bluuebunny/crossref_metadata_2025 huggingface dataset:
Post-synthesis treatment of graphene oxide/silica particles nanocomposite with piranha acid for functionalization
Authors: Mukherjee Ahana , Kumari Munesh , Ghosh Moulick Ranjita
Published: December 2021

The discovery of 2D materials has led researchers to a broad material platform. Their excellent physical, chemical and electrical properties along with the layered structure have found applications in various fields. However, these materials also have limitations and functionalisation is one of the mechanisms that improves their properties. In our previous work, we observed surface-enhanced Raman spectroscopy (SERS) after covalent attachment of protein to the graphene nanocomposite where piranha acid was used to generate the functional groups. The current work describes the synthesis and characterisation of a graphene oxide-silica particle nanocomposite after piranha acid treatment at different time intervals. X-ray diffraction (XRD), scanning electron microscopy (SEM), transmission electron microscopy (TEM), Fourier transform infrared spectroscopy (FTIR) and Raman spectroscopy were performed to indicate structural changes which facilitated the protein attachment. The SEM and TEM results indicated that the sample which was piranha acid activated for 3 min displayed better arrangement of silica particles on the graphene sheets with exposition of the highest net surface area in the graphene sheet, compared to the other samples and determined to be the best functionalised nanocomposite for further applications. Morphological instability of the graphene sheets and clustering of silica particles were observed in the samples treated for more than 3 min. Interestingly, the same degree of graphitisation was observed in all the samples when I

D
/I

G
ratios {(≤0.99) ≠ 0} were determined by Raman spectroscopy.
Quality assurance for the NHS abdominal aortic aneurysm screening programme in England
Authors: Campbell Abigail , Waggett Helena , Armer Morag , Jacomelli Jo , Earnshaw Jonothan J.
Published: December 2021

Introduction

The National Health Service Abdominal Aortic Aneurysm Screening Programme (NAAASP) was introduced in England in 2009 to offer ultrasound screening to men over 65 years, in order to reduce aneurysm-related deaths. This study describes the development of a quality assurance (QA) process and conducts an analysis of the first round of QA visit reports. The aim was to identify themes where local providers can target their efforts for improvement.

Methods

Forty-one providers were assessed over 4 years using a process of QA visits adapted from previously established screening programmes. A mixture of qualitative and quantitative methods was used to analyse the 41 QA reports, which identified a range of recommendations for providers. The data were coded for key words and assigned to themes. The number of recommendations per visit report was compared with experience of the providers and performance against national screening standards.

Results

A total of 773 recommendations were made, with an average of 19 per QA visit. Around one third of the recommendations were based on governance and leadership standards, with 43.0 per cent of those based around commissioning and accountability. A significant relationship was seen between number of infrastructure recommendations and performance against standards.

Conclusion

This review of a QA cycle found that sound infrastructure is key to the success of a local provider.
Brain capillary obstruction during neurotoxicity in a mouse model of anti-CD19 chimeric antigen receptor T-cell therapy
Authors: Faulhaber Lila D. , Phuong Anthea Q. , Hartsuyker Kendra Jae , Cho Yeheun , Mand Katie K. , Harper Stuart D. , Olson Aaron K. , Garden Gwenn A. , Shih Andy Y. , Gust Juliane
Published: December 2021

Immunotherapy for haematologic malignancies with CD19-directed chimeric antigen receptor T cells has been highly successful at eradicating cancer but is associated with acute neurotoxicity in ∼40% of patients. This neurotoxicity correlates with systemic cytokine release syndrome, endothelial activation and disruption of endothelial integrity, but it remains unclear how these mechanisms interact and how they lead to neurologic dysfunction. We hypothesized that dysfunction of the neurovascular unit is a key step in the development of neurotoxicity. To recapitulate the interaction of the intact immune system with the blood–brain barrier, we first developed an immunocompetent mouse model of chimeric antigen receptor T-cell treatment-associated neurotoxicity. We treated wild-type mice with cyclophosphamide lymphodepletion followed by escalating doses of murine CD19-directed chimeric antigen receptor T cells. Within 3–5 days after chimeric antigen receptor T-cell infusion, these mice developed systemic cytokine release and abnormal behaviour as measured by daily neurologic screening exams and open-field testing. Histologic examination revealed widespread brain haemorrhages, diffuse extravascular immunoglobulin deposition, loss of capillary pericyte coverage and increased prevalence of string capillaries. To measure any associated changes in cerebral microvascular blood flow, we performed in vivo two-photon imaging through thinned-skull cranial windows. Unexpectedly, we found that 11.9% of cortical capillaries were plugged by Day 6 after chimeric antigen receptor T-cell treatment, compared to 1.1% in controls treated with mock transduced T cells. The capillary plugs comprised CD45+ leucocytes, a subset of which were CD3+ T cells. Plugging of this severity is expected to compromise cerebral perfusion. Indeed, we found widely distributed patchy hypoxia by hypoxyprobe immunolabelling. Increased serum levels of soluble ICAM-1 and VCAM-1 support a putative mechanism of increased leucocyte–endothelial adhesion. These data reveal that brain capillary obstruction may cause sufficient microvascular compromise to explain the clinical phenotype of chimeric antigen receptor T-cell neurotoxicity. The translational impact of this finding is strengthened by the fact that our mouse model closely approximates the kinetics and histologic findings of the chimeric antigen receptor T-cell neurotoxicity syndrome seen in human patients. This new link between systemic immune activation and neurovascular unit injury may be amenable to therapeutic intervention.
Human Papillomavirus Antibody Levels Following Vaccination or Natural Infection Among Young Men Who Have Sex With Men
Authors: Chow Eric P F , Fairley Christopher K , Zou Huachun , Wigan Rebecca , Garland Suzanne M , Cornall Alyssa M , Atchison Steph , Tabrizi Sepehr N , Chen Marcus Y
Published: December 2021

Background

Australia introduced a school-based gender-neutral human papillomavirus (HPV) vaccination program for girls and boys aged 12–13 years in 2013. We examined HPV type–specific antibody levels in unvaccinated young men who have sex with men (MSM) with natural infection and compared these with levels in those vaccinated against HPV.

