bluuebunny/crossref_metadata_2025 huggingface dataset:
Baseline characteristics and evolution of Brazilian patients with atypical hemolytic uremic syndrome: first report of the Brazilian aHUS Registry
Authors: Vaisbich Maria Helena , de Andrade Luís Gustavo Modelli , de Menezes Neves Precil Diego Miranda , Palma Lílian Monteiro Pereira , de Castro Maria Cristina Ribeiro , Silva Cassiano Augusto Braga , de Holanda Barbosa Maria Izabel Neves , Penido Maria Goretti Moreira Guimarães , Neto Oreste Ângelo Ferra , Sobral Roberta Mendes Lima , Miranda Silvana Maria Carvalho , de Almeida Araújo Stanley , Pietrobom Igor Gouveia , Takase Henrique Mochida , Ribeiro Cláudia , da Silva Rafael Marques , de Carvalho César Augusto Almeida , Machado David José Barros , e Silva Ana Mateus Simões Teixeira , da Silva Andreia Ribeiro , Russo Enzo Ricardo , Barros Flávio Henrique Soares , Nasserala Jarinne Camilo Landim , de Oliveira Luciana Schmitt Cardon , de Castro Sylvestre Lucimary , Weissheimer Rafael , Nascimento Sueli Oliveira , Bianchini Gilson , de Carvalho Barreto Fellype , Veloso Valéria Soares Pigozzi , Fortes Patrícia Marques , Colares Vinicius Sardão , Gomes Jaelson Guilhem , Leite André Falcão Pedrosa , Mesquita Pablo Girardelli Mendonça , Vieira-Neto Osvaldo Merege
Published: April 2022

Background

Atypical hemolytic uremic syndrome (aHUS) is an ultra-rare disease. Therefore, studies involving large samples are scarce, making registries powerful tools to evaluate cases. We present herein the first analysis of the Brazilian aHUS Registry (BRaHUS).

Methods

Analysis of clinical, laboratory, genetic and treatment data from patients inserted in the BRaHUS, from 2017 to 2020, as an initiative of the Rare Diseases Committee of the Brazilian Society of Nephrology.

Results

The cohort consisted of 75 patients (40 adults and 35 pediatric). There was a predominance of women (56%), median age at diagnosis of 20.7 years and a positive family history in 8% of cases. Renal involvement was observed in all cases and 37% had low C3 levels. In the <2 years of age group, males were predominant. Children presented lower levels of hemoglobin (P = .01) and platelets (P = .003), and higher levels of lactate dehydrogenase (LDH) (P = .004) than adults. Genetic analysis performed in 44% of patients revealed pathogenic variants in 66.6% of them, mainly in CFH and the CFHR1-3 deletion. Plasmapheresis was performed more often in adults (P = .005) and 97.3% of patients were treated with eculizumab and its earlier administration was associated with dialysis-free after 3 months (P = .08).

Conclusions

The cohort of BRaHUS was predominantly composed of female young adults, with renal involvement in all cases. Pediatric patients had lower hemoglobin and platelet levels and higher LDH levels than adults, and the most common genetic variants were identified in CFH and the CFHR1-3 deletion with no preference of age, a peculiar pattern of Brazilian patients.
An update of the salmon louse (Lepeophtheirus salmonis) reference genome assembly
Authors: Joshi Jay , Flores Anne-Marie , Christensen Kris A , Johnson Hollie , Siah Ahmed , Koop Ben F
Published: April 2022

Salmon lice have plagued the salmon farming industry and have negatively impacted salmon populations in the wild. In response, researchers have generated high density genetic maps, genome assemblies, transcriptomes, and whole-genome resequencing data to better understand this parasite. In this study, we used long-read sequencing technology to update the previous genome assemblies of Atlantic Ocean salmon lice with a more contiguous assembly and a more comprehensive gene catalog of Pacific Ocean salmon lice. We were also able to further characterize genomic features previously identified from other studies by using published resequenced genomes of 25 Atlantic and 15 Pacific salmon lice. One example was further characterizing the ZW sex chromosomes. For both the Atlantic and Pacific Ocean salmon lice subspecies, we found that the female W-chromosome is only a small fraction of the Z-chromosome and that the vast majority of the W and Z-chromosome do not contain conserved regions (i.e. pseudoautosomal regions). However, conserved orthologous protein sequences can still be identified between the W- and Z-chromosomes.
Comparable Pregnancy Outcomes for HIV-Uninfected and HIV-Infected Women on Antiretroviral Treatment in Kenya
Authors: Mugo Cyrus , Nduati Ruth , Osoro Eric , Nyawanda Bryan O , Mirieri Harriet , Hunsperger Elizabeth , Verani Jennifer R , Jin Hafsa , Mwaengo Dufton , Maugo Brian , Machoki James , Otieno Nancy A , Ombok Cynthia , Shabibi Mufida , Okutoyi Lydia , Kinuthia John , Widdowson Marc Alain , Njenga Kariuki , Inwani Irene , Wamalwa Dalton
Published: April 2022

Background

The impact of human immunodeficiency virus (HIV) on pregnancy outcomes for women on antiretroviral therapy (ART) in sub-Saharan Africa remains unclear.

Methods

Pregnant women in Kenya were enrolled in the second trimester and followed up to delivery. We estimated effects of treated HIV with 3 pregnancy outcomes: loss, premature birth, and low birth weight and factors associated with HIV-positive status.

