bluuebunny/crossref_metadata_2025 huggingface dataset:
Randomized clinical trial of BCG vaccine in patients with convalescent COVID‐19: Clinical evolution, adverse events, and humoral immune response
Authors: Jalalizadeh Mehrsa , Buosi Keini , Dionato Franciele A. V. , Dal Col Luciana S. B. , Giacomelli Cristiane F. , Ferrari Karen L. , Pagliarone Ana Carolina , Leme Patrícia A. F. , Maia Cristiane L. , Yadollahvandmiandoab Reza , Trinh Quoc‐Dien , Franchini Kleber G. , Bajgelman Marcio C. , Reis Leonardo O.
Published: May 2022

Background

The Bacillus Calmette–Guérin (BCG) vaccine may confer cross‐protection against viral diseases in adults. This study evaluated BCG vaccine cross‐protection in adults with convalescent coronavirus disease 2019 (COVID‐19).

Method

This was a multicenter, prospective, randomized, placebo‐controlled, double‐blind phase III study (ClinicalTrials.gov: NCT04369794). Setting: University Community Health Center and Municipal Outpatient Center in South America. Patients: a total of 378 adult patients with convalescent COVID‐19 were included. Intervention: single intradermal BCG vaccine (n = 183) and placebo (n = 195). Measurements: the primary outcome was clinical evolution. Other outcomes included adverse events and humoral immune responses for up to 6 months.

Results

A significantly higher proportion of BCG patients with anosmia and ageusia recovered at the 6‐week follow‐up visit than placebo (anosmia: 83.1% vs. 68.7% healed, p = 0.043, number needed to treat [NNT] = 6.9; ageusia: 81.2% vs. 63.4% healed, p = 0.032, NNT = 5.6). BCG also prevented the appearance of ageusia in the following weeks: seven in 113 (6.2%) BCG recipients versus 19 in 126 (15.1%) placebos, p = 0.036, NNT = 11.2. BCG did not induce any severe or systemic adverse effects. The most common and expected adverse effects were local vaccine lesions, erythema (n = 152; 86.4%), and papules (n = 111; 63.1%). Anti–severe acute respiratory syndrome coronavirus 2 humoral response measured by N protein immunoglobulin G titer and seroneutralization by interacting with the angiotensin‐converting enzyme 2 receptor suggest that the serum of BCG‐injected patients may neutralize the virus at lower specificity; however, the results were not statistically significant.

Conclusion

BCG vaccine is safe and offers cross‐protection against COVID‐19 with potential humoral response modulation. Limitations: No severely ill patients were included.
Finite Element Analysis of the Stress Distribution Associated With Different Implant Designs for Different Bone Densities
Authors: Leblebicioğlu Kurtuluş Ikbal , Kilic Kerem , Bal Burak , Kilavuz Ahmet
Published: May 2022

Purpose

The main objective of this study was to investigate the influence of implant design, bone type, and abutment angulation on stress distribution around dental implants.

Materials and methods

Two implant designs with different thread designs, but with the same length and brand were used. The three‐dimensional geometry of the bone was simulated with four different bone types, for two different abutment angulations. A 30° oblique load of 200 N was applied to the implant abutments. Maximum principal stress and minimum principal stresses were obtained for bone and Von misses stresses were obtained for dental implants.

Results

The distribution of the load was concentrated at the coronal portion of the bone and implants. The stress distributions to the D4 type bone were higher for implant models. Increased bone density and increased cortical bone thickness cause less stress on bone and implants. All implants showed a good distribution of forces for non‐axial loads, with higher stresses concentrated at the crestal region of the bone‐implant interface. In implant types using straight abutments there was a decrease in stress as the bone density decreased. The change in the abutment angle also caused an increase in stress.

Conclusions

The use of different implant threads and angled abutments affects the stress on the surrounding bone and implant. In addition, it was observed that a decrease in density in trabecular bone and a decrease in cortical bone thickness increased stress.
Effects of habitat and sampling time on bacterial community composition and diversity in the gut of the female house fly, Musca domestica Linnaeus (Diptera: Muscidae)
Authors: Neupane Saraswoti , Nayduch Dana
Published: May 2022

Adult house flies feed and breed in a variety of microbe‐rich habitats and serve as vectors for human and animal pathogens. To better understand their role in harbouring and disseminating bacteria, we characterized the composition and diversity of bacterial communities in the gut of female house flies collected from three different habitats in Kansas: agricultural (dairy farm), urban (business area dumpsters) and mixed (business located between residential and animal agriculture areas). Bacterial community composition and diversity were influenced more by the house flies' habitat than by sampling time. The most abundant taxa were also highly prevalent in the house flies collected from all three habitats, potentially representing a ‘core microbiome’ attributable to the fly's trophic and reproductive associations with substrates and food sources comprised of decaying matter and/or animal waste. Bacterial taxa associated with vertebrate guts/faeces and potential pathogens were highly abundant in agricultural fly microbial communities. Interestingly, taxa of potential pathogens were highly abundant in flies from the mixed and urban sites. House flies harboured diverse bacterial communities influenced by the habitat in which they reside, including potential human and animal pathogens, further bolstering their role in the dissemination of pathogens, and indicating their utility for pathogen surveillance.
Factors influencing Ralstonia pseudosolanacearum infection incidence and disease development in rose plants
Authors: van der Wolf Jan , Kastelein Pieter , Poleij Leo , Krijger Marjon , Mendes Odette , Sedighian Nasim , Allen Caitilyn , Bonants Peter , Kurm Viola
Published: May 2022