Methods

Serum specimens at baseline were collected from MSM aged 16–20 years in the HYPER1 (Human Papillomavirus in Young People Epidemiological Research) and HYPER2 studies, conducted in 2010–2013 and 2017–2019, respectively. Merck’s 4-plex HPV competitive Luminex Immunoassay was used to quantify HPV6-, HPV11-, HPV16-, and HPV18-specific antibodies. We compared antibody levels for each HPV genotype between unvaccinated men (HYPER1) and vaccinated men (HYPER2) using the Mann-Whitney U test.

Results

There were 200 unvaccinated men and 127 vaccinated men included in the analysis. Median antibody levels among vaccinated men were significantly higher than levels among unvaccinated men for HPV6 (223 milli-Merck units per milliliter [mMU/mL] vs 48 mMU/mL, P < .0001), HPV11 (163 mMU/mL vs 21 mMU/mL, P < .0001), HPV16 (888 mMU/mL vs 72 mMU/mL, P < .0001), and HPV18 (161 mMU/mL vs 20 mMU/mL, P < .0001). Antibody levels did not change over time for up to 66 months for all 4 genotypes among vaccinated men.

Conclusions

Among young MSM vaccinated with the quadrivalent HPV vaccine, antibody levels for HPV6, HPV11, HPV16, and HPV18 were significantly higher than those in unvaccinated MSM following natural infection. Antibody levels following vaccination appeared to remain stable over time.

Clinical Trials Registration

NCT01422356 for HYPER1 and NCT03000933 for HYPER2.
Successful Fidaxomicin Hospital Discharges of Adult Patients With Clostridioides difficile Infections Post–2021 Guidelines: Are Economic Barriers Finally Coming Down?
Authors: Fang Noah , Ha David , Dong Kimberly , Leung Thomas , Lee Sydney , Holubar Marisa , Meng Lina
Published: December 2021

We reviewed Clostridioides difficile–positive patients discharged on fidaxomicin after local adoption of 2021 C. difficile infection (CDI) guidelines. From 14 June to 3 October 2021, 80% (12/15) had copayments of $0–$35 and 27% (4/15) required prior authorization. The 30-day CDI recurrence was 7%.
A reappraisal of the sinus venosus defect
Authors: Chowdhury Ujjwal Kumar , Anderson Robert H , Pandey Niraj Nirmal , Sharma Srikant , Sankhyan Lakshmi Kumari , George Niwin , Goja Shikha , Arvind Balaji
Published: December 2021

OBJECTIVES

The phenotypic features and morphogenesis of the ‘sinus venosus defect’ remain controversial. The phenotypic features are anomalous systemic connections of 1 or more pulmonary veins that retain their left atrial connection, usually associated with a biatrial connection of the superior caval vein. Cases with these features, however, have not always been described as sinus venosus defects.

METHODS

We reviewed the findings documented in the literature from 11 patients with a biatrial connection of the superior caval vein, most reported following an autopsy examination. We compared these findings with the anatomical details of 50 patients undergoing surgical correction in our centre, paying particular attention to the override of the superior caval vein.

RESULTS

In only two-thirds of those undergoing surgery did the superior caval vein override the rims of the oval fossa, with the degree of override >50% in only 2 individuals. It is only these latter 2 cases that are directly comparable to the reported cases of biatrial connection of the superior caval vein.

CONCLUSIONS

Our comparisons provide new insights into the developmental background and phenotypic features of the superior sinus venosus defect. The defects exist because of the anomalous systemic connection of the pulmonary veins that retain their left atrial connections but not always in association with a biatrial connection of the superior caval vein. In extreme cases, nonetheless, they can underscore the connection of the caval vein to the morphologically left atrium, frequently described previously as a ‘biatrial connection’. The sinus venosus defect is better considered a venovenous malformation than a septal defect.
Prevalence and clinical significance of isolated low QRS voltages in young athletes
Authors: Zorzi Alessandro , Bettella Natascia , Tatangelo Mario , Del Monte Alvise , Vessella Teresina , Poscolieri Barbara , Crescenzi Cinzia , Pegorin Davide , D’Ascenzi Flavio , Pescatore Valentina , Giada Franco , Sarto Patrizio , Calò Leonardo , Schiavon Maurizio , Gregori Dario , Hadley David M , Drezner Jonathan A , Pelliccia Antonio , Corrado Domenico
Published: December 2021

Aims

Low QRS voltages (peak to peak <0.5 mV) in limb leads (LQRSV) on the athlete’s electrocardiogram (ECG) may reflect an underlying cardiomyopathy, mostly arrhythmogenic cardiomyopathy (ACM) or non-ischaemic left ventricular scar (NILVS). We studied the prevalence and clinical meaning of isolated LQRSV in a large cohort of competitive athletes.

