bluuebunny/crossref_metadata_2025 huggingface dataset:
Shiny GATOM: omics-based identification of regulated metabolic modules in atom transition networks
Authors: Emelianova Mariia , Gainullina Anastasiia , Poperechnyi Nikolay , Loboda Alexander , Artyomov Maxim , Sergushichev Alexey
Published: May 2022

Multiple high-throughput omics techniques provide different angles on systematically quantifying and studying metabolic regulation of cellular processes. However, an unbiased analysis of such data and, in particular, integration of multiple types of data remains a challenge. Previously, for this purpose we developed GAM web-service for integrative metabolic network analysis. Here we describe an updated pipeline GATOM and the corresponding web-service Shiny GATOM, which takes as input transcriptional and/or metabolomic data and finds a metabolic subnetwork most regulated between the two conditions of interest. GATOM features a new metabolic network topology based on atom transition, which significantly improves interpretability of the analysis results. To address computational challenges arising with the new network topology, we introduce a new variant of the maximum weight connected subgraph problem and provide a corresponding exact solver. To make the used networks up-to-date we upgraded the KEGG-based network construction pipeline and developed one based on the Rhea database, which allows analysis of lipidomics data. Finally, we simplified local installation, providing R package mwcsr for solving relevant graph optimization problems and R package gatom, which implements the GATOM pipeline. The web-service is available at https://ctlab.itmo.ru/shiny/gatom and https://artyomovlab.wustl.edu/shiny/gatom.
AllerCatPro 2.0: a web server for predicting protein allergenicity potential
Authors: Nguyen Minh N , Krutz Nora L , Limviphuvadh Vachiranee , Lopata Andreas L , Gerberick G Frank , Maurer-Stroh Sebastian
Published: May 2022

Proteins in food and personal care products can pose a risk for an immediate immunoglobulin E (IgE)-mediated allergic response. Bioinformatic tools can assist to predict and investigate the allergenic potential of proteins. Here we present AllerCatPro 2.0, a web server that can be used to predict protein allergenicity potential with better accuracy than other computational methods and new features that help assessors making informed decisions. AllerCatPro 2.0 predicts the similarity between input proteins using both their amino acid sequences and predicted 3D structures towards the most comprehensive datasets of reliable proteins associated with allergenicity. These datasets currently include 4979 protein allergens, 162 low allergenic proteins, and 165 autoimmune allergens with manual expert curation from the databases of WHO/International Union of Immunological Societies (IUIS), Comprehensive Protein Allergen Resource (COMPARE), Food Allergy Research and Resource Program (FARRP), UniProtKB and Allergome. Various examples of profilins, autoimmune allergens, low allergenic proteins, very large proteins, and nucleotide input sequences showcase the utility of AllerCatPro 2.0 for predicting protein allergenicity potential. The AllerCatPro 2.0 web server is freely accessible at https://allercatpro.bii.a-star.edu.sg.
Clinical and Immunological Markers of Pulmonary Impairment Among People With HIV in India
Authors: Baidya Anurima , Sangle Shashikala , Marbaniang Ivan , Kulkarni Vandana , Deshpande Prasad , Nimkar Smita , Chavan Amol , Salvi Sonali , Lokhande Rahul , Kadam Dileep , Gupta Amita , Mave Vidya , Gupte Akshay N
Published: May 2022

Background

Despite antiretroviral therapy, chronic lung diseases remain an important source of morbidity and mortality in people with HIV (PWH). We sought to identify clinical and immunological markers of pulmonary impairment among PWH in India.

Methods

Two hundred ten adult PWH receiving antiretroviral therapy (ART) were prospectively evaluated for 3 years. Plasma concentrations of interleukin (IL)-6, IL-10, tumor necrosis factor alpha, D-dimer, C-reactive protein, soluble (s)CD14, and sCD163 were measured at enrollment. We used multivariable linear and logistic regression to measure the association of baseline and time-varying clinical and immunological variables with spirometry-defined chronic obstructive pulmonary disease (COPD), restrictive spirometry pattern (RSP), preserved ratio impaired spirometry (PRISm), forced expiratory volume in 1 second (FEV1), and forced vital capacity (FVC) during the third year of follow-up.

Results

After adjusting confounders, females were 7 times more likely to have RSP (95% CI, 2.81 to 17.62; P < .001) and 22 times more likely to have PRISm (95% CI, 7.42 to 69.92; P < .001) compared with men. Higher IL-6 concentrations were associated with lower FEV1 z-scores (β, −0.14 per log-higher; 95% CI, −0.29 to 0.008; P = .06) and higher odds of COPD (adjusted odds ratio [aOR], 2.66 per log-higher; 95% CI, 1.16 to 6.09; P = .02). Higher D-dimer concentrations were associated with lower FVC z-scores (β, −0.40 per log-higher; 95% CI, −0.78 to −0.01; P = .04). Conversely, higher IL-10 concentrations were associated with lower odds of PRISm (aOR, 0.76 per log-higher; 95% CI, 0.59 to 0.99; P = .04).

