bluuebunny/crossref_metadata_2025 huggingface dataset:
Ali Abdullah Saleh’s Regime, Unification, and al-Qaeda
Authors: Orkaby Asher
Published: February 2022

This chapter evaluates how Ali Abdullah Saleh was appointed president of Yemen in July of 1978.
In the months following the assassination of both al-Ghashmi and Rubayya Ali, the armies of both
North and South Yemen massed along the border and numerous threats were made on Saleh's life.
When it seemed as if border tensions might escalate into a larger conflict that could imperil
the Saudi Kingdom, the United States made a fateful decision to ship tanks and anti-tank
missiles to Saleh, thus turning the tide of Yemen's North-South conflict. In the aftermath of
the Iranian Revolution that had taken place earlier in 1979, the United States chose to support
North Yemen out of concern for Soviet designs on the Middle East. The declaration of support for
Saleh both saved his presidency and marked the beginning of a roller-coaster relationship with
the Americans over the next three decades. The chapter then looks at the 1986 South Yemen civil
war; how and why Saleh united Yemen in 1990; and why Saleh supported Saddam Hussein during the
First Gulf War. It also considers Saleh's relationship with the Islamists in Yemen, and when
al-Qaeda of the Arabian Peninsula was founded.
Arabian Minorities
Authors: Orkaby Asher
Published: February 2022

This chapter addresses the minorities living in Yemen. There is a long tradition of migration
between the Horn of Africa and Yemen. This cross-Red Sea migration has led to the prevalence of
mixed households of Yemenis, Eritreans, Ethiopians, Djiboutians, and Somalis. Known as
muwalladeen, or the birthed, these groups are subject to covert
discrimination by those who do not view them as "pure Yemenis," despite legislation abolishing
the country's traditional social hierarchy. Aside from the African refugees in Yemen, there is a
small population of Jews currently living under government protection in Sana'a. The chapter
then looks at how the Jews were treated by local ruling authorities; the role they played in
Yemen's economy; why they left the country; and whether there is a connection between the Jewish
Yemeni diaspora and Yemen. It also considers other religious minorities in Yemen.
The Arab Spring in Yemen
Authors: Orkaby Asher
Published: February 2022

This chapter explores the Arab Spring in Yemen, which arrived as a wave of popular dissent
directed against the regime of Ali Abdullah Saleh in early 2011. What made this round of public
demonstrations unique was both the scale of the participants in terms of sheer numbers and their
ability to cut across political, religious, and gender boundaries in their opposition to the
president. Although the movement was termed the "youth" revolution, participants were of all
ages, united in their economic, societal, and political marginalization and disenfranchisement.
Debating the future of Yemen was no longer limited to conversations held among the intellectual
and military elite but was now conducted openly through social media, made available to any
Yemeni with an internet connection. The new generation of Yemeni youth, in particular, was given
the space and tools to participate in politics outside the purview of their elders. The very
location of the protests in Change Square (Sahat alTaghiyir), in front of the new Sana'a
University campus, reflected the movement's youth and educational aspirations. The chapter then
looks at the main highlights of the protests in Yemen; how the protests were finally dissolved;
and what kind of transitional government emerged.
Airway misadventures in adult critical care: a concise narrative review of managing lost or compromised artificial airways
Authors: Budde Anna M. , Kadar Rachel B. , Jabaley Craig S.
Published: February 2022

Purpose of review

Loss or compromise of artificial airways in critically ill adults can lead to serious adverse events, including death. In contrast to primary emergency airway management, the optimal management of such scenarios may not be well defined or appreciated.

Recent findings

Endotracheal tube cuff leaks may compromise both oxygenation and ventilation, and supraglottic cuff position must first be recognized and distinguished from other reasons for gas leakage during positive pressure ventilation. Although definitive management involves tube exchange, if direct visualization is possible temporizing measures can often be considered. Unplanned extubation confers variable and context-specific risks depending on patient anatomy and physiological status. Because risk factors for unplanned extubation are well established, bundled interventions can be employed for mitigation. Tracheostomy tube dislodgement accounts for a substantial proportion of death and disability related to airway management in critical care settings. Consensus guidelines and algorithmic management of such scenarios are key elements of risk mitigation.

Management of lost or otherwise compromised artificial airways is a key skill set for adult critical care clinicians alongside primary emergency airway management.
When is it safe to resume anticoagulation in traumatic brain injury?
Authors: Ng Ireana C. , Barnes Christopher , Biswas Subarna , Wright David , Dagal Arman
Published: February 2022

Purpose of review

When to resume or initiate anticoagulation therapy following traumatic brain injury (TBI) is controversial. This summary describes the latest evidence to guide best practice.

Recent findings

Following trauma, prophylactic, and therapeutic anticoagulation (TAC) have been widely encouraged to prevent major comorbidities such as pulmonary embolism and deep venous thrombosis. Increased rebleeding risk and potentially catastrophic outcome from initiation of anticoagulation treatment in TBI are mainly influenced by institutional guidelines or physician preference in the absence of level I or II recommendations. In recent years, there has been an increasing number of TBI in the elderly population on anticoagulation for other medical conditions; this complicates the decision and timing to restart anticoagulation after the injury.

