bluuebunny/crossref_metadata_2025 huggingface dataset:
The role of peak troponin in patients with a working diagnosis of myocardial infarction with non-obstructive coronary arteries (MINOCA)
Authors: Williams MGL , Liang K , De Garate E , Spagnoli L , Fiori E , Lawton CB , Biglino G , Dastidar A , Johnson TW , Bucciarelli-Ducci C
Published: July 2021

Funding Acknowledgements

Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Rosetrees Trust James Tudor Foundation

Background

6-10% of patients who present with an acute coronary syndrome have a myocardial infarction with non-obstructive coronary arteries (MINOCA). Troponin T predicts infarct size and outcomes in patients with ST-elevation myocardial infarction. The value of peak troponin T in patients with a working diagnosis of MINOCA is not well understood.

Purpose

The aim of this study is to investigate the diagnostic and prognostic role of troponin in patients with MINOCA. 

Methods

Consecutive patients with a working diagnosis of MINOCA (n = 719) from a single tertiary centre who underwent comprehensive cardiovascular magnetic resonance (CMR) imaging with late gadolinium enhancement (LGE) were followed prospectively. The primary endpoint was all-cause mortality.

Results

Peak troponin T ≥211 ng/L and time to CMR of ≤17 days have a positive predictive value of 94% for being able to make a diagnosis on CMR. If the scan was performed in ≤17 days the diagnostic yield was still 75% even in the lowest troponin decile, but this was 59% if performed after 17 days. Each increase in troponin decile increases the mean diagnostic yield of the CMR by 3.7% (p < 0.001, 95% CI 3.4 – 3.9; R2 0.84; Figure 1). There is no overall difference in median troponin in patients who died and those who survived (229 ng/l v. 424 ng/l; p = 0.157), however mortality is significantly lower in the highest two troponin quartiles (11.9% versus 6.9%; p = 0.009, figure 2). 

Conclusions

Peak troponin T and time to CMR can be used by cardiologists to determine the likelihood of making a diagnosis using CMR. A higher troponin quartile is associated with lower mortality.
Prognostic implications of peak early diastolic strain rate (PEDSR) by feature-tracking cardiac magnetic resonance in patients with st-elevation myocardial infarction
Authors: Wei LAI , Ge HENG , Pu JUN
Published: July 2021

Funding Acknowledgements

Type of funding sources: Foundation. Main funding source(s): the National Key Research and Development Program of China

OnBehalf

Renji Hospital Affiliated to Medical College of Shanghai Jiaotong University

Background：The prognostic value of Peak Early Diastolic Strain Rate (PEDSR) measured by Cardiac Magnetic Resonance (CMR) in ST-Elevation Myocardial Infarction (STEMI) is not clear.

Methods：420 first-STEMI patients from the EARLY Assessment of MYOcardial Tissue Characteristics by CMR in STEMI (EARLY-MYO-CMR) registry (NCT03768453) and 40 normal people were enrolled and followed up. The patients received timely percutaneous coronary intervention (PCI) within 12h and CMR within 1 week (median,5 days; range, 2-7 days) after infarction. LV circumferential, radial, longitudinal PEDSR and other routine CMR parameters were measured. Clinical end point was a composite major adverse cardiovascular events (MACEs) including cardiovascular death, re-infarction and re-hospitalization for heart failure.

Results：During follow-up (median: 52 months, inter-quartile range: 29–78 months), 73 (17.4%) patients experienced a MACE event. Compared with normal people, STEMI patients had lower PEDSR (circumf. PEDSR 0.77 vs. 1.27%/s, P < 0.001). Patients who developed MACEs also had lower PEDSR than patients who didn’t (circumf. PEDSR 0.64 vs. 0.78%/s, P < 0.001). Circumf. PEDSR can significantly predict MACEs with an AUC of 0.659 (95%CI 0.587-0.731, P < 0.001) which is not inferior to LVEF (0.659 vs. 0.651, P = 0.843), LVIS (0.659 vs. 0.661, P = 0.678) and LVMVO (0.659 vs. 0.666, P = 0.600). Circumf. PEDSR ≤ 0.665%/s is the independent predictive factor of MACEs in clinical (HR 2.099 [95%CI 1.273-3.461], P = 0.004) and CMR models (HR 1.795 [95%CI 1.065-3.026], P = 0.028). In Kaplan-Meier curve, patients with impaired PEDSR are more likely to experience MACEs (P < 0.001). When subdivided by LVEF, PEDSR still makes a significant difference to MACEs in patients with LVEF > 50.28% (P = 0.003) but not in reduced LVEF patients (P = 0.204). PEDSR is also incremental to LVEF (Continuous NRI 0.515 [95%CI 0.268-0.763], P < 0.001), LVIS (Continuous NRI 0.576 [95%CI 0.330-0.822], P < 0.001), and LVMVO (Continuous NRI 0.576 [95%CI 0.330-0.822], P < 0.001). Finally, worse TIMI flow post-PCI (HR 3.353 [95%CI 1.603-7.016], P = 0.001) and LVEF (HR 0.920 [95%CI 0.900, 0.940], P < 0.001) are the risk factors for PEDSR impairment.