Results

Of 2113 participants, 311 (15%) were HIV infected and on ART. Ninety-one of 1762 (5%) experienced a pregnancy loss, 169/1725 (10%) a premature birth (<37 weeks), and 74/1317 (6%) had a low-birth-weight newborn (<2500 g). There was no evidence of associations between treated HIV infection and pregnancy loss (adjusted relative risk [aRR], 1.19; 95% confidence interval [CI], .65–2.16; P = .57), prematurity (aRR, 1.09; 95% CI, .70–1.70; P = .69), and low birth weight (aRR, 1.36; 95% CI, .77–2.40; P = .27). Factors associated with an HIV-positive status included older age, food insecurity, lower education level, higher parity, lower gestation at first antenatal clinic, anemia, and syphilis. Women who were overweight or underweight were less likely to be HIV infected compared to those with normal weight.

Conclusions

Currently treated HIV was not significantly associated with adverse pregnancy outcomes. HIV-infected women, however, had a higher prevalence of other factors associated with adverse pregnancy outcomes.
Defective Monocyte Enzymatic Function and an Inhibitory Immune Phenotype in Human Immunodeficiency Virus-Exposed Uninfected African Infants in the Era of Antiretroviral Therapy
Authors: Afran Louise , Jambo Kondwani C , Nedi Wilfred , Miles David J C , Kiran Anmol , Banda Dominic H , Kamg’ona Ralph , Tembo Dumizulu , Pachnio Annette , Nastouli Eleni , Ferne Brigit , Mwandumba Henry C , Moss Paul , Goldblatt David , Rowland-Jones Sarah , Finn Adam , Heyderman Robert S
Published: April 2022

Background

Human immunodeficiency virus-exposed uninfected (HEU) infants are a rapidly expanding population in sub-Saharan Africa and are highly susceptible to encapsulated bacterial disease in the first year of life. The mechanism of this increased risk is still poorly understood. We investigated whether human immunodeficiency virus (HIV)-exposure dysregulates HEU immunity, vaccine-antibody production, and human herpes virus amplify this effect.

Methods

Thirty-four HIV-infected and 44 HIV-uninfected pregnant women were recruited into the birth cohort and observed up to 6 weeks of age; and then a subsequent 43 HIV-infected and 61 HIV-uninfected mother-infant pairs were recruited into a longitudinal infant cohort at either: 5–7 to 14–15; or 14–15 to 18–23 weeks of age. We compared monocyte function, innate and adaptive immune cell phenotype, and vaccine-induced antibody responses between HEU and HIV-unexposed uninfected (HU) infants.

Results

We demonstrate (1) altered monocyte phagosomal function and B-cell subset homeostasis and (2) lower vaccine-induced anti-Haemophilus influenzae type b (Hib) and anti-tetanus toxoid immunoglobulin G titers in HEU compared with HU infants. Human herpes virus infection was similar between HEU and HU infants.

Conclusions

In the era of antiretroviral therapy-mediated viral suppression, HIV exposure may dysregulate monocyte and B-cell function, during the vulnerable period of immune maturation. This may contribute to the high rates of invasive bacterial disease and pneumonia in HEU infants.
Functional roles of xylanase enhancing intestinal health and growth performance of nursery pigs by reducing the digesta viscosity and modulating the mucosa-associated microbiota in the jejunum
Authors: Moita Vitor Hugo C , Duarte Marcos Elias , Kim Sung Woo
Published: April 2022

This study was conducted to investigate the functional roles of an endo-β-1,4-xylanase on the intestinal health and growth performance of nursery pigs. A total of 60 pigs (21 d old, 6.9 ± 0.8 kg body weight [BW]) were allotted based on a randomized complete block design with sex and initial BW as blocks. Dietary treatments had nutrients meeting the requirements with increasing levels of endo-β-1,4-xylanase (0, 220, 440, 880, 1,760 xylanase unit [XU] per kg feed) and fed to pigs in three phases (phases 1, 2, and 3 for 10, 14, and 14 d, respectively). Titanium dioxide (0.4%) was added to the phase 3 diets as an indigestible marker. On day 38, all pigs were euthanized to collect ileal digesta to measure apparent ileal digestibility (AID), jejunal digesta to measure viscosity, and jejunal mucosa to evaluate intestinal health. Data were analyzed using the MIXED procedure for polynomial contrasts and the NLMIXED procedure for broken line analysis of SAS. Increasing xylanase in the nursery diets reduced (linear, P < 0.05) the digesta viscosity in the jejunum. Increasing xylanase tended to reduce the relative abundance of Cupriavidus (P = 0.073) and Megasphaera (P = 0.063); tended to increase the relative abundance of Succinivibrio (P = 0.076) and Pseudomonas (P = 0.060); and had a quadratic effect (P < 0.05) on the relative abundance of Acinetobacter (maximum: 2.01% at 867 XU per kg feed). Xylanase from 0 to 1,087 XU per kg feed reduced (P < 0.05) jejunal malondialdehyde. Xylanase from 0 to 1,475 XU per kg feed increased (P < 0.05) the AID of neutral detergent fiber. Increasing xylanase increased (P < 0.05) the AID of ether extract and tended to increase (P = 0.058) the AID of crude protein. Increasing xylanase did not affect growth performance on overall period, whereas xylanase from 0 to 736 XU per kg feed increased (P < 0.05) average daily gain (ADG) during days 31 to 38. In conclusion, xylanase supplementation showed benefits on intestinal health by reducing digesta viscosity, the relative abundance of potentially harmful bacteria, and the oxidative stress in the jejunal mucosa, collectively enhancing intestinal morphology and the AID of nutrients. Xylanase supplementation at a range of 750 to 1,500 XU per kg feed provided benefits associated with reduced oxidative stress, increased nutrient digestibility, resulting in potential improvement on growth performance of nursery pigs by increasing the average daily feed intake and moderately improving the ADG throughout the last week of feeding.
Cancer Mortality Patterns by Birthplace and Generation Status of Mexican Latinos: The Multiethnic Cohort
Authors: Chen Hongjie , Wu Anna H , Wang Songren , Bookstein Arthur , Le Marchand Loïc , Wilkens Lynne R , Haiman Christopher A , Cheng Iona , Monroe Kristine R , Setiawan Veronica Wendy
Published: April 2022

Background

Latinos are the largest minority group in the United States. We assessed cancer mortality by birthplace and generation status of Mexican Latinos in the Multiethnic Cohort.

