bluuebunny/crossref_metadata_2025 huggingface dataset:
Convection-Enhanced Delivery of Enhancer of Zeste Homolog-2 (EZH2) Inhibitor for the Treatment of Diffuse Intrinsic Pontine Glioma
Authors: Sasaki Takahiro , Katagi Hiroaki , Goldman Stewart , Becher Oren J , Hashizume Rintaro
Published: June 2020

BACKGROUND

Diffuse intrinsic pontine glioma (DIPG) is a fatal childhood brain tumor and the majority of patients die within 2 yr after initial diagnosis. Factors that contribute to the dismal prognosis of these patients include the infiltrative nature and anatomic location in an eloquent area of the brain, which precludes total surgical resection, and the presence of the blood-brain barrier (BBB), which reduces the distribution of systemically administered agents. Convection-enhanced delivery (CED) is a direct infusion technique to deliver therapeutic agents into a target site in the brain and able to deliver a high concentration drug to the infusion site without systemic toxicities.

OBJECTIVE

To assess the efficacy of enhancer of zeste homolog-2 (EZH2) inhibitor by CED against human DIPG xenograft models.

METHODS

The concentration of EZH2 inhibitor (EPZ-6438) in the brainstem tumor was evaluated by liquid chromatography-mass spectrometry (LC/MS). We treated mice-bearing human DIPG xenografts with EPZ-6438 using systemic (intraperitoneal) or CED administration. Intracranial tumor growth was monitored by bioluminescence image, and the therapeutic response was evaluated by animal survival.

RESULTS

LC/MS analysis showed that the concentration of EPZ-6438 in the brainstem tumor was 3.74% of serum concentration after systemic administration. CED of EPZ-6438 suppressed tumor growth and significantly extended animal survival when compared to systemic administration of EPZ-6438 (P = .0475).

CONCLUSION

Our results indicate that CED of an EZH2 inhibitor is a promising strategy to bypass the BBB and to increase the efficacy of an EZH2 inhibitor for the treatment of DIPG.
Left Modified Orbitozygomatic Approach for Clipping of Multilobulated Middle Cerebral Artery Bifurcation Aneurysm: 2-Dimensional Operative Video
Authors: Hendricks Benjamin K , Spetzler Robert F
Published: June 2020

Middle cerebral artery (MCA) aneurysms are associated with one of the most favorable approaches for microsurgical treatment; however, aneurysm geometrics can pose challenges during clip application. The surgeon must be mindful of the clip configuration options available during the planning of ideal clip occlusion for irregular or multilobulated aneurysm domes. This patient had an incidental multilobulated MCA bifurcation aneurysm and underwent an orbitozygomatic approach for microsurgical treatment. Proximal and distal control of the aneurysm were achieved, and complete clip occlusion was achieved following the placement of a single permanent clip. Flow within the parent vessel was well preserved, and complete aneurysm occlusion was achieved. The patient gave informed consent for surgery and video recording. Institutional review board approval was deemed unnecessary. Used with permission from Barrow Neurological Institute, Phoenix, Arizona.
A SPECIAL CASE OF QUASIMINIMALITY FOR THE COMPLEX EXPONENTIAL FIELD
Authors: Boxall Gareth
Published: June 2020

We obtain a non-trivial special case of Zilber’s quasiminimality conjecture for the complex exponential field. Specifically, we deal with those subsets of $\mathbb{C}$ defined by formulas of the form $\exists \bar{y}(P(x,\bar{y})=0)$, where $P$ is a term formed from the language $\{+,\times ,\exp \}$ together with parameters from $\mathbb{C}$.
Association of systemic lupus erythematosus with peripheral arterial disease: a meta-analysis of literature studies
Authors: Forte Francesco , Buonaiuto Alessio , Calcaterra Ilenia , Iannuzzo Gabriella , Ambrosino Pasquale , Di Minno Matteo Nicola Dario
Published: June 2020

Objective

SLE patients have an increased cardiovascular morbidity and mortality. Contrasting data are available about the association between peripheral arterial disease (PAD) and SLE. We aimed to perform a meta-analysis of studies evaluating the association between SLE and PAD.

Methods

Studies were systematically searched in the PubMed, Web of Science, Scopus and EMBASE databases according to preferred reporting items for systematic reviews and meta-analyses guidelines.

Results

Eight studies reporting on 263 258 SLE patients and 768 487 controls showed that the prevalence of PAD was 15.8% (95% CI: 10.5%, 23.2%) in SLE patients and 3.9% (95% CI: 1.8%, 7.9%) in controls with a corresponding odds ratio of 4.1 (95% CI: 1.5, 11.6; P <0.001). In addition, five studies reporting on ankle-brachial index showed significantly lower values in 280 SLE patients as compared with 201 controls (mean difference: −0.018; 95% CI: −0.034, −0.001; P =0.033). Meta-regression models showed that age, hypertension and diabetes were inversely associated with the difference in the prevalence of PAD between SLE patients and non-SLE controls, whereas no effect for all the other clinical and demographic variables on the evaluated outcome was found.

