bluuebunny/crossref_metadata_2025 huggingface dataset:
CD103-CD23+ classical hairy cell leukemia
Authors: Zhao Hong-li , Cui Hong-hua , Jin Li-fang , Zhao Meng , Shen Wei-zhang
Published: December 2021

Introduction:

This case report is presented to improve our understanding of the atypical immunophenotype of hairy cell leukemia.

Patient concerns:

A 58-year-old woman presented to our department with fatigue for >10 days.

Diagnosis:

The patient was diagnosed with an increased proportion of abnormal lymphocytes in peripheral blood and bone marrow smear, positive for CD11c, CD19, CD20, CD22, CD25, CD123, CD200, and Kappa, partial expression of CD23, but no expression of CD103, positive for BRAF V600E mutation.

Interventions and outcomes:

Cladribine combined with rituximab achieved complete remission of minor residual disease negativity.

Conclusion:

Hairy cell leukemia is rare, and the diagnosis and differential diagnosis should be made by combining the patient's medical history, clinical manifestations, immunophenotype, gene detection, and other means. Purine nucleoside analogs are the first-line treatments.
Pregnancy exacerbated lymph node metastasis of well differentiated thyroid carcinoma
Authors: Tu I-Ju , Huang Shih-Ming , Chen Ying-Ren
Published: December 2021

Introduction:

Differentiated thyroid carcinoma is the second most frequently diagnosed cancer during pregnancy, second to breast cancer. Pregnancy can cause an increase in the size of existing thyroid nodules due to the similar structure of placental human chorionic gonadotropin and thyroid stimulating hormone. However, the impact of pregnancy on malignant thyroid tumors is still unclear.

Patient concerns:

We report a 27-year-old woman with initial thyroid follicular carcinoma was managed with total thyroidectomy and radioiodine therapy. Tumor recurrences with right neck lymph node enlargement were noted during the first and third trimester of pregnancy two years after initial diagnosis.

Diagnosis:

Right neck lymph node dissection was performed for two episodes of recurrence and the pathology revealed both metastatic papillary thyroid carcinoma, follicular variant but with different pathologic features. And next-generation DNA sequencing of 275 cancer-related genes, which was a commercial set, including common mutations in thyroid cancer revealed only point mutations with unknown clinical correlation.

Intervention:

For the first recurrence during pregnancy, right neck lymph node dissection was performed at the second trimester of pregnancy. As for the second recurrence in the third trimester of pregnancy, the patient received right neck lymph node dissection with radioiodine therapy one month after uncomplicated delivery.

Outcomes:

After complete treatment with surgery and radioiodine therapy, the serum thyroglobulin level was 10 ng/ml. During two-year regular follow-ups with serum thyroglobulin and ultrasound, no more recurrence was noted.

Conclusion:

Pregnancy in differentiated thyroid cancer survivors should be managed and monitored with caution, especially when cancer recurrence is noticed. Further studies are recommended to investigate these previously unreported gene mutations associated with thyroid cancer.
Corneal perforation in ocular cicatricial pemphigoid
Authors: Hwang Suan , Kuo Shu-Chun
Published: December 2021

Rationale:

Ocular cicatricial pemphigoid (OCP) is a potentially blinding, rare systemic autoimmune disease. The definite etiology of OCP remains under debate, early diagnosis is important to prevent rapid deterioration. The majority of the discussion has been focused on its medical therapeutic strategy, while little effort has been made to study the role of amniotic membrane transplantation (AMT). We describe the first case of OCP with minimal immunosuppressant and initial ocular surface reconstruction procedure using double layer AMT.

Patient concerns:

A 66-year-old female patient presented to our outpatient department with right eye pain for several days.

Diagnosis:

Slit lamp examination revealed the right eye cornea perforation with iris incarceration and total collapse of anterior chamber. Symblepharon formation and severe fornix shortening was also noted. While bulbi phthisis with ankyloblepharon and ocular surface keratinization was observed in the left eye. The final diagnosis was right eye stage III ocular cicatricial pemphigoid complicated with corneal perforation and iris prolapsed.

Interventions:

The patient underwent ocular surface reconstruction with the aid of amniotic membrane. The first layer of the amniotic membrane was attached with tissue adhesive and fibrin glue while the second layer amniotic membrane came with a conformer ring which supported the fornix space that was recreated. Postoperative care included topical medications for inflammation alleviation. Systemic immunosuppressive agents were not administered except for oral prednisolone.

Outcomes:

No recurrence of symblepharon was noted during the one year follow-up.

Lessons:

We aim at highlighting the possible important role of AMT in advance OCP. Further investigation is still needed for providing evidence to incorporate the procedure into treatment protocol.
Clinical efficacy and safety of methotrexate compared with leflunomide in the treatment of rheumatoid arthritis
Authors: Qi Weiyu , Xia Yu , Li Xin , Cao Jianzhong
Published: December 2021

Background:

Methotrexate and leflunomide are classic treatments for rheumatoid arthritis (RA), however, which is the best choice for patients of RA is still an important question clinically, and this meta-analysis is used to systematically evaluate and compare their efficacy and safety.

Methods:

We searched PubMed, Cochrance Library, Embase, SinoMed, China National Knowledge Infrastructure, China Science and Technology Journal Database, WanFang Data databases. The retrieval time was from the establishment to September 7, 2021. Literature screening, data extraction, and quality assessment were performed according to the Cochrane risk of bias tool. Meta-analysis of the included studies was performed using RevMan 5.3 software and Stata 12.0 software.

