bluuebunny/crossref_metadata_2025 huggingface dataset:
The Stability of Influenza Vaccination Behavior Over Time: A Longitudinal Analysis of Individuals Across 8 Years
Authors: Walsh Matthew M , Parker Andrew M , Vardavas Raffaele , Nowak Sarah A , Kennedy David P , Gidengil Courtney A
Published: May 2020

Background

Seasonal influenza vaccination is an important behavior with significant individual and public health consequences, yet fewer than half of individuals in the USA are vaccinated annually. To promote vaccination adherence, it is important to understand the factors that affect vaccination behavior.

Purpose

In this research, we focused on one such factor, an individual’s vaccination history. We gathered longitudinal data to track and understand the relationship between an individual’s vaccination history and their current behaviors.

Methods

U.S. adults completed multiple surveys over an 8 year period, which asked about whether they had received the influenza vaccination during the previous flu season. We analyzed the data to determine the strength of the relationship between vaccination decisions across single-year and multiyear intervals. Additionally, we fitted two mathematical models to the data to determine whether individuals were better characterized as having a stable propensity to vaccinate or a stable propensity to repeat their previous decisions.

Results

Individuals exhibited highly consistent behavior across adjacent years, yet, across the complete extent of the longitudinal study, they were far more likely to repeat the earlier decision to vaccinate. Surprisingly, the results of the mathematical model suggest that individuals are better characterized as having a stable propensity to repeat their previous decisions rather than a stable propensity to vaccinate per se. Although most individuals had an extremely strong tendency to repeat the previous decision, some had a far weaker propensity to do so.

Conclusions

This suggests that interventions intended to increase vaccination uptake might be most impactful for those individuals with only a weak tendency to vaccinate or not to vaccinate.
Analysing non-coaxial folding effects in the Small Circle Intersection method
Authors: Calvín P , Pueyo E L , Ramón M J , Casas-Sainz A M , Villalaín J J
Published: May 2020

The Small Circle (SC) tools analyse the stereographic tracks (small circles) followed by the palaeomagnetic vectors during folding processes. Working with interfolding and synfolding remagnetizations, the Small Circle Intersection (SCI) method allows finding the best solution of grouping that should correspond with the remagnetization direction. Once this is known, it is possible to determine the magnetization age as well as the degree of bed tilting at this moment. The SC tools are based on some assumptions, among which the coaxiality between the different deformation events is the one addressed in this work (i.e. absence of vertical axis rotations, VARs, or differential horizontal axis rotations, dHARs). This assumption is based on the necessity of knowing the rotation axis for folding after the acquisition of the remagnetization, and SC tools consider the bedding strike as this axis, something that is only accomplished under coaxial folding. In order to explore how non-coaxiality affects the solutions derived from the SC methods, we first (i) identify the variables that control these errors through simple models that only consider two theoretical palaeomagnetic sites, after that it is possible (ii) to derive the mathematical relationships between them. Finally, we (iii) simulate errors derived from the use of SC tools using a population of 30 palaeomagnetic sites recreating different possible scenarios with VARs and dHARs in nature.
The Effect of Transcranial Direct Current Stimulation on Chronic Neuropathic Pain in Patients with Multiple Sclerosis: Randomized Controlled Trial
Authors: Young Jamie , Zoghi Maryam , Khan Fary , Galea Mary P
Published: May 2020

Objective

Chronic neuropathic pain is a common symptom in multiple sclerosis (MS). This randomized controlled single-blinded study investigated whether a new protocol involving five days of transcranial direct current stimulation (tDCS) with an interval period would be effective to reduce pain using the visual analog scale (VAS). Other secondary outcomes included the Neuropathic Pain Scale (NPS), Depression Anxiety Stress Score (DASS), Short Form McGill Pain Questionnaire (SFMPQ), and Multiple Sclerosis Quality of Life 54 (MSQOL54).

Design

A total of 30 participants were recruited for the study, with 15 participants randomized to a sham group or and 15 randomized to an active group. After a five-day course of a-tDCS, VAS and NPS scores were measured daily and then weekly after treatment up to four weeks after treatment. Secondary outcomes were measured pretreatment and then weekly up to four weeks.

Results

After a five-day course of a-tDCS, VAS scores were significantly reduced compared with sham tDCS and remained significantly low up to week 2 post-treatment. There were no statistically significant mean changes in MSQOL54, SFMPQ, NPS, or DASS for the sham or treatment group before treatment or at four-week follow-up.

Conclusions

This study shows that repeated stimulation with a-tDCS for five days can reduce pain intensity for a prolonged period in patients with MS who have chronic neuropathic pain.
Study of Long-Term Follow-up of Exercise Levels Following Participation in a Prehabilitation Program in Esophagogastric Cancer
Authors: Doganay Emre , Wynter-Blyth Venetia , Halliday Laura , MacKinnon Tom , Osborn Hayley , Moorthy Krishna
Published: May 2020

Background:

Sedentary behavior is emerging as an important field of scientific enquiry for cancer survivorship. The posttreatment period is associated with prolonged recovery, deterioration in quality of life, disability, poor mental health, and reduced productivity. Exercise in cancer survivors has been linked with reduced fatigue, improved functional outcomes, and improved survival.

Purpose:

To evaluate the effect of a surgical cancer prehabilitation program on the long-term physical and psychological health in a cohort of patients undergoing surgery for esophagogastric cancer.