Conclusions：CMR-derived PEDSR can significantly predict MACEs with the discriminative power not inferior to LVEF, LVIS and LVMVO. Circumf. PEDSR ≤ 0.665%/s is an independent predictive factor of MACEs and is incremental in the prognostic risk stratification of STEMI.
Framework for large-scale automatic curation of heterogeneous cardiac MRI (ACUR MRI)
Authors: Galazis C , Vimalesvaran K , Zaman S , Petri C , Howard J , Linton N , Peters N , Cole G , Bharath AA , Varela M
Published: July 2021

Funding Acknowledgements

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): UKRI CDT in AI for Healthcare http://ai4health.io and British Heart Foundation

Background 

Data curation is an important process that structures and organises data, supporting research and the development of artificial intelligence models. However, manually curating a large volume of medical data is a time-consuming, repetitive and costly process that puts additional strain on clinical experts. The curation becomes more complex and demanding as more data sources are used. This leads to an introduction of disparity in the data structure and protocols. 

Purpose 

Here, we propose an automatic framework to curate large volumes of heterogenous cardiac MRI scans acquired across different sites and scanner vendors. Our framework requires minimal expert involvement throughout and works directly on DICOM images from the scanner or PACS.  The resulting structured standardised data allow for straightforward image analysis, hypothesis testing and the training and application of artificial intelligence models. 

Methods 

It is broken down into three main components

anonymisation, cataloguing and outlier detection (see Figure 1). Anonymisation automatically removes any identifiable patient information from the DICOM image attributes. These data are replaced with anonymised labels, whilst maintaining relevant longitudinal information from each patient. DICOM attributes are also used to automatically group the different images according to imaging sequence (e.g. CINE, Delayed-Enhancement, T1 maps), acquisition geometry (e.g. short-axis, 2-chamber, 4-chamber) and imaging attributes (e.g. slice thickness, TE, TR), for easier querying. The sorting characteristics are flexible and can easily be defined by the user. Finally, we detect and flag, for subsequent manual inspection, any outliers within those groups, based on the similarity levels of chosen DICOM attributes. This framework additionally offers interactive image visualisation to allow users to assess its performance in real time. 

Results 

We tested the performance of ACUR CMRI on 26,668 CMR image series (723,531 images) from 858 patient examinations, which took place across two sites in four different scanners. With an average execution time per patient of 100 seconds, ACUR was able to sort imaging data with 1191 different sequence names into 43 categories. The framework can be freely downloaded from https://bitbucket.org/cmr-ai-working-group/acur/. 

Conclusions 

We present ACUR, an automatic framework to curate large volumes of heterogeneous cardiac MRI data. We show how it can quickly and automatically curate data, grouping it according to desired imaging characteristics defined in DICOM attributes. The proposed framework is flexible and ideally suited as a pre-processing tool for large biomedical imaging data studies.
The Effect of Adult Entertainment Establishments on Sex Crime: Evidence from New York City
Authors: Ciacci Riccardo , Sviatschi María Micaela
Published: July 2021

In this paper we study how the presence of adult entertainment establishments affects the incidence of sex crimes. We build a high-frequency daily and weekly panel that combines the exact location of non-self-reported sex crimes with the day of opening and exact location of adult entertainment establishments in New York City. We find that these businesses decrease sex crime by 13% per police precinct one week after the opening, and have no effect on other types of crime. The results suggest that the reduction is mostly driven by potential sex offenders frequenting these establishments rather than committing crimes.
European Society of Cardiology Quality Indicators for the care and outcomes of cardiac pacing: developed by the Working Group for Cardiac Pacing Quality Indicators in collaboration with the European Heart Rhythm Association of the European Society of Cardiology
Authors: Aktaa Suleman , Abdin Amr , Arbelo Elena , Burri Haran , Vernooy Kevin , Blomström-Lundqvist Carina , Boriani Giuseppe , Defaye Pascal , Deharo Jean-Claude , Drossart Inga , Foldager Dan , Gold Michael R , Johansen Jens Brock , Leyva Francisco , Linde Cecilia , Michowitz Yoav , Kronborg Mads Brix , Slotwiner David , Steen Torkel , Tolosana José Maria , Tzeis Stylianos , Varma Niraj , Glikson Michael , Nielsen Jens Cosedis , Gale Chris P
Published: July 2021

Aims

To develop a suite of quality indicators (QIs) for the evaluation of the care and outcomes for adults undergoing cardiac pacing.

Methods and results

Under the auspice of the Clinical Practice Guideline Quality Indicator Committee of the European Society of Cardiology (ESC), the Working Group for cardiac pacing QIs was formed. The Group comprised Task Force members of the 2021 ESC Clinical Practice Guidelines on Cardiac Pacing and Cardiac Resynchronization Therapy, members of the European Heart Rhythm Association, international cardiac device experts, and patient representatives. We followed the ESC methodology for QI development, which involved (i) the identification of the key domains of care by constructing a conceptual framework of the management of patients receiving cardiac pacing, (ii) the development of candidate QIs by conducting a systematic review of the literature, (iii) the selection of the final set of QIs using a modified-Delphi method, and (iv) the evaluation of the feasibility of the developed QIs. Four domains of care were identified: (i) structural framework, (ii) patient assessment, (iii) pacing strategy, and (iv) clinical outcomes. In total, seven main and four secondary QIs were selected across these domains and were embedded within the 2021 ESC Guidelines on Cardiac Pacing and Cardiac Resynchronization therapy.