Conclusion

SLE patients exhibit an increased prevalence of PAD and lower ankle-brachial index values as compared with non-SLE controls. This should be considered when planning prevention, interventional and rehabilitation strategies for these chronic patients with functional disability and poor long-term outcomes.
Distal phalangeal bone erosions observed by HR-pQCT in patients with psoriatic onycholysis
Authors: Villani Axel P , Boutroy Stéphanie , Coutisson Céline , Carlier Marie-Christine , Barets Loïs , Marotte Hubert , Richert Bertrand , Chapurlat Roland D , Jullien Denis , Confavreux Cyrille B
Published: June 2020

Objectives

PsA prevalence among skin psoriasis is ∼30%. Nail psoriasis, especially onycholysis, is present in >70% of PsA and the risk of developing PsA is more than doubled in patients with nail involvement. We hypothesized that onycholysis may be associated with early bone erosions of the DIP joint without harbouring PsA symptoms.

Methods

We compared tendon thickness, assessed by US, and bone erosions, assessed by high-resolution peripheral quantitative CT, of the DIP joint in patients with psoriatic onycholysis without PsA (ONY) with those in patients with cutaneous psoriasis only (PSO). We used patients with PsA as reference (PsA group), and healthy age-matched controls (CTRL). Differences between groups were assessed by analysis of variance tests followed by post hoc analysis using the Scheffe method.

Results

Mean (s.e.m.) age of the 87 participants (61% males) was 45.2 (1.3) years. The mean extensor tendon thickness was significantly larger in ONY than in PSO patients. In the PsA group, 68% of patients exhibited erosions of three different shapes: V-, Omega- and U-shape. Association with erosions was greater in the ONY group than in the PSO group (frequency: 57 vs 14%; P < 0.001; mean number of erosions: 1.10 (0.35) vs 0.03 (0.03); P < 0.001).

Conclusion

Onycholysis was associated with significant enthesopathy and bone erosions in our cohort. These data support the pathogenic role of enthesopathy in PsA. Onycholysis may be considered as a surrogate marker of severity in psoriasis.

Trial registration

ClinicalTrails.gov, https://clinicaltrials.gov, NCT02813720
Refugee Rights Across Regions: A Comparative Overview of Legislative Good Practices in Latin America and the EU
Authors: Freier Luisa Feline , Gauci Jean-Pierre
Published: June 2020

The office of the United Nations High Commissioner for Refugees (UNHCR) has identified a number of legislative good practices in Latin American asylum and refugee laws. At the same time, academics and policy-makers have long called for cross-regional comparative analyses of policies and laws to allow different regions to learn from each other’s best practices. In this article, we compare refugee legislations of Latin American countries with European Union protection standards based on UNHCR’s legislative good practices across three areas: (i) Core Principles and Scope of Protection; (ii) Procedural Safeguards and Guarantees for Vulnerable Groups; and (iii) Integration. We find that six of 19 refugee laws in Latin America provide more expansive protection than the Common European Asylum System framework, whereas other Latin American countries fall behind. The gap between Latin American legislations and European Union protection standards is closer regarding procedural safeguards, the protection of vulnerable groups, and integration provisions. Finally, Latin American countries, on average, score significantly below the European Union regarding the core principles of asylum and the scope of protection. In the second part of the article, we engage in a qualitative discussion of these legislative good practices to allow for cross-fertilization, and deliver policy recommendations.
Quantitative Lesser Trochanter Profile Versus Cortical Step Sign in Assessing Femoral Malrotation After Femoral Nailing
Authors: Klaucke Jonathan , O'Hara Nathan N. , Peterson David , Gitajn Ida Leah , Natoli Roman , Sciadini Marcus F. , Manson Theodore T. , Nascone Jason W. , Gage Mark , LeBrun Christopher , Pollak Andrew N. , O'Toole Robert V.
Published: June 2020

We describe the novel quantitative lesser trochanter profile (QLTP) technique to determine the magnitude and direction of femoral malrotation and to compare its performance with the cortical step sign technique. For this assessment, 9 orthopaedic surgeons estimated the magnitude and direction of femoral malrotation with each technique in 198 anteroposterior view images of the proximal cadaveric femur and osteotomy sites. Based on the results, the main benefit of the QLTP technique over the cortical step sign technique is the ability to determine the direction of femoral malrotation. The QLTP technique was also more accurate in measuring malrotation and had less error. However, the QLTP technique requires additional imaging, and the mean difference in error between the 2 techniques might not be clinically meaningful.
Tension Band Wiring Provides Excellent Patient-Reported Long-Term Results for Both Comminuted and Simple Displaced Olecranon Fractures
Authors: Terstappen Afra L. E. , Joosse Pieter , van Dijke Cornelis F. , Mirck Boj , van den Brand Johan G. H.
Published: June 2020

Objectives:

To assess the long-term functional results of both simple and comminuted olecranon fractures treated with tension band wiring (TBW).

Design:

Retrospective.

Setting:

Level 1 trauma center.

Patients & Intervention:

Between 2004 and 2014, 178 fractures in 178 patients >16 years of age were treated with TBW for a unilateral olecranon fracture.

Main Outcome Measurements:

Subjective functionality was tested with the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire and the Mayo Elbow Performance Index (MEPI).

Results:

Fifty percent of our cohort were lost to follow-up leaving 89 for review. A total of 51.7% had a comminuted fracture. Mean follow-up time was 7.1 years. Reoperation rate for implant removal was 84%. The total median DASH score was 0.83. Eighty-five patients (95.5%) were rated excellent using the MEPI score. No significant difference in either score was found between the simple (SF) and the comminuted (CF) group. Median range of motion was flexion/extension: 145/−2 degrees, supination/pronation: 90/90 degrees. No clinically relevant difference in range of motion was found between the 2 groups.