Conclusions

Female sex, higher concentrations of IL-6 and D-dimer, and lower concentrations of IL-10 were associated with pulmonary impairment in adult PWH receiving ART in India.
Quantification and Progress Over Time of Specific Antibodies Against Severe Acute Respiratory Syndrome Coronavirus 2 in Breast Milk of Lactating Women Vaccinated With BNT162b2 Pfizer-BioNTech Coronavirus Disease 2019 Vaccine (LacCOVID)
Authors: Esteve-Palau Erika , Gonzalez-Cuevas Araceli , Guerrero M Eugenia , Garcia-Terol Clara , Alvarez M Carmen , Garcia Geneva , Moreno Encarna , Medina Francisco , Casadevall David , Diaz-Brito Vicens
Published: May 2022

Background

Several observational studies demonstrated the passage of postvaccine antibodies through breast milk in women vaccinated against coronavirus disease 2019 (COVID-19), mostly with messenger RNA (mRNA)–based vaccines, but lacked long-term data.

Methods

A 6-month prospective cohort study was performed to determine severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccine–induced antibody levels in the breast milk of 33 lactating healthcare workers at different timepoints after mRNA BNT162b2 Pfizer-BioNTech COVID-19 vaccination. Moreover, we examined the correlation of SARS-CoV-2 antibody levels between serum and breast milk, adverse events related to vaccination, and rate of SARS-CoV-2 infections.

Results

Mothers’ median age was 38 (interquartile range [IQR], 36–39) years and 15 (IQR, 10–22) months for infants. Median (IQR) SARS-CoV-2 immunoglobulin G (IgG) spike protein subunit S1 (S1) vaccine–induced levels at different timepoints for serum–milk pairs were 519 (234–937) to 1 (0–2.9) arbitrary units (AU)/mL at 2 weeks after first dose and 18 644 (9923–29 264) to 78 (33.7–128), 12 478 (6870–20 801) to 50.4 (24.3–104), 4094 (2413–8480) to 19.9 (10.8–51.9), 1350 (831–2298) to 8.9 (7.8–31.5) AU/mL at 2, 4, 12 and 24 weeks after second dose, respectively. We observed a positive correlation of antibody levels between serum and breast milk, no serious adverse events related to vaccination, and 2 (6%) COVID-19 vaccine breakthrough infections.

Conclusions

Women vaccinated with Pfizer-BioNTech transmit antibodies into breast milk with a positive correlation with serum levels. Both decreased over time in a 6-month follow-up.
Understanding the mechanics of complex topology of the 3D printed Anthill architecture
Authors: Kushwaha Brijesh , Kumar Avinash , Ambekar Rushikesh S , Arya Vinay , Negedu Solomon Demiss , Bakshi Deep , Olu Femi Emmanuel , Sastri Ayyagari Ravi , Pal Varinder , Sadasivuni Kishor Kumar , Pugno Nicola M , Bakli Chirodeep , Tiwary Chandra S
Published: May 2022

The present work aimed to investigate the deformation behavior of complex ant mound architectures under compression. We have used the cement casting method to extract four different ant nest morphologies. These casted cement structures were digitalized using a 3D micro-computer tomography scan. The digitized structures were simulated under different loading conditions using finite-element methods (FEMs). In order to supplement the numerical understanding, the digital architectures were 3D printed and experimentally tested under uniaxial loading conditions. Ants produce a variety of complex architectures for adapting to the surrounding environment and ants’ needs. Ant mound consists of at least one pillar with a broad base tapered toward its tip. Anthill architectures have unique topological features. Mechanical strength of ant mould can be 600 times enhanced by tuning topology. Thickness and angle of pillars have huge effect on load-bearing property. The branched structures can endure larger stress and deform in the process under a volumetric pressure application, making them sacrificial units for extreme disasters like floods and earthquakes. The 3D printing experiments and FEMs simulations are needed to tackle the complex ant mound architectures and appear in good agreement, suggesting a robust design and thus the possibility of constructing anthill-inspired civil buildings with a tree-trunk-like geometry.
Reliability, Validity, and Responsiveness of the Craniocervical Flexion Test in People Who Are Asymptomatic and Patients With Nonspecific Neck Pain: A Systematic Review and Meta-Analysis
Authors: Romeo Antonio , Baccini Marco , Carreras Giulia , Sagripanti Marco , Ruggeri Martina , Pillastrini Paolo , Di Bari Mauro
Published: May 2022

Objective

Among the tests designed to evaluate neck neuromuscular function, the craniocervical flexion test (CCFT) assesses the function of the deep cervical flexor muscles (DCFs). The purpose of this study was to conduct a review and meta-analysis of published articles about all measurement properties of the different CCFT versions (CCFT Activation Score [CCFT-AS], CCFT Performance Index [CCFT-PI], CCFT Cumulative Performance Index [CCFT-CPI], and CCFT alternative procedures for measuring activation level (CCFT1) or endurance (CCFT2) in people who were asymptomatic and people with nonspecific neck pain.

Methods

PubMed Central, MEDLINE, CINAHL, Scopus, Web of Science, and Google Scholar were searched from inception to June 30, 2020. Studies were selected if they reported data on reliability, validity, and/or responsiveness of the CCFT in adults who were asymptomatic or who had nonspecific neck pain. Two reviewers independently selected the studies, conducted quality assessment, and extracted the results. All meta-analyses used a random-effects model.

Results

Twenty-one studies met the inclusion criteria. The rating of interrater reliability (assessed for CCFT-AS and CCFT-CPI) was positive only for using the test at a group level. The same rating was ascribed to the intrarater reliability of CCFT-AS, CCFT1, and CCFT2, whereas CCFT-PI and CCFT-CPI showed positive intrarater reliability for assessment of individuals as well. CCFT validity was rated as positive for expressly assessing DCF action when measuring DCF activation through electromyography—not through ultrasonography—or craniocervical flexion motion as well as for differentiating patients who were asymptomatic and patients who had nonspecific neck pain (only the AS version). CCFT validity was rated as negative for investigating the CCFT performance correlation with the severity of nonspecific neck pain. CCFT responsiveness was rated as negative.