Methods and results

The index group included 2229 Italian competitive athletes [median age 18 years (16–25), 67% males, 97% Caucasian] without major ECG abnormalities at pre-participation screening. Three control groups included Black athletes (N = 1115), general population (N = 1115), and patients with ACM or NILVS (N = 58). Echocardiogram was performed in all athletes with isolated LQRSV and cardiac magnetic resonance (CMR) in those with ventricular arrhythmias or echocardiographic abnormalities. The isolated LQRSV pattern was found in 1.1% index athletes and was associated with increasing age (median age 28 vs. 18 years; P < 0.001), elite status (71% vs. 34%; P < 0.001), body surface area, and body mass index but not with sex, type of sport, and echocardiographic left ventricular mass. The prevalence of isolated LQRSV was 0.2% in Black athletes and 0.3% in young individuals from the general population. Cardiomyopathy patients had a significantly greater prevalence of isolated LQRSV (12%) than index athletes, Black athletes, and general population. Five index athletes with isolated LQSRV and exercise-induced ventricular arrhythmias underwent CMR showing biventricular ACM in 1 and idiopathic NILVS in 1.

Conclusions

Unlike cardiomyopathy patients, the ECG pattern of isolated LQRSV was rarely observed in athletes. This ECG sign should prompt clinical work-up for exclusion of an underlying cardiomyopathy.
Social Support and Depressive Symptoms Among Men and Women With Same-Sex Experiences in Later Life
Authors: Saunders R Kyle , Carr Dawn C
Published: December 2021

Background and Objectives

Social support is a vital psychological health resource for well-being in later life. However, research on the associations of social support has largely excluded sexual minorities. This study compares the association between sources of social support and depressive symptoms across groups of older heterosexual and sexual minority men and women. Sexual minority status herein is based on self-reported sexual histories of having same-sex and opposite-sex only experiences (SSE and OSO).

Research Design and Methods

Based on a pooled cross-sectional data set drawn from 3 waves of the National Social Life, Health, and Aging Project, we used ordinary least squares regression and moderation tests to evaluate how 3 sources of social support—partner, family, friend—are related to depressive symptoms for SSE and OSO men and women.

Results

Results show OSO men and women both had significant negative associations between depressive symptoms and social support regardless of the source. SSE women, in contrast, only have a significant association between high levels of friend support, and SSE men only show significant effects in relation to high levels of partner support.

Discussion and Implications

These results suggest the effects of social support on psychological health are significantly constrained/circumscribed for sexual minority men and women. Interventions designed to decrease symptoms of depression in older sexual minorities through social support are discussed.
Current laboratory protocols for detecting fish species with environmental DNA optimize sensitivity and reproducibility, especially for more abundant populations
Authors: Stoeckle Mark Y , Adolf Jason , Ausubel Jesse H , Charlop-Powers Zach , Dunton Keith J , Hinks Greg
Published: December 2021

Analysing environmental DNA (eDNA) in seawater can aid in monitoring marine fish populations. However, the extent to which current methods optimize fish eDNA detection from water samples is unknown. Here, we test modifications to laboratory components of an eDNA metabarcoding protocol targeting marine finfish. As compared to baseline methods, amplifying a smaller proportion of extracted DNA yielded fewer species, and, conversely, amplifying a larger proportion identified more taxa. Higher-read species were amplified more reproducibly and with less variation in read number than were lower-read species. Among pooled samples, 20-fold deeper sequencing recovered one additional fish species out of a total of 63 species. No benefit was observed with additional PCR cycles, alternative primer concentrations, or fish-selective primers. Experiments using an exogenous DNA standard to assess absolute eDNA concentration suggested that, for a given proportion of a DNA sample, current laboratory methods for metabarcoding marine fish eDNA are near to maximally sensitive. Our results support the unofficial standard collection volume of one liter for eDNA assessment of commonly encountered marine fish species. We conclude that eDNA rarity poses the main challenge to current methods.
A review of partial information in additive multicriteria methods
Authors: Da Silva Lucas Borges Leal , Frej Eduarda Asfora , De Almeida Adiel Teixeira , Ferreira Rodrigo José Pires , Morais Danielle Costa
Published: December 2021

The relevance of multiple criteria decision-making/aiding is reinforced by the prominence of these methods in a wide range of applications. Whether by solving problems with a single decision-maker (DM) or a group of DMs, additive modelling, based on value or utility functions, is the most traditional. However, applying this kind of method raises a critical issue: the difficulty in eliciting DM’s preferences and recommending a decision. Actually, it is a hard task for the DM to provide complete information regarding their preferences, because the DM may not be able to provide such information in the detailed way required, or even they may not be willing to do so. From this perspective, the emergence and growth of partial (incomplete or imprecise) information-based methods is indicative that these are a useful way of guiding decision-making as they require less cognitive input from a DM. Thus, this paper systematically reviews the literature on multicriteria decision methods that deal with partial information, focusing on the Multi-Attribute Value/Utility Theory context. Strategic research questions guide a bibliometric and content analysis of 105 peer-reviewed papers selected from the Web of Science (Main Collection). An integrated analysis of the results provides scholars, researchers and other professionals with a deeper comprehension of methodological advances and respective contributions, and of the main challenges and trends in this field of knowledge. Our analysis aims to show that when these methods are applied more reliable decision-making can be achieved.
On Locally Conformally Kähler Threefolds with Algebraic Dimension Two
Authors: Angella Daniele , Parton Maurizio , Vuletescu Victor
Published: December 2021

The paper is part of an attempt of understanding non-Kähler threefolds. We start by looking at compact complex non-Kähler threefolds with algebraic dimension two and admitting lcK metrics. Under certain assumptions, we prove that they are blown-up quasi-bundles over a projective surface.
Quantitating and assessing interoperability between electronic health records
Authors: Bernstam Elmer V , Warner Jeremy L , Krauss John C , Ambinder Edward , Rubinstein Wendy S , Komatsoulis George , Miller Robert S , Chen James L
Published: December 2021

Objectives

Electronic health records (EHRs) contain a large quantity of machine-readable data. However, institutions choose different EHR vendors, and the same product may be implemented differently at different sites. Our goal was to quantify the interoperability of real-world EHR implementations with respect to clinically relevant structured data.

