bluuebunny/crossref_metadata_2025 huggingface dataset:
Change of serum B-cell activating factor level in patients with positive antiphospholipid antibodies and previous adverse pregnancy outcomes and its significance
Authors: Li Xin-Yi , Duan Hong-Ji , Liu Xiang-Yuan , Deng Xiao-Li
Published: August 2020

Background:

B-cell activating factor (BAFF) is vital for B cell survival. Serum BAFF levels are elevated in thrombotic antiphospholipid syndrome, but little is known about levels in patients with positive antiphospholipid antibodies (aPLs) and previous adverse pregnancy outcomes (APOs). We aimed to analyze serum BAFF concentrations of these patients in early pregnancy along with different pregnancy outcomes.

Methods:

Thirty-six pregnant patients positive for aPLs and previous APOs (patient group), 25 healthy pregnant females (HP group) and 35 healthy non-pregnant females (HNP group) from the Peking University Third Hospital, between October 2018 and March 2019, were enrolled in this study. Serum of HNP and serum of patients as well as HP in the first gestational trimester were collected. Enzyme-linked immunosorbent assay kits were used to measure serum BAFF and interferon-alpha (IFN-α) concentrations. Cytometric bead array analysis was used to measure serum concentrations of cytokines. The patient group was further divided into APOs and non-APOs (NAPOs) group, fetal loss and live birth group according to pregnancy outcomes. The Mann-Whitney U-test was used to assess significance between and within groups. Spearman rank-order was used to evaluate correlation coefficients between BAFF and related cytokines.

Results:

The serum BAFF level in HP group was significantly lower than HNP group (245.24 [218.80, 265.90] vs. 326.94 [267.31, 414.80] pg/mL, Z = −3.966, P < 0.001). The BAFF level was obviously elevated in patient group compared to that in HP group (307.77 [219.86, 415.65] vs. 245.24 [218.80, 265.90] pg/mL, Z = −2.464, P = 0.013). BAFF levels in APOs group tended to be higher than that in NAPOs group (416.52 [307.07, 511.12] vs. 259.37 [203.59, 375.81] pg/mL, Z = −2.718, P = 0.006). Compared to HP group, concentrations of IFN-α, interleukin (IL-6) and tumor necrosis factor were higher in patient group (33.37 [18.85, 48.12] vs. 13.10 [6.85, 25.47] pg/mL, Z = −2.023, P = 0.043; 39.16 [4.41, 195.87] vs. 3.37 [2.92, 3.90] pg/mL, Z 
= −3.650, P < 0.001; 8.23 [2.27, 64.46] vs. 1.53 [1.25, 2.31] pg/mL, Z = −3.604, P < 0.001, respectively). Serum BAFF levels had a positive correlation with the concentrations of both IL-6 and IL-10 (IL-6: r = 0.525, P = 0.002; IL-10: r = 0.438, P = 0.012).

Conclusions:

Serum BAFF levels are increased in patients with positive aPLs and previous APOs as compared to healthy pregnant females and tend to be higher in individuals with current APOs. The BAFF levels have a positive correlation with serum IL-6 and IL-10.
Xylazine Identified in the Unregulated Drug Supply in British Columbia, Canada
Authors: Tobias Samuel , Shapiro Aaron M. , Wu Harvey , Ti Lianping
Published: August 2020

Objectives:

Drug checking is a harm reduction intervention that provides people who use drugs with information about the substance they are intending to, or have already, used. It also functions as a way to monitor the local drug supply providing real-time alerts to the community, researchers, and decision makers. These alerts include, but are not limited to, novel adulterants detected in the drug supply.

Methods:

Drug samples were sent from a point-of-care drug checking service utilizing Fourier transform infrared (FTIR) spectroscopy and fentanyl immunoassay strips at two supervised consumption sites in Vancouver and Surrey, British Columbia to receive confirmatory laboratory-based testing with gas chromatography/mass spectrometry (GC/MS).

Results:

Between June 1, 2018 and November 30, 2018, xylazine was detected in four samples sent for confirmatory testing and co-occurred with fentanyl in all cases. Point-of-care drug checking with FTIR was unable to detect xylazine in these samples.

Conclusions:

Xylazine is a depressant that may potentiate certain desirable effects of opioid drugs, which may explain its presence in the unregulated drug supply. The implications of xylazine as an adulterant are unknown, but drug checking has shown to be a valuable tool in early warning for the community and healthcare providers.

Objectifs:

La analyse des drogues est une intervention de réduction des méfaits auprès des personnes qui consomment des drogues en fournissant des informations sur la substance qu’elles envisagent ou ont déjà consommée. Cela fonctionne également comme un moyen de surveiller l’approvisionnement local en médicaments, fournissant des alertes en temps réel à la communauté, aux chercheurs et aux décideurs. Ces alertes comprennent, mais sans s’y limiter, les nouveaux adultérants détectés dans les drogues.

Méthodes:

Des échantillons de drogues ont été envoyés à partir d’un service de analyse des drogues utilisant la spectroscopie infrarouge à transformée de Fourier (IRTF) et des bandelettes immunologiques de fentanyl dans deux sites de consommation supervisée à Vancouver et Surrey, en Colombie-Britannique, afin de recevoir des tests de confirmation en laboratoire avec chromatographie en phase gazeuse/spectrométrie de masse (GC/MS).

Résultats:

Entre le 1er juin 2018 et le 30 novembre 2018, la xylazine a été détectée dans quatre échantillons envoyés pour des tests de confirmation et coproduite avec le fentanyl dans tous les cas. La vérification des drogues au point de service par IRTF n’a pas permis de détecter la xylazine dans ces échantillons.

