bluuebunny/crossref_metadata_2025 huggingface dataset:
RdRp-scan: A bioinformatic resource to identify and annotate divergent RNA viruses in metagenomic sequence data
Authors: Charon Justine , Buchmann Jan P , Sadiq Sabrina , Holmes Edward C
Published: August 2022

Despite a rapid expansion in the number of documented viruses following the advent of metagenomic sequencing, the identification and annotation of highly divergent RNA viruses remain challenging, particularly from poorly characterized hosts and environmental samples. Protein structures are more conserved than primary sequence data, such that structure-based comparisons provide an opportunity to reveal the viral ‘dusk matter’: viral sequences with low, but detectable, levels of sequence identity to known viruses with available protein structures. Here, we present a new open computational resource—RdRp-scan—that contains a standardized bioinformatic toolkit to identify and annotate divergent RNA viruses in metagenomic sequence data based on the detection of RNA-dependent RNA polymerase (RdRp) sequences. By combining RdRp-specific hidden Markov models (HMMs) and structural comparisons, we show that RdRp-scan can efficiently detect RdRp sequences with identity levels as low as 10 per cent to those from known viruses and not identifiable using standard sequence-to-sequence comparisons. In addition, to facilitate the annotation and placement of newly detected and divergent virus-like sequences into the diversity of RNA viruses, RdRp-scan provides new custom and curated databases of viral RdRp sequences and core motifs, as well as pre-built RdRp multiple sequence alignments. In parallel, our analysis of the sequence diversity detected by the RdRp-scan revealed that while most of the taxonomically unassigned RdRps fell into pre-established clusters, some fell into potentially new orders of RNA viruses related to the Wolframvirales and Tolivirales. Finally, a survey of the conserved A, B, and C RdRp motifs within the RdRp-scan sequence database revealed additional variations of both sequence and position that might provide new insights into the structure, function, and evolution of viral polymerases.
The Future of Endowed Chairs in Academic Medicine
Authors: Buckley Peter F. , Sime Patricia J. , Collins Love , Eggleston Niles , Davenport Jay E.
Published: August 2022

As the landscape of philanthropy changes following the COVID-19 pandemic, this commentary considers the future of endowed chairs in academic medicine in the light of articles by Thorndyke and colleagues and by Chin-Hong and colleagues in this issue. The authors evaluate the traditional allocation of endowed chairs, which can attract and retain talented faculty and can support focused research far into the future, while other gifts may support more timely concerns, but over a shorter term. The authors weigh the benefits and challenges of allocation of endowed chairs, such as the need to improve representation, diversity, equity, and inclusion, and opportunities to support early-career investigators or research teams. New endowed positions can be challenging to establish, as there may be competition with learner scholarship programs and programmatic support. Leadership turnover of university presidents and deans can slow philanthropic growth and make recruitment and fundraising for new positions even more challenging. The authors discuss the balance of institutional priorities and ways to use endowed chairs for scholarship in evolving areas of medicine and science. They further suggest working with donors to develop more adaptable gift agreements, which will allow institutions to transform endowed positions to meet changing needs while preserving the intentions of the donor. To maintain endowed chairs as a worthwhile and relevant outlet for philanthropy, one which donors will enthusiastically support, it is essential to align them with the changing needs of the institution and the broader environment of academic medicine.
Food Insecurity and Substance Use Among Young Adult College Students in the United States
Authors: Oh Hans , Smith Lee , Jacob Louis , Du Jinyu , Shin Jae Il , Zhou Sasha , Koyanagi Ai
Published: August 2022

Background

Food insecurity is prevalent among college students in the United States and has been associated with substance use. We sought to provide updated prevalence estimates and associations between food insecurity and a broad range of substances during the SARS-CoV-2 pandemic.

Methods

Using cross-sectional data from the Health Minds Study (N = 94,722; September 2020–June 2021), we used multivariable logistic regression to examine associations between food insecurity and several substances, adjusting for age, gender, race/ethnicity, hours worked, and residence. We then added a block of adjustments consisting of mental health factors (depression, anxiety, loneliness, financial stress).

Results

Food insecurity was associated with significantly greater odds of having used most individual substances, including greater odds of binge drinking (adjusted odds ratio [aOR], 1.21; 95% confidence interval [CI], 1.13–1.30), cigarette use (aOR, 1.91; 95% CI, 1.73–2.10), vaping (aOR, 1.74; 95% CI, 1.62–1.87), and a range of illicit or prescription drugs (using any illicit/prescription drug; aOR, 1.43; 95% CI, 1.32–1.55) These associations attenuated and many lost significance after adjusting for mental health factors.

Conclusions

This study found evidence to suggest that food insecurity is related to substance use in a large sample of young adult college students in the United States, calling for targeted interventions.
Impact of Family Presence on Delirium in Critically Ill Patients: A Retrospective Cohort Study*
Authors: Mohsen Samiha , Moss Stephana J. , Lucini Filipe , Krewulak Karla D. , Stelfox Henry T. , Niven Daniel J. , Sauro Khara M. , Fiest Kirsten M.
Published: August 2022

OBJECTIVE:

To assess the effect of family presence on the prevalence and duration of delirium in adults admitted to an ICU.

DESIGN:

Retrospective cohort study.

SETTING:

Medical-surgical ICUs in Alberta, AB, Canada.

PATIENTS:

A population of 25,537 unique patients admitted at least once to an Alberta ICU.