Strategies and timing to start prophylactic and TAC differ significantly between institutions and physicians. Each TBI patient should be evaluated on a case-by-case basis on when to start anticoagulation. More investigation is required to guide best practice.
Negative Mood Regulation Expectancies (NMRE) as a Moderator of the Association Between Stress and Treatment Outcomes in Interdisciplinary Chronic Pain Treatment
Authors: Blaettler Larissa T. , Goméz Penedo Juan M. , Schwegler Kyrill , Egloff Niklaus , grosse Holtforth Martin
Published: February 2022

Objective:

Negative mood regulation expectancies (NMRE) describe the expectancies of an individual regarding his or her ability to regulate or reduce negative mood states by certain cognitive or behavioral strategies. NMRE are closely associated with the actual emotion regulation and potentially buffer the negative psychological and physical health consequences of stress. In the context of chronic pain, stress plays a central role, as long-term stress can have additional negative consequences regarding pain and its progression. The present study investigated the relationship of NMRE with treatment outcome, and more importantly, its buffering role in the association between stress and treatment outcomes.

Method:

Two hundred six chronic pain inpatients (fulfilling the International Classification of Diseases, 10th Revision [ICD-10] diagnosis of F45.41) of an interdisciplinary treatment completed standardized self-report questionnaires at intake and discharge. Hierarchical linear regression analyses were used to test the main effects of the Negative Mood Regulation Scale—Short Form on pain intensity, pain-related disability, and psychological distress as treatment outcomes and its moderating role in the association of stress and the 3 outcome measures.

Results:

A significant main effect of NMRE on treatment outcome was only found for psychological distress. However, for all 3 outcome measures, a significant moderating effect of NMRE on the association between stress level and treatment outcome was found.

Discussion:

NMRE appear to play an important role for the outcome of inpatient treatment for chronic pain. Due to their buffering effect on the negative association between stress and therapy outcome, they should be targeted in the treatment of chronic pain.
The Role of Spinal Cord Stimulation in Reducing Opioid Use in the Setting of Chronic Neuropathic Pain
Authors: Smith Cynthia A. , Roman Jessica , Mammis Antonios
Published: February 2022

Objective:

The aim was to examine research on the impact of spinal cord stimulation (SCS) on the reduction of preimplantation opioid dose and what preimplantation opioid dose is associated with a reduction or discontinuation of opioid use postimplantation.

Methods:

Systematic review of literature from PubMed, Web of Science, and Ovid Medline search of “opioid” and “pain” and “spinal cord stimulator.” Inclusion criteria included original research providing data on SCS preimplantation opioid dosing and 12 months postimplantation opioid dosing or that correlated specific preimplantation opioid dose or opioid dose cutoff with significantly increased likelihood of opioid use discontinuation at 12 months postimplantation.

Results:

Systematic review of the literature yielded 17 studies providing data on pre-SCS and post-SCS implantation dose and 4 providing data on the preimplantation opioid dose that significantly increased likelihood of opioid use discontinuation at 12 months postimplantation. Data from included studies indicated that SCS is an effective tool in reducing opioid dose from preimplantation levels at 12 months postimplantation. Data preliminarily supports the assertion that initiation of SCS at a preimplantation opioid dose of ≤20 to ≤42.5 morphine milligram equivalents increases the likelihood of postimplantation elimination of opioid use.

Discussion:

SCS is an effective treatment for many types of chronic pain and can reduce or eliminate chronic opioid use. Preimplantation opioid dose may impact discontinuation of opioid use postimplantation and the effectiveness of SCS in the relief of chronic pain. More research is needed to support and strengthen clinical recommendations for initiation of SCS use at lower daily opioid dose.
Spinal screening, malignancy, medical therapy, and surgical correction of deformity in pediatric patients with neurofibromatosis type 1: a systematic review
Authors: Suresh Krishna V. , Xu Amy L. , Groves Mari L. , Sponseller Paul D.
Published: February 2022

The objective of this systematic review was to synthesize evidence regarding spinal screening recommendations, types of spinal and thoracic neurofibromatosis type 1 (NF1) tumors, medical therapy for NF1-associated neoplasms, and treatment with magnetically controlled growing rods (MCGRs) or cervical kyphosis correction in pediatric patients with NF1.

We queried PubMed, Embase, Cochrane Library, Web of Science, Scopus, Clinicaltrials.gov, and medRxiv for studies reporting spinal screening recommendations, prognosis, and medical therapy for NF1-associated spinal tumors and MCGR use or cervical kyphosis correction in pediatric NF1 patients, yielding 758 publications, 33 of which were included.

There is no consensus on spinal screening interval. Computed tomography is recommended for postoperative monitoring. Patients with gangliomas and spinal neurofibromas had nearly complete symptom resolution after resection. Plexiform neurofibromas were most commonly treated with resection and laminectomy; some patients reported tumor enlargement after intervention. Malignant nerve sheath tumors have high rates of metastasis even after chemoradiation and resection. MEK-inhibitors produced limited regression in tumor size. Sirolimus and thalidomide reduced tumor size but caused more severe adverse effects than MEK-inhibitors. Improvements in major curves and T1–T12 height gain were reported after MCGR intervention. Anteroposterior arthrodesis produced the greatest correction of dystrophic cervical kyphosis.

There may be value in establishing standardized spinal screening protocols for pediatric NF1 patients. Surgical correction of NF1-associated spinal deformity is effective, though current medical therapies for spinal tumors have limited success. Areas for further investigation include determining appropriate screening intervals, choice of medical therapy for spinal tumors, and long-term outcomes of MCGRs. Level of Evidence: IV.
Incidence and Risk Factors for Heterotopic Ossification in a Matched Cohort Adolescent Population Undergoing Hip Arthroscopy
Authors: Feroe Aliya G. , Hassan Mahad M. , Flaugh Rachel A. , Maier Stephen P. , Cook Danielle L. , Yen Yi-Meng , Kocher Mininder S.
Published: February 2022

Background:

Heterotopic ossification (HO) is a known complication after hip arthroscopy in adults, positively associated with larger cam resection, male sex, older age, and obesity, and negatively associated with nonsteroidal anti-inflammatory drug (NSAID) use and capsular closure. However, it has not been well-documented in adolescents. The purpose of this study was to determine the incidence and risk factors for the development of HO in adolescent patients undergoing hip arthroscopy.

