bluuebunny/crossref_metadata_2025 huggingface dataset:
Staged surgically created type B aortic dissection model with endovascular reintervention for different morphological features
Authors: Guo Baolei , Akhtar Riaz , Liu Haofei , Yan Cheng , Guo Daqiao , Patterson Benjamin , Fu Weiguo
Published: August 2023

OBJECTIVES

Understanding morphology and how this relates to treatment strategy is critical for achieving remodelling in aortic dissection. A controllable and reproducible large animal model is required for investigating new therapeutic devices and interventions.

METHODS

Our experimental protocol involved the development of surgically created type B aortic dissection (TBAD) and endovascular reintervention-induced TBAD porcine models. The sample was randomly divided into 2 groups: 1 underwent a secondary tear creation (STC) procedure and the other underwent a false lumen extension (FLE) procedure. Anatomical features were observed at 1 and 3 months, and 2 animals in each group were euthanized at 3 months after the procedures. The aorta and main branches were harvested en bloc, cross-sectioned and prepared for histological examination.

RESULTS

All surgically created TBAD models were successfully generated, and no unintended complications occurred. The endovascular reintervention-induced TBAD model was successfully created in 11 of 12 animals, with 6 in the STC group and 5 in the FLE group. In the STC group, the intraoperative mean diameter of the new secondary tear was 7.23 mm, and a slight increase was observed at first 30 days (P = 0.0026). In the FLE group, the intraoperative new propagation length was (235.80 ± 84.94) mm. The FL propagation length at the 1-month follow-up was significantly longer than that measured intraoperatively (P = 0.0362). Histological evaluation demonstrated that the elastic fibres in the media layer of the aortic wall were disrupted and appeared to be significantly stretched on the adventitial side of the false lumen.

CONCLUSIONS

Our endovascular reintervention is a reliable, minimally invasive approach for producing specific TBAD models with different morphologies.
Quantitative PCR-Based Diagnosis and Follow-up of Chagas Disease Primary Infection After Solid Organ Transplant: A Multicentre Study
Authors: Barcan Laura A , Smud Astrid , Besuschio Susana A , Giorgio Patricia L , Temporiti Elena , Salgueira Claudia , Pinoni Maria V , Nagel Claudia , Schijman Alejandro G
Published: August 2023

Chagas disease in solid organ transplant recipients may present as a primary infection (PI). Early detection is crucial for timely treatment. This is the largest observational multicentre study evaluating qPCR for early diagnosis and treatment monitoring of PI in seronegative recipients of organs from seropositive donors. Of 34 patients admitted at 5 health centers, PI was detected by qPCR in 8 (23.5%) within a posttransplant period of 40 days (interquartile range [IQR], 31–50 days). No PI was detected by the Strout test or clinical symptoms/signs. All patients had favorable treatment outcome with negative qPCR 31 days (IQR, 18–35 days) after treatment, with no posttreatment relapse episodes.
Imipenem/funobactam (formerly XNW4107) in vivo pharmacodynamics against serine carbapenemase-producing Gram-negative bacteria: a novel modelling approach for time-dependent killing
Authors: Fratoni Andrew J , Berry Angela V , Liu Xiao , Chen Xi , Wu Yuchuan , Nicolau David P , Abdelraouf Kamilia
Published: August 2023

Background

Imipenem/funobactam (formerly XNW4107) is a novel β-lactam/β-lactamase inhibitor with activity against MDR Acinetobacter baumannii, Pseudomonas aeruginosa and Enterobacterales strains. Using a neutropenic murine thigh infection model, we aimed to determine the pharmacokinetic/pharmacodynamic (PK/PD) index, relative to funobactam exposure, that correlated most closely with the in vivo efficacy of imipenem/funobactam combination and the magnitude of index required for efficacy against serine carbapenemase-producing clinical strains.

Methods

Dose-fractionation was conducted against three strains. Imipenem human-simulated regimen (HSR, 500 mg q6h 1 h infusion) efficacy in combination with escalating funobactam exposures against seven A. baumannii, four P. aeruginosa and four Klebsiella pneumoniae (imipenem/funobactam MICs 0.25–16 mg/L) was assessed as 24 h change in log10cfu/thigh.

Results

Increased funobactam fractionation enhanced efficacy, indicating time-dependent killing. Changes in log10cfu/thigh versus %fT > MIC were poorly predictive of efficacy; bactericidal activity was observed at %fT > MIC = 0%. Across different threshold plasma funobactam concentrations (CTs), %fT > CT(1 mg/L) had the highest correlation with efficacy. Normalizing the %fT > CT = 1 mg/L index to the respective isolate imipenem/funobactam MIC ([%fT > CT]/MIC) allowed integration of the isolate’s susceptibility, which further enhanced the correlation. Median (%fT > CT[1 mg/L])/MIC values associated with 1-log reductions were 9.82 and 9.90 for A. baumannii and P. aeruginosa, respectively. Median (%fT > CT[1 mg/L])/MIC associated with stasis was 55.73 for K. pneumoniae. Imipenem/funobactam 500/250 mg q6h 1 h infusion HSR produced >1-log kill against 6/7 A. baumannii, 4/4 P. aeruginosa and stasis against 4/4 K. pneumoniae.