Results:

The clinical efficacy and safety of leflunomide and methotrexate are evaluated by American College of Rheumatology (ACR)20/50/70, DAS28, total effective rate, adverse reaction rate, morning stiffness, swollen joint count, tender joint count, erythrocyte sedimentation rate, C-reactive protein, and rheumatoid factor.

Conclusion:

The results of this meta-analysis will provide reliable evidence clinical efficacy and safety for RA. More high-quality randomized controlled trials are still needed to provide more reliable evidence for the treatment of RA.

PROSPERO number:

CRD42021270980
Knowledge, attitude, and behaviors toward liver health and viral hepatitis-related liver diseases in Thailand
Authors: Phisalprapa Pochamana , Tanwandee Tawesak , Neo Boon-Leong , Singh Shikha
Published: December 2021

This study aimed to quantify and evaluate the knowledge and awareness toward liver health and diseases as well as explore the attitudes and knowledge toward screening, diagnosis, and treatment of liver disease among the Thai population.

This is a cross-sectional, self-reported and web-based questionnaire study. Awareness, perceptions and attitudes toward liver-related health and diseases as well as screening, diagnosis and treatment of liver diseases were assessed among 500 Thai adults.

Respondents were mostly ≥35 years (62.0%) and females (52.0%). While there was an overall awareness regarding viral hepatitis as the main etiology of liver failure/cancer, respondents expressed misperceptions that hint at social stigmatization or discrimination toward infected individuals. A significant proportion lacked knowledge of liver screening tests and relevant diagnostic tests for viral hepatitis-related liver diseases. Screening or treatment costs and perception of being healthy were among reasons for not seeking medical consultation when exposed to risk factors or diagnosed. Treatment practices of hepatitis included prescription medication (59.1%), functional foods (51.8%) and traditional treatment (28.2%). Multivariate analysis identified income, recent health screening status and being diagnosed with liver disease(s) as significant predictors of the knowledge, attitude, and behaviors of the Thai population toward liver diseases.

This study highlighted a degree of misperception and lack of in-depth understanding toward hepatitis-related liver diseases including poor attitudes and knowledge toward screening, diagnosis, and treatment of liver diseases. Factors identified suggest an unmet need to encourage proactive health-seeking behaviors to reduce transmission risks of hepatitis-related liver diseases within the community.
Prevailing treatment methods for lumbar spondylolysis
Authors: Tanveer Fahad , Arslan Syed Asadullah , Darain Haider , Ahmad Ashfaq , Gilani Syed Amir , Hanif Asif
Published: December 2021

Background:

Aim of this study was to systematically review the prevailing treatment methods for lumbar spondylolysis.

Methods:

Manuscripts published between 1951 and 2020 were searched by using PubMed, Medline, Scopus, Springer, Web of Science databases. The study protocol was registered with PROSPERO (CRD42020218651). The inclusion criteria for all articles of prevailing treatment methods for spondylolysis were:

Standards have been independently applied by using 2 reviewers and another author resolved disagreements.

Results:

Data extraction screened 12 full-length articles. Description, treatment, outcome, and findings were individually extracted and cross-referenced.

Discussion:

Current review has suggested that the noninvasive treatment method specifically low intensity pulsed ultrasound, electro acupuncture and pulsed electromagnetic filed is effective for bone union while operative treatment specifically pedicle screw fixation +/- interbody fusion depending the extent of disk degeneration and craniocaudal foraminal stenosis is effective for minimizing pain and functional disability in patients with spondylolysis. This review concluded that the noninvasive treatment method specifically low intensity pulsed ultrasound is effective for bone union.

Review Registration:

PROSPERO (CRD42020218651).
Congenital pulmonary varix
Authors: Maruyama Takuji , Kariya Shuji , Nakatani Miyuki , Ono Yasuyuki , Ueno Yutaka , Komemushi Atsushi , Tanigawa Noboru
Published: December 2021

Rationale:

Patients with congenital pulmonary varix are asymptomatic and require no treatment, but the radiological characteristics of a pulmonary varix are similar to those of a pulmonary arteriovenous malformation, which requires treatment. Pulmonary angiography is useful for obtaining information about the dynamics of pulmonary blood flow to differentiate a pulmonary varix from a pulmonary arteriovenous malformation for the purpose of treatment planning. Two cases of congenital pulmonary varices that were differentiated from pulmonary arteriovenous malformations based on pulmonary angiography findings are presented.

Patient concerns and diagnosis:

The first patient was an asymptomatic 39-year-old man. Non-contrast-enhanced computed tomography performed as part of the treatment course for pneumonia showed pulmonary arteriovenous malformation in the right lung. Pulmonary angiography was performed and showed that it was a pulmonary varix. The second patient was an asymptomatic 23-year-old woman. As part of her regular health check-up, she underwent plain chest X-ray examination, which showed an abnormal shadow. Non-contrast-enhanced computed tomography was performed, and pulmonary arteriovenous malformation was suspected. However, contrast-enhanced computed tomography findings suggested that the patient had a congenital pulmonary varix rather than a pulmonary arteriovenous malformation. Pulmonary angiography was subsequently performed for diagnosis, and a pulmonary varix was confirmed.

Interventions and outcomes:

No treatment was administered to either patient. The first patient was followed up for four years, and the second patient for two years. Both patients had no symptoms or complications during the follow-up period.

