bluuebunny/crossref_metadata_2025 huggingface dataset:
Use of Intensive Care Unit Diary as an Integrated Tool in an Italian General Intensive Care Unit
Authors: Iannuzzi Luigi , Villa Silvia , Vimercati Simona , Villa Marta , Pisetti Carmen Francesca , Viganò Giulia , Fumagalli Roberto , Rona Roberto , Lucchini Alberto
Published: May 2021

Purpose

The aim of this study was to investigate the implementation of an intensive care unit (ICU) diary in an Italian general ICU.

Methods

A mixed-methods pilot study was performed, enrolling all patients who received an ICU diary in an Italian ICU during the study period.

Results

Study results are presented in 2 sections: (1) diary evaluation and content themes and (2) follow-up program results. Sixty-six patients were assessed for eligibility. Diary administration was possible in 31 patients (47%). The overall diary entries, in 31 analyzed diaries, were 1331, with a median of 25 entries (interquartile range, 16–57 entries) for each diary. Participants' relatives and friends wrote a median of 1.2 (0.3–1.6), and nurses wrote 1.1 (0.8–1.2). Other ICU staff wrote a total of 24 entries (2%). Follow-up results revealed low incidence of delirium detected in only 1 patient at the 7-day visit (3%). The median value of PTSS-10 (Post Traumatic Stress Symptoms) score was 12 (3.5–12) at the 7-day visit, 6 (1.5–12) at 3 months' telephone interview, and 12 (1.5–17) at 6 months' visit.

Conclusions

To our knowledge, this is the first Italian report about the introduction of an ICU diary. The diaries were easily implemented in our clinical practice as a “low-cost” initiative. In our study, nurses and participants' relatives and friends wrote a similar number of entries in each analyzed diary. This project could be effective in reducing survivors' delirium and post-traumatic stress disorder and in implementing mutual understanding between clinical staff and relatives during ICU stay.
Evaluation of a Novel Absorbable Mesh in a Porcine Model of Abdominal Wall Repair
Authors: Mlodinow Alexei S. , Yerneni Ketan , Hasse Michelle E. , Cruikshank Todd , Kuzycz Markian J. , Ellis Marco F.
Published: May 2021

Background:

Bioabsorbable meshes have seen increasing clinical use to reinforce soft tissue, and exist on a spectrum of strength loss versus absorption: several retain their strength for months, but remain in situ for years. Others lose strength fully by 6 weeks. An intermediate profile, with some strength for 3 -4 months, but consistent absorption in less than a year, may be an optimal balance of near-term support and long-term safety. In this large animal study, we evaluate such a mesh (DuraSorb, SIA), assessing its utility in a porcine model of abdominal wall repair.

Methods:

Two full-thickness defects were created in the abdominal walls of nine Yucatan swine via midline approach and repaired preperitoneally with either DuraSorb or long-lasting control mesh (TIGR, Novus Scientific). At 30 days, 3 months, and 1 year, the implantations were assessed by clinical pathology, post-necropsy histopathology, and burst strength testing.

Results:

No device-associated complications were found in vivo, at necropsy, or histologically. DuraSorb was well-integrated and vascularized by 30 days. DuraSorb demonstrated minimal/mild inflammation and fibroplasia, and lower inflammatory scores when compared with TIGR at all time points (P < 0.05). Burst strength of the repair sites was higher than adjacent abdominal wall at all time points (P < 0.05).

Conclusions:

DuraSorb provided durable long-term support, minimal inflammation, and consistent absorption in this porcine model of abdominal wall repair, as compared to a long-term control. Clinical data is needed, but these results suggest that this mesh provides adequate structural support while potentially reducing long-term device reactions.
Defining Heterogeneous Cognitive Trajectories in Bipolar Disorder: A Perspective
Authors: Millett Caitlin E. , Burdick Katherine E.
Published: May 2021

Bipolar disorder (BD) is a highly disabling mental illness that affects approximately 1% of the global population. Cognitive capacity is a strong predictor of “everyday” functional outcome in BD and should thus be considered a key treatment target. Interventions to improve cognition have been largely unsuccessful, likely due to the substantial heterogeneity inherent to the illness. It is known that 40%–60% of people with BD have cognitive impairment, yet impairment is not “one size fits all”; in fact, the literature supports discrete cognitive subtypes in BD (e.g., intact, globally impaired, and selectively impaired). Gaining a better understanding of these cognitive subtypes, their longitudinal trajectories, and their biological underpinnings will be essential for improving patient outcomes. The prevailing hypothesis for the development of cognitive impairment in BD postulates a stepwise cumulative effect of repeated mood episodes causing wear-and-tear on the brain. However, a paucity of data supports this idea at the group level. We propose that studying heterogeneity longitudinally will allow for clearer delineation of the natural history of cognitive trajectories in BD. In sum, parsing heterogeneity in BD will allow us to identify causal mechanisms and optimize treatment at the level of the individual.
Corynebacterium Minutissimum
Authors: Vanaparthy Rachana , Greene John
Published: May 2021

Corynebacterium minutissimum has previously been considered a contaminant but is now increasingly being recognized as a cause of a variety of infections. Corynebacterium minutissimum is the most common causative agent of erythrasma. It has been associated with various extracutaneous manifestations, including cellulitis, meningitis, endocarditis, endophthalmitis, costochondral abscess, and peritonitis. The increasing use of intravenous access devices and a rising number of immunocompromised patients are potential contributions to this disease presentation. We report 3 cases of C. minutissimum infection in immunocompromised patients at the H. Lee Moffitt Cancer Center and Research Institute and review the literature. In such rare diseases, proper infection control guidelines, prompt prophylaxis, and treatment with antibiotics will maximize benefits in these patients.
Breast Infections With Mycobacterium goodii After Reduction Mammaplasty
Authors: Al Zoubi Moamen , Spier Addie B.
Published: May 2021

Mycobacterium goodii was identified in 1999 as a rapidly growing nontuberculous mycobacteria species related to the Mycobacterium smegmatis group isolated from human wound infections. Infection with this organism is exceptionally rare after breast surgery in the absence of a prosthetic implant.