METHODS:

We obtained electronic health records of consecutive adults (≥ 18 yr) admitted to one of 14 medical-surgical ICU in Alberta, Canada, from January 1, 2014, to December 30, 2018. Family presence was quantified using a validated algorithm and categorized as: 1) physical presence in ICU, 2) telephone call only, and 3) no presence (reference group). Delirium was measured using the Intensive Care Delirium Screening Checklist (ICDSC) and defined as an ICDSC greater than or equal to 4. Multivariable mixed-effects logistic and linear regression were used to evaluate the association between family presence and prevalence (binary) and duration (d) of delirium, respectively.

INTERVENTIONS:

None.

MEASUREMENTS AND MAIN RESULTS:

The association between family presence and delirium prevalence differed according to admission type and admission Glasgow Coma Scale (GCS). Among medical and emergency surgical patients irrespective of admission GCS, physical presence of family was not significantly associated with the prevalence of delirium. In elective surgical patients, physical presence of family was associated with decreased prevalence of delirium in patients with intact Glasgow Coma Scale (GCS = 15; adjusted odds ratio, 0.60; 95% CI, 0.39–0.97; p = 0.02). Physical presence of family (adjusted mean difference [AMD] –1.87 d; 95% CI, –2.01 to –1.81; p < 0.001) and telephone calls (AMD –1.41 d; 95% CI, –1.52 to –1.31; p < 0.001) were associated with decreased duration of delirium in all patients.

CONCLUSIONS:

The effects of family presence on delirium are complex and dependent on type of visitation, reason for ICU admission, and brain function on ICU admission.
The Use of IV Vasoactive Intestinal Peptide (Aviptadil) in Patients With Critical COVID-19 Respiratory Failure: Results of a 60-Day Randomized Controlled Trial*
Authors: Youssef Jihad Georges , Lavin Philip , Schoenfeld David A. , Lee Richard A. , Lenhardt Rainer , Park David J. , Fernandez Javier Perez , Morganroth Melvin L. , Javitt Jonathan C. , Jayaweera Dushyantha
Published: August 2022

OBJECTIVES:

Respiratory failure is a lethal complication of COVID-19 that has remained resistant to drug therapy. Vasoactive intestinal peptide (VIP) is shown in nonclinical studies to upregulate surfactant production, inhibit cytokine synthesis, prevent cytopathy, and block replication of the severe acute respiratory syndrome coronavirus 2 virus in pulmonary cells. The study aims to determine whether Aviptadil (synthetic VIP) can improve survival and recovery in patients with COVID-19 respiratory failure compared with placebo and demonstrate biological effects in such patients.

DESIGN:

A multicenter, placebo-controlled trial.

SETTING:

Ten U.S. hospitals: six tertiary-care hospitals and four community hospitals.

PATIENTS:

A total of 196 patients with COVID-19 respiratory failure.

INTERVENTIONS:

Participants were randomized 2:1 to receive 3 days of IV Aviptadil or placebo.

MEASUREMENTS AND MAIN RESULTS:

The primary end point (alive and free from respiratory failure at day 60) did not reach statistical significance (odds ratio [OR], 1.6; 95% CI, 0.86–3.11) for patients treated with Aviptadil when controlling for baseline ventilation status as prespecified in the protocol. There was, however, a statistically significant two-fold odds of improved survival (OR, 2.0; 95% CI, 1.1–3.9) at 60 days (p = 0.035). There was significant improvement in respiratory distress ratio and reduced interleukin 6 cytokine release (p = 0.02) by day 3.

Subgroup analysis identified a statistically significant likelihood of achieving primary end point among those treated with high-flow nasal oxygen at baseline (p = 0.039). Subjects on mechanical ventilation also experienced a 10-fold increased odds of survival with drug versus placebo (p = 0.031).

CONCLUSIONS:

The primary end point did not reach statistical significance, indicating that there was no difference between Aviptadil versus placebo. However, Aviptadil improves the likelihood of survival from respiratory failure at day 60 in critical COVID-19 across all sites of care. Given the absence of drug-related serious adverse events and acceptable safety profile, we believe the benefit versus risk for the use of Aviptadil is favorable for patient treatment.
Flexible Coping in Cancer Care
Authors: Eto Miwako , Yamamoto Sena , Arao Harue
Published: August 2022

Background:

A cancer diagnosis, its associated symptoms, treatment, and side effects place a significant burden on patients. Therefore, the organization of various definitions and perceptions of flexibility in nursing care are crucial to support the development of coping strategies in adult patients in treatment for cancer.

Objective:

To render an operational definition of flexible coping for cancer patients under diverse and variable stressful situations.

Interventions/Methods:

Walker and Avant’s analytical method was used to analyze the underlying attributes and internal structure of flexible coping and clarify its nature.

Results:

Based on its attributes, flexible coping was defined as “a dynamic process that involves appraising controllability amidst a long-term, unpredictable, and changing situation; selecting a strategy for coping with a difficult situation from a diverse repertoire; evaluating the overall process; discontinuing any ineffective strategies; devising valid alternatives; and moving toward adaptation”.

Conclusions:

This concept analysis revealed the characteristic attributes of flexible coping, and provides important suggestions for nursing practice aimed at assisting cancer patients to cope with stressful situations.

Implications for Practice:

These attributes are useful for assessing coping patterns in adult oncology patients. Nurses may discuss and evaluate the coping process with a patient in order to facilitate effective coping, support efforts to readjust goals, and identify appropriate coping strategies.