Lessons:

Two cases of congenital pulmonary varices were reported. Information about the dynamics of pulmonary blood flow obtained by performing pulmonary angiography was effective in distinguishing between pulmonary arteriovenous malformation and congenital pulmonary varix.
The usefulness of subtraction coronary computed tomography angiography for in-stent restenosis assessment of patients with CoCr stent using 320-row area detector CT
Authors: Li Jian , Guo Man-Tao , Yang Xiao , Gao Fang , Li Na , Huang Ming-Gang
Published: December 2021

The aim of this study was to assess in-stent restenosis (ISR) of coronary artery for patients with CoCr stent using subtraction coronary computed tomography angiography (CCTA) with one-breath-hold scan on 320-row area detector CT, invasive coronary angiography (ICA) as clinical standard.

Patients who were referred for CCTA from January 2020 to May 2021 were retrospectively analyzed. Pre-contrast and CCTA was performed with dedicated one-breath-hold subtraction scan protocol and post processing to get subtracted-CCTA image without stent. Subjective image qualities and diagnosable rate were analyzed for CCTA and subtracted-CCTA respectively. The ISR degree of each stent was evaluated both on CCTA and subtracted-CCTA images. The receiver-operating characteristic curve with sensitivity, specificity, accuracy of CCTA, and subtracted-CCTA in the diagnosis of ISR were calculated with ICA as reference.

Forty patients with 85 CoCr coronary stents of 3 to 3.5 mm diameter with ICA confirmation within 1 month were finally included. Subtracted-CCTA showed more diagnosable segments of stent (91.76% [78/85]) than those of CCTA (50.59% [43/85]) (P < .001). The subjective image quality score of CCTA was 2.23 ± 1.32 while 3.41 ± 0.90 on subtracted-CCTA (P < .001). Both subtracted-CCTA and CCTA showed high consistency with ICA (Kappa = 0.795 and 0.918 respectively). The area under the curve was 0.607 for CCTA and 0.757 for subtracted-CCTA (P < .001) for stent based diagnose, respectively. The sensitivity, specificity, accuracy of CCTA, and subtracted-CCTA were 90.0%, 97.0%, 95.3%, and 87.5%, 100.0%, 97.43%, respectively.

Subtracted-CCTA showed improved diagnose performance for ISR, which potentially reduce further follow-up ICA procedures for patients with CoCr stents.
Reliability of BRAF mutation detection using plasma sample
Authors: Ye Peng , Cai Peiling , Xie Jing , Zhang Jie
Published: December 2021

Background:

Testing of B-Raf proto-oncogene (BRAF) mutation in tumor is necessary before targeted therapies are given. When tumor samples are not available, plasma samples are commonly used for the testing of BRAF mutation. The aim of this study was to investigate the diagnostic accuracy of BRAF mutation testing using plasma sample of cancer patients.

Methods:

Databases of Pubmed, Embase, and Cochrane Library were searched for eligible studies investigating BRAF mutation in paired tissue and plasma samples of cancer patients. A total of 798 publications were identified after database searching. After removing 229 duplicated publications, 569 studies were screened using the following exclusion criteria: (1) BRAF mutation not measured in plasma or in tumor sample; (2) lacking BRAF-wildtype or BRAF-mutated samples; (3) tissue and plasma samples not paired; (4) lacking tumor or plasma samples; (5) not plasma sample; (6) not cancer; (7) un-interpretable data. Accuracy data and relevant information were extracted from each eligible study by 2 independent researchers and analyzed using statistical software.

Results:

After pooling the accuracy data from 3943 patients of the 53 eligible studies, the pooled sensitivity, specificity, and diagnostic odds ratio of BRAF mutation testing using plasma sample were 69%, 98%, and 55.78, respectively. Area under curve of summary receiver operating characteristic curve was 0.9435. Subgroup analysis indicated that BRAF mutation testing using plasma had overall higher accuracy (diagnostic odds ratio of 89.17) in colorectal cancer, compared to melanoma and thyroid carcinoma. In addition, next-generation sequencing had an overall higher accuracy in detecting BRAF mutation using plasma sample (diagnostic odds ratio of 63.90), compared to digital polymerase chain reaction (PCR) and conventional PCR, while digital PCR showed the highest sensitivity (74%) among the 3 techniques.

Conclusion:

BRAF testing using plasma sample showed an overall high accuracy compared to paired tumor tissue sample, which could be used for cancer genotyping when tissue sample is not available. Large prospective studies are needed to further investigate the accuracy of BRAF mutation testing in plasma sample.
The prognostic value of lncRNA AGAP2-AS1 in cancer patients
Authors: Zhong Pingyong , Hua Hao , Chen Shun , Zhu Zhidan , Xie Fei
Published: December 2021

Background:

ArfGAP with GTPase domain, Ankyrin repeat and PH domain 2 Antisense 1 (AGAP2-AS1) is a promising long noncoding RNA that may possess prognostic value for different types of tumors. The objective of this meta-analysis is to evaluate the prognostic value of long noncoding RNA AGAP2-AS1 in cancer patients.

Methods:

A systematic literature search of the PubMed, Cochrane Library, EMBASE, Medline, Web of Science, CNKI, Weipu, and Wanfang electronic databases were carried out in this meta-analysis. Synthetic hazard ratios (HRs) or odd ratios (ORs) with 95% confidence intervals (CIs) were obtained to determine the prognostic and clinicopathological significance of AGAP2-AS1 expression in tumors.