Conclusions

The CCFT is a potentially useful tool for detecting impairment in DCF control and identifying patients who have nonspecific neck pain and who would benefit from a targeted intervention. However, the limited reliability affects its suitability for that purpose. Further research on the reliability of different CCFT versions in which the raters are thoroughly trained is strongly recommended.

Impact

The CCFT might help to detect impairment in DCF control and identify patients who have nonspecific neck pain and who would benefit from a targeted intervention. However, the poor reliability of most versions of the test greatly limits its application in clinical practice. Only CCFT-PI and CCFT-CPI seem reliable enough to help in clinical decision-making at the individual level.
Adipose tissue distribution is associated with cardio-metabolic alterations in adult patients with juvenile-onset dermatomyositis
Authors: Marstein Henriette S , Witczak Birgit N , Godang Kristin , Schwartz Thomas , Flatø Berit , Bollerslev Jens , Sjaastad Ivar , Sanner Helga
Published: May 2022

Objectives

Primary aims were to compare adipose tissue distribution in adult patients with juvenile-onset DM (JDM), with matched controls. Secondary aims were to explore how adipose tissue distribution is associated with cardio-metabolic status (cardiac dysfunction and metabolic syndrome) in patients.

Methods

Thirty-nine JDM patients (all aged ≥18 y, mean age 31.7 y and 51% female) were examined mean 22.7 y (s.d. 8.9 y) after disease onset and compared with 39 age/sex-matched controls. In patients, disease activity and lipodystrophy were assessed by validated tools and use of prednisolone noted. In all participants, dual-energy X-ray absorptiometry (DXA) and echocardiography were used to measure visceral adipose tissue (VAT)(g) and cardiac function, respectively. Risk factors for metabolic syndrome were measured and associations with adipose tissue distribution explored. For primary and secondary aims, respectively, P-values ≤0.05 and ≤0.01 were considered significant.

Results

Patients exhibited a 2.4-fold increase in VAT, and reduced HDL-cholesterol values compared with controls (P-values ≤ 0.05). Metabolic syndrome was found in 25.7% of the patients and none of the controls. Cardiac dysfunction (systolic and/or diastolic) was found in 23.7% of patients and 8.1% of controls (P = 0.07). In patients, VAT levels were correlated with age, disease duration and occurrence of metabolic syndrome and cardiac dysfunction. Occurrence of lipodystrophy (P = 0.02) and male sex (P = 0.04) tended to be independently associated with cardiac dysfunction.

Conclusion

Adults with JDM showed more central adiposity and cardio-metabolic alterations than controls. Further, VAT was found increased with disease duration, which was associated with development of cardio-metabolic syndrome.
Impaired Hematopoietic Stem/Progenitor Cell Traffic and Multi-organ Damage in Diabetes
Authors: Fadini Gian Paolo , Albiero Mattia
Published: May 2022

During antenatal development, hematopoietic stem/progenitor cells (HSPCs) arise from a specialized endothelium and migrate from the extraembryonic mesoderm to the fetal liver before establishing hematopoiesis in the bone marrow (BM). It is still debated whether, in adulthood, HSPCs display such ontologic overlap with vascular cells and capacity for endothelial differentiation. Yet, adult HSPCs retain a prominent migratory activity and traffic in the bloodstream to secondary lymphoid organs and all peripheral tissues, before eventually returning to the BM. While patrolling parenchymatous organs, HSPCs locate close to the vasculature, where they establish local hematopoietic islands and contribute to tissue homeostasis by paracrine signals. Solid evidence shows that diabetes mellitus jeopardizes the traffic of HSPCs from BM to the circulation and peripheral tissues, a condition called “mobilopathy.” A reduction in the levels of circulating HSPCs is the most immediate and apparent consequence, which has been consistently observed in human diabetes, and is strongly associated with future risk for multi-organ damage, including micro- and macro-angiopathy. But the shortage of HSPCs in the blood is only the visible tip of the iceberg. Abnormal HSPC traffic results from a complex interplay among metabolism, innate immunity, and hematopoiesis. Notably, mobilopathy is mechanistically connected with diabetes-induced myelopoiesis. Impaired traffic of HSPCs and enhanced generation of pro-inflammatory cells synergize for tissue damage and impair the resolution of inflammation. We herein summarize the current evidence that diabetes affects HSPC traffic, which are the causes and consequences of such alteration, and how it contributes to the overall disease burden.
Managing severe acute and necrotizing pancreatitis
Authors: Van Wieren Alizabeth , Guild Michelle , Raucci Nicole , Meyer Sharon
Published: May 2022

Acute pancreatitis is associated with significant morbidity and mortality, and is one of the most common gastrointestinal disorders requiring hospitalization. This article describes current concepts in the diagnosis and management of severe acute and necrotizing pancreatitis. Management of this disease requires IV fluids, pain control, and advanced medical and interventional care. Early identification and intervention may help to prevent patient morbidity and mortality.
Coagulopathy Underlying Rotational Thromboelastometry Derangements in Trauma Patients: A Prospective Observational Multicenter Study
Authors: Dujardin Romein W. G. , Kleinveld Derek J. B. , Gaarder Christine , Brohi Karim , Davenport Ross A. , Curry Nicola , Stanworth Simon , Johansson Pär I. , Stensballe Jakob , Maegele Marc , Juffermans Nicole P.
Published: May 2022

Background

Viscoelastic hemostatic assays such as rotational thromboelastometry (ROTEM) are used to guide treatment of trauma induced coagulopathy. The authors hypothesized that ROTEM derangements reflect specific coagulation factor deficiencies after trauma.

