antibody responses to COVID-19 immunization. Although there is no information regarding T-cell immunity, this suggests that while vaccination is certainly still recommended for this population, patients should be strongly encouraged to maintain social distancing precautions and should be revaccinated after an appropriate interval from the end of their antilymphoma therapy.
Single-cell ATAC-seq reveals GATA2-dependent priming defect in myeloid and a maturation bottleneck in lymphoid lineages
Authors: Avagyan Serine , Weber Margaret C. , Ma Sai , Prasad Meera , Mannherz William P. , Yang Song , Buenrostro Jason D. , Zon Leonard I.
Published: July 2021

Germline heterozygous mutations in GATA2 are associated with a syndrome characterized by cytopenias, atypical infections, and increased risk of hematologic malignancies. Here, we generated a zebrafish mutant of gata2b that recapitulated the myelomonocytopenia and B-cell lymphopenia of GATA2 deficiency syndrome. Using single-cell assay for transposase accessible chromatin with sequencing of marrow cells, we showed that loss of gata2b led to contrasting alterations in chromosome accessibility in early myeloid and lymphoid progenitors, associated with defects in gene expression. Within the myeloid lineage in gata2b mutant zebrafish, we identified an attenuated myeloid differentiation with reduced transcriptional priming and skewing away from the monocytic program. In contrast, in early lymphoid progenitors, gata2b loss led to accumulation of B-lymphoid transcription factor accessibility coupled with increased expression of the B-cell lineage-specification program. However, gata2b mutant zebrafish had incomplete B-cell lymphopoiesis with loss of lineage-specific transcription factor accessibility in differentiating B cells, in the context of aberrantly reduced oxidative metabolic pathways. Our results establish that transcriptional events in early progenitors driven by Gata2 are required to complete normal differentiation.
Polatuzumab vedotin as a salvage and bridging treatment in relapsed or refractory large B-cell lymphomas
Authors: Liebers Nora , Duell Johannes , Fitzgerald Donnacha , Kerkhoff Andrea , Noerenberg Daniel , Kaebisch Eva , Acker Fabian , Fuhrmann Stephan , Leng Corinna , Welslau Manfred , Chemnitz Jens , Middeke Jan-Moritz , Weber Thomas , Holtick Udo , Trappe Ralf , Pfannes Roald , Liersch Ruediger , Spoer Christian , Fuxius Stefan , Gebauer Niklas , Caillé Léandra , Geer Thomas , Koenecke Christian , Keller Ulrich , Claus Rainer , Mougiakakos Dimitrios , Mayer Stephanie , Huettmann Andreas , Pott Christiane , Trummer Arne , Wulf Gerald , Brunnberg Uta , Bullinger Lars , Hess Georg , Mueller-Tidow Carsten , Glass Bertram , Lenz Georg , Dreger Peter , Dietrich Sascha
Published: July 2021

The antibody-drug conjugate polatuzumab vedotin (pola) has recently been approved in combination with bendamustine and rituximab (pola-BR) for patients with refractory or relapsed (r/r) large B-cell lymphoma (LBCL). To investigate the efficacy of pola-BR in a real-world setting, we retrospectively analyzed 105 patients with LBCL who were treated in 26 German centers under the national compassionate use program. Fifty-four patients received pola as a salvage treatment and 51 patients were treated with pola with the intention to bridge to chimeric antigen receptor (CAR) T-cell therapy (n = 41) or allogeneic hematopoietic cell transplantation (n = 10). Notably, patients in the salvage and bridging cohort had received a median of 3 prior treatment lines. In the salvage cohort, the best overall response rate was 48.1%. The 6-month progression-free survival and overall survival (OS) was 27.7% and 49.6%, respectively. In the bridging cohort, 51.2% of patients could be successfully bridged with pola to the intended CAR T-cell therapy. The combination of pola bridging and successful CAR T-cell therapy resulted in a 6-month OS of 77.9% calculated from pola initiation. Pola vedotin-rituximab without a chemotherapy backbone demonstrated encouraging overall response rates up to 40%, highlighting both an appropriate alternative for patients unsuitable for chemotherapy and a new treatment option for bridging before leukapheresis in patients intended for CAR T-cell therapy. Furthermore, 7 of 12 patients with previous failure of CAR T-cell therapy responded to a pola-containing regimen. These findings suggest that pola may serve as effective salvage and bridging treatment of r/r LBCL patients.
A retrospective cohort study of idiopathic diaphragmatic palsy: a diagnostic triad, natural history and prognosis
Authors: Nafisa Syeda , Messer Ben , Downie Beatrice , Ehilawa Patience , Kinnear William , Algendy Sherif , Sovani Milind
Published: July 2021