Methods

We included 26 751 Latinos of Mexican origin and 6093 non-Latino Whites aged 45-74 years at cohort entry (1993-1996) from the California Multiethnic Cohort component. The Mexican Latinos comprised 42% first-generation Mexico-born immigrants, 42% second-generation (28% US-born with both parents Mexico-born and 14% US-born with 1 parent US-born and 1 parent Mexico-born), and 16% third-generation or more who were US-born with both parents US-born. Multivariable Cox models were used to calculate covariate adjusted hazard ratios and 95% confidence intervals for overall and site-specific cancer mortality by birthplace and generation status. All statistical tests were 2-sided.

Results

Cancer death rate was highest among the US-born with 1 parent US-born and 1 parent Mexico-born (age-adjusted rate = 471.0 per 100 000 person-years) and US-born with both parents US-born (age-adjusted rate = 469.0 per 100 000 person-years) groups. The US-born with both parents Mexico-born group had a 30% (hazard ratio = 1.30, 95% confidence interval = 1.18 to 1.44) higher risk of cancer death than the first-generation Mexico-born immigrants group, showing US birthplace was associated with an elevated cancer mortality. For cancer-specific mortality, US birthplace was positively associated with colorectal, liver and lung, and ovarian cancer (P values ranged from .04 to .005). Among US-born Mexican Latinos, generation status was not statistically significantly associated with overall cancer or site-specific cancer mortality.

Conclusions

Our findings suggest that US birthplace is a risk factor for cancer death in Mexican Americans. Identification of the contributing factors is important to curtail patterns of increasing cancer mortality in US-born Mexican Latinos.
A policy-aware epistemic framework for social networks
Authors: Moezkarimi Zahra , Ghassemi Fatemeh , Mousavi Mohammad Reza
Published: April 2022

We provide a semantic framework to specify information propagation in social networks; our semantic framework features both the operational description of information propagation and the epistemic aspects in social networks. In our framework, based on annotated labelled transition systems, actions are decorated with function views to specify different types of announcements. Our function views enforce various common types of local privacy policies, i.e. those policies concerning a single action. Furthermore, we specify global privacy policies, those concerning multiple actions, using a combination of modal $\mu $-calculus and epistemic logic. To illustrate the applicability of our framework, we apply it to the specification of a real-world case study. As a fundamental property for the epistemic aspect of our semantic model, we prove that its indistinguishability relations are equivalence relations, namely they are reflexive, symmetric and transitive. We also study the complexity bounds for the model-checking problem concerning a subset of our logic and show that model checking is PSPACE-complete for the studied subset.
Core formation via filament fragmentation and the impact of ambient pressure on it
Authors: Anathpindika S V , Francesco J Di
Published: April 2022

Prestellar cores are generally spheroidal, some of which appear oblate while others appear prolate. Very few of them appear circular in projection. Little, however, is understood about the processes or the physical conditions under which prolate/oblate cores form. We find that an initially subcritical filament experiencing relatively low pressure (≲104 K cm−3) forms prolate cores (i.e. those with axial ratios in excess of unity) via gradual accumulation of gas in density crests. Meanwhile, a filament that is initially transcritical and experiences pressure similar to that in the Solar neighbourhood (between few × 104 and few × 105 K cm−3) forms oblate cores (i.e. those with axial ratios less than unity) via Jeans-like fragmentation. At higher pressure, however, fragments within the filament do not tend to survive as they rebound soon after formation. We also argue that quasi-oscillatory features of velocity gradient observed along the filament axis, and in the direction orthogonal to the axis, are integral to the filament evolution process and arise due to the growth of corrugations on its surface. The axial component of the velocity gradient, in particular, traces the gas flow along the filament length. We therefore posit that it could be used to constrain the filament-formation mechanism. The magnitude of the respective components of velocity gradients increases with increasing external pressure.
Dust spectral energy distributions in Milky Way-like galaxies in the IllustrisTNG simulations based on the evolution of grain size distribution
Authors: Chang Chiung-Yin , Huang Yu-Hsiu , Hirashita Hiroyuki , Cooper Andrew P
Published: April 2022

To understand how the evolution of grain size distribution in galaxies affects observed dust properties, we apply a post-processing dust evolution model to galaxy merger trees from the IllustrisTNG cosmological hydrodynamical simulation. Our dust model includes stellar dust production, sputtering in hot gas, dust growth by accretion and coagulation in the dense interstellar medium (ISM), and shattering in the diffuse ISM. We decompose the grain size distribution into different dust species depending on the elemental abundances and the dense ISM fraction given by the simulation. In our previous work, we focused on Milky Way (MW) analogues and reproduced the observed MW extinction curve. In this study, we compute dust spectral energy distributions (SEDs) for the MW analogues. Our simulated SEDs broadly reproduce the observed MW SED within their dispersion and so does the observational data of nearby galaxies, although they tend to underpredict the MW SED at short wavelengths where emission is dominated by polycyclic aromatic hydrocarbons. We find that metallicity and dense gas fraction are the most critical factors for the SED shape, through their influence on coagulation and shattering. The overall success of our models in reproducing the MW SED further justifies the dust evolution processes included in the model and predicts the dispersion in the SEDs caused by the variety in the assembly history. We also show that the most significant increase in the dust SED occurs between redshifts z ∼ 3 and 2 in the progenitors of the simulated MW-like galaxies.
MIGHTEE – H i. The relation between the H i gas in galaxies and the cosmic web
Authors: Tudorache Madalina N , Jarvis M J , Heywood I , Ponomareva A A , Maddox N , Frank B S , Adams N J , Bowler R A A , Whittam I H , Baes M , Pan H , Rajohnson S H A , Sinigaglia F , Spekkens K
Published: April 2022