Methods

This was a secondary analysis of a prospective cohort study in six European trauma centers in patients presenting with full trauma team activation. Patients with dilutional coagulopathy and patients on anticoagulants were excluded. Blood was drawn on arrival for measurement of ROTEM, coagulation factor levels, and markers of fibrinolysis. ROTEM cutoff values to define hypocoagulability were as follows: EXTEM clotting time greater than 80 s, EXTEM clot amplitude at 5 min less than 40 mm, EXTEM lysis index at 30 min less than 85%, FIBTEM clot amplitude at 5 min less than 10 mm, and FIBTEM lysis index at 30 min less than 85%. Based on these values, patients were divided into seven deranged ROTEM profiles and compared to the reference group (ROTEM values within reference range). The primary endpoint was coagulation factors levels and fibrinolysis.

Results

Of 1,828 patients, 732 (40%) had ROTEM derangements, most often consisting of a combined decrease in EXTEM and FIBTEM clot amplitude at 5 min, that was present in 217 (11.9%) patients. While an isolated EXTEM clotting time greater than 80 s had no impact on mortality, all other ROTEM derangements were associated with increased mortality. Also, coagulation factor levels in this group were similar to those of patients with a normal ROTEM. Of coagulation factors, a decrease was most apparent for fibrinogen (with a nadir of 0.78 g/l) and for factor V levels (with a nadir of 22.8%). In addition, increased fibrinolysis can be present when the lysis index at 30 min is normal but EXTEM and FIBTEM clot amplitude at 5 min is decreased.

Conclusions

Coagulation factor levels and mortality in the group with an isolated clotting time prolongation are similar to those of patients with a normal ROTEM. Other ROTEM derangements are associated with mortality and reflect a depletion of fibrinogen and factor V. Increased fibrinolysis can be present when the lysis index after 30 min is normal.

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Early Postoperative Infections After Closed Reduction and Percutaneous Pinning in Type II and Type III Pediatric Supracondylar Humerus Fractures
Authors: Ezeokoli Ekene U. , Borici Neritan , Serrano Eduardo , Inneh Ifeoma , Shenava Vinitha , Smith Brian G.
Published: May 2022

Background:

Supracondylar humerus fractures (SCHF) are the most common elbow fracture type in children, and one of the most common pediatric fracture types overall. Excellent outcomes are generally reported with closed reduction and pinning (CRPP), but the technique involves leaving the pins outside the skin. External pins can act as a nidus for infection. We characterize the infection complications from SCHF treatment at a single-centre tertiary children’s hospital over 10 years. This is the largest series on infectious outcomes after CRPP of SCHF reported to date.

Methods:

Pediatric patients undergoing CRPP for a type II or type III SCHF from 2011 to 2021 with postsurgical infections within 90 days were identified. Demographic and clinical data were retrieved from medical records. Descriptive statistics were estimated and reported as means or medians with range values or counts with percentages.

Results:

A total of 18 patients met inclusion criteria, 10 and 8 with type II and III SCHF, respectively. The average age at diagnosis of fracture was 4.7 (2 to 9) years. The average operating time for the index surgery was 29 minutes (12 to 42). The average number of postoperative days until pin removal was 29.8 (18 to 52), and the average number of postoperative days until readmission or visit with symptoms was 38.9 (18 to 77). There was a documented history of a wet cast in 6 patients (33%). Ten (56%) patients presented with fever, and the most common positive culture was methicillin-sensitive Staphylococcus aureus (9, 50%). Thirteen (72%) patients returned to the operating room for incision and drainage. There were no cases with continued complications after the original infection after a median follow-up of 63 days (8 to 559). Infection after CRPP of SCHF is a rare adverse event. In our series, it was most often associated with common pathogens and wet casts. The necessity of return to the operating room will vary with the presentation, but if efficaciously treated afterwards with oral antibiotics, there is a low chance of recurrence or subsequent complications. Patients should be carefully instructed in cast care and demonstrate understanding of risks and complications, and to contact their orthopaedist if their cast demonstrates lack of integrity.

Level of Evidence:

Prognostic level IV.
Preoperative Predictors for Acute Pain After Photorefractive Keratectomy
Authors: Toyota Adriana M. , Garcia Renato , Torricelli Andre A. M. , Silva Valquiria A. , Galhardoni Ricardo , Teixeira Manoel J. , de Andrade Daniel C. , Bechara Samir J.
Published: May 2022

Purpose:

The aim of this study was to identify preoperative predictors for the occurrence of early severe postoperative pain in patients undergoing photorefractive keratectomy (PRK). The implementation of preoperative screening methods may facilitate more specific or aggressive pain therapies specifically targeted to individuals at a high risk of experiencing severe postoperative pain.

