bluuebunny/crossref_metadata_2025 huggingface dataset:
Digital health and artificial intelligence in kidney research: a report from the 2020 Kidney Disease Clinical Trialists (KDCT) meeting
Authors: Yi Tae Won , Laing Chris , Kretzler Matthias , Nkulikiyinka Richard , Legrand Matthieu , Jardine Meg , Rossignol Patrick , Smyth Brendan
Published: November 2021

The exponential growth in digital technology coupled with the global coronavirus disease 2019 pandemic is driving a profound change in the delivery of medical care and research conduct. The growing availability of electronic monitoring, electronic health records, smartphones and other devices and access to ever greater computational power provides not only new opportunities, but also new challenges. Artificial intelligence (AI) exemplifies the potential of this digital revolution, which also includes other tools such as mobile health (mHealth) services and wearables. Despite digital technology becoming commonplace, its use in medicine and medical research is still in its infancy, with many clinicians and researchers having limited experience with such tools in their usual practice. This article, derived from the ‘Digital Health and Artificial Intelligence’ session of the Kidney Disease Clinical Trialists virtual workshop held in September 2020, aims to illustrate the breadth of applications to which digital tools and AI can be applied in clinical medicine and research. It highlights several innovative projects incorporating digital technology that range from streamlining medical care of those with acute kidney injury to the use of AI to navigate the vast genomic and proteomic data gathered in kidney disease. Important considerations relating to any new digital health project are presented, with a view to encouraging the further evolution and refinement of these new tools in a manner that fosters collaboration and the generation of robust evidence.
Managing an acute asthma exacerbation in children
Authors: Trottier Evelyne D , Chan Kevin , Allain Dominic , Chauvin-Kimoff Laurel
Published: November 2021

Children and youth with acute asthma exacerbations frequently present to an emergency department with signs of respiratory distress. The most severe episodes are potentially life-threatening. Effective treatment depends on the accurate and rapid assessment of disease severity at presentation. This statement addresses the assessment, management, and disposition of paediatric patients with a known diagnosis of asthma who present with an acute asthma exacerbation. Guidance includes the assessment of asthma severity, treatment considerations, proper discharge planning, follow-up, and prescription for inhaled corticosteroids to prevent exacerbation and decrease chronic morbidity.
Towards resolution of a paradox in plant G-protein signaling
Authors: Ghusinga Khem Raj , Elston Timothy C , Jones Alan M
Published: November 2021

G-proteins are molecular on–off switches that are involved in transmitting a variety of extracellular signals to their intracellular targets. In animal and yeast systems, the switch property is encoded through nucleotides: a GDP-bound state is the “off-state” and the GTP-bound state is the “on-state”. The G-protein cycle consists of the switch turning on through nucleotide exchange facilitated by a G-protein coupled receptor and the switch turning off through hydrolysis of GTP back to GDP, facilitated by a protein designated REGULATOR OF G SIGNALING 1 (RGS). In plants, G-protein signaling dramatically differs from that in animals and yeast. Despite stringent conservation of the nucleotide binding and catalytic structures over the 1.6 billion years that separate the evolution of plants and animals, genetic and biochemical data indicate that nucleotide exchange is less critical for this switch to operate in plants. Also, the loss of the single RGS protein in Arabidopsis (Arabidopsis thaliana) confers unexpectedly weaker phenotypes consistent with a diminished role for the G cycle, at least under static conditions. However, under dynamic conditions, genetic ablation of RGS in Arabidopsis results in a strong phenotype. We explore explanations to this conundrum by formulating a mathematical model that takes into account the accruing evidence for the indispensable role of phosphorylation in G-protein signaling in plants and that the G-protein cycle is needed to process dynamic signal inputs. We speculate that the plant G-protein cycle and its attendant components evolved to process dynamic signals through signaling modulation rather than through on–off, switch-like regulation of signaling. This so-called change detection may impart greater fitness for plants due to their sessility in a dynamic light, temperature, and pest environment.
Single-particle decomposition of nuclear surface diffuseness
Authors: Horiuchi Wataru
Published: November 2021

Nuclear surface diffuseness reflects spectroscopic information near the Fermi level. I propose a way to decompose the surface diffuseness into single-particle (s.p.) contributions in a quantitative manner. Systematic behavior of the surface diffuseness of neutron-rich even–even O, Ca, Ni, Sn, and Pb isotopes is analyzed with a phenomenological mean-field approach. The role of the s.p. wave functions near the Fermi level is explored: The nodeless s.p. orbits form a sharp nuclear surface, while the nodal s.p. orbits contribute to diffusing the nuclear surface.
Performance of an emulsion telescope for gamma-ray observations in the GRAINE2018 balloon-borne experiment
Authors: Nakamura Yuya , Aoki Shigeki , Iyono Atsushi , Karasuno Ayaka , Kodama Kohichi , Komatani Ryosuke , Komatsu Masahiro , Komiyama Masahiro , Kuretsubo Kenji , Marushima Toshitsugu , Matsuda Syota , Morishima Kunihiro , Morishita Misaki , Naganawa Naotaka , Nakamura Mitsuhiro , Nakamura Motoya , Nakamura Takafumi , Nakano Noboru , Nakano Toshiyuki , Nishio Akira , Oda Miyuki , Rokujo Hiroki , Sato Osamu , Sugimura Kou , Suzuki Atsumu , Takahashi Satoru , Torii Mayu , Yamamoto Saya , Yoshimoto Masahiro
Published: November 2021