We study the 3D axis of rotation (3D spin) of 77 H i galaxies from the MIGHTEE-H i Early Science observations, and its relation to the filaments of the cosmic web. For this H i-selected sample, the alignment between the spin axis and the closest filament (|cos ψ|) is higher for galaxies closer to the filaments, with 〈|cos ψ|〉 = 0.66 ± 0.04 for galaxies <5 Mpc from their closest filament compared to 〈|cos ψ|〉 = 0.37 ± 0.08 for galaxies at 5 < d < 10 Mpc. We find that galaxies with a low H i-to-stellar mass ratio (log10(MH i/M⋆) < 0.11) are more aligned with their closest filaments, with 〈|cos ψ|〉 = 0.58 ± 0.04; whilst galaxies with (log10(MH i/M⋆) > 0.11) tend to be mis-aligned, with 〈|cos ψ|〉 = 0.44 ± 0.04. We find tentative evidence that the spin axis of H i-selected galaxies tend to be aligned with associated filaments (d < 10 Mpc), but this depends on the gas fractions. Galaxies that have accumulated more stellar mass compared to their gas mass tend towards stronger alignment. Our results suggest that those galaxies that have accrued high gas fraction with respect to their stellar mass may have had their spin axis alignment with the filament disrupted by a recent gas-rich merger, whereas the spin vector for those galaxies in which the neutral gas has not been strongly replenished through a recent merger tend to orientate towards alignment with the filament. We also investigate the spin transition between galaxies with a high H i content and a low H i content at a threshold of $M_{\rm{H\,{\small {I}}}}\approx 10^{9.5} \mathrm{ M}_{\odot }$ found in simulations; however, we find no evidence for such a transition with the current data.
Cosmological nanolensing by dense gas clouds
Authors: Tuntsov Artem V , Walker Mark A
Published: April 2022

We study the influence of a cosmological population of dense gas clouds on distant sources, with an emphasis on quasar optical variability. In addition to gravitational lensing, such clouds affect flux measurements via refraction in the neutral gas and via dust extinction, leading to a variety of possible light curves even in the low optical depth limit. We classify and illustrate the types of light curves that can arise. For sources as large as quasars, we show that gravitational lensing and extinction are the dominant effects, with gas refraction playing only a minor role. We find that clouds with mass $\sim 10^{-4.5\pm 0.5}\, \mathrm{M}_\odot$ can reproduce the observed distribution of quasar variation amplitudes, but only if such clouds make up a large fraction of the closure density. In that case, there may also be substantial extinction of distant optical sources, which can, in principle, be constrained by data on ‘standard candles’ such as type Ia supernovae. Unfortunately, that extinction is essentially grey, even when the material opacity is strongly wavelength dependent, making it difficult to distinguish from the influence of the background geometry. We propose a novel statistical test of the origin of quasar variability, based on the angular structure of the variation timescale for a large number of quasars distributed all over the sky. If quasar variability is primarily due to nanolensing, then angular structure is expected to include a quadrupole term of amplitude $\sim 5{{\ \rm per\ cent}}$, which ought to be measurable with future data from the Gaia mission.
Macrophage-associated immune checkpoint CD47 blocking ameliorates endometriosis
Authors: Li Jing , Yan Shumin , Li Qiuju , Huang Yufei , Ji Miaomiao , Jiao Xue , Yuan Ming , Wang Guoyun
Published: April 2022

Peritoneal macrophages play a significant role in the progression of endometriosis (EM), but their functional differentiation is still unclear, and their phagocytic ability is weak. CD47-signal-regulated protein α (SIRPα) and PD-L1-PD-1 are considered immune checkpoints associated with macrophage phagocytosis. A specific blockade of these two pathways had been shown to increase the phagocytic clearance of cancer cells by macrophages in most cancers. We hypothesized that targeting CD47/PD-L1 in EM could improve the phagocytosis of macrophages, thereby delaying the progression of EM. From localization to quantification, from mRNA to protein, we comprehensively evaluated the expression of CD47 and PD-L1 in EM. We demonstrated that the CD47 expression in ectopic endometrium from patients with EM was significantly increased, but PD-L1 was not. We performed direct co-culture experiments of endometrial stromal cells with macrophages in vitro and in vivo to assess whether ectopic endometrial stromal cells escape macrophage phagocytosis through the CD47-SIRPα signaling pathway. The results showed that targeting CD47 increased the phagocytic capacity of macrophages. Interestingly, we also found that the reduction of CD47 expression promoted apoptosis of endometrial stromal cells. In conclusion, these data suggested that targeting CD47 can effectively target ectopic endometrial stromal cells through a dual mechanism of increased phagocytosis of macrophages and induced apoptosis of ectopic endometrial stromal cells. Thus, immunotherapy based on the CD47-SIRPα signaling pathway has some potential in treating EM, but further mechanistic studies are needed to explore more effective and specific antibodies.
Factors associated with health-related quality of life (HRQoL) deterioration in glioma patients during the progression-free survival period
Authors: Coomans Marijke B , Dirven Linda , Aaronson Neil , Baumert Brigitta G , van den Bent Martin , Bottomley Andrew , Brandes Alba A , Chinot Olivier , Coens Corneel , Gorlia Thierry , Herrlinger Ulrich , Keime-Guibert Florence , Malmström Annika , Martinelli Francesca , Stupp Roger , Talacchi Andrea , Weller Michael , Wick Wolfgang , Reijneveld Jaap C , Taphoorn Martin J B
Published: April 2022

Background

Maintenance of functioning and well-being during the progression-free survival (PFS) period is important for glioma patients. This study aimed to determine whether health-related quality of life (HRQoL) can be maintained during progression-free time, and factors associated with HRQoL deterioration in this period.