Conclusions:

La xylazine est un dépresseur qui peut potentialiser certains effets souhaitables des médicaments opioïdes, ce qui peut expliquer sa présence dans l’approvisionnement non réglementé en médicaments. Les implications de la xylazine en tant qu’adultérant sont inconnues, mais le analyse des drogues s’est révélé être un outil précieux d’alerte précoce pour la communauté et les prestataires de soins de santé.
Explaining the Sex Effect on Survival in Cystic Fibrosis: a Joint Modeling Study of UK Registry Data
Authors: Taylor-Robinson David , Schlüter Daniela K. , Diggle Peter J. , Barrett Jessica K.
Published: August 2020

Background:

Male sex is associated with better lung function and survival in people with cystic fibrosis but it is unclear whether the survival benefit is solely due to the sex-effect on lung function.

Methods:

This study analyzes data between 1996 and 2015 from the longitudinal registry study of the UK Cystic Fibrosis Registry. We jointly analyze repeated measurements and time-to-event outcomes to assess how much of the sex effect on lung function also explains survival. These novel methods allow examination of association between percent of forced expiratory volume in 1 second (%FEV1) and covariates such as sex and genotype, and survival, in the same modeling framework. We estimate the probability of surviving one more year with a probit model.

Results:

The dataset includes 81,129 lung function measurements of %FEV1 on 9,741 patients seen between 1996 and 2015 and captures 1,543 deaths. Males compared with females experienced a more gradual decline in %FEV1 (difference 0.11 per year 95% confidence interval [CI] = 0.08, 0.14). After adjusting for confounders, both overall level of %FEV1 and %FEV1 rate of change are associated with the concurrent hazard for death. There was evidence of a male survival advantage (probit coefficient 0.15; 95% CI = 0.10, 0.19) which changed little after adjustment for %FEV1 using conventional approaches but was attenuated by 37% on adjustment for %FEV1 level and slope in the joint model (0.09; 95% CI = 0.06, 0.12).

Conclusions:

We estimate that about 37% of the association of sex on survival in cystic fibrosis is mediated through lung function.
Latinx Parents' Perceptions of Neighborhood Walking Safety for Their Youth With Intellectual Disabilities
Authors: Early Amy , Suarez-Balcazar Yolanda , Arias Dalmina
Published: August 2020

Increased walking distance and frequency has been linked to positive health outcomes. Neighborhood walkability disproportionately impacts youth with intellectual and developmental disabilities (IDD). We investigated concerns of Latinx parents of youth with IDD about walkability and their impact on families' walking behavior. We surveyed Latinx parents of youth with IDD (n = 21) and compared results with the general population. Results were triangulated with a focus group (n = 5). Survey data were analyzed using a Mann-Whitney U test, and focus group data via thematic analysis. We found a significant difference (P < .05) between parents of youth with IDD and the general population on perceived aesthetics, opportunity to participate, and satisfaction. Latinx parents and their youth with IDD experience disparities in the safety and pleasantness of their communities for walking, which may contribute to decreased community participation, poorer health outcomes, and lower levels of neighborhood satisfaction among this already vulnerable population.
An Integrative Review of Current Practice Models and/or Process of Family-Centered Early Intervention for Children Who Are Deaf or Hard of Hearing
Authors: Maluleke Ntsako P. , Khoza-Shangase Katijah , Kanji Amisha
Published: August 2020

Over the past few decades, there has been an increasing shift toward emphasizing the importance of the child's family taking an active role in the habilitation process through family-centered early intervention (FCEI) programs. Accordingly, the Health Professions Council of South Africa recommends that early intervention services following confirmation of hearing loss must be family-centered within a community-based model of service delivery that is culturally congruent. The aim of this study was to explore and document current evidence reflecting trends in FCEI for children who are deaf or hard of hearing (DHH) by identifying and describing current practice models and/or processes of FCEI for these children. This study describes our first steps in formulating a framework for FCEI for children who are DHH in South Africa. An integrative literature review was conducted. Sage, Science Direct, PubMed, and Google Scholar databases were searched for studies published in English between January 2009 and January 2019 reporting on FCEI programs for children who are DHH. Studies that focused on the following were excluded from the study: speech and language outcomes of children, youth, and adults who are DHH; education for children who are DHH; universal newborn hearing screening; professionals' roles in early hearing detection and intervention; diagnosis of hearing loss; and sign language. Kappa statistics were performed to determine agreement between reviewers. Twenty-two studies were included in the review. Cohen's kappa revealed a substantial agreement (κ = 0.8) between reviewers for data extraction and synthesis in terms of the articles that met the criteria for inclusion in the review. Findings were discussed under 5 themes: caregiver involvement; caregiver coaching/information sharing; caregiver satisfaction; challenges with FCEI; and telehealth. Generally, there is sufficient evidence for FCEI, with caregivers indicating the need for full involvement in their children's care. Methods of caregiver involvement involving caregiver coaching/information sharing need to be culturally and linguistically appropriate, with sensitivities around time and manner. This increases caregiver satisfaction with intervention programs and improves outcomes for children who are DHH. Challenges identified by the studies raise implications for early hearing detection and intervention programs, as well as Departments of Health and Social Welfare. These included logistical challenges, professional-related challenges, and caregiver-related challenges. Various aspects of FCEI have been reported in the review. Findings of these studies have significant implications for the formulation of quality FCEI programs to ensure contextually relevant and contextually responsive care of children who are DHH.
Identifying Infants and Young Children at Risk of Unplanned Hospital Admissions and Clinic Visits in Dar es Salaam, Tanzania
Authors: Rees Chris A. , Kisenge Rodrick , Manji Karim P. , Liu Enju , Fawzi Wafaie W. , Duggan Christopher P.
Published: August 2020

Background:

Pediatric inpatient mortality rates are as high as 11% in parts of sub-Saharan Africa. Unscheduled clinic visits also burden children in sub-Saharan Africa. Our objective was to identify factors associated with hospital admissions and unscheduled clinic visits among Tanzanian children < 24 months of age.

