bluuebunny/crossref_metadata_2025 huggingface dataset:
The effect of COVID-19 on maternal newborn and child health (MNCH) services in Bangladesh, Nigeria and South Africa: call for a contextualised pandemic response in LMICs
Authors: Ahmed Tanvir , Rahman Ahmed Ehsanur , Amole Taiwo Gboluwaga , Galadanci Hadiza , Matjila Mushi , Soma-Pillay Priya , Gillespie Bronwen M. , El Arifeen Shams , Anumba Dilly O. C.
Published: March 2021

Global response to COVID-19 pandemic has inadvertently undermined the achievement of existing public health priorities and laregely overlooked local context. Recent evidence suggests that this will cause additional maternal and childhood mortality and morbidity especially in low- and middle-income countries (LMICs). Here we have explored the contextual factors influencing maternal, neonatal and children health (MNCH) care in Bangladesh, Nigeria and South Africa amidst the pandemic. Our findings suggest that between March and May 2020, there was a reduction in utilisation of basic essential MNCH services such as antenatal care, family planning and immunization due to: a) the implementation of lockdown which triggered fear of contracting the COVID-19 and deterred people from accessing basic MNCH care, and b) a shift of focus towards pandemic, causing the detriment to other health services, and c) resource constraints. Taken together these issues have resulted in compromised provision of basic general healthcare. Given the likelihood of recurrent waves of the pandemic globally, COVID-19 mitigation plans therefore should be integrated with standard care provision to enhance system resilience to cope with all health needs. This commentary suggests a four-point contextualised mitigation plan to safeguard MNCH care during the pandemic using the observed countries as exemplars for LMIC health system adaptations to maintain the trajectory of progress regarding sustainable development goals (SDGs).
Examining the role of wind in human illness due to pesticide drift in Washington state, 2000–2015
Authors: Kasner Edward J. , Prado Joanne B. , Yost Michael G. , Fenske Richard A.
Published: March 2021

Background

Pesticides play an important role in protecting the food supply and the public’s health from pests and diseases. By their nature, pesticides can be toxic to unintended target organisms. Changing winds contribute to pesticide drift— the off-target movement of pesticides—and can result in occupational and bystander illness.

Methods

We systematically linked historical weather data to documented pesticide drift illnesses. We used Washington State Department of Health data to identify 252 drift events that included 690 confirmed cases of illness from 2000 to 2015. To characterize wind speed and direction at the time of the events, we paired these data with meteorological data from a network of 171 state weather stations. We report descriptive statistics and the spatio-temporal extent of drift events and compare applicator-reported weather conditions to those from nearby meteorological stations.

Results

Most drift events occurred in tree fruit (151/252 = 60%). Ground spraying and aerial applications accounted for 68% and 23% of events, respectively; 69% of confirmed cases were workers, and 31% were bystanders. Confirmed cases were highest in 2014 (129) from 22 events. Complete applicator spray records were available for 57 drift events (23%). Average applicator-reported wind speeds were about 0.9 m •sec− 1 (2 mi •hr− 1) lower than corresponding speeds from the nearest weather station values.

Conclusions

Drift events result from a complex array of factors in the agricultural setting. We used known spatio-temporal aspects of drift and historical weather data to characterize these events, but additional research is needed to put our findings into practice. Particularly critical for this analysis is more accurate and complete information about location, time, wind speed, and wind direction. Our findings can be incorporated into new training materials to improve the practice of pesticide application and for better documentation of spray drift events. A precision agriculture approach offers technological solutions that simplify the task of tracking pesticide spraying and weather conditions. Public health investigators will benefit from improved meteorological data and accurate application records. Growers, applicators, and surrounding communities will also benefit from the explanatory and predictive potential of wind ramping studies.
Dynamic contrast enhanced-MRI and diffusion-weighted image as predictors of lymphovascular invasion in node-negative invasive breast cancer
Authors: Choi Bo Bae
Published: March 2021

Background

Lymphovascular invasion (LVI) is an important risk factor for prognosis of breast cancer and an unfavorable prognostic factor in node-negative invasive breast cancer patients. The purpose of this study was to evaluate the association between LVI and pre-operative features of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) and diffusion-weighted imaging (DWI) in node-negative invasive breast cancer.

Methods

Data were collected retrospectively from 132 cases who had undergone pre-operative MRI and had invasive breast carcinoma confirmed on the last surgical pathology report. MRI and DWI data were analyzed for the size of tumor, mass shape, margin, internal enhancement pattern, kinetic enhancement curve, high intratumoral T2-weighted signal intensity, peritumoral edema, DWI rim sign, and apparent diffusion coefficient (ADC) values. We calculated the relationship between presence of LVI and various prognostic factors and MRI features.

Results

Pathologic tumor size, mass margin, internal enhancement pattern, kinetic enhancement curve, DWI rim sign, and the difference between maximum and minimum ADC were significantly correlated with LVI (p < 0.05).

