bluuebunny/crossref_metadata_2025 huggingface dataset:
Adaptive immunity and vaccination – iron in the spotlight
Authors: Preston Alexandra E , Drakesmith Hal , Frost Joe N
Published: June 2021

Vaccination programmes are critically important to suppress the burden of infectious diseases, saving countless lives globally, as emphasised by the current COVID-19 pandemic. Effective adaptive immune responses are complex processes subject to multiple influences. Recent genetic, pre-clinical, and clinical studies have converged to show that availability of iron is a key factor regulating the development of T and B cell responses to infection and immunisation. Lymphocytes obtain iron from circulating transferrin. The amount of iron bound to transferrin is dependent on dietary iron availability and is decreased during inflammation via upregulation of the iron-regulatory hormone, hepcidin. As iron deficiency and chronic inflammatory states are both globally prevalent health problems, the potential impact of low iron availability on immune responses is significant. We describe the evidence supporting the importance of iron in immunity, highlight important unknowns, and discuss how therapeutic interventions to modulate iron availability might be implementable in the context of vaccination and infectious disease.
On Unitarizable Harish-Chandra Bimodules for Deformations of Type-A Kleinian Singularities
Authors: Klyuev Daniil
Published: June 2021

The notion of a Harish-Chandra bimodule, that is, finitely generated $U(\mathfrak {g})$-bimodule with locally finite adjoint action, was generalized to any filtered algebra in a work of Losev [9]. Similarly to the classical case we can define the notion of a unitarizable bimodule. We investigate a question when the regular bimodule, that is, the algebra itself, for a deformation of Kleinian singularity of type $A$ is unitarizable. We obtain a partial classification of unitarizable regular bimodules.
Geospatial distribution and bypassing health facilities among National Health Insurance Scheme enrollees: implications for universal health coverage in Nigeria
Authors: Adewole David A , Reid Steve , Oni Tolu , Adebowale Ayo S
Published: June 2021

Background

This study was carried out to enable an assessment of geospatial distribution and access to healthcare facilities under the National Health Insurance Scheme (NHIS) of Nigeria. The findings will be useful for efficient planning and equitable distribution of healthcare resources.

Methods

Data, including the distribution of selected health facilities, were collected in Ibadan, Nigeria. The location of all facilities was recorded using Global Positioning System and was subsequently mapped using ArcGIS software to produce spider-web diagrams displaying the spatial distribution of all health facilities.

Results

The result of clustering analysis of health facilities shows that there is a statistically significant hotspot of health facility at 99% confidence located around the urban areas of Ibadan. The significant hotspot result is dominated by a feature with a high value and is surrounded by other features also with high values. Away from the urban built-up area of Ibadan, health facility clustering is not statistically significant. There was also a high level (94%) of bypassing of NHIS-accredited facilities among the enrollees.

Conclusions

Lopsided distribution of health facilities in the study area should be corrected as this may result in inequity of access to available health services.
Pathways to Deeper News Engagement: Factors Influencing Click Behaviors on News Sites
Authors: Collier Jessica R. , Dunaway Johanna , Stroud Natalie Jomini
Published: June 2021

This study draws on models of motivated news exposure and literature on affordances to examine how devices (i.e., PC or mobile) and paths to exposure (i.e., news homepages, search, or social referrals) relate to people’s behavior on news sites. Using behavioral data from seven local broadcast news sites, we assess how the device used and referral site affect whether people click on links to more news. We experimentally test four components of the presentation of links on news sites: content, labels, location on page, and images. Findings show that accessing news via social media and mobile devices reduces clicks relative to other paths and devices. Further, link presentation matters; for instance, links to Related content yielded more clicks than Popular content for those coming from search or a news homepage on PCs. We advance a conditional explanation of motivated news exposure and identify practical insights for news organizations.

Lay Summary

The devices people use (PC or mobile) and the paths they take to news (news homepage, search, or social referrals) relate to their behaviors once on a news site. Using data from seven local broadcast news sites, we assess how devices and referral sites affect whether people click on links to more news. We test four components of the presentation of links on news sites: content, labels, location on page, and images. We find that accessing news via social media and mobile devices leads to fewer clicks compared to other pathways to news. We also find that how links are presented matters. For example, the highest click-through rate we observed was when people using a PC and a search engine to visit a news site saw Related links at the end of a page accompanied by images and labeled in a way that appealed to social motivations. These conditional pathways are important for understanding news exposure and can provide practical insights for news organizations.
Virtual randomized study comparing lobectomy and particle beam therapy for clinical stage IA non-small cell lung cancer in operable patients
Authors: Seo Young-Seok , Park Woo-Yoon , Kim Si-Wook , Kim Dohun , Min Byung Jun , Kim Won-Dong
Published: June 2021