The Gamma-Ray Astro-Imager with Nuclear Emulsion (GRAINE) project is aimed at the precise observation of astronomical gamma-ray sources in the energy range of 10 MeV–100 GeV using a balloon-borne telescope utilizing a nuclear emulsion, which can help realize precise imaging with high angular resolution (1.0○ at 100 MeV), polarization sensitivity, and large aperture area (10 m2). In 2018, the third balloon experiment was carried out as a demonstration of the detection of the brightest known astronomical gamma-ray source, the Vela pulsar, with an aperture area of 0.38 m2. In these data, some gamma rays were produced by the π0 → 2γ decay, which was caused by the hadronic interactions of cosmic rays in the detector. These could be used to calibrate the reconstructed angle, energy, and so on. In this study, we establish a method of searching for hadronic interactions and concomitant gamma rays with high statistics and purity. Our analysis indicates that the performance of our detector for gamma rays is as expected in wide incidence angle and energy ranges. We plan to commence scientific observations using the proposed system with the verified high angular resolution and largest aperture area in 2022 or later.
Condensates, massive gauge fields, and confinement in the SU(3) gauge theory
Authors: Sawayanagi Hirohumi
Published: November 2021

SU(3) gauge theory in the nonlinear gauge of the Curci–Ferrari type is studied. In the low-energy region, ghost condensation and subsequent gauge field condensation can happen. The latter condensation makes classical gauge fields massive. If the color electric potential with a string is chosen as the classical gauge field, it produces the static potential with the linear potential. We apply this static potential to the three-quark system, and show, differently from the Y-type potential, that infrared divergence remains in the Δ-type potential. The color electric flux is also studied, showing that a current which plays the role of the magnetic current appears
P023 Impact of Juvenile Idiopathic Arthritis on schooling and family life
Authors: Miri Sirine , Triki Wafa , Maatallah Kaouther , Ferjani Hanene , Ben Nessib Dorra , Kaffel Dhia , Hamdi Wafa
Published: November 2021

Background

Juvenile Idiopathic Arthritis (JIA) and its related symptoms have been associated with interference in the daily life of children and adolescents with JIA including their friendships, their school attendance and sometimes their family life. The aim of the study was to describe the impact of JIA on schooling, social and family life from the point of view of children.

Methods

We interviewed 23 children and adolescents, diagnosed with JIA according to the classification criteria of the International League of Associations for Rheumatology (ILAR).

Results

The mean age of our group was 16 years, with a sex ratio of 3. Eight percent of the children were in elementary school, 21.7% in high school and 8.7% in university. Eighty-seven per cent reported school absenteeism due to JIA (pain, being hospitalized,) with a mean of 8 missed school days. Forty-three per cent failed in their schooling at some point. Thirty percent thought it was related to the consequences of their disease. Only 47.8% found the school staff to be helpful and supportive. Seventy eight percent felt understood and supported by their family in dealing with the different aspects of JIA. Twenty-six per cent felt more spoiled than their other siblings, creating tension sometimes. Fifty two percent felt different and not accepted by their peers because of the JIA.

Conclusions

Children with JIA are already suffering from the physical aspect of their disease. Initiating an open discussion with them might reduce the burden these children are carrying often in silence, and improve long-term outcomes in terms of schooling, social and, family life.
P026 Efficacy and safety of Etanercept for the treatment of Juvenile Idiopathic Arthritis
Authors: Okka Kamelia , Belghazi M , Dehimi A , Benarab Z , Bouabdallah S , Bioud B
Published: November 2021

Background

Etanercept (ETN) is the first anti-TNF to have obtained FDA approval in 1999 for juvenile idiopathic arthritis (JIA) refractory to methotrexate. Currently, the indications of ETN cover the polyarticular JIA, the extended oligoarticular, and enthesitis-related arthritis. To assess the efficacy of Etanercept, as well as its tolerance in JIA.

Material and methods

We carried out a retrospective study of children with JIA according to the criteria of the ILAR classification and treated with Etanercept at the pediatric center of the CHU de Sétif since 2015.

Nineteen children were included and considered to 3 months, 6 months, 1 year, 2 years, 3 years, 4 years, 5 years on the criteria epidemiology, the efficiency criteria (joint Scores, uveitis, ESR, CHAQ), and the occurrence possible side effects.

We defined the improvement of 30% (ACR 30), 50% (ACR 50), 70% (ACR 70), 90% (ACR 90), and 100% (ACR 100) as the improvement of minus 3 criteria out of 6 of 30%, 50%, 70%, 90%, 100%; patients must not have a worsening of > 30% of any of the 6 criteria.

Results

The epidemiological features were the following: 12 girls and 7 boys, 10 present polyarticular form, 6 present oligoarticular form, 2 cases with psoriatic arthritis, and a single case of enthesitis-related arthritis. ACR 30 is obtained in 75%, 84%, 88% of cases at 3 months, 6 months, and 1 year, respectively. The strongest responses were obtained in polyarticular, oligoarticular, and enthesitis-related arthritis. Complete remission was maintained in the majority of patients for varied durations depending on the follow-up. Furthermore, no clinical or biological adverse effects were noted.