Methods:

The PREPARE program is a multimodal cancer prehabilitation program. All patients who underwent curative esophagogastric cancer surgery and completed the PREPARE program were included in the study. Weekly activity scores, self-efficacy, exercise testing, and hand grip strength were assessed.

Results:

A total of 39 patients met the eligibility criteria. At baseline, 31% of patients were active, 13% were moderately active, and 56% were insufficiently active. At follow-up, 44% of patients were active, 13% were moderately active, and 44% were insufficiently active. There was a significant increase in leisure score index (P = .048, z = −1.981),

JOURNAL/reonc/04.03/01893697-202007000-00004/4FSM1/v/2023-08-24T151015Z/r/image-gif

o
2max, mL.kg−1.min−1 (P ≤ .01), and hand grip strength (P ≤ .01) from baseline to follow-up. There was no change in self-efficacy through baseline to follow-up.

Limitations:

Improvements in the postoperative period could be expected as part of recovery. The absence of a control group makes this difficult to establish.

Conclusion:

Starting prehabilitation at the time of diagnosis leads to sustained confidence and improved activity and exercise levels in the posttreatment period.
Multidimensional Pelvic Fluoroscopy: A New and Novel Technique for Assessing Safety and Accuracy of Percutaneous Iliosacral Screw Fixation
Authors: Shaw James , Gary Joshua , Ambrose Catherine , Routt Milton Chip
Published: May 2020

Objectives:

Multidimensional fluoroscopy is new imaging technology that generates intraoperative cross sectional imaging. Can this technology be used to assess accuracy and safety of percutaneously placed iliosacral screws intraoperatively?

Design:

Retrospective study.

Setting:

Level 1 academic trauma center.

Patients/Participants:

Fifty-two consecutive patients during a 7-month period with unstable posterior pelvic ring disruptions.

Intervention:

All patients were treated with percutaneous iliosacral and/or transsacral screw fixation by a single experienced surgeon. Traditional triplanar fluoroscopy was performed during guidepin insertion. Intraoperative multidimensional fluoroscopy was used for all patients after iliosacral screw fixation.

Main Outcome Measurements:

Intraoperative multidimensional fluoroscopy and postoperative computed tomography (CT) scans for each patient were retrospectively reviewed by the treating surgeon and another trauma surgeon. Screw position in relation to the sacral neuroforamen was assessed using multidimensional fluoroscopy and compared to postoperative CT scan. Screws were classified as extraforaminal, juxtaforaminal, or intraforaminal.

Results:

No screws were intraforaminally seen on intraoperative multidimensional fluoroscopy or postoperative CT scan. All iliosacral and transsacral screws were considered safe. Intraobserver and interobserver variability existed between reviewers when grading screws as extraforaminal versus juxtaforaminal. This was not clinically significant because both agreed that extraforaminal and juxtaforaminal screw positions are safe. Multidimensional fluoroscopy was used in 3 patients to assess guidepin placement before definitive screw fixation. Two patients underwent a change of fixation after reviewing multidimensional fluoroscopy. No postoperative neurological examination changes occurred.

Conclusions:

Multidimensional fluoroscopy is a novel imaging technology that can safely be used intraoperatively to accurately determine iliosacral and transsacral screw placement.

Levels of Evidence:

Diagnostic Level III. See Instructions for Authors for a complete description of levels of evidence.
Scleral Buckling Using Chandelier and Releasable Suture: A Useful Surgical Variant
Authors: Savastano Alfonso , Weinberg Tamir , Faraldi Francesco , Caporossi Tomaso , Rizzo Stanislao
Published: May 2020

Purpose:

To describe a surgical variant for scleral buckling technique using a chandelier and scleral releasable suture.

Methods:

We collected retrospectively 20 eyes of 20 patients who underwent to scleral buckling for retinal detachment. In all cases, the surgeons performed the surgical variant of scleral buckling using a 27-gauge (G) chandelier as endoillumination and releasable 7.0 vicryl scleral suture.

Results:

None of the operated eyes developed lens opacity or lens marks at the entrance site of the chandelier used during the surgery, and no cataract development was observed as well, during the follow-up. Retinal reattachment was achieved in 19 out of 20 eyes at the first surgery in the follow-up time of 6 months.

Conclusion:

The association of chandelier and releasable suture was a useful surgical variant when performing scleral buckling technique for retinal detachment. Complications like lens opacity or lens marks at the entrance site of the chandelier due to the use of chandelier itself can be greatly reduced, as well as complications due to vitreous prolapse from the sclerotomy by using releasable scleral suture.
Comparison of intraoperative vs postoperative optical coherence tomography measurement of implantable collamer lens vaulting
Authors: Torbey Julien , Mehanna Carl-Joe , Abdul Fattah Maamoun , Awwad Shady T.
Published: May 2020

Purpose:

To compare intraoperative vs postoperative optical coherence tomography (OCT) measurements of implantable collamer lens (ICL) vaulting.

Setting:

American University of Beirut Medical Center, Beirut, Lebanon.

Design:

Prospective observational cohort study.

Methods:

Patients with myopia or myopic astigmatism undergoing ICL insertion in which intraoperative OCT measurements were obtained were included. Exclusion criteria included coexisting ocular problems and previous ocular surgery. The outcome measures were ICL vaulting as determined by OCT intraoperatively and postoperatively at 1 day, 1 week, 1 month, and 3 months.