To the best of our knowledge there have been no randomized controlled trials comparing lobectomy—a standard treatment for patients with early-stage non-small cell lung cancer (NSCLC)—and particle beam therapy (PBT), the best performing existing radiotherapy. We conducted a virtual randomized trial in medically operable patients with stage IA NSCLC to compare lobectomy and PBT effectiveness. A Markov model was developed to predict life expectancy after lobectomy and PBT in a cohort of patients with stage IA NSCLC. Ten thousand virtual patients were randomly assigned to each group. Sensitivity analyses were performed as model variables and scenarios changed to determine which treatment strategy was best for improving life expectancy. All estimated model parameters were determined using variables extracted from a systematic literature review of previously published articles. The preferred strategy differed depending on patient age. In young patients, lobectomy showed better life expectancy than that of PBT. The difference in life expectancy between lobectomy and PBT was statistically insignificant in older patients. Our model predicted lobectomy as the preferred strategy when operative mortality was under 5%. However, the preferred strategy changed to PBT if operative mortality post lobectomy was over 5%. For medically operable patients with stage IA NSCLC, our Markov model revealed the preferred strategy of lobectomy or PBT regarding operative mortality changed with varying age and comorbidity. Until randomized controlled trial results become available, we hope the current results will provide a rationale background for clinicians to decide treatment modalities for patients with stage IA NSCLC.
Cutaneous leishmaniasis and the vicious cycle of neglect
Authors: Barkati Sapha , Libman Michael D
Published: June 2021

Cutaneous leishmaniasis remains a widespread poorly controlled disease, also seriously affecting travellers and migrants. Resources for diagnosis and management are lacking in endemic areas, timely recognition of cases is problematic everywhere, and we lack evidence to support guidelines for treatments, which are incompletely effective and often toxic, despite scores of publications.
The impact of self-interacting dark matter on the intrinsic alignments of galaxies
Authors: Harvey David , Chisari Nora Elisa , Robertson Andrew , McCarthy Ian G
Published: June 2021

The formation and evolution of galaxies is known to be sensitive to tidal processes leading to intrinsic correlations between their shapes and orientations. Such correlations can be measured to high significance today, suggesting that cosmological information can be extracted from them. Among the most pressing questions in particle physics and cosmology is the nature of dark matter. If dark matter is self-interacting, it can leave an imprint on galaxy shapes. In this work, we investigate whether self-interactions can produce a long-lasting imprint on intrinsic galaxy shape correlations. We investigate this observable at low redshift (z < 0.4) using a state-of-the-art suite of cosmological hydro-dynamical simulations where the dark matter model is varied. We find that dark matter self-interactions induce a mass-dependent suppression in the intrinsic alignment signal by up to 50 per cent out to tens of mega-parsecs, showing that self-interactions can impact structure outside the very core of clusters. We find evidence that self-interactions have a scale-dependent impact on the intrinsic alignment signal that is sufficiently different from signatures introduced by differing baryonic physics prescriptions, suggesting that it is detectable with upcoming all-sky surveys.
Results of a Team Objective Structured Clinical Examination (OSCE) in a Patient with Pain
Authors: Barreveld Antje M , Flanagan Jane M , Arnstein Paul , Handa Shruti , Hernández-Nuño de la Rosa María F , Matthews Michele L , Shaefer Jeffry R
Published: June 2021

Purpose

As rates of chronic pain and opioid use disorder continue to rise, improved pain education is essential. Using an interprofessional team objective structured clinical examination (OSCE) simulation, this study evaluates whether prior exposure to a case-based learning module improves students’ assessment and treatment planning of a standardized patient prescribed chronic opioids presenting with acute pain.

Methods

A quasi-experimental mixed method approach using convenience sampling was employed to evaluate student performance and the impact of the educational intervention.

Results

Fourteen (intervention) and 16 (control) nurse practitioner, physician assistant, medical, pharmacy, and dental students in the final pre-licensure program years completed the team OSCE. Demographics, OSCE learning scores, Interprofessional Attitudes Scale scores, and pain management plans did not differ between groups. All students evaluated the activity highly. Qualitative analysis did not demonstrate differences between groups, but did identify similar themes: students missed opportunities to establish patient-provider rapport and educate across disciplines; opioid use disorder was assumed with chronic opioid therapy; team discussions improved treatment plans; moderators variably influenced team discussion.

Conclusions

This novel approach to interprofessional training in pain management using a team OSCE is promising, with modifications suggested. A case-based learning module without structured education prior to the OSCE did not improve students’ assessment and pain management skills compared to a control group. Nonetheless, important themes emerged including biases towards the standardized patient. Additional research is needed to develop effective curricular initiatives to foster and improve interprofessional collaboration in assessing and managing a standardized patient with acute and chronic pain.
Extrapolative Bubbles and Trading Volume
Authors: Liao Jingchi , Peng Cameron , Zhu Ning
Published: June 2021

We propose an extrapolative model of bubbles to explain the sharp rise in prices and volume observed in historical financial bubbles. The model generates a novel mechanism for volume: because of the interaction between extrapolative beliefs and disposition effects, investors are quick to not only buy assets with positive past returns but also sell them if good returns continue. Using account-level transaction data on the 2014–2015 Chinese stock market bubble, we test and confirm the model’s predictions about trading volume. We quantify the magnitude of the proposed mechanism and show that it can increase trading volume by another 30$\%$.
Attuning and Queering SAMHSA’s Strategic Prevention Framework
Authors: Mendoza Natasha S , Mackey Cynthia , Harner Vern , Jackson Kelly
Published: June 2021

To prevent substance use disorder (SUD) and its consequences, the Substance Abuse and Mental Health Services Administration developed the Strategic Prevention Framework (SPF). The SPF is a structured planning model that evaluates community behavioral health needs and facilitates prevention planning to address substance use concerns. Despite the SPF’s stated foundation in cultural competency, the framework lacks appropriate guidelines to address systemic oppression of historically marginalized communities. Thus, the authors propose that an SPF based on a cultural attunement framework can enhance prevention-based social workers’ ability to dismantle systemic barriers that create and perpetuate health disparities surrounding substance use and treatment for SUD. Using an example scenario, authors offer recommendations for social workers seeking to expand the SPF and fully actualize its application.
Focus on How Plants Engage With Beneficial Microorganisms While at the Same Time Restricting Pathogens
Authors: Harris Jeanne M. , Jones Kathryn M. , Wang Dong , Zuccaro Alga
Published: June 2021