Materials and Methods

We analyzed de-identified and aggregated data from 68 oncology sites that implemented 1 of 5 EHR vendor products. Using 6 medications and 6 laboratory tests for which well-accepted standards exist, we calculated inter- and intra-EHR vendor interoperability scores.

Results

The mean intra-EHR vendor interoperability score was 0.68 as compared to a mean of 0.22 for inter-system interoperability, when weighted by number of systems of each type, and 0.57 and 0.20 when not weighting by number of systems of each type.

Discussion

In contrast to data elements required for successful billing, clinically relevant data elements are rarely standardized, even though applicable standards exist. We chose a representative sample of laboratory tests and medications for oncology practices, but our set of data elements should be seen as an example, rather than a definitive list.

Conclusions

We defined and demonstrated a quantitative measure of interoperability between site EHR systems and within/between implemented vendor systems. Two sites that share the same vendor are, on average, more interoperable. However, even for implementation of the same EHR product, interoperability is not guaranteed. Our results can inform institutional EHR selection, analysis, and optimization for interoperability.
How should we appropriately classify low-risk uterine cervical cancer patients suitable for de-intensified treatment?
Authors: Murakami Naoya , Kuno Ikumi , Yoshida Hiroshi , Shiraishi Kouya , Kato Tomoyasu , Igaki Hiroshi
Published: December 2021

We suggested de-escalation would be possible for cervical cancer like human papillomavirus (HPV)-related oropharyngeal cancer. However, the classification was based on tumor shrinkage that can be obtained after half of the treatment was finished. Our other article found adverse factors which can be obtained prior to treatment, and they might classify patients earlier.
Depression and Anxiety as Mediators of PTSD Symptom Clusters and Pain in Treatment-Seeking Canadian Forces Members and Veterans
Authors: Roth Maya , King Lisa , Richardson Don
Published: December 2021

Introduction

Chronic pain (CP) commonly presents alongside psychiatric conditions such as depression, PTSD, and generalized anxiety. The current study sought to better understand this complex relationship by determining whether anxiety and depression symptom severity mediated the relationship between DSM-5 PTSD symptom clusters and pain symptoms in a sample of 663 Canadian Armed Forces (CAF) personnel and veterans seeking treatment for mental health conditions.

Materials and Methods

Generalized anxiety disorder, depression, and PTSD symptom severity were measured using self-report scales provided as part of a standard intake protocol. Pain symptoms were measured using the Bodily Pain subscale of the SF-36 (SF-36 BPS). Linear regressions were used to explore the relationship between PTSD symptom clusters, depression, anxiety, and pain. Bootstrapped resampling analyses were employed to test mediation effects.

Results

The average SF-36 BPS score in this sample was 36.6, nearly 1.5 SDs below the population health status, enforcing the salience of pain symptoms as a concern for veterans and CAF seeking treatment for military-related psychiatric conditions. The effects of PTSD symptom clusters avoidance, negative mood and cognitions, and arousal on pain were fully mediated by anxiety and depression severity. However, the effect of intrusion on pain was not mediated by depression and only partly mediated by anxiety.

Conclusion

Findings emphasize the importance of including anxiety and depression in models of PTSD and pain, particularly in samples where psychiatric comorbidity is high. Clinically, results highlight the need for improved treatment regimens that address pain symptoms alongside common psychiatric comorbidities.
Gradients of chemical abundances in the Milky Way from H ii regions: distances derived from Gaia EDR3 parallaxes and temperature inhomogeneities
Authors: Méndez-Delgado J E , Amayo A , Arellano-Córdova K Z , Esteban C , García-Rojas J , Carigi L , Delgado-Inglada G
Published: December 2021

We present a reassessment of the radial abundance gradients of He, C, N, O, Ne, S, Cl, and Ar in the Milky Way using the deep optical spectra of 42 H ii regions presented in Arellano-Córdova et al. (2020, 2021) and Méndez-Delgado et al. (2020) exploring the impact of: (1) new distance determinations based on Gaia EDR3 parallaxes and (2) the use of Peimbert’s temperature fluctuations paradigm (t2 > 0) for deriving ionic abundances. We find that distances based on Gaia EDR3 data are more consistent with kinematic ones based on Galactic rotation curves calibrated with radio parallaxes, which give less dispersion and uncertainties than those calibrated with spectrophotometric stellar distances. The distances based on the Gaia parallaxes – DR2 or EDR3 – eliminate the internal flattening observed in previous determinations of the Galactic gradients at smaller distances than ∼7 kpc. Abundances and gradients determined assuming t2 > 0 – not only for O but also for the rest of elements – are not affected by the abundance discrepancy problem and give elemental abundances much consistent with the solar ones for most elements. We find that our radial abundance gradient of He is consistent with the most accurate estimates of the primordial He abundance. We do not find evidence of azimuthal variations in the chemical abundances of our sample. Moreover, the small dispersion in the O gradient – indicator of metallicity in photoionized regions – indicate that the gas of the H ii regions is well mixed in the sampled areas of the Galaxy.
Positive Selection and Enhancer Evolution Shaped Lifespan and Body Mass in Great Apes
Authors: Tejada-Martinez Daniela , Avelar Roberto A , Lopes Inês , Zhang Bruce , Novoa Guy , de Magalhães João Pedro , Trizzino Marco
Published: December 2021

