bluuebunny/crossref_metadata_2025 huggingface dataset:
Cardiac rehabilitation of Baduanjin exercise in coronary heart disease after PCI
Authors: Li Xing-Xing , Fan Zong-Jing , Cui Jie , Lin Quan , Zhuang Rui , Liu Rong-Peng , Wu Yang
Published: April 2021

Background:

Percutaneous coronary intervention (PCI) is an effective revascularization strategy in patients with coronary heart disease (CHD). However, recent studies had indicated that postPCI patients usually suffer from a low-quality life. Cardiac rehabilitation (CR) has been recommended by numerous guidelines in the clinic for these patients. And Baduanjin exercise can significantly benefit patients with CHD. Regrettably, the effect of Baduanjin exercise on postPCI patients is still not clear. Therefore, this systematic review and meta-analysis protocol is planned to explore the effect of Baduanjin exercise in patients with CHD who have undergone PCI.

Methods:

PubMed, Excerpta Medica Database, Cochrane Library, Web of Science, Wanfang Database, SINOMED, China Science and Technology Journal Database, and China National Knowledge Infrastructure will be searched for appropriate articles from respective inceptions until December 1th, 2020. Two reviewers will independently conduct article selection, data collection, and risk of bias evaluation. Disagreements will be resolved first by discussion and then by consulting a third author for arbitration. The primary outcome will include left ventricular ejection fraction. And the change in the scores on the Seattle Angina Questionnaire, SF-36 health survey scale, Zung Self-rating Anxiety scale and self-rating depression scale will be used as the secondary outcomes. RevMan 5.3 will be used for meta-analysis.

Results:

This systematic review and meta-analysis will explore whether Baduanjin exercise is an effective intervention in postPCI patients.

Conclusion:

This systematic review and meta-analysis will provide convincing evidence of Baduanjin exercise that specifically focuses on CR of Baduanjin exercise on CHD after PCI.

Registration number:

INPLASY202130065.
A case report on death from acute bacterial cholangitis accompanied by von Meyenburg complexes
Authors: Watanabe Noriko , Ohno Shin-ichiro , Sakuma Moe , Kuriwaki Mayo , Miura Mai , Kuroda Masahiko
Published: April 2021

Rationale:

In some cases, autopsy is the first opportunity to find a previously unrecognized critical infection. Pathogens are identified by various methods, such as microscopic examination, special stains, culture tests, and immunohistochemistry. Here, we report a case of 16S ribosomal RNA (rRNA) gene sequencing using a postmortem formalin-fixed, paraffin-embedded (FFPE) tissue, which was useful for identifying pathogenic microbes.

Patient concerns:

Autopsy was performed on an 87-year-old man who had chronic renal failure and had developed sepsis from a central venous catheter infection 10 days before his death. Prior to these events, von Meyenburg complexes (VMCs) were also found during regular checkups.

Diagnosis:

Postmortem microscopic examination revealed acute purulent cholangitis with numerous microabscesses, accompanied by VMCs. Gram-negative rods were observed in some microabscesses, which were considered causative pathogens.

Interventions:

16S rRNA gene sequencing using postmortem FFPE tissue

Outcomes:

Pseudomonas aeruginosa was identified, different from the one detected in the central venous catheter culture while alive.

Lessons:

16S rRNA gene sequencing is a useful tool for identifying pathogenic microbes in postmortem FFPE tissues. This technique may be useful for amplicon sizes of approximately 100 bp or less.
Dual therapy with an oral non-vitamin K antagonist and a P2Y12 inhibitor vs triple therapy with aspirin, a P2Y12 inhibitor and a vitamin K antagonist for the treatment of diabetes mellitus patients with co-existing atrial fibrillation following percutaneous coronary intervention
Authors: Wang Qiang , Yang Keping
Published: April 2021

Background:

In this analysis, we aimed to compare the efficacy and safety of dual therapy (DT) with a non-vitamin K oral anticoagulant (NOAC) and an adenosine diphosphate receptor antagonist (P2Y12 inhibitor) vs triple therapy (TT) with aspirin, a P2Y12 inhibitor and a vitamin K antagonist for the treatment of diabetes mellitus (DM) patients with co-existing atrial fibrillation (AF) following percutaneous coronary intervention (PCI).

Methods:

Medical Literature Analysis and Retrieval System Online (MEDLINE), http://www.ClinicalTrials.gov, Excerpta Medical data BASE (EMBASE), Web of Science, Cochrane Central and Google Scholar were the searched databases. Studies that were randomized trials or observational studies comparing DT vs TT for the treatment of DM patients with co-existing AF following PCI were included in this analysis. The adverse cardiovascular outcomes and bleeding events were the endpoints. This meta-analysis was carried out by the RevMan version 5.4 software. Risk ratios (RR) with 95% confidence intervals (CI) were used to represent data and interpret the analysis.

Results:

A total number of 4970 participants were included whereby 2456 participants were assigned to the DT group and 2514 participants were assigned to the TT group. The enrollment period varied from year 2006 to year 2018. Our current results showed that major adverse cardiac events (RR: 1.00, 95% CI: 0.84–1.20; P = .98), mortality (RR: 1.08, 95% CI: 0.78–1.48; P = .66), myocardial infarction (RR: 1.02, 95% CI: 0.74–1.42; P = .90), stroke (RR: 0.94, 95% CI: 0.53–1.67; P = .84) and stent thrombosis (RR: 1.09, 95% CI: 0.56–2.10; P = .80) were similar with DT versus TT in these patients. However, the risks for total major bleeding (RR: 0.66, 95% CI: 0.54–0.82; P = .0001), total minor bleeding (RR: 0.74, 95% CI: 0.64–0.85; P = .0001), Thrombolysis in Myocardial Infarction (TIMI) defined major bleeding (RR: 0.58, 95% CI: 0.35–0.95; P = .03), TIMI defined minor bleeding (RR: 0.62, 95% CI: 0.42–0.92; P = .02), intra-cranial bleeding (RR: 0.34, 95% CI: 0.13–0.95; P = .04) and major bleeding defined by the International Society on Thrombosis and Hemostasis (RR: 0.68, 95% CI: 0.51–0.90; P = .008) were significantly higher with TT.