Plants live in a world filled with microbes, and spend their lives engaged in the delicate dance of nurturing beneficial interactions while simultaneously reducing disease-causing interactions. How do plants engage with beneficial microorganisms while at the same time restricting pathogens? was recently selected in a crowd-sourced effort as the top, unanswered question in the field of molecular plant-microbe interactions. Elaborating on this question and setting the stage for this focus issue , the Top10 review by Thoms, Liang and Haney examines the way multiple inputs are integrated to initiate programs of immunity or mutualistic symbiosis, and how this shapes the microbiome. This comprehensive review describes the current landscape of the field, focusing on the plant-microbe-soil continuum, but providing ideas for extending these concepts to leaves, where much of the research on immunity has centered. Other papers in this issue examine the simultaneous interaction of plants with beneficial and pathogenic microorganisms, as well as many diverse relationships with beneficial microbes that can improve plant health by increasing access to nutrients or by decreasing disease.

[Formula: see text] Copyright © 2021 The Author(s). This is an open access article distributed under the CC BY 4.0 International license .
Co-occurrence of Blount’s disease and Legg-Calvé-Perthes disease: is obesity a factor?
Authors: Jardaly Achraf H , Hicks James W , Doyle John S , Conklin Michael J , Gilbert Shawn R
Published: June 2021

Legg-Calvé-Perthes disease (LCPD) and Blount’s disease share a similar presenting age in addition to similar symptoms such as limp or knee pain. A little overlap is mentioned about both diseases. We sought to present cases of children having both conditions to discuss the implications of this co-occurrence on diagnosis and management. After institutional review board approval, we retrospectively reviewed records of four children who developed both Blount’s disease and LCPD. Patient details and outcomes were analyzed. Radiographs were evaluated for the lateral pillar classification, Stulberg classification, tibial metaphyseal-diaphyseal angle and tibiofemoral angle. Two of the cases were initially diagnosed with Blount’s disease and subsequently developed Perthes, one case presented initially with both disorders and the final case had Perthes followed by Blount’s. Three children were obese and one was overweight. The common symptom to all patients was an abnormal gait, which was painless in two children and painful in two. Blount’s disease required surgery in three children. Radiographs showed Lateral Pillar B, B/C border and C hips, and the final Stulberg was stage II (n = 2) or stage IV (n = 2). Obesity is associated with Blount’s disease and LCPD, so obese children can be at an increased risk of developing both disorders. Therefore, a child with Blount’s disease who has persistent, recurrent or worsening symptoms such as gait disturbance or thigh or knee pain might benefit from a careful physical exam of the hips to prevent a delayed or even missed LCPD diagnosis.
Time-Motion Study to Evaluate the Impact of Purchasing within Clinical Engineering
Authors: Pare' Mara , Gresch Alan
Published: June 2021

Biomedical equipment technicians and clinical engineers order medical device parts in most hospitals because of the technical nature, knowledge, and expertise associated with medical equipment. But biomedical equipment technicians/clinical engineers can sometimes fail to source high-quality parts at the lowest prices, fill out work orders properly, or follow up when parts are not delivered on time. Moreover, the hours they spend on parts ordering could be better utilized on repairs to increase the uptime of critical equipment. Solutions include hiring specialized buyers within clinical engineering departments or contracting with an online marketplace to simplify the ordering process.
COVID-19 Vaccine Uptake and Intent Among Emergency Healthcare Workers
Authors: Pacella-LaBarbara Maria L. , Park Yunseo Linda , Patterson P. Daniel , Doshi Ankur , Guyette Maria Koenig , Wong Ambrose H. , Chang Bernard P. , Suffoletto Brian P.
Published: June 2021

Objective:

Vaccine hesitancy limits population protection from SARS-CoV (coronavirus disease [COVID-19]). Vaccine hesitancy among healthcare workers (HCW) could put patients and coworkers at risk.

Methods:

We surveyed 475 emergency department and emergency medical service workers from January to February 2021 to determine vaccine intent/uptake, perceived COVID-19 vulnerability, and factors associated with vaccine intent/uptake.

Results:

Although 79% of HCWs received or had plans to receive the COVID-19 vaccine, 21% had no intent/were unvaccinated; intent/uptake was lower among females (odds ratio [OR] = 0.34) and those with a history of COVID-19 infection (OR = 0.55), and higher among those with advanced degrees (OR = 3.53) and high perceived COVID-19 vulnerability (OR = 1.99).

Conclusions:

This study provides a timely assessment of vaccination status among frontline HCWs and highlights subgroups who may be at high risk of exposure and transmission.
The analysis of acne increasing suicide risk
Authors: Xu Shuangyan , Zhu Yun , Hu Hu , Liu Xiuhong , Li Li , Yang Binbin , Wu Wei , Liang Zuohui , Deng Danqi
Published: June 2021

Acne is associated with depression and anxiety; however, the relationship between acne and suicide is still unclear. This study is aimed to evaluate the association between acne and suicide by conducting a meta-analysis. Studies were identified by electronic searches of the PubMed and EMBASE databases from their inception through Jan 10, 2020. Two authors separately assessed the quality and extracted data from the selected studies. When the heterogeneity was significant, we used a random-effects model to calculate overall pooled risk estimates.