Glasshouse experiments were conducted to study infection and disease development in rockwool‐grown rose plants inoculated with Ralstonia pseudosolanacearum. A R. pseudosolanacearum strain isolated from rose plants was more aggressive than strains from anthurium or curcuma. The three rose cultivars tested, Avalanche, Red Naomi, and Armando, differed in susceptibility. At 20°C, the rose strain caused hardly any symptoms over a 6‐week period, whereas at 28°C typical wilt symptoms were observed within 2 weeks after stem inoculation of Armando, the most susceptible cultivar. Inoculating roots with the rose strain resulted only in weak atypical symptoms. Nevertheless, inoculating roots of cv. Armando at a relatively low inoculum dose of 104 cfu/ml led to high densities in the base of stems in one out of two experiments. R. pseudosolanacearum occasionally spread from stem inoculated plants with symptoms in rockwool slabs. This limited spread resulted in a low infection incidence, and only of plants directly adjacent to the plants with symptoms.
Self‐reported executive function problems in adults born very low birthweight
Authors: Kim Hyun Min , Horwood L. John , Harris Sarah L. , Bora Samudragupta , Darlow Brian A. , Woodward Lianne J.
Published: May 2022

Background

Executive function difficulties are common among children born very preterm and/or very low birthweight (<1500 g; VLBW), but little is known about whether they persist into adulthood.

Objectives

Examine the nature and pattern of self‐reported executive functioning at 23 and 28 years of age using data from a national cohort study of adults born VLBW and a comparison group of same‐age full‐term (FT) born adults. Also examined were associations between executive function difficulties and socio‐economic outcomes.

Methods

All infants born VLBW in New Zealand during 1986 were prospectively included in an audit of retinopathy of prematurity (n = 413), with 250 (77% of survivors) followed to median age 28 years. A comparison group of FT adults was also recruited at age 23 and followed to 28 years (n = 100). Across both adult assessments, executive functioning was assessed using the Behaviour Rating Inventory of Executive Function—Adult Version (BRIEF‐A) and analysed with semi‐parametric models to examine the effects of age and group on executive function.

Results

At 23 and 28 years, VLBW adults had increased risk of executive function impairment compared with FT adults in behaviour regulation (relative risk [CI] 2.37, 95% confidence interval (CI)1.27, 4.45), meta‐cognition (RR 6.03, 95% CI 2.18, 16.78) and global functioning (RR 3.20, 95% CI 1.40, 7.28). Impaired global executive functioning was associated with lower socio‐economic status (regression estimate [b] = −0.43, 95% CI −0.59, −0.27) and a reduced likelihood of home ownership by age 28 years (RR 0.98, 95% CI 0.96, 1.00), even after controlling for sex, ethnicity and parental socio‐economic backgrounds for both groups.

Conclusion(s)

VLBW‐born adults continue to experience more executive function difficulties in their everyday life relative to term controls at age 28 years. These difficulties were negatively associated with their socio‐economic opportunities as young adults.
Lockdown, Earnings Losses and Household Asset Buffers in Europe1
Authors: Kuypers Sarah , Marx Ive , Nolan Brian , Palomino Juan C.
Published: May 2022

Measures taken to contain the spread of COVID‐19 affected some workers' capability to work and hence earning more than others. The initial impact may have been mitigated, for instance by relying on savings and assets, but access to these buffers likely varied within and across countries. In this article we estimate COVID‐19 potential earnings losses using the Lockdown Working Ability Index and relate this to households' savings and assets observed in the Eurosystem Household Finance and Consumption Survey. We find that, without government support, households in the Euro Area could only offset on average half of their losses by relying on liquid assets and almost half would deplete their savings in doing so, although there is significant cross‐country variation. When considering the effect of income support policies, liquid assets cover on average 65 percent of the remaining losses and still 20 percent would exhaust their liquid assets on average in the Euro Area.
Last meals and final statements: Social science research on America's death row
Authors: Walliss John
Published: May 2022

Over the past two decades, a growing body of work has emerged in the social sciences that explores various aspects of capital punishment in the contemporary United States. This article reviews one strand of this literature that focuses on the execution ritual itself – specifically on condemned inmates’ last meals and the final statements that they make in the execution chamber just prior to their execution. It also discusses some of the limitations of the research and offers some ideas for future scholarship in this area.
Cytomegalovirus antiviral stewardship in solid organ transplant recipients: A new gold standard
Authors: Jorgenson Margaret R. , Descourouez Jillian L. , Kleiboeker Hanna , Goldrosen Kerry , Schulz Lucas , Rice John P. , Odorico Jon S. , Mandelbrot Didier A. , Smith Jeannina A. , Saddler Christopher M.
Published: May 2022

Purpose

Antimicrobial stewardship programs (ASPs) are essential entities that promote the appropriate use of antimicrobials, leading to improved patient outcomes and reduced resistance. Application to the immunocompromised host is a natural progression for expansion. Cytomegalovirus (CMV) infection is a common complication following solid organ transplant with significant implications on graft survival, making it an attractive ASP target. The aim of this piece is to review our center‐specific experience with the development, implementation, and maintenance of a CMV stewardship initiative at a large transplant center.

Methods

Our CMV stewardship initiative began in 2018. Herein, we review 3 years’ experience and quality‐related improvement that occurred from initiation to present state and share our stewardship algorithms. Special attention is paid to the impact of the program as well as our increased understanding of the complex interplay between prevention, treatment, and host development of CMV‐specific cell‐mediated immunity (CMI).