Conclusions

We suggest that DCE-MRI with DWI would assist in predicting LVI status in node-negative invasive breast cancer patients.
Correction to: Performance of BioFire array or QuickVue influenza A + B test versus a validation qPCR assay for detection of influenza A during a volunteer A/California/2009/H1N1 challenge study
Authors: McIlwain David R. , Chen Han , Apkarian Maria , Affrime Melton , Bock Bonnie , Kim Kenneth , Mukherjee Nilanjan , Nolan Garry P. , McNeal Monica M.
Published: March 2021

An amendment to this paper has been published and can be accessed via the original article.
Re-operation rate after surgical treatment of osteochondral lesions of the talus in paediatric and adolescent patients
Authors: Körner Daniel , Gonser Christoph E. , Döbele Stefan , Konrads Christian , Springer Fabian , Keller Gabriel
Published: March 2021

Background

The aim of this study is to analyse the re-operation rate after surgical treatment of osteochondral lesions of the talus (OCLTs) in children and adolescents.

Methods

Between 2009 and 2019, 27 consecutive patients with a solitary OCLT (10 male, 17 female; mean age 16.9 ± 2.2 years; 8 idiopathic vs. 19 traumatic) received primary operative treatment (arthroscopy + bone marrow stimulation [BMS], n = 8; arthroscopy + retrograde drilling, n = 8; autologous chondrocyte implantation [ACI]/autologous bone grafting, n = 9; arthroscopy + BMS + retrograde drilling; n = 1; flake fixation, n = 1). Seventeen OCLTs were located at the medial and ten at the lateral talus.

‘Re-operation’ as the outcome measure was evaluated after a median follow-up of 42 months (range 6–117 months). Patients were further subdivided into groups A (re-operation, n = 7) and B (no re-operation, n = 20). Groups A and B were compared with respect to epidemiological, lesion- and therapy-related variables.

Results

Seven of 27 patients needed a re-operation (re-operation rate 25.9% after a median interval of 31 months [range 13–61 months]). The following operative techniques were initially used in these seven patients: arthroscopy + BMS n = 2, arthroscopy + retrograde drilling n = 4, ACI + autologous bone grafting n = 1. A comparison of group A with group B revealed different OCLT characteristics between both groups. The intraoperative findings according to the International Cartilage Repair Society (ICRS) classification revealed significantly more advanced cartilage damage in group B than in group A (p = 0.001).

Conclusions

We detected a re-operation rate of 25.9% after primary surgical OCLT treatment. Patients with re-operation had significantly lower ICRS classification stages compared to patients without re-operation.
Bacterial survival on inanimate surfaces: a field study
Authors: Katzenberger Ruth Hanna , Rösel Anja , Vonberg Ralf-Peter
Published: March 2021

Objective

Environmental surfaces may serve as potential reservoirs for nosocomial pathogens and facilitate transmissions via contact depending on its tenacity. This study provides data on survival kinetics of the most important nosocomial bacteria on a panel of commonly used surfaces. Type strains of S. aureus, K. pneumoniae, P. aeruginosa, A. baumannii, S. marcescens, E. faecium, E. coli, and E. cloacae were suspended in 0.9% NaCl solution at a McFarland of 1 and got then plated via cotton swabs either on glass, polyvinyl chloride, stainless steel, or aluminum. Surfaces were stored at regular ambient temperature and humidity to simulate routine daycare conditions. Sampling was performed by contact plates for a time period of four weeks.

Results

The longest survival was observed for A. baumannii and E. faecium on all materials (at least four weeks). S. aureus remained viable for at least one week. Gram negative species other than A. baumannii were usually inactivated in less than two days. Nosocomial transmission of the above mentioned bacteria may easily occur if no appropriate infection control measures are applied on a regular daily basis. This might be of particular importance when dealing with outbreaks of A. baumannii and E. faecium.
Platelet desialylation and TFH cells–the novel pathway of immune thrombocytopenia
Authors: Chen Yuwen , Hu Jianda , Chen Yingyu
Published: March 2021

Immune thrombocytopenia (ITP) is an autoimmune disease characterized by immune-mediated destruction of one’s own platelets. The progression of thrombocytopenia involves an imbalance of platelet production and clearance. B cells can induce autoantibodies, and T cells contribute to the pathological progression as well. Some patients with ITP have a poor response to common first-line therapies. Recent studies have shown that a novel Fc-independent platelet clearance pathway is associated with poor prognosis in these patients. By this pathway, desialylated platelets can be cleared by Ashwell-Morell receptor (AMR) on hepatocytes. Research has demonstrated that patients with refractory ITP usually have a high level of desialylation, indicating the important role of sialylation on platelet membrane glycoprotein (GP) in patients with primary immune thrombocytopenia, and neuraminidase 1(NEU1) translocation might be involved in this process. Patients with ITP who are positive for anti-GPIbα antibodies have a poor prognosis, which indicates that anti-GPIbα antibodies are associated with this Fc-independent platelet clearance pathway. Experiments have proven that these antibodies could lead to the desialylation of GPs on platelets. The T follicular helper (TFH) cell level is related to the expression of the anti-GPIbα antibody, which indicates its role in the progression of desialylation. This review will discuss platelet clearance and production, especially the role of the anti-GPIbα antibody and desialylation in the pathophysiology of ITP and therapy for this disease.
Organic colorants based on lac dye and brazilwood as markers for a chronology and geography of medieval scriptoria: a chemometrics approach
Authors: Nabais Paula , Melo Maria J. , Lopes João A. , Vieira Márcia , Castro Rita , Romani Aldo
Published: March 2021

