bluuebunny/crossref_metadata_2025 huggingface dataset:
A Novel Mining Method for Longwall Panel Face Passing through Parallel Abandoned Roadways
Authors: Li Yang , Ren Yuqi , Wang Nan , Luo Junbo , Li Na , Liu Yikun , Li Guoshuai
Published: June 2021

Mining pressure behavior in the process of longwall panel face passing through the parallel abandoned roadways (PARs) is different from the ordinary longwall panel face. It is easy to induce the accident of roof falling, coal wall spalling, and crush accident of shield. In order to reduce the occurrence of mine pressure accidents and ensure safe mining, a new mining method named “swing‐inclined” mining method was proposed and was employed in the E13103 of Cuijiazhai coal mine. Based on the process of the longwall panel face passing through the PARs, a long‐span and multisupport mass‐structure model of the roof was established. The maximum support capacity of shield was calculated combined with stability relation between “roof‐shield‐PAR‐‘similar pillar (SP)’‐coal wall.” It provided the basis for determining the reasonable support capacity of shield. Moreover, the sensitivity analysis of influenced factors to the maximum support capacity of shield was carried out by using Matlab software. The sensitivity analysis results indicated that different factors had a different effect on the support capacity of shield. And, the process of passing through the PARs can be divided into 3 stages, depending on the relation between support capacity of shield and width of SP. In different stages, the change degree of support capacity of shield was different. The support capacity of shield is mainly influenced by the hanging distance of the main roof and the horizontal distance between the support point of the coal wall and the breaking position of the main roof. By on‐site measurement, the sensitivity analysis results were verified.
Tumor-Infiltrating B Lymphocyte Profiling Identifies IgG-Biased, Clonally Expanded Prognostic Phenotypes in Triple-Negative Breast Cancer
Authors: Harris Robert J. , Cheung Anthony , Ng Joseph C.F. , Laddach Roman , Chenoweth Alicia M. , Crescioli Silvia , Fittall Matthew , Dominguez-Rodriguez Diana , Roberts James , Levi Dina , Liu Fangfang , Alberts Elena , Quist Jelmar , Santaolalla Aida , Pinder Sarah E. , Gillett Cheryl , Hammar Niklas , Irshad Sheeba , Van Hemelrijck Mieke , Dunn-Walters Deborah K. , Fraternali Franca , Spicer James F. , Lacy Katie E. , Tsoka Sophia , Grigoriadis Anita , Tutt Andrew N.J. , Karagiannis Sophia N.
Published: June 2021

In breast cancer, humoral immune responses may contribute to clinical outcomes, especially in more immunogenic subtypes. Here, we investigated B lymphocyte subsets, immunoglobulin expression, and clonal features in breast tumors, focusing on aggressive triple-negative breast cancers (TNBC). In samples from patients with TNBC and healthy volunteers, circulating and tumor-infiltrating B lymphocytes (TIL-B) were evaluated. CD20+CD27+IgD− isotype-switched B lymphocytes were increased in tumors, compared with matched blood. TIL-B frequently formed stromal clusters with T lymphocytes and engaged in bidirectional functional cross-talk, consistent with gene signatures associated with lymphoid assembly, costimulation, cytokine–cytokine receptor interactions, cytotoxic T-cell activation, and T-cell–dependent B-cell activation. TIL-B–upregulated B-cell receptor (BCR) pathway molecules FOS and JUN, germinal center chemokine regulator RGS1, activation marker CD69, and TNFα signal transduction via NFκB, suggesting BCR–immune complex formation. Expression of genes associated with B lymphocyte recruitment and lymphoid assembly, including CXCL13, CXCR4, and DC-LAMP, was elevated in TNBC compared with other subtypes and normal breast. TIL-B–rich tumors showed expansion of IgG but not IgA isotypes, and IgG isotype switching positively associated with survival outcomes in TNBC. Clonal expansion was biased toward IgG, showing expansive clonal families with specific variable region gene combinations and narrow repertoires. Stronger positive selection pressure was present in the complementarity determining regions of IgG compared with their clonally related IgA in tumor samples. Overall, class-switched B lymphocyte lineage traits were conspicuous in TNBC, associated with improved clinical outcomes, and conferred IgG-biased, clonally expanded, and likely antigen-driven humoral responses.