Results

We found our stewardship initiative not only reduced the incidence of ganciclovir resistance but also streamlined care via a centralized and structured approach. This objective, protocolized program has resulted in a significant shift away from a reactive to a proactive state and in turn, reduced CMV treatment rates (26% at initiation to 12% in the current state, p = .012).

Conclusion

A dedicated multidisciplinary team focused on CMV stewardship is imperative in providing a patient‐centered approach focused on development of CMV‐specific CMI, and as a result prevention of CMV disease. We believe these programs will be the new gold standard for CMV management.
Insights from developing and evaluating the NHS blood choices transfusion app to support junior and middle‐grade doctor decision making against guidelines
Authors: Dhesi Amanpreet Singh , Wyatt Jeremy C. , Estcourt Lise J. , McSporran Wendy , Allard Shubha
Published: May 2022

Objectives

To: 1. Develop a CE‐marked smartphone App to support doctors' concordance with transfusion guidelines in non‐bleeding adult patients, emphasising informed consent and anaemia management. 2. Test App accuracy and potential to improve user decisions.

Background

Studies have shown inappropriate use of blood components and that most junior doctors own smartphones with medical apps.

Methods

A multidisciplinary team developed App screens and logic through an iterative process based on national guidelines. Thirty medical or surgical transfusion scenarios were developed based on national guidelines and each sent to Consultant Haematologist experts in Transfusion Medicine. To obtain a clinical consensus and exclude ambiguous scenarios, their independent decisions and associated certainty were compared. The consensus clinical decision was then compared with guidance from the App. To explore potential App impact on simulated user decisions, 26 junior doctors responded to five transfusion scenarios before and after access to the App.

Results

The Blood Choices App agreed with 91% (95% CI: 72%–99%) of expert decisions with a sensitivity of 100% (69% to 100%) and specificity of 85% (55%–98%). Excluding one malfunction scenario, the App had the potential to increase correct decisions by junior doctors from 83% (73%–90%) pre‐App use to 96% (88%–99%) post (p‐value 0.013), with 90% (67%–99%) saying they would use it in practice.

Conclusions

Transfusion guidelines can be converted into an App with potential to improve guideline concordance. However, evaluating such Apps is essential to understand their limitations, detect malfunctions and prevent harm.
Benefits, companion animal zoonotic disease prevalence and public perceptions of pet ownership among people experiencing homelessness in northern California
Authors: Conway Kimberly Lynn , Jasuja Raina Marie , Hauser Naomi Elisabeth , Foley Janet Elizabeth
Published: May 2022

California has the highest proportion of unhoused individuals in the country, and up to 25% of unhoused individuals own pets, providing substantial benefits but unique challenges including access to housing, transportation and unfounded grounds for social stigmatization. Unhoused individuals and pets may also be at risk for diseases due to impaired access to sanitation facilities. The purpose of this cross‐sectional survey was to evaluate differences in perceived benefits, challenges and public perceptions among pet owners of varying housing security and the prevalence of diseases among their pets. Questionnaires were administered to housed and unhoused pet owners and pet blood screened for rickettsiosis, bartonellosis, ehrlichiosis, anaplasmosis, borreliosis, West Nile fever and heartworm. Among 147 canine and 16 feline blood samples, seropositivity of ectoparasitic diseases did not vary by housing status. Among 45 housed and 56 unhoused owners, unhoused owners were significantly more likely to report protective benefits, challenges obtaining housing, finding a flea on their pet, using bottled water for their pet and their pet sleeping in their bed. Housed owners were significantly more likely to report companionship and entertainment benefits, challenges with pet sitting and consistently administering parasite preventatives. Similar (96–98%) percentages stated they would not give up their pet for better housing and 31% of housed pet owners believed that people should not own pets if they do not have secure housing. Social stigma against unhoused pet owners is present within the community, requiring education to change public perception and guide policy regarding housing for pet owners experiencing homelessness.
Approaches for Minimizing Joints in Single-Degree-of-Freedom Origami-Based Mechanisms
Authors: Brown Nathan C. , Ynchausti Collin , Lytle Amanda , Howell Larry L. , Magleby Spencer P.
Published: May 2022

Origami patterns have been used in the design of deployable arrays. In engineering applications, paper creases are often replaced with surrogate folds by providing a hinge-like function to enable motion. Overconstraint observed in multivertex origami patterns combined with imperfect manufacturing may cause the resulting mechanisms to bind. The removal of redundant constraints decreases the likelihood of binding, may simplify the overall system, and may decrease the actuation force by reducing friction and other resistance to motion. This paper introduces a visual and iterative approach to eliminating redundant constraints in origami-based mechanisms through joint removal. Several techniques for joint removal are outlined and illustrated to reduce overconstraints in origami arrays.
Mechanical and Microstructural Characterization of Inconel 625 Welds After Corrosion at Supercritical Water Conditions
Authors: Cota-Sanchez German , Xiao Lin , Rousseau Stephane
Published: May 2022