This work presents the first proof of concept for the use of molecular fluorescence signatures in medieval colours based on lac dye and brazilwood lake pigments. These two important medieval dyes were tested as markers using their UV–Visible emission and excitation spectra. These medieval paints had been previously fully characterized through a multi-analytical approach. In this work, molecular fluorescence spectra were acquired in manuscripts dating from 12th to 15th c., which were produced in monastic scriptoria or workshops. First, the spectral distribution and relative intensity of the emission and excitation spectra were discussed in detail by comparison with reference compounds, including reproductions of paints based on medieval technical texts. It was possible to group the spectra according to recipe specificities. Then, statistical methods (principal component analysis and hierarchical cluster analysis) were applied to the same fluorescence spectra and the generated clusters were compared with the previous ones. Principal component analysis was initially employed to eliminate redundancy in fluorescence data, so minimizing bias on the hierarchical cluster analysis results. Except for some misplaced spectra, the placement of samples per group was confirmed. The outliers resulted from either a poor signal to noise ratio or occurred because certain paints were unique, such as the colour produced by mixing lac dye and brazilwood, which was found in manuscripts from the Alcobaça monastic scriptorium. Previously, by using infrared or Raman spectroscopies, only lac dye could be detected. Notably, these paints compare well with a recipe that was reproduced from the text by Jean Le Begue, in which both dyes were required.
Allergies/asthma and root resorption: a systematic review
Authors: dos Santos Cibelle Cristina Oliveira , Bellini-Pereira Silvio Augusto , Medina Melany Clarissa Gamez , Normando David
Published: March 2021

Background

This review synthesizes the available evidence about the predisposition of individuals with asthma or allergies to orthodontically induced inflammatory root resorption (OIIRR) and possible factors related to root resorption that were investigated in the included studies, such as the type of malocclusion, duration of orthodontic treatment, and tooth units.

Material and methods

Six electronic databases and partial gray literature were searched without date or language restrictions until September 2020. Prospective and retrospective observational cohort and case-control studies were included. The risk of bias (RoB) was assessed using the checklists from the Joanna Briggs Institute and the certainty of the evidence using the GRADE tool. To complement the case-control studies, the odds ratio (OR) of the individuals with allergies/asthma to develop root resorption was calculated.

Results

Six studies were included. One study with low RoB, one with moderate, and one with high RoB stated that allergic patients did not report a greater chance of developing OIIRR (OR = 1.17 to 2.10, p = 0.1 to 1), while only one study with low RoB reported that individuals with allergies tend to develop root resorption (OR = 2.4, 95% CI = 1.08-5.37). Three studies with low RoB and one with moderate showed no significant association between asthma and OIIRR (OR = 1.05 to 3.42, p = 0.12 to 0.94). No association was identified between the type of malocclusion and the degree of OIIRR. Uniradicular dental units and a prolonged treatment time seem to be associated with an increased risk of resorption. The certainty of the evidence was considered low for both exposure factors.

Conclusion

Evidence with a low level of certainty indicates that individuals with allergies or asthma are not more predisposed to OIIRR. Uniradicular teeth and long-term orthodontic treatments are associated with a higher risk of OIIRR.

Systematic review registration

PROSPERO CRD42020188463
Sustainable operation of geothermal power plants: why economics matters
Authors: Hackstein Fynn V. , Madlener Reinhard
Published: March 2021

This paper, based on a novel hybrid techno-economic model for geothermal power plants with endogenized plant lifetime, investigates the economic feasibility of a sustainable exploitation of geothermal resources for electricity generation. To this end, standard terminology and classifications from the literature are reviewed, such as “sustainability”, “sustainable operation”, “renewability”, “recovery”, “recharge”, and “regeneration”. An illustrative conventional, convective high-enthalpy hydrothermal system is contrasted with an enhanced, conductive low-enthalpy petrothermal system. Furthermore, different (mostly geophysical) sustainable operation criteria for the use of geothermal energy are derived from the literature. The conditions for complying with these criteria are compared with the economic criteria of cost minimization (levelized cost of electricity, LCOE) and profit maximization (net present value, NPV), respectively, revealing differences that vary in intensity, particularly depending on the type of reservoir and their respective properties. For the two case studies, LCOE of 2.9 €-ct/kWh and 16.9 €-ct/kWh are found, which are further scrutinized by a detailed sensitivity analysis. The hydrothermal system, in contrast to the petrothermal system investigated, is found to be able to meet several of the sustainability criteria examined (extraction equals recharge, operating lifetime of 100 to 300 years), whereas economically optimal operation leads to excessive overexploitation in both cases, showing a distinct trade-off between profit maximization and sustainable operation that has not been discussed in the literature so far.
Criminal punishment and violent injury in Minnesota
Authors: Santaularia N. Jeanie , Larson Ryan , Uggen Christopher
Published: March 2021

Background

Violence is one of the leading causes of injury and death in the United States. One-way society attempts to eliminate violence is through criminal punishment. Yet, in many contexts, punishment fails to reduce violence and may cause other harms. Current research on violence often suffers from same-source bias which can produce spurious associations. This study assesses the associations of different forms of criminal punishment (monetary sanctions, incarceration, and probation) with violent injuries in two unique datasets.