Conclusions

Imipenem/funobactam showed potent in vivo efficacy against serine carbapenemase-producers. The novel PK/PD index (%fT > CT)/MIC appeared to best describe in vivo activity.
Automated identification of unstandardized medication data: a scalable and flexible data standardization pipeline using RxNorm on GEMINI multicenter hospital data
Authors: Waters Riley , Malecki Sarah , Lail Sharan , Mak Denise , Saha Sudipta , Jung Hae Young , Imrit Mohammed Arshad , Razak Fahad , Verma Amol A
Published: August 2023

Objective

Patient data repositories often assemble medication data from multiple sources, necessitating standardization prior to analysis. We implemented and evaluated a medication standardization procedure for use with a wide range of pharmacy data inputs across all drug categories, which supports research queries at multiple levels of granularity.

Methods

The GEMINI-RxNorm system automates the use of multiple RxNorm tools in tandem with other datasets to identify drug concepts from pharmacy orders. GEMINI-RxNorm was used to process 2 090 155 pharmacy orders from 245 258 hospitalizations between 2010 and 2017 at 7 hospitals in Ontario, Canada. The GEMINI-RxNorm system matches drug-identifying information from pharmacy data (including free-text fields) to RxNorm concept identifiers. A user interface allows researchers to search for drug terms and returns the relevant original pharmacy data through the matched RxNorm concepts. Users can then manually validate the predicted matches and discard false positives. We designed the system to maximize recall (sensitivity) and enable excellent precision (positive predictive value) with efficient manual validation. We compared the performance of this system to manual coding (by a physician and pharmacist) of 13 medication classes.

Results

Manual coding was performed for 1 948 817 pharmacy orders and GEMINI-RxNorm successfully returned 1 941 389 (99.6%) orders. Recall was greater than 0.985 in all 13 drug classes, and the F1-score and precision remained above 0.90 in all drug classes, facilitating efficient manual review to achieve 100% precision. GEMINI-RxNorm saved time substantially compared with manual standardization, reducing the time taken to review a pharmacy order row from an estimated 30 to 5 s and reducing the number of rows needed to be reviewed by up to 99.99%.

Discussion and Conclusion

GEMINI-RxNorm presents a novel combination of RxNorm tools and other datasets to enable accurate, efficient, flexible, and scalable standardization of pharmacy data. By facilitating efficient manual validation, the GEMINI-RxNorm system can allow researchers to achieve near-perfect accuracy in medication data standardization.
Relationships of genomic estimated breeding values for age at puberty, birth weight, and growth during development in normal cyclic and acyclic gilts
Authors: Wijesena Hiruni R , Nonneman Dan J , Rohrer Gary A , Lents Clay A
Published: August 2023

Managing replacement gilts to reach optimal body weight and growth rate for boar stimulation and first breeding is a key component for sow reproductive longevity and producer profitability. Failure to display pubertal estrus remains a major reason that gilts are culled from the herd. Puberty is metabolically gated so evaluating phenotypic and genetic relationships between birth weight and growth traits with age at puberty and acyclicity can provide valuable insight for efficient gilt development. Data on a litter of origin of the gilt, average daily gain at different stages of development, and age at puberty were available for age-matched cyclic (n = 4,861) and acyclic gilts (prepubertal anestrus, n = 578; behavioral anestrus, n = 428). Genomic estimated breeding values were predicted for each trait using genomic best linear unbiased prediction. Primiparous sows produced more acyclic gilts than multiparous sows (P < 0.05). Accounting for effects of parity and litter size, prepubertal anestrus gilts were heavier at birth and behaviorally anestrus gilts grew faster during the finisher period compared to cyclic gilts (P < 0.05), reflecting possible prenatal programming that negatively affects optimal pubertal development and antagonistic effects between adolescent growth and expression of estrus of gilts from first parity sows. Regression of phenotypic age at puberty with lifetime growth rate (birth to selection) showed a negative linear relationship whereas genomic estimated breeding values showed a negative quadratic relationship indicating that gilts with the least and greatest growth are less optimal as replacements. The slopes of these relationships are small with low negative phenotypic (r = –0.06) and genetic correlations (r = –0.13). The addition of data from acyclic gilts did not substantially change the estimates for genetic relationships between growth and pubertal onset. Although this study identified differences in birth weight and growth rate between cyclic and acyclic gilts the genetic relationships are weak, suggesting that genetic selection for these traits can be achieved separately. Avoiding the smallest and largest gilts in a cohort born to first parity sows could result in gilts with optimal development and reduce the proportion of replacement gilts that are acyclic.
Does Referral Distance Deteriorates the Burn Patients Outcome? Results From an Academic Tertiary Hospital in a Developing Country
Authors: Zeinalipour Zahra , Goldani Fatemeh , Khadem-Rezaiyan Majid , Ahmadabadi Ali , Tavousi Seyed Hassan
Published: August 2023