Five studies involving a total of 2,276,798 participants were finally included in the meta-analysis; 52,075 participants had acne. Suicide was positively associated with acne in the overall analysis (odds ratio (OR) 1.50, 95% confidence interval (95% CI): 1.09–2.06, P = .004, I2 = 74.1%). Subgroup analyses were performed for suicidal behavior groups (P = .002, I2 = 80.4%), suicidal ideation or thoughts groups (P = .849, I2 = 0.0%), International Classification of Diseases version 9 (ICD-9) groups (P = .137, I2 = 49.6%), non-ICD-9 groups (P = .950, I2 = 0.0%), American groups (P = .311, I2 = 2.4%), and non-American groups (P = .943, I2 = 0.0%). Sensitivity analyses indicated flawed results. No publication bias was detected.

Acne may significantly increase suicide risk. Clinicians should actively treat acne and consider suicide screening. Further international studies with high-quality analyses are needed as more data are published.

Ethical approval and patient consent are not required because this study is a literature-based study.
The prevalence and break down of narrow anterior chamber angle pathology presenting to a general ophthalmology clinic
Authors: Jain Nikhil , Zia Rashad
Published: June 2021

To approximate the breakdown of narrow anterior chamber angle conditions, on general ophthalmology clinics, in the predominantly white population of the South East Kent region in the United Kingdom.

A review was done of all patients attending a secondary care ophthalmology general clinic over a 3-year period. Patients were assessed with: slitlamp biomicroscopy with indentation gonioscopy; SD optical coherence tomography, Humphrey visual field analyzer, and high frequency ultrasound and categorized into various narrow angle conditions. These were: narrow Van Herrick but open angle; primary narrow angle but nonoccludable; primary angle closure suspect; primary angle closure; chronic narrow angle glaucoma; plateau iris configuration; plateau iris syndrome, and phacomorphic narrow angle.

A total of 14,520 patients were referred to the clinic, of those 10,491 attended and were analyzed. Six hundred seventy four (6.4%) of the patients had some form of narrow angle condition in at least 1 eye. The majority of these patients were at relative low risk of pathology such as nonoccludable narrow angles (359/53.3%) and narrow Van Herrick but open angles (93/13.8%). 8.8% of all the narrow angle patients had primary angle closure suspect or primary angle closure. Plateau iris pathology was seen in 68 (10.1%) of patients with 18 (26%) having confirmed plateau iris syndrome after peripheral iridotomy. Phacomorphic pathology was confirmed in 75 (11.1%) patients.

Narrow angle patients form a significant proportion (6.4%) of those attending general ophthalmology clinic in the predominantly white population in the South East Kent Region of the United Kingdom. The majority of these (67.1%) are at a relatively low risk of developing acute or chronic angle closure glaucoma. Of the remaining patients 8.8% have primary angle closure suspect or primary angle closure and 2.9% have already progressed to chronic narrow angle closure glaucoma. Plateau iris pathology and phacomorphic glaucoma account for the remainder of the presentations.
Bioinformatics analysis of the key potential ceRNA biomarkers in human thymic epithelial tumors
Authors: Chen Kegong , Bai Long , Ji Lin , Wu Libo , Li Guanghua
Published: June 2021

Background:

Thymic epithelial tumors (TETs), originating from the thymic epithelial cells, are the most common primary neoplasms of the anterior mediastinum. Emerging evidence demonstrated that the competing endogenous RNAs (ceRNAs) exerted a crucial effect on tumor development. Hence, it is urgent to understand the regulatory mechanism of ceRNAs in TETs and its impact on tumor prognosis.

Methods:

TETs datasets were harvested from the UCSC Xena as the training cohort, followed by differentially expressed mRNAs (DEmRNAs), lncRNAs (DElncRNAs), and miRNAs (DEmiRNAs) at different pathologic type (A, AB, B, and TC) identified via DESeq2 package. clusterProfiler package was utilized to carry out gene ontology and Kyoto encyclopedia of genes and genomes functional analysis on the DEmRNAs. Subsequently, the lncRNA-miRNA-mRNA regulatory network was constructed to screen the key DEmRNAs. After the key DEmRNAs were verified in the external cohort from Gene Expression Omnibus database, their associated-ceRNAs modules were used to perform the K-M and Cox regression analysis to build a prognostic significance for TETs. Lastly, the feasibility of the prognostic significance was validated by receiver operating characteristic (ROC) curves and the area under the curve.

Results:

Finally, a total of 463 DEmRNAs, 87 DElncRNAs, and 20 DEmiRNAs were obtained from the intersection of differentially expressed genes in different pathological types of TETs. Functional enrichment analysis showed that the DEmRNAs were closely related to cell proliferation and tumor development. After lncRNA-miRNA-mRNA network construction and external cohort validation, a total of 4 DEmRNAs DOCK11, MCAM, MYO10, and WASF3 were identified and their associated-ceRNA modules were significantly associated with prognosis, which contained 3 lncRNAs (lncRNA LINC00665, lncRNA NR2F1-AS1, and lncRNA RP11-285A1.1), 4 mRNAs (DOCK11, MCAM, MYO10, and WASF3), and 4 miRNAs (hsa-mir-143, hsa-mir-141, hsa-mir-140, and hsa-mir-3199). Meanwhile, ROC curves verified the accuracy of prediction ability of the screened ceRNA modules for prognosis of TETs.