Conclusion

The Etanercept has been dramatically effective in children with juvenile idiopathic arthritis, especially in the polyarticular subtype, oligoarticular, and enthesitis-related arthritis. Its overall tolerance is very good.
P027 Assessment of physical activity in Juvenile Idiopathic Arthritis
Authors: Ben Ouahma B , Triki W , Maatallah K , Ferjani H , Ben Nessib D , Kaffel D , Hamdi W
Published: November 2021

Background

Juvenile idiopathic arthritis (JIA) is the most common chronic rheumatic disease in childhood, grouping together different diseases characterized by arthritis of unknown origin with onset before age of 16 years. JIA may cause functional impairment and a limited exercise capacity thus a reduced time engaged in physical activity. The aim of the study was to describe participation in physical activity among children with JIA.

Methods

We conducted a descriptive retrospective study including 23 patients with JIA according to the classification criteria of the International League of Associations for Rheumatology ILAR. Demographic data were collected. All patients answered a questionnaire referring to physical activity.

Results

The mean age of our patients was 16 years old with a sex ratio of 3. The education level was distributed as follows: 8,7% were in elementary school and 21,7% were in high school. Only 4,3% of the children were participating in high loading sports. Twenty-one per cent of the children reported spending >3 h per week in physical activity during leisure time. Participation in compulsory school-educational physical activity was reported in 43,5% of the children and 26,1% reported full participation. Full exemption from school sports was reported in 46.5% of cases and it was mostly associated with functional limitations.

Exercise therapy was prescribed in 26.1% of patients and it was mainly swimming. The impact of physical activity on symptoms was divided into 43,5% of the children who reported an aggravation, 8,7% who reported an improvement and 34,8% who didn't report any change.

Conclusion

Physical activity in childhood is important to acquire knowledge and behavioral skills in order to maintain an active lifestyle. A special attention to children with JIA is required in order to promote their full potential of social interaction and improve long-term outcome.
P052 Juvenile dermatomyositis, a multi-faceted disease
Authors: Okka Kamelia , Belghazi M , Dehimi A , Benarab Z , Bouabdallah S , Bioud B
Published: November 2021

Background

Dermatomyositis is a rare disease. In children, the incidence is 2–3 per million habitants. It is a serious disease whose mortality is < 5% but whose complications and long-term prognosis remain pejorative for some children. The objective is to report the epidemiological, clinical, therapeutic options and the course of a retrospective series carried out at the CHU pediatric center of Sétif (Algeria) comprising 8 cases of juvenile dermatomyositis.

Methods

The mean age of onset is 7.7 years (0–15.5 years), The sex ratio was 0.1; The diagnosis delay averaged at 4, 4 months. At disease onset, 100% had rash, 84% a eyelids telangiectasias, 40% Gottron nodules, 90% muscular weakness, 40% arthritis, 13% fever, and 25% dysphagia. The muscular enzymes were increased in 8 cases. The DNA antibodies were present in one patient with myositis overlap, NXP was positive in one child. The electromyogram is myogenic in all patients. Seven patients underwent a histopathological exam, showing interstitial and parenchymal myositis. Treatment regimens were variable depending on the severity of the disease onset. All children were treated with steroids as the first line. Methotrexate was prescribed in 5 cases (62.5%). The immunoglobulin was indicated in 2 cases. The failure to thrive was observed in 2 (25%), and one child died following aspiration pneumonia.

Results

The dermatomyositis diagnosis is based on the Bohan and Peter criteria. The clinical characteristics of our series are in line with the literature data with a predominance of cutaneous and muscular involvement. However, some specificities are individualized: a case of overlapping myositis with lupus, a case of extensive calcinosis. The treatment was based on corticosteroids and methotrexate.

Conclusion

Dermatomyositis juvenile is a rare disease with a pejorative prognosis requiring a multidisciplinary management.
P054 Acute articular rheumatism at the Hassan II hospital center, Fez, Morocco (prospective study: about 152 cases)
Authors: Sara Himri , Bouchra Oumokhtar , Samira El Fakir , Samir Atmani
Published: November 2021

Background

Acute Articular Rheumatism (AAR) is a major public health problem in developing countries, due to the high prevalence of its main complication, which is rheumatic heart disease. The objective of this study is to determine the clinical and biological manifestations of rheumatic fever in children at CHU Hassan II in Fez, Morocco.

Methods

This is a prospective study carried out from January 2016 to July 2019 in the cardiopediatric unit of CHU Hassan II in Fez. Included were patients below 18 years of age. 152 children with RAA are diagnosed according to the modified Jones criteria. The patients are classified into 2 groups: group 1: RAA with carditis and group 2: RAA without carditis. Patient data is collected on operating sheets. Statistical analysis was performed using SPSS v 21 software.

Results

The average age of the patients was 12 years and 10 months. The male/female sex ratio was 0.7. The most represented age group was between 5 and 15 years (76.16%). Patients of urban origin presented 78.8%. The majority of children who are diagnosed with AAR with and without cardiac involvement are admitted in winter and fall respectively. A family history of RAA was found in 1 patient and recurrent tonsillitis were mentioned in 68.42%. Cardiac involvement is found in 78.3% of patients. Arthritis was the most common major end point in patients with and without carditis (24.4% and 12.1% respectively). Arthralgia was the most common minor outcome in these patients (67.2% and 78.8% respectively). Penicillin A was the most prescribed antibiotic in the two groups (80.83% and 79.31% respectively). The predominant valve disease in children with cardiac involvement is mitral leakage (69%). Serological proof of a streptococcal infection (ASLO> 300U/ml) was found in 37.2% of cases. A high biological inflammatory syndrome (ESR> 20) was noted in 29.4%. Corticosteroid therapy was used in 42.8% of patients with carditis and in 30.3% of patients without carditis. There was a recurrence in surveillance, this is an aggravation of the mitral leakage with in an 11-year-old boy. 6 patients (3.9%) underwent valve replacement: 4 valve replacements (mitral or aortic) and two double valve replacements (mitral and aortic). One death is noted, a form of acute carditis.