Methods

This study examines a unique combination of hospital discharge data and court administrative data, two Minnesota county-level data sources. First, we assess the spatial distribution of the three criminal punishment variables and two violent injury variables, violent injury overall and violent injury in children by county from 2010 to 2014, using Moran’s I statistic and Local Indicators of Spatial Autocorrelation. Then we assess the association of criminal punishment on violent injury and child abuse injury using a two-way fixed effects panel models.

Results

Child abuse injuries are relatively rare in our data but are significantly concentrated geographically, unlike violent injuries which are more dispersed throughout Minnesota. Incarceration and probation are significantly geographically concentrated in similar regions while monetary sanctions are not geographically concentrated. We find a link between probation loads and violent injury, specifically, with a 1 day increase in per capita probation supervision associated with a 0.044 increase in violent injury incidence per 1000 people. In contrast, monetary sanctions and incarceration loads have little association with either violent injury or child abuse injury incidence.

Conclusions

Criminal punishment is intended to reduce harm in society, but many argue that it may bring unintended consequences such as violence. This study finds that county-level probation has a modest positive association with county-level violent injury rates, but monetary sanctions and incarceration are less associated with violence injury rates. No measure of criminal punishment was associated with a reduction in violence. This study addresses a gap in previous literature by examining the association of punishment and violence in two unrelated datasets. High rates of criminal punishment and violent injury are both urgent public health emergencies. Further individual-level investigation is needed to assess potential links.
Performance of statistical and machine learning-based methods for predicting biogeographical patterns of fungal productivity in forest ecosystems
Authors: Morera Albert , Martínez de Aragón Juan , Bonet José Antonio , Liang Jingjing , de-Miguel Sergio
Published: March 2021

Background

The prediction of biogeographical patterns from a large number of driving factors with complex interactions, correlations and non-linear dependences require advanced analytical methods and modeling tools. This study compares different statistical and machine learning-based models for predicting fungal productivity biogeographical patterns as a case study for the thorough assessment of the performance of alternative modeling approaches to provide accurate and ecologically-consistent predictions.

Methods

We evaluated and compared the performance of two statistical modeling techniques, namely, generalized linear mixed models and geographically weighted regression, and four techniques based on different machine learning algorithms, namely, random forest, extreme gradient boosting, support vector machine and artificial neural network to predict fungal productivity. Model evaluation was conducted using a systematic methodology combining random, spatial and environmental blocking together with the assessment of the ecological consistency of spatially-explicit model predictions according to scientific knowledge.

Results

Fungal productivity predictions were sensitive to the modeling approach and the number of predictors used. Moreover, the importance assigned to different predictors varied between machine learning modeling approaches. Decision tree-based models increased prediction accuracy by more than 10% compared to other machine learning approaches, and by more than 20% compared to statistical models, and resulted in higher ecological consistence of the predicted biogeographical patterns of fungal productivity.

Conclusions

Decision tree-based models were the best approach for prediction both in sampling-like environments as well as in extrapolation beyond the spatial and climatic range of the modeling data. In this study, we show that proper variable selection is crucial to create robust models for extrapolation in biophysically differentiated areas. This allows for reducing the dimensions of the ecosystem space described by the predictors of the models, resulting in higher similarity between the modeling data and the environmental conditions over the whole study area. When dealing with spatial-temporal data in the analysis of biogeographical patterns, environmental blocking is postulated as a highly informative technique to be used in cross-validation to assess the prediction error over larger scales.
Portfolio diversification benefits of alternative currency investment in Bitcoin and foreign exchange markets
Authors: Qarni Muhammad Owais , Gulzar Saiqb
Published: March 2021

This study examines the portfolio diversification benefits of alternative currency trading in Bitcoin and foreign exchange markets. The following methods are applied for the analysis: the spillover index method of Diebold and Yilmaz (Int J Forecast 28(1): 57–66, 2012.10.1016/j.ijforecast.2011.02.006), the spillover asymmetry measures of Barunik et al. (J Int Money Finance 77: 39–56, 2017.10.1016/j.jimonfin.2017.06.003), and the frequency connectedness method of Barunik and Křehlík (J Financ Econom 16(2): 271–296, 2018.10.1093/jjfinec/nby001). The findings identify the presence of low-level integration and asymmetric volatility spillover as well as a dominant role of short horizon spillover among Bitcoin markets and foreign exchange pairs for six major trading currencies (US dollar, euro, Japanese yen, British pound sterling, Australian dollar, and Canadian dollar). Bitcoin is found to provide significant portfolio diversification benefits for alternative currency foreign exchange portfolios. Alternative currency Bitcoin trading in euro is found to provide the most significant portfolio diversification benefits for foreign exchange portfolios consisting of major trading currencies. The findings of the study regarding spillover dynamics and portfolio diversification capabilities of the Bitcoin market for foreign exchange markets of major trading currencies have significant implications for portfolio diversification and risk minimization.
Involving people affected by a rare condition in shaping future genomic research
Authors: Nunn Jack S. , Gwynne Kylie , Gray Sarah , Lacaze Paul
Published: March 2021

Background

There is evidence that involving potential participants and the public in co-designing research can improve the quality of the study design, recruitment and acceptability of the research, but appropriate methodologies for doing this are not always clear. In this study we co-designed a way of involving people affected by a rare genomic disease in shaping future genomic research about the condition. The aim was to report the process, experiences and outcomes of involving people in genomic research in a standardised way, in order to inform future methods of involvement in research co-production.

