bluuebunny/crossref_metadata_2025 huggingface dataset:
The Recognition of Whispered Speech in Real-Time
Authors: Hendrickson Kristi , Ernest Danielle
Published: September 2021

Objectives:

Whispered speech offers a unique set of challenges to speech perception and word recognition. The goals of the present study were twofold: First, to determine how listeners recognize whispered speech. Second, to inform major theories of spoken word recognition by considering how recognition changes when major cues to phoneme identity are reduced or largely absent compared with normal voiced speech.

Design:

Using eye tracking in the Visual World Paradigm, we examined how listeners recognize whispered speech. After hearing a target word (normal or whispered), participants selected the corresponding image from a display of four—a target (e.g., money), a word that shares sounds with the target at the beginning (cohort competitor, e.g., mother), a word that shares sounds with the target at the end (rhyme competitor, e.g., honey), and a phonologically unrelated word (e.g., whistle). Eye movements to each object were monitored to measure (1) how fast listeners process whispered speech, and (2) how strongly they consider lexical competitors (cohorts and rhymes) as the speech signal unfolds.

Results:

Listeners were slower to recognize whispered words. Compared with normal speech, listeners displayed slower reaction times to click the target image, were slower to fixate the target, and fixated the target less overall. Further, we found clear evidence that the dynamics of lexical competition are altered during whispered speech recognition. Relative to normal speech, words that overlapped with the target at the beginning (cohorts) displayed slower, reduced, and delayed activation, whereas words that overlapped with the target at the end (rhymes) exhibited faster, more robust, and longer lasting activation.

Conclusion:

When listeners are confronted with whispered speech, they engage in a “wait-and-see” approach. Listeners delay lexical access, and by the time they begin to consider what word they are hearing, the beginning of the word has largely come and gone, and activation for cohorts is reduced. However, delays in lexical access actually increase consideration of rhyme competitors; the delay pushes lexical activation to a point later in processing, and the recognition system puts more weight on the word-final overlap between the target and the rhyme.
The comparison of different medical treatment modalities in pes anserinus tendino-bursitis: a prospective clinical study
Authors: Yalcinozan Mehmet , Aydin Deniz , Sari Enes
Published: September 2021

Background:

Periarticular knee pain is a frequent and age-independent condition that affects patients during daily life. Lower-extremity pain caused by disability is one of the major interests of both orthopaedic and physical therapy departments. The aim of this study was to compare different medical treatment options and describe an effective treatment modality in pes anserinus tendino-bursitis, which has been an underestimated problem. This study was a prospective randomized clinical study of 45 patients who were clinically diagnosed with pes anserinus tendino-bursitis.

Methods:

Three study groups (n=15) were created, and each group underwent different treatment modalities by different physicians. The first group of patients was prescribed one intralesional corticosteroid injection. The second group of patients was prescribed a topical medical treatment regimen for 20 days in total. The third group of patients was prescribed nonsteroidal antiinflammatory drugs (NSAIDs) in addition to cold application for 3 wk. The patients were observed according to Knee injury and Osteoarthritis Outcome Scores (KOOS) and Visual Analog Scale (VAS) scores.

Results:

This study revealed significantly better results with a triple topical treatment combination when compared with other common medical treatment modalities in terms of pain relief and functional improvement of patients.

Conclusions:

Combined topical treatment was an effective treatment regimen for pes anserinus bursitis. With the support of daily functional modification, this treatment decreased the healing time and increased patient function during the treatment with better pain control.

Level of Evidence:

Level II.
What Are the Risk Factors for Infection After Operative Treatment of Peritalar Fracture Dislocations?
Authors: Levitt Eli B. , Patch David A. , Johnson Michael D. , McLynn Ryan , Debell Henry , Harris James B. , Spitler Clay A.
Published: September 2021

Objective:

To assess the risk factors associated with deep infection after operative treatment of peritalar fracture dislocations.

Design:

A retrospective study was performed to identify patients who had operative treatment of a peritalar fracture dislocation over an 11-year period (2008–2019).

Setting:

Level 1 trauma center.

Participants:

Patients were identified by review of all surgical billing that included open reduction of peritalar dislocation. Minimum follow-up for inclusion was 3 months or the outcome of interest. A total of 178 patients were identified, and 154 patients met inclusion criteria.

Main Outcome:

The primary outcome was deep infection, defined as return to the operating room for debridement with positive cultures.

Results:

A total of 19 (12.3%) patients developed a postoperative deep infection. The most common associated fractures were talus (47%), calcaneus (33%), and fibula (9%) fractures. The infected group was significantly older (47.2 vs. 39.5 years, P = 0.03). Patients undergoing operative management for peritalar fracture dislocations with current smoking were found to have significantly higher odds of postoperative deep infection (74 vs. 34%, adjusted odds ratio = 7.4, 95% confidence interval, 2.3–24.1, P = 0.001). There was a significantly higher risk of infection in patients with a Gustilo–Anderson type 3 open fracture (32 vs. 12%, adjusted odds ratio = 5.7, 95% confidence interval, 1.6–20.3, P = 0.007). The infected group had high rates of below knee amputation when compared with the group without infection (47 vs. 1%, P < 0.001).

Conclusion:

In our retrospective study, risk factors for infection after peritalar fracture dislocation included older age, smoking, and Gustilo–Anderson type 3 open fracture.

Level of Evidence:

Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
The Coronavirus Disease 2019 Pandemic Impacts Burnout Syndrome Differently Among Multiprofessional Critical Care Clinicians—A Longitudinal Survey Study
Authors: Moll Vanessa , Meissen Heather , Pappas Sharon , Xu Kejun , Rimawi Ramzy , Buchman Timothy G. , Fisher Lisa , Bakshi Vishal , Zellinger Mary , Coopersmith Craig M.
Published: September 2021

OBJECTIVES:

To determine the impact of coronavirus disease 2019 on burnout syndrome in the multiprofessional ICU team and to identify factors associated with burnout syndrome.