Within primates, the great apes are outliers both in terms of body size and lifespan, since they include the largest and longest-lived species in the order. Yet, the molecular bases underlying such features are poorly understood. Here, we leveraged an integrated approach to investigate multiple sources of molecular variation across primates, focusing on over 10,000 genes, including approximately 1,500 previously associated with lifespan, and additional approximately 9,000 for which an association with longevity has never been suggested. We analyzed dN/dS rates, positive selection, gene expression (RNA-seq), and gene regulation (ChIP-seq). By analyzing the correlation between dN/dS, maximum lifespan, and body mass, we identified 276 genes whose rate of evolution positively correlates with maximum lifespan in primates. Further, we identified five genes, important for tumor suppression, adaptive immunity, metastasis, and inflammation, under positive selection exclusively in the great ape lineage. RNA-seq data, generated from the liver of six species representing all the primate lineages, revealed that 8% of approximately 1,500 genes previously associated with longevity are differentially expressed in apes relative to other primates. Importantly, by integrating RNA-seq with ChIP-seq for H3K27ac (which marks active enhancers), we show that the differentially expressed longevity genes are significantly more likely than expected to be located near a novel “ape-specific” enhancer. Moreover, these particular ape-specific enhancers are enriched for young transposable elements, and specifically SINE–Vntr–Alus. In summary, we demonstrate that multiple evolutionary forces have contributed to the evolution of lifespan and body size in primates.
How Academic Health Systems Can Be Ready for the Next Pandemic
Authors: Dzau Victor J. , Ellaissi William F. , Krishnan K. Ranga Rama , Balatbat Celynne A.
Published: December 2021

The COVID-19 pandemic created significant challenges for academic health systems (AHSs) across their tripartite mission of providing clinical care, conducting research, and educating learners. Despite these challenges, AHSs played an invaluable role in responding to the pandemic. Clinicians worked tirelessly to care for patients, and institutions quickly reoriented their care delivery systems. Furthermore, AHSs played an important role in advancing science, launching studies and clinical trials to examine new vaccines and treatments for COVID-19. However, there is room for improvement; AHSs can use lessons learned from the COVID-19 pandemic to reshape their operations for the future. To prepare for the next pandemic, AHSs must modernize, adapt, and transform their clinical operations, research infrastructure, and educational programs to include public health and to build surveillance capacity for detecting, monitoring, and managing emerging outbreaks.

In this Invited Commentary, the authors describe the opportunities AHSs have to build on their experiences during the COVID-19 pandemic and the ways they can take advantage of their unique strengths in each of their 3 mission areas. Within clinical care, AHSs can reach patients outside traditional clinical settings, build national and regional networks, advance data-driven insights, engage with the community, and support and protect the workforce. Within research, they can leverage data science and artificial intelligence, perform pandemic forecasting, leverage the social and behavioral sciences, conduct clinical trials, and build a research and development preparedness and operational plan. Within education, AHSs can promote remote learning, make interprofessional learning the norm, and build a system of continuing education.
Quality Improvement Initiative in the NICU for Improved Practice of Cuff Blood Pressure Measurements
Authors: Cistone Nicole , Erlenwein Danielle , Bapat Roopali , Ryshen Greg , Thomas Leslie , Haghnazari Maria S. , Thomas Roberta , Foor Nicholas , Fathi Omid
Published: December 2021

Background:

Extreme preterm infants face lengthy hospitalizations and are often subjected to painful stimuli. These stimuli may be related to routine caregiving that may negatively impact long-term developmental outcomes. Frequently obtained cuff blood pressure (BP) measurements are an example of a potentially noxious stimulus to preterm infants that may have a cumulating impact on development.

Purpose:

The primary aim was to explore the frequency of cuff BP measurements obtained in hemodynamically stable extreme preterm infants in the neonatal intensive care unit (NICU). Our secondary aim was to reduce the number of cuff BP measurements obtained in hemodynamically stable extreme preterm infants in the NICU.

Methods:

Quality improvement methodologies per the Institute for Healthcare Improvement were used combined with a multidisciplinary approach. Participants were infants born less than 27 weeks of gestation and discharged home. The baseline period was 2015 through Q2-2018 and the intervention period was Q3-2018 through Q1-2020. The electronic medical record was used to collect data and Minitab Statistical Software was used for data analysis.

Findings/Results:

A baseline of 5.0% of eligible patients received the desired number of cuff BP measurements and increased to 63.2% after the intervention period.

Implications for Practice:

Findings demonstrate that using quality improvement methodology can improve clinical care. Findings suggest the feasibility and safety of reducing the number of cuff BP measurements obtained on hemodynamically stable infants in the NICU.