Inconel 625 is considered one of the candidate materials for fuel cladding in the Canadian supercritical water reactor. Gas tungsten arc welding (GTAW) is being evaluated as a joining technique for SCWR fuel cladding since this method is widely used to join components in the power and nuclear industry. The thermal cycle, during the GTAW process, produces different types of microstructures that affect the material's mechanical properties. The objective of this work was to study the effect of corrosion testing at supercritical water conditions on mechanical properties of Inconel 625 base material (BM) and weldments. Tubular Inconel 625 specimens were welded using a GTAW orbital process. Corrosion testing was conducted in an autoclave at 575 °C (848.15 K) and 23.5 MPa for 500 h (1.8 × 106 s). Weld characterization included mechanical tests, optical microscopy, and scanning electron microscopy-energy dispersive X-ray spectroscopy. The composition of second phase precipitates observed during microstructural characterization was elucidated using equilibrium phase diagrams. Tensile tests showed that both BM and welds displayed an increase in strength and a decrease in ductility after corrosion testing. The ultimate tensile strength increased about 2% and 9% for the BM and the weldment, respectively. The maximum specimen elongation decreased around 35% for the BM and 45% for the weldment. The microstructure showed indications of second phase precipitation and grain morphology changes produced by both welding and corrosion processes. Results show that ductility of Inconel 625 GTAW welds is significantly reduced after exposure to supercritical water for 500 h (1.8 × 106 s).
The Impact of Sleep Inertia on Physical, Cognitive, and Subjective Performance Following a 1- or 2-Hour Afternoon Nap in Semiprofessional Athletes
Authors: Romyn Georgia , Roach Gregory D. , Lastella Michele , Miller Dean J. , Versey Nathan G. , Sargent Charli
Published: May 2022

Purpose: This study examined the impact of sleep inertia on physical, cognitive, and subjective performance immediately after a 1- or 2-hour afternoon nap opportunity. Methods: Twelve well-trained male athletes completed 3 conditions in a randomized, counterbalanced order—9 hours in bed overnight without a nap opportunity the next day (9 + 0), 8 hours in bed overnight with a 1-hour nap opportunity the next day (8 + 1), and 7 hours in bed overnight with a 2-hour nap opportunity the next day (7 + 2). Nap opportunities ended at 4:00 PM. Sleep was assessed using polysomnography. Following each condition, participants completed four 30-minute test batteries beginning at 4:15, 4:45, 5:15, and 5:45 PM. Test batteries included a warm-up, self-ratings of readiness to perform, motivation to perform and expected performance, two 10-m sprints, 2 agility tests, a 90-second response-time task, and 5 minutes of seated rest. Results: Total sleep time was not different between conditions (P = .920). There was an effect of condition on readiness (P < .001), motivation (P = .001), and expected performance (P = .004)—all 3 were lower in the 8 + 1 and 7 + 2 conditions compared with the 9 + 0 condition. There was no effect of condition on response time (P = .958), sprint time (P = .204), or agility (P = .240), but a large effect size was observed for agility. Conclusions: After waking from a nap opportunity, agility may be reduced, and athletes may feel sleepy and not ready or motivated to perform. Athletes should schedule sufficient time (∼1 h) after waking from a nap opportunity to avoid the effects of sleep inertia on performance.
Global Positioning System Watches and Electronic Journals: Are Training-Load Measures Similar in High School Cross-Country Runners?
Authors: Garcia Micah C. , Bazett-Jones David M.
Published: May 2022

Purpose: Running programs are designed to progress training loads by manipulating the duration, frequency, and/or intensity of running sessions. While some studies use journals to monitor training load, others have used wearable technology. The purpose of this study was to compare the validity of self-reported and global positioning system (GPS)–watch-derived measures of external and internal loads in high school cross-country runners. Methods: Twenty-two high school cross-country runners participated in the study during fall 2020. Participants recorded running sessions using a GPS watch and self-reported the running session using an electronic journal. External (distance and duration) and internal loads (session rating of perceived exertion [sRPE], average, and maximum heart rate) were retrieved from the GPS watch and electronic journal. Correlations compared relationships, and Bland–Altman plots compared agreements between GPS-watch-derived and self-reported measures of training loads. Results: We found moderate relationships between self-reported and GPS-watch-derived measures of external loads (distance: r = .76, moving duration: r = .74, and elapsed duration: r = .70) and poor relationships between internal loads (sRPE vs average heart rate: ρ = .11, sRPE vs maximal heart rate: ρ = .13). We found mean differences of −0.8 km (95% = –6.3 to +4.8 km) for distance, −4.5 minutes (95% = −27.8 to +33.2 min) for moving duration, and 2.7 minutes (95% = –27.8 min to +33.2 min) for elapsed duration. Conclusions: High school runners overreported running distance and duration using self-reports, and self-reported and GPS-watch-derived measures of internal loads demonstrated poor agreement. Coaches and clinicians should use caution when comparing results from studies using different methods of monitoring training loads.
BacMam Expressing Highly Glycosylated Porcine Interferon Alpha Induces Robust Antiviral and Adjuvant Effects against Foot-and-Mouth Disease Virus in Pigs
Authors: Kim Aro , Lee Gyeongmin , Hwang Ji-Hyeon , Park Jong-Hyeon , Lee Min Ja , Kim Byounghan , Kim Su-Mi
Published: May 2022

Early inhibition of foot-and-mouth disease (FMD) virus (FMDV) replication in pigs is highly desirable as FMDV transmission and shedding rates are higher in pigs than in cattle. However, commercial FMD vaccines require at least 4 to 7 days postvaccination (dpv) for protection, and animals are vulnerable to heterologous viruses before acquiring high antibody levels after the second vaccination.
Regulation of Translation by Lysine Acetylation in Escherichia coli
Authors: Feid Sarah C. , Walukiewicz Hanna E. , Wang Xiaoyi , Nakayasu Ernesto S. , Rao Christopher V. , Wolfe Alan J.
Published: May 2022