DESIGN:

Longitudinal, cross-sectional survey.

SETTING:

All adult ICUs within an academic health system.

SUBJECTS:

Critical care nurses, advanced practice providers, physicians, respiratory therapists, pharmacists, social workers, and spiritual health workers were surveyed on burnout in 2017 and during the coronavirus disease 2019 pandemic in 2020.

INTERVENTIONS:

None.

MEASUREMENTS AND MAIN RESULTS:

Burnout syndrome and contributing factors were measured using the Maslach Burnout Inventory of Health and Human Service and Areas of Worklife Survey. Response rates were 46.5% (572 respondents) in 2017 and 49.9% (710 respondents) in 2020. The prevalence of burnout increased from 59% to 69% (p < 0.001). Nurses were disproportionately impacted, with the highest increase during the pandemic (58–72%; p < 0.0001) with increases in emotional exhaustion and depersonalization, and personal achievement decreases. In contrast, although burnout was high before and during coronavirus disease 2019 in all specialties, most professions had similar or lower burnout in 2020 as they had in 2017. Physicians had the lowest rates of burnout, measured at 51% and 58%, respectively. There was no difference in burnout between clinicians working in ICUs who treated coronavirus disease 2019 than those who did not (71% vs 67%; p = 0.26). Burnout significantly increased in females (71% vs 60%; p = 0.001) and was higher than in males during the pandemic (71% vs 60%; p = 0.01).

CONCLUSIONS:

Burnout syndrome was common in all multiprofessional ICU team members prior to and increased substantially during the pandemic, independent of whether one treated coronavirus disease 2019 patients. Nurses had the highest prevalence of burnout during coronavirus disease 2019 and had the highest increase in burnout from the prepandemic baseline. Female clinicians were significantly more impacted by burnout than males. Different susceptibility to burnout syndrome may require profession-specific interventions as well as work system improvements.
Rapid Development and Deployment of an Intensivist-Led Venovenous Extracorporeal Membrane Oxygenation Cannulation Program
Authors: Kouch Michael , Green Adam , Damuth Emily , Noel Christopher , Bartock Jason , Rosenbloom Michael , Schorr Christa , Rios Robert , Loperfido Nancy , Puri Nitin
Published: September 2021

OBJECTIVES:

To determine the safety and efficacy of a rapidly deployed intensivist-led venovenous extracorporeal membrane oxygenation cannulation program in a preexisting extracorporeal membrane oxygenation program.

DESIGN:

A retrospective observational before-and-after study of 40 patients undergoing percutaneous cannulation for venovenous extracorporeal membrane oxygenation in an established cannulation program by cardiothoracic surgeons versus a rapidly deployed medical intensivist cannulation program.

SETTING:

An adult ICU in a tertiary academic medical center in Camden, NJ.

PATIENTS:

Critically ill adult subjects with severe respiratory failure undergoing percutaneous cannulation for venovenous extracorporeal membrane oxygenation.

INTERVENTIONS:

Percutaneous cannulation for venovenous extracorporeal membrane oxygenation performed by cardiothoracic surgeons compared with cannulations performed by medical intensivists.

MEASUREMENTS AND MAIN RESULTS:

Venovenous extracorporeal membrane oxygenation cannulation site attempts were retrospectively reviewed. Subject demographics, specialty of physician performing cannulation, type of support, cannulation configuration, cannula size, imaging guidance, success rate, and complications were recorded and summarized. Twenty-two cannulations were performed by three cardiothoracic surgeons in 11 subjects between September 2019 and February 2020. The cannulation program rapidly transitioned to an intensivist-led and performed program in March 2020. Fifty-seven cannulations were performed by eight intensivists in 29 subjects between March 2020 and December 2020. Mean body mass index for subjects did not differ between groups (33.86 vs 35.89; p = 0.775). There was no difference in days on mechanical ventilation prior to cannulation, configuration, cannula size, or discharge condition. There was no difference in success rate of cannulation on first attempt per cannulation site (95.5 vs 96.7; p = 0.483) or major complication rate per cannulation site (4.5 vs 3.5; p = 1).

CONCLUSIONS:

There is no difference between success and complication rates of percutaneous venovenous extracorporeal membrane oxygenation canulation when performed by cardiothoracic surgeons versus medical intensivist in an already established extracorporeal membrane oxygenation program. A rapidly deployed cannulation program by intensivists for venovenous extracorporeal membrane oxygenation can be performed with high success and low complication rates.
Barotrauma in Coronavirus Disease 2019 Patients Undergoing Invasive Mechanical Ventilation: A Systematic Literature Review*
Authors: Belletti Alessandro , Todaro Gabriele , Valsecchi Gabriele , Losiggio Rosario , Palumbo Diego , Landoni Giovanni , Zangrillo Alberto
Published: September 2021

OBJECTIVE:

There are concerns of a high barotrauma rate in coronavirus disease 2019 patients with acute respiratory distress syndrome receiving invasive mechanical ventilation. However, a few studies were published, and reported rates were highly variable. We performed a systematic literature review to identify rates of barotrauma, pneumothorax, and pneumomediastinum in coronavirus disease 2019 acute respiratory distress syndrome patients receiving invasive mechanical ventilation.

DATA SOURCE:

PubMed and Scopus were searched for studies reporting barotrauma event rate in adult coronavirus disease 2019 patients receiving invasive mechanical ventilation.