Method

Participants were recruited from an online community hosted by an Australian-based rare disease charity and were over the age 18 years. Once people gave consent, we shared learning resources with participants and invited them to complete an online survey before joining a two-week facilitated online discussion, followed by a second online survey. We used the novel tool ‘Standardised Data on Initiatives - Alpha Version 0.1’ (STARDIT) to map preferences, plan involvement and report any outcomes from the process, with quantitative data analysed descriptively and qualitative data thematically analysed.

Results

Of the 26 people who gave consent and completed the initial survey, 15 participated in the online discussion and 12 completed the follow-up survey. STARDIT was used to report six outcomes from the process, including 60% of participants’ responses showing a change towards ‘widening’ their view of who should be involved in research to include more people. Outcomes also included an improved understanding of research and how to be involved. Participants enjoyed online discussions, found learning resources useful and asked to stay involved in the research process. The partner organisation reported that a similar online discussion will be used in future research prioritisation processes.

Conclusion

Involving people in co-designing the process improved the study design, ensuring it met the needs of participants. Whilst the study includes participants from only one disease group, using STARDIT allowed us to map people’s preferences and report the methods and outcomes from involving people, providing a way for learning from this case study to inform future research studies beyond the discipline of public health genomics.
Effects of calcium level and source, formic acid, and phytase on phytate degradation and the microbiota in the digestive tract of broiler chickens
Authors: Krieg Jochen , Borda-Molina Daniel , Siegert Wolfgang , Sommerfeld Vera , Chi Yung Ping , Taheri Hamid Reza , Feuerstein Dieter , Camarinha-Silva Amélia , Rodehutscord Markus
Published: March 2021

Background

Diet acidification, dietary calcium (Ca) level, and phytase supplementation are known influences on the microbial community in the digestive tract and on phosphorus (P) utilization of broiler chickens. Effects of dietary factors and microbiota on P utilization may be linked because microorganisms produce enzymes that release P from phytate (InsP6), the main source of P in plant feedstuffs. This study aimed to detect linkages between microbiota and InsP6 degradation by acidifying diets (i.e., replacing Ca carbonate (CaCO3) by Ca formate or adding formic acid to CaCO3-containing diets), varying Ca levels, and supplementing phytase in a three-factorial design. We investigated i) the microbial community and pH in the digestive tract, ii) prececal (pc) P and Ca digestibility, and iii) InsP6 degradation.

Results

All factors under investigation influenced digesta pH and the microbiota composition. Predicted functionality and relative abundance of microorganisms indicated that diets influenced the potential contribution of the microbiota on InsP degradation. Values of InsP6 degradation and relative abundance of the strains Lactobacillus johnsonii and Lactobacillus reuteri were correlated. Phytase supplementation increased pc InsP6 disappearance, with differences between Ca levels, and influenced concentrations of lower inositol phosphate isomers in the digestive tract. Formic acid supplementation increased pc InsP6 degradation to myo-inositol. Replacing CaCO3 by Ca-formate and the high level of these Ca sources reduced pc InsP6 disappearance, except when the combination of CaCO3 + formic acid was used. Supplementing phytase to CaCO3 + formic acid led to the highest InsP6 disappearance (52%) in the crop and increased myo-inositol concentration in the ileum digesta. Supplementing phytase leveled the effect of high Ca content on pc InsP6 disappearance.

Conclusions

The results point towards a contribution of changing microbial community on InsP6 degradation in the crop and up to the terminal ileum. This is indicated by relationships between InsP6 degradation and relative abundance of phosphatase-producing strains. Functional predictions supported influences of microbiota on InsP6 degradation. The extent of such effects remains to be clarified. InsP6 degradation may also be influenced by variation of pH caused by dietary concentration and solubility of the Ca in the feed.
Interleukin-37 as an anti-inflammatory cytokine: does its relation to disease activity suggest its potential role in rheumatoid arthritis therapy?
Authors: Baraka Eman A. , Balata Mona G. , Ahmed Shereen H. , Khamis Afaf F. , Elattar Enas A.
Published: March 2021

Background

This study aimed to measure the serum and synovial interleukin (IL)-37 levels in rheumatoid arthritis (RA) patients compared to patients with primary knee osteoarthritis (PKOA) and healthy controls and to detect its relation to RA disease activity.

Results

This cross-sectional study included 50 RA patients with a mean age of 40.24 ± 8.62 years, 50 patients with PKOA with a mean age of 56.69 ± 4.21, and 40 healthy controls with a mean age of 41.75 ± 7.38 years. The mean serum IL-37 level in the RA patients (382.6 ± 73.97 pg/ml) was statistically significantly (P < 0.001) the highest among the studied groups; however, it showed a non-significant difference between the PKOA patients (70.38 ± 27.49 pg/ml) and the healthy controls (69.97 ± 25.12 pg/ml) (P > 0.94). Both serum and synovial IL-37 levels were significantly positively correlated with disease activity scores (r = 0.92, P< 0.001 and r = 0.85, P < 0.001), tender joint counts (r = 0.83, P < 0.001 and r = 0.82, P < 0.001 ), swollen joint counts (r = 0.72, P < 0.001 and r = 0.60, P < 0.001), visual analog scale (r = 0.82, P < 0.001 and r = 0.82, P < 0.001), erythrocyte sedimentation rate (r = 0.75, P < 0.001 and r = 0.65, P < 0.001), and C-reactive protein (r = 0.93, P < 0.001 and r = 0.79, P < 0.001), respectively.