Conclusion

By way of a standardized process, 11 QIs for cardiac pacing were developed. These indicators may be used to quantify adherence to guideline-recommended clinical practice and have the potential to improve the care and outcomes of patients receiving cardiac pacemakers.
Increasing Frequency and Transmission of HIV-1 Non-B Subtypes Among Men Who Have Sex With Men in the Swiss HIV Cohort Study
Authors: Duran Ramirez Jessy J , Ballouz Tala , Nguyen Huyen , Kusejko Katharina , Chaudron Sandra E , Huber Michael , Hirsch Hans H , Perreau Matthieu , Ramette Alban , Yerly Sabine , Cavassini Matthias , Stöckle Marcel , Furrer Hansjakob , Vernazza Pietro , Bernasconi Enos , Günthard Huldrych F , Kouyos Roger D ,   Swiss HIV Cohort Study, Aebi-Popp K , Anagnostopoulos A , Battegay M , Bernasconi E , Böni J , Braun D L , Bucher H C , Calmy A , Cavassini M , Ciuffi A , Dollenmaier G , Egger M , Elzi L , Fehr J , Fellay J , Furrer H , A Fux C , Günthard H F , Haerry D , Hasse B , Hirsch H H , Hoffmann M , Hösli I , Huber M , Kahlert C R , Kaiser L , Keiser O , Klimkait T , Kouyos R D , Kovari H , Kusejko K , Ledergerber B , Martinetti G , Martinez de Tejada B , Marzolini C , Metzner K J , Müller N , Nicca D , Paioni P , Pantaleo G , Perreau M , Rauch A , Rudin C , Schmid P , Speck R , Stöckle M , Tarr P , Trkola A , Vernazza P , Wandeler G , Weber R , Yerly S
Published: July 2021

Background

In Switzerland, HIV-1 transmission among men who have sex with men (MSM) has been dominated by subtype B, whilst non-B subtypes are commonly attributed to infections acquired abroad among heterosexuals. Here, we evaluated the temporal trends of non-B subtypes and the characteristics of molecular transmission clusters (MTCs) among MSM.

Methods

Sociodemographic and clinical data and partial pol sequences were obtained from participants enrolled in the Swiss HIV Cohort Study. For non-B subtypes, maximum likelihood trees were constructed, from which Swiss MTCs were identified and analyzed by transmission group.

Results

Non-B subtypes were identified in 8.1% (416/5116) of MSM participants. CRF01_AE was the most prevalent strain (3.5%), followed by subtype A (1.2%), F (1.1%), CRF02_AG (1.1%), C (0.9%), and G (0.3%). Between 1990 and 2019, an increase in the proportion of newly diagnosed individuals (0/123 [0%] to 11/32 [34%]) with non-B subtypes in MSM was found. Across all non-B subtypes, the majority of MSM MTCs were European. Larger MTCs were observed for MSM than heterosexuals.

Conclusions

We found a substantial increase in HIV-1 non-B subtypes among MSM in Switzerland and the occurrence of large MTCs, highlighting the importance of molecular surveillance in guiding public health strategies targeting the HIV-1 epidemic.
Focusing on Young Children in Pediatric Psychology Research: Introduction to the Special Issue on Young Children
Authors: Tully Carrie , McMurtry C Meghan , Streisand Randi
Published: July 2021

This special issue focusing on pediatric psychology research in young children highlights 15 papers that focus on infants through preschoolers. Studies selected for inclusion cover a range of pediatric health conditions such as food allergy, medical trauma, injuries/traumatic brain injury, cancer, inflammatory bowel disease, pain, and sleep. The inherent challenges of researching young children are described, and studies vary in their methods for assessment and intervention; multiple studies include an observational component or developmental evaluation. Six of the studies employ diverse samples of children and/or parents and demonstrate the feasibility as well as importance of increasing our understanding of factors related to health disparities. Taken together, the special issue demonstrates the high quality of research focusing on young children. As the special issue editors, we hope this collection will spark an interest in others to focus on research with young children across pediatric populations.
Lithium in red giants: the roles of the He-core flash and the luminosity bump
Authors: Deepak  , Lambert David L
Published: July 2021

Lithium abundances for red giants in the GALAH DR3 survey are studied. The rare examples of Li-enriched stars with abundances A(Li) ≥1.5 are confirmed to be He-core burning stars belonging to or evolved from the red clump with similar masses and metallicity: M ≃ 1.1 ± 0.2 M⊙ and [Fe/H] ≃ −0.3 ± 0.3. Li enrichment over the Li abundance present in a star’s predecessor at the tip of the red giant branch likely occurs in all these red clump stars. Examination of the elemental abundances (C to Eu) in the GALAH catalogue shows no anomalous abundances in red clump giants and, in particular, no dependence on the Li abundance, which ranges over at least five dex. Lithium synthesis is attributed to the He-core flash occurring in stars at the tip of the red giant branch. Models from the Modules for Experiments in Stellar Astrophysics (MESA) match the observed evolution of these stars along the red giant branch and to the red clump but only at the low effective temperature end of the observed spread of red clump giants. Run of Li abundance on the red giant branch is fairly well reproduced by MESA models. A speculation is presented that the series of He-core flashes not only leads to 7Li synthesis from a star’s internal reservoir of 3He but also may lead to internal restructuring leading to the observed effective temperature spread of red clump stars at about a constant luminosity. Giants exhibiting marked Li enrichments are not found at other evolutionary phases and, in particular, not directly associated with the luminosity bump on the red giant branch for which the Li abundance increase does not exceed 0.3 dex.
Genomic Evidence for Speciation with Gene Flow in Broadcast Spawning Marine Invertebrates
Authors: Hirase Shotaro , Yamasaki Yo Y , Sekino Masashi , Nishisako Masato , Ikeda Minoru , Hara Motoyuki , Merilä Juha , Kikuchi Kiyoshi
Published: July 2021