STUDY SELECTION:

We included all studies investigating adult patients with coronavirus disease 2019 acute respiratory distress syndrome requiring mechanical ventilation. Case reports, studies performed outside ICU setting, and pediatric studies were excluded. Two investigators independently screened and selected studies for inclusion.

DATA EXTRACTION:

Two investigators abstracted data on study characteristics, rate of pneumothorax, pneumomediastinum and overall barotrauma events, and mortality. When available, data from noncoronavirus disease 2019 acute respiratory distress syndrome patients were also collected. Pooled estimates for barotrauma, pneumothorax, and pneumomediastinum were calculated.

DATA SYNTHESIS:

A total of 13 studies with 1,814 invasively ventilated coronavirus disease 2019 patients and 493 noncoronavirus disease 2019 patients were included. A total of 266/1,814 patients (14.7%) had at least one barotrauma event (pooled estimates, 16.1% [95% CI, 11.8–20.4%]). Pneumothorax occurred in 132/1,435 patients (pooled estimates, 10.7%; 95% CI, 6.7–14.7%), whereas pneumomediastinum occurred in 162/1,432 patients (pooled estimates, 11.2%; 95% CI, 8.0–14.3%). Mortality in coronavirus disease 2019 patients who developed barotrauma was 111/198 patients (pooled estimates, 61.6%; 95% CI, 50.2–73.0%). In noncoronavirus disease 2019 acute respiratory distress syndrome patients, barotrauma occurred in 31/493 patients (6.3%; pooled estimates, 5.7%; 95% CI, −2.1% to 13.5%).

CONCLUSIONS:

Barotrauma occurs in one out of six coronavirus disease 2019 acute respiratory distress syndrome patients receiving invasive mechanical ventilation and is associated with a mortality rate of about 60%. Barotrauma rate may be higher than noncoronavirus disease 2019 controls.
Extended Lung Ultrasound to Differentiate Between Pneumonia and Atelectasis in Critically Ill Patients: A Diagnostic Accuracy Study
Authors: Haaksma Mark E. , Smit Jasper M. , Heldeweg Micah L. A. , Nooitgedacht Jip S. , de Grooth Harm J. , Jonkman Annemijn H. , Girbes Armand R. J. , Heunks Leo , Tuinman Pieter R.
Published: September 2021

OBJECTIVES:

To determine the diagnostic accuracy of extended lung ultrasonographic assessment, including evaluation of dynamic air bronchograms and color Doppler imaging to differentiate pneumonia and atelectasis in patients with consolidation on chest radiograph. Compare this approach to the Simplified Clinical Pulmonary Infection Score, Lung Ultrasound Clinical Pulmonary Infection Score, and the Bedside Lung Ultrasound in Emergency protocol.

DESIGN:

Prospective diagnostic accuracy study.

SETTING:

Adult ICU applying selective digestive decontamination.

PATIENTS:

Adult patients that underwent a chest radiograph for any indication at any time during admission. Patients with acute respiratory distress syndrome, coronavirus disease 2019, severe thoracic trauma, and infectious isolation measures were excluded.

INTERVENTIONS:

None.

MEASUREMENTS AND MAIN RESULTS:

Lung ultrasound was performed within 24 hours of chest radiograph. Consolidated tissue was assessed for presence of dynamic air bronchograms and with color Doppler imaging for presence of flow. Clinical data were recorded after ultrasonographic assessment. The primary outcome was diagnostic accuracy of dynamic air bronchogram and color Doppler imaging alone and within a decision tree to differentiate pneumonia from atelectasis. Of 120 patients included, 51 (42.5%) were diagnosed with pneumonia. The dynamic air bronchogram had a 45% (95% CI, 31–60%) sensitivity and 99% (95% CI, 92–100%) specificity. Color Doppler imaging had a 90% (95% CI, 79–97%) sensitivity and 68% (95% CI, 56–79%) specificity. The combined decision tree had an 86% (95% CI, 74–94%) sensitivity and an 86% (95% CI, 75–93%) specificity. The Bedside Lung Ultrasound in Emergency protocol had a 100% (95% CI, 93–100%) sensitivity and 0% (95% CI, 0–5%) specificity, while the Simplified Clinical Pulmonary Infection Score and Lung Ultrasound Clinical Pulmonary Infection Score had a 41% (95% CI, 28–56%) sensitivity, 84% (95% CI, 73–92%) specificity and 68% (95% CI, 54–81%) sensitivity, 81% (95% CI, 70–90%) specificity, respectively.

CONCLUSIONS:

In critically ill patients with pulmonary consolidation on chest radiograph, an extended lung ultrasound protocol is an accurate and directly bedside available tool to differentiate pneumonia from atelectasis. It outperforms standard lung ultrasound and clinical scores.
Identifying Prokineticin2 as a Novel Immunomodulatory Factor in Diagnosis and Treatment of Sepsis*
Authors: Yu Xiaoyan , Chen Jingyi , Tang Hong , Tu Qianqian , Li Yue , Yuan Xi , Zhang Xuemei , Cao Ju , Molloy David Paul , Yin Yibing , Chen Dapeng , Song Zhixin , Xu Pingyong
Published: September 2021

OBJECTIVES:

Sepsis remains a highly lethal disease, whereas the precise reasons for death remain poorly understood. Prokineticin2 is a secreted protein that regulates diverse biological processes. Whether prokineticin2 is beneficial or deleterious to sepsis and the underlying mechanisms remain unknown.

DESIGN:

Prospective randomized animal investigation and in vitro studies.

SETTING:

Research laboratory at a medical university hospital.