Foundational:

Flexible coping refers to the ability to evaluate one’s own coping strategies, abandon ineffective strategies, and create and implement effective alternatives. The use of this concept to provide individualized support to adult patients in treatment for cancer may improve their coping ability and mental health.
The Impact of COVID-19 on Adolescent and Young Adult Cancer Services
Authors: Hughes Luke , Peters Marlies , Ellis Isabelle , Mcmonagle Lisa
Published: August 2022

Background:

The COVID-19 pandemic led to systemic change within healthcare settings. Policies were enacted in order to protect vulnerable cancer patients, meaning the landscape of service provision was significantly altered.

Objective:

To evaluate the experiences of young cancer patients and their caregivers during the first wave of the pandemic, to inform future service provision.

Method:

Semistructured interviews were conducted via video software with a cohort of teenage and young adult (AYA) patients (n = 8), as well as caregivers (n = 4). Interviews were analyzed using Framework Analysis.

Results:

AYA patients and caregivers highlighted areas of care which remained unchanged throughout the pandemic (treatment, communication, safety, and kindness) and areas impacted by the pandemic (visitation, inconsistent rules, lack of resources, and staff conduct).

Conclusions:

The pandemic was challenging for patients and caregivers. Issues such as extended periods of isolation and inconsistent rules have heavily impacted the wellbeing of AYA patients and their caregivers, and may possibly have further impacts on them.

Implications for Practice:

Patients and caregivers who received care during the pandemic may need further support. Isolation of patients should be avoided where possible, and rules should be consistent for all AYA patients. Staff should be reminded of the impact their conduct can have on patients and caregivers, both positively and negatively.

Foundational:

There is little currently known about the long term impact of having cancer during COVID-19 for the AYA cohort. This report makes suggestions on areas which will need attention.
Quality of Life Profiles of Colorectal Cancer Patients After Treatments in Oman
Authors: Chan Moon Fai , Al-Shandudi Maryam , Al-Moundhri Mansour , Al-Balushi Muna , Al-Azri Mohammed
Published: August 2022

Background:

Persons treated for colorectal cancer (CRC) continue to suffer from physical, psychological, emotional, and social problems after post-treatment completion.

Objective:

To explore whether different profiles exist in a cohort of patients treated for CRC regarding their sociodemographic characteristics, medical, and quality of life outcomes.

Methods:

A cross-sectional study screened 124 patients, with 118 participating in the study (response rate of 95.2%). Data were collected from August 2020 to February 2021 using convenience sampling. Instruments included sociodemographic characteristics, medical history, and the EORTC QLQ-CR29 questionnaire. Cluster analysis, t-test, chi-square, Fisher’s exact tests were used for data analysis.

Results:

Cluster 1 (n = 44) was characterized as a “poor-to-moderate functional and severe symptom” group. Cluster 2 (n = 74) was characterized as a “good functional and less symptom” group.

Conclusions:

There are substantial differences in age, gender, marital status, employment status, symptoms, and functional deficiencies between the two clusters. A customized, individualized care plan and a specifically tailored approach are needed for those in cluster 1.

Implications for Practice:

It is essential that oncology nurses recognize that a one-sizefits-all policy is not adequate to address the needs of two distinct groups of adult survivors of CRC in Oman.

What is Foundational:

Despite knowledge gaps on the need of survivors of CRC, findings from this research can be used to enhance oncology nurses’ understanding of the need and support from different symptom and function groups.
Association of preconception mixtures of phenol and phthalate metabolites with birthweight among subfertile couples
Authors: Zhang Yu , Mustieles Vicente , Williams Paige L. , Souter Irene , Calafat Antonia M. , Demokritou Melina , Lee Alexandria , Vagios Stylianos , Hauser Russ , Messerlian Carmen
Published: August 2022

Background:

Although parental preconception exposure to some phenols and phthalates have been associated with reduced birthweight, few studies have examined these chemicals as complex mixtures.

Methods:

We included 384 mothers and 211 fathers (203 couples) who gave birth to 384 singletons from a prospective cohort of couples seeking fertility evaluation. Urinary concentrations of bisphenol A (BPA), parabens, and 11 phthalate metabolites including those of di(2-ethylhexyl) phthalate (DEHP) were examined. Birthweight was abstracted from delivery records. We used principal component analysis and Bayesian Kernel Machine Regression (BKMR) to examine maternal and paternal preconception mixtures in relation to singleton birthweight. We also fit couple-based BKMR with hierarchical variable selection to assess couples’ joint mixtures in relation to birthweight.

Results:

PC scores of maternal and paternal preconception low molecular weight phthalates factor, and paternal preconception DEHP-BPA factor were associated with reduced birthweight. In BKMR models, we found that maternal preconception monoethyl phthalate and BPA concentrations, and paternal preconception mono-n-butyl phthalate concentrations were inversely associated with birthweight when the remaining mixture components were held at their median concentrations. In couple-based BKMR models, paternal preconception biomarkers contributed more to couples’ joint effect on birthweight compared with maternal preconception biomarkers. A decreasing trend of birthweight was observed across quantiles of maternal, paternal, and couples’ total preconception mixture concentrations, respectively.

Conclusions:

Results from this preconception cohort of subfertile couples suggest a complex interplay between paternal and maternal preconception exposure to mixtures of nonpersistent chemicals, with both parental windows of exposure jointly contributing to reduced birthweight.
Legislations Mandating Insurance Coverage Are Highly Effective in Delivering Surgical Care of Transgender Patients
Authors: Faletsky Adam , Jonczyk Michael M. , Guo Lifei
Published: August 2022

Background:

Although gender-affirming surgery is increasingly performed, few studies have examined any temporal correlation between legislations mandating transgender care and the actuation of such surgical care.