Significance:

Tumor-infiltrating B lymphocytes assemble in clusters, undergoing B-cell receptor–driven activation, proliferation, and isotype switching. Clonally expanded, IgG isotype-biased humoral immunity associates with favorable prognosis primarily in triple-negative breast cancers.
ADAM10 Evens Out the Double-Edged Sword of Radiotherapy in Pancreatic Cancer
Authors: Garcia Garcia Carolina J. , Abi Jaoude Joseph , Taniguchi Cullen M.
Published: June 2021

Radiotherapy plays an important role in the management of pancreatic ductal adenocarcinoma (PDAC), especially when patients are not surgical candidates. Radiation-induced tumor death provokes an acute inflammation followed by a late-fibrotic response that parallels the fibroinflammatory tumor microenvironment of PDAC, inciting the question of whether radiation-induced fibrosis contributes to PDAC progression. The study published in this issue by Mueller and colleagues presents a potential mechanism linking radiation-induced fibrosis with expression of a disintegrin and metalloprotease 10 (ADAM10) and ephrinB2, which may also contribute to tumor progression. The authors show that ablation of ADAM10 decreases radiation-induced fibrosis and improves survival in preclinical models. These data suggest that targeting ADAM10 may help to improve clinical outcomes with radiotherapy, particularly if definitive radiation is not possible. A better understanding of the biology of radiotherapy in pancreatic cancer remains crucial, and Mueller and colleagues offer important insight in this regard.

See related article by Mueller et al., p. 3255
Immune Activation and Microbial Translocation as Prognostic Biomarkers for AIDS-Related Non-Hodgkin Lymphoma in the AMC-034 Study
Authors: Martínez Laura E. , Lensing Shelly , Chang Di , Magpantay Larry I. , Mitsuyasu Ronald , Ambinder Richard F. , Sparano Joseph A. , Martínez-Maza Otoniel , Epeldegui Marta
Published: June 2021

Purpose:

AIDS-related non-Hodgkin lymphoma (ARL) is the most common cancer in HIV-infected individuals in the United States and other countries in which HIV-positive persons have access to effective combination antiretroviral therapy (cART). Our prior work showed that pretreatment/postdiagnosis plasma levels of some cytokines, such as IL6, IL10, and CXCL13, have the potential to serve as indicators of clinical response to treatment and survival in ARL. The aims of this study were to identify novel prognostic biomarkers for response to treatment and/or survival in persons with ARL, including biomarkers of microbial translocation and inflammation.

Experimental Design:

We quantified plasma levels of several biomarkers (sCD14, LBP, FABP2, EndoCab IgM, IL18, CCL2/MCP-1, sCD163, IP-10/CXCL10, TARC/CCL17, TNFα, BAFF/BLyS, sTNFRII, sCD44, and sIL2Rα/sCD25) by multiplexed immunometric assays (Luminex) or ELISA in plasma specimens obtained from ARL patients enrolled in the AMC-034 trial, which compared infusional combination chemotherapy (EPOCH: etoposide, vincristine, doxorubicin, cyclophosphamide, and prednisone) with concurrent or sequential rituximab. Plasma was collected prior to the initiation of therapy (n = 57) and after treatment initiation (n = 55).

Results:

We found that several biomarkers decreased significantly after treatment, including TNFα, sCD25, LBP, and TARC (CCL17). Moreover, pretreatment plasma levels of BAFF, sCD14, sTNFRII, and CCL2/MCP-1 were univariately associated with overall survival, and pretreatment levels of BAFF, sTNFRII, and CCL2/MCP-1 were also associated with progression-free survival.

Conclusions:

Our results suggest that patients with ARL who responded to therapy had lower pretreatment levels of inflammation and microbial translocation as compared with those who did not respond optimally.
Relevance of Platinum-free Interval and BRCA Reversion Mutations for Veliparib Monotherapy after Progression on Carboplatin/Paclitaxel for gBRCA Advanced Breast Cancer (BROCADE3 Crossover)
Authors: Puhalla Shannon L. , Diéras Véronique , Arun Banu K. , Kaufman Bella , Wildiers Hans , Han Hyo S. , Ayoub Jean-Pierre , Stearns Vered , Yuan Yuan , Helsten Teresa , Riley-Gillis Bridget , Murphy Erin , Kundu Madan G. , Wu Meijing , Maag David , Ratajczak Christine K. , Ramathal Cyril Y. , Friedlander Michael
Published: June 2021

Purpose:

Safety, efficacy, and exploratory biomarker analyses were evaluated in patients with advanced HER2-negative germline breast cancer susceptibility gene (gBRCA)-associated breast cancer enrolled in the BROCADE3 trial who received crossover veliparib monotherapy after disease progression on placebo plus carboplatin/paclitaxel.

Patients and Methods:

Eligible patients (N = 513) were randomized 2:1 to veliparib plus carboplatin/paclitaxel or placebo plus carboplatin/paclitaxel; patients had variable platinum-free intervals (PFI) at progression. In the placebo arm, patients were eligible to receive crossover veliparib monotherapy (300–400 mg twice daily continuous). Antitumor activity and adverse events were assessed during crossover veliparib treatment. BRCA reversion mutations at crossover were analyzed retrospectively using next-generation sequencing on plasma circulating tumor DNA (ctDNA).