SUBJECTS:

Prokineticin2 deficiency and wild-type C57BL/6 mice were used for in vivo studies; sepsis patients by Sepsis-3 definitions, patient controls, and healthy controls were used to obtain blood for in vitro studies.

INTERVENTIONS:

Prokineticin2 concentrations were measured and analyzed in human septic patients, patient controls, and healthy individuals. The effects of prokineticin2 on sepsis-related survival, bacterial burden, organ injury, and inflammation were assessed in an animal model of cecal ligation and puncture–induced polymicrobial sepsis. In vitro cell models were also used to study the role of prokineticin2 on antibacterial response of macrophages.

MEASUREMENTS AND MAIN RESULTS:

Prokineticin2 concentration is dramatically decreased in the patients with sepsis and septic shock compared with those of patient controls and healthy controls. Furthermore, the prokineticin2 concentration in these patients died of sepsis or septic shock is significantly lower than those survival patients with sepsis or septic shock, indicating the potential value of prokineticin2 in the diagnosis of sepsis and septic shock, as well as the potential value in predicting mortality in adult patients with sepsis and septic shock. In animal model, recombinant prokineticin2 administration protected against sepsis-related deaths in both heterozygous prokineticin2 deficient mice and wild-type mice and alleviated sepsis-induced multiple organ damage. In in vitro cell models, prokineticin2 enhanced the phagocytic and bactericidal functions of macrophage through signal transducers and activators of transcription 3 pathway which could be abolished by signal transducers and activators of transcription 3 inhibitors S3I-201. Depletion of macrophages reversed prokineticin2-mediated protection against polymicrobial sepsis.

CONCLUSIONS:

This study elucidated a previously unrecognized role of prokineticin2 in clinical diagnosis and treatment of sepsis. The proof-of-concept study determined a central role of prokineticin2 in alleviating sepsis-induced death by regulation of macrophage function, which presents a new strategy for sepsis immunotherapy.
Obesity and metabolic syndrome induce hyperfiltration, glomerulomegaly, and albuminuria in obese ovariectomized female mice and obese male mice
Authors: Rodríguez-Rodríguez Ana Elena , Donate-Correa Javier , Luis-Lima Sergio , Díaz-Martín Laura , Rodríguez-González Covadonga , Pérez-Pérez José Antonio , Acosta-González Nieves Guadalupe , Fumero Cecilia , Navarro-Díaz Maruja , López-Álvarez Dolores , Villacampa-Jiménez Jacobo , Navarro-González José Antonio , Ortiz Alberto , Porrini Esteban
Published: September 2021

Objective:

Obese patients with metabolic syndrome have a high risk of chronic kidney disease. The prevalence of obesity, metabolic syndrome, and insulin resistance increase in women after menopause, as does the risk of chronic kidney disease. This may indicate an interaction between obesity, metabolic syndrome, and menopause in the induction of renal damage. However, the pathogenesis of kidney disease in postmenopausal obese women is poorly understood.

Methods:

We investigated the interaction of an obesogenic diet and menopause on renal dysfunction in ovariectomized and non-ovariectomized lean (n = 8 and 17) and obese (n = 12 and 20) female mice. Obese (n = 12) and lean (n = 10) male mice were also studied. Glucose metabolism, insulin resistance, and kidney function were evaluated with gold standards procedures. Changes in kidney histology and lipid deposition were analyzed. Females had a lower number of glomeruli than males at baseline.

Results:

Only female ovariectomized obese animals developed insulin resistance, hyperglycemia, and kidney damage, evidenced as glomerulomegaly, glomerular hyperfiltration, and increased urinary albumin excretion, despite a similar increase in weight than obese non-ovariectomized female mice. Male obese mice developed hyperglycemia, insulin resistance, and hyperfiltration without major renal histological changes. Males on high fat diet showed higher renal lipid content and females on high fat diet (ovariectomized or non-ovariectomized) showed higher total cholesterol content than males.

Conclusions:

In mice, there is a clear interplay between obesity, metabolic syndrome, and menopause in the induction of kidney damage.

Video Summary:
http://links.lww.com/MENO/A803.
Effect of Descemet Membrane Endothelial Keratoplasty Graft Storage Time on Graft Elasticity
Authors: Shilova Natalya F. , Anisimova Natalia S. , Livny Eitan , Malyugin Boris E.
Published: September 2021

Purpose:

The purpose of this study was to evaluate the effect of Descemet membrane endothelial keratoplasty (DMEK) graft storage time on its elastic properties, measured using atomic force microscopy (AFM).

Methods:

Twenty human corneas (from 10 donors), unsuitable for transplantation, were obtained from the eye bank (S. Fyodorov Eye Microsurgery State Institution, Moscow). Ten DMEK grafts were prepared and stored in the corneal storage medium, Optisol-GS at 4°C after preparation, and AFM analysis was performed within 12 hours after preparation (group A). Ten paired corneas from the respective donors were stored in Optisol-GS at 4°C for 1 week after preparation before AFM analysis (group B). Data were analyzed using the Hertz model for the evaluation of the Young modulus of elasticity.

Results:

Force–distance curve analysis showed an increase in the Young modulus of elasticity in group B in comparison with that in group A, and the mean values were 10.4 ± 1.8 kPa and 6.77 ± 2.25 kPa, respectively (P < 0.001). There was no correlation between the Young modulus of elasticity and donor age (r = 0.110, P = 0.644), endothelial cell count (r = −0.145, P = 0.541), and procurement interval (r = 0.14, P = 0.755).