Methods:

We conducted a secondary analysis of 2 trials conducted in Dar es Salaam, Tanzania. We performed univariate and Poisson multivariable regression analyses to identify factors associated with hospital admissions and unscheduled clinic visits.

Results:

Of 4784 children < 24 months of age, 293 (6.1%) were hospitalized at least once and 1308 (27.3%) had ≥ 1 unscheduled clinic visit. Infants and children who were exposed to but HIV-negative had increased risk of hospital admission [adjusted risk ratios (aRR): 3.67; 95% CI: 2.45–5.50; P < 0.001] compared with HIV-unexposed children. Those who were HIV-positive had even higher risk of hospital admission compared with those not exposed to HIV (aRR: 10.87; 95% CI: 7.01–16.89; P < 0.001). Birth weight and breast-feeding status were not associated with increased risk of hospital admission. Children with Apgar scores < 7 (aRR: 1.32; 95% CI: 1.03–1.69; P = 0.001), not exclusively breast-fed up to 6 months of age (aRR: 1.34; 95% CI: 1.12–1.60; P = 0.001), and who were HIV-exposed and HIV-negative (aRR: 2.35; 95% CI: 2.08–2.66; P < 0.001) or HIV-positive (aRR: 3.02; 95% CI: 2.52–3.61; P < 0.001) had higher risk of unscheduled clinic visits.

Conclusions:

Exposure to HIV and being HIV-positive were associated with the greatest risk for hospital admission and unplanned clinic visits among infants and children in Tanzania. Targeting these vulnerable populations in interventional studies may reduce morbidity.
Parents' Experiences of Transition From Hospital to Home After Their Infant's First-Stage Cardiac Surgery
Authors: Gaskin Kerry L. , Barron David , Wray Jo
Published: August 2020

Background

The intersurgical stage is a critical time for fragile infants with complex congenital heart disease, but little is known about the impact on parents.

Objective

The aim of this study was to explore parents' experiences of the transition from hospital to home with their infant after stage 1 cardiac surgery for complex congenital heart disease.

Method

This is a prospective, longitudinal, mixed methods feasibility study using semistructured interviews and self-report instruments at 4 time points: before discharge (baseline), 2 weeks post discharge, 8 weeks post discharge, and after stage 2 surgery. Qualitative data were analyzed thematically; and quantitative data, descriptively.

Results

Sixteen parents of 12 infants participated. All parents described signs of acute stress disorder; 4 parents described symptoms of posttraumatic stress disorder before discharge. Parents' fear and uncertainty about going home were multifaceted, underpinned by exposure to numerous traumatic events. By 8 weeks post discharge, parents' feelings and emotions were positive, relieved, and relaxed. Mean generalized anxiety and depression scores were higher before discharge; most individual anxiety and depression scores decreased over time. Physiological survival included self-care needs, such as eating and sleeping properly. Physical survival included preparation of the home environment and home alterations adapting to their infant's equipment needs. Financial survival was a burden, particularly for those unable to return to work.

Conclusion

Patterns of experience in surviving the transition included psychological, physical, physiological, and financial factors. Authors of further longitudinal research could test the effectiveness of psychological preparation interventions, while encouraging early consideration of the other factors influencing parents' care of their infant after discharge from hospital.
Measuring Adherence to U.S. Preventive Services Task Force Diabetes Prevention Guidelines Within Two Healthcare Systems
Authors: Brunisholz Kimberly D. , Conroy Molly B. , Belnap Thomas , Joy Elizabeth A. , Srivastava Raj
Published: August 2020

Measuring adherence to the 2015 U.S. Preventive Services Task Force (USPSTF) diabetes prevention guidelines can inform implementation efforts to prevent or delay Type 2 diabetes. A retrospective cohort was used to study patients without a diagnosis of diabetes attributed to primary care clinics within two large healthcare systems in our state to study adherence to the following: (1) screening at-risk patients and (2) referring individuals with confirmed prediabetes to participate in an intensive behavioral counseling intervention, defined as a Center for Disease Control and Prevention (CDC)-recognized Diabetes Prevention Program (DPP). Among 461,866 adults attributed to 79 primary care clinics, 45.7% of patients were screened, yet variability at the level of the clinic ranged from 14.5% to 83.2%. Very few patients participated in a CDC-recognized DPP (0.52%; range 0%–3.53%). These findings support the importance of a systematic implementation strategy to specifically target barriers to diabetes prevention screening and referral to treatment.
Blood pressure control in patients with chronic kidney disease according to office and home blood pressures
Authors: Chantrel François , Ott Julien , Dimitrov Yves , Babici Daniela , Fourcade Jacques , Hanon Olivier , Achard Jean-Michel , Jabourek Olivier , Ducher Michel , Fauvel Jean-Pierre
Published: August 2020

Objectives

The aim of this study was to assess blood pressure (BP) control in patients with chronic kidney disease (CKD) according to office and home BP and to assess the prevalence of normal BP, white-coat uncontrolled hypertension (WUCH), masked uncontrolled hypertension (MUCH) and elevated BP.