Numerous cellular processes are regulated in response to the metabolic state of the cell. One such regulatory mechanism involves lysine acetylation, a covalent modification involving the transfer of an acetyl group from central metabolite acetyl-coenzyme A or acetyl phosphate to a lysine residue in a protein.
Contribution of Membrane Vesicle to Reprogramming of Bacterial Membrane Fluidity in Pseudomonas aeruginosa
Authors: Mozaheb Negar , Van Der Smissen Patrick , Opsomer Tomas , Mignolet Eric , Terrasi Romano , Paquot Adrien , Larondelle Yvan , Dehaen Wim , Muccioli Giulio G. , Mingeot-Leclercq Marie-Paule
Published: May 2022

Membrane rigidification is a survival strategy in
Pseudomonas aeruginosa
exposed to stress. Despite various studies dedicated to the mechanism behind this phenomenon, not much attention has been paid to the contribution of the bacterial membrane vesicles (MVs) in this regard.
Superinfection Exclusion of Alphaherpesviruses Interferes with Virion Trafficking
Authors: Cwick James P. , Owen Jonathan E. , Kochetkova Irina , Hain Kyle S. , Horssen Nick Van , Taylor Matthew P.
Published: May 2022

Most viruses utilize a form of superinfection exclusion to conserve resources and control population dynamics. gD-dependent superinfection exclusion in alphaherpesviruses is well documented. However, the undercharacterized gD-independent SIE provides new insight into how alphaherpesviruses limit sequential infection.
PqsE Expands and Differentially Modulates the RhlR Quorum Sensing Regulon in Pseudomonas aeruginosa
Authors: Letizia Morgana , Mellini Marta , Fortuna Alessandra , Visca Paolo , Imperi Francesco , Leoni Livia , Rampioni Giordano
Published: May 2022

The ability of
Pseudomonas aeruginosa
to cause difficult-to-treat infections relies on its capacity to fine-tune the expression of multiple virulence traits via the
las
,
rhl
, and
pqs
QS systems. Both the
pqs
effector protein PqsE and the
rhl
transcriptional regulator RhlR are required for full production of key virulence factors
in vitro
and pathogenicity
in vivo
.
Circular RNAs Represent a Novel Class of Human Cytomegalovirus Transcripts
Authors: Yang Shaomin , Liu Xiaolian , Wang Mei , Cao Di , Jaijyan Dabbu Kumar , Enescu Nicole , Liu Jian , Wu Songbin , Wang Sashuang , Sun Wuping , Xiao Lizu , Gu Alison , Li Yaolan , Zhou Hong , Tyagi Sanjay , Wu Jianguo , Tang Qiyi , Zhu Hua
Published: May 2022

HCMV infects 40% to 100% of the human population globally and may be a life-threatening pathogen in immunocompromised individuals. CircRNA is a family of unique RNA that is the most newly found and remains unknown in many aspects.
How to use autoantibodies in suspected paediatric rheumatic disease
Authors: Keightley Jaclyn , Walsh Jo , Bland Ruth M
Published: May 2022

Autoantibodies can be an important indicator of paediatric rheumatic disease and useful in establishing a diagnosis. However, autoantibodies may be requested in cases where the patient does not have clinical features strongly suggestive of a rheumatic disease. This can lead to further unnecessary investigations, specialist referral and undue anxiety for the family. The aim of this article is to provide guidance for when it is appropriate to request autoantibodies, which ones to perform and how to interpret the results.
Follicular dendritic cell sarcoma of the thigh: a clinicopathological report and management approach
Authors: Rajan Rajasree , Roshni Divya Gireesan , Mathew Suzann Mary , Jojo Annie , Nair Haridas Mohanachandran , Kottarathil Vijayakumar Dehannathparambil
Published: May 2022

Follicular dendritic cells are antigen-presenting immune accessory cells of mesenchymal origin. Follicular dendritic cell sarcomas (FDCS) typically occur in nodal and extranodal sites. However, presentation in the extremity has rarely been reported. A woman in her 60s had a painless, slow-growing right posterior thigh swelling, which had been present for 9 months. Imaging revealed a subcutaneous lesion in the posterior aspect of the right mid-thigh. Fine-needle aspiration cytology from the lesion was suggestive of a malignant spindle cell neoplasm, and she underwent its wide local excision. Immunohistochemistry showed expression of epithelial membrane antigen and CD35, but an absence of cytokeratin, desmin, CD23 and S100. The Ki-67 index was low and a diagnosis of FDCS was made. The lack of clinical guidelines was a challenge in the treatment of this rare case. A multidisciplinary board discussion played a critical role in the planning of the patient’s adjuvant treatment.
Traumatic avulsion of the tricuspid valve: an unusual cardiac complication of an equine accident
Authors: White Alexandra , Cullen Paul , Hinchion John
Published: May 2022

A stablehand in his 20s presented with increasing dyspnoea on exertion and chest pain months after being kicked directly in the chest by a horse. Further investigations revealed severe isolated, primary tricuspid regurgitation due to partial avulsion of the anterior leaflet. Open surgical repair was successfully performed from which he recovered uneventfully with resolution of his symptoms and minimal residual tricuspid regurgitation. Although uncommon, blunt force trauma to the chest is becoming increasingly recognised as a rare cause of tricuspid regurgitation. Symptoms may be insidious, and a high index of suspicion is required to avoid missing the diagnosis.
How inequity threatens the lives of pregnant women: barriers to accessing health services during an incomplete miscarriage in rural southern Mexico
Authors: Gutiérrez-Peláez Karen , Aranda Zeus , Jiménez-Peña Andrea , Mata-González Hellen
Published: May 2022