Conclusions:

A longer graft storage time in cold storage medium was found to significantly reduce the elasticity of the DMEK graft. Clinically, this could potentially influence the unfolding of the DMEK graft within the anterior chamber during surgery and the postoperative detachment rate.
A review on antiviral efficacy of Bifidobacterium species
Authors: Abdi Milad , Ranjbar Reza
Published: September 2021

Viral infections like diarrheal infections (Rotavirus diarrhea) and respiratory infections transmitted virus (influenza virus [IFV]) are of the most common diseases in humans. Studies have shown that probiotics are able to decrease the risk or duration of viral infection symptoms. The purpose of this paper is to review the current studies on the efficacy of Bifidobacterium spp on viral infections and to provide insights on their possible antiviral mechanisms. A PubMed, Scopus, and Google Scholar database search was performed up to February 2021 using appropriate search terms The terms ‘probiotic’, ‘bifidobacterium’ and ‘virus’. Altogether, 21 relevant studies were obtained which 8, 4, and 9 studies were related to antiviral efficacy of Bifidobacterium spp on Rotavirus, IFV, and other viruses, respectively. Based on reviewed studies, Bifidobacterium spp may exert their antiviral effects via direct interaction or via stimulation of the immune system. More in vitro, in vivo, and clinical trials are needed to evaluate the antiviral efficacy and mechanisms of Bifidobacterium spp.
Patient/Family Involvement Leads to Successful Outcomes Following Lower Extremity Arthroplasties
Authors: James Bonnie , Odicio Nilsy , Baldwin Kathleen M. , Johnson Tracey
Published: September 2021

BACKGROUND:

Based on feedback from some of our orthopaedic surgeons and data on readmissions, our orthopaedic hospital implemented two initiatives aimed at improving outcomes following lower extremity arthroplasty (LEA). The first was the education for family/significant others of LEA patients and the other the provision of phone-based follow-up and monitoring postdischarge. As such, study objectives were as follows:

THE APPROACH:

A discharge education nurse provided daily education classes to families/significant others of LEA patients; these classes were provided on the morning of the patient's planned discharge. In addition, a discharge education nurse made follow-up phone calls at 1 and 5 weeks postdischarge to ask about compliance to discharge instructions and provide additional support as needed.

METHODS:

The sample comprised 122 total arthroscopy subjects admitted in 2018: 42 had hip replacements, 80 had knee replacements. A nonsignificant Pearson rho showed patients continued to follow instructions. Linear forecasting showed a small positive effect on selected Press Ganey questions.

CONCLUSION:

Based on our findings, we conclude that family/significant other discharge education improved compliance with discharge instruction.
Methotrexate Intolerance
Authors: Salt Elizabeth , Lohr Kristine , Edward Jean
Published: September 2021

An estimated 11%–33% of persons taking methotrexate for rheumatoid arthritis (RA) are intolerant to this medication. Medications for RA are often discontinued or changed because of patient intolerance. Yet, intolerance is a poorly defined perspective, specifically the patient's perspective. This study used descriptive qualitative methodologies to describe methotrexate intolerance from the perspective of adult patients with RA. Semistructured, audio-recorded individual interviews were conducted with 14 adult English-speaking patients with RA who had been prescribed, were taking, or had ever taken methotrexate. Methotrexate intolerance involves a complex belief system involving 3 themes: beliefs about the risk of methotrexate, beliefs about the benefits of methotrexate, and beliefs about the threat of RA. Participants reported a threshold by which perceived risks and benefits of methotrexate were weighed against perceived risks of RA. The critical underpinnings of the largely undefined and unique patient perspective of methotrexate intolerance are described.
Role of new antibiotics in extended-spectrum β-lactamase-, AmpC- infections
Authors: Bassetti Matteo , Giacobbe Daniele Roberto , Castaldo Nadia , Russo Alessandro , Vena Antonio
Published: September 2021

Purpose of review

Extended-spectrum β-lactamases (ESBL)- and ampicillinase class C (AmpC)-producing Enterobacterales represent one of the major public threats of the current era. As a consequence, during the last decades there have been great efforts to develop new therapeutic agents against these microorganisms. The aim of this review is to summarize the clinical features associated with novel antibiotics with activity against ESBL- and AmpC-producing isolates.

Recent findings

There a number of therapeutic agents with activity against ESBL and AmpC than have been introduced and approved over the past few years. Ceftazidime-avibactam and ceftolozane-tazobactam are both carbapenem sparing agents that appear interesting alternatives for treatment of serious Gram-negative infections. Other new β-lactams/ β-lactamase inhibitors (e.g. cefepime-enmetazobactam; ceftaroline fosamil-avibactam; aztreonam-avibactam and cefepime-zidebactam) as well as eravacycline, omadacycline, and plazomicin are also promising agents for treatment of ESBL- and AmpC- infections, but further clinical data are needed to establish their efficacy in comparison to carbapenems. The role of carbapenems/ β-lactamase inhibitors remains to be clarified.

New therapeutic agents against ESBL- and AmpC-producing Enterobacterales have distinctive specificities and limitations that require further investigations. Future randomized clinical trials are required to define the best strategy for their use in patients with serious infections due to ESBL- and/or AmpC- infections.
Radiopaque Fiducials Guiding Laparoscopic Resection of Liver Tumors
Authors: Falkenberg Mårten , Rizell Magnus , Sternby Eilard Malin , Regensburger Alois , Razazzian Roya , Kvarnström Niclas
Published: September 2021

Background:

Minimal invasive laparoscopic resection of liver tumors is less traumatic compared with open surgical resection and may be a better option for many patients. However, localization of intrahepatic tumors remains a challenge. Availability of hybrid operating rooms, equipped for high performance radiologic imaging, allows for new methods of surgical navigation.