Conclusion

Serum and synovial IL-37 were significantly elevated in the RA patients, and they were closely correlated. Being less invasive, the serum IL-37 could be a marker of disease activity and could reflect the effective disease control by drugs. Having an anti-inflammatory effect could not suggest IL-37 as the key player to control inflammation alone, but its combination with other anti-proinflammatory cytokines could be investigated.
Development of an Oncology Acute Care Risk Prediction Model
Authors: Csik Valerie P. , Li Michael , Binder Adam F. , Handley Nathan R.
Published: March 2021

PURPOSE

Acute care utilization (ACU), including emergency department (ED) visits or hospital admissions, is common in patients with cancer and may be preventable. The Center for Medicare & Medicaid Services recently implemented OP-35, a measure in the Hospital Outpatient Quality Reporting Program focused on ED visits and inpatient admissions for 10 potentially preventable conditions that arise within 30 days of chemotherapy. This new measure exemplifies a growing focus on preventing unnecessary ACU. However, identifying patients at high risk of ACU remains a challenge. We developed a real-time clinical prediction model using a discrete point allocation system to assess risk for ACU in patients with active cancer.

METHODS

We performed a retrospective cohort analysis of patients with active cancer from a large urban academic medical center. The primary outcome, ACU, was evaluated using a multivariate logistic regression model with backward variable selection. We used estimates from the multivariate logistic model to construct a risk index using a discrete point allocation system.

RESULTS

Eight thousand two hundred forty-six patients were included in the analysis. ED utilization in the last 90 days, history of chronic obstructive pulmonary disease, congestive heart failure or renal failure, and low hemoglobin and low neutrophil count significantly increased risk for ACU. The model produced an overall C-statistic of 0.726. Patients defined as high risk (achieving a score of 2 or higher on the risk index) represented 10% of total patients and 46% of ACU.

CONCLUSION

We developed an oncology acute care risk prediction model using a risk index–based scoring system, the REDUCE (Reducing ED Utilization in the Cancer Experience) score. Further efforts to evaluate the effectiveness of our model in predicting ACU are ongoing.
The Interactive Effect of Prepregnancy Overweight/Obesity and Isolated Maternal Hypothyroxinemia on Macrosomia
Authors: Liu Yindi , Guo Fei , Zhou Yulai , Yang Xi , Zhang Yong , Fan Jianxia
Published: March 2021

Context

Prepregnancy overweight/obesity (OWO) and isolated maternal hypothyroxinemia (IMH) may increase the risk of macrosomia, but little is known about their potential combined effect on macrosomia.

Objective

The aim of this study was to assess whether prepregnancy OWO and first-trimester IMH have a synergistic effect on the risk of macrosomia.

Methods

A large prospective cohort study in a Chinese population from January 2016 to December 2018 in a tertiary care center. In total, 34 930 pregnant women were included. The main outcome measure was macrosomia.

Results

A total of 34 930 participants comprising IMH and euthyroid cases was included in this study. Prepregnancy OWO and first-trimester IMH were independently associated with an increased risk of macrosomia (adjusted odds ratio [OR] 2.48, 95% CI 2.22, 2.78, and adjusted OR 1.65, 95% CI 1.34, 2.01, respectively). The coexistence of prepregnancy OWO and IMH was associated with macrosomia, with an adjusted OR of 5.26 (95% CI 3.9, 7.0) compared with pregnant women without either condition. The additive interaction between prepregnancy OWO and IMH was found to be significant with regard to macrosomia.

Conclusion

Prepregnancy OWO and IMH in the first trimester may synergistically increase the risk of macrosomia.
Point-of-Care Lung Ultrasound Pattern in Healthy Parturients: Prevalence of Pulmonary Interstitial Syndrome Following Vaginal Delivery, Elective and Unplanned Intrapartum Cesarean Delivery
Authors: Macias Paul , Wilson Jennifer G. , Austin Naola S. , Guo Nan , Carvalho Brendan , Ortner Clemens M.
Published: March 2021

BACKGROUND:

Pregnancy-related cardiovascular physiologic changes increase the likelihood of pulmonary edema, with the risk of fluid extravasating into the pulmonary interstitium being potentially at a maximum during the early postpartum period. Data on the impact of labor and peripartum hemodynamic strain on lung ultrasound (LUS) are limited, and the prevalence of subclinical pulmonary interstitial syndrome in peripartum women is poorly described. The primary aim of this exploratory study was to estimate the prevalence of pulmonary interstitial syndrome in healthy term parturients undergoing vaginal (VD), elective (eCD), and unplanned intrapartum cesarean deliveries (uCD). Secondary aims were to estimate the prevalence of positive lung regions (≥3 B-lines on LUS per region) and to assess the associations between positive lung regions and possible contributing factors.