Implications for Research:

Future endeavors should aim to reduce the quantity of painful stimuli in the NICU. Long-term developmental outcomes should be correlated in these patients.
Neonatal Care Provider Tasks for Hospitalized Well Newborns
Authors: Smith Misty , Bosque Elena
Published: December 2021

Background:

Changes in the pediatrician's practice model have created demand for other medical care providers for hospitalized well newborns. Well newborn care may be the responsibility of those who work in any level I-IV neonatal intensive care units, whether in a primary or secondary role. No recent publications exist about how to approach the organization of tasks.

Purpose:

The purpose of this article is to present a structure and resources to guide the organization of tasks in the care of hospitalized well newborns for learners or occasional care providers.

Methods:

The methods used in this project included literature review to develop evidence-based practice resources. The literature was reviewed regarding the relevant history and resources to support task organization of well newborn care provided by skilled providers in the hospital. The goal is to establish a reference to support education about these approaches, which appear to be rooted in tradition.

Findings:

Evidence-based resources include an overview of provider tasks and responsibilities for well newborn care for each hospital day and per shift.

Implication for Research:

Future studies can measure mentor or learner perceptions of the value of these resources, critical thinking improvement, safety, and clinical outcomes.

Implication for Practice:

These resources may provide structure for learners or occasional providers who have studied the physiology, pathophysiology, and problem management concepts but need to learn how to execute their responsibilities in these busy environments.
Self-management of the Dual Diagnosis of HIV/AIDS and Diabetes During COVID-19
Authors: Zuñiga Julie A. , Cuevas Heather E. , Jones Kristian , Adiele Kristine , Cebulske Lauren , Frost Livia , Sannigrahi Siddhaparna , García Alexandra A. , Heitkemper Elizabeth M.
Published: December 2021

The purpose of this qualitative secondary analysis research was to describe the impact of the COVID-19 pandemic on self-management behaviors and practices for people living with the dual diagnoses of HIV/AIDS and type 2 diabetes mellitus and to identify early pandemic-specific disruptions or changes to their self-management practices. In-depth interviews conducted in May-June 2020 with 9 participants, and analyzed using content analysis, revealed 5 themes: adjusting to living with HIV/AIDS and diabetes impacts beliefs about COVID-19 risks; COVID-19 information seeking and accuracy; trade-offs in self-managing multiple chronic conditions; balance between safety, relationships, and the society at large; and discordant perceptions and actions. Some participants were resilient from previous experiences. Many received mixed messages about their risk for COVID-19, resulting in inaccurately or inconsistently applying guidelines for social isolation.
Elongation-Derotation-Flexion Casting Treatment of Early-Onset Progressive Scoliosis in Skeletal Dysplasia
Authors: Ulusaloglu Armagan C. , Asma Ali , Rogers Kenneth J. , Bowen James Richard , Mackenzie William G. , Mackenzie William Giles Stuart
Published: December 2021

Background:

Early-onset scoliosis in children with skeletal dysplasia is progressive, contributing to cardiopulmonary restrictive disease. Serial elongation-derotation-flexion (EDF) casting, used in other etiologies of scoliosis to delay curve progression, may be beneficial in maximizing spine growth. Our hypothesis is serial EDF casting can be safely used as a temporary alternative to surgery, delaying progression and preserving growth, to treat scoliosis in skeletal dysplasia.

Methods:

All patients with skeletal dysplasia treated at a single institution with serial EDF casting for scoliosis were reviewed retrospectively. Radiographic parameters: Cobb angle of major and minor curves, curve location, thoracic height, thoracolumbar height, space available for lung, and rib vertebra angle difference were measured before casting (C1), in first casting (C2), in last casting (C3), and out of last casting (C4). Peak inspiratory pressure (PIP) values were monitored and recorded during the casting application.

Results:

Eleven patients met the inclusion criteria (mean 9.7 castings). The mean duration of EDF serial casting was 35 months. The mean major Cobb angles were 54 degrees° (C1), 30 degrees (C2), 37 degrees (C3), and 49 degrees (C4) with no statistically significant differences. The mean minor Cobb angles were 35 degrees (C1), 25 degrees (C2), 33 degrees (C3), and 51 degrees (C4) with no statistically significant differences. The mean thoracic heights were 130 mm (C1), 155 mm (C2), 173 mm (C3), and 160 mm (C4). The 19-mm mean difference between C2 and C3 represents spinal growth. The PIP-1, PIP-2, and PIP-3 mean values were 15, 27, and 18 cmH2O, respectively. Changes in PIP-1 and PIP-2 and PIP-2 and PIP-3 were statistically significant.

Conclusion:

Serial EDF casting can delay surgical scoliosis correction in children younger than 7 years with a diagnosis of skeletal dysplasia. Our study showed that serial casting controls progression of the major curve and allows longitudinal growth of the spine with possible expansion of lung volume for nearly 3 years. During cast application, PIP increased with molding and traction, and improved until windowing and trimming of the cast.

Level of Evidence:

Level IV—retrospective study.
Local Anesthetic Injection Before Incision Decreases General Anesthesia Requirements in Pediatric Trigger Thumb Release: A Randomized Controlled Trial
Authors: Lin Elaina E. , Fazal Faris Z. , Pearsall Matthew F. , Talwar Divya , Chang Hannah , Shah Apurva S.
Published: December 2021

Background:

Animal studies have shown evidence of neurotoxicity from inhalational anesthesia, yet clinical studies have been less conclusive. While ongoing studies investigate the clinical significance of anesthesia-associated neurodevelopmental changes in young children, reducing anesthetic exposure in pediatric orthopaedic surgery is prudent. The primary objective of this study is to determine if local anesthetic injection before surgical incision versus after surgical release decreased inhalational anesthetic exposure in children undergoing unilateral trigger thumb release. The secondary objectives were to determine if the timing of local anesthetic injection affected postoperative pain or length of stay.