Every year millions of people are burned and many of them are transported to specialized burn centers. One of the most important challenges in the face of burn patients in urban areas is deciding about referring patients to specialized burn centers. In this study, correlation between referral distance and mortality rate is investigated. Our cross-sectional analytic study included admission data of 7248 burn patients from Imam Reza Burn Center (Mashhad, Iran) over 9 years. The outcomes of interest were mortality, length of hospital stay, and the Abbreviated Burn Severity Index (ABSI). Also, we measured the distance between the patient referral location to Mashhad. SPSS version 16 was used for data analysis. Overall, 52.7% of admitted patients were referred from hospitals in other cities. The referred group had more severe burn injury (P < .001), higher mortality rate (P < .001), and longer length of hospital stay (P < .001). The referred distance was associated with an increased risk of death (Odds ratio = 1.68, 95% CI, 1.47–1.92), but after controlling the severity of burns, only ABSI was the statistically significant predictor of mortality (Odds ration = 2.17, 95% CI, 2.05–2.28). Therefore, increasing the distance from urban areas to specialized burn center did not increase the mortality rate. After adjusting for ABSI, the mortality rate in referred patients was not related to referral distance. By observing referral points based on available guidelines, distance from a referral burn center does not affect mortality rate independently. Therefore, equipping the existing burn centers instead of building new ones and focusing on improving referral system can be a good strategy in low- and middle-income countries with limited resources.
Management and Outcomes of Acute Kidney Injury due to Burns: A Literature Review
Authors: Khandelwal Anjay , Satariano Matthew , Doshi Kush , Aggarwal Pushan , Avasarala Vardhan , Sood Aneil , Bansal Shyam , Neyra Javier A , Raina Rupesh
Published: August 2023

Acute kidney injury (AKI), a common and severe complication following burn injuries, presents a significant challenge due to its broad clinical manifestations and diverse etiologies. AKI, previously known as acute renal failure, can present abruptly following burns or thermal injuries, causing detrimental health outcomes such as progressive kidney dysfunction, increased hospital length of stay, and requirement of renal replacement therapy (RRT). AKI affects the maintenance of homeostasis of fluid and electrolytes, elimination of metabolic wastes and byproducts, and acid–base balance. Aggressive nutritional support is particularly necessitated in burn patients to prevent protein-energy wasting and a negative nitrogen balance. Understanding the pathogenesis of AKI in burns and improving its prevention and early diagnosis are active areas of research in this field. Despite the potential benefits, the optimal timing and threshold for RRT initiation in burn patients with AKI remain unclear, warranting further studies. Ongoing investigations focus on refining RRT techniques, evaluating biomarkers for early detection of AKI, and exploring adjunctive therapies to enhance renal recovery. The aim of this study is to review the etiology, diagnostic tools, and interventions that improve outcomes associated with AKI in burn-related settings.
Introduction of the ectoparasite Rhipicephalus pulchellus (Ixodida: Ixodidae) into Connecticut with a human traveler from Tanzania, and a review of its importation records into the United States
Authors: Stafford Kirby C , Molaei Goudarz , Williams Scott C , Mertins James W
Published: August 2023

Globalization, increased frequency of travel, and a rise in legal and illegal animal trades can introduce exotic ticks into the United States. We herein report the importation of a male Rhipicephalus pulchellus (Gerstäcker) on a human traveler returning to Connecticut from Tanzania, Africa, and review historical importation records of this species into the United States. This common tick is broadly distributed throughout East Africa, from Eritrea to Tanzania, has a wide host range on domestic animals and wildlife, and has been most frequently introduced into the United States on tick-infested wild animal hosts and animal trophies, but documentation of importation on humans has been rare. Archival records at the United States Department of Agriculture’s National Veterinary Services Laboratories show R. pulchellus has been introduced into the United States at least 40 times over the last 62 yr. Rhipicephalus pulchellus has been linked to Rickettsia conorii, the agent of boutonneuse fever in humans, Crimean-Congo hemorrhagic fever orthonairovirus, and Nairobi sheep disease orthonairovirus. Given the potential for this exotic tick to introduce animal or human pathogens, proper surveillance, interception, identification, and reporting of these ticks are vital in protecting human and animal health.
Changes in amount and intensity of physical activity over time in breast cancer survivors
Authors: Marell Paulina S , Vierkant Robert A , Olson Janet E , Herrmann Joerg , Larson Nicole L , Lebrasseur Nathan K , D’Andre Stacy D , Ehlers Diane K , Stan Daniela L , Cheville Andrea L , Barksdale Toure , Loprinzi Charles L , Couch Fergus J , Ruddy Kathryn J
Published: August 2023

Background

Physical activity is associated with decreased breast cancer recurrence and mortality, as well as fewer treatment-related symptoms. Nevertheless, most breast cancer survivors do not meet physical activity guidelines. The purpose of this manuscript is to characterize physical activity trends over time in breast cancer survivors.

Methods

Mayo Clinic Breast Disease Registry participants received surveys at baseline and at 1 and 4 years after diagnosis; breast cancer recurrence and/or metastatic disease were exclusion criteria. Participants were considered to be meeting guidelines if they self-reported at least 150 minutes of moderate-intensity (eg, fast walking) and/or strenuous (eg, jogging) physical activity per week. Statistical analyses include analysis of covariance methods, paired t tests, conditional logistic regression models, and McNemar tests of homogeneity.

Results

A total of 171 participants were included in the analysis. The amount of total physical activity decreased over time (P = .07). Mild-intensity physical activity (eg, easy walking) decreased most over time (P = .05). Among participants aged 18-49 years, mild-intensity (P = .05) and moderate-intensity (P = .02) physical activity decreased over time. Strenuous-intensity physical activity levels decreased over time among participants with a normal body mass index (P = .002) and with obesity (P = .01).