Conclusions:

We found no relevant differences in either subjective or objective functionality between patients with simple or comminuted olecranon fractures after fixation with TBW. Therefore, TBW seems to be an adequate and justifiable treatment modality for both simple and comminuted olecranon fractures.

Level of Evidence:

Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
The Learning Curve of Suprapatellar Nailing: Adoption Over Time Can Decrease Operative Time and Radiation Exposure
Authors: Allen Jerad D. , Matuszewski Paul E. , Comadoll Shea M. , Hamilton David A. , Abbenhaus Eric J. , Aneja Arun , Wright Raymond D. , Moghadamian Eric S.
Published: June 2020

Objective:

To determine whether suprapatellar nailing (SPN) over time can decrease operative time and radiation exposure when compared with infrapatellar nailing (IPN) of tibial shaft fractures.

Design:

Retrospective.

Setting:

Single, Level 1 trauma center.

Patients:

Extra-articular adult tibial shaft fractures treated with intramedullary nailing alone within a 7-year period.

Intervention:

Patients were treated with SPN or IPN techniques based on the discretion of the operating surgeon.

Main Outcome Measurements:

Operative time and radiation exposure.

Results:

Three hundred forty-one fractures (SPN: 177, IPN: 164) were included in the analysis. No differences in patient body mass index, sex, or open fracture incidence existed between the 2 groups. A significant difference in average operative time (IPN 130 minutes vs. SPN 110 minutes, P < 0.01), fluoroscopy time (IPN 159 minutes vs. SPN 143 minutes, P = 0.02), and radiation dose (IPN 8.6 mGy vs. SPN 6.5 mGy, P < 0.01) existed between IPN and SPN. Early tibias treated with SPN had similar operative times (P = 0.11), fluoroscopy time (P = 0.94), and radiation dose (P = 0.34) compared with IPN. Later SPN patients had significantly lower operative time (P = 0.03), fluoroscopy time (P < 0.01), and radiation dose (P < 0.013) compared with earlier SPN. Regression analysis revealed with the increased use of SPN, operative time, fluoroscopy time, and radiation dose significantly decreased (P = 0.018, 0.046, 0.011).

Conclusions:

Tibia fractures treated with SPN have significantly decreased operative times and radiation exposure compared with those treated with IPN, after allowing time for the surgeon to gain sufficient experience with the technique. The surgeon should consider this when deciding to adopt this technique.

Level of Evidence:

Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
Quadruple Versus Double Flexible Intramedullary Nails to Treat Pediatric Distal-third Tibial Shaft Fractures: A Biomechanical Comparison
Authors: Zubair Adnan , Samuelson Eric M. , Morris Randal P. , Foreman Mark , Gagnon-Bartsch Johann A. , Rosenfeld Scott B.
Published: June 2020

Background:

The vast majority of pediatric distal-third tibial shaft fractures can be treated with closed reduction and casting. If conservative measures fail, then these fractures are usually treated with 2 antegrade flexible intramedullary nails. A postoperative cast is usually applied because of the tenuous fixation of the 2 nails. Recent studies have described the use of 4 nails to increase the stability of the fixation, a technique that may preclude the need for postoperative casting. The purpose of this biomechanical study is to quantify the relative increase in stiffness and load to failure when using 4 versus 2 nails to surgically stabilize these fractures.

Methods:

Short, oblique osteotomies were created in the distal third of small fourth-generation tibial sawbones and stabilized with 2 (double) or 4 (quadruple) flexible intramedullary nails. After pilot testing, 5 models per fixation method were tested cyclically in axial compression, torsion, and 4-point bending in valgus and recurvatum. At the end of the study, each model was loaded to failure in valgus. Stiffness values were calculated, and yield points were recorded. The data were compared using Student’s t tests. Results are presented as mean±SD. The level of significance was set at P≤0.05.

Results:

Stiffness in valgus 4-point bending was 624±231 and 336±162 N/mm in the quadruple-nail and double-nail groups, respectively (P=0.04). There were no statistically significant differences in any other mode of testing.

Conclusions:

The quadruple-nail construct was almost 2 times as stiff as the double-nail construct in resisting valgus deformation. This provides biomechanical support for a previously published study describing the clinical success of this fixation construct.
Electronic Consultation Systems: Impact on Pediatric Orthopaedic Care
Authors: Chang Youjin , Carsen Sasha , Keely Erin , Liddy Clare , Kontio Ken , Smit Kevin
Published: June 2020

Background:

The demand for pediatric orthopaedic surgery consultation has grown rapidly, leading to longer wait times for elective consultation in some regions. Some specialties are addressing this increased demand through electronic consultation services. We wanted to examine the impact of pediatric orthopaedic e-consultations in Canada’s Eastern Ontario region.

Methods:

We developed a cross-sectional study of all the cases directed to a pediatric orthopaedic surgery specialist using the Champlain Building Access to Specialists through eConsultation (BASE) eConsult service over a 2-year period and examined their impact on in-person referrals, time of e-consultation and primary care satisfaction as well as types of clinical questions that were asked.

Results:

Electronic consultations avoided in-person appointments in 68% of the submitted cases. The median response by specialists received by the primary care providers (PCPs) was <20 hours. A total of 69% of consultations involve >1 type of clinical questions, most commonly about basic trauma/fracture care and management recommendations. Ninety-seven percent of the PCPs found the overall value for the care of the patients to be good or excellent.