Methods:

We assembled a retrospective cohort utilizing the National Inpatient Sample database from 2000 to 2018. We stratified utility trends of gender-affirming surgery based on insurance payer types and regions in a crisscrossing effort to detect any temporal or cause-effect relationship between legislations and outcomes. All regions according to the latest National Inpatient Sample categorization were examined based on the nature of their member state’s legislations relating to gender-affirming care coverage. Diametrically, opposite regions were selected for further comparisons. Interrupted time series analyses were used to demonstrate any significant uptrend since implementation of relevant legislations.

Results:

In states with explicit inclusion of gender-affirming care, our interrupted time series analyses showed a significant increase in the number of patients on state-dependent insurance (Medicaid and private insurance) receiving gender-affirming surgery around the time during which state legislations began mandating care (P < 0.01) and thereafter (P < 0.01). This significance was not seen in the same regions among patients under nonstate-dependent payers (Medicare and self-pay), nor was it seen in either payer group in states without explicit inclusion of gender-affirming care. At the federal level, statistical significance was noted among Medicare recipients across all states around the time federal legislations took effect and thereafter.

Conclusion:

Legislations mandating coverage seem highly effective in actuating surgical care of transgender patients in corresponding jurisdictions, which may provide a roadmap for further care expansion.
Intersectionality Between Epigenetics and Cancer Health Disparities Stemming from Social Determinants of Health (SDoH) Through a Gynecologic Oncology Lens: A Narrative Review
Authors: Uribe Yesenia , Brown Denisha , Dean Julie Robin , O’Brian Catherine Ann , Simon Melissa A.
Published: August 2022

Racial health disparities within gynecologic cancers persist. We aim to explore the impact of epigenetics on these disparities and how social determinants of health fuel this effect. We queried PubMed with terms associated with social determinants of health and epigenetics in the scope of 3 gynecologic cancers: ovarian, endometrial, and cervical. Using the publications found, we highlight various socioeconomic and environmental factors that may influence epigenetic mechanisms and further disparities in cancer incidence, mortality, and treatment. This narrative review exposes existing gaps in evidence and provides recommendations of future preventive efforts that can target the mitigation of gynecologic cancer disparities.
Reproductive Health Care for Incarcerated People: Advancing Health Equity in Unequitable Settings
Authors: Rajagopal Karissa , Landis-Lewis Deborah , Haven Kimberly , Sufrin Carolyn
Published: August 2022

There are over 150,000 incarcerated females in the United States. Structural inequities, including racism, adversely affect the reproductive health outcomes, autonomy, and access to care that people in custody face. This article reviews the status of reproductive health and health care among incarcerated women and describes ways that community OB/GYNs can address health inequities by providing comprehensive, compassionate care to incarcerated people, especially when they come to community settings for care while they are in custody. To address reproductive health disparities and inequities that adversely affect incarcerated individuals, community providers can implement these recommendations and also engage in advocacy.
An Exploration of Organizational Characteristics and Training Adoption in Irish Community Drug Treatment Services
Authors: Kelly Peter , Hegarty Josephine , Dyer Kyle R. , Donovan Aine O.
Published: August 2022

Background

Changes in patterns of drug use and population needs necessitate the adoption of new technologies. Despite high failure rates in adopting new technologies acquired in training, little is known about the process that can support successful change. This study explores the impact that staff and service characteristics have on the process of training adoption in Irish opiate substitution therapy services, with a specific focus on the concept of organizational readiness to change.

Methods

A cross-sectional survey was conducted on a convenience sample of 132 staff members across 12 services in Ireland. The relationship between staff demographics, their perceptions of organizational readiness to change, burnout, and a four-stage process of training adoption were considered.

Results

Discipline, job tenure, and educational levels are important predictors of engagement in the adoption process. Staff in services with higher institutional needs, greater pressures for change, and poorer resources were less likely to be exposed to, or adopt, training. Having lower levels of stress and more influence with peers was associated with better adoption of training.

Conclusions

Planners and service managers need to carefully consider the composition or dynamics of services when initiating change. Organizational readiness to change and staff characteristics as measured by instruments used in this study are important determinants of the process of innovation or training adoption and provide a good basis for developing further understanding of how treatment services work. This article expands on results from previous studies conducted in the United States to a European context.
Factors Predicting Frailty Among Postoperative Brain Tumor Patients
Authors: Mungngam Chorpaka , Utriyaprasit Ketsarin , Tankumpuan Thitipong , Sitthinamsuwan Bunpot
Published: August 2022