Results:

Forty-five eyes of 26 patients were included. Mean age was 27.23 ± 6.47 years (range 17 to 48 years), and mean manifest refraction spherical equivalent was −10.20 ± 3.92 diopters (D) (range −20.50 to −4.50 D). Mean ICL vaulting measured 731 ± 215 μm intraoperatively, 648 ± 219 μm at 1 day, 640 ± 204 μm at 1 week, 628 ± 212 μm at 1 month, and 632 ± 210 μm at 3 months postoperatively (P = .0009, with all postoperative vaulting measurements statistically similar to each other, but significantly different from the intraoperative measurement). However, intraoperative ICL vaulting had high predictability of postoperative vaulting at 3 months with r
2 = 0.81 (P < .0001), and Bland–Altman analysis demonstrates a relatively constant difference between the 2 measurements as plotted against their mean with a bias of 98.27 μm and tight 95% limits of agreement range.

Conclusions:

Intraoperative ICL vaulting measured by OCT correlated highly with postoperative OCT vaulting and can be considered a reliable tool to predict the final ICL vault.
Putting on the Same Shoes: Lived Experiences of Women Who Are Reincarcerated
Authors: Blair-Lawton Donna , Mordoch Elaine , Chernomas Wanda
Published: May 2020

Background

Women are discharged daily from correctional institutions across the world. Many of these women cycle in and out of jail and experience the “revolving door syndrome,” characterized by release, reimprisonment, and subsequent rerelease into the community. Although many factors contribute to this phenomenon, there is limited understanding of its impact on imprisoned women, including their perceptions of returning to community life.

Purpose/Objective

This phenomenological study examined the lived experiences of women who were imprisoned, released to the community, and returned to custody.

Method

Twelve women, nine of whom were Indigenous were interviewed at the Women's Correctional Centre in Manitoba. Individual, face-to-face, in-depth interviews were employed using a woman-centered conversational approach. Qualitative thematic analysis, informed by van Manen's approach, was used to inductively arrive at themes.

Findings

Themes and subthemes organized around van Manen's existentials (temporality, spatiality, relationality, and corporeality) highlight the barriers and challenges women face as they try to sustain change in their lives to avoid the revolving door. Threaded through their accounts are experiences of personal and historical trauma, painful childhoods, difficult relationships, and ineffective or absent personal and systemic supports.

Conclusion

This study highlights the need for trauma-informed comprehensive health care and programing sensitive to women's experience of trauma in their complex lives. Nurses need to partner with service providers and policy makers to address the social/economical inequities that impede the positive life changes these women need to make to prevent reimprisonment.
The effects of green cardamom supplementation on blood pressure and endothelium function in type 2 diabetic patients
Authors: Ghazi Zahedi Shohreh , Koohdani Fariba , Qorbani Mostafa , Siassi Fereydoun , Keshavarz Ali , Nasli-Esfahani Ensieh , Aghasi Mohadeseh , Khoshamal Hoorieh , Sotoudeh Gity
Published: May 2020

Introduction:

Cardamom possesses antioxidant, anti-inflammation, and blood pressure lowering properties, which might improve endothelial function in type 2 diabetic patients. However, no study has examined the effect of cardamom on diabetic patients. The present study aimed to examine the effects of 10-week green cardamom intake on blood pressure, concentrations of inflammatory and endothelial function biomarkers in type 2 diabetes mellitus patients, and its potential mechanisms.

Methods and Analysis Design:

Eighty overweight or obese patients with type 2 diabetes mellitus (aged 30–60 years) will be recruited into the trial and will assign to receive either cardamom (3 g/day, 6 capsules) or placebo (rusk powder, 6 capsules) for a period of 10 weeks. Systolic blood pressure and diastolic blood pressure, asymmetric dimethylarginine, and nitric oxide will be measured. Serum inflammatory markers namely interleukin 6, tumor necrosis factor-α, high-sensitivity C-reactive protein, and factors related to endothelial function including intercellular adhesion molecule-1, vascular cell adhesion molecule 1, CD62 antigen-like family member E, and cluster of differentiation 163 will be measured at baseline and at the end of the trial. Sociodemographic, International Physical Activity Questionnaire, and three 24-hour dietary recall questionnaires will be collected for each participant.

Ethics and dissemination:

The study has been approved by The Ethics Committee of Tehran University of Medical Sciences (IR.TUMS.REC.1395.2700). Each participant will sign a written informed consent at the beginning of the study. At the end of the study, results will be published timely manner.

Trial registration number:

(http://www.irct.ir, identifier: IRCT-2016042717254N5) Date of registration: 2016-11-23
Treatment of hypothyroidism using Korean medicine: 2 case reports
Authors: Kim Hyongjun , Moon Sun-Young , Han Kyungsun , Lee Jun-Hwan , Im Jong Hwan , Kim Sungha , Yoo Jeong-Eun
Published: May 2020

Introduction:

Hypothyroidism, the most common endocrine disease, comprises a deficiency of thyroid hormone, causing coldness, fatigue, and dysmenorrhea. Here, we report the improvement of hypothyroidism symptoms and thyroid hormone level normalization by using Korean herbal medicine and acupuncture therapy.

Patient concerns:

A 30-year-old woman (Case 1) presented at the clinic with continuous seborrheic dermatitis on the scalp, accompanied by dysmenorrhea. A 55-year-old woman (Case 2) presented with symptoms of coldness of the limbs and fatigue.