Results:

The final meta-analysis included 10 studies that contained 948 patients. The pooled results provided evidence that AGAP2-AS1 overexpression predicted reduced overall survival (OS) (HR = 1.77, 95% CI: 1.49–2.09, P < .00001), disease-free survival (HR = 1.84, 95% CI: 1.40–2.41, P < .0001), and progression-free survival (HR = 1.84, 95% CI: 1.01–3.33, P = .04) and for various cancers. Additionally, the AGAP2-AS1 overexpression was concerned with lymph node metastasis (positive vs negative, OR = 2.95, 95% CI: 1.96–4.45, P < .00001), advanced tumor node metastasis stage (III/IV vs I/II, OR = 3.73, 95% CI: 2.71–5.13, P < .00001), and tumor size (larger vs smaller, OR = 2.28, 95% CI: 1.24–4.18, P = .008). Besides, data from gene expression profiling interactive analysis dataset verified the results in our meta-analysis. The results showed that the expression level of AGAP2-AS1 was higher in most tumor tissues than in the corresponding normal tissues and was linked to poor OS and disease-free survival.

Conclusions:

Our results indicated that AGAP2-AS1 overexpression was closely correlated with shorter OS in multiple cancer types, suggesting that AGAP2-AS1 might function as a promising predictor for clinical outcomes in cancer.
Acute exacerbation of pulmonary toxoplasmosis during corticosteroid therapy for immune thrombocytopenia
Authors: Omori Koji , Imoto Naoto , Norose Kazumi , Maeda Matsuyoshi , Hikosaka Kenji , Kurahashi Shingo
Published: December 2021

Rationale:

Pulmonary toxoplasmosis (PT) is an infectious disease that can be fatal if reactivation occurs in the recipients of hematopoietic stem cell transplantation (HSCT) who were previously infected with Toxoplasma gondii. However, whether the toxoplasmosis reactivation is an actual risk factor for patients receiving immunosuppressive therapies without HSCT remains unclear. Therefore, reactivated PT is not typically considered as a differential diagnosis for pneumonia other than in patients with HSCT or human immunodeficiency virus (HIV).

Patient concerns:

A 77-year-old man presented with fever and nonproductive cough for several days. He was hospitalized due to atypical pneumonia that worsened immediately despite antibiotic therapy. Before 4 months, he was diagnosed with immune thrombocytopenia (ITP) and received corticosteroid therapy. Trimethoprim–sulfamethoxazole (ST) was administered to prevent pneumocystis pneumonia resulting from corticosteroid therapy.

Diagnosis:

The serological and culture test results were negative for all pathogens except T. gondii immunoglobulin G antibody. Polymerase chain reaction, which can detect T. gondii from frozen bronchoalveolar lavage fluid, showed positive results. Therefore, he was diagnosed with PT.

Intervention:

ST, clindamycin, and azithromycin were administered. Pyrimethamine and sulfadiazine could not be administered because his general condition significantly worsened at the time of polymerase chain reaction (PCR) examination.

Outcomes:

The patient died of acute respiratory distress syndrome despite anti-T. gondii treatment. An autopsy revealed a severe organizing pneumonia and a small area of bronchopneumonia.

Lessons:

PT should be considered as a differential diagnosis in patients with pneumonia, particularly in seropositive patients who receive immunosuppressive therapies even for other than HSCT or HIV.
Efficacy and safety of moxibustion for benign prostatic hyperplasia
Authors: Wang Jiaze , Deng Tingting , Sun Hao , Sun Xiaolu , You Yuwei , Wang Ying , Xun Qi , Ma Yuxia
Published: December 2021

Background:

Benign prostatic hyperplasia (BPH) is a non-malignant enlargement of the prostate gland that is common in older men. The clinical manifestations of BPH are frequent urination, urgency, incomplete dribbling of urine, and urinary retention. Moxibustion, as a convenient, safe and effective method, has been widely applied in the clinical treatment of BPH. The study aim to assess the efficacy and safety of moxibustion for BPH.

Methods:

The following electronic databases will be searched regardless of language and publication status: Pubmed, MEDLINE, EMBASE, China Biomedical Database, China National Knowledge Infrastructure, VIP Database, and Wanfang Database, to select studies that meet the requirements. The study will consist of a prospective randomised controlled clinical trials (RCTs) of moxibustion in the treatment of BPH, language of publication does not have barrier of blinding or restrictions, adverse events will be assessed and reported for safety assessment. Two reviewers will independently conduct and screen all included studies and the meta-analysis will be performed with RevMan V5.3.

Results:

The study will provide a high-quality convincing assessment of efficacy and safety of moxibustion for BPH.

Conclusion:

The conclusion of this study will provide the latest evidence for judging whether moxibustion is effective and safe in the treatment of BPH.

Trial registration number:

INPLASY2021120021.
Developing a Nurse-Driven Vascular Access Device Order Set Using the Electronic Medical Record
Authors: Bechdel Beth A. , Bardman Karen J. , Machemer Cheryl
Published: December 2021