Methods

Patients with renal failure with or without proteinuria were included in this multicenter observational study. Office BP was first measured by the physician using a self-monitoring BP device (three automatic readings), then by the patient at home (morning and evening) over 3 consecutive days. WUCH was defined as a systolic BP (SBP)/diastolic BP (DBP) ≥140/90 mmHg in the clinic and SBP/DBP<135/85 mmHg at home. MUCH was defined as SBP/DBP <140/90 mmHg in the clinic and SBP/DBP ≥135/85 mmHg at home.

Results

Among the 243 included subjects, data of 225 patients were analyzed. Mean estimated glomerular filtration rate was 37.7 ± 15.7 mL/min/1.73 m2 and mean office SBP/DBP was 154 ± 19/83 ± 13 mmHg. Mean office SBP/DBP was significantly higher than home SBP/DBP (+9.0 ± 15.1/+7.0 ± 10.0 mmHg, P < 0.01). Normal BP (office and home BP), WUCH, MUCH and elevated BP (office and home BP) rates were 12.0, 14.2, 6.7 and 67.1%, respectively. The patients were taking, on average, 2.8 ± 1.5 antihypertensive drugs/day.

Conclusion

BP control in patients with CKD was poor. Routine use of ‘out-of-office’ BP measurement, in addition to office BP by which we can identify patients with WUCH or MUCH, should be recommended based on the current findings.
Effect of written and video discharge instructions on parental recall of information about analgesics in children: a pre/post-implementation study
Authors: Hoek Amber E. , Bouwhuis Marna G. , Haagsma Juanita A. , Keyzer – Dekker Claudia M.G. , Bakker Berdine , Bokhorst Eric F. , Oostenbrink Rianne , Rood Pleunie P.M.
Published: August 2020

Objective

The aim of this study was to determine whether written and video instructions improved the recall of how to use analgesics correctly in parents of children discharged following assessment in the emergency department (ED).

Methods

This was a prospective pre- and post-implementation study set in the EDs of a tertiary teaching hospital and an urban general hospital in the Netherlands. The participants were parents/carers of children under 12-years-old who had been assessed in and subsequently discharged from the ED. The pre-implementation phase involved 165 participants; the post-phase involved 174 participants. In the post-implementation phase, written instructions about correct analgesic use in children and a link to an online video were provided at discharge. Endpoints were measured using a questionnaire designed to ascertain participants’ recall of how to use analgesics correctly and their patterns of use, completed 3–5 days following discharge of their child from the ED. Additionally, participants were asked about re-attending healthcare services and their satisfaction with and preferences for information about analgesic use.

Results

Recall of the correct use of analgesics was significantly higher in participants in the post-implementation phase compared to the pre-implementation phase [difference 29%; 95% confidence interval (CI) 19–39%]. In the post-implementation phase, participants represented to healthcare services less frequently (difference –6%; 95% CI –13–0%). Patterns of use of analgesics varied between the pre- and post-phases, with significantly more participants giving analgesics at home (difference 11%; 95% CI 1–20%). Participants in the post-implementation phase were significantly more (highly) satisfied about the analgesic advice they received compared to parents in the pre-implementation phase (difference –13; 95% CI –23% to –3%). Verbal (93%) or written instructions (83%) were the most popular choices for discharge instructions.

Conclusion

In our study, we observed that the recall of the correct use of analgesics was increased in participants who had been given written instructions at discharge.
Surgical Treatment for Capsular Contracture: A New Paradigm and Algorithm
Authors: Hidalgo David A. , Weinstein Andrew L.
Published: August 2020

Background:

Capsular contracture following breast augmentation is prone to recurrence with conventional surgical therapy. Adding acellular dermal matrix improves results but significantly increases operating time and cost. This study tested a new treatment algorithm that uses acellular dermal matrix selectively to optimize success rates while minimizing its drawbacks.

Methods:

All patients surgically treated by the authors for Baker grade III/IV capsular contracture between 2007 and 2018 were included in this retrospective cohort study. Data were collected on patient, breast augmentation, capsular contracture, and surgical treatment characteristics, in addition to follow-up findings. Treatment success was defined as Baker grade II or better.

Results:

One hundred eighty patients underwent 217 surgical treatments for capsular contracture. Conventional treatment was used in 185 cases and acellular dermal matrix in 32. Twenty-six patients were treated for a second occurrence and four were treated for a third. The average follow-up was 2.4 years. Conventional treatment was successful in 72.5 percent of first occurrences, 62.5 percent of second occurrences, and 50.0 percent of third occurrences. Acellular dermal matrix was successful in 96.9 percent of cases. The odds of failure were increased by bilateral capsular contracture (3.9 times) and previous treatment failure (3.5 times). When acellular dermal matrix was used selectively for bilateral capsular contracture or in unilateral cases with a previous treatment failure, the overall treatment success rate improved to 85.6 percent compared with 64.2 percent when this algorithm was not followed (p < 0.001).

Conclusion:

This study demonstrates that selective acellular dermal matrix use can increase success rate to over 85 percent in the overall treatment of capsular contracture, and to nearly 100 percent in individual cases.
High Prevalence of HIV-1 Drug Resistance and Dynamics of Transmission Among High-Risk Populations in Port-au-Prince, Haiti
Authors: Jean Louis Frantz , Domercant Jean Wysler , Ignacio Caroline , Gianella Sara , Galbaud Guethina , Leonard Maureen , Smith Davey M. , Chaillon Antoine
Published: August 2020

Background:

In low HIV prevalence settings, understanding the transmission dynamics and the impact of drug resistance is critical to curb down the epidemic. This study aims to explore the prevalence and dynamics of transmission of HIV drug-resistance mutations (DRMs) among key populations in Haiti.