Methods:

Clinical and operative records from a pediatric institution were queried to identify patients aged 21 years or younger who underwent hip arthroscopy between 2008 and 2018. The 27 cases that developed HO were matched 1:4 on age and sex with 107 controls. The bivariate analysis assessed the relationship between demographic and perioperative factors on the development of HO. Multivariable logistic regression evaluated the association between prophylactic NSAID use (indomethacin 75 mg, 3 wk) and HO, controlling for surgeon and extent of cam resection (change in alpha angle).

Results:

Twenty-seven of 595 (4.5%) hips that underwent hip arthroscopy developed HO within 2 years of surgery. Prophylactic indomethacin was not significantly associated with developing HO [30% (8/27), P=0.83], after controlling for surgeon and extent of cam resection—nor were age, sex, and body mass index percentile. Of patients who developed HO, a smaller proportion underwent reoperation for HO excision among those who received prophylactic indomethacin than those who did not [13% (1/8) vs. 63% (12/19), P=0.03].

Conclusions:

The incidence of HO within 2 years of hip arthroscopy in this adolescent population was 4.5%. Although studies in the adult hip arthroscopy population have pointed to a protective role of NSAIDs (eg, indomethacin) in radiographic HO, the effect was less certain in this adolescent sample. Larger studies are important to further evaluate the role of prophylactic NSAIDs and variations in arthroscopic technique in developing HO.

Level of Evidence:

Level III—therapeutic, case-control study.
Genu Valgum After Distal Femur Extension Osteotomy in Children With Cerebral Palsy
Authors: Liou Yen-Lyin , Lee Wei-Chun , Kao Hsuan-Kai , Yang Wen-E , Chang Chia-Hsieh
Published: February 2022

Background:

Distal femur extension osteotomy (DFEO) is a common treatment for knee flexion contracture and crouch gait in patients with cerebral palsy (CP), but skeletally immature patients tend to develop genu valgum deformities after DFEO. This study aimed to report the tendency of valgus changes after DFEO and determine the risk factors for subsequent surgery for excessive genu valgum.

Methods:

This retrospective case-control study included 25 children with CP who underwent DFEO in 44 limbs for knee flexion contractures ≥15 degrees at a mean age of 11.0 years. Radiologic measurements included the anatomic lateral distal femoral angle (aLDFA), anatomic tibiofemoral angle (aTFA), medial proximal tibia angle, and plate-condyle angle, postoperatively and at the latest follow-up. Age, sex, preoperative knee flexion contracture angle, Gross Motor Function Classification System level, and radiographic measurements were compared between children with and without subsequent guided growth for genu valgum.

Results:

A significant valgus change was observed at the distal femur in the first postoperative year (aLDFA from 83.6 to 80.1 degrees, P<0.001; aTFA from 176.1 to 172.5 degrees, P<0.01; plate-condylar angle from 5.3 to 9.5 degrees, P<0.001). Valgus changes occurred in 36 of the 44 limbs (82%) by an average of −4.6 degrees in the aLDFA, and subsequent guided growth was performed in 5 patients (20%). Guided growth for genu valgum was associated with a greater postoperative valgus angle (aLDFA: 78.0 vs. 84.9 degrees, P<0.01) but not with age, Gross Motor Function Classification System level, or preoperative flexion contracture.

Conclusions:

Distal metaphyseal osteotomies and distally placed angled plates near the physis are associated with valgus changes following growth. We recommend making a slight varus alignment during DFEO to compensate for subsequent valgus changes.

Level of Evidence:

Level III—therapeutic, retrospective comparative study.
Long-term Outcomes of Talonavicular Arthrodesis for the Treatment of Planovalgus Foot in Children With Cerebral Palsy
Authors: Ramírez-Barragán Ana , Galán-Olleros María , Maroto Raquel , Egea-Gámez Rosa M. , Martínez-Caballero Ignacio
Published: February 2022

Background:

Planovalgus foot (PVF) in cerebral palsy (CP) tends toward progression and rigidity in adolescence, especially in patients with greater functional impairment. Deformity at the talonavicular joint justifies the use of talonavicular arthrodesis as a corrective surgical technique. This study aims to assess patient or caregiver functional satisfaction and radiographic outcomes of talonavicular arthrodesis for PVF in CP patients with assisted ambulation in the long-term.

Methods:

Retrospective comparative study of level III and level IV pediatric CP patients who underwent talonavicular arthrodesis for PVF between 1999 and 2010 as part of multilevel surgery and with a minimum follow-up of 10 years. Radiologic correction at 10 years was compared with preintervention values, and functional impact at 10 years was measured by the foot function index (FFI); correlation between radiologic measurements and FFI were obtained, and complications were recorded.

Results:

Forty-nine PVFs in 25 patients with CP (72% level III and 28% level IV) were included; 52% were male. The patients had a median age of 12 years at the time of surgery (range: 11 to 15) and 23 years at the time of the study (21 to 26). Significant (P<0.01) pre-post radiologic improvements were obtained in Meary angle (37.86±10.7/8.37±5.5 degrees), calcaneal pitch (3.20±8.1/13.22±5.6 degrees), lateral talocalcaneus angle (42.18±12.1/25.29±2.9 degrees), Moreau-Costa-Bartani angle (167.04±8/146.12±7.1 degrees), talus-first metatarsal angle (27.92±13.9/9.69±4.4 degrees), anteroposterior talocalcaneal angle (37.61±7.4/22.61±2.4 degrees), and talus coverage angle (37.04±11.11/2.45±2.5 degrees). At 10 years postoperatively, functional outcome measured with the FFI was satisfactory (33.9±15.2%) and the mean maximum pain was 3.04; 56% of cases had mild pain. All patients were able to wear an ankle-foot orthosis and 8 no longer needed the device. A significant correlation was found between the talofirst metatarsal angle and the FFI (P=0.024). There were 8% of cases with screw protrusion and 14% presented pseudarthrosis, most of them asymptomatic.