Globally, obstetric emergencies majorly account for maternal morbidity and mortality. Guerrero, Oaxaca and Chiapas accounted for more than 13% of maternal deaths in the country in 2021. Obstetric haemorrhage was the leading cause of maternal death after COVID-19 infection and hypertensive disorders. This case highlights the clinical course and social determinants of health that limited access to health services in a young woman with an obstetric emergency in rural southern Mexico. The case describes common challenges during an obstetric emergency in resource-poor settings, such as timely referral to a second level of care. Our analysis identifies the social determinants of health behind the slow and inadequate emergency response. Additionally, we present several interventions that can be implemented in low-resource settings for strengthening the response to obstetric emergencies at the primary and secondary levels of care.
Rare case of Stevens-Johnson syndrome with bronchiolitis obliterans as a chronic complication
Authors: Mitani Kazuki , Hida Shinya , Fujino Hisanori , Sumimoto Shinichi
Published: May 2022

A young girl in her teens presented with fever, rashes and various mucocutaneous symptoms. Flat erythematous macules were seen mainly on the limbs, without blisters or skin detachments. The lips were swollen with crusts and haemorrhage. The oral cavity and pharynx showed ulcerative lesions with exudate. Severe bilateral ocular lesions with pseudomembrane formation and corneal epithelial defects were present. Also, urogenital lesion and gastrointestinal symptoms with frequent haematochezia were observed. Her symptoms and pathological findings were consistent with Stevens-Johnson syndrome. She was treated with prednisolone and methylprednisolone pulse therapy. Her ocular and cutaneous symptoms improved without severe chronic complications. However, 1 month later, she developed dyspnoea, and a pulmonary function test revealed severe obstructive ventilation disorder. After discharge, she was regularly followed up for respiratory complications. High-resolution chest CT performed 9 months after onset revealed mosaic perfusions and bronchiectasis, consistent with bronchiolitis obliterans.
Large free-floating right atrial mass presenting as intermediate-high risk pulmonary embolism: is reperfusion a better definite strategy?
Authors: Martinho Mariana , Calé Rita , Ferreira Filipa , Pereira Helder
Published: May 2022

We present a woman in her 60s diagnosed with an intermediate-high risk acute pulmonary embolism and a large, non-serpiginous right atrial (RA) mass. Conservative therapy with unfractionated heparin was started and further assessment of the mass with cardiac MRI suggested thrombus as the most likely diagnosis. Despite 1 month of anticoagulation, mass size remained stable and surgical RA embolectomy and left pulmonary endarterectomy was performed. Histopathology confirmed thrombus. The patient died 10 weeks after surgery.
Minimally invasive combined approach robotic thymectomy and transcervical total thyroidectomy
Authors: Crudeli Connor , Reid Lisa , Burg Jennifer , Shersher David
Published: May 2022

Myasthenia gravis (MG) is the most common autoimmune disorder affecting the neuromuscular junction in the USA. It is not uncommon for these patients to have concomitant autoimmune diseases including autoimmune thyroid disease. We describe here our method of performing a reproducible robotically assisted one-stage thymectomy and thyroidectomy. An African-American woman presented to our institution with a medical history of hypertension, morbid obesity, type 2 diabetes mellitus, symptomatic MG and symptomatic non-toxic substernal multinodular goitre. A one-stage minimally invasive right-sided robotic radical thymectomy and a transcervical total thyroidectomy with excision of the substernal goitre was successfully performed. The treatment of thyroid and thymus pathologies varies drastically from medical observation to surgery. This combined approach surgery clearly benefits the patient by offering similar operative time, fewer operative and postoperative recovery experiences, decreased anaesthesia risks associated with MG patients through fewer intubations, and a faster return to baseline function.
Population-based incidence of intraocular tumours in Olmsted County, Minnesota
Authors: Oyemade Kafayat A , Xu Timothy T , Lopez Dominguez Johanny , Dumbrava Mihai G , Hodge David O , White Launia J , Dalvin Lauren A
Published: May 2022

Background/aims

To determine population-based incidence of intraocular tumours in Olmsted County, Minnesota.

Methods

Record review of the Rochester Epidemiology Project medical record linkage system from 1 January 2006 to 31 December 2015 for patient demographics, tumour type by clinical diagnosis and presence or absence of confirmation by histopathology. The incidence rate of any intraocular tumour and of each tumour type was calculated per million person-years. Poisson regression analysis was used to analyse changes in incidence over time.

Results

There were 948 patients diagnosed with intraocular tumours resulting in an age-adjusted and sex-adjusted incidence rate of 727.5 per million (95% CI: 680.8 to 774.2, p<0.05). Most tumours were benign (953, 98%). Of the benign lesions, melanocytic lesions were the majority (942, 97%), with adjusted incidence rates of 646.9 (95% CI: 602.8 to 691.1) for choroidal nevus and 55.8 (95% CI: 43.2 to 64.8) for iris nevus. Malignant lesions were rare (16, 2%) with 13 cases of choroidal melanoma and 1 case each of iris melanoma, retinal leukaemic infiltration and metastasis. The adjusted incidence rate for choroidal melanoma was 7.1 (95% CI: 2.5 to 11.8).