Conclusions:

DT with a NOAC and a P2Y12 inhibitor was associated with significantly less bleeding events without increasing the adverse cardiovascular outcomes when compared to TT with aspirin, a P2Y12 inhibitor and a Vitamin K antagonist for the treatment of DM patients with co-existing AF following PCI. Hence, DT is comparable in efficacy, but safer compared to TT. This interesting hypothesis will have to be confirmed in future studies.
Combined use of peripheral blood blast count and platelet count during and after induction therapy to predict prognosis in children with acute lymphoblastic leukemia
Authors: Dai Qingkai , Shi Rui , Zhang Ge , Yang Hui , Wang Yuefang , Ye Lei , Peng Luyun , Guo Siqi , He Jiajing , Jiang Yongmei
Published: April 2021

Several studies have reported an association between the rapidity of reduction in peripheral blood blast count or recovery of normal hematopoiesis and treatment outcome during therapy in children with acute lymphoblastic leukemia (ALL). However, little is known about the impact of both of these aspects on prognosis in pediatric ALL. Accordingly, the purpose of this study was to evaluate whether the combined use of blood blast count and platelet count could predict event-free survival (EFS) and overall survival (OS) when minimal residual disease (MRD) detection was not available.

A total of 419 patients aged 0 to 14 years diagnosed and treated for ALL between 2011 and 2015 were enrolled.

Patients with a blast count ≥0.1 × 109/L on day 8 exhibited significantly lower survival rates than that in those with blast counts <0.1 × 109/L. The EFS and OS in patients with platelet count ≥100 × 109/L on day 33 were significantly higher than those with platelet counts <100 × 109/L. In univariate and multivariate analyses, patients with low blast count on day 8 and high platelet count on day 33 were significantly associated with better EFS and OS. The combination of blast cell count on day 8 and platelet count on day 33 demonstrated a strong association with MRD-based risk stratification.

Complete blood count is an inexpensive, easy to perform, and reliable measurement in children with ALL. The combination of blast count and platelet count during and after induction chemotherapy was a significant and independent prognostic factor for treatment outcome in pediatric ALL.
Myocardial protective effect of intracoronary administration of nicorandil and alprostadil via targeted perfusion microcatheter in patients undergoing elective percutaneous coronary intervention
Authors: Zhang Weifeng , Dai Jinjie , Zheng Xiaowen , Xu Ke , Yang Xiaoxiao , Shen Lan , Wang Xiaolei , Hao Ziyong , Qiu Xingbiao , Jiang Lisheng , Shi Hongyu , Shen Linghong , He Ben
Published: April 2021

Background:

The aim of the study was to evaluate the efficacy of nicorandil and alprostadil on myocardial protection in patients undergoing elective percutaneous coronary intervention (PCI).

Methods:

In this prospective, single-blinded, randomized controlled study, 90 consecutive patients scheduled for elective PCI for de novo coronary lesions were assigned to the nicorandil, alprostadil, and nitroglycerin groups in a 1:1:1 ratio. Drugs were administered intracoronary via a targeted perfusion microcatheter. The primary endpoint was the thrombolysis in myocardial infarction (TIMI) myocardial perfusion frame count (TMPFC). Additionally, the corrected TIMI frame count (cTFC), TIMI myocardial perfusion grade (TMPG), and incidence of periprocedural myocardial injury (PMI) were assessed.

Results:

Both nicorandil and alprostadil were significantly effective in reducing TMPFC (114.6 ± 33.7 vs 93.4 ± 30.9, P = .016; 114.3 ± 34.3 vs 94.7 ± 33.3, P = .029, respectively). Similar findings were observed in the improvement of cTFC (20.3 ± 10.5 vs 13.5 ± 5.0, P = .003; 20.2 ± 7.4 vs 15.2 ± 5.2, P = .003, respectively) and percentage of TMPG 3 (100% vs 82.8%, P = .052; 83.3% vs 96.7%, P = .196, respectively); whereas, nitroglycerin produced a limited effect on TMPFC (114.4 ± 30.9 vs 112.1 ± 31.9, P = .739), cTFC (19.4 ± 7.2 vs 19.3 ± 7.2, P = .936), and percentage of TMPG 3 (86.7% vs 86.7%, P = 1.000). No significant difference was found in the incidence of PMI (16.7% vs 16.0% vs 27.6%, P = .537), though it was comparatively lower in the nicorandil and alprostadil groups. Furthermore, the intracoronary administration of nicorandil and alprostadil had a mild effect on blood pressure and heart rate.

Conclusions:

The intracoronary administration of nicorandil and alprostadil via a targeted perfusion microcatheter was more effective in improving myocardial perfusion in patients undergoing elective PCI than nitroglycerin.
Extremely delayed solitary cerebral metastasis in patient with T1N0M0 renal cell carcinoma after radical nephrectomy
Authors: Choo Yoon-Hee , Seo Youngbeom , Choi Joonhyuk
Published: April 2021

Rationale:

Although renal cell carcinoma (RCC) is one of the common origins of brain metastasis, few cases of extremely delayed brain metastasis from RCC, more than 10 years after nephrectomy, have been reported. We present a rare case of extremely delayed brain metastasis from RCC, also performed a literature review to increase knowledge of the characteristics for extremely delayed brain metastasis from RCC.