Conclusions:

The adequate functional outcome, as well as the persistence of long-term radiologic correction and acceptable number of complications, enables us to recommend talonavicular arthrodesis as an alternative treatment to consider in level III and level IV CP patients with PVF.

Level of Evidence:

Level III—retrospective comparative study.
In COVID-19 Patients Who Suffer In-Hospital Cardiac Arrest, Cardiopulmonary Resuscitation Outcomes May Be Impacted by Arrest Etiology and Local Pandemic Conditions
Authors: Murphy Charles G. , Nishikawa Mia S. , Char Steven T. , Nemeth Samantha K. , Parekh Madhavi , Bulman William A. , Wu Caroline , Neuberg Gerald W. , Louh Irene K. , Schluger Neil W. , Prager Kenneth M. , Fischkoff Katherine N. , Burkart Kristin M.
Published: February 2022

OBJECTIVES:

The utility and risks to providers of performing cardiopulmonary resuscitation after in-hospital cardiac arrest in COVID-19 patients have been questioned. Additionally, there are discrepancies in reported COVID-19 in-hospital cardiac arrest survival rates. We describe outcomes after cardiopulmonary resuscitation for in-hospital cardiac arrest in two COVID-19 patient cohorts.

DESIGN:

Retrospective cohort study.

SETTING:

New York-Presbyterian Hospital/Columbia University Irving Medical Center in New York, NY.

PATIENTS:

Those admitted with COVID-19 between March 1, 2020, and May 31, 2020, as well as between March 1, 2021, and May 31, 2021, who received resuscitation after in-hospital cardiac arrest.

INTERVENTIONS:

None.

MEASUREMENT AND MAIN RESULTS:

Among 103 patients with coronavirus disease 2019 who were resuscitated after in-hospital cardiac arrest in spring 2020, most self-identified as Hispanic/Latino or African American, 35 (34.0%) had return of spontaneous circulation for at least 20 minutes, and 15 (14.6%) survived to 30 days post-arrest. Compared with nonsurvivors, 30-day survivors experienced in-hospital cardiac arrest later (day 22 vs day 7; p = 0.008) and were more likely to have had an acute respiratory event preceding in-hospital cardiac arrest (93.3% vs 27.3%; p < 0.001). Among 30-day survivors, 11 (73.3%) survived to hospital discharge, at which point 8 (72.7%) had Cerebral Performance Category scores of 1 or 2. Among 26 COVID-19 patients resuscitated after in-hospital cardiac arrest in spring 2021, 15 (57.7%) had return of spontaneous circulation for at least 20 minutes, 3 (11.5%) survived to 30 days post in-hospital cardiac arrest, and 2 (7.7%) survived to hospital discharge, both with Cerebral Performance Category scores of 2 or less. Those who survived to 30 days post in-hospital cardiac arrest were younger (46.3 vs 67.8; p = 0.03), but otherwise there were no significant differences between groups.

CONCLUSIONS:

Patients with COVID-19 who received cardiopulmonary resuscitation after in-hospital cardiac arrest had low survival rates. Our findings additionally show return of spontaneous circulation rates in these patients may be impacted by hospital strain and that patients with in-hospital cardiac arrest preceded by acute respiratory events might be more likely to survive to 30 days, suggesting Advanced Cardiac Life Support efforts may be more successful in this subpopulation.
Initiation of a Lung Protective Ventilation Strategy in the Emergency Department: Does an Emergency Department-Based ICU Make a Difference?
Authors: Harvey Carrie E. , Haas Nathan L. , Chen Chiu-Mei , Cranford James A. , Hamera Joseph A. , Havey Renee A. , Tsuchida Ryan E. , Bassin Benjamin S.
Published: February 2022

BACKGROUND:

Lung protective ventilation (LPV) is a key component in the management of acute respiratory distress syndrome and other acute respiratory pathology. Initiation of LPV in the emergency department (ED) is associated with improved patient-centered and system outcomes, but adherence to LPV among ED patients is low. The impact of an ED-based ICU (ED-ICU) on LPV adherence is not known.

METHODS:

This single-center, retrospective, cohort study analyzed rates of adherence to a multifaceted LPV strategy pre- and post-implementation of an ED-ICU. LPV strategy components included low tidal volume ventilation, avoidance of severe hyperoxia and high plateau pressures, and positive end-expiratory pressure settings in alignment with best-evidence recommendations. The primary outcome was adherence to the LPV strategy at time of ED departure.

RESULTS AND CONCLUSIONS:

A total of 561 ED visits were included in the analysis, of which 60.0% received some portion of their emergency care in the ED-ICU. Adherence to the LPV strategy was statistically significantly higher in the ED-ICU cohort compared with the pre-ED-ICU cohort (65.8% vs 41.4%; p < 0.001) and non-ED-ICU cohort (65.8% vs 43.1%; p < 0.001). Among the ED-ICU cohort, 92.8% of patients received low tidal volume ventilation. Care in the ED-ICU was also associated with shorter ICU and hospital length of stay. These findings suggest improved patient and resource utilization outcomes for mechanically ventilated ED patients receiving care in an ED-ICU.
Initial combination therapy for hypertension in patients of African ancestry: a systematic review and meta-analysis
Authors: Brewster Lizzy M. , Boermeester Amber S. , Seedat Yackoob K. , Van Montfrans Gert A.
Published: February 2022

We systematically reviewed randomized controlled trials (RCTs) that consider the effect of initial dual antihypertensive combination treatment on blood pressure (BP), morbidity, or mortality in hypertensive African ancestry adults, using the methodology of the Cochrane Collaboration. Main outcomes were difference in means (continuous data) and risk ratio (dichotomous data).