How early stages of speciation in free-spawning marine invertebrates proceed is poorly understood. The Western Pacific abalones, Haliotis discus, H. madaka, and H. gigantea, occur in sympatry with shared breeding season and are capable of producing viable F1 hybrids in spite of being ecologically differentiated. Population genomic analyses revealed that although the three species are genetically distinct, there is evidence for historical and ongoing gene flow among these species. Evidence from demographic modeling suggests that reproductive isolation among the three species started to build in allopatry and has proceeded with gene flow, possibly driven by ecological selection. We identified 27 differentiation islands between the closely related H. discus and H. madaka characterized by high FST and dA, but not high dXY values, as well as high genetic diversity in one H. madaka population. These genomic signatures suggest differentiation driven by recent ecological divergent selection in presence of gene flow outside of the genomic islands of differentiation. The differentiation islands showed low polymorphism in H. gigantea, and both high FST, dXY, and dA values between H. discus and H. gigantea, as well as between H. madaka and H. gigantea. Collectively, the Western Pacific abalones appear to occupy the early stages speciation continuum, and the differentiation islands associated with ecological divergence among the abalones do not appear to have acted as barrier loci to gene flow in the younger divergences but appear to do so in older divergences.
Genetic testing in the diagnosis of chronic kidney disease: recommendations for clinical practice
Authors: Knoers Nine , Antignac Corinne , Bergmann Carsten , Dahan Karin , Giglio Sabrina , Heidet Laurence , Lipska-Ziętkiewicz Beata S , Noris Marina , Remuzzi Giuseppe , Vargas-Poussou Rosa , Schaefer Franz
Published: July 2021

The overall diagnostic yield of massively parallel sequencing–based tests in patients with chronic kidney disease (CKD) is 30% for paediatric cases and 6–30% for adult cases. These figures should encourage nephrologists to frequently use genetic testing as a diagnostic means for their patients. However, in reality, several barriers appear to hinder the implementation of massively parallel sequencing–based diagnostics in routine clinical practice. In this article we aim to support the nephrologist to overcome these barriers. After a detailed discussion of the general items that are important to genetic testing in nephrology, namely genetic testing modalities and their indications, clinical information needed for high-quality interpretation of genetic tests, the clinical benefit of genetic testing and genetic counselling, we describe each of these items more specifically for the different groups of genetic kidney diseases and for CKD of unknown origin.
Evolutionary Rate Variation among Lineages in Gene Trees has a Negative Impact on Species-Tree Inference
Authors: Vankan Mezzalina , Ho Simon Y W , Duchêne David A
Published: July 2021

Phylogenetic analyses of genomic data provide a powerful means of reconstructing the evolutionary relationships among organisms, yet such analyses are often hindered by conflicting phylogenetic signals among loci. Identifying the signals that are most influential to species-tree estimation can help to inform the choice of data for phylogenomic analysis. We investigated this in an analysis of 30 phylogenomic data sets. For each data set, we examined the association between several branch-length characteristics of gene trees and the distance between these gene trees and the corresponding species trees. We found that the distance of each gene tree to the species tree inferred from the full data set was positively associated with variation in root-to-tip distances and negatively associated with mean branch support. However, no such associations were found for gene-tree length, a measure of the overall substitution rate at each locus. We further explored the usefulness of the best-performing branch-based characteristics for selecting loci for phylogenomic analyses. We found that loci that yield gene trees with high variation in root-to-tip distances have a disproportionately distant signal of tree topology compared with the complete data sets. These results suggest that rate variation across lineages should be taken into consideration when exploring and even selecting loci for phylogenomic analysis.[Branch support; data filtering; nucleotide substitution model; phylogenomics; substitution rate; summary coalescent methods.]
Interleukin-1β and Interleukin-1 receptor antagonist gene polymorphism in pediatric patients with Helicobacter pylori-associated chronic gastritis
Authors: Barakat Sana Hosny , Meheissen Marwa Ahmed , El-Gendi Saba Mohamed , Fouad Ingy Ali , Mahfouz Aml Mohamed
Published: July 2021

Background

The severity of Helicobacter pylori infection is determined by the interplay between bacterial virulence, host genetic and environmental factors. This study aimed to identify interleukin-1 beta (IL-1β) and interleukin receptor antagonist (IL-1RN) gene polymorphisms and their associations with H. pylori infection, and severity of chronic gastritis in Egyptian children.

Methods

A case control study was conducted on 100 children (50 H. pylori positive and 50 controls). Genotyping of IL-1β-31 gene was done by PCR-CTPP (confronting two-pair primers), of IL-1β-511 was performed using allele specific PCR, and investigation of the variable number tandem repeat polymorphism of the IL-1RN gene was done by PCR.

Results

The genotype C/T of IL1β-511 was the predominant genotype (36/50; 72%) among H. pylori positive cases (p ≤ 0.001). The presence of C/T genotype at position 511 of IL1β was associated with increased risk of infection with H. pylori (p ≤ 0.001, odds ratio = 6.612) and with more severe disease (p = 0.004, odds ratio = 8.333). No association of IL-1β-31 or IL-1RN gene polymorphisms with H. pylori infection or with risk of severe gastric diseases was found. Children who carry two polymorphisms are almost four times at risk for development of H. pylori infection (p = 0.026, odds ratio = 3.937).