Diagnosis:

Both patients were diagnosed with “Yin deficiency and Yang hyperactivity” and hypothyroidism after serum thyroid function tests.

Interventions:

Both patients received herbal medicine decoction, acupuncture, and electroacupuncture therapy.

Outcomes:

Korean medicine improved the symptoms of hypothyroidism and significantly normalized thyroid-stimulating hormone and free-thyroxine levels.

Conclusion:

These outcomes suggest that Korean medicine may be effective for resolution of hypothyroidism; however, further research is needed to confirm these findings.
Clinical characteristics and pregnancy outcomes of atypical hemolysis, elevated liver enzymes, and low platelets syndrome
Authors: Jiang Ruoan , Wang Ting , Li Baohua , He Jing
Published: May 2020

Rationale:

Hemolysis, elevated liver enzymes, and low platelets (HELLP) syndrome is a serious and rare disease, which is secondary to preeclampsia in most cases. Hypertension is usually considered as a premonitory symptom of HELLP syndrome. In some patients with HELLP syndrome; however, they develop hypertension very late, even after liver enzymes are elevated or platelet count is decreased. This condition is known as atypical HELLP syndrome.

Patient concerns:

We screened and identified 4 cases of atypical HELLP syndrome in our hospital database from January 2007 to December 2018. All patients had a history of nonspecific symptoms for a few days before hospital admission, such as dizziness, nausea, and vomiting. They developed hypertension after abnormalities were noted in liver enzymes and platelet count.

Diagnoses:

They were diagnosed with atypical HELLP syndrome.

Interventions:

These patients received same treatments as those with HELLP syndrome. Two patients took oral antihypertensive treatment to normalize the blood pressure.

Outcomes:

In our patients, both mothers and neonates had favorable outcomes. In follow-ups, they reported no incidences of high blood pressure after recovery from atypical HELLP syndrome.

Lessons:

These cases provided additional clinical evidences of atypical HELLP syndrome. The incidence of atypical HELLP syndrome is extremely low. Hypertension is not essential for the diagnosis of HELLP syndrome, and can even appear after the onset of laboratory abnormalities. Advanced age, multiple pregnancies, hepatitis B virus infection, and obesity may be potential risk factors for atypical HELLP syndrome. Blood pressure should be monitored closely after delivery.
Transfusion rates and disease spectrum in neonates treated with blood transfusion in China
Authors: Sun Yang , Ma Ting , Wang Wen-hua , Zhang Qin , Jin Zhen-ai , Yang Jiang-Cun
Published: May 2020

This study aimed to investigate blood transfusion rates and spectrum of diseases in hospitalized neonates treated with blood transfusion in China to provide supporting data for future studies on neonatal blood transfusion.

Data on hospitalized neonates were obtained from more than 100 experts from the Department of Neonatology of 55 hospitals in China between January 1, 2012 and December 31, 2016, using a standardized survey. A statistical analysis was conducted to evaluate the data collected, including the blood transfusion rates, blood component transfused, spectrum of diseases, and spectrum of major diseases.

Between 2012 and 2016, 541,128 neonates were hospitalized in the 55 hospitals surveyed. There were 70,433 neonates who received blood transfusion, with an average transfusion rate of 13.02%. The rates of red blood cell transfusion, platelet transfusion, and plasma transfusion were 9.44%, 0.66%, and 4.77%, respectively. The neonatal blood transfusion rate was 17.99% in Northeast China, 9.74% in Northwest China, and between 10.60% and 16.22% in other regions. The neonatal blood transfusion rate was 12.3% in general hospitals and 13.8% in women and children's hospitals. The top 10 diseases identified in hospitalized neonates treated by blood transfusion were, in rank order, as follows:prematurity,pneumonia, hyperbilirubinemia, bacterial sepsis, respiratory distress syndrome, anemia, hemolytic disease, asphyxia, hemorrhage, and necrotizing enterocolitis.

The neonatal blood transfusion rate in China is 13.03%.The rank order in the disease spectrum of the hospitalized neonates and that in hospitalized neonates treated with blood transfusion are different.
Study of efficacy and safety of Jiaotai pill in the treatment of depression
Authors: Zhou Zhihuan , Fu Shufei , Liu Yijia , Wang Yuhan , Bu Huaien , Mei Yan , Tong Yi , Yu Chunquan
Published: May 2020

Background:

Depression is a common affective disorder characterized by marked and lasting melancholia, with corresponding thought and behavior changes. Due to an accelerated pace of life and increased work pressure, the incidence of depression has risen sharply, causing great harm to family and social life. Jiaotai pill (JTP) is a Chinese herbal formula that is commonly prescribed for depression and insomnia in clinical treatment, and exhibits antidepressant effects as shown in animal experimental research. However, there are no standard clinical trials to confirm its efficacy in treating depression.

Objective:

This study aims to assess the efficacy and safety of JTP in the treatment of depression, so as to tap the clinical efficacy advantages of JTP and provide data support for its clinical application.

Methods:

A randomized, multicenter clinical trial with parallel groups was designed in this study. A total of 40 patients with depression were included and randomly divided to either the treatment or the control group with a ratio of 1:1. The patients received JTP plus fluoxetine or fluoxetine alone once per day for 8 weeks. The primary outcome included the Hamilton Depression Rating Scale score for patients and brain structure and function by functional magnetic resonance imaging. The secondary outcomes included Traditional Chinese medicine syndrome integral scale scores, Wisconsin Card Sorting Test, blood metabonomics, urine metabonomics.