The authors present a case of breast infections with M. goodii after a reduction mammaplasty.
Exploration of Geriatric Care Competencies in Registered Nurses in Hospitals
Authors: HU Fang-Wen , LEE Huan-Fang , LI Yueh-Ping
Published: May 2021

Background

Older adults occupy one third of acute care hospital beds, and the regular duties of many nurses include caring for older patients. A working knowledge of geriatric care competencies is necessary for nurses to provide high-quality care to older patients and their families. It is unclear how nurses who work in acute care hospitals self-evaluate their geriatric care competencies and how these self-evaluated abilities differ from the objective abilities of these nurses.

Purposes

This study was designed to explore the geriatric care competencies of nurses in hospitals and to identify the factors associated with these competencies.

Methods

This was a cross-sectional study. Nurses who were employed and directly caring for patients aged 65 years and older in any of the adult wards of a medical center located in southern Taiwan were recruited as participants. A structured questionnaire was developed based on a review of the relevant literature and validated using expert consensus. This questionnaire included a demographic datasheet, knowledge of geriatric care scale, attitude of geriatric care scale, self-evaluation of geriatric care competency, and geriatric care competency test. Descriptive and inferential statistics were used to analyze the geriatric care competencies of the participants and related factors.

Results

One hundred seventy nurses were enrolled as participants. The average self-evaluation score for geriatric care competency was 67.74 (SD = 0.84). However, the average percentage of correct answers given on the geriatric care competency test was much lower (17.6%). The self-evaluation score was found to be significantly associated with job satisfaction and having received continuing education in geriatric care. In addition, age was shown to significantly affect the percentage of correct answers given on the geriatric care competency test.

Conclusions/Implications for Practice

A significant gap was found between the self-perceived and actual competencies of nurses in terms of providing geriatric care. Appropriate policies are necessary to improve the geriatric care competencies of nurses working in hospitals and to oversee the implementation of effective educational methods in Taiwan.
Gastric adenocarcinoma of fundic gland (chief cell predominant type) coexisting with well differentiated intestinal adenocarcinoma
Authors: Liu Lifeng , Han Lin , Ma Qingzhu , Zhang Jinliang
Published: May 2021

Rationale:

Gastric adenocarcinoma of fundic gland (chief cell predominant type) (GA-FG-CCP) is a new, rare variant of gastric adenocarcinoma, which is characterized by mild nuclear atypia and specific immunohistochemical markers.

Patient concerns:

An 84-year-old Chinese man was referred to our hospital for endoscopic resection of a gastric lesion.

Interventions:

We performed endoscopic submucosal dissection, and successfully removed the lesion.

Diagnosis:

Esophago gastroduodenoscopy showed a slightly elevated lesion with a diameter of 22 mm in the posterior wall of cardia. Magnifying endoscopy with narrow band imaging revealed an abnormal microsurface and microvessels on the tumor surface. Endoscopic ultrasonography revealed a hypoechoic mass located in the first layer. The pathological diagnosis of the biopsy specimens indicated that the tumor was high grade intraepithelial neoplasia. The pathological diagnosis differed between the superficial and deeper part of the lesion. The superficial part was composed of a tubular structure with prominent atypia and was diagnosed as well differentiated intestinal adenocarcinoma. The deeper part was composed of a well-differentiated tubular adenocarcinoma mimicking the fundic gland cells, mainly the chief cells. The tumor cells showed mild nuclear atypia and was positive for pepsinogen-I (PG-I) and mucin-6 (MUC6). This deeper part was diagnosed as GA-FG-CCP.

Outcomes:

The tumor was successfully removed. This patient had no discomfort during the follow-up period (10 months).

Lessons:

We present a rare case of GA-FG-CCP coexisted with well-differentiated tubular adenocarcinoma. GA-FG-CCP exists in the deep mucosal layer and the muscularis mucosa, which could not be found under endoscopy, but could be discerned in pathology with mild nuclear atypia and special biomarkers.
Cervical spine lateral radiograph versus whole spine lateral radiograph
Authors: Lee Dong-Ho , Park Sehan , Kim Dong Gyun , Hwang Chang Ju , Lee Choon Sung , Hwang Eui Seung , Cho Jae Hwan
Published: May 2021

This study is aimed to compare whole-spine lateral radiograph (WLR) and cervical lateral radiograph (CLR) in terms of T1 slope visibility and cervical sagittal parameters and to identify the superior imaging modality for assessment of cervical sagittal parameters.

We retrospectively reviewed the radiographic data of 60 consecutive adult patients (male-to-female ratio, 38:22; mean age, 55.6 ± 1.3 years) who presented with only neck pain (without radiculopathy or myelopathy). All the patients underwent standing CLR and WLR. The following parameters were measured and analyzed:

The visibility of the T1 slope was significantly lower with WLR than with CLR (28.3% vs 83.3%, P  = .049). The mean CAC2–C7 on WLR was significantly less lordotic than that on CLR (11.2 ± 9.2° vs 14.3 ± 11.3°; P = .01). The mean cSVA was translated more posteriorly on WLR than on CLR (9.9 ± 18.9 mm vs 15.0 ± 13.4 mm, P = .04). However, no significant differences in T1 slope, C7 slope, and CAC0–C2 were found between CLR and WLR.