Background

Isolated diaphragmatic palsy in the absence of progressive neuromuscular disease is uncommon. It poses diagnostic challenges and limited data are available regarding prognosis. We present retrospective cohort data from two large teaching hospitals in the United Kingdom.

Method

60 patients who were assessed either as inpatients or outpatients were included in this study. Patients with progressive neuromuscular disease were excluded. Clinical presentation, tests of respiratory muscle function (sitting/supine vital capacity, maximal expiratory pressure (MEP), maximal inspiratory pressure (MIP) and sniff nasal inspiratory pressure (SNIP)) and outcomes were recorded.

Results

For patients with diaphragmatic palsy, mean±sdseated and supine vital capacity pre-noninvasive ventilation (NIV) were reduced at 1.7±1.2 L and 1.1±0.9 L, respectively, with a mean±sdpostural fall in vital capacity of 42±0.16%. The mean MEP/MIP and MEP/SNIP ratios for diaphragmatic palsy were 3 and 3.5, respectively. After a year of treatment with NIV, mean±sdupright and supine vital capacity had increased to 2.1±0.9 L and 1.8±1 L, respectively, and the mean±sdfall in vital capacity from sitting to supine reduced to 29±0.17%. MEP/MIP and MEP/SNIP ratios reduced to 2.6 and 2.9, respectively, from the pre-NIV values. The values of postural fall in vital capacity correlated (p<0.05) with MEP/MIP and MEP/SNIP ratio (r2=0.86 and r2=0.7, respectively).

Conclusion

Tests of respiratory muscle strength are valuable in the diagnostic workup of patients with unexplained dyspnoea. A triad of 1) orthopnoea, with 2) normal lung imaging and 3) MEP/MIP and/or MEP/SNIP ratio ≥2.7 points towards isolated diaphragmatic palsy. This needs to be confirmed by prospective studies.
Identification of novel genomic regions associated with nine mineral elements in Chinese winter wheat grain
Authors: Wang Wei , Guo Hong , Wu Chongning , Yu Hui , Li Xiaokang , Chen Guangfeng , Tian Jichun , Deng Zhiying
Published: July 2021

Background

Mineral elements are important for maintaining good human health besides heavy metals. Mining genes that control mineral elements are paramount for improving their accumulation in the wheat grain. Although previous studies have reported some loci for beneficial trace elements, they have mainly focused on Zn and Fe content. However, little information is available regarding the genetic loci differences in dissecting synchronous accumulation of multiple mineral elements in wheat grains, including beneficial and heavy elements. Therefore, a genome-wide association study (GWAS) was conducted on 205 wheat accessions with 24,355 single nucleotide polymorphisms (SNPs) to identify important loci and candidate genes for controlling Ca, Fe, Zn, Se, Cu, Mn, Cd, As, and Pb accumulation in wheat grains.

Results

A total of 101 marker-trait associations (MTAs) (P < 10–5) loci affecting the content of nine mineral elements was identified on chromosomes 1B, 1D, 2A, 2B, 3A, 3B, 3D, 4A, 4B, 5A, 5B, 5D, 6B, 7A, 7B, and 7D. Among these, 17 major MTAs loci for the nine mineral elements were located, and four MTAs loci (P < 10–5) were found on chromosomes 1B, 6B, 7B, and 7D. Eight multi-effect MTAs loci were detected that are responsible for the control of more than one trait, mainly distributed on chromosomes 3B, 7B, and 5A. Furthermore, sixteen candidate genes controlling Ca, Fe, Zn, Se, Cd, and Pb were predicted, whose functions were primarily related to ion binding, including metals, Fe, Ca, Cu, Mg, and Zn, ATP binding, ATPase activity, DNA binding, RNA binding, and protein kinase activity.