Methods

We included longitudinal HRQoL data from previously published clinical trials in glioma. The percentage of patients with stable HRQoL until progression was determined per scale and at the individual patient level (i.e. considering all scales simultaneously). We assessed time to a clinically relevant deterioration in HRQoL, expressed in deterioration-free survival and time-to-deterioration (the first including progression as an event). We also determined the association between sociodemographic and clinical factors and HRQoL deterioration in the progression-free period.

Results

Five thousand five hundred and thirty-nine patients with at least baseline HRQoL scores had a median time from randomization to progression of 7.6 months. Between 9–29% of the patients deteriorated before disease progression on the evaluated HRQoL scales. When considering all scales simultaneously, 47% of patients deteriorated on ≥1 scale. Median deterioration-free survival period ranged between 3.8–5.4 months, and median time-to-deterioration between 8.2–11.9 months. For most scales, only poor performance status was independently associated with clinically relevant HRQoL deterioration in the progression-free period.

Conclusions

HRQoL was maintained in only 53% of patients in their progression-free period, and treatment was not independently associated with this deterioration in HRQoL. Routine monitoring of the patients’ functioning and well-being during the entire disease course is therefore important, so that interventions can be initiated when problems are signaled.
Brain-eating amoeba
Authors: Perkins Amanda
Published: April 2022

Water activities enjoyed by millions of people around the world carry the risk of primary amoebic meningoencephalitis—a rare but deadly central nervous system infection.
Preventing dental erosion in at-risk patients
Authors: Schenkel Sara , Mulvaney-Roth Patricia , Hanna Debra R.
Published: April 2022

Learn when and how to educate patients who are at high risk for tooth damage, especially those experiencing high-frequency or chronic vomiting.
How to recognize compassion fatigue
Authors: Lockhart Lisa
Published: April 2022

The COVID-19 pandemic has created the perfect storm for healthcare workers, but compassion fatigue can be avoided.
Building a case for inpatient palliative care referrals
Authors: Melonson Paulette , Campbell Lisa A.
Published: April 2022

Lessons from a Doctor of Nursing Practice educational experience
Weekly Telephone Call Impacts Outcomes of an Individualized Home Exercise Program in People Recovering From Cancer
Authors: Mayer Jill E. , Plumeau Kayleigh
Published: April 2022

Background and Purpose:

Home exercise programs (HEPs) improve quality of life (QoL), physical function, and fatigue in individuals recovering from cancer; however, they often lack supervision and individualization. Use of a weekly telephone call by a physical therapist (PT) may provide substantial guidance to improve outcomes and adherence. The purpose of this study was to determine the effect of weekly calls in addition to an individualized HEP on physical function, QoL, fatigue, and adherence in people with cancer.

Methods:

A prospective 2-armed single-cohort design implemented with survivors of cancer in early recovery. Control and intervention groups received in-home instruction of a PT-prescribed, 8-week HEP. The intervention group received weekly phone calls while the control group had no formal follow-up or program monitoring. Outcome measures assessed pre-/postintervention: 6-minute walk test (6MWT), Fullerton Advanced Balance Scale, European Organization of Research and Treatment of Cancer QoL Questionnaire (EORTC QLQ-C30), and Functional Assessment of Chronic Illness Therapy Fatigue Scale (FACIT). Nonparametric statistics were used to analyze changes within and between groups.

Results:

Fifteen participants (n = 7 intervention and n = 8 control) completed the study. The intervention group improved significantly in all outcomes except the 6MWT (P < .05). The control group did not demonstrate any significant improvements. Between groups, there was a significant difference at program completion in the FACIT (P = .007) and EORTC QLQ-C30 physical function subscale (P = .042).

Limitations:

A small, heterogeneous sample.

Conclusions:

An individualized HEP with weekly calls may be a safe and effective way to improve outcomes of physical function, QoL, and fatigue in individuals with cancer during early recovery.
Coaching and Surgical Performance
Authors: Bellaire Laura , Ramo Brandon A. , Tolo Vernon T.
Published: April 2022

Surgical coaching is a form of mentoring that can improve surgical performance. While professional athletes have coaching their entire career, other professions, such as medicine, law, and education, are expected to manage their own improvement in performance over their careers. Methods of surgical coaching and the pros and cons of coaching to improve surgical performance and improve patient safety will be presented.
Leveraging Telehealth: Utilizing Digital Health Technology to Improve Patient Care in Orthopaedics
Authors: Maheu Arlene R. , Atanda Alfred
Published: April 2022

The past decade has seen a shift in health care delivery models to be more value-based: patient-centered, accessible, and cost-effective. One of the primary modes of addressing these needs has been through the implementation of telemedicine—digital health care technology that streamlines and enhances traditional health care delivery. In the orthopaedic setting, there are various methods of telemedicine utilization, each uniquely optimized for different clinical scenarios. There are certain financial and technological limitations when utilizing telemedicine for orthopaedic care that pose notable barriers to uniform utilization across the specialty. Nonetheless, these challenges are currently being tested as orthopaedic surgeons continuously become more innovative and creative as to how they deliver care. As we enter our “new normal” in the post-COVID-19 era, the availability and use of telemedicine will equip orthopaedic surgeons to deliver high-quality, affordable, and accessible care in an ever-changing health care landscape.
Better Patient Care Through Physician Extenders and Advanced Practice Providers
Authors: Milewski Matthew D. , Coene Ryan P. , Flynn John M. , Imrie Meghan N. , Annabell Lucas , Shore Benjamin J. , Dekis Joanne C. , Sink Ernest L.
Published: April 2022