Patient concerns:

A 72-year-old man presented with right-sided hemiplegia and dysarthria. The patient had a history of radical nephrectomy for RCC with stage T1N0M0 15 years earlier.

Diagnosis:

Magnetic resonance imaging with contrast revealed a 2-cm sized non-homogenous enhanced mass in the left frontal lobe with peritumoral edema. The pathological examination after surgery reported metastatic clear cell RCC.

Interventions:

A craniotomy for removal of the mass was performed at the time of diagnosis. Stereotactic radiosurgery was performed for the tumor bed 3 weeks after craniotomy, and then, chemotherapy was started 2 months after the SRS.

Outcomes:

Metastasis progressed to multiple organs 6 months after the craniotomy. The patient chose a hospice and no longer visited the hospital.

Lessons:

In cases with a history of nephrectomy for RCC, long period follow-up is necessary for monitoring RCC brain metastasis and pathologic diagnosis should be confirmed.
Comparison of 18F-labelled fluoro-2-deoxyglucose-PET with conventional computed tomography for staging and response assessment in paediatric and adult patients with nodular lymphocyte-predominant Hodgkin’s lymphoma
Authors: Rauf M. Shahzad , Khan Z.A. , Zahir M.N. , Al-Sweedan Suleimman , Al-Kofide Amani , Alharthy Hannan , Almugbel Fahad A. , Osmani Asif , Elhassan Tusneem Ahmed M. , Khafaga Yasser , Maghfoor Irfan , Akhtar Saad
Published: April 2021

Background

Nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL) is an uncommon subtype of Hodgkin lymphoma. Data are limited regarding 18F-labelled fluoro-2-deoxyglucose (FDG)-PET use in NLPHL. We are reporting our experience with FDG-PET utility in staging and response assessment NLPHL patients.

Methods

We retrospectively studied a population of all newly diagnosed or relapsed/refractory patients who underwent both pre-treatment contrast-enhanced computed tomography (CeCT) and an FDG-PET and also at the end of planned treatment.

Results

We identified 68 patients found to have in total 312 scans, 78 paired pre-therapeutic and post-treatment CeCT and FDG-PET scans. Among them, 55 were male, with a median follow-up was 48 months. Median SUV-max was 8.3 (2.0–21.0). FDG-PET and CeCT were concordant in 80% (62/78) of staging scans. In 20% (16/78) of patients in whom a discordance was observed, FDG-PET resulted in upstaging in 13 scans and downstaging in 3 scans. The sensitivity of CeCT was 92% for nodal staging and 42% for extralymphatic staging when compared to FDG-PET. The specificity of CeCT was 98% as compared to FDG-PET. For response assessment, there was poor agreement between the CeCT and FDG-PET in assigning complete remission of disease scores as FDG-PET was able to identify the absence of disease despite the presence of a radiologically evident residual mass on CeCT. The sensitivity for CeCT compared to FDG-PET was 100% while the specificity was 43% for detection of post-treatment response.

Conclusion

For NLPHL, pre-therapeutic FDG-PET scan is better than CeCT staging. FDG-PET has much better specificity for response assessment than CeCT.
Successful Bone Marrow Transplantation With Intensive Post-transplant Intrathecal Chemotherapy for CNS Relapsed AML in 2 Infants
Authors: Andolina Jeffrey R. , Fries Carol , Boulware Renee , Vargas Alyssa , Fraint Ellen , Barth Matthew , Ambrusko Steven , Comito Melanie , Monteleone Philip
Published: April 2021

Background:

Infant acute myeloid leukemia is a rare but aggressive form of leukemia.

Observation:

We report 2 children who presented with hyperleukocytosis, subsequently diagnosed with infant acute myeloid leukemia, and both developed isolated central nervous system relapse while on chemotherapy. Both infants underwent successful bone marrow transplantation with myeloablative conditioning (thiotepa, busulfan, and cyclophosphamide) without radiation, followed by 12 empiric post-transplant lumbar punctures with intrathecal cytarabine. Both patients tolerated these therapies well, and are without infections, chronic graft-versus-host disease, or any post-transplant sequelae.

Conclusion:

Nonradiation-based conditioning followed by empiric central nervous system-directed intrathecal chemotherapy may be considered for high-risk infants with leukemia.
Impact on periosteal vasculature after dual plating of the distal femur: a cadaveric study
Authors: Chen Michael J. , Goodnough Lawrence Henry , Salazar Brett P. , Gardner Michael J.
Published: April 2021

Objectives:

Although dual plating of distal femur fractures has been described for injuries at risk of varus displacement, the vascular insult to the medial distal femur utilizing this technique is unknown. The aim of this study was to evaluate the perfusion of the medial distal femoral periosteal arteries after supplemental medial plating of the distal femur.

Methods:

Fifteen human fresh-frozen cadaveric femora were thawed and randomized to lateral locked plating alone or with supplemental medial plate fixation. Conventional submuscular medial plating was performed using a 12-hole small fragment plate and multiple cortical screws. The superficial femoral artery was injected with latex dye. Specimens were dissected. The patency of the medial distal femoral periosteal vessels was evaluated.