Conclusion:

Our study revealed that ceRNAs modules might exert a crucial role in the progression of TETs. The mRNA associated-ceRNA modules could effectively predict the prognosis of TETs, which might be the potential prognostic and therapeutic markers for TETs patients.
Determining the association between hypertension and bone metabolism markers in osteoporotic patients
Authors: Hu Zhuoqing , Yang Kevin , Hu Zhihui , Li Miaosheng , Wei Hao , Tang Zheng , Chen Baitong , Su Chengbiao , Cai De , Xu Jinrong
Published: June 2021

The aim of the case study is to examine the association between hypertension and the level of bone metabolism markers in newly diagnosed osteoporotic patients.

A cross-sectional study of 518 subjects was done to see the association between hypertension and the level of osteocalcin (OC), bone-specific alkaline phosphatase (B-ALP), Tartrate-resistant acid phosphatase (TRAP.5B), and 25-hydroxy vitamin D (25-OHD). There were 243 (46.9%) osteoporosis patients with hypertension. Both univariate and multivariate analysis have suggested that lower OC and 25-OHD levels were associated with hypertension. The potential confounders-adjusted OC level was significantly lower in hypertensive female group than that in the female without hypertension group [β = -0.20, 95% confidence interval (95% CI) = -0.37 to -0.03, P = .02 in final adjust model]. The potential confounders-adjusted 25-OHD level was significantly lower in hypertensive male group than that in male without hypertension group (β = -0.34, 95% CI = -0.58 to -0.10, P = .01 in final adjust model). The B-ALP and TRACP.5B levels were positively associated with hypertension in all patients or subgroup analysis. However, all the correlations had no statistical significance for the B-ALP and TRACP.5B.

In conclusion, the hypertension was associated with low level of OC and 25-OHD. Hypertension probably led to low bone turnover, which may be one of the mechanisms of hypertension-related osteoporosis.
Ropivacaine continuous wound infusion after mastectomy with immediate autologous breast reconstruction
Authors: Lee Jeong Eun , Park Young Je , Lee Jeong Woo
Published: June 2021

Continuous wound infusion usually provides postoperative analgesia as a multimodal analgesia with systemic opioid use. When continuous wound infusion of local anesthetics (LA) supports successful postoperative analgesia without systemic opioid use, the side effects of opioid can be reduced. Nevertheless, continuous wound infusion after mastectomy with immediate autologous breast reconstruction leads to concerns about wound healing. This study evaluated analgesic effects and wound healing conditions of continuous wound infusion of LA compared with opioid-based, intravenous patient-controlled analgesia (IV PCA) in mastectomy with immediate autologous breast reconstruction.

This retrospective observational study included females, aged between 33 and 67 years, who underwent mastectomy with immediate autologous breast reconstruction. Sixty-five patients were enrolled. The eligible patients were placed into 2 groups for managing postoperative pain, one used continuous wound infusion with 0.5% ropivacaine (ON-Q, n = 32) and the other used a fentanyl-based IV PCA (IV PCA, n = 33). Using the electronic medical record system, the postoperative recovery profiles were examined over 5 days using a visual analogue scale (VAS), incidence of postoperative nausea and vomiting (PONV), incidence of sleep disturbance, frequency of rescue analgesic use, analgesia-related adverse events, length of hospital stay, and degree of patient satisfaction. The condition of the surgical wound was observed for 1 year after surgery.

The primary endpoint was the intensity of pain at 6 hours after surgery. The VAS was comparable between the groups (P > .05). Although recovery profiles and the degree of patient satisfaction were similar between the groups, the incidence of PONV was significantly lower in the ON-Q group than in the IV PCA group on the day of surgery and postoperative day 1. No patients had severe wound complications. The satisfaction score of analgesia in the ON-Q group was comparable with that of the patients in the IV PCA group.

This study demonstrates that single use of continuous wound infusion showed comparable analgesia with fentanyl-based IV PCA in patients who underwent mastectomy with immediate autologous breast reconstruction. Furthermore, the continuous infusion of LA directly on the surgical site did not significantly affect wound healing.
Increased photokeratitis during the coronavirus disease 2019 pandemic
Authors: Wang YingMing , Lou Jing , Ji Ye , Wang ZhenYu
Published: June 2021

An increased incidence of photokeratitis has occurred during the coronavirus disease 2019 (COVID-19) pandemic due to improper and unprotected use of ultraviolet lamps. Here, we summarize the clinical and epidemiological features of this increased incidence of photokeratitis and share advice in using health education to prevent it.

We collected data from patients diagnosed with photokeratitis from October 7, 2019 to December 1, 2019, and from February 17, 2020 to April 12, 2020, and compared the frequency of onset, site of ultraviolet radiation (UVR) exposure, reason for exposure, exposure time, and recovery time. We also implemented and evaluated multiple measures of public health education to prevent increased disease.

After the COVID-19 outbreak, the frequency of onset of photokeratitis increased significantly, especially among young women. The main reason for UVR exposure changed from welding to disinfection. The incidence sites varied, and the exposure time was longer. As a result, patients needed a longer time to recover. Positive health education was an useful and convenient measure to prevent the disease.