We retrieved 1728 reports yielding 13 RCTs of 4 weeks to 3 years duration (median 8 weeks) in 3843 patients. Systolic BP was significantly higher on β-adrenergic blocker vs. other combinations, 3.80 [0.82;6.78] mmHg, but comparable for other combinations. Hypokalemia and hyperglycemia occurred with calcium channel blocker (CCB) + diuretics > diuretics + angiotensin converting enzyme inhibitor (ACEI)/angiotensin-II-type-1-receptor antagonist (ARB) > CCB + ACEI/ARB. An RCT including high-risk patients reported combined morbidity/mortality for hydrochlorothiazide (mg) 25 + benazepril 40 vs. amlodipine 10 + benazepril 40 of respectively 8.9% vs. 6.6% (n = 1414, risk ratio 1.35 [0.94;1.94]; all patients, N = 11 506, 1.23 [1.11;1.37]).

We conclude that limited evidence supports CCB + ACEI rather than HCT + ACEI as first-line initial combination therapy in African ancestry patients with hypertension.

PROSPERO:

CRD42021238529

Graphical Abstract:

http://links.lww.com/HJH/B835
The Impact of Interventions to Prevent Neonatal Healthcare-associated Infections in Low- and Middle-income Countries: A Systematic Review
Authors: Fitzgerald Felicity C. , Zingg Walter , Chimhini Gwendoline , Chimhuya Simbarashe , Wittmann Stefanie , Brotherton Helen , Olaru Ioana D. , Neal Samuel R. , Russell Neal , da Silva André Ricardo Araujo , Sharland Mike , Seale Anna C. , Cotton Mark F. , Coffin Susan , Dramowski Angela
Published: February 2022

Background:

Clinically suspected and laboratory-confirmed bloodstream infections are frequent causes of morbidity and mortality during neonatal care. The most effective infection prevention and control interventions for neonates in low- and middle-income countries (LMIC) are unknown.

Aim:

To identify effective interventions in the prevention of hospital-acquired bloodstream infections in LMIC neonatal units.

Methods:

Medline, PUBMED, the Cochrane Database of Systematic Reviews, EMBASE and PsychInfo (January 2003 to October 2020) were searched to identify studies reporting single or bundled interventions for prevention of bloodstream infections in LMIC neonatal units.

Results:

Our initial search identified 5206 articles; following application of filters, 27 publications met the inclusion and Integrated Quality Criteria for the Review of Multiple Study Designs assessment criteria and were summarized in the final analysis. No studies were carried out in low-income countries, only 1 in Sub-Saharan Africa and just 2 in multiple countries. Of the 18 single-intervention studies, most targeted skin (n = 4) and gastrointestinal mucosal integrity (n = 5). Whereas emollient therapy and lactoferrin achieved significant reductions in proven neonatal infection, glutamine and mixed probiotics showed no benefit. Chlorhexidine gluconate for cord care and kangaroo mother care reduced infection in individual single-center studies. Of the 9 studies evaluating bundles, most focused on prevention of device-associated infections and achieved significant reductions in catheter- and ventilator-associated infections.

Conclusions:

There is a limited evidence base for the effectiveness of infection prevention and control interventions in LMIC neonatal units; bundled interventions targeting device-associated infections were most effective. More multisite studies with robust study designs are needed to inform infection prevention and control intervention strategies in low-resource neonatal units.
Active and sedentary behaviors in youth (6–14 years old): Data from the IAN-AF survey (2015–2016)
Authors: Pizarro Andreia Nogueira , Correia Daniela , Lopes Carla , Teixeira Pedro J. , Mota Jorge
Published: February 2022

Background:

Strategic health interventions must be guided by effective surveillance systems that monitor population trends and patterns, therefore we aimed to provide youth's (6–14 years) national prevalence estimates of physical activity (PA), active outdoor play (AOP), sedentary behaviur (SB), and structured PA (SPA).

Methods:

Measures of moderate-to-vigorous PA, SB, AOP, and SPA, were obtained for 719 participants in 2 groups (6–9 and 10–14 years) using diaries and questionnaires. National estimates were calculated, by sex, region, and parental education.

Results:

While 54% (95%CI: 47.4–61.3) of youth meet PA recommendations, the prevalence is lower for the older group (P 
= .034). Similarly, AOP decreases with age both on weekends, from 94.3% (95%CI: 90.8–97.8) to 68.7% (95%CI: 62.2–75.1), and on weekdays from 84% (95%CI: 76.5–91.5) to 64.8% (95%CI: 59–70.6). Watching TV for ≥2 h/day is extremely high on weekends [71.3% (95%CI: 65.4–77.2)] and more prevalent in boys than girls on weekdays (P = .043). Higher parental education significantly increased SPA and active time. Time in SB was greater in boys [7.26 h (95%CI: 6.87–7.65)] than girls [6.48 h (95%CI: 6.09–6.87)] and increased with age (P < .001).