Methods:

Twelve patients planned for laparoscopic resection of liver tumors were included. Before resection started, tumors were marked with radiopaque fiducials. Four fiducials were positioned with ultrasound within 1 cm of the tumor. Tumor and fiducials were localized with contrast enhanced cone beam computed tomography. Fluoroscopy with an overlay of cone beam computed tomography markings was projected side-by-side on the same screen as the laparoscopic view to visualize tumor location. The fiducials were eventually removed. Laparoscopic ultrasound, the standard method of localizing a tumor, was also used. The benefits of the 2 visualization methods were estimated by the operator. Procedure times, radiation doses and resection margins were recorded.

Results:

Fluoroscopy with radiopaque fiducials provided valuable information, complementing the laparoscopic ultrasound, particularly during the early phase of resection. In the later phase, mobilization of the tumor-containing liver segment caused significant displacement of the fluoroscopic overlay. The technique evolved during course of the study, with decreasing procedure times and radiation doses. Radical resection was achieved for all patients.

Conclusions:

Radiopaque fiducials and fluoroscopy can complement laparoscopic ultrasound for guiding resection of liver tumors. Combining radiologic and optical imaging in a hybrid operating suit may facilitate development of augmented reality techniques for surgical navigation.
Disordered Eating Attitudes and Behaviors of Dietetics Students
Authors: Novotny Daniela , Matthews Eric , Powell Sara M.
Published: September 2021

The study of disordered eating in dietetics students is vital for health outcomes and ethical consequences for students and their future clients. The eating attitudes and behaviors of 317 undergraduate health students were examined using the Eating Attitudes Test (EAT-26). Findings indicated 5.1% of dietetics students had scores symptomatic of eating disorders. In addition, dietetics students who completed more nutrition courses had lower EAT-26 scores than students who completed fewer nutrition courses. Given the personal and professional consequences of disordered eating, resources for preventing, identifying, and treating disordered eating are needed in dietetics education programs.
High degree of conservation of the enzymes synthesizing the laminin-binding glycoepitope of α-dystroglycan
Authors: Bigotti Maria Giulia , Brancaccio Andrea
Published: September 2021

The dystroglycan (DG) complex plays a pivotal role for the stabilization of muscles in Metazoa. It is formed by two subunits, extracellular α-DG and transmembrane β-DG, originating from a unique precursor via a complex post-translational maturation process. The α-DG subunit is extensively glycosylated in sequential steps by several specific enzymes and employs such glycan scaffold to tightly bind basement membrane molecules. Mutations of several of these enzymes cause an alteration of the carbohydrate structure of α-DG, resulting in severe neuromuscular disorders collectively named dystroglycanopathies. Given the fundamental role played by DG in muscle stability, it is biochemically and clinically relevant to investigate these post-translational modifying enzymes from an evolutionary perspective. A first phylogenetic history of the thirteen enzymes involved in the fabrication of the so-called ‘M3 core’ laminin-binding epitope has been traced by an overall sequence comparison approach, and interesting details on the primordial enzyme set have emerged, as well as substantial conservation in Metazoa. The optimization along with the evolution of a well-conserved enzymatic set responsible for the glycosylation of α-DG indicate the importance of the glycosylation shell in modulating the connection between sarcolemma and surrounding basement membranes to increase skeletal muscle stability, and eventually support movement and locomotion.
ANGPTL8 in metabolic homeostasis: more friend than foe?
Authors: Guo Chang , Wang Chenxi , Deng Xia , He Jianqiang , Yang Ling , Yuan Guoyue
Published: September 2021

ANGPTL8 is an important cytokine, which is significantly increased in type 2 diabetes mellitus (T2DM), obesity and metabolic syndrome. Many studies have shown that ANGPTL8 can be used as a bio-marker of these metabolic disorders related diseases, and the baseline ANGPTL8 level has also been found to be positively correlated with retinopathy and all-cause mortality in patients with T2DM. This may be related to the inhibition of lipoprotein lipase activity and the reduction of circulating triglyceride (TG) clearance by ANGPTL8. Consistently, inhibition of ANGPTL8 seems to prevent or improve atherosclerosis. However, it is puzzling that ANGPTL8 seems to have a directing function for TG uptake in peripheral tissues; that is, ANGPTL8 specifically enhances the reserve and buffering function of white adipose tissue, which may alleviate the ectopic lipid accumulation to a certain extent. Furthermore, ANGPTL8 can improve insulin sensitivity and inhibit hepatic glucose production. These contradictory results lead to different opinions on the role of ANGPTL8 in metabolic disorders. In this paper, the correlation between ANGPTL8 and metabolic diseases, the regulation of ANGPTL8 and the physiological role of ANGPTL8 in the process of glucose and lipid metabolism were summarized, and the physiological/pathological significance of ANGPTL8 in the process of metabolic disorder was discussed.
Aquabacterium soli sp. nov., a novel bacterium isolated from soil under the long-term application of bifenthrin
Authors: Sun Lina , Chen Wei , Huang Kaihua , Lyu Weiguang , Gao Xinhua
Published: September 2021

Strain SJQ9T, an aerobic bacterium isolated from a soil sample collected in Shanghai, PR China, was characterized using a polyphasic approach. It grew optimally at pH 7.0, 30–35 °C and in the presence of 1 % (w/v) NaCl. A comparative analysis of 16S rRNA gene sequences showed that strain SJQ9T fell within the genus

Aquabacterium

. The closest phylogenetic relatives of strain SJQ9T were

Aquabacterium citratiphilum

DSM 11900T (98.6 % sequence similarity) and

Aquabacterium commune

DSM 11901T (96.4 %). Cells of the strain were Gram-stain-negative, motile, non-spore-forming, rod-shaped and positive for oxidase activity and negative for catalase. The chemotaxonomic properties of strain SJQ9T were consistent with those of the genus