BACKGROUND: Surgical frailty is a condition in which patients are weak with varied recovery of various organ functions after surgery resulting in unpleasant outcomes. Frailty studies have been conducted in several populations with a limited knowledge on postoperative brain tumor patients. This study aimed to examine factors predicting frailty in brain tumor patients after craniotomy. METHODS: This study was a cross-sectional predictive study. The sample included 85 patients who were 18 years or older and underwent craniotomy with tumor removal from 1 university hospital in Bangkok, Thailand, between February and October 2021. Data were analyzed using descriptive statistic, Pearson correlation, and multiple linear regression, which determined significance level at .05. RESULTS: The prevalence of frailty among participants was 50.6%. Postoperative symptom and mood state were positively associated with frailty (r = 0.410 and r = 0.448, respectively; P < .01). Postoperative symptom, mood state, age, tumor type, and income could explain the variance of frailty in brain tumor patients after craniotomy by 40.3% (R
2 = 0.403, P < .01). CONCLUSION: Healthcare providers should plan for discharge planning including assessment and develop the intervention for managing postoperative symptoms and psychological symptoms to promote recovery from frailty that generally occurs after brain tumor surgery.
Clinical and Cytogenetic Characteristics of Children With Leukemia 20-Year Retrospective Study
Authors: Runjic Edita , Jelicic Kadic Antonia , Bastian Lorenz , Lozic Mirela , Buljubasic Soda Maja , Petrovic Marija , Malic Tudor Karolina , Kuljis Dubravka , Armanda Visnja , Lozic Bernarda
Published: August 2022

Acute leukemias are the most common malignant diseases in childhood. The aims of this retrospective cohort study were to investigate the frequency of cytogenetic abnormalities in acute pediatric leukemia; the correlation between cytogenetic abnormalities and 5-year survival; and the correlation between cytogenetic abnormalities and clinical and laboratory features. We included 105 patients; acute lymphoblastic leukemia (ALL) had 80.9% patients, B-cell lineage ALL (B-ALL) 84.7% of them, and T-cell lineage (T-ALL) 15.3%. The overall 5-year survival for B-ALL was 85.9% and for T-ALL was 84.6%. The most common cytogenetic abnormalities in patients with B-ALL were t(12;21)(p13.2;q22.1); ETV6-RUNX1 with 22.2% and hyperdiploidy with 19.4%. Our survival analysis showed that t(12;21)(p13.2;q22.1); ETV6-RUNX1 and t(1;19)(q23;p13.3); TCF3-PBX1 had the best 5-year survival with 100% of patients surviving, whereas t(v;11q23.3); KMT2A rearranged had the worst 5-year survival of just 33.3% of patients surviving after 5 years. We found no difference in 5-year survival in B-ALL when comparing clinical features. Acute myelogenous leukemia had 20 patients with 70.6% 5-year survival. The most common cytogenetic abnormality in acute myelogenous leukemia was t(8;21)(q21;q22.1); RUNX1-RUNX1T1 (20%). In conclusion, this study showed the correlation of different cytogenetic abnormalities with 5-year survival in B-ALL patients. Such correlation was not found when comparing clinical features and 5-year survival of patients with B-ALL. This emphasized the significance of cytogenetic analysis in pediatric leukemia.
A Comparison Between Before and During the Pandemic in Nonsuicidal Self-Injury Behaviors of Bipolar Disorder
Authors: Deng Yanfang , He Jinai
Published: August 2022

The aim of this study was to assess the feature change of nonsuicidal self-injury (NSSI) behaviors in bipolar disorder before and during the pandemic. A total of 115 adolescents with NSSI were evaluated using a Wechsler Intelligence Scale for Children–Fourth Edition, Kiddie Schedule for Affective Disorders and Schizophrenia for School-Aged Children–Present and Lifetime Version, and some related scales. In comparison with the 2017 group, female sex, borderline personality disorder, self-reported internalizing disorders, anxiety/depression, and thinking disorders were all related with the 2021 and 2019 groups. The 2019 group was linked to a variety of somatic issues. Negative life experiences, bullying, eating disorders, social issues, depressed feelings, performance and social anxiety, and rejection sentiments were all linked to NSSI. Both shared and differential features between before and during the pandemic may represent possible change for diagnostic and preventative interventions of NSSI in patients with bipolar disorder. Therefore, the doctor should adjust the treatment strategy based on changing of features between before and during the pandemic.
Hemostasis Proteins in Invasive Meningococcal and Nonmeningococcal Infections: A Prospective Multicenter Study
Authors: Hagedoorn Nienke N. , Boeddha Navin P. , Kohlfuerst Daniela S. , Anderson Suzanne , Carrol Enitan D. , Agapow Paul , van der Flier Michiel , Hazelzet Jan , Herberg Jethro , Kuijpers Taco , Levin Michael , Martinon-Torres Federico , van Rijswijk Angelique , Schlapbach Luregn J. , Vermont Clementien , Zenz Werner , Dik Willem A. , Driessen Gertjan , Emonts Marieke ,   on behalf of the European Union Childhood Life-threatening Infectious Disease (EUCLIDS) Consortium
Published: August 2022

OBJECTIVES:

We aimed to describe the variation of hemostasis proteins in children with bacterial infections due to different pathogens (Neisseria meningitidis, Streptococcus pneumoniae, Staphylococcus aureus, and group A streptococcus [GAS]) and to study hemostasis proteins in relation to mortality.

DESIGN:

Preplanned analysis in prospective cohort study.

SETTING:

Hospitals in five European countries (Austria, The Netherlands, Spain, Switzerland, and the United Kingdom).

PATIENTS:

Admitted children (2012–2016) with community-acquired infections due to meningococci (n = 83), pneumococci (n = 64), S. aureus (n = 50), and GAS (n = 44) with available serum samples collected less than 48 hours after admission.

INTERVENTIONS:

None.

MEASUREMENTS AND MAIN RESULTS:

Fibronectin, plasminogen activator inhibitor type 1 (PAI-1), thrombomodulin, and a disintegrin and metalloproteinase with a thrombospondin type 1 motif, member 13 (ADAMTS-13) were measured in serum in 2019–2020. Additionally, von Willebrand factor, protein C, protein S, and factor IX were measured in citrate plasma available from a subset of patients. Outcome measures included in-hospital mortality and disease severity (need for ventilation/inotropes, Pediatric Index of Mortality score).