Conclusions

We found a trend-level decrease in total physical activity over time, driven mostly by a decrease in mild-intensity physical activity. Young breast cancer survivors are especially likely to reduce their physical activity over time. Further research on implementing physical activity guidelines in clinical practice is warranted.
The numerical investigation of aerodynamics and aeroacoustics effects in a full-scale true wireless headphone
Authors: Wang Wei-Hsiang , Chang Hua-Ching , Cheng Ta-Yuan , Chen Yu-Chien
Published: August 2023

This study investigates the flow characteristics and aeroacoustic effects in a true wireless (TWS) headphone using computational fluid dynamics simulations. A low-speed compressible flow solver is employed to analyze the flow fields and pressure variations associated with fluid-induced noise. The accuracy of the simulations is validated through comparisons with experimental and numerical data, demonstrating good consistency. The analysis reveals the presence of asymmetric vortex shedding patterns, attributed to the angle of airflow and the irregular surface of the headphones. The examination of the microphone chamber highlights the significance of design parameters in shaping flow patterns and acoustics. Optimized designs have the potential to achieve noise reductions of up to 10.62% or amplifications of up to 24.95%. These findings contribute to the development of improved active noise cancellation systems and the enhancement of TWS headphone technology, aiming to reduce external noise and enhance sound quality.
Diathermy induced gas explosion during laparotomy: a case report
Authors: Sindani Martin , Lugwaja Paul William Itule , Ngowi Novath
Published: August 2023

Diathermy-induced explosions in the gastrointestinal tract can occur during laparotomy and can be fatal. Hydrogen and methane are the most common flammable gases that are produced in the gastrointestinal tract. A 35-year-old male was referred to a tertiary hospital with abdominal pain after being assaulted and stabbed in the abdomen. He presented with a 2-cm wound in the midline below the xiphoid process and with an omentum protruding through the wound. Explorative laparotomy was done to repair the jejunal perforation, but a gastric blast occurred, making more than half of the gastric pouch non-viable. The operation was converted to a near-total gastrectomy with Roux-en-Y gastrojejunostomy. During open abdominal surgery, fires and explosions can occur. Precautions should be taken during open abdominal surgery to reduce the risk of explosions, such as allowing combustible gases to exit the cavity before using diathermy.
Validation of the eHEALTH Literacy Scale (Eheals) With Military Service Members
Authors: Foote Douglas , Giger Jarod T , Murray Teresa D , Engelhardt Ethan , Flaherty Christopher
Published: August 2023

Introduction

Medical readiness of individual service members (SMs) is an integral component of operational readiness. Electronic Health (eHealth) literacy, here defined as the ability to seek out, find, evaluate, and appraise, integrate, and apply what is gained in electronic environments toward solving a health problem, is a key skill to enhance individual medical readiness. The World Health Organization (WHO) has identified health literacy as an important social determinant of health. The Internet enables individuals to access information virtually anywhere, at any place, any time, which is especially beneficial for SMs who serve around the globe, often isolated from modern health care facilities.

Materials and Methods

This study examined the utility of the eHealth literacy scale (eHeals) as a potentially valuable tool to assist commanders and medical teams for assessing the health literacy of SMs. The main objective of our study was to examine the validity of the three-factor eHEALS measure for an active duty sample, using confirmatory factorial analysis.

Results

Our findings support the validity of the eHEALS measure of electronic health literacy among military SMs, potentially identifying a means of measuring SMs’ health literacy, and a target for intervention to increase medical readiness, well-being, and overall quality of life for individual SMs.

Conclusions

The study highlights a brief 6-item assessment tool that can quickly and efficiently be added to the current validated health and well-being measures for military personnel. This brief assessment can provide a measure of knowledge, skills, and confidence regarding ehealth information leading to better-informed health care decisions in the military context. These findings are especially relevant given the military’s current emphasis on modernization and the need to put people first in order to build the overall team and improve unit effectiveness.
Saquinavir potentiates itraconazole’s antifungal activity against multidrug-resistant Candida auris in vitro andin vivo
Authors: Elgammal Yehia , Salama Ehab A , Seleem Mohamed N
Published: August 2023

Candida species are highly opportunistic yeasts that are responsible for serious invasive fungal infections among immunocompromised patients worldwide. Due to the increase in drug resistance and incidence of infections, there is an urgent need to develop new antifungals and to identify co-drugs that can sensitize drug-resistant Candida to antifungals. The objective of this study was to assess the effect of saquinavir on the activity of azole antifungals against C. auris. The in vitro interaction of saquinavir and three azole antifungals (itraconazole, voriconazole, and fluconazole) was evaluated against a panel of C. auris isolates. The itraconazole/saquinavir combination exhibited a synergistic (SYN) relationship against all C. auris isolates tested with the fractional inhibitory concentration index ranging from 0.03 to 0.27. Moreover, a time-kill kinetics assay revealed that saquinavir restored the itraconazole’s fungistatic activity against C. auris. Furthermore, saquinavir restored itraconazole’s antifungal activity against other clinically important Candida species. The mechanistic investigation indicated that saquinavir significantly inhibited efflux pumps, glucose utilization, and ATP synthesis in Candida. Finally, a murine model of C. auris infection was used to evaluate the efficacy of the itraconazole/saquinavir combination in the presence of ritonavir (as a pharmacokinetic enhancer). The combination significantly reduced the fungal burden in the kidneys by 0.93-log10 colony-forming units (88%) compared to itraconazole alone. This study identified that saquinavir exhibits a potent SYN relationship in combination with itraconazole against Candida species, which warrants further consideration.
Significantly enhanced superconductivity in monolayer FeSe films on SrTiO3(001) via metallic δ-doping
Authors: Jiao Xiaotong , Dong Wenfeng , Shi Mingxia , Wang Heng , Ding Cui , Wei Zhongxu , Gong Guanming , Li Yanan , Li Yuanzhao , Zuo Binjie , Wang Jian , Zhang Ding , Pan Minghu , Wang Lili , Xue Qi-Kun
Published: August 2023