The creation of an electronic order set to identify appropriate vascular access device utilization was the basis of this prospective quality improvement investigation, at a Level 1 trauma center in southeastern Pennsylvania. The data used in this investigation were gathered over a 36-month time frame from January 2017 through December 2019. This patient-centered approach utilized the evidence-based guidelines developed from The Michigan Appropriateness Guide for Intravenous Catheters and recommendations from the Infusion Therapy Standards of Practice. The algorithmic approach developed by vascular access nurses led to statistically significant reductions in unnecessary peripherally inserted central catheter placement. The results also demonstrated an increase in appropriately placed peripheral intravenous catheters. Leveraging the electronic medical record with nursing expertise fosters patient safety across the continuum of care.
A Choice-Based Conjoint Analysis of the Psychiatrist Decision-Making Process Used in Determining When to Discharge Adults With Major Depressive Disorder Hospitalized for Active Suicidal Ideation With Intent
Authors: Voelker Jennifer , Wilkinson Samuel T. , Katz Eva G. , Nash Abigail I. , Daly Ella , Ali Ahan , Lovink Adrienne , Stahl John , Desai Arkit , Kuvadia Harsh , Neslusan Cheryl , Sheehan John J.
Published: December 2021

To ascertain the relative importance of attributes considered when deciding to discharge patients hospitalized with major depressive disorder (MDD) and active suicidal ideation with intent, a choice-based conjoint analysis was conducted via online survey among US-based psychiatrists actively managing such patients. Potential attributes and attribute levels were identified. Attribute importance in decision to discharge and the discharge time frame were assessed. One hundred psychiatrists completed the survey. The relative importance of attributes were current MDD severity (relative importance weight [out of 100] 24.8 [95% confidence interval, 23.3–26.3]), clinician assessment of current suicidal ideation (20.8 [18.5–23.0]), previous history of suicide attempts (16.7 [15.9–17.6]), psychosocial support at discharge (13.0 [11.7–14.4]), postdischarge outpatient follow-up (9.8 [8.8–10.8]), current length of hospital stay (9.2 [8.1–10.3]), and suicidal ideation at admission (5.7 [4.8–6.6]). Thus, current clinical symptoms were considered the most important attributes by psychiatrists when discharging patients initially hospitalized with MDD and active suicidal ideation with intent.
Hematemesis in Infants
Authors: Quitadamo Paolo , Anselmi Federica , Mantegazza Cecilia , Tambucci Renato , Campanozzi Angelo , Malamisura Monica , Raucci Umberto , Tipo Vincenzo , Dolce Pasquale , Saccomani Marco Deganello , Chiaro Andrea , Mancini Valentina , Felici Enrico , Orizio Paolo , Parma Barbara , Salvatore Silvia , Borrelli Osvaldo
Published: December 2021

Objectives

Infantile acute upper gastrointestinal bleeding involves a decision for therapeutic intervention that most pediatricians first coming into contact with the patient are, not unreasonably, unable to objectively provide. Therefore, some objective tools of individual risk assessment would seem to be crucial. The principal aim of the present study was to investigate the anamnestic and clinical parameters of infants with hematemesis, together with laboratory and instrumental findings, to create a scoring system that may help identify those infants requiring an appropriate and timely application of upper gastrointestinal (GI) endoscopy.

Methods

Clinical data of infants admitted for hematemesis to the participating centers over the study period were systematically collected. According to the outcome dealing with rebleeding, need for blood transfusion, mortality, finding of GI bleeding lesions, or need for surgical intervention, patients were blindly divided into a group with major clinical severity and a group with minor clinical severity. Univariate and multivariate logistic regressions were conducted to investigate significant prognostic factors for clinical severity.

Results

According to our findings, we drafted a practical diagnostic algorithm and a clinical score able to predict the need for timely upper GI endoscopy (BLOVO infant score). Our clinical scoring system was created by incorporating anamnestic factors, clinical parameters, and laboratory findings that emerged as predictors of a worst outcome.

Conclusions

We provided the first objective tool of individual risk assessment for infants with hematemesis, which could be very useful for pediatricians first coming into contact with the patient in the emergency department.
Clinical Profile, Etiology, and Management Outcomes of Pediatric Ocular Trauma in Saudi Arabia
Authors: AlGhadeer Huda , Khandekar Rajiv
Published: December 2021

Objective

To evaluate cases of pediatric ocular trauma at a tertiary eye hospital in central Saudi Arabia and determine the demographics, causes, ocular injuries, and visual status before and after management.

Methods

A retrospective review was performed of health records of children younger than 16 years with ocular trauma managed from January 1998 to December 2019. Data were collected on patient demographics, eye involved, cause of trauma, the presenting and final vision, and the duration of follow-up. Best-corrected visual acuity at the last follow-up was compared between open and closed eye injury groups. The Birmingham Eye Trauma Terminology was used to classify the ocular injuries.

Results

Among 1003 patients, 728 (72.6%) had open globe and 275 (27.4%) had closed globe injuries. The main causes of trauma were unsafe playing-related activities (n = 394; 39.3%), unsafe home environment (n = 158;15.8%) and injury by metallic objects (n = 166; 16.6%). Gunshot-related ocular trauma was noted in 62 (6.2%) children. Presenting vision less than 20/400 was noted in 292 (40.1%) eyes with open globe injuries and 110 (40%) eyes with closed globe injuries (P = 0.4). After a median follow-up of 13.3 months, best-corrected visual acuity was 20/20 to 20/200 in 393 (53%) eyes with open globe injuries and 137 (49.8%) eyes with closed globe injuries (P = 0.03).