Conclusions:

This cross-sectional study demonstrates the effective and timely use of eConsult in pediatric orthopaedic surgery. It also shows a significant reduction in the number of in-person consultations required and demonstrates a high satisfaction rate by PCPs using the service.

Clinical Relevance:

In addition to the efficacy and time-sensitive care provided to the patients, the study shows that, professionally, 89% of PCPs found this service to be excellent or good. The broader implications of electronic consultation on overall quality of care, population health, and patient satisfaction requires further investigation.
Consequences and Solutions for the Impact of Communication Impairment on Noninvasive Ventilation Therapy for Acute Respiratory Failure: A Focused Review
Authors: Wong An-Kwok Ian , Cheung Patricia C. , Happ Mary Beth , Gay Peter C. , Collop Nancy A.
Published: June 2020

Objectives:

With over 2 million cases of acute respiratory failure in the United States per year, noninvasive ventilation has become a leading treatment modality, often supplanting invasive mechanical ventilation as the initial treatment of choice. Most acute respiratory failure patients use a full face (oronasal) mask with noninvasive ventilation, which is known to impair communication, but its popularity and benefit has led many providers to accept the communication impairment. Medical staff periodically remove masks to communicate with patients, but patients are often limited to short utterances and risk lung derecruitment upon removal of positive pressure. These problems can lead to noninvasive ventilation failure, which is often linked to worse outcomes than first initiating invasive mechanical ventilation and can lead to increased hospitalization costs.

Data Sources:

We searched MEDLINE and Google Scholar for “speech,” “communication,” “impairment,” “failure,” “complications,” “NIPPV,” “NIV,” and “noninvasive ventilation.”

Study Selection:

We included articles with patients in acute respiratory failure. We excluded articles for patients using noninvasive ventilation therapy for obstructive sleep apnea.

Data Synthesis:

Communication impairment has been associated with increasing noninvasive ventilation anxiety (odds ratio, 1.25). Of patients using noninvasive ventilation, 48% require early discontinuation, 22% refuse noninvasive ventilation, and 9% are ultimately intubated. Improvements to communication have been shown to reduce fear and anxiety in invasive mechanical ventilation patients. Analogous communication problems exist with effective solutions in other fields, such as fighter pilot masks, that can be easily implemented to enhance noninvasive ventilation patient care, increase adherence to noninvasive ventilation treatment, and improve patient outcomes.

Conclusions:

Communication impairment is an underappreciated cause of noninvasive ventilation complications and failure and requires further characterization. Analogous solutions—such as throat microphones and mask-based microphones—that can be easily implemented show potential as cost-effective methods to reduce noninvasive ventilation failure.
Design for Implementation of a System-Level ICU Pandemic Surge Staffing Plan
Authors: Harris Gavin H. , Baldisseri Marie R. , Reynolds Benjamin R. , Orsino Antoinette S. , Sackrowitz Rachel , Bishop Jonathan M.
Published: June 2020

Background:

The current coronavirus disease 2019 pandemic is causing significant strain on ICUs worldwide. Initial and subsequent regional surges are expected to persist for months and potentially beyond. As a result of this, as well as the fact that ICU provider staffing throughout the United States currently operate at or near capacity, the risk for severe and augmented disruption in delivery of care is very real. Thus, there is a pressing need for proactive planning for ICU staffing augmentation, which can be implemented in response to a local surge in ICU volumes.

Methods:

We provide a description of the design, dissemination, and implementation of an ICU surge provider staffing algorithm, focusing on physicians, advanced practice providers, and certified registered nurse anesthetists at a system-wide level.

Results:

The protocol was designed and implemented by the University of Pittsburgh Medical Center’s Integrated ICU Service Center and was rolled out to the entire health system, a 40-hospital system spanning Pennsylvania, New York, and Maryland. Surge staffing models were developed using this framework to assure that local needs were balanced with system resource supply, with rapid enhancement and expansion of tele-ICU capabilities.

Conclusions:

The ICU pandemic surge staffing algorithm, using a tiered-provider strategy, was able to be used by hospitals ranging from rural community to tertiary/quaternary academic medical centers and adapted to meet specific needs rapidly. The concepts and general steps described herein may serve as a framework for hospital and other hospital systems to maintain staffing preparedness in the face of any form of acute patient volume surge.
Attentional Bias Assessed With Event-Related Potentials in Long-term Hypnotic Users
Authors: Yang Chien-Ming , Lin Yu-Siou , Tu Alice Yuting , Huang Ya-Chuan , Sung Jia-Ying
Published: June 2020

Purpose/Background

Attentional bias toward drug-related cues is considered to be an indication of neurocognitive processes associated with drug dependence. While this phenomenon has been shown in other addictive substances, whether hypnotic medication would lead to similar processes remains an issue to be investigated. The present study examined attentional bias toward drug-related cues in long-term hypnotic users and the effect of negative affect on this process.

Methods/Procedures

Thirteen long-term hypnotic users participated in this study. They spent 2 nights in the sleep laboratory: a mood-induction night and a neutral night. Attentional bias was measured through the recording of event-related potentials using a cue-reactivity paradigm; subjective craving for hypnotics was assessed using a single-item rating scale, and negative affect was measured using the Positive and Negative Affect Schedule.

Findings/Results

The results showed that the amplitudes of P300 and slow positive wave for hypnotic-related and sleep-related photographs were significantly higher than those for neutral photographs in both conditions. Negative mood induction did not significantly increase attentional bias.