Results:

Four vessels were consistently observed traversing the distal medial femur: the transverse and descending (d-MMPA) branches of the medial metaphyseal periosteal artery, and the transverse and longitudinal branches of the descending geniculate artery. The anterior longitudinal arch (ALA) was present in 13 of 15 specimens and was fed by the d-MMPA. The median number of periosteal arteries occluded by the medial plate was 2 (6 out of 8 specimens). The d-MMPA was occluded in 6 of 8 medially plated femurs, resulting in a complete lack of perfusion of the ALA.

Conclusions:

Submuscular medial plating of the distal femur compressed the d-MMPA in the majority of specimens. This vessel gives rise to the ALA, which lacked perfusion in these specimens. This vascular insult could affect the healing of metaphyseal distal femur fractures treated with dual plating.
Understanding the “Swiss Cheese Model” and Its Application to Patient Safety
Authors: Wiegmann Douglas A. , Wood Laura J. , Cohen Tara N. , Shappell Scott A.
Published: April 2021

This article reviews several key aspects of the Theory of Active and Latent Failures, typically referred to as the Swiss cheese model of human error and accident causation. Although the Swiss cheese model has become well known in most safety circles, there are several aspects of its underlying theory that are often misunderstood. Some authors have dismissed the Swiss cheese model as an oversimplification of how accidents occur, whereas others have attempted to modify the model to make it better equipped to deal with the complexity of human error in health care. This narrative review aims to provide readers with a better understanding and greater appreciation of the Theory of Active and Latent Failures upon which the Swiss cheese model is based. The goal is to help patient safety professionals fully leverage the model and its associated tools when performing a root cause analysis as well as other patient safety activities.
COVID-19–Related Circumstances for Hospital Readmissions: A Case Series From 2 New York City Hospitals
Authors: Choi Justin J. , Contractor Jigar H. , Shaw Amy L. , Abdelghany Youmna , Frye Jesse , Renzetti Madelyn , Smith Emily , Soiefer Leland R. , Lu Shuting , Kingery Justin R. , Krishnan Jamuna K. , Levine William J. , Safford Monika M. , Shapiro Martin F.
Published: April 2021

Objective

The aim of the study was to determine the main factors contributing to hospital readmissions and their potential preventability after a coronavirus disease 2019 (COVID-19) hospitalization at 2 New York City hospitals.

Methods

This was a retrospective study at 2 affiliated New York City hospitals located in the Upper East Side and Lower Manhattan neighborhoods. We performed case reviews using the Hospital Medicine Reengineering Network framework to determine potentially preventable readmissions among patients hospitalized for COVID-19 between March 3, 2020 (date of first case) and April 27, 2020, and readmitted to either of the 2 hospitals within 30 days of discharge.

Results

Among 53 readmissions after hospitalization for COVID-19, 44 (83%) were deemed not preventable and 9 (17%) were potentially preventable. Nonpreventable readmissions were mostly due to disease progression or complications of COVID-19 (37/44, 84%). Main factors contributing to potentially preventable readmissions were issues with initial disposition (5/9, 56%), premature discharge (3/9, 33%), and inappropriate readmission (1/9, 11%) for someone who likely did not require rehospitalization.

Conclusions

Most readmissions after a COVID-19 hospitalization were not preventable and a consequence of the natural progression of the disease, specifically worsening dyspnea or hypoxemia. Some readmissions were potentially preventable, mostly because of issues with disposition that were directly related to challenges posed by the ongoing COVID-19 pandemic. Clinicians should be aware of challenges with disposition related to circumstances of the COVID-19 pandemic.
Epidemiology and Outcomes of Alcohol Use Hospitalizations in People With Gout, Rheumatoid Arthritis, Fibromyalgia, Osteoarthritis, or Low Back Pain
Authors: Singh Jasvinder A.
Published: April 2021

Objective

To examine the incidence, time trends, and outcomes of alcohol use disorder (AUD) hospitalizations in people with gout, rheumatoid arthritis (RA), fibromyalgia, osteoarthritis, or low back pain (LBP).

Methods

We used the US National Inpatient Sample data from 1998 to 2016. We examined the rates of AUD hospitalizations in musculoskeletal diseases (MSDs), based on the presence of diagnostic codes for AUD in the primary and MSDs in a secondary position. Multivariable-adjusted (age, sex, race, and income) health care utilization and in-hospital mortality were compared by the presence/absence of MSDs, using linear or logistic regression.

Results

Alcohol use disorder hospitalizations increased over the 19-year study period from 1998 to 2014 to 3-fold higher in gout, osteoarthritis, or LBP; 3.5-fold in RA; and 4.5-fold in fibromyalgia. Compared with AUD hospitalizations in people without each respective MSD, adjusted total hospital charges were $3913 higher in people with gout and $1368 to $1614 lower for osteoarthritis, fibromyalgia, or LBP over the study period (all significant) and not significantly different for RA. The adjusted odds of hospital stay of more than 3 days were significantly higher for all 5 MSDs, with odds ratio ranging 1.10 for LBP to 1.34 for gout. The adjusted odds of in-hospital mortality were significantly lower for all 5 MSDs, with odds ratio ranging from 0.21 for fibromyalgia to 0.50 for gout.