Conclusion:

The results of this trial will find changes in brain structure, brain function, and metabolism in patients with depression, and provide critical evidence for JTP in the treatment of depression.
Association between polymorphisms in the XRCC1 gene and male infertility risk
Authors: Liu Zhengsheng , Lin Luqi , Yao Xiongbo , Xing Jinchun
Published: May 2020

Background:

X-ray repair cross-complementing group 1 (XRCC1) single nucleotide polymorphisms (SNPs) might correlate with male infertility susceptibility. This association has been described; however, the findings remain inconsistent. Consequently, this meta-analysis was conducted to characterize the relationship between XRCC1 SNPs and male infertility susceptibility.

Methods/main results:

Studies were systematically searched in databases to evaluate the association between SNPs of XRCC1 and infertility in males. The effect measures chosen were the 95% confidence intervals (95% CIs) and odds ratios (ORs). A total of 7 studies, including 6 case-controlled studies on XRCC1 Arg399Gln and 3 case-controlled studies on XRCC1 Arg194Trp, were included. Ultimately, the results of this analysis revealed that XRCC1 Arg399Gln SNPs were significantly associated with infertility in males in homozygote comparisons (GG vs GA+AA: OR = 0.614, 95% CI: 0.40–0.937, P = .024). This meta-analysis did not demonstrate a relationship between XRCC1 Arg194Trp and male infertility risk.

Conclusions:

Our study indicated that XRCC1 Arg399Gln polymorphism was associated with a significantly decreased male infertility risk, but not XRCC1 Arg194Trp.
Efficacy assessment of acupuncture in improving symptoms of uterine fibroids
Authors: Zheng Min-Qin , Weng Cai , Hu Wei , Shen Chong-Qing , Tao Yun , Pan Zheng-Wei
Published: May 2020

Introduction:

Uterine fibroids are a common benign genital tumor disease in gynecological diseases. It is mainly a change in physical function caused by the growth of smooth muscle cells in the factor uterus. Modern medicine's treatment of this disease is based on the dependence of uterine fibroids on sex hormones. Treatment with antiprogestin and estrogen drugs can reduce the volume of fibroids or slow the rate of increase in volume, thereby achieving the goal of alleviating clinical symptoms. In order to meet the needs of the majority of women of childbearing age and to maintain fertility, acupuncture treatment of uterine fibroids has a broad prospect for development.

Methods/design:

This study plans to select 60 cases that meet the corresponding selection criteria. According to the random principle, they will be divided into intervention group and control group, with 30 cases in each group. The general information, fibroid size, and TCM syndrome scores of the two groups of patients will be compared before treatment. In terms of treatment, the intervention group will be given acupuncture combined therapy; the control group will be given Chinese patent medicine. The treatment cycles in both groups will be three menstrual cycles. After the treatment is completed, the data of the relevant curative effect indicators are analyzed by using SPSS software to draw conclusions.

Discussion:

We aim to provide higher evidence-based medical evidence for acupuncture treatment of uterine fibroids.

Trial registration:

ClinicalTrials.gov, ChiCTR2000030438, Registered on March 01, 2020.
Characteristics and outcomes among a hospitalized patient cohort with Streptococcus pneumoniae infection
Authors: Micek Scott T. , Simmons James , Hampton Nicholas , Kollef Marin H.
Published: May 2020

Infection due to Streptococcus pneumoniae (SP) requiring hospitalization is common. However, recent clinical studies describing patient characteristics and outcomes for SP infection in adults requiring hospitalization are lacking. Our goal was to evaluate patient characteristics, contemporary antibiotic resistance, and clinical outcomes among hospitalized adults with SP infections.

A retrospective cohort study was conducted at Barnes-Jewish Hospital (1350 beds) in St. Louis, Missouri, USA for years 2012 through 2016. During the study period, 358 hospitalized adults, excluding those with meningitis, were identified with SP infection. Forty-four patients (12.3%) died within 30 days of the identification of their infection. Among these infections, 99 (27.7%) were assessed to be hospital-acquired and 259 (72.3%) were community-onset infections. The majority of infections involved the respiratory tract (88.5%). Azithromycin resistance was the most common antibiotic resistance at 51.4%, followed by enteral penicillin resistance (45.3%), trimethoprim-sulfamethoxazole (34.1%), second-generation cephalosporin (cefuroxime) (30.7%), and meropenem (22.6%). There were 70 isolates (19.6%) classified as multidrug resistant. Independent predictors of hospital mortality included increasing weight in 1-kilogram increments (adjusted odds ratio [AOR], 1.02; 95% CI, 1.01 – 1.02; P = .048), increasing Charlson Comorbidity Index scores (AOR, 1.31; 95% CI, 1.21 – 1.42; P = .001), and the presence of septic shock (AOR, 3.89; 95% CI, 2.31 – 6.57; P = .009). The median [interquartile range] hospital length of stay was 8.1 days [4.5 days, 16.8 days].