METHODS:

In this prospective observational cohort study, healthy women at term undergoing VD, eCD, or uCD were enrolled. Following international consensus recommendations, a LUS examination was performed within 4 hours after delivery applying an 8-region technique. Pulmonary interstitial syndrome was defined by the presence of 2 or more positive lung regions per hemithorax. Ultrasound studies were reviewed by 2 blinded reviewers and assessed for interobserver reliability.

RESULTS:

Seventy-five women were assessed (n = 25 per group). No pulmonary interstitial syndrome was found in the VD and eCD groups (each 0 of 25; 0%, 95% confidence interval [CI], 0-13.7). Pulmonary interstitial syndrome was found in 2 of 25 (8%, 95% CI, 1-26) women undergoing an uCD (P = .490 for VD versus uCD and P = .490 for eCD versus uCD). In 1 woman, this correlated clinically with the development of pulmonary edema. One or more positive lung regions were present in 5 of 25 (20%), 6 of 25 (24%), and 11 of 25 (44%) parturients following VD, eCD, and uCD, respectively (P = .136). Positive lung regions were predominantly found in lateral lung regions. The number of positive lung regions showed a weak correlation with patient age (r = 0.25, 95% CI, 0.05-0.47; P = .033). No significant association was found between LUS pattern and parity, duration of labor, labor augmentation, labor induction, estimated total intravenous fluid intake, or net intravenous fluid intake.

CONCLUSIONS:

Although many focal areas of increased extravascular lung water (20%–44% prevalence) can be identified on LUS, the overall prevalence of pulmonary interstitial syndrome was 2.7% (2 of 75; 95% CI, 0.3-9.3) among healthy term parturients soon after delivery. Focal areas of positive lung water regions were weakly correlated with maternal age.
Midazolam Premedication Immediately Before Surgery Is Not Associated With Early Postoperative Delirium
Authors: Wang Man-Ling , Min Jie , Sands Laura P. , Leung Jacqueline M. ,   the Perioperative Medicine Research Group
Published: March 2021

BACKGROUND:

Postoperative delirium is common among older surgical patients and may be associated with anesthetic management during the perioperative period. The aim of this study is to assess whether intravenous midazolam, a short-acting benzodiazepine used frequently as premedication, increased the incidence of postoperative delirium.

METHODS:

Analyses of existing data were conducted using a database created from 3 prospective studies in patients aged 65 years or older who underwent elective major noncardiac surgery. Postoperative delirium occurring on the first postoperative day was measured using the confusion assessment method. We assessed the association between the use or nonuse of premedication with midazolam and postoperative delirium using a χ2 test, using propensity scores to match up with 3 midazolam patients for each control patient who did not receive midazolam.

RESULTS:

A total of 1266 patients were included in this study. Intravenous midazolam was administered as premedication in 909 patients (72%), and 357 patients did not receive midazolam. Those who did and did not receive midazolam significantly differed in age, Charlson comorbidity scores, preoperative cognitive status, preoperative use of benzodiazepines, type of surgery, and year of surgery. Propensity score matching for these variables and American Society of Anesthesiology physical status scores resulted in propensity score–matched samples with 1–3 patients who used midazolam (N = 749) for each patient who did not receive midazolam (N = 357). After propensity score matching, all standardized differences in preoperative patient characteristics ranged from –0.07 to 0.06, indicating good balance on baseline variables between the 2 exposure groups. No association was found between premedication with midazolam and incident delirium on the morning of the first postoperative day in the matched dataset, with odds ratio (95% confidence interval) of 0.91 (0.65-1.29), P = .67.

CONCLUSIONS:

Premedication using midazolam was not associated with higher incidence of delirium on the first postoperative day in older patients undergoing major noncardiac surgery.
Association Between Cerebral Desaturation and Postoperative Delirium in Thoracotomy With One-Lung Ventilation: A Prospective Cohort Study
Authors: Cui Fan , Zhao Wei , Mu Dong-Liang , Zhao Xu , Li Xue-Ying , Wang Dong-Xin , Jia Hui-Qun , Dai Feng , Meng Lingzhong
Published: March 2021

BACKGROUND:

The association between cerebral desaturation and postoperative delirium in thoracotomy with one-lung ventilation (OLV) has not been specifically studied.

METHODS:

A prospective observational study performed in thoracic surgical patients. Cerebral tissue oxygen saturation (Scto
2) was monitored on the left and right foreheads using a near-infrared spectroscopy oximeter. Baseline Scto
2 was measured with patients awake and breathing room air. The minimum Scto
2 was the lowest measurement at any time during surgery. Cerebral desaturation and hypersaturation were an episode of Scto
2 below and above a given threshold for ≥15 seconds during surgery, respectively. The thresholds based on relative changes by referring to the baseline measurement were <80%, <85%, <90%, <95%, and <100% baseline for desaturation and >105%, >110%, >115%, and >120% baseline for hypersaturation. The thresholds based on absolute values were <50%, <55%, <60%, <65%, and <70% for desaturation and >75%, >80%, >85%, and >90% for hypersaturation. The given area under the threshold (AUT)/area above the threshold (AAT) was analyzed. Delirium was assessed until postoperative day 5. The primary analysis was the association between the minimum Scto
2 and delirium using multivariable logistic regression controlled for confounders (age, OLV time, use of midazolam, occurrence of hypotension, and severity of pain). The secondary analysis was the association between cerebral desaturation/hypersaturation and delirium, and between the AUT/AAT and delirium using multivariable logistic regression controlled for the same confounders. Multiple testing was corrected using the Holm-Bonferroni method. We additionally monitored somatic tissue oxygen saturation on the forearm and upper thigh.