Implications/Conclusions

The findings provide preliminary evidence that long-term hypnotic users do have attentional bias for hypnotic-related photos, suggesting the possibility of neurocognitive processes associated with drug dependence. However, the results did not show higher attentional bias under negative mood, suggesting that the use of hypnotics is not reinforced by the desire to eliminate negative affect. Because of the limited sample size and lack of a control group, the results should be considered as preliminary findings that call for future studies to further investigate this issue.
Longitudinal Immune Phenotype Assessment and Serological Outcome in Foreign‐born Children With Chronic Hepatitis B
Authors: Nicastro Emanuele , Mangili Benedetta , Giacomet Vania , Benincaso Anna Rita , Di Giorgio Angelo , Sansotta Naire , Callegaro Annapaola , D’Antiga Lorenzo
Published: June 2020

Objectives:

The aim of the study was to assess changes in clinical phenotype, and identify determinants of outcome in children with chronic hepatitis B virus (HBV) infection born in HBV‐endemic countries followed in 2 Italian tertiary care centers after immigration or adoption.

Methods:

A prospective observational study on hepatitis B e‐antibodies–negative chronic hepatitis B children started on 2002. Patients with liver fibrosis, or those needing antiviral treatment were excluded. Immune active patients were defined those with raised transaminases (alanine aminotransferase > 40 IU/L), immune tolerants those having normal alanine aminotransferase, both exhibiting substantial viral replication (HBV DNA >2000 IU/mL).

Results:

Sixty‐nine patients (44 boys, median age 4.7 years) had a median follow‐up of 53 months. At entry, 18 (26%) children were immune tolerant, 47 (68%) immune active, and 4 had indeterminant immune status. At last follow‐up, 14 (78%) of the immune‐tolerant patients remained so, whereas only 23 (49%) of the immune active children maintained their initial immune phenotype. Seroconversion to hepatitis B e antibodies (SCHBe) occurred in only 2 (11%) immune tolerants, whereas 13 (28%) immune active patients achieved SCHBe.

Ethnicity was the only feature independently correlated to SCHBe: Asian origin reduced by 4.1 times the probability of SCHBe (Asian vs other; odds ratio = 0.24 [95% confidence interval = 0.07–0.76]; P = 0.016) compared to other ethnicities, whereas viral genotype did not influence the outcome.

Conclusions:

Ethnicity and immune status phenotype against HBV, rather than HBV genotype, are the main determinants of SCHBe in foreign‐born children with chronic HBV infection.
Report of 2 Pediatric Cases With Li-Fraumeni Syndrome Related Malignancy in a Family
Authors: Takeoka Mami , Toyoda Hidemi , Hirayama Junya , Suzuki Naofumi , Hanaki Ryo , Amano Keishiro , Iwamoto Shotaro , Hirayama Masahiro
Published: June 2020

Li-Fraumeni syndrome (LFS) is a rare inherited disease characterized by a high and early-onset cancer risk. A cancer surveillance program is important to reduce cancer-related morbidity and mortality in individuals with LFS. We report 2 pediatric cases with LFS-related malignancy in a family. Eight-year-old elder brother was diagnosed with adrenocortical carcinoma and was found to have a heterozygous missense germline mutation c.736A>G: p.Met246Val in the TP53 gene. Cancer screening led to the diagnosis of rhabdomyosarcoma at a curable stage in his 2-year-old younger brother. Comprehensive surveillance resulted in early tumor detection and improved survival.
Effect of Tactile Experience During Preterm Infant Feeding on Clinical Outcomes
Authors: Pickler Rita H. , Meinzen-Derr Jareen , Moore Margo , Sealschott Stephanie , Tepe Karin
Published: June 2020

Background

Although the survival rate of very preterm infants has improved, rates of subsequent neurobehavioral disabilities remain high. One factor implicated in poor neurobehavioral and developmental outcomes is hospitalization and inconsistent caregiving patterns in the neonatal intensive care unit. Although much underlying brain damage occurs in utero or shortly after birth, neuroprotective strategies may stop progression of damage, particularly when these strategies are used during the most sensitive periods of neural plasticity 2–3 months before term age.

Objective

The purpose of this analysis was to test the effect of a patterned feeding experience involving a tactile component (touch and/or holding) provided during feedings on preterm infants’ clinical outcomes, measured by oral feeding progress, as an early indicator of neurodevelopment.

Methods

We used an experimental, longitudinal, two-group random assignment design. Preterm infants (n = 120) were enrolled within the first week of life and randomized to an experimental group receiving a patterned feeding experience or to a control group receiving usual feeding care.

Results

Analysis of data from 91 infants showed that infants receiving touch at more than 25% of early gavage feedings achieved full oral feeding more quickly; as touch exposure increased, time from first oral to full oral feeding decreased. There was no association between holding during early gavage feedings or touch during transition feedings and time to full oral feeding.