Settings:

Eligible participants (naive, treated) were selected from 7 key population friendly health care centers in Port-au-Prince, Haiti, from September 2018 to July 2019.

Methods:

A total of 119 HIV-1 pol sequences were analyzed from men having sex with men (MSM), female sex workers (FSWs), and their sexual partners. Screening for HIV DRMs was performed using the Stanford University Drug Resistance Database. Phylogenetic and network analyses using HIV-TRACE software were performed to infer putative relationships and shared DRMs.

Results:

Of the 119 participants, 62.2% were men (74/119), and 75.7% of them (56/74) reported MSM as a main risk factor. The overall DRM prevalence was 58.8% (70/119). A DRM was observed in 37.5% of MSM (21/56), 82.2% of FSWs (37/45), and 66.7% (12/18) among FSWs' clients. In a multivariate model, age and FSWs were significant predictors for DRMs (P = 0.001). Transmission network analysis found 24 of the 119 (20.2%) genetically linked individuals forming 8 clusters. Clustering participants were mostly MSM (15/24; 62.5%). Five clusters (62.5%) had shared DRMs, and K103N and M184V were the main shared mutations.

Conclusions:

High prevalence of HIV DRMs was observed among MSM, FSWs, and their clients in Port-au-Prince, Haiti. Network analysis revealed frequent DRM transmission among genetically linked individuals, highlighting the need for appropriate interventions to limit HIV transmission in these high-risk populations.
Model-Based Predictions of HIV Incidence Among African Women Using HIV Risk Behaviors and Community-Level Data on Male HIV Prevalence and Viral Suppression
Authors: Moore James R. , Donnell Deborah J. , Boily Marie-Claude , Mitchell Kate M. , Delany-Moretlwe Sinead , Bekker Linda-Gail , Mgodi Nyaradzo M. , El-Sadr Wafaa , Cohen Myron S. , Celum Connie L. , Dimitrov Dobromir
Published: August 2020

Background:

Pre-exposure prophylaxis (PrEP) with tenofovir disoproxil fumarate and emtricitabine has proven highly effective in preventing HIV acquisition and is therefore offered to all participants in the control group as part of the standard of care package in many new HIV prevention studies. We propose a methodology for predicting HIV incidence in a hypothetical “placebo arm” for open-label studies or clinical trials with active control among African women. We apply the method to an open-label PrEP study, HIV Prevention Trials Network 082, which tested strategies to improve PrEP adherence in young African women all of whom were offered PrEP.

Methods:

Our model predicted HIV infection risk for female study cohorts in sub-Saharan Africa using baseline behavioral risk factors and contemporary HIV prevalence and viral suppression in the local male population. The model was calibrated to HIV incidence in the Vaginal and Oral Interventions to Control the Epidemic study.

Results:

Our model reproduced the annual HIV incidence of 3.2%–4.8% observed over 1 year of follow-up in the placebo groups of 4 completed clinical studies. We predicted an annual HIV incidence of 3.7% (95% confidence interval: 3.2 to 4.2) among HIV Prevention Trials Network 082 participants in the absence of PrEP and other risk reduction interventions.

Conclusions:

We demonstrated the potential of the proposed methodology to provide HIV incidence predictions based on assessment of individual risk behaviors and community and time-specific HIV exposure risk using HIV treatment and viral suppression data. These estimates may serve as comparators in HIV prevention trials without a placebo group.
Cardiothoracic Complications of Immune Checkpoint Inhibitor Therapy: An Imaging Review
Authors: Agarwal Saurabh , Healey Terrance T.
Published: August 2020

Immune checkpoint inhibitor therapy has revolutionized the treatment of many different types of cancer. However, despite dramatic improvements in tumor oncologic response and patient outcomes, immune checkpoint blockade has been associated with multiple distinctive side-effects termed immune-related adverse events. These often have important clinical implications because these can vary in severity, sometimes even resulting in death. Therefore, it is important for both radiologists and clinicians to recognize and be aware of these reactions to help appropriately guide patient management. This article specifically highlights imaging manifestations of the most common cardiothoracic toxicities of these agents, including pneumonitis, sarcoid-like granulomatosis and lymphadenopathy, and myocarditis.
Renal Cell Carcinoma: Predicting DNA Methylation Subtyping and Its Consequences on Overall Survival With Computed Tomography Imaging Characteristics
Authors: Yu Taihen , Lin Chunmiao , Li Xinming , Quan Xianyue
Published: August 2020

Purpose

The aim of the study was to investigate associations between computed tomography (CT) imaging characteristics, DNA methylation subtyping, and overall survival in renal cell carcinomas.

Methods

Survival curves were calculated using the Kaplan-Meier analysis. The CT data from 212 patients generated with The Cancer Imaging Archive (TCIA) were reviewed. Identified were 70 (33.0%) M1 subtype, 17 (8.0%) M2 subtype, and 125 (59.0%) M3 subtype. Univariate and multivariate analyses were performed using the logistic regression model.