Conclusions:

Almost half of the youth failed to achieve PA guidelines, whereas 71% exceeded recommended TV time on weekends, suggesting the urgency of intervention measures.
SARS-CoV-2 reinfection in a healthcare worker: First case in Portugal confirmed by viral genome sequencing
Authors: Nunes-Silva Cláudio , Pereira Sara , Canelas Gabriela , Pedro Nicole , Fernandes Paulo , Pereira Luísa , Tavares Margarida
Published: February 2022

Few reports of SARS-CoV-2 reinfection by antigenically similar variants are well documented. The interplay between natural acquired immunity, escape by emerging variants, and protective measures in the healthcare setting is considered in this description of the first phylogenetically confirmed SARS-CoV-2 reinfection in Portugal.
Development 68Ga trastuzumab Fab and bioevaluation by PET imaging in HER2/neu expressing breast cancer patients
Authors: Rathore Yogesh , Shukla Jaya , Laroiya Ishita , Deep Amar , Lakhanpal Tamanna , Kumar Rajender , Singh Harmandeep , Bal Amanjit , Singh Gurpreet , Gopal Thakur Krishan , Mittal B R
Published: February 2022

Introduction

Receptors on breast cancer cells play a crucial role in the management of patients. Trastuzumab is a widely used drug for the treatment of HER2/neu expressing tumors. ImmunoPET with trastuzumab is not feasible due to slow pharmacokinetics. Fragment of antigen-binding (Fab) radiolabeled with positron emitters can be used for immunoPET.

Methods

Fab has been generated by papain digestion and conjugated with the bifunctional chelating agent NOTA. The SDS-PAGE and MALDI-TOF were used to see the integrity of Fab and conjugated Fab. In-vitro stability and target specificity for HER2/neu receptors were performed in plasma and receptor binding with bio-layer interferometry (BLI) techniques. Radiolabeling was standardized with 68GaCl3 and PET imaging was performed in seven patients showing 18F fluorodeoxyglucose (18F-FDG) uptake and correlated with HER2/neu expression by immunohistochemistry.

Results

Fab production was optimized at molar ratio 23:1 of trastuzumab and papain at 37 °C with a constant stirrer at 850 rpm for 22-24 h, at pH 8. Conjugation with NOTA was standardized at molar ratio 1:25 of trastuzumab Fab and NOTA. Molecular mass of trastuzumab Fab-NOTA was found approximately 46.3 kDa (~1/3 of intact antibody). Trastuzumab Fab-NOTA showed radiolabelling efficiency of 48-70% with incubation time 15 min at 37-40 °C and pH 4.5–5.0. BLI demonstrated the affinity of trastuzumab, trastuzumab Fab and trastuzumab Fab-NOTA towards HER2/neu receptor with KD of <1pM, ~0.5nM and ~20nM, respectively. All immunohistochemistry proven patients showed uptake in primary breast lesion and lymph nodes.

Conclusion

Trastuzumab Fab-NOTA is suitable for radiolabelling with 68Ga and ImmunoPET imaging of HER2/neu receptor.
Health related behaviours and physical activity level of hypertensive individuals during COVID-19 pandemic
Authors: Durukan Beyza Nur , Vardar Yagli Naciye , Calik Kutukcu Ebru , Sener Yusuf Ziya , Tokgozoglu Lale
Published: February 2022

During the COVID-19 pandemic, all countries implemented lockdown to prevent transmission of coronavirus. The prolonged stay-at-home process created some unfavourable effects like unhealthy lifestyle, physical inactivity and sedentary behaviour especially in patients with cardiovascular risk. Hypertensive individuals are also affected in the pandemic because of limited access to healthcare services, screening, and altered lifestyles. We aimed to investigate physical activity (PA) level, sedentary behaviour, mental health and healthy lifestyle behaviours in patients with hypertension and compare these parameters with healthy controls. This prospective, cross-sectional study included 40 hypertensive and 40 age-sex matched healthy controls. We assessed PA with the International Physical Activity Questionnaire long-form, quality of life with Short-Form 36 (SF-36) questionnaire, anxiety and depression with Hospital Anxiety and Depression Scale (HADS) and lifestyle behaviours with Health-Promoting Lifestyle Profile Scale-II (HPLP-II). Moderate and vigorous PA levels of hypertensives’ were statistically lower than healthy controls (P = 0.001; P = 0.003, respectively). Hypertensive patients exhibited lower SF-36 physical function (P = 0.001), energy/vitality (P = 0.042), body pain scores than those of healthy controls (P = 0.007). Although HADS-anxiety, depression scores were similar (P > 0.05), the depression ratio (45%) was more common in the hypertensive group during the lockdown. The main findings are that hypertensive patients have lower PA levels and worse quality of life than healthy controls during the pandemic. In addition, the presence of depression is more common among hypertensive patients. Considering unhealthy lifestyles, governments, and health professionals should take some precautions and plan interventions against physical inactivity. As known, providing regular physical activity is a keystone to fighting against cardiovascular disease.
Effectiveness of a Reliable Toxicological Analysis for a Correct Diagnosis of Acute Intoxication in Pediatrics
Authors: Valli Antonella , Ferretti Virginia Valeria , Klersy Cathrine , Lonati Davide , Giardini Ilaria , Papa Pietro
Published: February 2022

Objectives

This study aimed to assess the role of the laboratory of toxicology as a support for a correct diagnosis of intoxication through the application of a reliable analytical approach, critically designed to meet pediatric needs.

Methods

Data collected from 360 cases of suspected intoxications in pediatric patients (aged 1 day to 17 years) during the period 2018 to 2019 are presented. Toxicological analyses were performed through different techniques (immunoassay and chromatography) with parameters (limit of detection and cut-off) adjusted according to pediatric needs to produce reliable toxicological data for a wide number of prescription drugs, drugs of abuse, and poisons.