Physician extenders and advanced practice providers (APPs) are now common in most adult and pediatric orthopaedic clinics and practices. Their utilization, with physician leadership, can improve patient care, patient satisfaction, and physician satisfaction and work/life balance in addition to having financial benefits. Physician extenders can include scribes, certified athletic trainers, and registered nurses, while APPs include nurse practitioners and physician assistants/associates. Different pediatric orthopaedic practices or divisions within a department might benefit from different physician extenders or APPs based on particular skill sets and licensed abilities. This article will review each of the physician extender and APP health care professionals regarding their training, salaries, background, specific skill sets, and scope of practice. While other physician extenders such as medical assistants, cast technicians, and orthotists/prosthetists have important roles in day-to-day clinical care, they will not be reviewed in this article. In addition, medical trainees, including medical students, residents, fellows, and APP students, have a unique position within some academic clinics but will also not be reviewed in this article. With the many different local, state, and national regulations, a careful understanding of the physician extender and APP roles will help clinicians optimize their ability to improve patient care.
Clinical Scores Predict Acute and Chronic Complications in Pediatric Osteomyelitis: An External Validation
Authors: Vij Neeraj , Singleton Ian , Kang Paul , Esparza Melissa , Burns Jessica , Belthur Mohan V.
Published: April 2022

Background:

Pediatric acute hematogenous osteomyelitis (AHO) outcomes are highly dependent on the disease severity. Recently, the A-SCORE and C-SCORE, were proposed as predictors of an acute complicated course and chronic morbidity, respectively. The purpose of this study was to externally validate the A-SCORE and C-SCORE at a single institution.

Methods:

This IRB-approved retrospective chart review included AHO patients admitted at a tertiary referral hospital between October 1, 2015 and December 31, 2019. The inclusion criteria were ages 0 to 18 and clinical response to treatment. The exclusion criteria were immunocompromised status or penetrating inoculation.

Results:

The A-SCORE demonstrated an area under the receiver operator curve (ROC area) of >86% with regards to all acute complications. It also demonstrated sensitivities >85% and specificities >92% at the cut-off of 4 (Youden index) for all acute complications. The C-SCORE demonstrated an ROC area of 100% with regards to chronic osteomyelitis. It also demonstrated sensitivities >70% and specificities >93% for the chronic morbidity variables seen in our population at the cut-off of 3 (Youden index.)

Conclusions:

These novel composite clinical scores, in combination with clinical judgment, could help guide early care decisions. The A-SCORE and C-SCORE are useful risk stratification tools in the management of pediatric AHO and in predicting acute complicated courses or chronic sequelae of AHO, respectively. These scoring systems, if integrated into standardized pediatric AHO guidelines, can allow clinicians to stratify the AHO population and guide clinical decision making.

Level of Evidence:

Level III (prognostic study, retrospective chart review).
Axicabtagene Ciloleucel in Patients Ineligible for ZUMA-1 Because of CNS Involvement and/or HIV: A Multicenter Experience
Authors: Yuen Carlen A. , Hsu Jing-Mei , Van Besien Koen , Reshef Ran , Iwamoto Fabio M. , Haggiagi Aya , Liechty Benjamin , Zhang Cenai , Wesley Sarah F. , Magge Rajiv
Published: April 2022

Secondary central nervous system lymphoma (SCNSL) is associated with poor prognosis and new therapeutic approaches are needed. The pivotal trial that led to US Food and Drug Administration (FDA) approval of axicabtagene ciloleucel excluded patients with SCNSL and human immunodeficiency virus. In this multi-institutional retrospective study, 14 SCNSL patients treated with axicabtagene ciloleucel, 3 of whom had human immunodeficiency virus, experienced rates of severe neurotoxicity and complete response of 32% and 58%, respectively. This is similar to rates observed in the pivotal ZUMA-1 trial that led to the approval of axi-cel at median follow-up of 5.9 months. Chimeric antigen receptor T-cell therapy is potentially a life-saving therapy for SCNSL patients and should not be withheld.
Self-reported Vital Sign Assessment Practices of Neurologic Physical Therapists
Authors: O'Brien Jamie , Wallmann Harvey W. , Karaffa Jaclynne , Kleilein Marissa , Prewitt Katherine , Schreiber Hannah , Zimmerman Hannah
Published: April 2022

Purpose:

This study's purpose was to describe the vital sign assessment (VSA) practices of physical therapists (PTs) during evaluation and treatment of patients with neurologic conditions.

Methods:

A survey was distributed to clinicians from a clinical site database and the Academy of Neurologic Physical Therapy's list serve. Respondents included US licensed PTs who treat patients with neurologic conditions.

Results:

Usable surveys included 133 US PTs with 69.2% doctorally prepared and 79.7% American Physical Therapy Association (APTA) members. Although 58.6% of survey respondents indicated that VSA is an essential part of the PT evaluation, at evaluation, only 37.6% and 39.1% of respondents always take heart rate (HR) and blood pressure (BP), and only 8.3% of respondents always take respiratory rate (RR). During treatment, only 14.3% of respondents report taking HR or BP at each session, while only 5.3% always take RR. Board certification was correlated with an increased frequency of HR assessment (P = .0027) and BP (P = 0.038) at evaluation, while importance of VSA strongly correlated with increased assessment of HR (P = 0.000), BP (P = 0.000), and RR (P = 0.003) at evaluation and with HR (P = 0.000) and BP (0.000) during treatment.