Superconductivity transition temperature (Tc) marks the inception of a macroscopic quantum phase-coherent paired state in fermionic systems. For 2D superconductivity, the paired electrons condense into a coherent superfluid state at Tc, which is usually lower than the pairing temperature, between which intrinsic physics including Berezinskii–Kosterlitz–Thouless transition and pseudogap state are hotly debated. In the case of monolayer FeSe superconducting films on SrTiO3(001), although the pairing temperature (Tp) is revealed to be 65–83 K by using spectroscopy characterization, the measured zero-resistance temperature (${{T}}_{{\rm c}}^0$) is limited to 20 K. Here, we report significantly enhanced superconductivity in monolayer FeSe films by δ-doping of Eu or Al on SrTiO3(001) surface, in which ${{T}}_{{\rm c}}^0$ is enhanced by 12 K with a narrowed transition width ΔTc ∼ 8 K, compared with non-doped samples. Using scanning tunneling microscopy/spectroscopy measurements, we demonstrate lowered work function of the δ-doped SrTiO3(001) surface and enlarged superconducting gaps in the monolayer FeSe with improved morphology/electronic homogeneity. Our work provides a practical route to enhance 2D superconductivity by using interface engineering.
Malaria Infections and Placental Blood Flow: A Doppler Ultrasound Study From a Preconception Cohort in Benin
Authors: Mondeilh Aude , Yovo Emmanuel , Accrombessi Manfred , Hounkonnou Cornelia , Agbota Gino , Atade William , Ladikpo Olaiitan T , Mehoba Murielle , Degbe Auguste , Vianou Bertin , Sossou Dariou , Ndam Nicaise Tuikue , Massougbodji Achille , McGready Rose , Fievet Nadine , Rijken Marcus J , Cottrell Gilles , Briand Valérie
Published: August 2023

Background

Malaria in pregnancy (MiP) has been associated with fetal growth restriction, the underlying pathogenic mechanisms of which remain poorly understood. Malaria in pregnancy is suspected to induce abnormalities in placental vascularization, leading to impaired placental development. Our study evaluated MIP's effect on uterine artery (UtA) and umbilical artery (UA) blood flow.

Methods

The analysis included 253 Beninese women followed throughout pregnancy and screened monthly for submicroscopic and microscopic malaria. Uterine artery Doppler measurement was performed once between 21 and 25 weeks’ gestation (wg), and UA Doppler measurement was performed 1–3 times from 28 wg. Linear and logistic regression models were used to assess the effect of malaria infections on UtA Doppler indicators (pulsatility index and presence of a notch), whereas a logistic mixed model was used to assess the association between malaria infections and abnormal UA Doppler (defined as Z-score ≥2 standard deviation or absent/reversed UA end-diastolic flow).

Results

Primigravidae represented 7.5% of the study population; 42.3% of women had at least 1 microscopic infection during pregnancy, and 29.6% had at least 1 submicroscopic infection (and no microscopic infection). Both microscopic and submicroscopic infections before Doppler measurement were associated with the presence of a notch (adjusted odds ratio [aOR] 4.5, 95% confidence interval [CI] = 1.2–16.3 and aOR 3.3, 95% CI = .9–11.9, respectively). No associations were found between malaria before the Doppler measurement and abnormal UA Doppler.

Conclusions

Malaria infections in the first half of pregnancy impair placental blood flow. This highlights the need to prevent malaria from the very beginning of pregnancy.
The Penn Medicine COVID-19 Therapeutics Committee—Reflections on a Model for Rapid Evidence Review and Dynamic Practice Recommendations During a Public Health Emergency
Authors: Anesi George L , Degnan Kathleen , Dutcher Lauren , Saw Stephen , Maguire Christina , Binkley Amanda , Patel Sonal , Athans Vasilios , Barton Todd D , Binkley Shawn , Candeloro Christina L , Herman David J , Kasbekar Nishaminy , Kennedy Leigh , Millstein Jeffrey H , Meyer Nuala J , Talati Naasha J , Patel Hinal , Pegues David A , Sayre Patrick J , Tebas Pablo , Terico Adrienne T , Murphy Kathleen M , O’Donnell Judith A , White Melissa , Hamilton Keith W
Published: August 2023

The Penn Medicine COVID-19 Therapeutics Committee—an interspecialty, clinician-pharmacist, and specialist–front line primary care collaboration—has served as a forum for rapid evidence review and the production of dynamic practice recommendations during the 3-year coronavirus disease 2019 public health emergency. We describe the process by which the committee went about its work and how it navigated specific challenging scenarios. Our target audiences are clinicians, hospital leaders, public health officials, and researchers invested in preparedness for inevitable future threats. Our objectives are to discuss the logistics and challenges of forming an effective committee, undertaking a rapid evidence review process, aligning evidence-based guidelines with operational realities, and iteratively revising recommendations in response to changing pandemic data. We specifically discuss the arc of evidence for corticosteroids; the noble beginnings and dangerous misinformation end of hydroxychloroquine and ivermectin; monoclonal antibodies and emerging viral variants; and patient screening and safety processes for tocilizumab, baricitinib, and nirmatrelvir-ritonavir.
Prevalence and influencing factors of depressive and anxiety symptoms among hospital-based healthcare workers during the surge period of the COVID-19 pandemic in the Chinese mainland: a multicenter cross-sectional study
Authors: Jing S , Dai Z , Wu Y , Liu X , Ren T , Liu X , Zhang L , Fu J , Chen X , Xiao W , Wang H , Huang Y , Qu Y , Wang W , Gu X , Ma L , Zhang S , Yu Y , Li L , Han Z , Su X , Qiao Y , Wang C
Published: August 2023