This study shows that standing CLR could provide better visualization of the upper endplate of T1. Furthermore, WLR taken in hands on clavicle position distorted radiographic measurements such as CAC2-C7 and cSVA. Therefore, CLR performed in the standing position seems to allow more-accurate measurements of cervical sagittal parameters.
A comparison between Qigong exercise and cycle ergometer exercise for the rehabilitation of chronic obstructive pulmonary disease
Authors: Dong Xiaosheng , Wang Xiangyu , Jia Ningxin , Chen Xianhai , Ding Meng
Published: May 2021

Background:

Chronic obstructive pulmonary disease (COPD) is a common respiratory disease that is associated with significant morbidity and mortality. Exercise training confers health benefits to people with COPD. The purpose of this study was to compare differences in the rehabilitation of COPD between Qigong exercise (QE) and aerobic exercise using a cycle ergometer (CE).

Methods:

This study was a randomized single-blind controlled trial. Twenty six participants were recruited and randomized to either the Qigong group or the cycle ergometer group. Both interventions lasted 12 weeks and comprised a 30 minutes supervised training session performed twice a week, that is, 24 sessions in total. The primary outcome measure was the endurance capacity measured by the six-minute walk test (6MWT). The secondary outcome measures were the results of the St. George's Hospital Respiratory Questionnaire (SGRQ) and the COPD assessment test (CAT).

Results:

Participants in the group that performed aerobic exercise using a cycle ergometer had significantly improved 6MWT (P = .005), SGRQ (P = .029), and CAT (P = .018) results. Participants in the Qigong exercise group had significant changes in 6MWT (P = .033). However, the differences in 6MWT and SGRQ were not statistically significant between the 2 groups. The changes in CAT scores before and after the intervention were significantly different between the 2 groups (P = .020). There were no reports of adverse events during the course of the trial.

Conclusions:

There was no difference in the primary outcome between groups. In particular, QE and cycle ergometer exercise had similar rehabilitation effects on the improvement of the cardiopulmonary endurance and quality of life of chronic obstructive pulmonary disease patients. In addition, cycle ergometer exercise may lead to a better trend of improvement in the quality of life and can improve the severity of the clinical symptoms of chronic obstructive pulmonary disease.

Trial registration:

ChiCTR-TRC-14004404.
Diagnostic yield, safety, and advantages of ultra-low dose chest CT compared to chest radiography in early stage suspected SARS-CoV-2 pneumonia
Authors: Argentieri Gianluca , Bellesi Luca , Pagnamenta Alberto , Vanini Gianluca , Presilla Stefano , Del Grande Filippo , Marando Marco , Gianella Pietro
Published: May 2021

To determine the role of ultra-low dose chest computed tomography (uld CT) compared to chest radiographs in patients with laboratory-confirmed early stage SARS-CoV-2 pneumonia.

Chest radiographs and uld CT of 12 consecutive suspected SARS-CoV-2 patients performed up to 48 hours from hospital admission were reviewed by 2 radiologists. Dosimetry and descriptive statistics of both modalities were analyzed.

On uld CT, parenchymal abnormalities compatible with SARS-CoV-2 pneumonia were detected in 10/12 (83%) patients whereas on chest X-ray in, respectively, 8/12 (66%) and 5/12 (41%) patients for reader 1 and 2. The average increment of diagnostic performance of uld CT compared to chest X-ray was 29%. The average effective dose was, respectively, of 0.219 and 0.073 mSv.

Uld CT detects substantially more lung injuries in symptomatic patients with suspected early stage SARS-CoV-2 pneumonia compared to chest radiographs, with a significantly better inter-reader agreement, at the cost of a slightly higher equivalent radiation dose.
The efficacy and safety of beta-blockers versus cyanoacrylate injection for gastric variceal bleeding
Authors: Sun Yubao , Li Sheng , Li Feng
Published: May 2021

Background:

The benefit of beta-blockers for secondary prophylaxis of gastric variceal bleeding has limited evidence. Therefore, a systematic review and meta-analysis was conducted to systematically analyze and compare the effect of beta-blockers versus cyanoacrylate injection for patients with gastric variceal bleeding.

Methods:

The Preferred Reporting Items for Systematic Reviews and Meta-Analyses reporting guidelines will be followed to conduct the present meta-analysis. From the inception to June 2021, the Web of Science, EMBASE, PubMed, and Cochrane Library electronic databases will be searched using the key phrases “beta-blockers,” “cyanoacrylate,” and “gastric variceal bleeding” for all relevant English-language trials. Study included in our meta-analysis has to meet the following criteria: observational or randomized controlled trial focusing on assessing the effectiveness of beta-blockers and cyanoacrylate injection for gastric variceal bleeding; the following outcome measures are reported: bleeding from gastric variceal, overall mortality, bleed related mortality, and complications.

Results:

This study expects to provide credible and scientific evidence for the efficacy and safety of beta-blockers versus cyanoacrylate injection for patients with gastric variceal bleeding.