While the COVID-19 pandemic is ongoing, more attention should be paid to public health and implement positive measures to prevent photokeratitis.
Toujie Quwen granule used with conventional western therapy for coronavirus disease 2019
Authors: Sun Peng , Yan Dongmei , Li Bin , Tang Liping , Xu Lingxia , Wang Fei
Published: June 2021

Background:

Coronavirus disease 2019 (COVID-19) is an epidemic infectious disease resulted from 2019 novel coronavirus (2019-nCoV). Up till now, COVID-19 has swept globally. Currently, due to many high-profiled benefits, clinical studies on Toujie Quwen granule (TJQW) have been increasing. The aim of the study is to assess the efficacy and safety of TJQW used with conventional western therapy for COVID-19.

Methods:

Relevant randomized controlled trials (RCTs) were searched in Chinese and English databases, and the search time is January 2020 to May 2021. English databases include PubMed, Embase, Web of Science, and the Cochrane Library. Chinese databases include CNKI, WF, VIP, and CBM. The international clinical trial registration platform and the Chinese clinical trial registration platform of controlled trials will be searched by us from January 2020 to May 2021. According to the inclusion and exclusion criteria, screening literature, extraction data will be conducted by 2 researchers independently. Statistical analysis will be conducted using the RevMan 5.3.5 software. After screening the literature based on the inclusion and exclusion criteria, The Recommendation, Assessment, Development, and Evaluation (GRADE) system will be used to evaluate the quality of each result.

Results:

This study will provide the evidence for TJQW to be used with conventional western therapy for COVID-19.

Conclusion:

The efficacy and safety of TJQW used with conventional western therapy for COVID-19 will be assessed.

INPLASY registration number:

INPLASY202150038
Mild to moderate COVID-19 illness in adult outpatients
Authors: Blair Janis E. , Gotimukul Ashwini , Wang Fangfang , Mina Syeda A. , Bartels Helen C. , Burns Mark W. , Kole Amy E. , Vikram Holenarasipur R. , Gea-Banacloche Juan C. , Seville M. Teresa , Petty Skye A. Buckner , Vikram Avinash , Orenstein Robert
Published: June 2021

Most patients with coronavirus disease 2019 (COVID-19) have mild to moderate illness not requiring hospitalization. However, no study has detailed the evolution of symptoms in the first month of illness.

At our institution, we conducted remote (telephone and video) visits for all adult outpatients diagnosed with COVID-19 within 24 h of a positive nasopharyngeal polymerase chain test for SARS-CoV-2. We repeated regular video visits at 7, 14, and 28 days after the positive test, retrospectively reviewed the prospective data collected in the remote visits, and constructed a week by week profile of clinical illness, through week 4 of illness.

We reviewed the courses of 458 symptomatic patients diagnosed between March 12, 2020, and June 22, 2020, and characterized their weekly courses. Common initial symptoms included fever, headache, cough, and chest pain, which frequently persisted through week 3 or longer. Upper respiratory or gastrointestinal symptoms were much shorter lived, present primarily in week 1. Anosmia/ageusia peaked in weeks 2 to 3. Emergency department visits were frequent, with 128 visits in the 423 patients who were not hospitalized and 48 visits among the 35 outpatients (7.6%) who were eventually hospitalized (2 subsequently died). By the fourth week, 28.9% said their illness had completely resolved. After the 4-week follow up, 20 (4.7%) of the 423 nonhospitalized patients had further medical evaluation and management for subacute or chronic COVID-19 symptoms.

Mild to moderate outpatient COVID-19 is a prolonged illness, with evolving symptoms commonly lasting into the fourth week of illness.
Which radiograph is most accurate for assessing hip joint penetration in infra-acetabular screw placement?
Authors: Lim Eic Ju , Sakong Seungyeob , Choi Wonseok , Oh Jong-Keon , Cho Jae-Woo
Published: June 2021

Although infra-acetabular screws have been used for anterior and posterior column transfixation, a screw penetrating the hip joint can result in harmful complications. However, the most accurate intraoperative radiologic imaging tool for identifying articular penetration has not been established. The purpose of the present study was, therefore, to evaluate the consistency with which standard pelvic radiographs compared with computed tomography (CT) can be used for demonstrating articular penetration.

This retrospective review was performed between January 2015 and December 2020. We evaluated the records of patients with acetabular or pelvic fractures who underwent open reduction and internal fixation with infra-acetabular screw placement. We collected demographic data and described infra-acetabular screw placement as follows: ideal placement, articular penetration, and out of the bone. Articular penetration was assessed independently on each pelvic radiograph and compared statistically with the CT scans. Sensitivity, specificity, correct interpretation rate, and prevalence-adjusted bias-adjusted kappa (PABAK) were calculated for each radiograph.

Thirty-nine patients underwent infra-acetabular screw placement. The mean age of patients was 55 years (range, 27–90 years); there were 29 men and 10 women. One patient underwent bilateral infra-acetabular screw placement; therefore, 40 infra-acetabular screws were included in total. Six (6/40, 15%) infra-acetabular screws showed articular penetration on CT and two (2/40, 5%) showed infra-acetabular screws extending out of the bone. Hip joint penetration was correctly identified at a rate of 92.5% (95% confidence interval [CI], 79.6–98.4%) on the outlet view and 87.5% (95% CI, 73.2–95.8%) on the anteroposterior (AP) view. The PABAK for the agreement between pelvic radiographs and CT scans was 0.85 in the outlet view and 0.75 in the AP view.