Conclusions

Despite proper management, children in this study sustained significant permanent visual loss secondary to ocular trauma. Public health efforts in Saudi Arabia are needed to reduce preventable injury-related childhood blindness.
Sepsis in Children in Latin America
Authors: Arriola-Montenegro Liliana , Escalante-Kanashiro Raffo
Published: December 2021

Pediatric sepsis is a worldwide public health issue because of its high mortality rate, which increases even more in low-income countries. In this article, we review the Latin American background, the burdens of pediatric sepsis in Latin America, and the Caribbean, as well as some strategies that could help improve the outcomes of sepsis in these regions from a public health view.
Predictors of Empiric Antibiotic Use in the Emergency Department in Children Without Urinary Tract Infections
Authors: Forster Catherine S. , Almaazi Ahmed , Hamdy Rana , Harik Nada
Published: December 2021

Objectives

Urinary tract infections (UTIs) are a common diagnosis within the pediatric emergency department (ED). Because of the necessary delay in obtaining urine culture results, clinicians must decide whether to prescribe antibiotics for a suspected UTI before urine culture results. The primary objective of this study was to identify the proportion of children given empiric antibiotics who subsequently did not meet consensus definition of an UTI. The secondary objective was to identify factors associated with return visits to the ED after an index visit for UTI. We also attempted to identify predictors of prescription of empiric antibiotics for children who did not have a UTI.

Methods

This was a retrospective chart review of all patients between the ages of 2 months and 18 years diagnosed with a UTI between July 2016 and June 2017 in the ED of a single urban quaternary care center. Patients were excluded for the following reasons: use of bag for urine collection, subsequent admission to the hospital, receipt of antibiotics within the previous 3 days, use of antibiotics for an indication other than a UTI, and urine culture obtained at an outside facility.

Results

Of 404 included patients, 389 (96.2%) were discharged on antibiotics and 243 (62.4%) did not have a UTI. On the multivariate analysis, age ≧ 36 months was associated with increased odds of receiving antibiotics and not having a UTI while both ≥1+ leukocyte esterase and ≥1+ nitrites on urinalysis were associated with decreased odds of receiving antibiotics and not meeting UTI criteria. Sixty-two patients revisited the ED within 30 days of the initial visit, 24 (38.7%) of which met criteria for UTI during the index visit. Prescription of antibiotics at the time of the index visit was associated with decreased odds of reutilization, whereas an extended-spectrum β-lactamase producing organism cultured from urine at the index visit was associated with increased odds of reutilization.

Conclusions

A high number of patients discharged on empiric antibiotics did not meet criteria for a UTI. We did not identify clinically useful factors that predicted prescription of empiric antibiotics for children who do not have a UTI. We believe that unnecessary antibiotic prescriptions could be substantially decreased by decreasing empiric use of antibiotics coupled with reliable follow-up for positive urine cultures.
Indoor Public Mask-Wearing Behavior Changes in Response to National, State, and Local COVID-19 Policies
Authors: Vest Joshua R. , Cash-Goldwasser Shama , Peters Bergquist Eleanor , Embi Peter J. , Caine Virginia , Halverson Paul K.
Published: December 2021

Objective:

To estimate changes in public mask-wearing behavior in response to public health policies during COVID-19.

Design:

Panel of observed public mask-wearing.

Setting:

Counts of adult behavior in Marion County, Indiana, between November 15, 2020, and May 31, 2021.

Determinants of Interest:

(1) Removal of state masking requirement; (2) introduction of the National Strategy for the COVID-19 Response and Pandemic Preparedness; (3) the Centers for Disease Control and Prevention (CDC) recommendation that vaccinated individuals did not need to wear masks in public; and (4) COVID-19 vaccine availability.

Outcome:

Percent observed with correct mask-wearing.

Analyses:

Fixed-effects models estimated the association between policies and mask-wearing.

Results:

Ending Indiana's mask requirement was not associated with changes in correct mask-wearing. The CDC's recommendation was associated with a decrease of 12.3 percentage points in correct mask-wearing (95% CI, −23.47 to −1.05; P = .032).

Conclusions:

Behavior encouraged by local mask requirements appeared to be resilient to changes in state policy. CDC recommendations appeared influential.
Funding Community Health Activities: An Experiment Comparing Health Foundation's Priorities to Those of Public Health Agencies, Hospitals, and Nonprofit Organizations
Authors: Rozier Michael D. , Banaszak-Holl Jane , Kiessling Karalyn A. , Singh Simone R.
Published: December 2021

Context:

Health foundations provide significant financial resources for community health. Foundation priorities, therefore, can play a key role in setting community agenda, but little is known about the criteria foundations use to prioritize projects.

Objective:

To understand the priorities that guide decision makers in health foundations and compare those priorities with what is known about nonprofit hospitals, public health, and community-based nonprofits.

Design:

An online survey with a discrete choice experiment and open-ended questions, asking respondents to choose between different types of community health projects based on project characteristics.

Setting:

Survey respondents were employed by health foundations located in the United States.

Participants:

Respondents were leaders at health foundations (n = 173), the majority of which (56.2%) worked at foundations with assets greater than $50 million. These respondents were compared with an earlier survey (n = 561) from nonprofit hospitals, public health, and community-based nonprofits.

Main Outcome Measures:

A conditional logit model was used to estimate how various project characteristics led to greater or lesser support of a given health project. Open-ended questions aided interpretation. A two sample t test was used to compare groups.

Results:

Foundation decision makers placed the greatest value on programs with coalitions of community partners, programs with a growing or existing base of evidence for effectiveness, and programs that focus on social determinants of health. These priorities are similar to those of community nonprofits, public health departments, and health systems. However, foundation leaders are more willing to fund interventions with longer time horizons and interventions that are not yet fully evidence-based. Foundations are also less interested in clinical care and more interested in advocacy programs.