Registration number:

10.17605/OSF.IO/CPV9T.
First open-label, single-arm, prospective study of real-world use of FIX replacement therapy in a predominantly pediatric hemophilia B population in China
Authors: Yang Renchi , Wu Runhui , Sun Jing , Sun Feifei , Rupon Jeremy , Huard Francois , Korth-Bradley Joan M. , Xu Lihong , Luo Binyu , Liu Yingxue Cathy , Rendo Pablo
Published: May 2021

Background:

Nonacog alfa (recombinant factor IX [FIX]) is approved in China for the control and prevention of bleeding events in patients with hemophilia B. This was the first study to assess prophylaxis and on-demand therapy with recombinant FIX replacement in a real-world setting in China. This study aimed to evaluate the safety and efficacy of nonacog alfa in Chinese patients with hemophilia B.

Methods:

In this open-label, multicenter study (clinicaltrials.gov identifier NCT02336178), patients received on-demand or prophylactic treatment with intravenous nonacog alfa for approximately 6 months or 50 exposure days, whichever occurred first. The primary safety outcome was medically important events (i.e., development of FIX inhibitors, allergic reactions, and thrombotic events). Key secondary efficacy outcomes included the annualized bleeding rate for on-demand treatment and prophylaxis, response to on-demand treatment, the number of infusions per bleeding event, and the number of breakthrough bleeding events within 48 hours of prophylaxis.

Results:

Seventy male patients (mean [standard deviation] age 7.8 [7.2] years) were enrolled (on-demand, n = 37; prophylaxis, n = 57 [24 patients were included in both groups]). Thirty-eight (54%) patients had up to 50 FIX exposure days before the study. The only medically important event was a transient low-titer FIX inhibitor (incidence 1.4%, 95% confidence interval, 0–7.7). The mean annualized bleeding rate was 26.3 for on-demand treatment and 6.5 for prophylaxis. A mean (standard deviation) of 1.5 (1.7) nonacog alfa infusions were given per bleeding episode; 78.8% of episodes resolved with 1 infusion. Response was “excellent” or “good” for 88% of the on-demand infusions. Twenty-three bleeding events (n = 11 patients) occurred within 48 hours of 2032 prophylaxis doses (1.13%).

Conclusion:

In the real-world setting, nonacog alfa is safe and effective for on-demand treatment and for prophylaxis for patients with hemophilia B in China.
KIF4A as a novel prognostic biomarker in cholangiocarcinoma
Authors: Zhang Deng Yong , Ma Shuo Shuo , Sun Wan-liang , Lv Xue Chen Huang , Lu Zheng
Published: May 2021

Cholangiocarcinoma (CCA) is one of the most common malignant tumors. Although gene-targeted therapies have significantly improved the outcome of many cancers, the results are still not satisfactory for patients with CCA. Owing to the lack of an effective biomarker for guiding clinical treatment and monitoring prognosis in patients with CCA, the purpose of this study was to identify a new biomarker that could help predict the outcome of patients with CCA using bioinformatics tools.

Gene expression data were collected from three publicly available datasets, comprising 263 patients with CCA and 22 healthy controls. Differentially expressed genes were obtained using the limma package (FDR < 0.05, |Log2FC|>1), and the respective protein–protein interaction revealed five relevant genes in the STRING dataset (TOP2A, BUB1, RRM2, TYMS, and KIF4A). The immunohistochemistry and PCR were used to analyze the difference in KIF4A expression in CCA.

Kinesin Family Member 4A (KIF4A) was the only gene significantly associated with overall patient survival (P .035), with higher KIF4A expression being associated with poor survival rates. Moreover, KIF4A was significantly correlated with the infiltration of activated memory T cells (P = .0198) and activated mast cells (P = .008) in the tumor microenvironment. Increase in KIF4A expression affected the infiltration degree of the immune cells, which may be involved in the regulation of immune tolerance by CCA cells. The results indicated that the expression of KIF4A in CCA was higher than that in paracancerous tissues.

Taken together, these findings suggest that KIF4A could be a potential new biomarker in CCA for predicting the response of patients to targeted immunotherapies.
Argon plasma coagulation with atezolizumab and chemoradiation in lung pleomorphic cancer showed a remarkable response
Authors: Harada Masanori , Morikawa Keisuke , Kagoo Namio , Ito Yutaro , Kubota Tsutomu , Ichijo Koshiro , Mochizuki Eisuke , Uehara Masahiro , Matsuura Shun , Yasuda Kazuyo , Tsukui Masaru , Koshimizu Naoki
Published: May 2021

Rationale:

Lung pleomorphic carcinoma (LPC) is generally resistant to chemotherapy or radiotherapy. However, a combination of immune checkpoint inhibitors and radiotherapy has a remarkable efficacy against LPC.

Patient Concerns and Diagnoses:

Here, we report the case of a 50-year old man diagnosed with progressive LPC. The tumor invaded the carina and predominantly obstructed the right main bronchus; therefore, a combination of palliative chemoradiotherapy and atezolizumab was initiated. However the trachea was gradually obstructed.

Intervention and Outcome:

Argon plasma coagulation (APC) was performed to prevent tumor invasion. After three APC sessions, the tumor showed a necrotic change and was easily excised using biopsy forceps.