Conclusion

Cardiac involvement was very common in our series, which shows that AAR still remains a public health problem in our country.

Keywords

RAA, child, cardiac involvement
P055 Title: Standard rate of ASLO in healthy children with streptococcal (angina) or post-streptococcal (RAA) infection in Morocco
Authors: Sara Himri , Bouchra Oumokhtar , Fakir Samira El , Samir Atmani
Published: November 2021

Background

The antistreptolysins O “ASLO” are anti streptococcal antibodies directed against streptolysin O. The assay of ASLO can provide proof of infection of streptococcal origin. However, it cannot confirm the presence of RAA or the degree of severity of the disease. A level of ASLO less than or equal to a critical threshold of 200 IU/ml is considered normal in children. Several factors influence the ASLO title and therefore their standard rate such as age, geographic location and seasonal variation. The objective of this study is to determine the upper normal limit (ULN) of ASLO in healthy children with angina or RAA at the CHU Hassan II of Fez in Morocco.

Methods

This is a cross-sectional study carried out from January 2016 to July 2019 in the cardiopediatric unit of CHU Hassan II and the Anarjiss health center in Fez. Patients below 18 years of age were included in this study. The children are classified into 3 groups: group 1: 152 children with RAA and who are diagnosed according to the modified Jones criteria, group 2: 177 children with angina, group 3: 157 healthy children who did not have an RAA, a history of recurrent or recent pharyngitis. Patient data is collected on operating sheets. Statistical analysis was performed using SPSS v 21 software. To establish a normal upper limit for ASLOs, the 90 percentile was used as it is a value below which at least 90% of cases studied in each group.

Results

The most common age group in the 3 groups is the age group between 5 and 15 years old. The frequency of children of urban origin is greater than that of rural origin in all the groups studied. The ULN is 421.4U/ml in the group of normal children, 641.95 U/ml in the RAA group and 561.8 U/ml in the group of children with pharyngitis. The study of changes in ASLO rates over time shows that they increase significantly in angina and tend to decrease in RAA. The LSN of ASLOs by gender shows that it is higher for boys than for girls. The ULN according to the residence shows that it is higher in urban areas. As well as the LSN of ASLO according to the season shows that it is higher in the cold period, especially in winter and spring (P < 0.001). With regard to age, the ULN of ASLOs is higher in the 5–15 age group.

Conclusion

In this study, it can be concluded that an ASLO level less than or equal to 400 U/ml is the critical threshold in a normal child, while an ASLO level >400 U/ml is considered pathological in children. children in Morocco.
P057 Uveitis in enthesitis-related arthritis: what are the predictive factors?
Authors: Miri Sirine , Triki Wafa , Ferjani Hanene , Maatallah Kaouther , Nsib Dorra Ben , Kaffel Dhia , Hamdi Wafa
Published: November 2021

Background

Juvenile idiopathic arthritis (JIA) is the most common rheumatic disease of childhood. Uveitis is its most common extra-articular manifestation [1]. It is a potentially sight-threatening condition with a considerable risk of morbidity. This study aimed to describe the prevalence and characteristics of JIA-related uveitis in enthesitis-related arthritis (ERA) patients.

Methods

We conducted a retrospective study including 40 patients with JIA according to the classification criteria of the International League of Associations for Rheumatology (ILAR). All selected patients presented with ERA. A screening of uveitis was conducted in all patients. Clinical, radiologic and, biologic features of JIA were collected. We evaluated the association between these features and the presence of uveitis.

Results

The mean age of our patients was 24 years, with a sex ratio of 3. The mean age at the onset of JIA was 11 years. Upon screening, fifteen percent of the patients had active uveitis. Nine percent of the patients presented with an acute onset of JIA. Forty-six percent had initial spinal symptoms, while 26% presented with peripheral onset. Upon examination, 4% of the patients presented with monoarthritis, 20.4% with oligoarthritis and 34.8% with polyarthritis. Thirteen percent had enthesitis. Fifty-seven percent of the patients had coxitis. Sixty-eight percent had sacroiliitis. The mean CRP and ESR levels were respectively 16 mg/l and 34. Human leucocyte antigen (HLA) B27 screening came back positive in 11% of the cases. The mean BASDAI and BASFI levels were both at 4.7. The mean MASES was 0.44.

Twenty percent of the patients received NSAIDs. Eleven percent received methotrexate, 18% salazopyrine and, 5.6% biologics.

A significant association was established between the presence of uveitis and a polyarticular onset of JIA (P = 0.036). However, no significant associations were established with the sex of patients (P = 0.457), age of onset (P = 0.828), activity of the disease as evaluated by BASDAI (P = 0.40) and MASES (P = 0.87), inflammatory markers (CRP P = 0.946, and ESR P = 0.662), the use of NSAIDS (P = 1), methotrexate (P = 0.318), salazopyrine (P = 0.170) and biologics (P = 1).

Conclusion

In conclusion, uveitis associated with JIA is a serious and sight-threatening disease.

Several factors associated with a more severe disease development have been identified [2–4]. Our study showed a significant association between the polyarticular onset of JIA and the occurrence of uveitis. Also, our study showed no significant association with male gender and HLA-B27 in children, unlike previous studies of spondyloarthritis conducted in adults [5–6].