Results

We present results about (1) agents involved in suspected poisonings and the methods adopted for a definite analytical diagnosis, (2) the assessment of the concordance of results for analyses proceeded by different techniques, and (3) the percentage of agreement between analytical result and clinical suspicion.

Conclusions

An analytical approach critically designed to minimize misinterpretation of laboratory data and able to provide reliable results for a wide number of substances in a time compatible with the urgency represents a useful support for a correct diagnosis of intoxication in pediatrics.
Examining the Role of Early Diagnostic Imaging for Craniosynostosis in the Era of Endoscopic Suturectomy: A Single Institution Experience
Authors: Guadix Sergio W. , Valenti Alyssa , Zappi Kyle E. , Garton Andrew L.A. , Yuan Melissa , Buontempo Michelle , Perera Imali , Souweidane Mark M. , Imahiyerobo Thomas , Hoffman Caitlin E.
Published: February 2022

Endoscopic suturectomy is a minimally invasive surgical treatment for single-suture craniosynostosis in children between 1 and 4 months of age. This study sought to characterize the role played by diagnostic imaging in facilitating early surgical management with endoscopic suturectomy. The authors also characterized the overall diagnostic utility of imaging in patients assessed for abnormal head shape at their institution, regardless of surgical status. A retrospective cohort of children diagnosed with singlesuture synostosis undergoing either primary endoscopic suturectomy or open calvarial reconstruction at the authors’ institution from 1998 to 2018 was first reviewed. Of 132 surgical patients, 53 underwent endoscopic suturectomy and 79 underwent open repair. There was no difference in the proportion of endoscopic and open surgery patients imaged preoperatively before (24.5% versus 35.4%; P = 0.24) or after (28.3% versus 25.3%; P = 0.84) craniofacial assessment. Stratifying by historical epoch (1998–2010 versus 2011–2018), there was also no difference found between preoperative imaging rates (63.6% versus 56.4%; P = 0.35). In another cohort of 175 patients assessed for abnormal head shape, 26.9% were imaged to rule out craniosynostosis. Positive diagnostic imaging rates were recorded for suspected unicoronal (100%), metopic (87.5%), lambdoidal (75.0%), sagittal (63.5%), multisuture (50%), and bicoronal (0%) synostosis. The authors conclude that the use of diagnostic imaging at their institution has not increased despite higher utilization of endoscopic suturectomy and need for expedient identification of surgical candidates.

However, their results suggest that imaging may play a greater diagnostic role for suspected bicoronal, sagittal, and multi-sutural synostosis among sutural subtypes of synostosis.
Nasal Reconstruction: Reconstruction of a Nasal Tip, Columella and Middle Crura Defect After Human Bite with a Turn Down Flap Associated With Conchal Graft and Interpolated Melolabial Flap
Authors: Almeida Alexandre Rui Rodrigues , Horta Ricardo José Moreira , de Carvalho Francisco Soares Martins
Published: February 2022

Nasal reconstruction is one of the most difficult procedures in plastic surgery due to its complex anatomy and function. A 31-year male was sent to our evaluation after an acquired nasal defect caused by a human bite 2 years before. The defect encompassed the nasal tip, columella, and both middle crura. After a detailed evaluation, the inner lining was reconstructed with a turndown flap of the released scar. In the same operative time, a shaped conchal cartilage graft was anchored to the remnants of both lateral crura and covered with a melolabial interpolated flap. Division, debulking, and final in setting of the flap was done after 5 weeks. Although simple steps were used, a good aesthetic reconstruction was achieved with minimal donor site morbidity.

This case proves that a good planning is a cornerstone of a good reconstruction.
Aequorivita iocasae sp. nov., a halophilic bacterium isolated from sediment collected at a cold seep field in the South China Sea
Authors: Zhang Huan , Wang Hao , Cao Lei , Chen Hao , Zhong Zhaoshan , Wang Minxiao , Lian Chao , Liu Rui , Zhou Li , Li Chaolun
Published: February 2022

A moderately halophilic bacterium, designated strain KX20305T, was isolated from sediment collected from a cold seep field in the South China Sea. Cells of strain KX20305T were Gram-stain-negative, rod-shaped, non-motile, facultatively anaerobic, oxidase- and catalase-positive, and grew optimally at 25–30 °C, pH 6.0–8.0 and with 3–6 % (w/v) NaCl. Phylogenetic analysis based on 16S rRNA gene sequences showed that strain KX20305T grouped with members of the genus

Aequorivita

, including

Aequorivita aquimaris

D-24T (98.3 % sequence similarity),

Aequorivita vladivostokensis

KMM 3516T (98.1 %) and

Aequorivita echinoideorum

CC-CZW007T (97.5 %). Genome sequencing of strain KX20305T revealed a genome size of 3.35 Mb and a DNA G+C content of 38.71 mol%. Genomic average nucleotide identity (orthoANI) values of strain KX20305T with

A. aquimaris

D-24T,

A. vladivostokensis

KMM 3516T and

A. echinoideorum

JCM 30378T were 83.8, 81.7 and 75.4 %, respectively, while in silico DNA–DNA hybridization (GGDC) values for strain KX20305T with these strains were 27.2, 25.0 and 19.6 %, respectively. The major fatty acids of strain KX20305T were iso-C15 : 0, iso-C17 : 0 3-OH and 10-methyl C16 : 0/iso-C17 : 1
 ω9c. The predominant respiratory quinone was menaquinone-6 (MK-6). The polar lipids mainly comprised phosphatidylethanolamine, two unidentified aminolipids and two unidentified lipids. Based on comparative analysis of phylogenetic, phylogenomic, phenotypic and chemotaxonomic characteristics, strain KX20305T represents a novel species of the genus