Conclusion:

Cooperation in funding and implementation is essential to community health improvement, and major organizations could benefit from everyone clearly articulating their priorities. There are good reasons to intentionally foster both similarities and differences in priorities across organizations.
Generation and Use of Evidence by Local Health Departments: The Role of Leader Attributes
Authors: Hearld Larry R. , Kelly Reena Joseph , Tafili Aurora
Published: December 2021

Objective:

The purpose of this study was to examine whether certain types of leaders were associated with the degree to which local health departments (LHDs) generate and use evidence to inform their service offering.

Design:

Pooled, cross-sectional analysis using 4 waves (2010, 2013, 2016, and 2019) of the National Profiles of Local Health Departments sponsored by the National Association of County and City Health Officials (NACCHO). Univariate analysis was used to assess the extent to which LHDs were generating and using evidence to improve the health of their local communities and whether this changed over time. Multinomial logistic regression models were used to examine the relationships between LHD leader attributes and the extent to which LHDs were generating and using evidence.

Participants:

Between 1496 and 2087 (varied by survey round) LHDs from throughout the United States.

Main Outcome Measure(s):

Two outcome variables pertaining to the generation of evidence: (1) how recently an LHD completed a community health assessment and (2) how recently an LHD completed a community health improvement plan. A third outcome variable reflected how extensively an LHD used the Community Guide, a compendium of evidence-based findings.

Results:

In 2010, 25.1% and 41.4% of all LHDs had not completed a community health assessment or a community health improvement plan, respectively; by 2019, those figures declined significantly to 14.6% and 24.7%. Similarly, in 2010, 61.7% of all LHDs were not using the Community Guide; by 2019, that percentage declined significantly to 42.5%. Multivariable analysis revealed that leader experience was a more robust correlate of evidence generation and use by LHDs than leader education.

Conclusions:

While LHDs' generation and use of evidence have grown over the past decade, there is room for improvement. Local health department leader attributes—education and experience—highlight targeted opportunities to fill gaps in the use of evidence-based public health practices.
Genome placement of alpha-haemolysin cluster is associated with alpha-haemolysin sequence variation, adhesin and iron acquisition factor profile of Escherichia coli
Authors: Kolenda Rafał , Sidorczuk Katarzyna , Noszka Mateusz , Aleksandrowicz Adrianna , Khan Muhammad Moman , Burdukiewicz Michał , Pickard Derek , Schierack Peter
Published: December 2021

Since the discovery of haemolysis, many studies focused on a deeper understanding of this phenotype in

Escherichia coli

and its association with other virulence genes, diseases and pathogenic attributes/functions in the host. Our virulence-associated factor profiling and genome-wide association analysis of genomes of haemolytic and nonhaemolytic

E. coli

unveiled high prevalence of adhesins, iron acquisition genes and toxins in haemolytic bacteria. In the case of fimbriae with high prevalence, we analysed sequence variation of FimH, EcpD and CsgA, and showed that different adhesin variants were present in the analysed groups, indicating altered adhesive capabilities of haemolytic and nonhaemolytic

E. coli

. Analysis of over 1000 haemolytic

E. coli

genomes revealed that they are pathotypically, genetically and antigenically diverse, but their adhesin and iron acquisition repertoire is associated with genome placement of hlyCABD cluster. Haemolytic

E. coli

with chromosome-encoded alpha-haemolysin had high frequency of P, S, Auf fimbriae and multiple iron acquisition systems such as aerobactin, yersiniabactin, salmochelin, Fec, Sit, Bfd and hemin uptake systems. Haemolytic

E. coli

with plasmid-encoded alpha-haemolysin had similar adhesin profile to nonpathogenic E. coli, with high prevalence of Stg, Yra, Ygi, Ycb, Ybg, Ycf, Sfm, F9 fimbriae, Paa, Lda, intimin and type 3 secretion system encoding genes. Analysis of HlyCABD sequence variation revealed presence of variants associated with genome placement and pathotype.
Confidence as a noisy decision reliability estimate
Authors: Boundy-Singer Zoe M. , Ziemba Corey M. , Goris Robbe L. T.
Published: December 2021

Decisions vary in difficulty. Humans know this and typically report more confidence in easy than in difficult decisions. However, confidence reports do not perfectly track decision accuracy, but also reflect response biases and difficulty misjudgments. To isolate the quality of confidence reports, we developed a model of the decision-making process underlying choice-confidence data. In this model, confidence reflects a subject’s estimate of the reliability of their decision. The quality of this estimate is limited by the subject’s uncertainty about the uncertainty of the variable that informs their decision (“meta-uncertainty”). This model provides an accurate account of choice-confidence data across a broad range of perceptual and cognitive tasks, revealing that meta-uncertainty varies across subjects, is stable over time, generalizes across some domains, and can be manipulated experimentally. The model offers a parsimonious explanation for the computational processes that underlie and constrain the sense of confidence.
Conjunctival epithelial cells resist productive SARS-CoV-2 infection
Authors: Jackson Robert M , Hatton Catherine F , Spegarova Jarmila Stremenova , Georgiou Maria , Collin Joseph , Stephenson Emily , Verdon Bernard , Haq Iram J , Hussain Rafiqul , Coxhead Jonathan M , Mudhar Hardeep-Singh , Wagner Bart , Hasoon Megan , Davey Tracey , Rooney Paul , Anjam Khan C.M. , Ward Chris , Brodlie Malcolm , Haniffa Muzlifah , Hambleton Sophie , Armstrong Lyle , Figueiredo Francisco , Queen Rachel , Duncan Christopher J A , Lako Majlinda
Published: December 2021