Conclusion

In a population-based setting, most intraocular tumours are benign and melanocytic. Although malignant lesions are less common, it is important to remain vigilant with appropriate monitoring given the potential for vision loss and life-threatening malignancy.
Association between statin use and rates of structural and functional loss in glaucoma
Authors: Kang Jessica Minjy , Jammal Alessandro Adad , Medeiros Felipe A
Published: May 2022

Background/aims

To evaluate the association between statin use and rates of standard automated perimetry (SAP) and retinal nerve fibre layer (RNFL) change in patients with glaucoma and glaucoma suspects.

Methods

This retrospective cohort study included subjects from the Duke Glaucoma Registry with primary open-angle glaucoma and glaucoma suspects. Subjects were assigned to groups according to history of statin use. Rates of change in SAP mean deviation (MD) and spectral-domain optical coherence tomography (SD OCT) RNFL thickness over time were estimated using linear mixed models and compared in the statin versus control groups. The effect of duration of statin use was also assessed. Patients with glaucoma versus suspects were analysed separately. Analyses were adjusted for potential confounding factors of age, gender, race, intraocular pressure and follow-up time.

Results

The study included 10 049 SAP tests and 14 198 SD OCT tests from 3007 eyes (1978 patients) followed for an average of 4.7±2.0 years. Of these, 775 subjects (1179 eyes) had a history of statin use. No difference in rates of change was seen between the statin versus control groups for MD (−0.07±0.16 dB/year vs −0.07±0.15 dB/year; p=0.873, respectively) or RNFL thickness (−0.70±0.60 µm/year vs −0.70±0.61 µm/year; p=0.923, respectively). Multivariable models controlling for potential confounders showed no significant association between duration of statin use and rates of MD or RNFL thickness change.

Conclusions

We did not find a statistically significant association between statin use or duration of statin use and rates of structural and functional change in those with glaucoma or glaucoma suspects.
Incidence and clinical characteristics of paediatric keratitis
Authors: Tanke Laurel B , Kim Eric J , Butterfield Samantha D , Ashby Grayson B , Bothun Erick D , Hodge David O , Mohney Brian G
Published: May 2022

Background/aims

To report the incidence and clinical characteristics of paediatric keratitis diagnosed over a 10-year period in a well-defined population.

Design

Retrospective, population-based study.

Methods

Setting: multicentre. Population: patients (<19 years) diagnosed with keratitis as residents of Olmsted County from 1 January 2000, through 31 December 2009. Main outcome measures: calculated annual age-specific and gender-specific incidence rates, demographic information and initial and final visual acuity.

Results

A total of 294 diagnoses of keratitis occurred in 285 children during the 10-year period, yielding an incidence of 78.0 per 100 000 younger than 19 years (95% CI 69.0 to 87.1) or approximately 1 in 1282 children. The incidence increased throughout the 10-year study period (p<0.001). The mean age at diagnosis was 15.3 years (range, 0.2–18.9) and 172 (60.4%) were women. The observed forms included keratitis due to contact lens wear in 134 (45.6%), infectious keratitis in 72 (24.5%), keratitis not otherwise specified in 65 (22.1%) and keratitis sicca in 23 (7.8%). The visual acuity was reduced to ≤20/40 in 61 (21.4) of the 285 patients at the initial examination and in 24 (8.4%) at the final examination. Children with infectious keratitis had the poorest presenting vision and the best final vision, whereas the reverse was true for those with keratitis sicca.

Conclusions

Keratitis, regardless of aetiology, was observed in approximately 1 in 1300 children by 19 years of age in this population-based cohort. Nearly half were related to contact lens wear and a decrease in vision to ≤ 20/40 occurred in 1 in 12 patients.
Changes in glaucoma management following visual field testing and optical coherence tomography
Authors: Sun Michelle T. , Singh Kuldev , Wang Sophia Y.
Published: May 2022

Background

Optimal utilisation of investigations in glaucoma management remains unclear. We aimed to assess whether a temporal association exists between such testing and management changes.

Methods

Retrospective observational study using nationwide healthcare insurance claims database. Glaucoma outpatient encounters from patients aged ≥40 years with/without Humphrey visual field (HVF) and/or optical coherence tomography (OCT) were identified. An encounter was considered associated with an intervention if surgery occurred within 90 days, or if medication change or laser trabeculoplasty (LT) occurred within 30 days.

Results

12 669 324 outpatient encounters of 1 863 748 individuals from 2003 to 2020 were included. HVF and OCT was performed during 32.8% and 22.2% of encounters respectively. Of the 36 763 (0.3%) encounters preceding surgery, 28.1% included HVF, 11.9% had OCT and 8.5% both. 79 181 (0.6%) visits preceded LT, of which 28.2% had HVF, 13.2% OCT and 9.3% both. Of the 515 899 (4.5%) encounters preceding medication changes, 29.1% had HVF, 16.7% OCT and 12.2% both. Compared with encounters with no investigations, those with HVF and/or OCT were associated with a 49% increased odds of a management change (p<0.001). In multivariate analyses, compared with encounters without investigations, visits with HVF alone had higher odds of subsequent surgery and LT, while HVF and/or OCT were associated with higher odds of medication change (p<0.001 for all).