Conclusions:

Although VSA by neurologic PTs is higher than other identified PT groups, it is still below-recommended assessment guidelines.
Novel Approach for Midface Depression
Authors: Yamamoto Koji , Fukushima Kuniaki
Published: April 2022

Background:

Although Le Fort type II, prosthesis detainment, and orthodontic treatment are considered for the management of midface retraction, they may be limited by their high cost, infection risk, and excessive amount of tooth movement. Therefore, the Point A-Koji method was devised as a novel treatment in patients with midface retraction.

Methods:

This is a case report of a 26-year-old woman who presented with a feeling of depressed midface and protrusion of the mouth. Preoperatively, the position of the lip and line connecting the nasal apex and mental muscles (E-line) were normal, but the subnasale was located posteriorly. The patient had a narrow nasolabial angle of 74 degrees and the subnasale-Pog’ to the upper lip of 6.5 mm. After insertion of a metallic-plate implant under the periosteum, the plate was screwed and fixed to the bone. The Point A-Koji method was used for treatment in this patient. This is characterized by the A-point anterior migration technique in which the periosteum of hard tissue A-point circumferential attachment was shifted anteriorly, thereby preventing the return of soft tissue.

Results:

The following changes with respect to preoperative findings were noted 5 months postsurgery: facial convexity from 3.3 degrees to 7.6 degrees; nasolabial angle from 74 degrees to 90.2 degrees; true horizontal line from 50 degrees to 73 degrees; and subnasale-Pog’ to the upper lip from 6.5 mm to 4.7 mm. This resulted in an improved midface retraction.

Conclusion:

The Point A-Koji method may be an ideal method to improve the midface retraction in patients.
Do Mechanically Ventilated COVID-19 Patients Present a Higher Case-Fatality Rate Compared With Other Infectious Respiratory Pandemics? A Systematic Review and Meta-Analysis
Authors: Blumenfeld Orit , Fein Shai , Miller Asaf , Hershkovitz Yael , Caspi Inbar , Niv Yaron , Keinan-Boker Lital
Published: April 2022

Background

Early reports on COVID-19 patient outcomes showed a marked fatality rate among patients requiring invasive mechanical ventilation (IMV).

Objective

Our aim was to compare case fatality rate (CFR) outcomes for patients requiring IMV due to severe acute respiratory syndrome (SARS)-associated coronavirus 2 (COVID-19), SARS-associated coronavirus 1, Middle East respiratory syndrome (MERS), and influenza (H1N1).

Materials and Methods

We searched PubMed, EMBASE, MEDLINE, Google Scholar, and Cochrane Library for relevant studies published between December 2019 and April 2021 for COVID-19, between January 2002 and December 2008 for SARS, between January 2012 and December 2019 for MERS, and between January 2009 and December 2016 for influenza (H1N1).

Results

Overall, this study included 81 peer-reviewed studies, pertaining to 65,058 patients requiring IMV: 61 studies including 62,809 COVID-19 patients, 4 studies including 148 SARS patients, 9 studies including 875 MERS patients, and 7 studies including 1226 influenza (H1N1) patients. The CFR for COVID-19 patients requiring IMV was not significantly different from the CFR for SARS and influenza (H1N1) patients (45.5% [95% confidence interval (CI), 38.5%–52.8%] vs. 48.1% [95% CI, 39.2%–57.2%] and 39.7% [95% CI, 29.3%–51.3%], respectively). However, CFR for COVID-19 patients was significantly lower compared with that for MERS patients (CFR, 70.6%; 95% CI, 60.9%–78.8%).

Conclusions

COVID-19 patients requiring IMV show a similar CFR compared with SARS and H1N1 influenza patients but a lower CFR compared with MERS patients. To improve survival in future pandemics, we recommend examining the pros and cons of the liberal use of endotracheal intubation and considering drafting guidelines for the selection of patients to intubate and the timing of intubation.
Angle κ and its effect on the corneal elevation maps in refractive surgery candidates
Authors: Salouti Ramin , Nowroozzadeh M. Hossein , Azizi Ali , Salouti Kia , Ghoreyshi Maryam , Oboodi Reza , Tajbakhsh Zahra
Published: April 2022

Purpose:

To assess the associations of angle κ and Pentacam decentration indices with elevation maps in normal refractive surgery candidates.

Setting:

Salouti Cornea Research Center, Salouti Eye Clinic, Shiraz, Iran.

Design:

Retrospective observational study.

Methods:

In this research, the right eyes of 173 refractive surgery candidates were assessed. Data of front and back corneal elevation maps, keratometric data, decentration indices, and corneal astigmatism obtained by Pentacam HR system and angle κ obtained by Orbscan IIz were extracted. Maximum elevation (or depression) for each of the 4 quadrants was recorded. Correlations of elevation values with angle κ, Pentacam decentration indices, keratometry, and astigmatism were examined by Pearson correlation coefficient. 148 age- and sex-matched cases with keratoconus grade 1 were selected as a positive control group, and Pentacam variables were compared between the groups.

Results:

Overall, data from 173 eyes of 173 normal refractive surgery candidates and 148 eyes of 148 patients with keratoconus were recorded and analyzed. In normal refractive surgery candidates, the mean of angle κ was 5.32 ± 1.36 (SD) degrees. Angle κ had a positive correlation with front and back temporal elevations based on a best-fit sphere (BFS) (r = 0.339, P = .001; r = 0.300, P < .001, respectively). Front and back keratometric astigmatisms were positively correlated with front and back nasal and temporal elevations (r ≥ 0.543, P < .001) and negatively correlated with superior and inferior elevations (r ≤ −0.547, P < .001). These associations no longer existed when using best-fit toric ellipse (BFTE) for calculating elevation data. The thinnest point to vertex decentration was significantly associated with the back temporal elevation (based on the BFTE) in both normal (r = 0.311, P < .001) and keratoconus (r = 0.190, P = .021) eyes.