Although tropism of SARS-CoV-2 for respiratory tract epithelial cells is well established, an open question is whether the conjunctival epithelium is also a target for SARS-CoV-2. Conjunctival epithelial cells, which express viral entry receptors ACE2 and TMPRSS2, constitute the largest exposed epithelium of the ocular surface tissue, and may represent a relevant viral entry route. To address this question, we generated an organotypic air-liquid-interface model of conjunctival epithelium, composed of progenitor, basal and superficial epithelial cells and fibroblasts, which could be maintained successfully up to day 75 of differentiation. Using single-cell RNA Seq, with complementary imaging and virological assays, we observed that while all conjunctival cell types were permissive to SARS-CoV-2 genome expression, a productive infection did not ensue. The early innate immune response to SARS-CoV-2 infection in conjunctival cells was characterised by a robust autocrine and paracrine NF-Kβ activity, without activation of antiviral interferon signalling. Collectively, these data enrich our understanding of SARS-CoV-2 infection at the human ocular surface, with potential implications for the design of preventive strategies and conjunctival transplants.
dynamAedes: a unified modelling framework for invasiveAedesmosquitoes
Authors: Da Re Daniele , Van Bortel Wim , Reuss Friederike , Müller Ruth , Boyer Sebastien , Montarsi Fabrizio , Ciocchetta Silvia , Arnoldi Daniele , Marini Giovanni , Rizzoli Annapaola , L’Ambert Gregory , Lacour Guillaume , Koenraadt Constantianus J.M. , Vanwambeke Sophie O. , Marcantonio Matteo
Published: December 2021

Mosquito species belonging to the genusAedeshave attracted the interest of scientists and public health officers for their invasive species traits and efficient capacity of transmitting viruses affecting humans. Some of these species were brought outside their native range by human activities such as trade and tourism, and colonised new regions thanks to a unique combination of eco-physiological traits.

Considering mosquito physiological and behavioural traits to understand and predict the spatial and temporal population dynamics is thus a crucial step to develop strategies to mitigate the local densities of invasiveAedespopulations.

Here, we synthesised the life cycle of four invasiveAedesspecies (Ae. aegypti,Ae. albopictus,Ae. japonicusandAe. koreicus) in a single multi-scale stochastic modelling framework which we coded in the R packagedynamAedes. We designed a stage-based and time-discrete stochastic model driven by temperature, photo-period and inter-specific larval competition that can be applied to three different spatial scales: punctual, local and regional. These spatial scales consider different degrees of spatial complexity and data availability, by accounting for both active and passive dispersal of mosquito species as well as for the heterogeneity of the input temperature data.

Our overarching aim was to provide a flexible, open-source and user-friendly tool rooted in the most updated knowledge on species biology which could be applied to the management of invasiveAedespopulations as well as for more theoretical ecological inquiries.
Draft Genome of Cochliopodium minus (Amoebozoa): Insights into Its Complex Sexual Behavior, Across Domain Gene Acquisitions and Metazoan Type Signaling
Authors: Tekle Yonas I. , Wang Fang , Tran Hanh , Hayes T. Danielle , Ryan Joseph F.
Published: December 2021

To date, genomic analyses in amoebozoans have been mostly limited to model organisms or medically important lineages. Consequently, the vast diversity of Amoebozoa genomes remain unexplored. A draft genome of Cochliopodium minus, an amoeba characterized by extensive cellular and nuclear fusions, is presented. C. minus has been a subject of recent investigation for its unusual sexual behavior. Cochliopodium’s sexual activity occurs during vegetative stage making it an ideal model for studying sexual development, which is sorely lacking in the group. Here we generate a C. minus draft genome assembly. From this genome, we detect a substantial number of lateral gene transfer (LGT) instances from bacteria (15%), archaea (0.9%) and viruses (0.7%) the majority of which are detected in our transcriptome data. We identify the complete meiosis toolkit genes in the C. minus genome, as well as the absence of several key genes involved in plasmogamy and karyogamy. Comparative genomics of amoebozoans reveals variation in sexual mechanism exist in the group. Similar to complex eukaryotes, C. minus (some amoebae) possesses Tyrosine kinases and duplicate copies of SPO11. We report a first example of alternative splicing in a key meiosis gene and draw important insights on molecular mechanism of sex in C. minus using genomic and transcriptomic data.
Understanding Harmonic Structures Through Instantaneous Frequency
Authors: Fabus Marco S. , Woolrich Mark W. , Warnaby Catherine W. , Quinn Andrew J.
Published: December 2021

The analysis of harmonics and non-sinusoidal waveform shape in neurophysiological data is growing in importance. However, a precise definition of what constitutes a harmonic is lacking. In this paper, we propose a rigorous definition of when to consider signals to be in a harmonic relationship based on an integer frequency ratio, constant phase, and a well-defined joint instantaneous frequency. We show this definition is linked to extrema counting and Empirical Mode Decomposition (EMD). We explore the mathematics of our definition and link it to results from analytic number theory. This naturally leads to us to define two classes of harmonic structures, termed strong and weak, with different extrema behaviour. We validate our framework using both simulations and real data. Specifically, we look at the harmonics structure in the FitzHugh-Nagumo model and the non-sinusoidal hippocampal theta oscillation in rat local field potential data. We further discuss how our definition helps to address mode splitting in EMD. A clear understanding of when harmonics are present in signals will enable a deeper understanding of the functional and clinical roles of non-sinusoidal neural oscillations.