The outlet view is an accurate method for detecting articular penetration of infra-acetabular screws. We recommend the insertion of an infra-acetabular screw under fluoroscopic outlet view to avoid articular penetration intraoperatively.
Panintestinal capsule endoscopy in patients with celiac disease
Authors: Foerster Friedrich , Neumann Helmut
Published: June 2021

Introduction

Capsule endoscopy has proven its utility in diagnosing villous atrophy and lymphoma in patients with celiac disease. Recently, a novel capsule endoscopy system was introduced which enables the examination of the small and large bowel. So far, it has not been evaluated in patients with celiac disease.

Objective

The primary objective of this study was to evaluate the novel panintestinal capsule endoscopy system in patients with celiac disease.

Methods

Eleven patients with histologically proven celiac disease (Marsh 0–IV), who underwent a panintestinal capsule endoscopy between March 2018 and April 2019 at our institution, were included in this retrospective single-center study. All patients performed standard bowel preparation prior to the examination. Diagnostic yield, safety and therapeutic impact were analyzed. In addition, the correlation between capsule endoscopy findings and the histology of the duodenal mucosa was assessed.

Results

Panintestinal capsule endoscopy was feasible and produced an acceptable visualization quality in all cases. Concordance of capsule endoscopy findings with the Marsh classification showed a good correlation (r = 0.8). No lymphomas were detected. Evaluation of the colon revealed diminutive polyps (median size 4 mm) in 18% of patients.

Conclusions

The novel panintestinal capsule endoscopy system shows a fair correlation with the Marsh classification in patients with celiac disease. It is also capable of identifying colon polyps. Therefore, the novel panintestinal capsule endoscopy system can be considered for patients with celiac disease and an indication for capsule endoscopy.
Neurocognitive and Motor Functions in Biliary Atresia Patients: A Cross-sectional, Prospective National Cohort Study
Authors: Ruuska Satu , Lähteenmäki Mikko , Häyrinen Taru , Kanerva Kaisa , Jahnukainen Timo , Haataja Leena , Kolho Kaija-Leena , Pakarinen Mikko P.
Published: June 2021

Objectives:

The aim of the study was to evaluate the neurocognitive and motor development of biliary atresia (BA) patients in childhood and adolescence and to identify risk factors for impaired outcome.

Methods:

We invited all BA patients between ages 1 and 20 years followed up at Helsinki University Children's Hospital in Finland between 1 January 2019 to 31 January 2020 to participate. All participants underwent age-appropriate validated neurocognitive tests. Participants between 3.0 and 16.9 years of age were assessed with the Movement Assessment Battery for children, version 2. Guardians of participants between ages 5 and 17 years filled the Five-to-Fifteen-Revised (5-15R) parental questionnaire.

Results:

The mean (±standard deviation [SD]) total intelligence quotient (IQ) of the 39 participants was 91 ± 15, lower compared with test norms (mean IQ 100 ± 15, P < 0.01). Earlier clearance of jaundice (COJ) had a positive effect on mean (±SD) total IQ (COJ <3 months 96 ± 13 vs COJ ≥3 months post-portoenterostomy 84 ± 13, P < 0.05). Out of 30 participants assessed, 13 (43%) were either at risk or fulfilled the criteria for impaired motor development. Guardians reported elevated rates of functional difficulties affecting everyday life. There were no significant differences between native liver and liver transplanted (16/41%) groups.

Conclusions:

IQ is moderately, and motor scores markedly impaired in BA patients compared with normative data. Standardised cognitive and motor assessment before school-age for all BA patients is advisable to identify individuals in need of additional support.
Thymoma: Challenges and Pitfalls in Biopsy Interpretation
Authors: Oramas Diana M. , Moran Cesar A.
Published: June 2021

The interpretation of biopsy specimens in the diagnosis of thymoma is a subject that is generally not addressed in the literature. Even though the diagnosis of thymoma may seem to be an easy step in the assessment of these tumors, in reality, it is the biopsy specimen interpretation that will be use to determine course of action in any particular patient. It may determine whether a patient is a surgical candidate or on the contrary whether a patient may be benefited the most by medical therapy. In addition, there may be conditions in which all that is required is surgical resection without any further treatment, and that the evaluation of those conditions does not necessarily required the careful pathologic staging that thymomas need. In addition, it is important to highlight that in small biopsies, there are limitations not only in terms of the cellularity and other features that may not be present in such biopsy but also the limitation in term of immunohistochemical interpretation. Herein we have attempted to highlight numerous tumoral conditions that are frequently encountered in the daily practice of mediastinal pathology, some of them pose significant problems in separating them from thymomas. Needles to say, the entire spectrum of mediastinal pathology that may at any given time mimic thymoma is well beyond the scope of this review. Furthermore, we also herein emphasize the need for proper clinical and radiologic information and correlation in order to lead to a better interpretation of the biopsy specimen. The emphasis in this review is on thymoma and their possible pitfall and shortcomings while evaluating small biopsy specimens.
Morphologic, Immunohistochemical, and Genetic Differences Between High-grade and Low-grade Fetal Adenocarcinomas of the Lung
Authors: Li Yue , Xi Shao-yan , Yong Juan-juan , Wu Xiao-yan , Yang Xin-hua , Wang Fang
Published: June 2021