Lessons:

A combination of chemoradiotherapy, atezolizumab, and APC showed a good efficacy, and the patient had a good response to atezolizumab maintenance therapy. Multidisciplinary treatments, such as a combination of immune checkpoint inhibitors and APC, could have synergistic efficacy in lung cancer.
Serum transglutaminase antibodies do not always detect the persistent villous atrophy in patients with celiac disease on a gluten-free diet
Authors: Stefanelli Gianpiero , Navisse Sara , Valvano Marco , Vernia Filippo , Ciccone Antonio , Melideo Dina , Necozione Stefano , Calvisi Giuseppe , Coletti Gino , Viscido Angelo , Latella Giovanni
Published: May 2021

Background and aim

Serum transglutaminase antibodies (tTGs) are used for celiac disease screening and to monitor celiac disease patients on a gluten-free diet (GFD). The need for histology of duodenal biopsies to assess mucosal healing after a GFD is still a matter of debate. We evaluated whether tTGs are adequate to detect the persistence of histological lesions of duodenal mucosa in celiac patients after a GFD.

Methods

In total 253 patients with histological diagnosis of celiac disease according to Marsh criteria, both at the time of diagnosis (T0) and 18–24 months after starting a GFD (T2), were included. tTGs were evaluated both at T0 and T2; endomysial antibodies (EMAs) only at T0.

Results

At T0, 9.2% of patients had both tTG and EMA negative values, despite the evidence of duodenal lesions: 33.3% of Marsh 1, 14.3% of Marsh 2 and 5.2% of Marsh 3. At T2, tTGs were negative in 77.6% of patients: 82.2% of Marsh 0, 79.8% of Marsh 1, 70.0% of Marsh 2 and 59.1% of Marsh 3. At T2, approximately 60% of patients with the persistence of mucosal atrophy had negative tTGs. At T0, tTG median values were lower in patients with Marsh 1 and Marsh 2 than patients with Marsh 3 (P < 0.001), whereas no difference was found at T2 regardless of Marsh’s grade (P = 0.4).

Conclusions

The results of our study highlight how histologic evaluation of duodenal biopsies remains the gold standard for both celiac disease diagnosis and the evaluation of mucosal recovery after 18–24 months of a GFD.
Application of Hemocoagulase Bothrops Atrox in the submucosal injection for endoscopic submucosal dissection: a preliminary trial
Authors: Liu Yiting , Li Rui , Tan Chenhuan , Ma Yifan , Feng Ji , Xu Qingpeng , Sun Jianing
Published: May 2021

Objective

This study aimed to evaluate the efficacy and safety of using Hemocoagulase Bothrops Atrox in the submucosal injection solution for endoscopic submucosal dissection (ESD).

Methods

A total of 120 patients with superficial neoplastic lesions of the esophagus, stomach, and colon receiving ESD were randomly divided into two groups: The epinephrine group used epinephrine-containing submucosal fluid cushion for ESD, while the hemocoagulase group used Hemocoagulase Bothrops Atrox-containing submucosal fluid cushion for ESD. The preoperative, intraoperative, and postoperative clinical parameters and postoperative adverse events of the two groups were recorded, and comparative analysis within and between groups was performed.

Results

There was no significant difference in the demographic and clinical characteristics between the hemocoagulase and epinephrine group (all P > 0.05). ESD surgery was completed in all patients. The hemocoagulase group had significantly shorter surgery time (P = 0.003) and less number of intraoperative bleeding (P = 0.010) than the epinephrine group. However, there was no significant difference in the incidences of postoperative delayed hemorrhage, and adverse events between the two groups (all P > 0.05). Multivariate linear regression demonstrated that the epinephrine group had significantly more number of intraoperative bleeding (B: 0.98, 95% confidence interval: 0.04–1.93) as compared with the hemocoagulase group.

Conclusion

Compared with epinephrine, using Hemocoagulase Bothrops Atrox in the submucosal injection for ESD surgery can significantly reduce the number of intraoperative bleeding, shorten the operation time, and did not elevate the incidence of adverse events.
Trajectories of frailty, physical function, and physical activity levels in elderly patients with heart failure: impacts of interruption and resumption of outpatient cardiac rehabilitation due to COVID-19
Authors: Kato Michitaka , Ono Shintaro , Seko Hiromasa , Tsukamoto Toshiya , Kurita Yasunari , Kubo Akira , Omote Toshiya , Omote Shingo
Published: May 2021

During the nationwide state of emergency, many hospitals could not provide outpatient cardiac rehabilitation for cardiac disease patients in order to minimize coronavirus disease 2019 (COVID-19) incidence. The purpose of this study was to examine the trajectories of frailty, physical function and physical activity levels due to interruption and resumption of outpatient cardiac rehabilitation by COVID-19 in elderly heart failure patients. Fifteen patients who did not attend outpatient cardiac rehabilitation during the state of emergency but resumed it after the state of emergency were included. Frailty, physical function and physical activity levels were assessed with the Kihon checklist (KCL), various tests including short physical performance battery (SPPB), and life space assessment (LSA), respectively. Objective parameters were measured at three points; before and after the nationwide state of emergency in Japan and 3 months after resuming outpatient cardiac rehabilitation. The post-state of emergency KCL score was significantly higher than the pre-state of emergency score (P = 0.03), whereas there was no significant difference in KCL between post-state of emergency and 3 months after cardiac rehabilitation resumption. SPPB and LSA scores did not change significantly between pre- and post-state of emergency. The changes in LSA from post-state of emergency to 3 months after cardiac rehabilitation resumption tended to correlate with changes in KCL (r = −0.71, P = 0.11). We demonstrated that frailty status deteriorated significantly in elderly heart failure patients whose outpatient cardiac rehabilitation was interrupted due to COVID-19. In addition, the frailty status showed no significant improvement after 3 months of resuming cardiac rehabilitation.
Central obesity is a contributor to systemic inflammation and monocyte activation in virally suppressed adults with chronic HIV in Kenya
Authors: Temu Tecla M. , Wagoner Jessica , Masyuko Sarah , O’Connor Aidan , Zifodya Jerry S. , Macharia Paul , Wanjalla Celestine N. , Mogaka Jerusha N. , Chohan Bhavna , Omodi Victor M. , Gervassi Ana L. , Oyugi Julius , Page Stephanie T. , Farquhar Carey , Polyak Stephen J.
Published: May 2021

Objectives:

Heightened systemic inflammation is common in obese individuals and persons with HIV (PWH) and is independently associated with an increased risk of cardiovascular diseases (CVDs). We investigated the combined effect of central obesity, a surrogate measure of visceral fat and HIV on circulating levels of inflammatory cytokines among Kenyan adults.