Methods:

This was exploratory research that included patients who underwent PRK. Before PRK, patients were administered a sociodemographic questionnaire, the Pain Catastrophizing Scale, and the State-Trait Anxiety Inventory and underwent corneal sensitivity and conditioned pain modulation (CPM) tests. Post-PRK pain was assessed using a pain intensity visual analog scale (VAS), and the short-form McGill Pain Questionnaire (SF-MPQ) was completed 21 days before PRK and 1, 24, 48, and 72 hours after PRK. Spearman correlations were calculated for pain scores and preoperative predictors.

Results:

This research included 34 eyes of 34 patients. Preoperative corneal sensitivity was positively correlated with post-PRK pain scores as assessed by VAS and SF-MPQ (rho = 0.39 and rho = 0.41, respectively, P < 0.05). No correlations were found between Pain Catastrophizing Scale, State-Trait Anxiety Inventory, and CPM scores and post-PRK pain scores (P > 0.05).

Conclusions:

Abnormal presurgical corneal sensitivity was a protective marker for severe pain after PRK, while scores as assessed by VAS and SF-MPQ and CPM were not related to postoperative pain.
Rapid Antigen Tests For Safe School Opening in the COVID-19 Pandemic Era
Authors: Goldenfeld Miki , Cohen Carmit , Gilboa Mayan , Pessach Itai M. , Mehnick Bella , Tal Ilana , Meltzer Lilac , Amit Sharon , Gonen Tal , Afek Arnon , Kreiss Yitshak , Regev-Yochay Gili
Published: May 2022

Background:

Since the beginning of the Sever Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) pandemic, school closure as a mitigating measure was at the center of a public and professional debate. While the negative effects of school closure cannot be ignored, accumulating data suggested that it is necessary for reducing community transmission. Our study presents an optional strategy for safe school opening during a pandemic, implemented in selected Israeli high schools by a special task force constructed by the Sheba Medical Center (SMC).

Methods:

The study took place between November 2020 and April 2021. Three schools from different areas of Israel were enrolled. The participants were asked to undergo bi-weekly SARS-CoV-2 rapid diagnostic antigen tests (Ag-RDT). Those who tested positive were requested to self-isolate, whereas their school contacts were tested daily by Ag-RDT. Participants with a previously documented SARS-CoV-2 infection or who were found to be SARS-CoV-2 seropositive upon enrollment were exempted from screening.

Results:

Of a total of 361 participants who enrolled in the study, 12.3% were found to be seropositive. Fourteen SARS-CoV-2 cases were detected (3.5%), 12 of them in one single school located in an endemic area for SARS-CoV-2. The 14 cases resulted in 84 days of COVID-19-related absence from school, comparing with 1775 potential days of COVID-19-related absence under a strategy implementing self-isolation instead of testing.

Conclusions:

Safe continuation of academic routine during the pandemic is possible when using rapid Ag-RDT as a screening tool, while allowing swab collection by trained students and teachers.
Annual Trend in Lumbar Puncture for Infants Younger Than 3 Months Hospitalized With Suspected Serious Bacterial Infection: A Nationwide Inpatient Database Study
Authors: Fuseda Yasuyuki , Michihata Nobuaki , Kumazawa Ryosuke , Fushimi Kiyohide , Yasunaga Hideo
Published: May 2022

Background:

A lumbar puncture is no longer necessary in febrile infants younger than 3 months when they are at low risk of serious bacterial infection because the risk factors for a severe bacterial infection have been identified. The purpose of this study was to identify the annual trend in the proportion of lumbar punctures in infants with suspected serious bacterial infections using a national inpatient database in Japan.

Methods:

Using the Diagnosis Procedure Combination database, we identified infants < 3 months of age who underwent blood and urine culture tests on admission from April 2011 to March 2020 in Japan.

Results:

In total, 44,910 eligible infants were included in the study. The proportion of lumbar punctures decreased gradually from 57.9% to 50.4% in infants 4–28 days old and from 54.5% to 37.3% in infants 29–89 days old between 2011 and 2019. Of the 18 hospitals, 15 (83.3%) recorded a lumbar puncture proportion of >50% in 2011 and 7 (38.9%) recorded >50% in 2019. In 3 hospitals, the proportion of lumbar punctures remained >75% in 2019.

Conclusion:

The proportion of lumbar punctures with hospitalized infants admitted with blood and urine culture tests decreased over the years, and this trend was greater in infants 29–89 days of age. The reduction in the proportion of lumbar punctures varied widely among the hospitals.
Age-specific Clinical Presentation and Risk Factors for Extrapulmonary Tuberculosis Disease in Children
Authors: Dubois Melanie M. , Brooks Meredith B. , Malik Amyn A. , Siddiqui Sara , Ahmed Junaid F. , Jaswal Maria , Amanullah Farhana , Becerra Mercedes C. , Hussain Hamidah
Published: May 2022

Background:

Clinical presentation for extrapulmonary tuberculosis (EPTB) in children can be variable and nonspecific, leading to delayed diagnosis, disease and death. We describe the age-specific clinical presentation and identify risk factors for EPTB among children in Pakistan.

Methods:

In 2015–2016 in 4 facilities in Sindh, Pakistan, children were diagnosed with TB either through bacteriologic confirmation or clinical-radiologic criteria. EPTB comprised any form of TB disease that did not involve the lungs. Among children with TB disease, we report demographics, clinical characteristics and symptoms, family medical history and diagnostic test results for children with and without EPTB. We conduct age-specific regression analyses to identify factors associated with an EPTB diagnosis among children age 0–4, 5–9 and 10–14 years.