Conclusions

Polymorphism at position -511 of IL1β gene is associated with increased risk of H. pylori infection as well as of severe corpus gastric disease in Egyptian children. This population should be considered a high-risk group, which needs regular gastric endoscopic surveillance, and should be target for H. pylori eradication.

Lay summary

The genotype C/T of IL1β-511 gene was the predominant genotype (36/50; 72%) among H. pylori positive children. Polymorphism at position -511 of IL1β gene is associated with increased risk of Helicobacter pylori infection as well as of severe corpus gastric disease in Egyptian children. No association of IL-1β-31 or IL-1RN gene polymorphisms with H. pylori infection or with risk of severe gastric diseases in Egyptian children.
Original Research: Well-Being and Resilience Among Health Care Workers During the COVID-19 Pandemic: A Cross-Sectional Study
Authors: Munn Lindsay Thompson , Liu Tsai-Ling , Swick Maureen , Rose Robert , Broyhill Britney , New Luci , Gibbs Michael
Published: July 2021

Background:

Poor well-being among health care workers, often observed as professional burnout, is a well-documented phenomenon. The coronavirus disease 2019 (COVID-19) pandemic has further stressed the health care workforce, but its specific effects on this workforce remain unknown. This study examined well-being and resilience among health care workers during the COVID-19 pandemic.

Methods:

The study used a cross-sectional survey design. Data collection took place through anonymous surveys of nurses (LPNs and RNs), advanced practice providers (NPs, physician assistants, and certified nurse midwives), certified registered nurse anesthetists, respiratory therapists, health care technicians, and therapy service professionals (physical, occupational, and speech therapists). Of the 6,120 health care workers recruited to participate in the study, data from 2,459 participants were analyzed using logistic regression and linear regression.

Results:

The study found that several factors significantly increased the likelihood of at-risk well-being. These included having a lower level of resilience, using support resources, feeling the organization lacked understanding of the emotional support needs of health care workers during the pandemic, believing the workload had increased, believing there was insufficient personal protective equipment, believing there was inadequate staffing to safely care for patients, and having a lower degree of psychological safety. After controlling for health care workers' role and employment location, several factors were found to be significantly associated with higher levels of resilience. These included having positive perceptions about the organization's understanding of the emotional support needs of health care workers during the pandemic, believing sufficient educational resources were available regarding the care of COVID-19 patients, having positive perceptions of leadership support from direct managers, having positive perceptions of the redeployment policy, and having a higher degree of psychological safety.

Conclusions:

This study identified several work environment factors that have significantly affected health care workers' well-being and resilience during the COVID-19 pandemic. This knowledge has practical relevance for health care leaders who aim to better understand and address the well-being and resilience of the health care workforce during this pandemic and beyond.
CE: Monitoring Adult Patients for Intolerance to Gastric Tube Feedings
Authors: Metheny Norma A.
Published: July 2021

Gastric tube feeding is a common and valuable intervention for patients in a variety of care settings. While tube feeding can save the lives of patients for whom oral feeding isn't possible, intolerance to tube feeding is a potential complication. This article discusses risk factors for feeding intolerance; the assessment of signs and symptoms of feeding intolerance; the various means of assessing gastric emptying, including the practice of monitoring gastric residual volume (GRV); the controversy surrounding GRV monitoring in assessing feeding tolerance; and the special considerations for monitoring feeding tolerance in acutely and critically ill adults with coronavirus disease 2019. The author, a nurse researcher with extensive experience in the area of enteral feeding, briefly summarizes recommendations and guidelines for enteral feeding published by national and international health care organizations between 2015 and 2020, and offers her perspective on best nursing practices for monitoring food tolerance in adults.
Inflammatory Biomarkers Are Associated With a Decline in Functional Status at Discharge in Children With Acute Respiratory Failure: An Exploratory Analysis
Authors: Carlton Erin F. , Weeks Heidi M. , Dahmer Mary K. , Quasney Michael W. , Sapru Anil , Curley Martha A.Q. , Flori Heidi R.
Published: July 2021

OBJECTIVES:

To evaluate the link between early acute respiratory failure and functional morbidity in survivors using the plasma biomarkers interleukin-8, interleukin-1 receptor antagonist, thrombomodulin, and plasminogen activator inhibitor-1. We hypothesized that children with acute respiratory failure with higher levels of inflammation would have worse functional outcomes at discharge, as measured by Pediatric Overall Performance Category.

DESIGN:

Secondary analysis of the Genetic Variation and Biomarkers in Children with Acute Lung Injury (R01HL095410) study.

SETTING:

Twenty-two PICUs participating in the multisite clinical trial, Randomized Evaluation of Sedation Titration for Respiratory Failure (U01 HL086622) and the ancillary study (Biomarkers in Children with Acute Lung Injury).

SUBJECTS:

Children 2 weeks to 17 years requiring invasive mechanical ventilation for acute airways and/or parenchymal lung disease. Patients with an admission Pediatric Overall Performance Category greater than 3 (severe disability, coma, or brain death) were excluded.

INTERVENTIONS:

None.