Design:

A cross-sectional study.

Methods:

We analysed and compared data from 287 virally suppressed PWH and 277 noninfected Kenyan adults, including biomarkers of gut epithelial dysfunction (intestinal fatty acid binding protein), monocyte activation (soluble CD163 and CD14) and inflammation [interleukin (IL)-1β, IL-6, TNF-α and hsCRP] by HIV/central obesity status (HIV-positive/obese, HIV-negative/obese, HIV-positive/nonobese and HIV-negative/nonobese). Central obesity was defined as waist circumference more than 80 cm for women and more than 94 cm for men. We assessed the association of HIV/obesity status with elevated biomarkers (>75th percentile) using logistic regression.

Results:

Median age for participants was 44 years and 37% were centrally obese. Levels of all biomarkers were higher among the HIV-positive/obese compared with the HIV-negative/nonobese (P < 0.05 for all comparisons). The HIV-positive/obese group had the greatest odds of having elevated inflammatory biomarkers compared with other groups even after adjustment of age, BMI and other conventional CVD risk factors (P < 0.05 for all). Additional adjustment for sCD163 in the multivariate model substantially attenuated the association for HIV-positive/obesity with IL-1β, IL-6 and TNF-α but not hsCRP. The contribution of HIV-positive/obesity to inflammation was independent of the degree of immunosuppression.

Conclusion:

Central obesity is prevalent among virally suppressed African PWH and is associated with greater inflammation and monocyte activation independent of other comorbidities and HIV-specific factors.
Diffuse Cutaneous Angiosarcoma in the Scalp and Face Demonstrated on FDG PET/CT Imaging
Authors: Xiao Liu , Zhang Wenjie , Li Lin
Published: May 2021

Diffuse cutaneous angiosarcomas are rare. Herein, we reported FDG PET/CT findings of cutaneous angiosarcoma in a 59-year-old man. FDG PET/CT imaging was performed for staging, showing diffuse intense FDG uptake with an SUVmax of 19 in the scalp and face. Chemotherapy was recommended for this patient because surgery and radiotherapy were not appropriate due to the widespread skin involvement. Our case suggests that cutaneous angiosarcoma can present with diffuse skin involvement, and FDG PET/CT plays an important role in determining the treatment plan to avoid unnecessary surgery and radiotherapy.
Incidentally Detected Hypermetabolism in Pons Suggestive of Pontine Myelinolysis on 18F-FDG PET/CT Scan
Authors: Zade Anand , Ingule Amol , Trivedi Chintan , Jha Smriti , Agrwal Anup
Published: May 2021

Central pontine myelinolysis (CPM) is demyelinating condition of pons caused by osmotic stress due to rapid correction of hyponatremia. We present a case where CPM was an incidental finding on FDG PET/CT scan. To the best of our knowledge, only 3 case reports have been published till date describing CPM on 18F-FDG PET/CT scans.
Multiple-Organ Involvement in Familial Hemophagocytic Lymphohistiocytosis Type 2 Shown on FDG PET/CT
Authors: Wang Wei , Yang Xu , Yang Jigang
Published: May 2021

FDG PET/CT in an 18-year-old man with known familial hemophagocytic lymphohistiocytosis (HLH) type 2 demonstrated abnormally in the brain, liver, and lymph nodes. Pathology showed no sign of lymphoproliferative disease. The patient underwent the chemotherapy of HLH. Six months after chemotherapy, a follow-up FDG PET/CT did not show any abnormal 18F-FDG activity, suggesting a complete response. The present case shows FDG PET/CT might not only be useful in staging the familial HLH but also able to evaluate the therapy response.
68Ga-DOTATATE and 68Ga-NODAGA-JR11 PET/CT Images in a Patient With Gastric Neuroendocrine Tumor
Authors: Lin Zefang , Lin Rong , Zhang Jiaying , Yao Shaobo , Miao Weibing
Published: May 2021

A 52-year-old man with newly diagnosed gastric neuroendocrine tumor (NET) underwent 68Ga-NODAGA-JR11 and 68Ga-DOTATATE imaging. 68Ga-DOTATATE PET/CT showed no 68Ga-DOTATATE uptake in the lesion, where 68Ga-NODAGA-JR11 showed intense uptake. The patient subsequently received endoscopic submucosal dissection and en bloc resection of the lesion, which was pathologically confirmed as gastric NET (G2). The positive findings of 68Ga-NODAGA-JR11 in the current case highlighted that 68Ga-NODAGA-JR11 PET/CT may be a promising molecular imaging technique for the detection of NETs with high sensitivity.
FDG PET/CT Findings of a Primary Paravertebral Liposarcoma
Authors: Wang Rang , Shen Guohua , Tian Rong
Published: May 2021