Background

From November 2022 to February 2023, the Chinese mainland experienced a surge in COVID-19 infection and hospitalization, and the hospital-based healthcare workers (HCWs) might suffer serious psychological crisis during this period. This study aims to assess the depressive and anxiety symptoms among HCWs during the surge of COVID-19 pandemic and to provide possible reference on protecting mental health of HCWs in future infectious disease outbreaks.

Methods

A multicenter cross-sectional study was carried out among hospital-based HCWs in the Chinese mainland from 5 January to 9 February 2023. The PHQ-9 (nine-item Patient Health Questionnaire) and GAD-7 (seven-item Generalized Anxiety Disorder Questionnaire) were used to measure depressive and anxiety symptoms. Ordinal logistic regression analysis was performed to identify influencing factors.

Results

A total of 6522 hospital-based HCWs in the Chinse mainland were included in this survey. The prevalence of depressive symptoms among the HCWs was 70.75%, and anxiety symptoms was 47.87%. The HCWs who perceived higher risk of COVID-19 infection and those who had higher work intensity were more likely to experience depressive and anxiety symptoms. Additionally, higher levels of mindfulness, resilience and perceived social support were negatively associated with depressive and anxiety symptoms.

Conclusion

This study revealed that a high proportion of HCWs in the Chinese mainland suffered from mental health disturbances during the surge of the COVID-19 pandemic. Resilience, mindfulness and perceived social support are important protective factors of HCWs’ mental health. Tailored interventions, such as mindfulness practice, should be implemented to alleviate psychological symptoms of HCWs during the COVID-19 pandemic or other similar events in the future.
Cash Is King: The Role of Financial Infrastructure in Digital Adoption
Authors: Aggarwal Bhavya , Kulkarni Nirupama , Ritadhi S K
Published: August 2023

This paper examines whether a one-time, extensive, but temporary shock to cash supply can affect the adoption of digital payments. We exploit the 2016 demonetization episode in India, which overnight discontinued 86% of cash in circulation. Using novel administrative data from retail debit card transactions, we identify a 12% increase in digital payments in areas adversely affected by the cash shortage, which persisted well after the restoration of cash supply. Examining mechanisms, we find a limited role for social networks and stronger support for learning by doing. Further, information frictions hinder the immediate adoption of digital payments. (JEL E5, 023)

Authors have furnished an Internet Appendix, which is available on the Oxford University Press Web site next to the link to the final published paper online.
Funding Contagion through Common Owners
Authors: Larrain Borja , Sertsios Giorgo , Urzúa I Francisco
Published: August 2023

Funding contagion is the impaired ability of a firm to raise external funds when negative shocks hit other firms under the same owner. We study this possibility with pairs of private firms in unrelated industries that share a large common shareholder. We find that a firm’s debt growth and financial leverage go down when the partner firm experiences negative shocks. Our results are consistent with creditors contracting the credit supply because of cash flow cross-pledging between related firms. Funding contagion increases when control rights are strong, and the credit market is less developed. (JEL G30, G32)

Received: February 17, 2021; Editorial decision: July 18, 2023 by Editor: Andrew Ellul. Authors have furnished an Internet Appendix, which is available on the Oxford University Press Web site next to the link to the final published paper online.
E07 Development of a coordinated transitional care program on adolescents with juvenile idiopathic arthritis: looking through the patient lens
Authors: Miedany Yasser El , Abu-Zaid Mohammed Hassan , Eissa Mervat , Hassan Waleed A , Mortada Mohamed , Tabra Samar Abd Alhamed , Mohamed Sally S , Maher Sheren Esam , Gaafary Maha El , Medhat Basma M , Mosa Doaa Mosad , Fouad Nermeen Ahmed , Amer Youmna Ahmed , Nasef Samah Ismail , Shalaby Radwa H , Adel Yasmin , Elkhalek Reham Abd , Mahgoub Marwa Yahia , Lotfy Hala M
Published: August 2023

Background

Transition of care means the process of educating and empowering adolescents and young adults to take an active role in their own healthcare, develop decision-making skills, and eventually transition from paediatric to adult healthcare providers. Most people don't switch doctors until they are young adults, but it can be beneficial to start preparing children earlier.

Objectives

To provide a toolset specifically suited for adult and paediatric rheumatologists to help them transition the care of children with rheumatic diseases from adult to paediatric rheumatology care.

Methods

The preliminary scientific committee identified a total of ten major clinical questions in this study, which was conducted to obtain expert consensus. To reach consensus on the transition of care for young adults and adolescents with rheumatic diseases, the core leadership team sought out researchers and clinicians with expertise in both paediatric and adult rheumatic diseases management.

Results

The expert panel's participation was restricted to an online survey (n = 18); each expert completed both rounds. After round 2, a total of 10 points had been collected. 88.9% to100% of respondents (ranks 7–9) indicated they agreed with the recommendations. The scientific committee's 10 clinical standards were all prepared in the same style. A structured template describing the integrated pathway for transition of care was developed using the responses to the structured key questions and the results of the literature review.