Results

Patients with M1 subtype had the shortest median overall survival (P < 0.001). On univariate analysis, long axis of 70 mm, intratumoral calcifications, enhancement, long axis > median, short axis > median, and intratumoral vascularity were associated with a significantly higher incidence of M1 subtype (P < 0.05). Short axis ≤ median, absence of necrosis, absence of intratumoral vascularity, and nodular enhancement were associated with M2 subtype (P < 0.05). Short axis ≤ median, long axis ≤ median, long axis of less than 70 mm, and necrosis were associated with a significantly higher incidence of M3 subtype (P < 0.05). On multivariate logistic regression analysis, long axis of greater than 70 mm (odds ratio [OR] = 2.452, P = 0.004; 95% confidence interval [CI] = 1.332–4.514) and necrosis (OR = 4.758, P = 0.041, 95% CI = 1.065–21.250) were associated with M1 subtype (area under the curve [AUC] = 0. 664). Necrosis (OR = 0.047, P < 0.001, 95% CI = 0.012–0.178) and enhancement (OR = 0.083, P = 0.024, 95% CI = 0.010–0.716) were associated with M2 subtype (AUC = 0.909). Long axis > median (OR = 0.303, P < 0.001, 95% CI = 0.164–0.561) and necrosis (OR = 3.256, P = 0.003, 95% CI = 1.617–10.303) were associated with M3 subtype (AUC = 0. 664).

Conclusions

The shortest survival was observed in patients with M1 subtype. This preliminary radiogenomics analysis of renal cell carcinoma demonstrated associations between CT imaging characteristic and DNA methylation subtyping.
Computed Tomography Findings in Vernix Caseosa Peritonitis
Authors: Becker-Weidman David , Chung Celina M.C. , Nadeem Muhammad , Virk Jas , Chung Charles
Published: August 2020

Introduction

Vernix caseosa peritonitis (VCP) is a rare peripartum complication secondary to the introduction of fetal vernix into the maternal peritoneal cavity. Vernix caseosa peritonitis typically manifests a few hours to days after a cesarian section and is often initially misdiagnosed as a more common disease process resulting in delayed diagnosis. We report the computed tomography (CT) findings in 2 patients with VCP and reviewed the previously reported CT findings of VCP.

Cases

Two patients, aged 17 and 24 years, presented with signs and symptoms of peritonitis within days of undergoing a cesarian section. In both cases, CT scans of the abdomen and pelvis demonstrated ascites and multiple small, well-defined, peripherally enhancing, cystic peritoneal nodules which were most prominent around the liver and became larger and more numerous over time. Antibiotic therapy was not effective, subsequent laparoscopic peritoneal biopsy demonstrated VCP, and patients were successfully treated with lavage and the addition of intravenous steroids.

Conclusions

Vernix caseosa peritonitis is an underrecognized disorder that is most often mistaken for other more common causes of peritonitis. In the setting of peripartum peritonitis, the CT findings of ascites with multiple small, well-defined, peripherally enhancing, cystic peritoneal nodules, especially adjacent to the liver, which grow in size and number strongly suggests VCP.
The Effect of Rectal Distention on the Intravoxel Incoherent Motion Parameters: Using Sonography Transmission Gel
Authors: Song Gesheng , Sun Hongjun , Chen Xu , Li Houying , Li Panpan , Li Jinye , Li Aiyin
Published: August 2020

Objective

To compare the intravoxel incoherent motion (IVIM) parameters of rectal tumors before and after lumen distension obtained with sonography transmission gel.

Methods

Twenty-five patients were enrolled. The multiple b values of IVIM including 0, 20, 50, 100, 150, 200, 400, 600, 800, 1000, 1500, and 2000 s/mm2. Two blinded readers have drawn the region of interests and calculated the D, D*, and f values. Interobserver variability between the 2 readers was measured by intraclass correlation coefficients and Altman-Bland plots. The intergroup differences of the average values were compared with the paired sample t test.

Results

After distention, the interrater agreement of the D* value increased obviously (from 0.547 to 0.692) and that of the D and f values increased slightly (from 0.731 and 0.618 to 0.807 and 0.666). The difference in the D value had statistical significance (P = 0.0043).

Conclusions

Intraluminal distension can increase the repeatability of IVIM parameters and the value of IVIM.
Primary Pharyngeal Flap With Palate Repair Improves Speech Outcome in Older Children and Adults
Authors: Gill Nauman Ahmad , Fayyaz Ghulam Qadir , Bashir Muhammad Mustehsan , Ganatra Muhammad Ashraf , Sohail Muhammad , Jan Saadia Nosheen , ElShazly Mohamed , Aazam Muhammad , Siddique Kashif , Daiem Muhammad
Published: August 2020

Background

Repair of cleft palate after 6 years of age is controversial in regard to the surgical procedure and the speech outcome. Primary repair alone may not be considered sufficient to achieve intelligible speech. The authors consider addition of pharyngeal flap at the time of primary repair to be a significant factor in improving speech.

Methods

Prospectively maintained data of all cleft palate patients operated from 2013 to 2017 (5 years) was analyzed to identify patients older than 6 years. Complete cleft palate, incomplete cleft palate, and cleft of the soft palate were further stratified according to different Randall types. They were divided into 2 main types: primary palate repair only and primary palate repair with pharyngeal flap. Speech was assessed preoperatively and 12 months postoperatively by Pittsburgh weighted speech scale.

Results

A total of 139 patients were analyzed. There were 78 males and 61 females. Their ages ranged from 6 to 60 years (mean age, 12.5 years). The overall preoperative speech score in palate repair–only group was 12.15, whereas the postoperative score was 7.32. In patients who underwent primary pharyngeal flap along with palate repair, the preoperative speech score was 11.3, and the postoperative score was 3.76.