Liposarcoma is a soft tissue tumor that commonly appears in the retroperitoneum and the extremities. Herein, we presented the imaging findings of a 68-year-old man with a paravertebral liposarcoma involving the adjacent vertebral bodies, appendices, and ribs. MRI revealed this mass located in the left side of T9 to T10 vertebral bodies. FDG PET/CT demonstrated the mass with intense FDG uptake. Finally, the pathological findings were consistent with a diagnosis of a primary paravertebral liposarcoma.
18F-FDG PET/CT Findings of Myeloid Sarcoma in the Pancreas
Authors: Filizoglu Nuh , Ozguven Salih
Published: May 2021

Myeloid sarcoma (MS) is a rare neoplasm of leukemic cells that infiltrates an extramedullary soft tissue. MS may present at initial diagnosis of any myeloproliferative disease or relapse after treatment. It is most commonly associated with acute myeloid leukemia. The incidence of pancreatic involvement of MS is very rare. Herein we present FDG PET/CT findings of a rare case of MS involving the pancreas, which was initially misdiagnosed as pancreatic carcinoma.
The intertwined history of non-human primate health and human medicine at the Smithsonian's National Zoo and Conservation Biology Institute
Authors: Gutierrez Sara , Canington Stephanie L. , Eller Andrea R. , Herrelko Elizabeth S. , Sholts Sabrina B.
Published: May 2021

In April 2020, the Bronx Zoo made a headline-grabbing announcement: one of their tigers tested positive for COVID-19, a striking example of zoos as microcosms of human health and medicine. Indeed, many diseases and health problems experienced by zoo animals are found in, and frequently linked to, humans. Furthermore, the veterinary care they receive often incorporates knowledge, tools and treatments used in human health care. Here, we analyse these developments across the history of non-human primate health at the Smithsonian's National Zoo and Conservation Biology Institute (NZP), one of the oldest zoos in the United States. From NZP's opening in 1891, we distinguish five historical time periods within its first century based on how animal health was described, treated and understood. Concentrating on descriptions of primates in annual Smithsonian reports, we see notable changes in NZP activities focused on housing and environment (1889–1900), disease diagnosis and prevention (1901–1916), human–animal connections (1917–1940), research and collaboration (1941–1973) and conservation (1974–1989). We relate these shifts to concurrent medical events and trends in the United States, and interpret NZP's history in a broader scientific and societal context leading to a ‘One Health’ approach to animal care and welfare today.
Sustained coevolution of phage Lambda and Escherichia coli involves inner- as well as outer-membrane defences and counter-defences
Authors: Burmeister Alita R. , Sullivan Rachel M. , Gallie Jenna , Lenski Richard E.
Published: May 2021

Bacteria often evolve resistance to phage through the loss or modification of cell surface receptors. In

Escherichia coli

and phage λ, such resistance can catalyze a coevolutionary arms race focused on host and phage structures that interact at the outer membrane. Here, we analyse another facet of this arms race involving interactions at the inner membrane, whereby

E. coli

evolves mutations in mannose permease-encoding genes manY and manZ that impair λ’s ability to eject its DNA into the cytoplasm. We show that these man mutants arose concurrently with the arms race at the outer membrane. We tested the hypothesis that λ evolved an additional counter-defence that allowed them to infect bacteria with deleted man genes. The deletions severely impaired the ancestral λ, but some evolved phage grew well on the deletion mutants, indicating that they regained infectivity by evolving the ability to infect hosts independently of the mannose permease. This coevolutionary arms race fulfils the model of an inverse gene-for-gene infection network. Taken together, the interactions at both the outer and inner membranes reveal that coevolutionary arms races can be richer and more complex than is often appreciated.
Mask mandate and use efficacy for COVID-19 containment in US States
Authors: Guerra Damian D. , Guerra Daniel J.
Published: May 2021

Background

COVID-19 pandemic mitigation requires evidence-based strategies. Because COVID-19 can spread via respired droplets, most US states mandated mask use in public settings. Randomized control trials have not clearly demonstrated mask efficacy against respiratory viruses, and observational studies conflict on whether mask use predicts lower infection rates. We hypothesized that statewide mask mandates and mask use were associated with lower COVID-19 case growth rates in the United States.

Methods

We calculated total COVID-19 case growth and mask use for the continental United States with data from the Centers for Disease Control and Prevention and Institute for Health Metrics and Evaluation. We estimated post-mask mandate case growth in non-mandate states using median issuance dates of neighboring states with mandates.

Results

Earlier mask mandates were not associated with lower total cases or lower maximum growth rates. Earlier mandates were weakly associated with lower minimum COVID-19 growth rates. Mask use predicted lower minimum but not lower maximum growth rates. Growth rates and total growth were comparable between US states in the first and last mask use quintiles during the Fall-Winter wave. These observations persisted for both natural logarithmic and fold growth models and when adjusting for differences in US state population density.