Conclusion

The created rheumatology-specific guideline provides young adults with juvenile rheumatic diseases with a focused, multidisciplinary transition of care strategy with equity of access, quality of care, and flexibility and establishes standards for transitional care.

Ethics

This study was performed in accordance with the Helsinki Declaration. The ‘Clinical, Evidence-based, Guidelines’ (CEG) initiative protocol was approved the local ethical committee: ethical approval code: 34842/8/21, ethical board Tanta University.
E16 Extra-articular manifestations and hip involvement in juvenile idiopathic arthritis: what is the link?
Authors: Rahmouni Safa , Tbini Houssem , Rekik Sonia , Ben Ammou Ahlem , Zouaoui Khaoula , Boussaid Soumaya , Sahli Hela , Elleuch Mohammed
Published: August 2023

Introduction

Juvenile idiopathic arthritis (JIA) is a complex pediatric rheumatism. The systemic and structural involvement of the disease is both functional and life threatening. Hip involvement can reach 50% of cases, especially in severe and destructive cases.

Objectives

The objective of this work is to study the relationship between systemic and hip involvement in JIA.

Methods

This was a retrospective study including adults with long-standing JIA according to the International League of Associations for Rheumatology (ILAR) criteria over a period of 28 years (1994–2022). Socio-demographic, clinical, biological, and radiographic data were collected.

Results

There were 29 patients (17 females and 12 males), the mean age was 35.69 ± 11.72 [18–61] years. The mean age of disease onset was 11.10 ± 4.25 [2–16] years. The average diagnostic delay was 52.96 ± 95.97 [0–336] months. The average disease duration was 24.48 ± 12.76 [1–47] years.

At least one extra-articular manifestation was noted in 20 patients. An ocular dry syndrome was present in 6 cases, with a delay of onset of 132.14 ± 134.18 [0–312] months.

Skin involvement was present in 4 cases with a mean onset delay of 24.25 ± 47.83 [0–96] months. Three patients had a pulmonary interstitial syndrome, the onset delay of this pulmonary involvement was 228.00 ± 74.94 [0–312] months. Valvular involvement was present in 3 cases and pericarditis in only one case, the onset delay of cardiac involvement was 211.33 ± 129.40 [70–324] months. Renal involvement was noted in 2 cases: one case of proteinuria and one case of renal failure, the time of onset of renal involvement was 12.50 ± 16.26 [1–24] months. Furthermore, hematological damage such as anaemia was noted in 20 of the patients included. No patients had macrophage activation syndrome in our study population.

Hip involvement was noted in 14 patients. It was bilateral in 9 cases. Twenty-three hips were affected in total. Hip involvement was diagnosed 14.5 ± 9.37 [1–28] years after disease onset.

Our statistical study identified a single correlation between hip involvement and cardiac involvement during JIA (r = 0.413; P = 0.026).

In contrast, no other correlation was identified between hip involvement and the rest of the extra-articular involvement in JIA.

Conclusion

Extra-articular and hip involvements are common in JIA. Both have a prognostic impact and must be systematically screened throughout the follow-up. In our study, hip involvement was correlated with cardiac involvement.
E25 The pattern of juvenile psoriatic arthritis in a tertiary centre in Libya
Authors: Hashad Soad S , Etayari Hala M , Almsellati Iman A , Etfil Majda N , Altwati Aya , Awhida Zuhaira
Published: August 2023

Background

Juvenile psoriatic arthritis (JPsA) is a relatively rare condition in childhood as it represents ∼5% of the whole Juvenile Idiopathic Arthritis (JIA). There are fewer reports describing the characteristics and outcome of patients with JPsA.

Aim

To describe the characteristic features and the treatment modalities of JPsA among Libyan children in pediatric rheumatology clinic at the Tripoli Children Hospital which is the only referral clinic covering the western, northern and southern part of Libya and to compare our results with other populations worldwide.

Methods

All the medical records of the children who were diagnosed to have JPsA according to ILAR classification criteria or Vancouver criteria (definite or probable) from January 2001 to January 2020 were included and retrospectively reviewed. Data were collected about demographic, clinical, and laboratory features and treatment

Results

The study included a total of 30 cases of JPsA that represents a 12% of total JIA cases over the study period, the mean age at presentation was 5.8 ± 5.3 years with male to female ratio of 1:1, with the mean duration of symptoms prior to diagnosis of JIA of 9 ± 10 months.

The foremost common type of arthritis was peripheral polyarthritis (83% & 58.3%), with the Small joints commonly affected, 30% of patients had hip joint involvement.

13% of the patient had psoriasis, half of them before presentation of arthritis. Nail changes secondary to psoriasis was seen in 1 of the cohort, and the percentage of patients with dactylitis among the group was 30%.

Family history of psoriasis found in 83% of the cohort, 26% found to be ANA positive. Chronic uveitis occurred in 10%. Patients of the total cohort, ANA positive, Unilateral anterior uveitis being the most common presentation.

The following table summarizes the Medications used during the course of the disease

At the time of the first visit 100%of total patients fulfilled the Vancouver criteria for juvenile PsA, While 5 of the12 patients didn’t fulfilled the ILAR criteria for JPsA.