Conclusions

In select group of patients who report late for palate repair, addition of pharyngeal flap along with the primary palate repair improves the speech outcome in all Randall groups.
Abrupt Discontinuation Versus Down-Titration of Vasopressin in Patients Recovering from Septic Shock
Authors: Lam Simon W. , Sacha Gretchen L. , Duggal Abhijit , Reddy Anita J. , Bauer Seth R.
Published: August 2020

Purpose:

To compare patient outcomes based on management of arginine vasopressin (AVP) during the recovery phase of septic shock (abrupt vs. tapering discontinuation).

Patients and Methods:

Multicenter, retrospective cohort study of patients receiving AVP with concomitant norepinephrine for septic shock. Primary outcome measure was time to intensive care unit (ICU) discharge (from decision to titrate or stop AVP). Secondary outcomes included ICU and hospital mortality, and incidence of hypotension.

Results:

A total of 958 (73%) abrupt discontinuation and 360 (27%) down-titration patients were included. Patient characteristics and septic shock treatment courses were similar between groups. Median time to ICU discharge was similar between abrupt discontinuation (7.9 days, 95% CI 7.2–8.7 days) and tapered patients (7.3 days, 95% CI 6.3–9.3 days, P = 0.60). After controlling for baseline discrepancies, down-titration was not an independent predictor of time to ICU discharge (HR = 0.99, 95% CI: 0.85–1.15, P = 0.91). There was no difference in ICU mortality (21.8% vs. 18.0%, P = 0.13) or hospital mortality (28.9% vs. 31.1%, P = 0.44). Although incidence of hypotension was similar (39.7% vs. 41.7%, P = 0.53), patients in the down-titration group more frequently required an escalation of AVP dose (5.7% vs. 11.1%, P < 0.001). Median AVP duration was shorter in the abrupt discontinuation group (1.4 days [IQR: 0.6–2.6 days] vs. 1.8 days [IQR: 1.1–3.2 days], P < 0.001).

Conclusions:

A difference in time to ICU discharge was not detected between abrupt AVP discontinuation and down-titration in patients recovering from septic shock. In patients recovering from septic shock, abrupt discontinuation of AVP appears to be safe and may lead to shortened AVP duration.
A Microdebriefing Crisis Resource Management Program for Simulated Pediatric Resuscitation in a Community Hospital
Authors: Jafri Farrukh N. , Mirante Doreen , Ellsworth Kelly , Shulman Jodi , Dadario Nicholas B. , Williams Kimiko , Yu Seongah , Thomas Jinu , Kumar Anshul , Edwards Roger A. , Torres Rafael E. , Straff Dean J.
Published: August 2020

Introduction

Crisis Resource Management (CRM) is a team training tool used in healthcare to enhance team performance and improve patient safety. Our program intends to determine the feasibility of high-fidelity simulation for teaching CRM to an interprofessional team in a community hospital and whether a microdebriefing intervention can improve performance during simulated pediatric resuscitation.

Methods

We conducted a single-center prospective interventional study with 24 teams drawn from 4 departments. The program was divided into an initial assessment simulation case (pre), a 40-minute microdebriefing intervention, and a final assessment simulation case (post). Post and pre results were analyzed for each team using t tests and Wilcoxon signed-rank tests. Primary outcome measures included (a) completion of program, (b) percent enrollment, (c) participant reaction, and (d) support of continued programs on completion. Secondary outcomes included (a) change in teamwork performance, measured by the Clinical Teamwork Scale; (b) change in time to initiation of chest compressions and defibrillation; and (c) pediatric advanced life support adherence, measured by the Clinical Performance Tool.

Results

We successfully completed a large-scale training program with high enrollment. Twenty-four teams with 162 participants improved in Clinical Teamwork Scale scores (42.8%–57.5%, P < 0.001), Clinical Performance Tool scores (61.7%–72.1%, P < 0.001), and time to cardiopulmonary resuscitation initiation (70.6–34.3 seconds, P < 0.001).

Conclusions

Our center ran a well-attended, well-received interprofessional program in a community hospital site demonstrating that teaching CRM skills can improve simulated team performance in a diverse experienced cohort.
Cultural pressure and biased responding in free will attitudes
Authors: Cracco Emiel , González-García Carlos , Hussey Ian , Braem Senne , Wisniewski David
Published: August 2020

Whether you believe free will exists has profound effects on your behaviour, across different levels of processing, from simple motor action to social cognition. It is therefore important to understand which specific lay theories are held in the general public and why. Past research largely focused on investigating free will beliefs (FWB, ‘Do you think free will exists?’), but largely ignored a second key aspect: free will attitudes (FWA, ‘Do you like/value will?’). Attitudes are often independently predictive of behaviour, relative to beliefs, yet we currently know very little about FWAs in the general public. One key issue is whether such attitudes are subject to biased, socially desirable responding. The vast majority of the general public strongly believes in the existence of free will, which might create cultural pressure to value free will positively as well. In this registered report, we used a very large (N= 1100), open available dataset measuring implicit and explicit attitudes towards free will and determinism to address this issue. Our results indicate that both explicit and implicit attitudes towards free will are more positive than attitudes towards determinism. We also show that people experience cultural pressure to value free will, and to devalue determinism. Yet, we found no strong evidence that this cultural pressure affected either implicit or explicit attitudes in this dataset.
The volatilization behaviour of typical fluorine-containing slag in steelmaking
Authors: Zhao Zhongyu , Zhao Junxue , Tan Zexin , Qu Boqiao , Cui Yaru
Published: August 2020