Results:

A total of 1163 children were diagnosed with TB disease, of which 157 (13.5%) had EPTB. Of those, 46 (29.3%) were 0–4, 53 (33.8%) were 5–9 and 58 (36.9%) were 10–14 years old. Of children with EPTB, the most frequently reported sites were lymph node (113, 72.4%) and abdominal (31, 19.9%). Weight loss was associated with an increased risk of EPTB in the 0–4-year-old (adjusted odds ratio: 2.80, 95% confidence interval: 1.05–7.47) and 10–14-year-old (adjusted odds ratio: 2.79, 95% confidence interval: 1.28–6.07) groups, and the presence of cough was associated with a decreased risk of EPTB.

Conclusions:

This study provides new knowledge about age-specific clinical presentation and risk factors of EPTB in children in Pakistan. Our results can help to optimize clinical algorithms designed to achieve a timely diagnosis in children with EPTB along with improved treatment outcomes.
Effect of femtosecond laser cutting parameters on the results of small-incision lenticule extraction
Authors: Enayati Sam , Zhou Wen , Stojanovic Aleksandar , Utheim Tor Paaske , Bian Zhiwen , Feng Yue , Chen Xiangjun
Published: May 2022

Purpose:

To determine the effect of femtosecond laser cutting parameters on small-incision lenticule extraction (SMILE) results by evaluating cap thickness, interface light scattering, and visual and refractive outcomes.

Setting:

SynsLaser Clinic, Oslo, Norway.

Design:

Retrospective.

Methods:

58 right eyes treated with SMILE using a programmed cap thickness of 130 μm were divided into 2 groups according to laser settings: Group 1: 165 nJ pulse energy and 4.5 μm spot separation (n = 36); Group 2: 125 nJ pulse energy and 4.2 μm spot separation (n = 22). The cap thickness was measured within the central 5 mm of the horizontal meridian using spectral-domain optical coherence tomography. Postoperative interface light scattering was graded based on the percentage area showing light scattering: 0: no scattering; 1: ≤25%; 2: 26% to 50%; 3: 51% to 75%; and 4: >75%.

Results:

At 3 months postoperatively, cap thickness was 138.9 ± 6.2 μm in Group 1 and 149.4 ± 3.5 μm in Group 2 (P < .001). Interface scattering was 0.9 ± 1.0 in Group 1 and 0.3 ± 0.9 in Group 2 (P < .05), with no scattering in 33.3% and 86.4% of the eyes, respectively. The postoperative spherical equivalent refraction was −0.03 ± 0.44 diopters (D) in Group 1 and −0.04 ± 0.31 D in Group 2. In Group 1, 83.3% of the eyes were within ± 0.5 D of the desired outcome, and 69.4% achieved an uncorrected distance visual acuity of 20/20 or better. In Group 2, these values were 95.5% and 86.4%, respectively.

Conclusions:

Lower pulse energy with tighter spots seems to reduce interface light scattering and improve refractive outcomes while also significantly increasing cap thickness.
Hospital Cultural Competency Leadership and Training is Associated with Better Financial Performance
Authors: Upadhyay Soumya , Weech-Maldonado Robert , Opoku-Agyeman William
Published: May 2022

Goal:

An organization’s cultural competency reflects its ongoing capacity to provide high-quality, equitable, safe, and patient-centered care. Cultural competency leadership and training (CCLT) influences organizational cultural competency, which could affect organizational performance. Policies regarding health disparities point to the need for hospitals to become culturally competent. This study aimed to explore if CCLT practices are associated with better financial performance.

Methods:

Using secondary data from three sources—the American Hospital Association Annual Survey, the Health Care Cost Information System, and the Area Health Resource File—a longitudinal panel study design reviewed 3,594 hospital-year observations for acute care hospitals across the United States from 2011 to 2012. CCLT, the independent variable, was measured as a summated scale of strategy, execution, implementation, and training in diversity practices. For financial performance, the operating and total margins of hospitals were measured as dependent variables. Two random-effects regression models with year- and state-fixed effects were used to examine the relationship, with hospital being the unit of analysis.

Principal Findings:

The descriptive statistics showed that hospitals had an average CCLT score of approximately 2 (the range was 0–4). Regression analysis indicated that an increase in the CCLT score was associated with a 0.3% and 0.4% increase in total and operating margins, respectively (p < .05). Also, with each 10 additional staffed beds, hospitals on average experienced a 0.1% increase in both total and operating margins. Overall, for-profit hospitals experienced a 2.4% higher total margin and a 4.9% higher operating margin, as compared to not-for-profit hospitals. On the contrary, government hospitals showed 1% and 5.8% lower total and operating margins, respectively.

Applications to Practice:

Results of our study support a business case for CCLT practices. Cultural competency makes good economic sense by helping to improve cost savings, increase market share, and enhance the efficiency of care. Therefore, healthcare leaders should consider investing in CCLT. With the growing emphasis on value-based purchasing related to patient outcomes and experience, hospitals that develop a high degree of cultural competency through CCLT can benefit from the changes in reimbursement. CCLT also affects financial performance through avoidance of costs related to employee absenteeism and turnover and improves team cohesiveness by reducing cultural conflicts. Other mechanisms by which CCLT assists in saving costs and affecting financial performance include avoidance of unnecessary readmissions and expensive hospitalizations through the proper screening of patients from diverse backgrounds. CCLT improves cultural competency and diversity management, thus creating a unique competitive advantage for hospitals.
Analysis of a Resident Competence Self-Assessment Survey
Authors: Mullen Ashley , Horn Catherine
Published: May 2022

Introduction

Orthotic and prosthetic clinicians need to self-assess their performance and make decisions about practice limitations and continuing education throughout their careers. The objectives of this study were to evaluate the internal consistency of a self-assessment survey, examine the latent common factors and responsiveness of the survey, and use the results of the analysis to develop a shortened self-assessment survey.