We conclude that the screening of uveitis should be performed in all JIA patients, especially those presenting initially with polyarthritis.
P073 Joint manifestations of IBD: about 9 cases
Authors: Nassiri N , Rkain M , El Ouali A , Ghannam A , Babakhouya A , Benajiba N
Published: November 2021

Background

Joint manifestations during chronic inflammatory bowel diseases (IBD) represent the most frequent extra digestive manifestations, dominated by spondylarthropathy, isolated sacroillitis and peripheral rheumatism. We conducted a retrospective study of 9 cases of IBD collected in the pediatric services of the CHU MOHAMMED VI of Oujda over a 4 year period from July 2017 to March 2021.The objective of our study is to describe the joint manifestations in inflammatory bowel diseases in children.

Materials and methods

This is a retrospective study of 9 cases of IBD collected in the pediatric services of the CHU MOHAMMED VI of Oujda over a 4-year period from June 2017 to March 2021.

All these parameters were collected on operating sheets and reported on ExcelThe data were collected from the files registered in a pediatric hospitalization register

Results

Our study includes 9 patients with male predominance in 60% of cases, the prevalence of joint manifestations was 45% of which 3/4 of cases are in Crohn's disease and 1/4 of cases in UC.Axial joint involvement was 25% in Crohn's disease while joint involvement was peripheral in 75% of which 2/3 in Crohn's and 1/3 in UC.Peripheral involvement affects the large joints in all patients with a bilateral character. With a biological inflammatory syndrome in which the CRP was >50 mg/l and the VS more than 30All patients received corticotherapy and analgesics in 25% of cases. The evolution was marked by a good clinical and biological improvement with an average delay of 10 days.

Discussion

Ulcerative colitis (UC) and Crohn's disease (CD) are chronic cryptogenetic inflammatory bowel diseases (IBD). In addition to intestinal involvement, these IBDs are associated in 20% to30% of cases with extra digestive manifestations, with joint manifestations being the most frequent. There are essentially two types: Peripheral attacks which are the most frequent (8–20% of patients) especially during Crohn's disease; All joints can be affected, but most often asymmetric oligoarthritisAxial involvement includes sacroiliitis (SI) and ankylosing spondylitis (SpA) SI is more prevalent than SpA in both UC and CD Treatment of joint manifestations involves rest and exercise% tocontrol spinal stiffening in axial involvement; and analgesics Close collaboration between gastro-pediatricians and pediatric rheumatologists is the key to optimal management of the extra-digestive manifestations of IBD.

Conclusion

Joint involvement plays an important role in the extra digestive manifestations of IBD. It should be systematically screened in IBD patients, especially if they present a biological inflammatory syndrome, thus enabling early diagnosis and better management.
Cardiovascular events in adult polymyositis and dermatomyositis: a meta-analysis of observational studies
Authors: Xiong Anji , Hu Ziyi , Zhou Shifeng , Qiang Yiying , Song Zhuoyao , Chen Huini , Xiang Qilang , Zhang Yan , Cao Yuzi , Cui Hongxu , Luo Jie , Wang Ye , Yang Yuan , Cui Beibei , Li Menglan , Shuai Shiquan
Published: November 2021

Objectives

We aimed to review whether PM and DM patients have an increased cardiovascular (CV) risk, including ischaemic heart disease (IHD), cerebrovascular accidents (CVA) and venous thromboembolism.

Methods

We searched PubMed, Embase and the Cochrane database for relevant studies from inception to February 2021.

Results

Twenty-two studies comprising 25 433 patients were included. With PM/DM vs general populations, the risk was significantly increased for CV events [relative risk (RR) = 2.37, 95% CI: 1.86, 3.02]. The RR of CV events for males with PM/DM was higher than for females (RR = 1.43; 95% CI: 1.17, 1.74). PM/DM patients followed for one to five years had a significantly higher CV risk than those followed for five to ten years (RR = 3.51, 95% CI: 1.95, 6.32). The risk was increased for North Americans (RR = 4.28, 95% CI: 2.57, 7.11), Europeans (RR = 2.29, 95% CI: 1.58, 3.31) and Asians (RR = 2.03, 95% CI: 1.41, 2.90). Our meta-analysis found that the elevated CV event risk was related to PM (RR = 2.35, 95% CI: 1.51, 3.66) and DM (RR = 2.55, 95% CI: 1.66, 3.93). Subgroup analyses showed that the risk was significantly increased for IHD (RR = 1.76, 95% CI: 1.40, 2.21), CVA morbidity (RR = 1.31, 95% CI: 1.03, 1.67) and ischaemic stroke (IS) (RR = 1.47, 95% CI: 1.26, 1.73), with no statistically significant increased risk of haemorrhagic stroke mortality (RR = 1.43, 95% CI: 0.92, 2.21). The CV event risk was increased for venous thromboembolism (RR = 4.60, 95% CI: 3.17, 6.66), deep venous thrombosis (RR = 5.53, 95% CI: 3.25, 9.39) and pulmonary embolism (RR = 5.26, 95% CI: 2.62, 10.55).