It was taken as typical steelmaking fluorine-containing slag systems with the remelting electroslag, continuous casting mould flux and refining slag. The volatilization behaviour of each slag system was analysed by thermogravimetric (TG) and mass spectrometry (MS) detection. The results showed that the remelting electroslag volatilized significantly above 1300°C and the volatiles were mainly CaF
2
, MgF
2
with a small amount of SiF
4
and AlF
3
; the continuous casting mould flux volatilization was divided into two stages, in the first stage (500°C∼800°C), CaF
2
and Na
2
O reacted to form NaF, and in the second stage (greater than 1200°C), the CaF
2
evaporation was highlighted; for CaF
2
-CaO-based refining slag, the volatilization was the most significant at the eutectic point 84% CaF
2
–16% CaO, and the volatility can be reduced by adding 5% SiO
2
. This research will be guiding significance for the composition and performance control of fluorine-containing slag and metallurgical environmental protection in the steelmaking process.
The first case of Mycobacterium vaccae sepsis in a non-Hodgkin lymphoma patient: biological understandings and clinical consequencies
Authors: Congedo Pierluigi , Gardellini Angelo , Corich Lucia , Papa Angela , Turrini Mauro
Published: August 2020

Mycobacterium vaccae

is a rapidly growing nonpathogenic species of the

Mycobacteriaceae

family of bacteria that can cause pulmonary and disseminated disease in particular in immunocompromised individuals. Here we describe a first case of matrix-assisted laser desorption/ionization-time of flight (MALDI-TOF) mass-spectrometry (MS) identification of this pathogen in a patient with non-Hodgkin’s lymphoma during chemoimmunotherapy salvage treatment, and its impact on clinical decision making.
Evaluation of nasopharyngeal swab collection techniques for nucleic acid recovery and participant experience: recommendations for COVID-19 diagnostics
Authors: Kinloch Natalie N. , Shahid Aniqa , Ritchie Gordon , Dong Winnie , Lawson Tanya , Montaner Julio S.G. , Romney Marc G. , Stefanovic Aleksandra , Matic Nancy , Brumme Chanson J. , Lowe Christopher F. , Brumme Zabrina L. , Leung Victor
Published: August 2020

Nasopharyngeal swabs are critical to the diagnosis of respiratory infections including COVID-19, but collection techniques vary. We compared two recommended nasopharyngeal swab collection techniques in adult volunteers and found that swab rotation following nasopharyngeal contact did not recover additional nucleic acid (as measured by human DNA/RNA copy number). Rotation was also less tolerable for participants. Notably, both discomfort and nucleic acid recovery were significantly higher in Asians, consistent with nasal anatomy differences. Our results suggest that it is unnecessary to rotate the swab in place following contact with the nasopharynx, and reveal that procedural discomfort levels can differ by ethnicity.

summary

Nasopharyngeal swabs are critical to COVID-19 diagnostics, but collection techniques vary. Comparison of two collection techniques revealed that swab rotation did not recover more nucleic acid and was more uncomfortable. Discomfort and biological material recovery also varied by participant ethnicity.
Survey of Core Facilities shows the importance of communication and management for optimal research quality
Authors: Kos-Braun IC , Gerlach B , Pitzer C
Published: August 2020

Recently, it has become evident that academic research faces issues with the reproducibility of research data. It is critical to understand the underlying causes in order to remedy this situation. Core Facilities (CFs) have a central position in the research infrastructure and therefore they are ideally suited to promote and disseminate good research standards through their users. However, there are currently no clear guidelines directly applicable to academic CFs. To identify the most important factors for research quality, we polled 253 CFs across Europe about their practices and analysed in detail the interaction process between CFs and their users, from the first contact to the publication of the results. Although the survey showed that CFs are dedicated to train and advise their users, it highlighted the following areas, the improvement of which would directly increase research quality: 1) motivating users to follow the advice and procedures for best research practice, 2) providing clear guidance on data management practices, 3) improving communication along the whole research process and 4) clearly defining the responsibilities of each party.
Diagnosis of SARS-CoV-2 in children: accuracy of nasopharyngeal swab compared to nasopharyngeal aspirate
Authors: Di Pietro Giada Maria , Capecchi Ester , Luconi Ester , Lunghi Giovanna , Bosis Samantha , Bertolozzi Giuseppe , Cantoni Barbara , Marano Giuseppe , Boracchi Patrizia , Biganzoli Elia , Castaldi Silvana , Marchisio Paola , Gori Andrea , Agostoni Carlo , Pinzani Raffaella , Ceriotti Ferruccio
Published: August 2020

The tests currently used for the direct identification of SARS-CoV-2 include specimens taken from upper and lower respiratory tract; recommendations from Word Health Organization prioritise nasopharyngeal swab (NS). In literature there are not available paediatric studies about the identification of SARS-CoV-2 through nasopharyngeal aspirate (NPA), but the use of NPA is deemed to be better than NS to identify respiratory viruses in children. The aim of our study is to evaluate diagnostic performances of NS compared to NPA for the detection of SARS-CoV-2 in children. We collected 300 paired samples (NS and NPA) from children hospitalized and followed up in our paediatric unit. We calculated the sensitivity and specificity of NS referred to NPA of the whole sample and then, considering both the age (≥ and < 6 years old) and the period of collection (March vs follow up) as covariates in different analysis. The NS has a low sensitivity in detecting SARS-CoV-2 in children when referred to NPA; whereas its specificity results high. In children under 6 years of age, our results suggest to prefer the collection of NS, whenever possible. Though statistically not significant, the sensitivity of NS becomes higher if it is performed before NPA.