Conclusions

In a national US study, the rate of AUD hospitalizations increased in all 5 MSDs. Providers and patients with MSDs should be counseled regarding the risk and impact of alcohol use. Interventions to reduce AUD hospitalization–associated health care burden in MSD are needed.
Performance of the 2017 American College of Rheumatology/European League Against Rheumatism Provisional Classification Criteria for Antineutrophil Cytoplasmic Antibody–Associated Vasculitis in a Peruvian Tertiary Care Center
Authors: Pimentel-Quiroz Victor R. , Sánchez-Torres Alfredo , Reátegui-Sokolova Cristina , Gamboa-Cárdenas Rocío V. , Sánchez-Schwartz César , Medina-Chinchón Mariela , Zevallos Francisco , Noriega-Zapata Erika , Alfaro-Lozano José , Cucho-Venegas Jorge M. , Rodríguez-Bellido Zoila , Pastor-Asurza César A. , Acevedo-Vásquez Eduardo , Perich-Campos Risto , Alarcón Graciela S. , Ugarte-Gil Manuel F.
Published: April 2021

Aim

To validate the new classification criteria for antineutrophil cytoplasmic antibody–associated vasculitis in a real-life Peruvian cohort of antineutrophil cytoplasmic antibody–associated vasculitis patients.

Methods

We reviewed medical records from a Peruvian tertiary care center from January 1990 to December 2019. Antineutrophil cytoplasmic antibody–associated vasculitis was diagnosed based on the 1990 American College of Rheumatology (ACR) criteria, the 2012 Chapel Hill Consensus Conference definitions, the European Medicines Agency (EMEA) algorithm, and the clinical acumen of the treating rheumatologists. We classified all patients using the “former criteria” (the 1990 ACR criteria for granulomatosis with polyangiitis [GPA] and eosinophilic GPA [EGPA] and the 1994 Chapel Hill Consensus Conference definition for microscopic polyangiitis [MPA]), the EMEA algorithm, and the “new criteria” (the 2017 ACR/European League Against Rheumatism Provisional Criteria). The level of agreement (using Cohen κ) was calculated using the clinical diagnosis as the criterion standard.

Results

We identified 212 patients, 12 of whom were excluded. One hundred fifty-four (77%) had MPA, 41 (20.5%) GPA, and 5 (2.5%) EGPA. The new criteria performed well for MPA (κ = 0.713) and EGPA (κ = 0.659), whereas the EMEA algorithm performed well for GPA (κ = 0.938). In the overall population, the new criteria showed better agreement (κ = 0.653) than the EMEA algorithm (κ = 0.506) and the former criteria (κ = 0.305).

Conclusions

The 2017 ACR/European League Against Rheumatism Provisional Criteria showed better agreement for the clinical diagnosis of all the patients overall and had the best performance for MPA and EGPA. The EMEA algorithm had the best performance for GPA.
Outcomes of Saphenous Vein Intervention in the Management of Superficial Venous Incompetence
Authors: Gasior Sara A. , O’Donnell John P. M. , Aherne Thomas M. , Jalali Amirhossein , Tang Tjun , Ryan Éanna J. , Walsh Stewart R.
Published: April 2021

Objective:

To determine the most effective modality of intervention to treat saphenous vein insufficiency.

Summary of Background Data:

Endovenous therapies have instigated a paradigm shift in the management of superficial venous incompetence. When compared with open surgery, endovenous interventions (foam sclerotherapy, radiofrequency ablation, endovenous laser ablation (EVLA), mechanochemical ablation, and CAE closure) potentially offer reduced morbidity with similar procedural efficacy.

Methods:

A systematic review and series of network meta-analyses of randomized controlled trials were performed assessing risks of procedural failure (within 6-weeks) and recurrence (6-weeks to 5-years), defined by ultrasound, between the different modalities of intervention for superficial venous incompetence. Treatment comparisons addressing risks of common adverse events, venous clinical severity score, and pain were also performed.

Results:

A systematic search identified 51 articles, describing 36 randomized controlled trials, incorporating 7576 limbs. Outcome data on 10 modalities of intervention were analyzed up to 5-year follow-up. CAE resulted in the lowest risk of procedural failure within 6-weeks. Foam sclerotherapy had the highest risk of recurrence while high ligation with stripping (HLS) and Conservatrice Hemodynamique de l’Insuffisance Veineuse en Ambulatoire were ranked best to reduce long-term recurrence. No intervention increased risks of venous thromboembolism and there was minimal difference in morbidity between treatments. All interventions improved venous clinical severity score (range −1.02 to −4.95), however, radiofrequency ablation demonstrated the greatest improvement, followed by EVLA and HLS between 2 to 5-years. EVLA was associated with the highest risk of pain, while mechanochemical ablation offered the least.

Conclusions:

Although CAE offered the lowest risk of initial procedural failure, HLS resulted in lower rates of long-term recurrence without considerably increasing morbidity when compared with other endovenous options.
The COVID-19 pandemic: challenges in providing supportive care to those with cardiovascular disease in a time of plague
Authors: Hill Loreena , Lambrinou Ekaterini , Moser Debra K. , Beattie James M.
Published: April 2021

Purpose of review

COVID-19 has permeated the very essence of human existence and society and disrupted healthcare systems. The attrition stemming from this highly contagious disease particularly affects those rendered vulnerable by age and infirmity, including those with underlying cardiovascular disease. This article critically reviews how best to integrate supportive care into the management of those affected.

Recent findings

Numerous studies have described the pathophysiology of COVID-19, including that specifically arising in those with cardiovascular disease. Potential treatment strategies have emerged but there is limited guidance on the provision of palliative care. A framework for implementation of this service needs to be developed, perhaps involving the training of non-specialists to deliver primary palliative care in the community, bolstered by the use of telemedicine. The appropriate use of limited clinical resources has engendered many challenging discussions and complex ethical decisions. Prospective implementation of future policies requires the incorporation of measures to assuage moral distress, burnout and compassion fatigue in healthcare staff who are psychologically and physically exhausted.