Conclusion

This meta-analysis found that PM/DM patients had a ∼2.37 times increased CV risk, particularly males diagnosed in the previous five years. PM/DM may be an independent risk factor for developing IHD, IS, deep venous thrombosis and pulmonary embolism.
A new pro-thrombotic mechanism of neutrophil extracellular traps in antiphospholipid syndrome: impact on activated protein C resistance
Authors: Foret Thomas , Dufrost Virginie , Salomon du Mont Lucie , Costa Patricia , Lakomy Cecile , Lagrange Jeremy , Lacolley Patrick , Regnault Veronique , Zuily Stephane , Wahl Denis
Published: November 2021

Objectives

In APS, precise evaluation of thrombotic risk is a major challenge. Different players, such as activated protein C (APC) resistance or neutrophil extracellular traps (NETs) contribute to the risk of thrombosis. Nevertheless, no study has investigated the interaction between these actors. The main objective of this study was to investigate the relation between NETs and APC resistance.

Methods

We designed a cross-sectional study including APS/antiphospholipid antibodies (aPL) patients and patients with autoimmune diseases (AID). We performed thrombin generation tests without and with APC to determine APC resistance. To evaluate circulating NETs, we measured plasma levels of MPO-DNA complexes and cell-free DNA with ELISA.

Results

We recruited 117 patients with definite APS/aPL or AID. We found a positive correlation between NETs and APC resistance, in APS patients and specifically in patients with high thrombotic risk, displaying LA or positivity of all three aPL tests (triple+), or anti-domain I IgG (aDI+). All these patient subgroups had increased NETs concentrations and APC resistance. As the risk profile for thrombosis increased, the relationship between NETs and APC resistance was stronger.

Conclusion

We have shown that NETs participate in the hypercoagulable state of APS patients by contributing to APC resistance, in particular in high-risk patients. In these most at-risk patients, a targeted action on NETs could reduce APC resistance and constitute a new therapeutic approach in the treatment of APS patients in addition to antithrombotic therapy.
Depression and Psychosis Risk Shared Vulnerability for Motor Signs Across Development, Symptom Dimensions, and Familial Risk
Authors: Damme Katherine S F , Park Jadyn S , Walther Sebastian , Vargas Teresa , Shankman Stewart A , Mittal Vijay A
Published: November 2021

Background

Motor abnormalities are strong transdiagnostic indicators of psychopathology risk that reflect emerging neural network abnormalities. Indeed, motor signs, such as motor slowing and agitation, are widely recognized as core features of both psychosis and depression. However, it is unclear whether these reflect shared or distinct etiology.

Methods

A sample of 11 878 adolescents completed self-reported clinical measures of rated psychotic-like experiences (PLEs) and depression. Familial risk for psychopathology and the presence of motor signs were drawn from parental reports, including developmental motor delays (eg, sitting, walking), and adolescent motor signs (eg, dyscoordination, psychomotor retardation, and psychomotor agitation). Finally, motor network connectivity in theoretically relevant networks (cortico-striatal, cortico-thalamic, and cortico-cerebellar) were related to symptoms and familial risk for psychopathology.

Results

Developmental motor delays related to increased PLEs, increased depression symptoms, and greater familial risk. Familial risk for both PLEs and depression showed higher rates of developmental motor delays than all other groups. Adolescent motor signs, however, showed unique patterns of relationships to symptoms and familial risk such that dyscoordination reflected risk for PLEs, both psychomotor agitation and retardation reflected depression risk, and psychomotor agitation reflected transdiagnostic risk. Cortico-striatal connectivity was related to depression and PLEs, but cortico-cerebellar connectivity was linked to PLEs only.

Conclusions

Motor signs may be a transdiagnostic marker of vulnerability for psychopathology. Early developmental motor delays could belie pluripotent, familial risk features. Unique items, eg, dyscoordination specifically related to PLEs, possibly reflecting processes inherent in distinct emerging forms of psychopathology.
Magnesium absorption, translocation, subcellular distribution and chemical forms in citrus seedlings
Authors: Xu Hao , Luo Ziwei , Hu Wenlang , Jia Yamin , Wang Yuwen , Ye Xin , Li Yan , Chen Li-Song , Guo Jiuxin
Published: November 2021

Magnesium (Mg) is an essential macronutrient for plant growth and development; however, the adaptive mechanisms of Mg deficiency to underlying changes in Mg translocation, subcellular distribution and chemical forms in citrus plants are unknown. In this study, we conducted a sand culture experiment with 0 (Mg-deficiency) or 2 (Mg-sufficiency) mmol l−1 Mg2+ treatments to investigate the responses underlying Mg adaptability, as well as the resulting growth and Mg transport features in citrus seedlings [Citrus sinensis (L.) Osbeck cv. ‘Xuegan’]. We found that Mg-deficiency significantly depressed biomass by 39% in the whole plant and by 66% in branch organs compared with Mg-sufficient conditions, which further resulted in a subsequent decrease in Mg concentration and accumulation with changes in its distribution in different organs and a reduction in root growth. Under Mg-sufficiency, >50% of Mg was sequestered in the soluble fraction and this was reduced by 30% under Mg-deficiency. Furthermore, >70% of Mg existed as inorganic (42%) and water-soluble (31%) forms with high mobility across treatments and organs. Under Mg-deficiency, the proportion of water-soluble Mg was reduced in leaf and increased in root, whereas the proportion of inorganic Mg increased in main stem leaves and decreased in branch leaves and root. However, under Mg-deficiency, the proportion of Mg forms with low mobility, including pectates and proteins, phosphates, oxalates and residues, was increased in leaf and root organs, with the exception of pectate and protein Mg, which was decreased in root. The Mg transfer factor showed that Mg-deficiency improved Mg transport from parent to branch organs, which was related to Mg subcellular distribution and chemical forms. Taken together, our study establishes a defined process to clarify the mechanisms of Mg absorption and translocation and reveals a possible strategy to effectively improve Mg mobility and availability in citrus plants.
Male High School Students’ Perceptions of Nursing as a Professional Career Choice: Nursing Pathway Project
Authors: Palazzo Steven J. , Erickson Mark S.
Published: November 2021

AIM

The aim of this study was to understand male high school students’ perceptions of nursing as a professional career choice.