Conclusions

Our study indicated the existence of gene interactions among mineral elements based on multi-effect MTAs loci and candidate genes. Meanwhile this study provided new insights into the genetic control of mineral element concentrations, and the important loci and genes identified may contribute to the rapid development of beneficial mineral elements and a reduced content of harmful heavy metals in wheat grain.
Hyperimmune plasma in three immuno-deficient patients affected by non-severe, prolonged COVID-19: a single-center experience
Authors: Cusi Maria Grazia , Conticini Edoardo , Gandolfo Claudia , Anichini Gabriele , Savellini Gianni Gori , Valente Serafina , Franchi Federico , Scolletta Sabino , Percivalle Elena , Frediani Bruno
Published: July 2021

Background

Convalescent plasma (CP) and hyperimmune plasma (HP) are passive immunotherapies consisting in the infusion of plasma from recovered people into infected patients. Following pre-existing evidence in many other viral diseases, such as SARS, MERS and Ebola, CP and HP have also been proposed for the treatment of COVID-19. Nevertheless, due to the lack of large, well-designed, clinical trials, no clear-cut guidelines exist about what subtype of patient CP and HP should be administered to.

Case presentation

We have reported the cases of 3 patients, all immunosuppressed and affected by non-severe, prolonged COVID-19. They were treated with HP, whose neutralizing titer was higher than 1/80. The first patient was a 55-year-old male, who had undergone lung transplant. He was under therapy with Tacrolimus and developed non-neutralizing antibodies against SARS-CoV2. The second patient was a 77-year-old female, affected by follicular lymphoma. She had tested positive for SARS-CoV2 after 6 months. The third was a 60-year-old patient, affected by chronic leukemia. He did not develop antibodies after 2-month disease. All 3 patients received HP and had tested negative for SARS-CoV2 within 2 weeks.

Conclusion

Despite encouraging initial data, no strong evidence exist in support of CP and HP to treat COVID-19. In our experience, although limited due to the reduced number of patients, we found a good safety and efficacy of HP in 3 immuno-deficient subjects. Further data are needed in order to assess whether this subtype of patients may particularly benefit from passive immunization.
Implementation and effectiveness of an intensive education program on phosphate control among hemodialysis patients: a non-randomized, single-arm, single-center trial
Authors: Yin Jinmei , Yin Jun , Lian Rongli , Li Peiqiu , Zheng Jing
Published: July 2021

Background

Hyperphosphatemia is a common complication in patients on maintenance hemodialysis. Patients’ adherence to phosphorus control can be improved by consistent education. However, few studies have focused on the model construction and effects of health education on phosphate control for hemodialysis patients.

Objective

To develop an intensive education program focusing on phosphate control among hemodialysis patients and to analyze the effectiveness of this program.

Design

A non-randomized, single-arm, single-center trial lasting for 6 months.

Setting

This program was conducted in a hemodialysis center in a teaching hospital in Zhuhai, China.

Participants

Patients on maintenance hemodialysis with hyperphosphatemia.

Methods

An intensive hyperphosphatemia control education program lasting for 6 months was conducted among 366 hemodialysis patients applying the First Principles of Instruction model, which focused on mastering four stages: (a) activation of prior experience, (b) demonstration of skills, (c) application of skills and (d) integration of these skills into real-world activities. The controlled percentage of serum phosphorus, knowledge of hyperphosphatemia, and adherence to phosphate binders before and after the education program were assessed.

Results

The proportion of controlled serum phosphorus was significantly increased from 43.5 to 54.9% (P<0.001). The scores on the knowledge of phosphate control were improved significantly from 59.0 ± 18.9 to 80.6 ± 12.4 (P < 0.001). The proportion of high adherence to phosphate binders was increased dramatically from 21.9 to 44.5% (P < 0.001).

Conclusion

The intensive education program can effectively improve serum phosphorus, knowledge of hyperphosphatemia, and adherence to phosphate binders among hemodialysis patients.

Trial registration

Chinese Clinical Trial Registry,ChiCTR2100042017. Retrospectively registered January 12th, 2021.
The perception of Italian pregnant women and new mothers about their psychological wellbeing, lifestyle, delivery, and neonatal management experience during the COVID-19 pandemic lockdown: a web-based survey
Authors: Stampini Viviana , Monzani Alice , Caristia Silvia , Ferrante Gianluigi , Gerbino Martina , De Pedrini Alberto , Amadori Roberta , Rabbone Ivana , Surico Daniela
Published: July 2021

Background

In response to the COVID-19 pandemic, drastic measures for social distancing have been introduced also in Italy, likely with a substantial impact in delicate conditions like pregnancy and puerperium. The study aimed to investigate the changes in lifestyle, access to health services, and mental wellbeing during the first Italian lockdown in a sample of Italian pregnant women and new mothers.