Hospitalized patients with infection attributed to SP have significant 30-day mortality and use of hospital resources. Antibiotic resistance is common among isolates associated with infection. Determinants of mortality are primarily severity of illness, underlying comorbidities and increasing patient weight. Efforts to improve the treatment and prevention of SP infections are needed.
Treatment strategy of unstable atlas fracture
Authors: Guo Wei , Lin Yang , Huang Jingwen , Hu Feng , Ding Zhou , Xiao Zengming
Published: May 2020

At present, the posterior cervical approach with open reduction and internal fixation (ORIF) remains a commonly effective treatment for unstable Atlas fracture. However, the inserted screws into the C1 lateral mass of some unstable atlas fracture are very difficult, so that the operation is forced to change into C0 to C2 fusion. In order to improve the successful rate of lateral mass screw placement, we introduced a method of fixing lateral mass with a towel clamp in posterior transpedicular fixation, and explore the efficacy and feasibility.

Twenty-one consecutive patients with unstable atlas fracture were treated via this method from October 2012 to July 2017. All cases had neck pain and restricted motion of neck movement on admission. Electronic medical records and pre- and postoperative radiographs were reviewed. Screw and rod placement, bone fusion, and spinal cord integrity were assessed via long-term follow-up with anteroposterior and lateral radiographs and computed tomography. Follow-up included clinical assessment of neurological function, assessment of pain using the visual analog scale (VAS), and assessment of the activities of daily living using the neck disability index (NDI).

The mean follow-up duration was 22.1 months (range: 12–54 months). No screw loosening or breakage, plate displacement, neurovascular injury, and severe complications occurred during follow-up. The mean operative time was 112.4 ± 14.9 min (range: 82–135 min), and mean blood loss was 386.2 ± 147.9 mL (range: 210–850 mL). One patient experienced continuous neck pain postoperatively, but this gradually disappeared with analgesic administration. At final follow-up, all patients had bone fusion, the VAS scores and NDI were significantly improved compared with preoperatively.

Fixing the C1 lateral mass with a towel clamp during posterior transpedicular fixation for unstable atlas fracture appears to be a safe and reliable method, with the advantages of being a simple technique with few complications.
COVID-19 with cystic features on computed tomography
Authors: Liu Kefu , Zeng Yuanying , Xie Ping , Ye Xun , Xu Guidong , Liu Jian , Wang Hao , Qian Jinxian
Published: May 2020

Rationale:

The cystic features of the novel coronavirus disease 2019 (COVID-19) found on computed tomography (CT) have not yet been reported in the published literature. We report the cystic chest CT findings of 2 patients confirmed to have COVID-19-related pneumonia.

Patient concerns:

A 38-year-old man and a 35-year-old man diagnosed with severe COVID-19 pneumonia were admitted to the intensive care unit.

Diagnoses:

Chest CT findings showed multiple cysts in ground-glass opacities (bilaterally) with/without pneumothorax. The cysts had a smooth inner wall.

Interventions:

The patients continued to be given oxygen by mask and received antitussive, phlegm-dispelling treatment.

Outcomes:

At follow up, there was a reduction in the number of multiple cystic lesions on CT. To date, 1 patient was discharged from hospital, while the other had been transferred to the rehabilitation department.

Lessons:

COVID-19 may independently result in pulmonary cyst formation and pneumothorax; the application of a ventilator may be another causative factor.
Caregiver and Provider Experiences of Home Healthcare Quality for Children With Medical Complexity
Authors: Foster Carolyn C. , Fuentes Molly M. , Wadlington Lauren A. , Jacob-Files Elizabeth , Desai Arti D. , Simon Tamara D. , Mangione-Smith Rita
Published: May 2020

Despite a growing population of children with medical complexity, little is known about the current quality of pediatric home healthcare. The objective of this study was to characterize the quality of pediatric home healthcare experienced by primary family caregivers (parents) and healthcare providers of children with medical complexity. Semistructured, in-depth key informant interviews of 20 caregivers and 20 providers were conducted and analyzed for factors affecting home healthcare quality using the Institute of Medicine's quality framework (effective, safe, patient-centered, timely, equitable, and efficient). System complexity, insurance denials, and workforce shortages affected patients' ability to establish and maintain access to home healthcare leading to hospital discharge delays and negative family impacts. When home healthcare was accessible, respondents experienced it as effective in improving patient and family daily life and minimizing use of emergency and hospital services. However, respondents identified a need for more pediatric-specific home healthcare training and increased efficiencies in care plan communication. Overall, home healthcare was not perceived as timely or equitable due to access barriers. This study provides a new conceptual framework representing the relationship between home healthcare quality and outcomes for children with medical complexity for future evaluations of quality improvement, research, and policy initiatives.
The Impact of Deep Brain Stimulation on the Sexual Function of Patients With Parkinson’s Disease
Authors: Pedro Tiago , Sousa Mário , Rito Manuel , Pereira Ricardo , Januário Cristina , Moreira Fradique
Published: May 2020

Background:

Deep brain stimulation (DBS) of the subthalamic nucleus (STN) is used in the treatment of advanced Parkinson’s disease (PD) with well-established benefits over motor complications. However, few studies addressing the impact of DBS on nonmotor dimensions such as sexual function have been conducted. This study aims to determine the effect of DBS-STN on the sexual activity of patients with PD and to establish predictive factors for sexual function decline after surgery.