MEASUREMENTS AND MAIN RESULTS:

Among survivors, 387 patients had no worsening of Pediatric Overall Performance Category at discharge while 40 had worsening functional status, defined as any increase in Pediatric Overall Performance Category from baseline. There was no significant relationship between worsening of Pediatric Overall Performance Category and interleukin-8 or plasminogen activator inhibitor-1 on any day. There was no significant relationship between interleukin-1 receptor antagonist, or thrombomodulin, and worsening Pediatric Overall Performance Category on day 1. Plasma interleukin-1 receptor antagonist and thrombomodulin were significantly elevated on days 2 and 3 in those with worse functional status at discharge compared with those without. In multivariable analysis, interleukin-1 receptor antagonist and thrombomodulin were associated with a decline in functional status on days 2 and 3 after adjustment for age and highest oxygenation index. However, after adjusting for age and cardiovascular failure, only day 2 thrombomodulin levels were associated with a worsening in Pediatric Overall Performance Category.

CONCLUSIONS:

Higher levels of interleukin-1 receptor antagonist or thrombomodulin following intubation were associated with worse Pediatric Overall Performance Category scores at hospital discharge in children who survive acute respiratory failure. These data suggest that persistent inflammation may be related to functional decline.
Performance Analysis of the National Early Warning Score and Modified Early Warning Score in the Adaptive COVID-19 Treatment Trial Cohort
Authors: Colombo Christopher J. , Colombo Rhonda E. , Maves Ryan C. , Branche Angela R. , Cohen Stuart H. , Elie Marie-Carmelle , George Sarah L. , Jang Hannah J. , Kalil Andre C. , Lindholm David A. , Mularski Richard A. , Ortiz Justin R. , Tapson Victor , Liang C. Jason
Published: July 2021

OBJECTIVES:

We sought to validate prognostic scores in coronavirus disease 2019 including National Early Warning Score, Modified Early Warning Score, and age-based modifications, and define their performance characteristics.

DESIGN:

We analyzed prospectively collected data from the Adaptive COVID-19 Treatment Trial. National Early Warning Score was collected daily during the trial, Modified Early Warning Score was calculated, and age applied to both scores. We assessed prognostic value for the end points of recovery, mechanical ventilation, and death for score at enrollment, average, and slope of score over the first 48 hours.

SETTING:

A multisite international inpatient trial.

PATIENTS:

A total of 1,062 adult nonpregnant inpatients with severe coronavirus disease 2019 pneumonia.

INTERVENTIONS:

Adaptive COVID-19 Treatment Trial 1 randomized participants to receive remdesivir or placebo. The prognostic value of predictive scores was evaluated in both groups separately to assess for differential performance in the setting of remdesivir treatment.

MEASUREMENTS AND MAIN RESULTS:

For mortality, baseline National Early Warning Score and Modified Early Warning Score were weakly to moderately prognostic (c-index, 0.60–0.68), and improved with addition of age (c-index, 0.66–0.74). For recovery, baseline National Early Warning Score and Modified Early Warning Score demonstrated somewhat better prognostic ability (c-index, 0.65–0.69); however, National Early Warning Score+age and Modified Early Warning Score+age further improved performance (c-index, 0.68–0.71). For deterioration, baseline National Early Warning Score and Modified Early Warning Score were weakly to moderately prognostic (c-index, 0.59–0.69) and improved with addition of age (c-index, 0.63–0.70). All prognostic performance improvements due to addition of age were significant (p < 0.05).

CONCLUSIONS:

In the Adaptive COVID-19 Treatment Trial 1 cohort, National Early Warning Score and Modified Early Warning Score demonstrated moderate prognostic performance in patients with severe coronavirus disease 2019, with improvement in predictive ability for National Early Warning Score+age and Modified Early Warning Score+age. Area under receiver operating curve for National Early Warning Score and Modified Early Warning Score improved in patients receiving remdesivir versus placebo early in the pandemic for recovery and mortality. Although these scores are simple and readily obtainable in myriad settings, in our data set, they were insufficiently predictive to completely replace clinical judgment in coronavirus disease 2019 and may serve best as an adjunct to triage, disposition, and resourcing decisions.
Clostridioides difficile-Associated Atypical Hemolytic-Uremic Syndrome Successfully Treated With Eculizumab: A Case Report and Literature Review
Authors: Moulton Michael N. , Kay Carl L. , Romain Joshua T. , Morrow Benjamin D. , Bobele Gilda M.
Published: July 2021

BACKGROUND:

Clostridioides difficile infection is a rare precipitant for patients to develop atypical hemolytic-uremic syndrome, of which the pathogenesis remains unclear. Previous reports suggest activation of cytokine storm from binding of cyotoxins A and B to colonic wall membranes.

CASE SUMMARY:

We present a case of a previously healthy 21-year-old woman who developed fulminant C. difficile colitis and atypical hemolytic-uremic syndrome requiring abdominal surgery and renal replacement therapy. She was ultimately treated with eculizumab without the use of plasmapheresis and remains in remission with full renal recovery.