Aequorivita

, for which the name Aequorivita iocasae sp. nov. is proposed. The type strain is KX20305T (=KCTC 82699T=MCCC 1K06238T=JCM 34635T).
Enhanced fitness of hepatitis C virus increases resistance to direct-acting antivirals
Authors: Soni Shalini , Singh Deepak , Aggarwal Rakesh , Veerapu Naga Suresh
Published: February 2022

Drug resistance mutations of hepatitis C virus (HCV) negatively impact viral replicative fitness. RNA viruses are known to change their replication behaviour when subjected to suboptimal selection pressure. Here, we assess whether mutation supply in HCV is sufficiently large to allow the selection of its variants during dual or triple direct-acting antiviral (DAA) treatment associated with augmented virus fitness or impairment. We engineered randomly mutagenized full-genome libraries to create a highly diverse population of replication-competent HCV variants in cell culture. These variants exhibited escape when treated with NS5A/NS5B inhibitors (daclatasvir/sofosbuvir), and relapse on treatment with a combination of NS3/NS5A/NS5B inhibitors (simeprevir or paritaprevir/daclatasvir/sofosbuvir). Analysis of the relationship between virus fitness and drug resistance of JFH1-derived NS5A-5B variants showed a significant positive correlation (P=0.003). At the earliest time points, intracellular RNA levels remain unchanged in both the subgenomic replicon and infection assays, whereas extracellular RNA levels increased upto ten-fold compared to wild-type JFH1. Beneficial substitutions hyperstimulated phosphatidylinositol 4-phosphate during DAA treatment, and showed decreased dependence on cyclophilins during cyclosporine A treatment, indicating an interplay of virus–host molecular mechanisms in beneficial substitution selection that may necessitate infectious virus production. This comprehensive study demonstrates a possible role for HCV fitness of overcoming drug-mediated selection pressure.
Virulent Mycobacterium avium subspecies hominissuis subverts macrophages during early stages of infection
Authors: Ndzeidze Robert , Leestemaker-Palmer Amy , Danelishvili Lia , Bermudez Luiz E.
Published: February 2022

Virulent non-tuberculous Mycobacteria (NTMs) successfully reside and multiply within the phagosomes of phagocytic cells such as monocytes and macrophages. Macrophages play a very important role in the innate clearance of intracellular pathogens including NTMs. Attenuated

Mycobacterium avium

subsp.

hominissuis

100 enters macrophages but is incapable of escaping these cells via canonical mycobacteria escape mechanisms. Alternatively, virulent

Mycobacterium avium

subsp.

hominissuis

104 and

Mycobacterium abscessus

subsp.

abscessus

are able to modify macrophages to suit their growth, survival and ultimately escape from macrophages, while non-virulent

Mycobacterium smegmatis

is readily killed by macrophages. In this study we focused on early infection of macrophages with NTMs to determine the phenotypic response of macrophages, M1 or M2 differentiation, and phosphorylation alterations that can affect cellular response to invading bacteria. Our findings indicate that infection of the macrophage with MAH 100 and

M. smegmatis

favours the development of M1 macrophage, a pro-inflammatory phenotype associated with the killing of intracellular pathogens, while infection of the macrophage with MAH 104 and

M. abscessus

favoured the development of M2 macrophage, an anti-inflammatory phenotype associated with the healing process. Interference with the host post-translational mechanisms, such as protein phosphorylation, is a key strategy used by many intracellular bacterial pathogens to modulate macrophage phenotype and subvert macrophage function. By comparing protein phosphorylation patterns of infected macrophages, we observed that uptake of both MAH 100 and

M. smegmatis

resulted in MARCKS-related protein phosphorylation, which has been associated with macrophage activation. In contrast, in macrophages infected with MAH 104 and

M. abscessus

, methionine adenosyltransferase IIβ, an enzyme that catalyses the biosynthesis of S-adenosylmethionine, a methyl donor for DNA methylation. Inhibition of DNA methylation with 5-aza-2 deoxycytidine, significantly impaired the survival of MAH 104 in macrophages. Our findings suggest that the virulent MAH 104 and

M. abscessus

enhance its survival in the macrophage possibly through interference with the epigenome responses.
Brain strain rate response: addressing computational ambiguity and experimental data for model validation
Authors: Zhou Zhou , Li Xiaogai , Liu Yuzhe , Hardy Warren N. , Kleiven Svein
Published: February 2022

Traumatic brain injury (TBI) is an alarming global public health issue with high morbidity and mortality rates. Although the causal link between external insults and consequent brain injury remains largely elusive, both strain and strain rate are generally recognized as crucial factors for TBI onsets. With respect to the flourishment of strain-based investigation, ambiguity and inconsistency are noted in the scheme for strain rate calculation within the TBI research community. Furthermore, there is no experimental data that can be used to validate the strain rate responses of finite element (FE) models of the human brain. Thus, the current work presented a theoretical clarification of two commonly used strain rate computational schemes: the strain rate was either calculated as the time derivative of strain or derived from the rate of deformation tensor. To further substantiate the theoretical disparity, these two schemes were respectively implemented to estimate the strain rate responses from a previous-published cadaveric experiment and an FE head model secondary to a concussive impact. The results clearly showed scheme-dependent responses, both in the experimentally determined principal strain rate and FE model-derived principal and tract-oriented strain rates. The results highlight that cross-scheme comparison of strain rate responses is inappropriate, and the utilized strain rate computational scheme needs to be reported in future studies. The newly calculated experimental strain rate curves in the supplementary material can be used for strain rate validation of FE head models.