Aquabacterium

: the major fatty acid was summed feature 3 (C16 : 1
 ω6c and/or C16 : 1
 ω7c). The isoprenoid quinone was Q-8. The major polar lipids were phosphatidylethanolamine, phosphatidylcholine, phosphatidylglycerol and diphosphatidylglycerol. The DNA G+C content was 65.7 mol%. Strain SH9T exhibited a DNA–DNA relatedness level of 34±2 % with

A. citratiphilum

DSM 11900T and 28±3 % with

A. commune

DSM 11901T. Based on the obtained data, strain SJQ9T represents a novel species of the genus

Aquabacterium

, for which the name Aquabacterium soli sp. nov. is proposed. The type strain is SJQ9T (=JCM 33106T=CCTCC AB 2018284T).
Characterization of Staphylococcus roterodami sp. nov., a new species within the Staphylococcus aureus complex isolated from a human foot infection
Authors: Schutte Annemiek H. J. , Strepis Nikolaos , Zandijk Willemien H. A. , Bexkens Michiel L. , Bode Lonneke G. M. , Klaassen Corné H. W.
Published: September 2021

This article introduces a new

Staphylococcus

species cultivated from a human foot wound infection in a Dutch traveller returning from the island of Bali, Indonesia: Staphylococcus roterodami sp. nov. Based on the genomic sequence, there is strong molecular evidence for assigning the strain to a novel species within the

S. aureus

complex. Differences in cellular fatty acid spectrum and biochemical tests underline these findings. Its ecological niche and pathogenicity require further study. The type strain is DSM111914T (JCM34415T).
First trimester gut microbiome induces Inflammation-dependent gestational diabetes phenotype in mice
Authors: Pinto Yishay , Frishman Sigal , Turjeman Sondra , Eshel Adi , Nuriel-Ohayon Meital , Ziv Oren , Walters William , Parsonnet Julie , Ley Catherine , Johnson Elizabeth L. , Schweitzer Ron , Khatib Soliman , Magzal Faiga , Tamir Snait , Gavish Kinneret Tenenbaum , Rautava Samuli , Salminen Seppo , Isolauri Erika , Yariv Or , Peled Yoav , Poran Eran , Pardo Joseph , Chen Rony , Hod Moshe , Ley Ruth E. , Schwartz Betty , Hadar Eran , Louzoun Yoram , Koren Omry
Published: September 2021

Gestational diabetes mellitus (GDM) is a condition in which non-diabetic women are diagnosed with glucose intolerance during pregnancy, typically in the second trimester. GDM can lead to a wide range of obstetrical and metabolic complications for both mother and neonate1. Early identification of GDM risk, along with a better understanding of its pathophysiology during the first trimester of pregnancy, may be effective in reducing GDM incidence, as well as its associated short and long term morbidities2. Here, we comprehensively profiled the gut microbiome, metabolome, inflammatory cytokines, nutrition and clinical records of 394 women during the first trimester of pregnancy. We found elevated levels of proinflammatory serum cytokines in those who later developed GDM. The women’s stool samples were also characterized by decreased levels of several fecal short-chain fatty acids and altered microbiome. We next tested the hypothesis that differences in GDM-associated microbial composition during the first trimester drove inflammation and insulin-resistance. Stool samples collected early in pregnancy from women from three populations who did and did not later develop GDM were transplanted to germ-free mice and confirmed that both inflammation and insulin-resistance are induced by the microbiome of pregnant women more than 10 weeks prior to GDM diagnosis. Following these observations, we used a machine-learning approach to predict GDM based on first trimester clinical, microbial and inflammatory markers. Our model showed high predictive accuracy. Overall, our results suggest that the gut microbiome of women in the first trimester plays a remarkable role in inflammation-induced GDM pathogenesis and point to dozens of GDM markers during the first trimester of pregnancy, some of which may be targets for therapeutic intervention.
Global Burden of Covid-19 Restrictions: National, Regional and Global Estimates
Authors: Fink Günther , Tediosi Fabrizio , Felder Stefan
Published: September 2021

A large literature has documented the high global mortality and mental health burden associated with the current Covid-19 pandemic. In this paper, we combine newly collected data on subjective reductions in the quality of life with the latest data on Covid-19 restrictions to quantify the total number of quality-adjusted life years (QALYs) lost due to government imposed restrictions globally. Our estimates suggest a total loss of 2980 (95% 2764, 3198) million QALYs as of September 6th 2021, with the highest burden absolute burden in lower and upper middle income countries. QALY losses appear to be particularly large for closures of schools and daycares as well as restaurants and bars, and seem relatively small for wearing masks in public and closure of fitness facilities.
Prediction of long-term kinetics of vaccine-elicited neutralizing antibody and time-varying vaccine-specific efficacy against the SARS-CoV-2 Delta variant by clinical endpoint
Authors: Chen Xinhua , Wang Wei , Chen Xinghui , Wu Qianhui , Sun Ruijia , Ge Shijia , Zheng Nan , Lu Wanying , Yang Juan , Rodewald Lance , Yu Hongjie
Published: September 2021