Fetal adenocarcinoma of the lung (FLAC) is a rare lung tumor classified into low-grade fetal adenocarcinoma of the lung (LG-FLAC) and high-grade fetal adenocarcinoma of the lung (HG-FLAC). It remains debatable whether HG-FLAC is a subset of FLAC or a distinct subtype of the conventional lung adenocarcinoma (CLA). In this study, samples of 4 LG-FLAC and 2 HG-FLAC cases were examined, and the clinicopathologic, immunohistochemical (IHC), and mutational differences between the 2 subtypes were analyzed using literature review. Morphologically, LG-FLACs had a pure pattern with complex glandular architecture composed of cells with subnuclear and supranuclear vacuoles, mimicking a developing fetal lung. In contrast, HG-FLACs contained both fetal lung-like (FLL) and CLA components. With regard to IHC markers, β-catenin exhibited a nuclear/cytoplasmic staining pattern in LG-FLACs but a membranous staining pattern in HG-FLACs. Furthermore, p53 was expressed diffusely and strongly in HG-FLACs, whereas in LG-FLACs, p53 staining was completely absent. Using next-generation sequencing targeting a 1021-gene panel, mutations of CTNNB1 and DICER1 were detected in all 4 LG-FLAC samples, and a novel mutation, MYCN P44L, was discovered in 2 LG-FLAC samples. DNA samples of the FLL and CLA components of HG-FLACs were separately extracted and sequenced. The FLL component harbored no CTNNB1, DICER1, or MYCN mutations; moreover, the FLL genetic profile largely overlapped with that of the CLA component. The morphologic, IHC, and genetic features of HG-FLAC indicate that it is a variant of CLA rather than a subset of FLAC. Thus, HG-FLAC should be treated differently from LG-FLAC.
HIV testing criteria to reduce testing volume and increase positivity in Botswana
Authors: Rowlinson Emily , Mawandia Shreshth , Ledikwe Jenny , Bakae Odirile , Tau Lenna , Grande Matias , Seckel Laura , Mogomotsi Goabaone Pankie , Mmatli Esther , Ngombo Modise , Norman Tebogo , Golden Matthew R.
Published: June 2021

Objective:

We used data from a routine HIV testing program to develop risk scores to identify patients with undiagnosed HIV infection while reducing the number of total tests performed.

Design:

Multivariate logistic regression.

Methods:

We included demographic factors from HIV testing data collected in 134 Botswana Ministry of Health & Wellness facilities during two periods (1 October 2018– 19 August 2019 and 1 December 2019 to 30 March 2020). In period 2, the program collected additional demographic and risk factors. We randomly split each period into prediction/validation datasets and used multivariate logistic regression to identify factors associated with positivity; factors with adjusted odds ratios at least 1.5 were included in the risk score with weights equal to their coefficient. We applied a range of risk score cutoffs to validation datasets to determine tests averted, test positivity, positives missed, and costs averted.

Results:

In period 1, three factors were significantly associated with HIV positivity (coefficients range 0.44–0.87). In period 2, 12 such factors were identified (coefficients range 0.44–1.37). In period 1, application of risk score cutoff at least 1.0 would result in 50% fewer tests performed and capture 61% of positives. In period 2, a cutoff at least 1.0 would result in 13% fewer tests and capture 96% of positives; a cutoff at least 2.0 would result in 40% fewer tests and capture 83% of positives. Costs averted ranged from 12.1 to 52.3%.

Conclusion:

Botswana's testing program could decrease testing volume but may delay diagnosis of some positive patients. Whether this trade-off is worthwhile depends on operational considerations, impact of testing volume on program costs, and implications of delayed diagnoses.
Discriminating Between Premigration and Postmigration HIV Acquisition Using Surveillance Data
Authors: Pantazis Nikos , Rosinska Magdalena , van Sighem Ard , Quinten Chantal , Noori Teymur , Burns Fiona , Cortes Martins Helena , Kirwan Peter D. , O'Donnell Kate , Paraskevis Dimitrios , Sommen Cécile , Zenner Dominik , Pharris Anastasia
Published: June 2021

Background:

Migrant populations are overrepresented among persons diagnosed with HIV in the European Union and the European Economic Area. Understanding the timing of HIV acquisition (premigration or postmigration) is crucial for developing public health interventions and for producing reliable estimates of HIV incidence and the number of people living with undiagnosed HIV infection. We summarize a recently proposed method for determining the timing of HIV acquisition and apply it to both real and simulated data.

Methods:

The considered method combines estimates from a mixed model, applied to data from a large seroconverters' cohort, with biomarker measurements and individual characteristics to derive probabilities of premigration HIV acquisition within a Bayesian framework. The method is applied to a subset of data from the European Surveillance System (TESSy) and simulated data.

Findings:

Simulation study results showed good performance with the probabilities of correctly classifying a premigration case or a postmigration case being 87.4% and 80.4%, respectively. Applying the method to TESSy data, we estimated the proportions of migrants who acquired HIV in the destination country were 31.9%, 37.1%, 45.3%, and 45.2% for those originating from Africa, Europe, Asia, and other regions, respectively.

Conclusions:

Although the considered method was initially developed for cases with multiple biomarkers' measurements, its performance, when applied to data where only one CD4 count per individual is available, remains satisfactory. Application of the method to TESSy data, estimated that a substantial proportion of HIV acquisition among migrants occurs in destination countries, having important implications for public health policy and programs.