Methods

We carried out a web-based survey to evaluate how pregnant women and new mothers were coping with the lockdown. We collected data about healthy habits (physical exercise and dietary habits), access to health services (care access, delivery and obstetric care, neonatal care, and breastfeeding), and mental wellbeing (psychological well-being and emotive support). Descriptive analysis was performed for both groups of participants, whereas a Poisson analysis was used to measure the association between some structural variables (age, education, socio-economic data, partner support, contact, free time, previous children, and pregnancy trimester) and anxiety or depression, difficulties in healthy eating and reduction in physical activity after lockdown started. Chi2 and Adjusted Prevalence Ratios were estimated only for pregnant women.

Results

We included 739 respondents (response rate 85.8 %), 600 were pregnant (81.2 %), and 139 (18.8 %) had delivered during lockdown (new mothers). We found a high score for anxiety and depression in 62.8 % of pregnant women and 61.9 % of new mothers. During the lockdown, 61.8 % of pregnant women reduced their physical exercise, and 44.3 % reported eating in a healthier way. 94.0 % of new mothers reported to have breastfed their babies during the hospital stay. Regarding the perceived impact of restrictive measures on breastfeeding, no impact was reported by 56.1 % of new mothers, whereas a negative one by 36.7 %.

Conclusions

The high prevalence of anxiety and depressive symptoms in pregnant women and new mothers should be a public health issue. Clinicians might also recommend and encourage “home” physical exercise. On the other hand, about half of the sample improved their approach towards healthy eating and a very high breastfeeding rate was reported soon after birth: these data are an interesting starting point to develop new strategies for public health.
Selling cannabidiol products in Canada: A framing analysis of advertising claims by online retailers
Authors: Zenone Marco Antonio , Snyder Jeremy , Crooks Valorie
Published: July 2021

Background

In Canada, the legalization of cannabis has enabled cannabidiol (CBD) to become a popular commercial product, increasingly used for medical or therapeutic purposes. There are currently over one thousand CBD products available globally, ranging from oil extracts to CBD-infused beverages. Despite increased usage and availability, the evidence supporting the medical efficacy of CBD is limited. Anecdotal evidence suggests CBD sellers represent their products for medical use through direct medical claims or advice, which in Canada, is not allowed under the Cannabis Act without Health Canada approval. However, it is not clear the extent of sellers making health claims or other strategies used to promote medical usage of CBD. The objective of this study is to determine how CBD sellers advertise their products online to consumers.

Methods

The product descriptions of 2165 CBD products from 70 websites selling CBD products for human consumption in Canada were collected from January 14th, 2020 to February 2nd, 2020 using an automated website scraper tool. A framing analysis was used to determine how CBD sellers frame their products to prospective customers. The specific medical conditions CBD is represented to treat and product forms were tabulated.

Results

CBD products are framed to prospective customer through three distinct frames: a specific cure or treatment (n = 1153), a natural health product (n = 872), and a product used in certain ways to achieve particular results (n = 1388). Product descriptions contained medical or therapeutic claims for 171 medical conditions and ailments, with 53.3% of products containing at least one claim. The most prevalent claims found in product descriptions were the ability to treat or manage pain (n = 824), anxiety (n = 609), and inflammation (n = 545). Claims were found for treating or managing serious and-life-threatening illnesses such as multiple sclerosis (n = 210), arthritis (n = 179), cancer (n = 169), Crohn’s disease (n = 78), Parkinson’s disease (n = 59), and human immunodeficiency virus (HIV) (n = 54). CBD most often came in oil/tincture/concentrate form (n = 755), followed by edibles (n = 428), and vaporizer pen/cartridge/liquid products (n = 290).

Conclusion

The findings suggest CBD is represented as a medical option for numerous conditions and ailments. We recommend Health Canada to conduct a systematic audit of companies selling CBD for regulatory adherence.