Conclusion

Glaucoma therapeutic changes occurred following approximately 5% of outpatient encounters. Surgery and LT were more likely to occur following a visit with a HVF rather than an OCT, while either investigation was associated with a higher odds of medication change.
Better TIR, HbA1c, and less hypoglycemia in closed-loop insulin system in patients with type 1 diabetes: a meta-analysis
Authors: Jiao Xiaojuan , Shen Yunfeng , Chen Yifa
Published: May 2022

The study aimed to evaluate the effectiveness and safety of long-term use of closed-loop insulin system (CLS) in non-pregnant patients with type 1 diabetes mellitus (T1DM) using systematic review and meta-analysis. A literature search was performed using MEDLINE, EMBASE, and the Cochrane Library. Randomized controlled trials (RCTs) on long-term use (not less than 8 weeks) of CLS in patients with T1DM were selected. Meta-analysis was performed with RevMan V.5.3.5 to compare CLS with controls (continuous subcutaneous insulin infusion with blinded continuous glucose monitoring or unblinded sensor-augmented pump therapy or multiple daily injections or predictive low-glucose suspend system) in adults and children with type 1 diabetes. Research quality evaluation was conducted using the Cochrane risk of bias tool. Eleven RCTs (817 patients) that satisfied the eligibility criteria were included in the meta-analysis. Compared with controls, the CLS group had a favorable effect on the proportion of time with sensor glucose level in 3.9–10 mmol/L (10.32%, 8.70% to 11.95%), above 10 mmol/L (−8.89%, −10.57% to −7.22%), or below 3.9 mmol/L (−1.09%, −1.54% to −0.64%) over 24 hours. The CLS group also had lower glycated hemoglobin levels (−0.30%, −0.41% to −0.19%), and glucose variability, coefficient of variation of glucose, and SD were lower by 1.41 (−2.38 to −0.44, p=0.004) and 6.37 mg/dL (−9.19 mg/dL to −3.55 mg/dL, p<0.00001). There were no significant differences between the CLS and the control group in terms of daily insulin dose, quality of life assessment, and satisfaction with diabetes treatment. CLS is a better solution than control treatment in optimizing blood glucose management in patients with T1DM. CLS could become a common means of treating T1DM in clinical practice.
Prevalence of long-term complications in inpatients with diabetes mellitus in China: a nationwide tertiary hospital-based study
Authors: Liu Yihao , Ning Xin , Zhang Luyao , Long Jianyan , Liang Ruiming , Peng Sui , Wang Haibo , Li Yanbing , Chen Wei , Xiao Haipeng
Published: May 2022

Introduction

There is absence of national data to estimate the prevalence of long-term diabetic complications among inpatients with diabetes in tertiary hospitals in China.

Research design and methods

Using the national Hospital Quality Monitoring System database, inpatients with type 1 diabetes mellitus (T1DM) and type 2 diabetes mellitus (T2DM) were identified by the International Classification of Diseases-10 code, and the temporal trends of microvascular and macrovascular complications 2013–2017 were calculated, and then the risk factors were analysed by multivariate regression analysis.

Results

A total of 92 413 inpatients with T1DM and 6 094 038 inpatients with T2DM were identified in 2013–2017. The proportions of inpatients with microvascular complications in inpatients with T1DM and T2DM increased from 29.9% and 19.0% in 2013 to 31.6% and 21.0% in 2017, respectively. The proportions of inpatients with macrovascular complications in inpatients with T1DM and T2DM increased from 7.3% and 14.5% in 2013 to 13.2% and 18.4% in 2017, respectively. Hypertension and hyperlipidemia were risk factors for both microvascular and macrovascular complications. Among inpatients with T1DM, the adjusted ORs of microvascular complications increased in 40–49 age group and Northeast region, while older age, male and North region were risks factor for macrovascular complications. Among inpatients with T2DM, the ORs of microvascular complications increased in 40–49 age group, female, urban and North region, while older age, male, urban and Southwest region were risks factor for macrovascular complications.

Conclusions

The proportions of long-term complications of inpatients with diabetes in China increased in 2013–2017. Efforts are needed to improve the management of patients with diabetes in China.
Offloading devices for neuropathic foot ulcers in adult persons with type 1 or type 2 diabetes: a rapid review with meta-analysis and trial sequential analysis of randomized controlled trials
Authors: Okoli George N , Rabbani Rasheda , Lam Otto L T , Askin Nicole , Horsley Tanya , Bayliss Lorraine , Tiszovszky Ildiko , Embil John M , Abou-Setta Ahmed M
Published: May 2022

Introduction

Healing time for neuropathic planter foot ulcers (NPFUs) in persons with diabetes may be reduced through use of non-removable fiberglass total contact casting (F-TCC) compared with removable cast walkers (RCWs), although the evidence base is still growing.

Research design and methods

We conducted a rapid review and systematically searched for, and critically assessed, randomized controlled trials (RCTs) that compared the efficacy of F-TCC versus RCW, focusing on the time to ulcer healing in adult persons (18+ years) with NPFUs and type 1 or type 2 diabetes. We meta-analysed the mean differences and associated 95% CIs using an inverse variance, random-effects model. We also conducted a trial sequential analysis (TSA) to assess if the available evidence is up to the required information size for a robust conclusion. We assessed and quantified statistical heterogeneity between the included studies using theI2statistic.

Results

Out of 102 retrieved citations, five RCTs met the eligibility criteria. Participants’ inclusion in relation to stage of ulcer was highly variable as was peripheral neuropathy complicating comparisons. F-TCC appeared to present a shorter ulcer healing time (−5.42 days, 95% CI −9.66 days to −1.17 days;I29.9%; 5 RCTs; 169 participants) compared with RCW. This finding was supported by the TSA.

Conclusions

There is limited evidence from RCTs to suggest that F-TCC has a shorter ulcer healing time compared with RCW among adults with diabetic NPFUs. Properly designed and conducted RCTs are still required for a stronger evidence base.