Methods:

This was a single-center randomized controlled trial of pediatric patients (4 y and below) undergoing unilateral trigger thumb release. Subjects were randomized into preincision or postrelease local anesthesia injection groups. The surgeon was aware of the treatment group, while the anesthesiologist was blinded. Patient demographics, operative times, cumulative sevoflurane dose, and postoperative anesthesia care unit recovery characteristics were collected. The χ2, Fisher exact, and Mann-Whitney U tests were conducted.

Results:

A total of 24 subjects were enrolled, with 13 randomized to the preincision injection group and 11 to the postprocedure injection group. There was no significant difference in age, sex, operative time, or tourniquet time between groups. There was a significant difference in the cumulative sevoflurane dose between the preincision injection group (23.2 vol%; interquartile range: 21.7 to 27.6) and the postprocedure injection group (28.1 vol%; interquartile range: 27 to 30) (P=0.03), with a 21% reduction in cumulative dose. There were no significant differences in postoperative pain scores, use of rescue pain medications, the incidence of nausea, or time to discharge between groups.

Conclusions:

Administering local anesthesia before incision versus at the end of the procedure significantly decreased cumulative sevoflurane dose for unilateral trigger thumb release. The results of this study suggest that local anesthetic injection before the incision is a low risk, easy method to reduce general anesthesia requirements during trigger thumb release and could decrease sevoflurane exposure more substantially in longer procedures and mitigate risks of neurotoxicity. Preincision injection with local anesthetic should be incorporated into routine clinical practice.

Level of Evidence:

Level I.
Risk of infections of biological and targeted drugs in patients with spondyloarthritis: meta-analysis of randomized clinical trials
Authors: Hu Lidong , Man Siliang , Ji Xiaojian , Wang Yiwen , Liu Xingkang , Zhang Jiaxin , Song Chuan , Zhu Jian , Huang Feng
Published: December 2021

Background:

Concerns exist regarding the risk of infections in patients with spondyloarthritis (SpA) treated with biologics. We assessed the risk of infections of biological and targeted drugs in patients with SpA by performing a meta-analysis based on randomized controlled trials (RCTs).

Methods:

A systematic literature search was conducted in PubMed, Embase, Web of Science, the Cochrane Library, and China Biology Medicine Disc for RCTs evaluating the risk of infections of biological therapy in patients with SpA from inception through August 9, 2021. We calculated a pooled Peto odds ratio (OR) for infections in biologics-treated patients vs. placebo patients. The risk of bias on the included RCTs was assessed by using the Cochrane Risk of Bias Tool.

Results:

In total, 62 studies were included in this meta-analysis. Overall, the risk of infection (Peto OR: 1.16, 95% confidence interval [CI]: 1.07–1.26, P < 0.001), serious infection (Peto OR: 1.65, 95% CI: 1.26–2.17, P < 0.001), upper respiratory tract infection (URTI) (Peto OR: 1.17, 95% CI: 1.04–1.32, P = 0.008), nasopharyngitis (Peto OR: 1.25, 95% CI: 1.10–1.42, P < 0.001), and Candida infection (Peto OR: 2.64, 95% CI: 1.48–4.71, P 
= 0.001) were increased in SpA patients treated with biologics compared with placebo. Sensitivity analysis based on biologics classes was conducted, and results demonstrated that compared with placebo, there was a higher risk of infection for tumor necrosis factor (TNF)-a inhibitors (Peto OR: 1.38, 95% CI: 1.13–1.68, P 
= 0.001) and interleukin (IL)-17 inhibitors (Peto OR: 1.55, 95% CI: 1.08–2.22, P 
= 0.018) in axial SpA, and for Janus kinase inhibitors in peripheral SpA (Peto OR: 1.39, 95% CI: 1.14–1.69, P 
= 0.001); higher risk of serious infection for IL-17 inhibitors in peripheral SpA (Peto OR: 3.46, 95% CI: 1.26–9.55, P = 0.016) and axial SpA (Peto OR: 2.01, 95% CI: 1.38–2.91, P < 0.001); higher risk of URTI for TNF-a inhibitors in axial SpA (Peto OR: 1.37, 95% CI: 1.05–1.78, P = 0.019), and for apremilast in peripheral SpA (Peto OR: 1.60, 95% CI: 1.08–2.36, P = 0.018); higher risk of nasopharyngitis for TNF-a inhibitors in axial SpA (Peto OR: 1.41, 95% CI: 1.05–1.90, P = 0.022) and peripheral SpA (Peto OR: 1.49, 95% CI: 1.09–2.05, P = 0.013), and for IL-17 inhibitors in axial SpA (Peto OR: 1.35, 95% CI: 1.01–1.82, P = 0.044); higher risk of herpes zoster for Janus kinase inhibitors in peripheral SpA (Peto OR: 2.18, 95% CI: 1.03–4.62, P = 0.043); higher risk of Candida infection for IL-17 inhibitors in peripheral SpA (Peto OR: 2.52, 95% CI: 1.31–4.84, P = 0.006).