RESULTS:

Delirium occurred in 35 (20%) of 175 patients (65 ± 6 years old). The minimum left or right Scto
2 was not associated with delirium. Cerebral desaturation defined by <90% baseline for left Scto
2 (odds ratio [OR], 5.82; 95% confidence interval [CI], 2.12-19.2; corrected P =.008) and <85% baseline for right Scto
2 (OR, 4.27; 95% CI, 1.77-11.0; corrected P =.01) was associated with an increased risk of delirium. Cerebral desaturation defined by other thresholds, cerebral hypersaturation, the AUT/AAT, and somatic desaturation and hypersaturation were all not associated with delirium.

CONCLUSIONS:

Cerebral desaturation defined by <90% baseline for left Scto
2 and <85% baseline for right Scto
2, but not the minimum Scto
2, may be associated with an increased risk of postthoracotomy delirium. The validity of these thresholds needs to be tested by randomized controlled trials.
Role of Pelvic Lymph Node Resection in Vulvar Squamous Cell Cancer: A Subset Analysis of the AGO-CaRE-1 Study
Authors: Woelber Linn , Bommert Mareike , Harter Philipp , Prieske Katharina , zu Eulenburg Christine , Jueckstock Julia , Hilpert Felix , de Gregorio Nikolaus , Iborra Severine , Sehouli Jalid , Ignatov Atanas , Hillemanns Peter , Fuerst Sophie , Strauss Hans-Georg , Baumann Klaus , Beckmann Matthias , Mustea Alexander , Meier Werner , Mahner Sven , Jaeger Anna
Published: March 2021

Background

As the population at risk for pelvic nodal involvement remains poorly described, the role of pelvic lymphadenectomy (LAE) in vulvar squamous cell cancer (VSCC) has been a matter of discussion for decades.

Methods

In the AGO-CaRE-1 study, 1618 patients with International Federation of Gynecology and Obstetrics (FIGO) stage IB or higher primary VSCC treated at 29 centers in Germany between 1998 and 2008 were documented. In this analysis, only patients with pelvic LAE (n = 70) were analyzed with regard to prognosis and correlation between inguinal and pelvic lymph node involvement.

Results

The majority of patients had T1b/T2 tumors (n = 47; 67.1%), with a median diameter of 40 mm (2–240 mm); 54/70 patients (77.1%) who received pelvic LAE had positive groin nodes. For 42 of these 54 patients, the number of affected groin nodes had been documented as a median of 3; 14/42 (33.3%) of these patients had histologically confirmed pelvic nodal metastases (median number of affected pelvic nodes 3 [1–12]). In these 14 patients, the median number of affected groin nodes was 7 (1–30), with a groin metastases median maximum diameter of 42.5 mm (12–50). Receiver operating characteristic analysis showed an area under the curve of 0.85, with 83.3% sensitivity and 92.6% specificity for the prediction of pelvic involvement in cases of six or more positive groin nodes. No cases of pelvic nodal involvement without groin metastases were observed. Prognosis in cases of pelvic metastasis was poor, with a median progression-free survival of only 12.5 months.

Conclusion

For the majority of node-positive patients with VSCC, pelvic nodal staging appears unnecessary since a relevant risk for pelvic nodal involvement only seems to be present in highly node-positive disease.
Novel Strategies for Healthy Brain Aging
Authors: Wahl Devin , Cavalier Alyssa N. , LaRocca Thomas J.
Published: March 2021

One of the best strategies for healthy brain aging is regular aerobic exercise. Commonly studied “anti-aging” compounds may mimic some effects of exercise on the brain, but novel approaches that target energy-sensing pathways similar to exercise probably will be more effective in this context. We review evidence in support of this hypothesis by focusing on biological hallmarks of brain aging.
Massage as a Mechanotherapy for Skeletal Muscle
Authors: Van Pelt Douglas W. , Lawrence Marcus M. , Miller Benjamin F. , Butterfield Timothy A. , Dupont-Versteegden Esther E.
Published: March 2021

Massage is anecdotally associated with many health benefits, but physiological and clinically relevant mechanisms recently have begun to be investigated in a controlled manner. Herein, we describe research supporting our hypothesis that massage can be used as a mechanotherapy imparting biologically relevant adaptations in skeletal muscle and improving muscle properties.
Physical Activity and Male Reproductive Function: A New Role for Gamete Mitochondria
Authors: Lunetti Paola , Capobianco Loredana , Zara Vincenzo , Ferramosca Alessandra
Published: March 2021

Several studies demonstrated that some types of physical exercise might affect male reproductive potential, even though the potential mechanisms involved in the modulation of sperm quality remain poorly understood. Therefore, we propose a new role for gamete mitochondria as a key hub that coordinates molecular events related to the effects induced by physical exercise.