CONCLUSIONS:

Our patient’s significant response to terminal complement inhibitor, without the use of plasmapheresis, suggests that the underlying pathology is significantly driven by the alternative complement pathway. We propose that C. difficile-associated atypical hemolytic-uremic syndrome be defined as primary atypical hemolytic-uremic syndrome and strongly consider eculizumab as first-line therapy.
Pharmacotherapy in Coronavirus Disease 2019 and Risk of Secondary Infections: A Single-Center Case Series and Narrative Review
Authors: Behal Michael , Barlow Brooke , Mefford Breanne , Thompson Bastin Melissa L. , Donaldson J. Chris , Laine Melanie , Bissell Brittany D.
Published: July 2021

OBJECTIVES:

Since the onset of the coronavirus disease 2019 pandemic, immune modulators have been considered front-line candidates for the management of patients presenting with clinical symptoms secondary to severe acute respiratory syndrome coronavirus 2 infection. Although heavy emphasis has been placed on early clinical efficacy, we sought to evaluate the impact of pharmacologic approach to coronavirus disease 2019 within the ICU on secondary infections and clinical outcomes.

DATA SOURCES:

PubMed (inception to March 2021) database search and manual selection of bibliographies from selected articles.

STUDY SELECTION AND DATA EXTRACTION:

Articles relevant to coronavirus disease 2019, management of severe acute respiratory syndrome coronavirus 2–associated respiratory failure, and prevalence of secondary infections with pharmacotherapies were selected. The MeSH terms “COVID-19,” “secondary infection,” “SARS-CoV-2,” “tocilizumab,” and “corticosteroids” were used for article identification. Articles were narratively synthesized for this review.

DATA SYNTHESIS:

Current data surrounding the use of tocilizumab and/or corticosteroids for coronavirus disease 2019 management are limited given the short follow-up period and conflicting results between studies. Further complicating the understanding of immune modulator role is the lack of definitive understanding of clinical impact of the immune response in coronavirus disease 2019.

CONCLUSIONS:

Based on the current available literature, we suggest prolonged trials and follow-up intervals for those patients managed with immune modulating agents for the management of coronavirus disease 2019.
Posture-induced Changes in Intraocular Pressure After Trabeculectomy in Patients With Primary Open-angle Glaucoma
Authors: Kang Yeon Soo , Helong Piao , Sung Mi Sun , Park Sang Woo
Published: July 2021

Précis:

Trabeculectomy can effectively reduce posture-induced changes in intraocular pressure (IOP) in patients with primary open-angle glaucoma (POAG).

Purpose:

The purpose of this study was to investigate posture-induced changes in IOP after trabeculectomy in patients with medically uncontrolled POAG.

Design:

This was a prospective, consecutive study.

Methods:

Thirty-seven eyes of 37 patients with POAG were included. IOP was measured before trabeculectomy and 1, 2, 3, and 6 months postoperatively with patients in the sitting position, supine position, and lateral decubitus position (LDP) sequentially using iCare IC200 rebound tonometry. In the LDP, the eye scheduled for trabeculectomy was in the dependent position, the contralateral unoperated eye was a control eye. The central corneal thickness, axial length, and anterior chamber depth were measured using partial coherence interferometry.

Results:

In the sitting, supine, and LDP, the IOP was significantly reduced at every time point during the follow-up. Although the posture-induced changes in IOP persisted during the follow-up, the range of IOP changes in the sitting and supine positions, sitting and LDP, and the supine and LDP were significantly reduced after than before trabeculectomy. The central corneal thickness did not change significantly after trabeculectomy.

Conclusion:

Trabeculectomy can effectively reduce posture-induced changes in IOP in patients with POAG.
Successful visual rehabilitation after unilateral extended range-of-vision intraocular lens implantation in a patient with previous LASIK
Authors: Guarro Mercè , Goñi Idoia , López Silvia , Ruiz Sergi , Piñero David P
Published: July 2021

A case of a 44-year-old man undergoing cataract surgery because of ocular trauma in his right eye in which a nondiffractive continuous extended range-of-vision intraocular lens (IOL) was implanted is described. Uneventful bilateral myopic laser in situ keratomileusis correction had been performed 13 years before (oblate corneal profile). At 3 months postoperatively, uncorrected distance, intermediate, and near visual acuities were 0.10, 0.10, and 0.20 logMAR, respectively. An improvement was also observed in most of the subscales of the Visual Functioning Questionnaire-25, with the largest improvement in the subscales driving, distance activities, and general vision. Light distortion indices of 10.19% and 3.82% were found in the right and left eyes, respectively. This case shows that the unilateral implantation of this type of IOL can be a good solution in eyes with previous myopic corneal laser refractive surgery when monocular cataract surgery is needed, allowing a successful binocular visual restoration.
Transient infection with SARS-CoV-2 without induction of systemic immunity
Authors: Gärtner Barbara C. , Klemis Verena , Schmidt Tina , Sester Martina , Meyer Tim
Published: July 2021

SARS-CoV-2 testing using PCR is currently used as screening test to guide isolation and contact tracing. Among 1,700 players and staff of the German Bundesliga and Bundesliga 2 who were regularly tested twice weekly, 98 individuals had a positive PCR. Among those, 11 asymptomatic cases were identified who only had a transient single positive PCR of low viral load. As only one out of 11 individuals developed SARS-CoV-2 specific cellular and humoral immunity, this indicates that transient colonization with SARS-CoV-2 may frequently occur without systemic induction of specific adaptive immunity. This knowledge may have implications for management of isolation and contact tracing, which may not be justified in these cases.
Metaphors that shape parents’ perceptions of effective communication with healthcare practitioners following child death: a qualitative UK study
Authors: Turner Sarah , Littlemore Jeannette , Topping Annie , Parr Eloise , Taylor Julie
Published: July 2021

Objectives

To offer an interpretation of bereaved parents’ evaluations of communication with healthcare practitioners surrounding the death of a child.