BACKGROUND

Nursing is predominantly female, with male nurses accounting for less than 10 percent of the nursing workforce.

METHOD

A 32-item descriptive survey that contained demography items and constructs of the theory of planned behavior was administered to 820 high school students from a large Pacific Northwest school district.

RESULTS

Male students scored higher (less positive) relative to female students on all scales. When gay and bisexual male students were compared to female students, there was no statistically significant difference. Gay and bisexual male students scored significantly lower (more positive) than straight male students.

CONCLUSION

Self-identified female individuals and self-identified gay and/or bisexual male individuals have a more positive perception of the nursing profession than other self-identified male individuals. Nurse educators should work with high schools, schools of nursing, and nursing professional organizations to implement strategies to recruit male high school students.
2022 American Society of Anesthesiologists Practice Guidelines for Management of the Difficult Airway *
Authors: Apfelbaum Jeffrey L. , Hagberg Carin A. , Connis Richard T. , Abdelmalak Basem B. , Agarkar Madhulika , Dutton Richard P. , Fiadjoe John E. , Greif Robert , Klock P. Allan , Mercier David , Myatra Sheila N. , O’Sullivan Ellen P. , Rosenblatt William H. , Sorbello Massimiliano , Tung Avery
Published: November 2021

The American Society of Anesthesiologists; All India Difficult Airway Association; European Airway Management Society; European Society of Anaesthesiology and Intensive Care; Italian Society of Anesthesiology, Analgesia, Resuscitation and Intensive Care; Learning, Teaching and Investigation Difficult Airway Group; Society for Airway Management; Society for Ambulatory Anesthesia; Society for Head and Neck Anesthesia; Society for Pediatric Anesthesia; Society of Critical Care Anesthesiologists; and the Trauma Anesthesiology Society present an updated report of the Practice Guidelines for Management of the Difficult Airway.
A Comprehensive Unit-based Safety Program to Improve Perioperative Efficiency in Adolescent Idiopathic Scoliosis
Authors: Raman Divya L. , Bixby Elise C. , Wang Kevin , Rossi Danielle , Ringler Jennifer , Wiggins Danielle A. , Arora Sushrut , Delfin Jema , Guida SarahJane , McLeod Lisa , Vitale Michael G.
Published: November 2021

Background:

Addressing operational inefficiencies in operating rooms (ORs) enhances patient access to care, reduces delays, and improves employee and patient satisfaction. The Comprehensive Unit-based Safety Program (CUSP) promotes patient safety through increased teamwork, empowerment of frontline staff, and utilization of science of safety principles. CUSP has demonstrated success in outpatient and inpatient settings to decrease complication rates and establish a culture of safety but has been used minimally in the perioperative setting. In this study, the CUSP methodology was utilized to improve perioperative efficiency in pediatric spine surgery, and preimplementation and postimplementation efficiency were compared, using the rate of first case on-time starts (FCOTS) as the primary metric.

Methods:

A CUSP quality improvement workgroup including nurses, technicians, surgeons, anesthesiologists, and administrators sought feedback on opportunities for improvement and tracked key performance metrics in the OR from 2015 to 2020. Key interventions developed in response to feedback included standardizing and streamlining room setup and adjusting staffing models for greater efficiency. Univariate analysis was conducted to compare time periods pre-CUSP and post-CUSP implementation.

Results:

First case on-time starts increased from 38% to a high of 81% after implementation. For more complex cases, the average patient in the room to anesthesia ready time improved by 31% with decreased variance over time, and average closure to patient out of room time improved by 45%. Improvements were sustained through Year 3, while CUSP remained a primary focus for the team.

Conclusions:

CUSP is effective in enhancing perioperative efficiency, demonstrating strong improvement in on-time starts over 5 years. The results indicate that process improvement in ORs requires consistent attention to sustain gains over time. Engaging frontline staff in quality improvement fosters collaboration and provides employee buy-in to promoting a culture of safety and improving value in patient care.

Level of Evidence:

Level III—retrospective comparative study.
The Effect of Surgeon Experience on Outcomes Following Growth Friendly Instrumentation for Early Onset Scoliosis
Authors: Heffernan Michael J. , Younis Manaf , Glotzbecker Michael P. , Garg Sumeet , Leonardi Claudia , Poon Selina C. , Brooks Jaysson T. , Sturm Peter F. , Sponseller Paul D. , Vitale Michael G. , Emans John B. , Roye Benjamin D.
Published: November 2021

Background:

The purpose of this study was to utilize a multicenter, multisurgeon cohort to assess the effect of surgeon experience on outcomes of growth friendly instrumentation (GFI) in early onset scoliosis (EOS). We hypothesized that unplanned return to the operating room (UPROR), estimated blood loss (EBL), and surgical time would be greater amongst early career surgeons (ECSs) when compared with advanced career surgeons (ACSs).