Of 241 children, 21 (8.7%) died and 177 (73.5%) were admitted to PICU. Mortality rate was similar for the pathogen groups. Levels of fibronectin and thrombomodulin differed for the different pathogens (p < 0.05). Fibronectin levels were lower in GAS infections than in S. pneumoniae and S. aureus infections but did not differ from meningococcal infections. Thrombomodulin levels in meningococcal infections were higher than in S. aureus and pneumococcal infections. Overall, the area under the curve for mortality was 0.81 (95% CI, 0.70–0.92) for thrombomodulin and 0.78 (95% CI, 0.69–0.88) for ADAMTS-13. The association of each hemostasis protein did not vary across pathogens for any of the outcome measures.

CONCLUSIONS:

Hemostatic disturbances in childhood bacterial infections are not limited to meningococcal sepsis but occur with a comparable severity across nonmeningococcal infections. High thrombomodulin and high ADAMTS-13 had good discriminative ability for mortality. Our results emphasize the importance of hemostatic disturbances in meningococcal and nonmeningococcal pediatric bacterial infections.
Composite FOXL2 Mutation-positive Adult Granulosa Cell Tumor and Serous Borderline Tumor of the Ovary
Authors: Guerrieri Claudio , Hudacko Rachel , Anderson Patrick
Published: August 2022

We report a case of a cystic ovarian neoplasm in a 76-yr-old female composed of 2 distinct and intimately associated components: a macrocystic adult granulosa cell tumor (AGCT) and a serous borderline tumor. The granulosa cell nature of the tumor was confirmed with positive immunohistochemical staining for inhibin, calretinin, and WT1, while the neoplastic nature of the granulosa cell proliferation was supported by the presence of a point mutation of the FOXL2 gene. A review of 19 previously reported mixed AGCT and epithelial neoplasms of the ovary is included. Of the eight mixed AGCT and epithelial tumors, including our case, that were tested for FOXL2 mutation, 4 of the 5 mutation-positive cases were notable for demonstrating a macroscopically visible nodule or mass of AGCT at the time of gross examination, while 2 of the 3 mutation-negative cases lacked a mass-producing granulosa cell component. This feature by itself may be sufficient to predict the true neoplastic nature of the granulosa cell proliferation. This is the first reported case of a composite neoplastic AGCT and serous borderline tumor. We also discuss the current histogenetic models for these rare mixed AGCT and epithelial tumors.
Early life trauma and social processing in HIV: the role of neuroendocrine factors and inflammation
Authors: Rubin Leah H. , Bhattacharya Deeya , Fuchs Joelle , Matthews Abigail , Abdellah Sarah , Veenhuis Rebecca T. , Langenecker Scott A. , Weber Kathleen M. , Nazarloo Hans P. , Keating Sheila M. , Carter C. Sue , Maki Pauline M.
Published: August 2022

Objective

Early life trauma (ELT) and HIV are associated with social processing deficits. In people with HIV (PWH), we examined whether facial emotion identification accuracy differs by ELT and whether neuroendocrine factors including cortisol, oxytocin (OT), and arginine vasopressin (AVP), and/or immune system measures play a role in the ELT-performance association.

Methods

We used secondary data from the placebo condition of a pharmacologic challenge study in PWH. Presence of ELT was measured with the Childhood Trauma Questionnaire (at least moderate experiences of sexual, physical, and/or emotional abuse). Social processing was measured with the Facial Emotion Perception Test (FEPT). Salivary immune system measures and cortisol were sampled across a 5-hour study session. Blood was collected at study session start (12 pm) to measure OT and AVP. We examined the association of ELT with FEPT and five biological moderators (from principal components analysis of 12 biomarkers) of ELT-FEPT associations.

Results

Of 58 PWH (42 males; mean age = 33.7, standard deviation = 8.9 years), 50% endorsed ELT. ELT-exposed PWH demonstrated lower identification accuracy across all emotional expressions (unstandardized beta[B] = 0.13; standard error [SE] = 0.05; P = 0.021, d = 0.63) and had higher OT levels compared to ELT-unexposed PWH (t(1,56) = 2.12, P = 0.039; d = 0.57). For total accuracy, an OT/C-reactive protein (OT/CRP) factor moderated the ELT-FEPT association (B = 0.14; SE = 0.05; P = 0.014); accuracy was lower in ELT-exposed PWH versus ELT-unexposed PWH when the factor was low but not when high. Similar results were obtained for fearful, neutral, and happy faces (P’s < 0.05). Regardless of ELT, a myeloid migration (MCP-1/MMP-9) factor was associated with reduced accuracy (P’s < 0.05).

Conclusions

Our pilot findings suggest that ELT may alter social processing in PWH, and that OT and CRP may be a target for improving social processing in ELT-exposed PWH, and myeloid migration markers may be a target in PWH more generally.
The Effects of Cooling Therapies on Fatigue, Physical Activity, and Quality of Life in Multiple Sclerosis
Authors: Bilgin Aylin , Kesik Gülsah , Ozdemir Leyla
Published: August 2022

Purpose

This meta-analysis examined the effects of the cooling therapies on fatigue, physical activity, and quality of life (QoL) in patients with multiple sclerosis (MS).