Discussion

Neurological expectation during critical periods of development is important for infants. However, a preterm infant’s environment is not predictable: Caregivers change regularly, medical procedures dictate touch and holding, and care provision based on infant cues is limited. Current knowledge supports caregiving that occurs with a naturally occurring sensation (i.e., hunger), is provided in a manner that is congruent with the expectation of the neurological system, and occurs with enough regularity to enhance neuronal and synaptic development. In this study, we modeled an experience infants would “expect” if they were not in the neonatal intensive care unit and demonstrated a shorter time from first oral feeding to full oral feeding, an important clinical outcome with neurodevelopmental implications. We recommend further research to determine the effect of patterned caregiving experiences on other areas of neurodevelopment, particularly those that may occur later in life.
Keratin 17 Expression Predicts Poor Clinical Outcome in Patients With Advanced Esophageal Squamous Cell Carcinoma
Authors: Haye Kester , Babu Sruthi , Oblein Lyanne , Gupta Rajarsi , Akalin Ali , Escobar-Hoyos Luisa F. , Shroyer Kenneth R.
Published: June 2020

The major roles of keratin 17 (K17) as a prognostic biomarker have been highlighted in a range of human malignancies. However, its relevance to esophageal squamous cell carcinoma (ESCC) remains unexplored. In this study, the relationship between K17 expression and clinicopathologic parameters and survival were determined by RNA sequencing (RNA-Seq) in 90 ESCCs and by immunohistochemistry (IHC) in 68 ESCCs. K17 expression was significantly higher in ESCC than in paired normal tissues at both the messenger RNA and protein levels. K17 messenger RNA and staining by IHC were significantly correlated with aggressive characteristics, including advanced clinical stage, invasion depth, and lymph node metastases; and were predictive of poor prognosis in advanced disease patients. Furthermore, K17 expression was detected by IHC in high-grade premalignant lesions of the esophageal mucosa, suggesting that K17 could also be a biomarker of dysplasia of the esophageal mucosa. Overall, this study established that K17 is a negative prognostic biomarker for the most common subtype of esophageal cancer.
Do Health Care Providers Pay Attention to Sharing Hospital Patient Safety Incidents Through Social Media in Saudi Arabia?
Authors: Alanzi Turki , Alfuraikh Alhanouf
Published: June 2020

Purpose

The aim of this study was to find out if health care providers in Saudi Arabia used social media to share the safety incidents that occurred in hospitals.

Participants and Methods

To carry out this study, we conducted a survey using a valid and reliable questionnaire that was distributed through WhatsApp groups by means of a link to a sample of 450 health care providers in Saudi Arabia. The response rate was 33.55%, and 151 respondents answered the questionnaire. The survey was carried out in January 2019. The data were analyzed using basic descriptive statistics.

Results

More than half of the respondents (54%) were female, and 68% of them were younger than 40 years. Also, 42% of the participants had a bachelor’s degree, and 57% were working in the health care quality field. The participants used the following social media: WhatsApp (21%), Twitter (17%), YouTube (15%), Snapchat (13%), LinkedIn (12%), and Instagram (12%). They used these networks for education and professional development (24%), networking (23%), self-promotion (16%), employment (15%), sharing incidents that affect patient safety (11%), and health promotion (11%). Besides, 60% of the participants reported safety incidents that occurred in hospitals, and 72% of them did not agree to share these incidences through social media. In addition, 82% of participants thought that social networks were beneficial to obtain knowledge about quality of patient care.

Conclusions

The findings of this research showed that most health care providers in Saudi Arabia considered that safety incidents that occur in hospitals should not be shared through social media because they affect the policies and privacy of hospitals, patients, and personnel. However, most of the respondents believed that social media could contribute to improving the quality of patient attention and thought that WhatsApp and Twitter could be the most useful social media for these purposes.
High-Alert Medication Stratification Tool—Revised Phase II: A Multisite Study Examining the Validity, Interrater Reliability, and Ease of Use of the High-Alert Medication Stratification Tool—Revised
Authors: Shenk McKenzie R. , Washburn Natalie C. , Stephens Sarah S. , Burger Gregory P. , Curtis James M. , Henney Jessalynn K. , McCarthy Jamie L. , Degenkolb Kerri E. , Fritschle Andrew C. , Macik Monica R. , Dossett Heather A. , Walroth Todd A.
Published: June 2020

Objectives

The primary objective of this multisite study, High-Alert Medication Stratification Tool—Revised (HAMST-R) phase II, was to assess the content validity of HAMST-R. Secondary outcomes included interrater reliability and ease of use.

Methods

HAMST-R was designed as an objective tool to evaluate high-alert medications (HAMs) at a single site during HAMST-R Phase I. Medication safety experts from 7 health systems across the United States volunteered to participate in this phase II study. Participants completed a demographic survey, oversaw evaluation of 47 HAMs and 35 non-HAMs using HAMST-R, and submitted scores for each medication evaluated. In addition, participants rated each question of HAMST-R on its relevance to assess a medication’s safety risk, measured as scale-content validity index. Positive and negative predictive values were evaluated in a post hoc analysis. Interrater reliability was evaluated using the Kendall coefficient of concordance (K), and ease of use was assessed using a mixed-methods approach.

Results

Scale-content validity index was 0.80, indicating that the tool was valid. Positive predictive value was 90.5% (95% confidence interval, 87.2%–93.0%), and negative predictive value was 98.2% (95% confidence interval, 95.4%–99.3%). A score of 4 or more differentiated between HAMs and non-HAMs, confirming phase I findings. K was 0.56, indicating moderate agreement. Participants confirmed that the tool was easy to use and plan to incorporate the tool into HAM policies and procedures, formulary review, and safety strategy implementation.