Conclusions

We did not observe association between mask mandates or use and reduced COVID-19 spread in US states. COVID-19 mitigation requires further research and use of existing efficacious strategies, most notably vaccination.
How COVID-19 challenged care for women and their newborns: a qualitative case study of the experience of Belgian midwives during the first wave of the pandemic
Authors: Huysmans Elise , Audet Constance , Delvaux Thérèse , Galle Anna , Semaan Aline , Asefa Anteneh , Benova Lenka
Published: May 2021

In this article, we describe the results of a rapid qualitative study conducted between May 19 and June 25, 2020 on the work experience of midwives during the first wave of the COVID-19 pandemic in Brussels and Wallonia (Belgium). Using semi-structured interviews conducted with fifteen midwives working in hospitals or practicing privately, we investigated the impact of the first COVID-19 wave on their work experience, the woman-midwife relationship, and midwife-perceived changes in quality of care. Findings include high levels of stress and insecurity related to the lack of resources and personal protective equipment, feelings of distrust from midwives towards the Belgian State and public health authorities, as well as structural and organizational challenges within maternity wards which negatively affected quality of care. Moreover, based on the midwives’ experiences, we demonstrate the need to recognise the views of all stakeholders involved in maternal and newborn care provision, and share five essential lessons learned from this study: 1) it is crucial to acknowledge the central role of midwives for maintaining maternal and newborn care amidst the pandemic and beyond; 2) creating unified national guidelines could support ensuring best practice; 3) efforts must be put in place to diminish the climate of mistrust towards health authorities and to repair the relationship between midwives and decision-makers which was damaged during the pandemic; 4) caring for front-line healthcare workers’ mental health is critical, and 5) quality of maternal care can be improved, even in the midst of a pandemic, through team effort and creative solutions tailored to the needs and demands of each setting.
Monoclonal Antibody Treatment, Prophylaxis and Vaccines Combined to Reduce SARS CoV-2 Spread
Authors: Kamal Mohamed A. , Kuznik Andreas , Qi Luyuan , Więcek Witold , Hussein Mohamed , Hassan Hazem E. , Patel Kashyap , Obadia Thomas , Toroghi Masood Khaksar , Conrado Daniela J. , Al-Huniti Nidal , Casciano Roman , O’Brien Meagan P. , Barnabas Ruanne V. , Cohen Myron S. , Smith Patrick F.
Published: May 2021

Background

Antiviral monoclonal antibodies (mAbs) developed for treatment of COVID-19 reduce the magnitude and duration of viral shedding and can thus potentially contribute to reducing transmission of the causative virus, severe acute respiratory coronavirus 2 (SARS-CoV-2). However, use of these mAbs in combination with a vaccine program has not been considered in public health strategic planning.

Methods

We developed an agent-based model to characterize SARS-CoV-2 transmission in the US population during an aggressive phase of the pandemic (October 2020 to April 2021), and simulated the effects on infections and mortality of combining mAbs as treatment and post-exposure prophylaxis (PEP) with a vaccine program plus non-pharmaceutical interventions. We also interrogated the impact of rapid diagnostic testing, increased mAb supply, and vaccine rollout.

Findings

Allocation of mAbs as PEP or targeting those ≥65 years provided the greatest incremental benefits relative to vaccine in averting infections and deaths, by up to 17% and 41%, respectively. Rapid testing, facilitating earlier diagnosis and mAb use, amplified these benefits. The model was sensitive to mAb supply; doubling supply further reduced infections and mortality, by up to two-fold, relative to vaccine. mAbs continued to provide incremental benefits even as proportion of the vaccinated population increased.

Interpretation

Use of anti-viral mAbs as treatment and PEP in combination with a vaccination program would substantially reduce SARS-CoV-2 transmission and pandemic burden. These results may help guide resource allocation and patient management decisions for COVID-19 and can also be used to inform public health policy for current and future pandemic preparedness.

Funding

Regeneron Pharmaceuticals.
Childhood body composition and BMI as a predictor of cardiometabolic non-communicable diseases in adulthood: A systematic review
Authors: Bander Amela , Murphy-Alford Alexia J , Owino Victor O , Loechl Cornelia U , Wells Jonathan CK , Gluning Imara , Kerac Marko
Published: May 2021

There is growing evidence that childhood malnutrition is associated with non-communicable diseases (NCDs) in adulthood and that body composition mediates some of this association. This review aims to determine: if childhood body composition can be used to predict later-life cardiometabolic NCDs; which measures of body composition best predict future NCDs. Three electronic databases were searched for studies where: children aged under 5 year had body composition measured; cardiometabolic health outcomes were measured a minimum of 10 years later. 29 studies met the inclusion criteria. Though a poor proxy measure of body composition, Body mass index (BMI) was commonly reported (n=28, 97%). 25% of these studies included an additional measure (Ponderal Index or skinfold thickness). Only some studies adjusted for current body size (n=11, 39%). Many studies reported that low infant BMI and high childhood BMI increased the risk of NCD-related outcomes in later life but no conclusions can be made about exact timing of child malnutrition and consequent impact on NCD. Because studies focused on BMI rather than direct measures of body composition, nothing can be said about which measures of body composition in childhood are most useful. Future research on child nutrition and long-term outcomes is urgently needed and should include validated body composition assessments as well as standard anthropometric and BMI measurements.
Variants of concern are overrepresented among post-vaccination breakthrough infections of SARS-CoV-2 in Washington State
Authors: McEwen Abbye E. , Cohen Seth , Bryson-Cahn Chloe , Liu Catherine , Pergam Steven A. , Lynch John , Schippers Adrienne , Strand Kathy , Whimbey Estella , Mani Nandita S , Zelikoff Allison J. , Makarewicz Vanessa A. , Brown Elizabeth R. , Mohamed Bakhash Shah A. , Baker Noah R. , Castor Jared , Livingston Robert J. , Huang Meei-Li , Jerome Keith R. , Greninger Alexander L. , Roychoudhury Pavitra
Published: May 2021

Across 20 vaccine breakthrough cases detected at our institution, all 20 (100%) infections were due to variants of concern (VOC) and had a median Ct of 20.2 (IQR=17.1-23.3). When compared to 5174 contemporaneous samples sequenced in our laboratory, VOC were significantly enriched among breakthrough infections (p < .05).