Design

Interpretative qualitative study employing thematic and linguistic analyses of metaphor embedded in interview data.

Setting

England and Scotland.

Participants

24 bereaved parents (21 women, 3 men)

Methods

Participants were recruited through the True Colours Trust website and mailing list, similar UK charities, and word of mouth. Following interviews in person or via video-conferencing platforms (Skype/Zoom), transcripts first underwent thematic and subsequently linguistic analyses supported by Nvivo. A focused analysis of metaphors used by the parents was undertaken allow in-depth interpretation of how they conceptualised their experiences.

Results

The findings illuminate the ways parents experienced communication with healthcare practitioners surrounding the death of a child. They show how their evaluations of effective care relate to the experience of the bereavement itself, as expressed through metaphor. We identified three broad themes: (1) Identity (2) Emotional and Physical Response(s) and (3) Time. Successful communication from healthcare practitioners takes account of parents’ experiences related to these themes.

Conclusions

This study suggests that healthcare practitioners when communicating with bereaved parents need to recognise, and seek to comprehend, the ways in which the loss impacts upon an individual’s identity as a parent, the ‘physical’ nature of the emotions that can be unleashed, and the ways in which the death of a child can alter their metaphorical conceptions of time.

Strengths and limitations of the study

This interpretative qualitative study contributes to the growing literature on the experience of parental bereavement through its focus on the use of metaphor in parents’ accounts of child loss.

The metaphor analysis afforded a focus not only on the content of the interviews, but also on the language that was used to express this content, providing more depth and nuance to the interpretation of the findings.

Participants were all UK-based and self-selecting which could limit transferability.
Direct detection of humoral marker corelates of COVID-19, glycated HSA and hyperglycosylated IgG3, by MALDI-ToF mass spectrometry
Authors: Iles Ray K , IIes Jason K , Zmuidinaite Raminta , Gardiner Anna , Lacey Jonathan , Harding Stephen , Heeney Jonathan , Baxendale Helen
Published: July 2021

The prefusion Spike protein of SARS-CoV2 binds advanced glycation end product (AGE) glycated human serum albumin (HSA) and a higher mass, hyperglycosylated/glycated, IgG3, as determined by matrix assisted laser desorption mass spectrometry (MALDI-ToF MS). We set out to investigate if the total blood plasma of patients who had recovered from acute respiratory distress as a result of COVID-19, contained more glycated HSA and higher mass (glycosylated/glycated) IgG3 than those with only clinically mild or asymptomatic infections. A direct dilution and disulphide bond reduction method was development and applied to plasma samples from SARS-CoV2 seronegative (N = 30) and seropositive (N = 31) healthcare workers and 38 convalescent plasma samples from patients who had been admitted with acute respiratory distress syndrome (ARDS) associated with COVID-19.

Patients recovering from COVID-19 ARDS had significantly higher mass, AGE-glycated HSA and higher mass IgG3 levels. This would indicate that increased levels and/or ratios of hyper-glycosylation (probably terminal sialic acid) IgG3 and AGE glycated HSA may be predisposition markers for development of ARDS as a result of COVID-19 infection. Furthermore, rapid direct analysis of plasma samples by MALDI-ToF MS for such humoral immune correlates of COVID-19 presents a feasible screening technology for the most at risk; regardless of age or known health conditions.

Abstract Figure
Aspirin Use is Associated with Decreased Mortality in Patients with COVID-19: A Systematic Review and Meta-analysis
Authors: Savarapu Pramod , Baral Nischit , Adhikari Govinda , Akanbi Maxwell , Abdelazeem Basel , Isa Sakiru O. , Khan Ashiya , Ali Maham , Jenumula Sravanthi , Kesari Kavitha , Kunadi Arvind
Published: July 2021

Background

Novel Corona Virus Disease 2019 (COVID-19) has resulted in more than three and half million deaths worldwide as of June 6, 2021. The role of aspirin in prevention of COVID-19 mortality has not been much studied. We aimed to study the relationship between aspirin use and covid-19 mortality.

Methods

We searched PubMed, MEDLINE, EMBASE, and Cochrane database for studies from January 2019 till June 6, 2021 with inclusion criteria of RCT, Cohort study, studies reporting mortality, and comparison studies on aspirin versus non-aspirin. Statistical analysis was done with Review Manager 5.4 statistical software using the inverse variance method. We assessed the pooled hazard ratio (HR), and 95% confidence interval using the random effect model and I-squared test was used to determine statistical heterogeneity.

Results

We included five retrospective cohort studies which met our inclusion criteria with total of 14065 participants in both groups. There were 6797 participants in the aspirin group and 7268 participants in the non-aspirin group. Our results show that the use of aspirin was associated with 53% decrease in mortality compared to non-aspirin in patients with COVID-19 (adjusted HR 0.47, 95% CI 0.35-0.63, P< 0.001, I2= 47%). In the analysis restricted to patients hospitalized for COVID-19, the use of aspirin was associated with a 49% reduction in the risk for in-hospital mortality (adjusted HR 0.51, 95% CI 0.33-0.80, P = 0.004, I2= 39%).

Conclusions

Our results show that aspirin is associated with decrease in both overall mortality and in-hospital mortality in patients with COVID-19.