Conclusions:

This meta-analysis shows that biological therapy in patients with SpA may increase the risk of infections, including serious infections, URTI, nasopharyngitis, and Candida infection, which should be paid attention to in our clinical practice.
When should we give up on expectant management for patients with proximal ureteral stones?
Authors: Shpunt Igal , Elbaz Etay , Avda Yuval , Modai Jonathan , Leibovici Dan , Berkowitz Brian , Shilo Yaniv
Published: December 2021

Background:

Proximal ureteral stones (PUS) have relatively low rates of spontaneous expulsion. However, some patients do well on expectant management. Our aim was to compare risk factors for surgical intervention in patients with PUS who underwent primary intervention to those subjected to expectant management.

Materials and methods:

We retrospectively reviewed the medical charts of patients presented to the emergency room with symptoms of renal colic and underwent computerized tomography between August 2016 and August 2017. A total of 97 consecutive patients were identified with up to 10mm PUS. We collected patient demographics, clinical, and imaging data, and performed binary regression analysis for risk of intervention.

Results:

The average age was 49years (range 17-97) and average stone size was 7.1mm (range 3-10). Forty-one patients underwent immediate intervention while the remaining 56 patients were treated conservatively. Of the 56 patients treated conservatively, 26 underwent delayed intervention while 30 reported spontaneous stone expulsion. On univariate analysis of all 97 patients, statistically significant risk factors for intervention were found based on stone size, age, serum lymphocyte, platelet counts, and stone density. Of these risk factors, stone size ≥ 7mm (p = 0.012, odds ratio = 5.4) and platelet count ≤ 230K/μL (p = 0.027, odds ratio = 4.9) remained statistically significant on multivariate analysis.

Conclusion:

Stone size and platelet count were found to be risk factors for surgical intervention in patients with up to 10mm PUS. These findings may assist in identifying patients who are more suitable for conservative approach.
Morphologic Spectrum of Rhabdomyomatous Mesenchymal Hamartomas (Striated Muscle Hamartomas) in Pediatric Dermatopathology
Authors: Al Amri Raniah , De Stefano Danielle V. , Wang Qian , Salgado Cláudia M. , Gómez Ana M. , Zambrano Eduardo V. , Reyes-Múgica Miguel
Published: December 2021

Background:

Rhabdomyomatous mesenchymal hamartomas (RMHs), also termed striated muscle hamartomas, are rare benign tumors of skin and subcutis, which mostly occur at birth with a predilection for the head and neck. Simple surgical excision is the treatment modality of choice with excellent prognosis.

Objective:

To review the spectrum of the different clinical and pathologic features of RMHs in pediatric patients and recognize their characteristics to avoid confusion with other lesions in their list of differential diagnosis.

Methods:

Six cases of RMH diagnosed at our institution from 2009 to 2021 were retrieved from our files and reviewed retrospectively after anonymization by an honest broker. This review is IRB-approved by the University of Pittsburgh School of Medicine, study STUDY19080192.

Results:

The patients' age ranged from 6 days to 8 years, with a female predominance (2:1). In all cases, the lesion was present at birth. All lesions, except for 2, occurred in the head and neck regions. One patient had multiple additional small nodules in the face, whereas all others presented with solitary RMHs. The size of the lesions varied, and their composition included bundles of skeletal muscle (the landmark finding) associated with variable amounts of adipose, fibrous, vascular, nerve, and adnexal structures.

Conclusions:

RMH is a benign hamartomatous lesion with a variable phenotypic spectrum. RMHs predominate in the head and neck. Familiarity with these lesions, including their presentation in less frequent anatomical sites, is important to avoid diagnostic misinterpretations and potential overtreatment. This study represents one of the largest series of RMHs in the literature, including an unusual case in a perianal location.
Inpatient Management and OBICU Care for Pregnant Patients With Severe COVID-19 Disease
Authors: VAUGHT ARTHUR J.
Published: December 2021

This manuscript will review intensive care management considerations for pregnant patients with severe COVID-19 disease.
CHANGES IN MYOPIC MACULOPATHY BASED ON ATN CLASSIFICATION SYSTEM
Authors: Wang Yanbing , Jiang Chengyan , Zhao Xiujuan , Chen Jing , Li Jun , Huang Xia , Liu Bingqian , Lu Lin
Published: December 2021

Purpose:

To assess changes in myopic maculopathy based on the ATN classification system with optical coherence tomography angiography.

Methods:

This was a cross-sectional study. The macular choroidal thickness (MCT) and the choriocapillaris flow (CC) were measured with optical coherence tomography angiography. The relationship of MCT and CC with different chorioretinal atrophy (A), myopic foveoschisis (T), and myopic neovascularization (N) grades was investigated.

Results:

One hundred and fifty-three participates (219 eyes) were included. MCT and CC had no significant correlation with different T grades (P > 0.05). Choriocapillaris flow had a significant decrease in eyes with lacquer cracks compared with those with no neovascular maculopathy (P < 0.05) and showed a significant increase in active choroidal neovascularization compared with those with lacquer cracks (P < 0.05). Macular choroidal thickness and CC had negative correlations with different A grades (P < 0.001). MCT showed the greatest decrease in the early stage of myopic atrophic maculopathy (P < 0.001), and CC showed the most significant reduction in the late stage (P < 0.001).

Conclusion:

Choroidal changes in the highly myopic patients were detected by optical coherence tomography angiography. Progressive ischemia in the macula may play an important role in the development of myopic atrophic maculopathy. Active choroidal neovascularization may have manifested as compensation for the decrease in MCT and CC. On the contrary, myopic traction maculopathy had little correlation with choroidal changes.