Further research based on patient-centred decision making and advance care planning is required to ensure the supportive needs of COVID-19 patients with cardiovascular disease are adequately met. This research should focus on interventions applicable to daily healthcare practice and include strategies to safeguard staff well-being.
Basic Tests of Autonomic Function
Authors: Chow Kevin E. , Dhyani Ruchi , Chelimsky Thomas C.
Published: April 2021

Over the past 3 decades, tests of autonomic function have become increasingly standardized across most laboratories, particularly with commercially available equipment similar to other neurophysiologic tests. Most neurologically based laboratories perform four or five tests of autonomic function. Two of these, the sudomotor axon reflex response and the thermoregulatory sweat test (which some laboratories do not perform because it requires extensive equipment), examine sudomotor autonomic function. The remaining three, the cardiovascular response to a tilt table test, the cardiovascular response to the Valsalva maneuver, and the cardiac response to deep breathing examine cardiovascular autonomic function. Tests of sweating typically localize the lesion in the neuraxis, differentiating between central nervous system pathways, the spinal cord, or pre- or postganglionic roots or nerves. Tests of cardiovascular function delineate specific autonomic subsystem involvement, whether vagal parasympathetic as reflected in the deep breathing response and specific phases of the Valsalva maneuver or sympathetic adrenergic as reflected in the tilt table test and the other phases of the Valsalva. This review details the basic performance, analysis, and interpretation of these and a few other tests, with illustrative patient cases.
First detection of a novel ‘unknown host’ flavivirus in a Malaysian rodent
Authors: Blasdell Kim R. , Wynne James W. , Perera David , Firth Cadhla
Published: April 2021

Current phylogenetic analysis of the flavivirus genus has identified a group of mosquito-borne viruses for which the vertebrate hosts are currently unknown. Here we report the identification of a novel member of this group from a peridomestic rodent species (Sundamys muelleri) collected in Sarawak, Malaysia in 2016. We propose to name this novel flavivirus Batu Kawa virus after the location in which it was identified, with the abbreviation BKWV. Characterization of the BKWV genome allowed identification of putative mature peptides, potential enzyme motifs and conserved structural elements. Phylogenetic analysis found BKWV to be most closely related to Nhumirim virus (from Brazil) and Barkedji virus (from Senegal and Israel). Both of these viruses have been identified in Culex mosquitoes and belong to a group of viruses with unknown vertebrate hosts. This is the first known report of a member of this group of viruses from a potential mammalian host.
Cupriavidus cauae sp. nov., isolated from blood of an immunocompromised patient
Authors: Kweon Oh Joo , Ruan Wenting , Khan Shehzad Abid , Lim Yong Kwan , Kim Hye Ryoun , Jeon Che Ok , Lee Mi-Kyung
Published: April 2021

A novel Gram-stain-negative, facultative aerobic and rod-shaped bacterium, designated as MKL-01T and isolated from the blood of immunocompromised patient, was genotypically and phenotypically characterized. The colonies were found to be creamy yellow and convex. Phylogenetic analysis based on 16S rRNA gene and whole-genome sequences revealed that strain MKL-01T was most closely related to

Cupriavidus gilardii

LMG 5886T, present within a large cluster in the genus

Cupriavidus

. The genome sequence of strain MKL-01T showed the highest average nucleotide identity value of 92.1 % and digital DNA–DNA hybridization value of 44.8 % with the closely related species

C. gilardii

LMG 5886T. The genome size of the isolate was 5 750 268 bp, with a G+C content of 67.87 mol%. The strain could grow at 10–45 °C (optimum, 37–40 °C), in the presence of 0–10 % (w/v) NaCl (optimum, 0.5%) and at pH 6.0–10.0 (optimum, pH 7.0). Strain MKL-01T was positive for catalase and negative for oxidase. The major fatty acids were C16 : 0, summed feature 3 (C16 : 1
 ω7c/C16 : 1
 ω6c and/or C16 : 1
 ω6c/C16 : 1
 ω7c) and summed feature 8 (C18 : 1
 ω7c and/or C18 : 1
 ω6c). The polar lipid profile consisted of phosphatidylglycerol, phosphatidylethanolamine, two unidentified phospholipids and one unidentified polar lipid. Moreover, strain MKL-01T contained ubiquinone Q-8 as the sole respiratory quinone. Based on its molecular, phenotypic and chemotaxonomic properties, strain MKL-01T represents a novel species of the genus

Cupriavidus

; the name Cupriavidus cauae sp. nov. is proposed for this strain. The type strain is MKL-01T.
SARS-CoV-2 one year on: evidence for ongoing viral adaptation
Authors: Peacock Thomas P. , Penrice-Randal Rebekah , Hiscox Julian A. , Barclay Wendy S.
Published: April 2021

SARS-CoV-2 is thought to have originated in the human population from a zoonotic spillover event. Infection in humans results in a variety of outcomes ranging from asymptomatic cases to the disease COVID-19, which can have significant morbidity and mortality, with over two million confirmed deaths worldwide as of January 2021. Over a year into the pandemic, sequencing analysis has shown that variants of SARS-CoV-2 are being selected as the virus continues to circulate widely within the human population. The predominant drivers of genetic variation within SARS-CoV-2 are single nucleotide polymorphisms (SNPs) caused by polymerase error, potential host factor driven RNA modification, and insertion/deletions (indels) resulting from the discontinuous nature of viral RNA synthesis. While many mutations represent neutral ‘genetic drift’ or have quickly died out, a subset may be affecting viral traits such as transmissibility, pathogenicity, host range, and antigenicity of the virus. In this review, we summarise the current extent of genetic change in SARS-CoV-2, particularly recently emerging variants of concern, and consider the phenotypic consequences of this viral evolution that may impact the future trajectory of the pandemic.
The association between loneliness during the COVID-19 pandemic and psychological distress
Authors: Konno Yusuke , Nagata Masako , Hino Ayako , Tateishi Seiichiro , Tsuji Mayumi , Ogami Akira , Yoshimura Reiji , Matsuda Shinya , Fujino Yoshihisa ,   for the CORoNaWork Project
Published: April 2021