Conclusions

HAMST-R is a valid, objective, and easy to use method that institutions may implement to evaluate a medication’s potential safety risk.
Neutrophil-to-Lymphocyte Ratio and Outcomes in Louisiana COVID-19 Patients
Authors: Tatum Danielle , Taghavi Sharven , Houghton August , Stover Jacob , Toraih Eman , Duchesne Juan
Published: June 2020

Background:

Due to the rapidly escalating number of cases and the low baseline of overall health in Louisiana, we sought to determine the prognostic value of the neutrophil-to-lymphocyte ratio (NLR) in hospitalized COVID patients in two major metropolitan areas with the highest prevalence of cases and exceedingly high rates of obesity and other comorbid conditions. We hypothesized that elevated NLR would be a prognostic indicator of mortality.

Methods:

This was a review of a prospective registry of adult (18+ years) hospitalized Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) patients from two large urban safety net hospitals in Louisiana. Blood cell counts at days 2 and 5 were used to obtain NLR. Receiver operating characteristic curve analysis assessed predictive capacity of NLR on mortality. Kaplan–Meier survival analysis and Cox regression models examined the effect of NLR on survival.

Results:

The study population of 125 patients was majority African American (88.6%) and female (54.8%) with a mean age and body mass index of 58.7 years and 34.2. Most (96.0%) had comorbidities of which hypertension (72.0%), obesity (66.7%), and diabetes (40.0%) were the most common. Mortality was 18.4%. NLR > 4.94 on day 1 predicted intubation (P = 0.02). NLR above established cutoff values on hospital days 2 and 5 each significantly predicted mortality (P < 0.001 and P = 0.002, respectively).

Conclusions:

NLR is a prognostic factor for endotracheal intubation upon hospital admission and independent predictor for risk of mortality in SARS-CoV-2 patients on subsequent hospital days. Clinical research efforts should examine effects of strategies such as arginase inhibition alone and/or inhaled nitric oxide to ameliorate the effects of elevated NLR.
The Clinical Application of a Self-developed Gasless Laparoendoscopic Operation Field Formation Device on Patients Undergoing Cholecystectomy
Authors: Hu Hai , Zhao Gang , Zhang Kai , Cai Hao , Jiang Zhaoyan , Huang Anhua , Cai Jingli , Xu Anan , Li Haidong , He Chuanqi
Published: June 2020

Background:

We have designed a new gasless laparoscopic operation field formation (LOFF) device for cholecystectomy which was successfully tested on animal model. The goal of this study is to investigate the feasibility, safety and effectiveness of this LOFF device on patients undergoing cholecystectomy.

Methods:

Patients with cholecystolithiasis or gallbladder polyps who underwent single port cholecystectomy from June 2015 to May 2016 were retrospectively reviewed. Either the LOFF-assisted laparoendoscopic single-port surgery (LESS) (LOFF-LESS) or the traditional LESS was performed. Operation time, intraoperative bleeding, postoperative hospital stay, surgical complications, incision pain score, shoulder and back pain and cosmetic satisfaction were compared.

Results:

A total of 186 patients were included in this study, with 79 in the LOFF-LESS group and 107 in the LESS group. There was no significant difference between LOFF-LESS group and LESS group in operation field establishment time, cholecystectomy time, intraoperative bleeding, postoperative hospital stay, incision pain and cosmetic satisfaction. A lower intraoperative arterial carbon dioxide pressure was documented in the LOFF-LESS group (P<0.01). The incidence of postoperative shoulder and back pain was significantly lower in LOFF-LESS group (P<0.01).

Conclusion:

LOFF-LESS has comparable benefits of traditional LESS; it deceases incidence of pneumoperitoneum related complications as well.
Self-induced class stratification in competitive societies of agents: Nash stability in the presence of envy
Authors: Gros Claudius
Published: June 2020

Envy, the inclination to compare rewards, can be expected to unfold when inequalities in terms of pay-off differences are generated in competitive societies. It is shown that increasing levels of envy lead inevitably to a self-induced separation into a lower and an upper class. Class stratification is Nash stable and strict, with members of the same class receiving identical rewards. Upper-class agents play exclusively pure strategies, all lower-class agents the same mixed strategy. The fraction of upper-class agents decreases progressively with larger levels of envy, until a single upper-class agent is left. Numerical simulations and a complete analytic treatment of a basic reference model, the shopping trouble model, are presented. The properties of the class-stratified society are universal and only indirectly controllable through the underlying utility function, which implies that class-stratified societies are intrinsically resistant to political control. Implications for human societies are discussed. It is pointed out that the repercussions of envy are amplified when societies become increasingly competitive.
Computer-assisted beat-pattern analysis and the flagellar waveforms of bovine spermatozoa
Authors: Walker Benjamin J. , Phuyal Shiva , Ishimoto Kenta , Tung Chih-Kuan , Gaffney Eamonn A.
Published: June 2020

Obstructed by hurdles in information extraction, handling and processing, computer-assisted sperm analysis systems have typically not considered in detail the complex flagellar waveforms of spermatozoa, despite their defining role in cell motility. Recent developments in imaging techniques and data processing have produced significantly improved methods of waveform digitization. Here, we use these improvements to demonstrate that near-complete flagellar capture is realizable on the scale of hundreds of cells, and, further, that meaningful statistical comparisons of flagellar waveforms may be readily performed with widely available tools. Representing the advent of high-fidelity computer-assisted beat-pattern analysis, we show how such a statistical approach can distinguish between samples using complex flagellar beating patterns rather than crude summary statistics. Dimensionality-reduction techniques applied to entire samples also reveal qualitatively distinct components of the beat, and a novel data-driven methodology for the generation of representative synthetic waveform data is proposed.
COVID-19-related coagulopathy – Is transferrin a missing link?
Authors: McLaughlin Katie-May , Bechtel Marco , Bojkova Denisa , Wass Mark N. , Michaelis Martin , Cinatl Jindrich
Published: June 2020