Methods

Articles published between 2000 and 2020 were searched in six databases. The standardized mean differences were determined by the upper and lower limits of 95% confidence intervals. Publication bias was assessed by conducting the Egger test, which uses linear regression. Publication bias was examined visually using a funnel plot.

Results

Nine studies were included in this meta-analysis. The types of cooling therapies included cooling garment (n = 4), cooling device (n = 2), cooling room (n = 1), precooling (n = 1), and cold water ingestion (n = 1). The results indicated a significant decrease in fatigue and an increase in physical activity following cooling therapy. Cooling therapies improved the QoL of patients with MS. The Egger test indicated no significant publication bias. However, the funnel plot presented a slight asymmetry among studies.

Conclusions and Clinical Relevance

Cooling therapies have a beneficial effect on fatigue, physical activity, and the QoL of patients with MS. Healthcare professionals can use cooling methods to manage thermosensitive symptoms in patients with MS.
One-Stage Repair of Alveolar Cleft and Nasal Deformities Using Grafts From Nasal Septum: Application of Vomer, Ethmoid, and Septal Cartilage
Authors: Xie Kunpeng , Sun Xiumei , Wang Lin , Chen Kai , Wu Guomin
Published: August 2022

Background:

Patients with alveolar cleft unrepaired suffer from nasal deformities of different magnitude. Bone and cartilage grafts are harvested through several incisions. In this study, we present a method to simultaneously correct nasal deformities and repair alveolar cleft using grafts from the nasal septum.

Patients and Methods:

All 6 patients with unilateral cleft lip and palate have alveolar cleft unrepaired combined with nasal deformity. Computed tomography scans and 3-dimensional-printed models of vomer and ethmoid bone were used for the purpose of preoperative design and for assessing the magnitude of deformity. Grafts of bone and cartilage from deviated septum were harvested by septoplasty through which dorsum deviation was corrected. Bone grafts from vomer and ethmoid were then fixed to the prepared alveolar cleft to repair the defect and elevate the alar base. Septal cartilage was adjusted into different shapes of grafts and deformities of nasal tip, nostrils, and columella were then corrected by rhinoplasty to restore the symmetry of the nose.

Results:

Symmetry of nostrils was improved. The height of alar base on the cleft side was elevated to the level close to the noncleft side. Deviation of the septum, nasal dorsum, and columella was corrected. Projection of the nasal tip was adjusted to facial midline. Midface aesthetics was generally improved.

Conclusion:

Application of septal grafts reduce the number of incisions. One-stage repair of alveolar cleft and nasal deformities, with the aid of digital design, improves the postoperative experience and the general outcome of the surgery.
Surgical Accuracy of 3D Virtual Surgery and CAD/CAM-Assisted Orthognathic Surgery for Skeletal Class III Patients
Authors: Ha Sung-Ho , Youn Suk Min , Kim Ci Young , Jeong Chun-Gi , Choi Jin-Young
Published: August 2022

Orthognathic surgery is an effective surgical method to achieve functionality and facial esthetics for mandibular prognathism. If surgery is performed with a conventional method, errors may occur in the surgical preparation process and the surgical procedures, and there is a limitation in that the accuracy of surgery is determined according to the surgeon’s experience and tactual sense. However, with the recent development of three-dimensional (3D) virtual planning and CAD/CAM technology, more 3D and predictable surgical planning and more accurate and time-saving surgery have become possible. The purpose of this study is to evaluate the surgical accuracy of 3D Virtual Surgery, CAD/CAM-Assisted Orthognathic surgery for Skeletal Class III Patients. The study included 18 patients who had undergone orthognathic surgery for skeletal class III malocclusion from January 2020 to December 2021. To evaluate the accuracy of the virtual planning, 3D facial cone-beam computed tomography taken immediately after surgery (T1) and virtual surgery data (Tv) were superimposed in each patient. Landmarks were set on each of the maxillary segment, mandibular distal segment, and left and right mandibular proximal segment, and the difference between T1 and Tv was compared 3D on the x, y, and z-axis. (ΔT: T1−Tv). As a result, the average distance between Tv and T1 at each landmark, all landmarks except for the posterior nasal spine of the maxillary segment showed <1 mm. In particular, the differences across the x and z-axis were very small, while the difference across the y-axis tend to be large. The comparison of the position of each segment in virtual surgery and actual surgery was as follows. It can be seen that all segments were located slightly downward, and the medial pole of the mandibular proximal segment was located posterolateral and the lateral pole was located anteromedial after the actual surgery compared with the virtual planning. It means that the proximal segment was slightly rotated, but the difference was within 1 mm, so it can be considered that the surgery was accurate. Base on this study, orthognathic surgery using 3D virtual surgery planning and CAD/CAM technologies was very accurate. By applying these cutting-edge technologies to clinical practice, it was possible not only to increase the predictability of surgery but also to improve the convenience of surgery. Therefore, it is thought that it will be important for clinicians to make continuous efforts to applicate cutting-edge technologies to be developed in the future to patient diagnosis and surgery.
Use of whole blood deployment programs for mass casualty incidents: South Texas experience in regional response and preparedness
Authors: Ciaraglia Angelo , Brigmon Erika , Braverman Maxwell , Kidd Emily , Winckler CJ , Epley Eric , Flores Jose , Barry John , DeLeon Daniel , Waltman Elizabeth , Eastridge Brian , Stewart Ronald , Liao Lillian , Nicholson Susannah , Jenkins Donald
Published: August 2022

INTRODUCTION

Firearm-related deaths have become the leading cause of death in adolescents and children. Since the Sutherland Springs, TX mass casualty incident (MCI), the Southwest Texas Regional Advisory Council for trauma instituted a prehospital whole blood (WB) program and blood deployment program for MCIs.