Conclusions

Juvenile psoriatic arthritis constituted 12% of our patients with juvenile idiopathic arthritis. Juvenile psoriatic arthritis constitutes 8% to20% of JIA patients worldwide with equal gender distribution and peak age at presentation of 6–13 years. More than four peripheral joints involvement were the most frequent presentation. Half of the patients had skin involvement before the development of arthritis. Prevalence of chronic anterior uveitis was higher in our cohort than worldwide (10% vs 5% respectively) as an extra articular manifestation. All patients were treated with NSAIDs at presentation and/or during follow-up. Methotrexate was the most commonly used second-line agent

Ethics

Our study was approved by local ethical committee of pediatric department at Tripoli children hospital.
E27 Performance of systemic juvenile idiopathic arthritis classification criteria: one-centre experience—Libya
Authors: Hashad Soad S , Etayari Hala M , Almsellati Iman A , Etfil Majda N , Altwati Aya , Awhida Zuhaira
Published: August 2023

Systemic juvenile idiopathic arthritis (sJIA) constitutes a small part of juvenile idiopathic arthritis (JIA), yet has a disproportionally higher rate of mortality. In comparison to the other (JIA), systemic juvenile idiopathic arthritis has many distinct clinical features that arthritis may be a non-prominent and/or a delayed manifestation. The Pediatric Rheumatology International Trial Organization (PRINTO), currently is developing a new criterion for JIA classification which will allow for better identification of sJIA cases with delayed onset of arthritis and fail to fulfil the currently used International League Against Rheumatism (ILAR) and Yamaguchi criteria. It is useful in classification of children with systemic juvenile idiopathic arthritis (sJIA) particularly in ‘pre-arthritic’, pure systemic phase of the illness.

Objectives

The purpose of this study is to compare the performances of the Yamaguchi diagnostic criteria vs PRINTO criteria vs current ILAR criteria for systemic juvenile idiopathic arthritis. We compared the proportions of patients classified and how closely the 3 instruments are related.

Methods

The study was performed at the Department of Paediatric Rheumatology in Tripoli children hospital. It is a retrospective study, covering the date range 2006–2020. We used clinicobiologic data recorded within 7 months of diagnosis of Patients diagnosed with sJIA. We assigned a diagnosis of sJIA according to the 3 sJIA classification systems (the Yamaguchi diagnostic criteria, PRINTO criteria and according to ILAR classification).

Results

Three different classification criteria were analysed in 38 assigned sJIA children (13% of total JIA cases). Females were 28 (52.6%), and mean age of JIA onset was 7 ± 3.9 yr. The mean of the time delay between disease onset and diagnosis was 7 ± 9 months. Overall, the ILAR and PRINTO criteria were fulfilled in a higher number of patients in the study (n = 35) (92% of patients), As compared with the Yamaguchi criteria (n = 29).(76% of patients). Among the 7.9% patients who were unclassifiable using the ILAR criteria were diagnosed as sJIA by both the PRINTO and the Yamaguchi diagnostic criteria. 7.89% neither fulfilled the Yamaguchi or the PRINTO Criteria. The table below compares the performance of the three different criteria.

Conclusions

In this cohort the ILAR criteria appear to be superior in the early recognition and classification of sJIA. Yamaguchi diagnostic criteria can only be used to classify a minority of sJIA patients, leaving a large proportion of sJIA patients unclassified. Compared with the Yamaguchi criteria, ILAR JIA categories aligned better with PRINTO criteria. All the criteria should incorporate strengths of each other.

Ethics

Our study was approved by local ethical committee of pediatric department at Tripoli children hospital.
E41 PAPA Syndrome: response to methotrexate in four members of the same family
Authors: Slimani Samy , Hadef Djohra , Ghodbane Nacif Eddine
Published: August 2023

Introduction

PAPA syndrome (Pyogenic Arthritis, Pyoderma gangrenosum and Acne) is a rare autosomal dominant disease that mainly affects the joints and skin. It is linked to a mutation of a gene of a protein named PSTPIP1 located on chromosome 15q. Arthritis is destructive, oligoarticular and predominantly affects large joints. It usually begins during childhood and not responsive to most treatments. The diagnosis is late and arises with infectious arthritis, given the destructive and pyogenic nature of arthritis and biological inflammatory syndrome.

Aim

We describe the cases of four members of the same family affected by PAPA syndrome who were treated empirically with long-term corticosteroids and then methotrexate to improve their joint involvement.

Case reports

We report the cases of 4 male patients belonging to the same large family (3 brothers and a first cousin), aged 28, 23, 21 and 15 years (patients 1–4, classified by age), affected by PAPA syndrome who presented with recurrent osteoarticular infections treated with antibiotics. They have no other conditions except vitiligo in patient 1 and Down syndrome in patient 3. Diagnosis was made in patient 1 based on joint and skin involvement. Other family members were subsequently called for diagnostic evaluation. A treatment combining methotrexate (10–15 mg/week) and corticosteroids (5 mg/day of prednisolone weaned and discontinued after 6–12 months of initiation) was associated with clinical and biological response in all patients with a decrease in pain, clinical and ultrasound improvement of synovitis and normalization of biological inflammatory markers in all four cases. Methotrexate was well tolerated and maintained as monotherapy, associated with on demand NSAIDs. The current average follow-up is 2.3 years.

Conclusion

Through our observations, we report a possible beneficial effect and good tolerance of methotrexate on joint involvement in PAPA syndrome. A more rigorous study (larger sample size, control arm) is necessary to validate this treatment.