Evidence on vaccine-specific protection over time and boosting impact against the Delta variant across different clinical endpoints and age groups is urgently needed. To address this, we used a previously published model, combined with neutralization data for four vaccines - mRNA-1273, BNT162b2, NVX-CoV2373, and CoronaVac - to evaluate long-term dynamics of neutralizing antibody and to predict time-varying efficacy against the Delta variant by specific vaccine, age group, and clinical severity. We found that booster vaccination produces higher neutralization titers compared with titers observed following primary-series vaccination for all vaccines studied. We estimate the efficacies of mRNA-1273 and BNT162b2 against Delta variant infection to be 63.5% (95%CI: 51.4-67.3%) and 78.4% (95%CI: 72.2-83.5%), respectively, 14-30 days after the second dose, and that efficacies decreased to 36.0% (95%CI: 24.1-58.0%) and 38.5% (95%CI: 28.7-49.1%) 6-8 months later. After administration of booster doses, efficacies against the Delta variant would be 97.0% (95%CI: 96.4-98.5%) and 97.2% (95.7-98.1%). All four vaccines are predicted to provide good protection against severe illness from the Delta variant after both primary and booster vaccination. Long-term monitoring and surveillance of antibody dynamics and vaccine protection, as well as further validation of neutralizing antibody or other markers that can serve as correlates of protection against SARS-CoV-2 and its variants are needed to inform COVID-19 pandemic preparedness.
Rapid replacement of the Beta variant by the Delta variant in South Africa
Authors: Tegally Houriiyah , Wilkinson Eduan , Althaus Christian L. , Giovanetti Marta , San James Emmanuel , Giandhari Jennifer , Pillay Sureshnee , Naidoo Yeshnee , Ramphal Upasana , Msomi Nokukhanya , Mlisana Koleka , Amoako Daniel G. , Everatt Josie , Mohale Thabo , Nguni Anele , Mahlangu Boitshoko , Ntuli Noxolo , Khumalo Zamantungwa T. , Makatini Zinhle , Wolter Nicole , Scheepers Cathrine , Ismail Arshad , Doolabh Deelan , Joseph Rageema , Strydom Amy , Mendes Adriano , Davis Michaela , Mayaphi Simnikiwe H. , Ramphal Yajna , Maharaj Arisha , Karim Wasim Abdool , Tshiabuila Derek , Anyaneji Ugochukwu J. , Singh Lavanya , Engelbrecht Susan , Fonseca Vagner , Marais Kruger , Korsman Stephen , Hardie Diana , Hsiao Nei-yuan , Maponga Tongai , van Zyl Gert , Marais Gert , Iranzadeh Arash , Martin Darren , Alcantara Luiz Carlos Junior , Bester Phillip Armand , Nyaga Martin M. , Subramoney Kathleen , Treurnicht Florette K. , Venter Marietjie , Goedhals Dominique , Preiser Wolfgang , Bhiman Jinal N. , Gottberg Anne von , Williamson Carolyn , Lessells Richard J. , de Oliveira Tulio
Published: September 2021

The Beta variant of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) emerged in South Africa in late 2020 and rapidly became the dominant variant, causing over 95% of infections in the country during and after the second epidemic wave. Here we show rapid replacement of the Beta variant by the Delta variant, a highly transmissible variant of concern (VOC) that emerged in India and subsequently spread around the world. The Delta variant was imported to South Africa primarily from India, spread rapidly in large monophyletic clusters to all provinces, and became dominant within three months of introduction. This was associated with a resurgence in community transmission, leading to a third wave which was associated with a high number of deaths. We estimated a growth advantage for the Delta variant in South Africa of 0.089 (95% confidence interval [CI] 0.084-0.093) per day which corresponds to a transmission advantage of 46% (95% CI 44-48) compared to the Beta variant. These data provide additional support for the increased transmissibility of the Delta variant relative to other VOC and highlight how dynamic shifts in the distribution of variants contribute to the ongoing public health threat.
Diagnostic Yield of Screening for SARS-CoV-2 among Patients Admitted for Alternate Diagnoses
Authors: Davis Phil , Rosychuk Rhonda J. , Hau Jeffrey P , Cheng Ivy , McRae Andrew D. , Daoust Raoul , Lang Eddy , Turner Joel , Khangura Jaspreet , Fok Patrick T. , Stachura Maja , Brar Baljeet , Hohl Corinne
Published: September 2021

Objectives

To determine the diagnostic yield of screening patients for SARS-CoV-2 who were admitted with a diagnosis unrelated to COVID-19, and identify risk factors for positive tests.

Design

Cohort from the Canadian COVID-19 Emergency Department Rapid Response Network (CCEDRRN) registry

Setting

30 acute care hospitals across Canada

Participants

Patients hospitalized for non-COVID-19 related diagnoses who were tested for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) between March 1, and December 29, 2020

Main outcome

Positive nucleic acid amplification test (NAAT) for SARS-CoV-2

Outcome measure

Diagnostic yield

Results

We enrolled 15,690 consecutive eligible adults who were admitted to hospital without clinically suspected COVID-19. Among these patients, 122 tested positive for COVID-19, resulting in a diagnostic yield of 0.8% (95% CI 0.64% – 0.92%). Factors associated with a positive test included presence of a fever, being a healthcare worker, having a positive household contact or institutional exposure, and living in an area with higher 7-day average incident COVID-19 cases.

Conclusions

Universal screening of hospitalized patients for COVID-19 across two pandemic waves had a low diagnostic yield and should be informed by individual-level risk assessment in addition to regional COVID-19 prevalence.

Trial registration

NCT04702945

SUMMARY BOXES

Section 1: Universal screening of admitted patients for SARS-CoV-2 was implemented in many hospitals at the beginning of the pandemic. The Infections Diseases Society of America (IDSA) recommended avoiding universal screening of asymptomatic hospitalized patients in areas and times of low-COVID prevalence (defined as <2% prevalence) with very low certainty of evidence, based on studies of COVID-19 prevalence among asymptomatic individuals in the community.

Section 2: This study supports IDSA recommendations to avoid universal screening for COVID-19 in times and areas of low COVID prevalence and identifies patient-level risk factors strongly associated with positive testing that should be considered for screening.