The purpose of this study was to examine the association between loneliness and psychological distress during the COVID-19 pandemic in Japan. We conducted a cross-sectional, online study from 22 to 26 December 2020. A total of 27,036 participants, all employed at the time of the survey, were included in the analysis. Participants were asked if they felt loneliness in a single-item question. The Kessler 6 (K6) was used to assess psychological distress defined as K6 scores of 5 or higher, and 13 or higher. The odds ratios (ORs) of psychological distress associated with loneliness were estimated using a multilevel logistic model nested in the prefecture of residence, with adjustment for age, sex, marital status, equivalent income, educational level, smoking, alcohol consumption, job type, number of workplace employees, and cumulative incidence rate of COVID-19 in the prefecture. Communication with friends, acquaintances, and family was strongly associated with psychological distress, so we adjusted for these factors and eating meals alone. Results showed a significant association between loneliness and psychological distress (OR = 36.62, 95%CI = 32.95-40.69). Lack of friends to talk to, lack of acquaintances to ask for help, and lack of people to communicate with through social networking sites were all strongly associated with psychological distress, as were family time and solitary eating. Even after adjusting for these factors, loneliness was still strongly associated with psychological distress (OR = 29.36, 95%CI = 26.44-32.98). The association between loneliness during the COVID-19 pandemic and psychological distress indicates the need for intervention.
The allometric propagation of COVID-19 is explained by human travel
Authors: Tuladhar Rohisha , Grigolini Paolo , Santamaria Fidel
Published: April 2021

We analyzed the number of cumulative positive cases of COVID-19 as a function of time in countries around the World. We tracked the increase in cases from the onset of the pandemic in each region for up to 150 days. We found that in 81 out of 146 regions the trajectory was described with a power-law function for up to 30 days. We also detected scale-free properties in the majority of sub-regions in Australia, Canada, China, and the United States (US). We developed an allometric model that was capable of fitting the initial phase of the pandemic and was the best predictor for the propagation of the illness for up to 100 days. We then determined that the power-law COVID-19 exponent correlated with measurements of human mobility. The COVID-19 exponent correlated with the magnitude of air passengers per country. This correlation persisted when we analyzed the number of air passengers per US states, and even per US metropolitan areas. Furthermore, the COVID-19 exponent correlated with the number of vehicle miles travelled in the US. Together, air and vehicular travel explained 70 % of the variability of the COVID-19 exponent. Taken together, our results suggest that the scale-free propagation of the virus is present at multiple geographical scales and is correlated with human mobility. We conclude that models of disease transmission should integrate scale-free dynamics as part of the modeling strategy and not only as an emergent phenomenological property.
Visually-biased perception in cochlear implant users: a study of the McGurk and sound-induced flash illusions
Authors: Butera Iliza M. , Stevenson Ryan A. , Gifford René H. , Wallace Mark T.
Published: April 2021

The reduction in spectral resolution by cochlear implants oftentimes requires complementary visual speech cues to aid in understanding. Despite substantial clinical characterization of auditory-only speech outcome measures, relatively little is known about the audiovisual integrative abilities that most cochlear implant (CI) users rely on for daily speech comprehension. In this study, we tested audiovisual integration in 63 CI users and 69 normal-hearing (NH) controls using the McGurk and sound-induced flash illusions. This study is the largest to-date measuring the McGurk effect in this population and the first to test the sound-induced flash illusion. When presented with conflicting audiovisual speech stimuli (i.e., the phoneme “ba” dubbed onto the viseme “ga”), we found that 55 CI users (87%) reported a fused percept of “da” or “tha” on at least one trial. However, overall, we found that CI users experienced the McGurk effect less often than controls—a result that was concordant with results with the sound-induced flash illusion where the pairing of a single circle flashing on the screen with multiple beeps resulted in fewer illusory flashes for CI users. While illusion perception in these two tasks appears to be uncorrelated among CI users, we identified a negative correlation in the NH group. Because neither illusion appears to provide further explanation of variability in CI outcome measures, further research is needed to determine how these findings relate to CI users’ speech understanding, particularly in ecological listening conditions that are naturally multisensory.
SARS-CoV-2 Detection from the Built Environment and Wastewater and Its Use for Hospital Surveillance
Authors: Hinz Aaron , Xing Lydia , Doukhanine Evgueni , Hug Laura A. , Kassen Rees , Ormeci Banu , Kibbee Richard J. , Wong Alex , MacFadden Derek , Nott Caroline
Published: April 2021

Background

SARS-CoV-2 causes significant morbidity and mortality in health care settings. Our understanding of the distribution of this virus in the built healthcare environment and wastewater, and relationship to disease burden, is limited.

Methods

We performed a prospective multi-center study of environmental sampling of SARS-CoV-2 from hospital surfaces and wastewater and evaluated their relationships with regional and hospital COVID-19 burden. We developed and validated a qPCR-based approach to surface sampling, and swab samples were collected weekly from different locations and surfaces across two tertiary care hospital campuses for a 10-week period during the pandemic, along with wastewater samples.