Materials and Methods:

Twenty-one patients with PD submitted to DBS-STN were compared with 19 eligible surgery candidates. Clinical measures included disease progression (Hoehn and Yahr scale), sexual function evaluation (Female Sexual Function Index and International Index of Erectile Function), severity of depressive symptoms (Beck Depressive Inventory-II), motor symptoms (Movement Disorders Society-Unified Parkinson’s Disease Rating Scale Part III), and quality of life (39-item Parkinson’s Disease Questionnaire). The primary outcomes were the development of sexual dysfunction in women and erectile dysfunction in men. Regression analysis was performed to outline risk factors for developing sexual function deterioration.

Results:

Erectile dysfunction was present in 83.3% of men and sexual dysfunction in 77.8% of women treated with DBS-STN. Women with sexual dysfunction had higher emotional well-being 39-item Parkinson’s Disease Questionnaire scores (P=0.017) and a higher prevalence of cardiovascular diseases (P=0.012) comparing with women without sexual dysfunction. Age was an independent predictive factor for developing erectile dysfunction in men (relative risk=1.26;P=0.033) and sexual dysfunction in women (relative risk =1.30;P=0.039), regardless of DBS-STN submission.

Conclusions:

Sexual function in both sexes of patients with PD does not seem to be influenced by DBS-STN itself, but by psychological and clinical features.
Critical Illness Myopathy
Authors: Z'Graggen Werner J. , Tankisi Hatice
Published: May 2020

Critical illness myopathy (CIM) is a primary myopathy associated with increased mortality and morbidity, which frequently develops in severely ill patients. Several risk factors have been suggested for the development of critical illness myopathy. However, neither the exact etiology nor the underlying mechanisms are known in detail. Although for definite diagnosis muscle biopsy is needed, electrophysiological tests are crucial for the diagnosis of probable critical illness myopathy and differential diagnosis. In this review, conventional electrophysiological tests such as nerve conduction studies, needle electromyography, direct muscle stimulation, and repetitive stimulation for diagnosis of critical illness myopathy are summarized. Moreover, studies using the novel method of recording muscle velocity recovery cycles are addressed.
Correlation between the serum procalcitonin level and the extension and severity of coronary artery disease in patients with non-ST-segment elevation myocardial infarction
Authors: Hashemipour Seyed-Vahid , Pourhosseini Hamidreza , Hosseinsabet Ali
Published: May 2020

Objectives

Research has shown correlations between some, but not all, inflammatory mediators and coronary atherosclerosis burden. Conflicting results have been reported on the correlation between the serum procalcitonin (PCT) level and the severity and extension of coronary artery disease (CAD). We evaluated the correlation between PCT and the severity and extension of CAD in patients with non-ST-elevation myocardial infarction (NSTEMI).

Patients and methods

In this prospective cross-sectional study, the serum PCT level was measured 48 h after hospital admission in 131 patients with a diagnosis of NSTEMI. All the patients underwent selective coronary angiography, and the severity and extension of their CAD was evaluated with the Gensini score. The study population was assigned to two groups on the basis of the median of the Gensini score: those with a score higher than the median and those with a score lower than the median.

Results

There was no statistically significant difference with regard to the serum PCT level between the two groups (P = 0.511). In the multivariable logistic regression analysis, after adjustment for the potential confounders, the serum PCT level was not a determinant of the Gensini score (P = 0.502).

Conclusion

The second 24-h postadmission serum PCT level was not correlated with the severity and extension of CAD according to the Gensini score in our patients with NSTEMI.
Atherosclerosis: integration of its pathogenesis as a self-perpetuating propagating inflammation: a review
Authors: Poston Robin N.
Published: May 2020

This review proposes that the development of the atherosclerotic plaque is critically dependent on its inflammatory components forming a self-perpetuating and propagating positive feedback loop. The components involved are: (1) LDL oxidation, (2) activation of the endothelium, (3) recruitment of inflammatory monocytes, (4) macrophage accumulation, which induces LDL oxidation, and (5) macrophage generation of inflammatory mediators, which also activate the endothelium. Through these stages, the positive feedback loop is formed, which generates and promotes expansion of the atherosclerotic process. To illustrate this dynamic of lesion development, the author previously produced a computer simulation, which allowed realistic modelling. This hypothesis on atherogenesis can explain the existence and characteristic focal morphology of the atherosclerotic plaque. Each of the components contributing to the feedback loop is discussed. Many of these components also contain subsidiary positive feedback loops, which could exacerbate the overall process.
Further insights into cardiovascular outcomes in diabetic and non-diabetic states: inhibition of sodium-glucose co-transports
Authors: Li Zhao
Published: May 2020

Cardiovascular diseases are the leading cause of morbidity and mortality in the world. Diabetes increase heart disease related to death by two- to four-fold. SGLT2 inhibitors are new antidiabetic agents. The growing evidence of cardiovascular benefit of SGLT2 inhibitors independent of their effects on glycemic control is especially intriguing. Several clinical trials have shown that sotagliflozin (SGLT1-1/2 inhibitor) decreases body weight and reduces blood pressure in adults with T2D. A phase 3 study designed to evaluate cardiovascular outcomes of sotagliflozin is currently ongoing. Many pre-clinical studies were conducted to investigate the potential mechanisms involved in cardiovascular benefits of SGLT1 or SGLT2 inhibition with or without diabetes. Although multiple mechanisms have been proposed, there are still not enough data to fully support the mechanisms of actions. This review aims to discuss the potential mechanisms involved in cardiovascular benefits of SGLT1 and SGLT2 inhibition in both diabetic and non-diabetic states.
Estimation of apolipoprotein A in early onset ST-segment elevation myocardial infarction
Authors: Mohammad Ameen Mosa , Hasan Yousif Ahmed , Ahmed Qasim Bayar , Aziz Joma Joma , Saeed Saad Younis
Published: May 2020

Aims

The role of apolipoprotein A in early onset ST-segment elevation myocardial infarction is not clear. This study sought to assess the apolipoprotein A in cohort of patients diagnosed with early onset acute ST-segment elevation myocardial infarction and to corelate it with major traditional cardiovascular risk factors.