METHODS

The program was adopted statewide by the Texas Emergency Medical Task Force, of which Southwest Texas Regional Advisory Council is the lead for Emergency Medical Task Force 8. The recent active shooter MCI in Uvalde, TX was the first time the MCI blood deployment program had been used. To our knowledge, no other similar programs exist in this or any other country.

RESULTS

On May 24, 2022, 19 children and 2 adults were killed at an MCI in Uvalde, TX. The MCI WB deployment protocol was initiated, and South Texas Blood and Tissue Center prepared 15 U of low-titer O-positive whole blood and 10 U of leukoreduced O packed cells. The deployed blood arrived at Uvalde Memorial Hospital within 67 minutes. One of the pediatric patients sustained multiple gunshots to the chest and extremities. The child was hypotensive and received 2 U of leukoreduced O packed cells, one at the initial hospital and another during transport. On arrival, the patient required 2 U of low-titer O-positive whole blood and underwent a successful hemorrhage control operation. The remaining blood was returned to South Texas Blood and Tissue Center for distribution.

CONCLUSION

Multiple studies have shown the association of early blood product resuscitation and improved mortality, with WB being the ideal resuscitative product for many. The ongoing efforts in South Texas serve as a model for development of similar programs throughout the country to reduce preventable deaths. This event represents the first ever successful deployment of WB to the site of an MCI related to a school shooting in the modern era.

LEVEL OF EVIDENCE

Therapeutic/Care Management; Level V.
Synthesis and structure of metal-TCPE (metal = Th, Ce) metal-organic frameworks based on 1,2,4,5-tetrakis(4-carboxyphenyl) ethylene
Authors: Li Lin , Yu Ting , Qian Zhenghua , Wu Xiaoling , He Hui , Ye Guoan , Qiao Yanbo
Published: August 2022

Two new metal-organic frameworks (MOFs) (Th/ Ce -TCPE) based on 1,2,4,5-tetrakis(4-carboxyphenyl)ethylene were obtained using a straightforward reaction under moderate conditions. Th and Ce formed the central units of this MOF in the mononuclear and in the unusual trinuclear cluster configurations, respectively. The resulting MOFs were analysed by fluorescence spectroscopy to understand their luminescence. The obtained data revealed that benzene's electron cloud density and torsion angle on the ligand were affected by the acetic acid molecule and Th(IV), which caused Th-TCPE to irradiate stronger blue emission, but Ce-TCPE showed no fluorescence due to the self-quenching. Such a unique luminescence property could be used for fluorescence or radiopharmaceutical sensing.
Saturation and periodic self-stress in geometric auxetics
Authors: Borcea Ciprian S. , Streinu Ileana
Published: August 2022

The auxetic structures considered in this paper are three-dimensional periodic bar-and-joint frameworks. We start with the specific purpose of obtaining an auxetic design with underlying periodic graph of low valency. Adapting a general methodology, we produce an initial framework with valency seven and one degree of freedom. Then, we describe a saturation process, whereby edge orbits are added up to valency 16, with no alteration of the deformation path. This is reflected in a large dimension for the space of periodic self-stresses. The saturated version has higher crystallographic symmetry and allows a precise description of the deformation trajectory. Reducing saturation by adequate removal of edge orbits results in vast numbers of distinct auxetic designs which obey the same kinematics.
Quantum mechanics with spatial non-local effects and position-dependent mass
Authors: El-Nabulsi Rami Ahmad , Anukool Waranont
Published: August 2022

A new higher order Schrödinger equation characterized by a position-dependent mass is introduced based on long-range spatial kernel effects and von Roos arguments. The extended Schrödinger equation depends on the sign of the moments

M
k

,
k
=
0
,
1
,
2
,
…

and a stabilized quantum dynamic is realized for

M
2

>
0

and

M
4

>
0

. We have discussed its implications in several quantum mechanical systems where more than a few were raised, mainly the emergence of the quantum Pais-Uhlenbeck and the relativistic quantum harmonic oscillators besides the complex periodic potential characterized by a
PT
symmetry.
Spectral theory of diffusion in partially absorbing media
Authors: Bressloff Paul C.
Published: August 2022

A probabilistic framework for studying single-particle diffusion in partially absorbing media has recently been developed in terms of an encounter-based approach. The latter computes the joint probability density (generalized propagator) for particle position

X

t

and a Brownian functional

U

t

that specifies the amount of time the particle is in contact with a reactive component

M

. Absorption occurs as soon as

U

t

crosses a randomly distributed threshold (stopping time). Laplace transforming the propagator with respect to

U

t

leads to a classical boundary value problem (BVP) in which the reactive component has a constant rate of absorption

z

, where

z

is the corresponding Laplace variable. Hence, a crucial step in the encounter-based approach is finding the inverse Laplace transform. In the case of a reactive boundary

∂

M

, this can be achieved by solving a classical Robin BVP in terms of the spectral decomposition of a Dirichlet-to-Neumann (D-to-N) operator on

∂

M

. In this paper, we develop the analogous construction in the case of a reactive substrate

M

. In particular, we show that the Laplace transformed propagator can be computed in terms of the spectral decomposition of a pair of D-to-N operators on

∂

M

. However, inverting the Laplace transform with respect to

z

is considerably more involved. We illustrate the theory by considering the D-to-N operators for some simple geometries.