Methods

Residents completed a self-assessment 29-item survey based on the six domains of the American Board for Certification in Orthotics, Prosthetics, and Pedorthics (ABC) Practice Analysis of Certified Practitioners in the Disciplines of Orthotics and Prosthetics at multiple times during the clinical residency. Internal consistency was examined through Cronbach α. Confirmatory and exploratory factor analysis were used to examine latent common factors and inform item reduction. Responsiveness was examined through repeated-measures analysis of variance (ANOVA).

Results

Analysis revealed a Cronbach α of 0.927. Confirmatory factor analysis indicated a poor fit of the six-factor model. The final and best-fitting model suggested four latent common factors: patient centeredness, regulatory awareness, device evaluation, and professional responsibility. Review and revision of the items resulted in a 14-item instrument. The instrument was responsive to changes over time.

Conclusions

The results indicate a need to reexamine current clinical practice framework in orthotics and prosthetics, particularly as it relates to clinical competence. Future research should evaluate the performance of the shortened self-assessment survey and consider implications for educational standards.

Clinical Relevance

The use of validated educational tools can strengthen the efficacy of assessments in clinical education and residency. Improved clinical education assessments may result in standardization of competency and improved graduate preparedness.
Name the Diagnosis
Authors: Lao Robyn Huey , Theodorou Christina M. , Kohler Jonathan E.
Published: May 2022

A 9-year-old male presents to the emergency department with abdominal pain, emesis, fever, and generalized peritonitis. Computed tomography images are reviewed and reveal the diagnosis of foreign body magnet ingestion. Surgical and post-operative management are discussed, including readmission due to repeat foreign body ingestion. Pica, defined as compulsive ingestion of nonedible substances, is described. The case report illustrates the importance of a comprehensive history and being wary of potential repeat ingestions in patients with pica.
The Clinicopathologic Challenge of Nonneoplastic Vulvar Acanthosis
Authors: Day Tania , Scurry James , Haqshenas Gholamreza , Murray Gerald , Tran Hong , Dennerstein Graeme , Garland Suzanne M.
Published: May 2022

Objective

The aim of the study was to evaluate clinicopathologic features of cases demonstrating an acanthotic tissue reaction not clearly consistent with psoriasis, lichen simplex chronicus, mycosis, or condyloma.

Materials and Methods

This is a retrospective pathologic case series of biopsies reported as “benign acanthotic lesion” and “acanthotic tissue reaction” that lacked a clear diagnosis on expert review. Cases with nuclear atypia were excluded. Clinical and histopathologic data were collected, immunohistochemistry for p16 and p53 were obtained, and molecular testing for 28 common anogenital human papillomavirus (HPV) genotypes was undertaken.

Results

There were 17 cases with a median age of 47 years. Unilaterality and medial location were clinical reasons for diagnostic difficulty. Histopathologic uncertainty often related to lack of papillary dermal fibrosis to support lichen simplex chronicus or psoriasiform lesions without parakeratosis, subcorneal pustules, and/or mycotic elements. Firm pathologic diagnoses were not possible, but 3 groups emerged: favoring chronic dermatitis, favoring psoriasis, and unusual morphologies. p16 results were negative or nonblock positive while p53 was normal or basal overexpressed. Human papillomavirus testing was negative in 12, low positive for HPV 16 in 1, unassessable in 3, and not requested in 1.

Conclusions

There is a group of acanthotic tissue reactions that cannot be classified with standard histopathologic assessment. Further clinicopathologic research into unilateral acanthotic lesions may provide insight into separation of psoriasis and mycosis when organisms are absent. Once nuclear atypia is excluded, immunohistochemistry for p16 and p53 and HPV molecular testing do not assist in diagnostic identification.
Temporary Left Ventricular Support Device as a Bridge to Heart-Liver or Heart-Kidney Transplant: Pushing the Boundaries of Temporary Support
Authors: Roach Amy , Emerson Dominic , Megna Dominick , Cole Robert , Catarino Pedro , Salabat Reza , Ramzy Danny , Moriguchi Jamie , Kobashigawa Jon , Trento Alfredo , Chikwe Joanna , Esmailian Fardad
Published: May 2022

In patients with severe cardiogenic shock, temporary mechanical circulatory support has become a viable strategy to bridge patients to heart transplantation. However, end-stage heart failure is often associated with progressive organ dysfunction of the liver or kidney. This can require a dual organ transplant for definitive management (combined heart-liver [HL] or heart-kidney [HK] transplantation). We evaluated temporary mechanical support to bridge patients to HL or HK transplant at a single, high-volume center. All patients who underwent Impella 5.0 placement from January 2014 to October 2018 were identified. From this dataset, patients who underwent placement as a bridge to dual organ transplant were selected, as were those who underwent Impella as a bridge to isolated heart transplant.