Methods

A total of 50 such patients and 40 age and sex-matched healthy controls, both aged less than 50 years with their baseline demographic, clinical characteristics and cardiovascular risk factors were studied. Apolipoprotein A was estimated for all enrollees.

Results

The mean age of cases was 43.37 ± 5.85 years. The levels of apolipoprotein A among cases were not significantly lower compared to controls (P = 0.52). They were lower among the male, current smokers and the dyslipidemia (P’s < 0.05). Considering the apolipoprotein A as the dependent factor, the early onset ST-segment elevation myocardial infarction was associated significantly with the male and the dyslipidemia in linear regression (P < 0.001 and 0.030), respectively.

Conclusion

Lower levels of apolipoprotein A are significantly related to conventional risk factors in early onset ST-segment elevation myocardial infarction. This apolipoprotein A that particularly develops in young patients with clustering of traditional cardiovascular risk factors should be targeted. Further studies are warranted to determine the diagnostic and prognostic indicators of this apolipoprotein in ST-segment elevation myocardial infarction.
Development and validation of an automated radiomic CT signature for detecting COVID-19
Authors: Guiot J. , Vaidyanathan A. , Deprez L. , Zerka F. , Danthine L. , Frix A.N. , Thys M. , Henket M. , Canivet G. , Mathieu S. , Eftaxia E. , Lambin P. , Tsoutzidis N. , Miraglio B. , Walsh S. , Moutschen M. , Louis R. , Meunier P. , Vos W. , Leijenaar R.T.H. , Lovinfosse P.
Published: May 2020

Background

The coronavirus disease 2019 (COVID-19) outbreak has reached pandemic status. Drastic measures of social distancing are enforced in society and healthcare systems are being pushed to and over their limits.

Objectives

To develop a fully automatic framework to detect COVID-19 by applying AI to chest CT and evaluate validation performance.

Methods

In this retrospective multi-site study, a fully automated AI framework was developed to extract radiomics features from volumetric chest CT exams to learn the detection pattern of COVID-19 patients. We analysed the data from 181 RT-PCR confirmed COVID-19 patients as well as 1200 other non-COVID-19 control patients to build and assess the performance of the model. The datasets were collected from 2 different hospital sites of the CHU Liège, Belgium. Diagnostic performance was assessed by the area under the receiver operating characteristic curve (AUC), sensitivity and specificity.

Results

1381 patients were included in this study. The average age was 64.4±15.8 and 63.8±14.4 years with a gender balance of 56% and 52% male in the COVID-19 and control group, respectively. The final curated dataset used for model construction and validation consisted of chest CT scans of 892 patients. The model sensitivity and specificity for detecting COVID-19 in the test set (training 80% and test 20% of patients) were 78.94% and 91.09%, respectively, with an AUC of 0.9398 (95% CI: 0.875–1). The negative predictive value of the algorithm was found to be larger than 97%.

Conclusions

Benchmarked against RT-PCR confirmed cases of COVID-19, our AI framework can accurately differentiate COVID-19 from routine clinical conditions in a fully automated fashion. Thus, providing rapid accurate diagnosis in patients suspected of COVID-19 infection, facilitating the timely implementation of isolation procedures and early intervention.
The role of hippocampal-vmPFC neural dynamics in building mental representations
Authors: Monk Anna M. , Dalton Marshall A. , Barnes Gareth R. , Maguire Eleanor A.
Published: May 2020

The hippocampus and ventromedial prefrontal cortex (vmPFC) play key roles in numerous cognitive domains including mind-wandering, episodic memory and imagining the future. Perspectives differ on precisely how they support these diverse functions, but there is general agreement that it involves constructing representations comprised of numerous elements. Visual scenes have been deployed extensively in cognitive neuroscience because they are paradigmatic multi-element stimuli. However, it remains unclear whether scenes, rather than other types of multi-feature stimuli, preferentially engage hippocampus and vmPFC. Here we leveraged the high temporal resolution of magnetoencephalography to test participants as they gradually built scene imagery from three successive auditorily-presented object descriptions and an imagined 3D space. This was contrasted with constructing mental images of non-scene arrays that were composed of three objects and an imagined 2D space. The scene and array stimuli were, therefore, highly matched, and this paradigm permitted a closer examination of step-by-step mental construction than has been undertaken previously. We observed modulation of theta power in our two regions of interest – anterior hippocampus during the initial stage, and in vmPFC during the first two stages, of scene relative to array construction. Moreover, the scene-specific anterior hippocampal activity during the first construction stage was driven by the vmPFC, with mutual entrainment between the two brain regions thereafter. These findings suggest that hippocampal and vmPFC neural activity is especially tuned to scene representations during the earliest stage of their formation, with implications for theories of how these brain areas enable cognitive functions such as episodic memory.