SARS-CoV-2 is the causative agent of COVID-19. Severe COVID-19 disease has been associated with disseminated intravascular coagulation and thrombosis, but the mechanisms underlying COVID-19-related coagulopathy remain unknown. Since the risk of severe COVID-19 disease is higher in males than in females and increases with age, we combined proteomics data from SARS-CoV-2-infected cells with human gene expression data from the Genotype-Tissue Expression (GTEx) database to identify gene products involved in coagulation that change with age, differ in their levels between females and males, and are regulated in response to SARS-CoV-2 infection. This resulted in the identification of transferrin as a candidate coagulation promoter, whose levels increases with age and are higher in males than in females and that is increased upon SARS-CoV-2 infection. A systematic investigation of gene products associated with the GO term “blood coagulation” did not reveal further high confidence candidates, which are likely to contribute to COVID-19-related coagulopathy. In conclusion, the role of transferrin should be considered in the course of COVID-19 disease and further examined in ongoing clinic-pathological investigations.
Asymptomatic and presymptomatic transmission of SARS-CoV-2: A systematic review
Authors: Savvides Christina , Siegel Robert
Published: June 2020

Background and Purpose

Many of the statutes comprising the shelter-in-place and phased-reopening orders are centered around minimizing asymptomatic and presymptomatic transmission. Assumptions about the presence and relative importance of asymptomatic and presymptomatic transmission are based on case reports, the failing of quarantine measures aimed at sequestering ill patients, viral dynamic studies suggesting SARS-CoV-2 production peaks before symptoms appear, and modeling evidence that calculates serial interval between successive generations of infection. In aggregate, these data offer compelling evidence of asymptomatic and presymptomatic transmission, but individually these studies have notable shortcomings that undermine their conclusions. The purpose of this review is to discuss the literature of asymptomatic and presymptomatic transmission, highlight limitations of recent studies, and propose experiments that, if conducted, would provide a more definitive analysis of the relative role of asymptomatic and presymptomatic transmission in the ongoing SARS-CoV-2 pandemic.

Methods

We conducted a systematic review of literature on PubMed using search filters that relate to asymptomatic and presymptomatic transmission as well as serial interval and viral dynamics. We focused on studies that provided primary clinical data.

Results

34 studies were eligible for inclusion in this systematic review: 11 case reports pertaining to asymptomatic transmission, 9 viral kinetic studies, 13 serial interval studies, and 1 study with viral kinetics and serial interval.

Conclusion

Different approaches to determining the presence and prevalence of asymptomatic and presymptomatic SARS-CoV-2 transmission have notable shortcomings, which were highlighted in this review and limit our ability to draw definitive conclusions. Conducting high quality studies with the aim of understanding the relative role of asymptomatic and presymptomatic transmission is instrumental to developing the most informed policies on reopening our cities, states, and countries.
Reducing SARS-CoV-2 infectious spreading patterns by removing S and R compartments from SIR model equation
Authors: Telles Charles Roberto
Published: June 2020

This research points to the asymptotic instability of SIR model and its variants to predict the behavior of SARS-CoV-2 infection spreading patterns over the population and time aspects. Mainly for the “S” and “R” terms of the equation, the predictive results fail due to confounding environment of variables that sustain the virus contagion within population complex network basis of analysis. While “S” and “R” are not homologous data of analysis, thus with improper topological metrics used in many researches, these terms leads to the asymptotic feature of “I” term as the most stable point of analysis to achieve proper predictive methods. Having in its basis of formulation the policies adopted by countries, “I” therefore presents a stable fixed point orientation in order to be used as a predictive analysis of nearby future patterns of SARS-CoV-2 infection. New metrics using a Weinbull approach for “I” are presented and fixed point orientation (sensitivity of the method) are demonstrated empirically by worldwide statistical data.
Catch and kill airborne SARS-CoV-2 to control spread of COVID-19 by a heated air disinfection system
Authors: Yu Luo , Peel Garrett K. , Cheema Faisal H. , Lawrence William S. , Bukreyeva Natalya , Jinks Christopher W. , Peel Jennifer E. , Peterson Johnny W. , Paessler Slobodan , Hourani Monzer , Ren Zhifeng
Published: June 2020

Airborne transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)viaair-conditioning systems poses a significant threat for the continued escalation of the current coronavirus disease (COVID-19) pandemic. Considering that SARS-CoV-2 cannot tolerate temperatures above 70 °C, here we designed and fabricated efficient air disinfection systems based on heated nickel (Ni) foam to catch and kill SARS-CoV-2. Virus test results revealed that 99.8% of the aerosolized SARS-CoV-2 was caught and killed by a single pass through a Ni-foam-based filter when heated up to 200 °C. Additionally, the same filter was also used to catch and kill 99.9% ofBacillus anthracis, an airborne spore. This study paves the way for preventing transmission of SARS-CoV-2 and other highly infectious airborne agents in closed environments.

One Sentence Summary

Heated Ni-foam filters are capable of effectively catching and killing airborne SARS-CoV-2 andBacillus anthracisspores.