Methods:

An international pediatric spine database was queried for patients ages 2 to 10 years treated by posterior distraction-based GFI with at least of 2-year follow up. Two groups were created for analysis based on surgeon experience: ECSs (with ≤10 y of experience) and ACSs (with >10 y of experience). The primary outcome was UPROR. Additional outcomes included: operating room time, EBL, neurological deficits, infection rate, hardware failure, and the Early Onset Scoliosis Questionnaire (EOSQ-24). Subgroup analysis was performed for further assessment based on procedure type, superior anchor type, etiology, and curve severity.

Results:

A total of 960 patients met inclusion criteria including 243 (25.3%) treated by ECS. Etiology, sex, superior anchor, and EOSQ-24 scores were similar between groups (P>0.05). There were no clinically significant differences in patient age or preoperative major coronal curve. UPROR (35.8% vs. 32.7%, P=0.532), infection (17.0% vs. 15.6%, P=0.698), operating room time (235 vs. 231 min, P=0.755), and EBL (151 vs. 155 mL, P=0.833) were comparable between ECS and ACS groups. The frequency of having at least 1 complication was relatively high but comparable among groups (60.7% vs. 62.6%, P=0.709). EOSQ-24 subdomain scores were similar between groups at 2-year follow-up (P>0.05). Subgroup analysis revealed that ECS had increased surgical time compared with ACS in severe curves >90 degrees (270 vs. 229 min, P=0.05).

Conclusions:

This study represents the first multicenter assessment of surgeon experience on outcomes in EOS. Overall, surgeon experience did not significantly influence UPROR, complication rates, EBL, or surgical time associated with GFI in this cohort of EOS patients.

Level of Evidence:

Level III.
Treatment of Hip Instability in Children With Down Syndrome: Keys to Managing a Challenging Problem
Authors: Hughes Jessica L. , Bomar James D. , Wenger Dennis R. , Upasani Vidyadhar V.
Published: November 2021

Introduction:

Management of hip instability in children with Down syndrome is a challenging task to undertake for even the most experienced surgeons. As life expectancy of these patients increases, the importance of preserving functional mobility and hip joint stability in order to minimize late hip degeneration and pain has become a priority. The aim of this study is to evaluate the clinical and radiographic outcomes of children with Down syndrome and hip instability who underwent surgical reconstruction with femoral and/or acetabular procedures.

Methods:

We performed a retrospective review of all children with Down syndrome age 18 years and younger, who underwent surgical intervention to address hip instability between 2003 and 2017. Data was recorded detailing the patient’s demographics, preoperative and postoperative functional status and surgical details. Preoperative and postoperative radiographic analysis was performed as well as 3-dimensional computed tomography scan evaluation, when available. All major and minor complications were recorded and classified using the Severin radiographic classification and the Clavien-Dindo-Sink clinical classification.

Results:

We studied 28 hips in 19 children that were followed for an average of 4.4 years postsurgical intervention for hip instability. The majority of patients improved in all radiographic parameters. A total of 14 hips (50%) had complications and 9 hips (32%) required a secondary surgery. Of those complications, 2 hips (7%) developed avascular necrosis and 4 hips (14%) developed recurrent instability after the index procedure. Two of these hips had a subsequent anteverting periacetabular osteotomy that produced a stable hip at final follow up.

Discussion:

Surgical management of hip instability in children with Down syndrome remains challenging. The treating surgeon must have a thorough understanding of the pathoanatomy and design the surgical treatment to meet all of the underlying sources of instability. Combined femoral and acetabular osteotomies plus capsulorrhaphy are often required along with postoperative hip spica immobilization. Although complication and revision surgery rates are high, hip stability and good functional outcomes can be achieved.
Omitting the Early Postoperative Follow-up in Uncomplicated Operative Supracondylar Humerus Fractures in Children Does Not Negatively Affect Outcomes
Authors: Boden Stephanie A. , Khedr Ahmed M. , Novak Natalie E. , Kenkre Tanya S. , Dede Ozgur
Published: November 2021

Background:

Supracondylar humerus (SCH) fractures are the most common surgically treated elbow injuries in children. There have been debates regarding if an early postoperative follow-up before pin removal is necessary to decrease the complications related to surgical fixation. To date, studies examining this topic have included smaller sample sizes, limiting the generalizability of their findings.

Methods:

A retrospective chart review of outcomes after operative management of Gartland type II and III SCH fractures at a single level 1 pediatric trauma center between 2005 and 2015 was performed. Patient demographics, fracture characteristics, pin number and configuration, timing of initial follow-up, change in treatment plan after initial follow-up, time to pin removal, initial and final fracture radiographic parameters, and complications were observed via chart review.

Results:

A total of 1518 SCH fractures underwent operative fixation: 755 Gartland type II and 765 type III. Of the 1518 SCH fractures identified, 1370 met inclusion criteria and were included for analysis. Of these, 1196 patients returned for initial follow-up within 1 to 2 weeks of surgery, and 174 patients had their initial follow-up 3 to 4 weeks postoperatively. There were 8 incidences where initial early follow-up resulted in a change of management; however, change in management was limited to cast alteration in 7 of these cases.

Conclusions:

Closed reduction and percutaneous pin fixation of otherwise uncomplicated closed SCH fractures have good outcomes and a very low complication rate at a level 1 pediatric trauma center. Early postoperative follow-up before the pin removal visit provides minimal utility in decreasing complications and may be safely omitted as long as the initial fracture fixation is deemed to be stable.

Level of Evidence:

Level III.