Over the 5 years of evaluation, 104 patients underwent Impella 5.0 placement. Of these, 14.3% (n = 15) were identified as potential dual organ recipients (11 HK, 4 HL). In total, 80% (12/15) successfully underwent dual organ transplant (8 HK, 4 HL), with a 1-year survival of 100% in both transplanted groups. Among patients undergoing Impella 5.0 placement as a bridge to isolated heart transplant (n = 33), 78.8% (26) were successfully bridged, and 1-year survival was 92% after transplantation.

Impella 5.0 is a viable bridge to dual organ transplantation and should be considered as a management strategy in these complex patients at experienced institutions.
Cardiac Dysfunction Biomarkers Are Associated With Potential for Successful Separation From Extracorporeal Membrane Oxygenation in Children
Authors: Coletti Kristen , Griffiths Megan , Nies Melanie , Brandal Stephanie , Everett Allen D. , Bembea Melania M.
Published: May 2022

Biomarkers of cardiac dysfunction may aid in decision making about organ recovery and optimal timing of separation from extracorporeal membrane oxygenation (ECMO). We conducted a prospective observational study of children from 0 to <18 years who underwent ECMO between 7/2010 and 6/2015 in a single center. In this pilot study, we aimed to determine whether Suppression of tumorigenicity 2 (ST2), N-terminal pro–B-type natriuretic peptide (NT-proBNP), galectin-3, and endostatin were associated with ability to separate from ECMO. Fifty neonatal and pediatric participants supported on venoarterial ECMO were included (median age 13 days, 50% male). Twelve (24%) participants were unable to separate from extracorporeal support. Plasma ST2 concentrations at cannulation were higher in children who were ultimately unable to separate versus those who successfully separated from ECMO (median 395.3 ng/mL vs. 207.4 ng/mL, p = 0.012). ST2 and NT-proBNP concentrations decreased significantly from the first to the last ECMO day in patients successfully separated from ECMO (p < 0.0001 and p = 0.017, respectively). Endostatin concentrations increased significantly from the first to the last ECMO day in both groups. Galectin-3 concentrations were not associated with the ability to separate from ECMO. Cardiac dysfunction biomarkers, particularly ST2, may aid in decannulation decision-making in pediatric ECMO patients. These results should be validated with a larger study.
Arterial Compliance and Continuous-Flow Left Ventricular Assist Device Pump Function
Authors: Adji Audrey , Shehab Sajad , Jain Pankaj , Robson Desiree , Jansz Paul , Hayward Christopher S.
Published: May 2022

Durable continuous-flow left ventricular assist devices (cfLVADs) demonstrate superior survival, cardiac functional status, and overall quality of life compared to medical therapy alone in advanced heart failure. Previous studies have not considered the impact arterial compliance may have on pump performance or developed arterial pressure. This study assessed the impact of alterations in arterial compliance, preload, and afterload on continuous-flow pump function and measured hemodynamics using an in-vitro pulsatile mock circulatory loop. Decreased arterial compliance was associated with a significant increase in arterial pressure pulsatility which was not evident in the flow pulsatility, as displayed in pump flow waveforms. There were marked changes in the pump flow waveforms due to the significant alteration in the aortoventricular gradient during diastole according to the changes in compliance. This study demonstrates that changes in systemic blood pressure, afterload, and left ventricular contractility each significantly affects the flow waveform. The association of hypertension with lower aortic compliance results in markedly decreased diastolic flow rates which may be important in contributing to a greater risk of adverse events under cfLVAD support.
Gluteus Maximus Muscle Activation Characteristics During a Chair-Rise in Adults With Chronic Stroke
Authors: Sawtelle Michelle , Roddey Toni , Ellison Jennifer , Tseng Shih-Chiao
Published: May 2022

Background and Purpose:

A successful chair-rise is an important indicator of functional independence post-stroke. Lower extremity electromyographic analyses provide a basis for muscle activation from which clinical intervention protocols may be derived. Gluteus maximus activation during the chair-rise has not been thoroughly researched in the chronic stroke population. This study investigated the magnitude and onset of gluteus maximus activation during the chair-rise comparing adults post-stroke with healthy controls.

Methods:

In this cross-sectional study, adults with chronic stroke (n = 12) and healthy controls (n = 12) completed 4 natural-speed chair-rise trials. Magnitude and onset of bilateral gluteus maximus activation were measured during the movement with secondary comparative data from biceps femoris and vastus lateralis muscles. Kinetic and kinematic measurements were used to quantify chair-rise phases and movement cycle duration.

Results:

Significant decreases in paretic (P = 0.002), and nonparetic (P = 0.001) gluteus maximus magnitudes were noted post-stroke compared with ipsilateral extremities of healthy adults. Significant gluteus maximus onset delays were noted in paretic extremities compared with nonparetic extremities post-stroke (P = 0.009) that were not apparent in comparative muscles. Similar onset times were noted when comparing the paretic extremity post-stroke to the ipsilateral extremity of healthy controls (P = 0.714) despite prolonged movement cycle durations in those with chronic stroke (P = 0.001). No onset delays were evident in the biceps femoris (P = 0.72) or vastus lateralis (P = 0.338) muscles.

Discussion and Conclusions:

Despite apparent unilateral muscle weakness post-stroke, bilateral decreases in gluteus maximus activation magnitudes and compounding onset deficits of the paretic extremity were observed during chair-rising. Further research is needed to determine whether interventions maximizing bilateral activation magnitudes and improving temporal activation congruency during chair-rising will carry over to functional gains

Video Abstract available for more insights from the authors (see the Video, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A387).