Conclusions:

This study showed that elevation maps obtained by the Pentacam system using BFS might be affected by both the large angle κ and corneal astigmatism, confounding the preoperative assessment of refractive surgery candidates. Using BFTE as a reference for calculating elevation data should eliminate most diagnostic issues and thus is encouraged in this context.
Adherence to guideline recommendations in the management of pediatric cardiac arrest: a multicentre observational simulation-based study
Authors: Corazza Francesco , Stritoni Valentina , Martinolli Francesco , Daverio Marco , Binotti Marco , Genoni Giulia , Ingrassia Pier Luigi , De Luca Marco , Palmas Giordano , Maccora Ilaria , Frigo Anna Chiara , Da Dalt Liviana , Bressan Silvia
Published: April 2022

Background and importance

Pediatric cardiac arrest is a rare emergency with associated high mortality. Its management is challenging and deviations from guidelines can affect clinical outcomes.

Objectives

To evaluate the adherence to guideline recommendations in the management of a pediatric cardiac arrest scenario by teams of pediatric residents. Secondarily, the association between the use of the Pediatric Advanced Life Support-2015 (PALS-2015) pocket card, and the teams’ adherence to international guidelines, were explored.

Design, settings and participants

Multicentre observational simulation-based study at three Italian University Hospitals in 2018, including PALS-2015 certified pediatric residents in their 3rd–5th year of residency program, divided in teams of three.

Intervention or exposure

Each team conducted a standard nonshockable pediatric cardiac arrest scenario and independently decided whether to use the PALS-2015 pocket card.

Outcome measure and analysis

The primary outcome was the overall number and frequency of individual deviations from the PALS-2015 guidelines, measured by the novel c-DEV15plus score (range 0–15). Secondarily, the performance on the validated Clinical Performance Tool for asystole scenarios, the time to perform resuscitation tasks and cardiopulmonary resuscitation (CPR) quality metrics were compared between the teams that used and did not use the PALS-2015 pocket card.

Main results

Twenty-seven teams (81 residents) were included. Overall, the median number of deviations per scenario was 7 out of 15 [interquartile range (IQR), 6–8]. The most frequent deviations were delays in positioning of a CPR board (92.6%), calling for adrenaline (92.6%), calling for help (88.9%) and incorrect/delayed administration of adrenaline (88.9%). The median Clinical Performance Tool score was 9 out of 13 (IQR, 7–10). The comparison between teams that used (n = 13) and did not use (n = 14) the PALS-2015 pocket card showed only significantly higher Clinical Performance Tool scores in the former group [9 (IQR 9–10) vs. 7 (IQR 6–8); P = 0.002].

Conclusions

Deviations from guidelines, although measured by means of a nonvalidated tool, were frequent in the management of a pediatric cardiac arrest scenario by pediatric residents. The use of the PALS-2015 pocket card was associated with better Clinical Performance Tool scores but was not associated with less deviations or shorter times to resuscitation tasks.
Clinical effect of ethanol co-use in patients with acute drug toxicity involving the use of central nervous system depressant recreational drugs
Authors: Heier Eva-Carina , Eyer Florian , Rabe Christian , Geith Stefanie , Dargan Paul I. , Wood David M. , Heyerdahl Fridtjof , Dines Alison M. , Giraudon Isabelle , Erik Hovda Knut , Yates Chris , Vallersnes Odd Martin , Miró Òscar , Liechti Matthias E. , Zellner Tobias ,   on behalf of the Euro-DEN Research Group
Published: April 2022

Background and importance

Patients who use recreational drugs frequently co-ingest ethanol, which is considered a central nervous system (CNS) depressant. The clinical relevance of this in acute toxicity involving other CNS depressants is not well described.

Objective

To assess the clinical impact of ethanol co-use in patients presenting to the emergency department (ED) with acute toxicity involving the use of CNS depressant drugs.

Design, settings and participants

A retrospective multicentre study using data from the Euro-DEN Plus database from January 2014 to December 2019.

Outcomes measure and analysis

Comparison of epidemiologic and clinical characteristics, ED and hospital management of patients with CNS depressant intoxication with or without ethanol co-use.

Main results

Although 7644 (17.5%) of the 43 633 presentations were included, ethanol was co-ingested in 3811 (49.9%). In total 53.3% required medical treatment, 14 patients died. Patients with ethanol co-use more frequently presented with a Glasgow Coma Scale (GCS) ≤8 (34.1% vs. 22.4%; P 
< 0.001), vomiting (8.1% vs. 4.6%; P 
< 0.001), anxiety (12 % vs. 6.4%; P 
< 0.001), agitation/aggression (22% vs. 14.7%; P 
< 0.001), seizures (3.8% vs. 2.4%; P 
< 0.001) and hypotension (7.5% vs. 4.6%; P 
< 0.001). They more often required ambulance transport (85.5% vs. 76.5%; P 
< 0.001), medical treatment (57.3% vs. 48.0%; P 
< 0.001), hospitalization (27.7% vs. 18.9%; P 
< 0.001), and admission to intensive care (12.2% vs. 4.0%; P 
< 0.001). Subgroup analysis showed that GCS ≤8 was particularly common in patients who combined ethanol with opioids or gamma-hydroxybutyrate (GHB)/gamma-butyrolactone (GBL).

Conclusion

Co-use of ethanol with CNS-depressant drugs appears to increase the risk of adverse effects and is associated with a higher need for medical treatment, especially when ethanol is combined with opioids or GHB/GBL.