Results

Over a 10-week period, 963 swab samples were collected and analyzed. We found 61 (6%) swabs positive for SARS-CoV-2, with the majority of these (n=51) originating from floor samples. Wards that actively managed patients with COVID-19 had the highest frequency of positive samples (p<0.01). Detection frequency in built environment swabs was significantly associated with active cases in the hospital throughout the study (p<0.025). Wastewater viral signal changes appeared to predate change in case burden.

Conclusions

Environment sampling for SARS-CoV-2, in particular from floors, may offer a unique and resolved approach to surveillance of COVID-19.
Rapid spread and high impact of the Variant of Concern P.1 in the largest city of Brazil
Authors: Barbosa Gabriela Rodrigues , Leão Moreira Luiz Vinicius , Oliveira Justo Alberto Fernando , Perosa Ana Helena , Cunha Chaves Ana Paula , Bueno Mariana Sardinha , de Souza Luna Luciano Kleber , Conte Danielle Dias , Almeida Carvalho Joseane Mayara , Prates Janesly , Dantas Patricia Sousa , Faico-Filho Klinger Soares , Camargo Clarice , Resende Paola Cristina , Mendonça Siqueira Marilda , Bellei Nancy
Published: April 2021

First in Manaus in the Brazilian Northern region, the Variant of Concern P.1 traveled 3800 kilometers southeast to endanger Sao Paulo contributing to the collapse of the health system. Here, we show evidence of how fast the VOC P.1 has spread in the most populated city in South America.
Neuroimaging correlates and predictors of response to repeated-dose intravenous ketamine in PTSD: preliminary evidence
Authors: Norbury Agnes , Rutter Sarah B. , Collins Abigail B. , Costi Sara , Jha Manish K. , Horn Sarah R. , Kautz Marin , Corniquel Morgan , Collins Katherine A. , Glasgow Andrew M. , Brallier Jess , Shin Lisa M. , Charney Dennis S. , Murrough James W. , Feder Adriana
Published: April 2021

Promising initial data indicate that the glutamate N-methyl-D-aspartate (NMDA) receptor antagonist ketamine may be beneficial in post-traumatic stress disorder (PTSD). Here, we explore the neural correlates of ketamine-related changes in PTSD symptoms, using a rich battery of functional imaging data (two emotion-processing tasks and one task-free scan), collected from a subset of participants of a randomized clinical trial of repeated-dose intravenous ketaminevsmidazolam (totalN=21). In a pre-registered analysis, we tested whether changes in ana prioriset of imaging measures from a target neural circuit were predictive of improvement in PTSD symptoms, using leave-one-out cross-validated elastic-net regression models (regions of interest in the target circuit consisted of the dorsal and rostral anterior cingulate cortex, ventromedial prefrontal cortex, anterior hippocampus, anterior insula, and amygdala). Improvements in PTSD severity were associated with increased functional connectivity between the ventromedial prefrontal cortex (vmPFC) and amygdala during emotional face-viewing (change score retained in model with minimum predictive error in left-out subjects, standardized regression coefficient [β]=2.90). This effect was stronger in participants who received ketamine compared to midazolam (interaction β=0.86), and persisted following inclusion of concomitant change in depressive symptoms in the analysis model (β=0.69). Improvement following ketamine was also predicted by decreased dorsal anterior cingulate activity during emotional conflict regulation, and increased task-free connectivity between the vmPFC and anterior insula (βs=-2.82, 0.60). Exploratory follow-up analysis via dynamic causal modelling revealed that whilst improvement in PTSD symptoms following either drug was associated with decreased excitatory modulation of amygdala→vmPFC connectivity during emotional face-viewing, increased top-down inhibition of the amygdala by the vmPFC was only observed in participants who improved under ketamine. Individuals with low prefrontal inhibition of amygdala responses to faces at baseline also showed greater improvements following ketamine treatment. These preliminary findings suggest that, specifically under ketamine, improvements in PTSD symptoms are accompanied by normalization of hypofrontal control over amygdala responses to social signals of threat.
“You’re just there, alone in your room with your thoughts” A qualitative study about the impact of lockdown among young people during the COVID-19 pandemic
Authors: McKinlay Alison R. , May Tom , Dawes Joanna , Fancourt Daisy , Burton Alexandra
Published: April 2021

Background

Adolescents and young adults have been greatly affected by quarantine measures during the coronavirus-19 pandemic. Quantitative evidence suggests that many young people have struggled with their mental health throughout “lockdown”, but little is understood about the qualitative impact of social distancing restrictions on mental health, wellbeing and social life. We therefore sought to elicit the views and experiences of adolescents and young adults living in the UK during the pandemic.

Methods

Semi-structured qualitative interviews were undertaken with 37 participants aged 13-24.

Results

We identified 4 superordinate themes most commonly described by participants about their experiences during the pandemic, including: a) missing social contact during lockdown, b) disruption to education, c) changes to social relationships, and d) improved wellbeing during lockdown. Although we identified some positive experiences during the pandemic, including an increased awareness of mental health and stronger relationship ties, many said they struggled with loneliness, a decline in mental health, and anxiety about socialising after the pandemic.

Conclusions

Findings suggest that some young people may have felt less stigma talking about their mental health now compared to before the COVID-19 pandemic. However, many are worried about how the pandemic has affected their education and social connections and may require additional psychological, practical and social support. Our findings highlight the important role that education providers play in providing a source of information and support to adolescents and young adults during times of uncertainty.