Results:

Seventy-five patients in the placebo plus carboplatin/paclitaxel arm received ≥1 dose of crossover veliparib postprogression (mean treatment duration: 154 days). Eight of 50 (16%) patients with measurable disease had a RECIST v1.1 response. Activity was greater in patients with PFI ≥180 days compared with <180 days [responses in 23.1% (3/13) vs. 13.5% (5/37) of patients]. BRCA reversion mutations that restored protein function were detected in ctDNA from 4 of 28 patients tested, and the mean duration of crossover veliparib monotherapy was <1 month in these 4 patients versus 7.49 months in patients lacking reversion mutations. The most frequent adverse events were nausea (61%), vomiting (29%), and fatigue (24%).

Conclusions:

Crossover veliparib monotherapy demonstrated limited antitumor activity in patients who experienced disease progression on placebo plus carboplatin/paclitaxel. PFI appeared to affect veliparib activity. BRCA reversion mutations may promote cross-resistance and limit veliparib activity following progression on platinum.
The Prognostic Potential of Human Prostate Cancer-Associated Macrophage Subtypes as Revealed by Single-Cell Transcriptomics
Authors: Siefert Joseph C. , Cioni Bianca , Muraro Mauro J. , Alshalalfa Mohammed , Vivié Judith , van der Poel Henk G. , Schoots Ivo G. , Bekers Elise , Feng Felix Y. , Wessels Lodewyk F.A. , Zwart Wilbert , Bergman Andries M.
Published: June 2021

Macrophages in the tumor microenvironment are causally linked with prostate cancer development and progression, yet little is known about their composition in neoplastic human tissue. By performing single cell transcriptomic analysis of human prostate cancer resident macrophages, three distinct populations were identified in the diseased prostate. Unexpectedly, no differences were observed between macrophages isolated from the tumorous and nontumorous portions of the prostatectomy specimens. Markers associated with canonical M1 and M2 macrophage phenotypes were identifiable, however these were not the main factors defining unique subtypes. The genes selectively associated with each macrophage cluster were used to develop a gene signature which was highly associated with both recurrence-free and metastasis-free survival. These results highlight the relevance of tissue-specific macrophage subtypes in the tumor microenvironment for prostate cancer progression and demonstrates the utility of profiling single-cell transcriptomics in human tumor samples as a strategy to design gene classifiers for patient prognostication.

Implications:

The specific macrophage subtypes present in a diseased human prostate have prognostic value, suggesting that the relative proportions of these populations are related to patient outcome. Understanding the relative contributions of these subtypes will not only inform patient prognostication, but will enable personalized immunotherapeutic strategies to increase beneficial populations or reduce detrimental populations.
Netherton Syndrome: Case Report and Review of the Literature
Authors: Herz-Ruelas Maira E. , Chavez-Alvarez Sonia , Garza-Chapa Juana Irma , Ocampo-Candiani Jorge , Cab-Morales Victor Andres , Kubelis-López David Emmanuel
Published: June 2021

Netherton syndrome (NS) is a rare genodermatosis with an autosomal recessive pattern of inheritance caused by pathogenic variants in the SPINK5 gene. It is characterized by a triad consisting of atopic diathesis, ichthyosis linearis circumflexa, and hair shaft abnormalities. Ichthyosis linearis circumflexa can be confused with atopic dermatitis leading to a delayed diagnosis. Furthermore, difficulty in making the differential diagnosis with other atopiform, erythrodermic, and ichthyosiform entities that exhibit hair shaft abnormalities represent a challenge. Trichoscopy is an accessible and noninvasive auxiliary diagnostic tool in these cases; the hair shaft abnormalities found in NS are bamboo, golf tee, and matchstick hairs. Identification of a pathogenic variant in the SPINK5 gene through genetic testing is necessary to confirm the diagnosis. Multiple treatment options are available including topical therapy with emollients, corticosteroids, calcineurin inhibitors, antiseptics, and narrowband UVB phototherapy. Systemic treatments comprehend intravenous immunoglobulins, and advances in the understanding of the pathophysiology of NS have led to more directed therapies with biologics such as infliximab, ixekizumab, secukinumab, ustekinumab, and dupilumab. Treatments currently under investigation include inhibitors of kallikrein 5, cathelicidins, drugs activating the transcription factor nuclear factor erythroid-derived 2-like 2, and gene therapy using autologous keratinocytes induced with a lentiviral vector encoding SPINK5.
A Late Dermatologic Presentation of Bullous Pemphigoid Induced by Anti-PD-1 Therapy and Associated with Unexplained Neurological Disorder
Authors: Wang Xiaoxiao , Suppa Mariano , Bruderer Pascal , Sirtaine Nicolas , Aspeslagh Sandrine , Kerger Joseph
Published: June 2021

Immunotherapy has become the standard of care for various cancer types. The widespread use of immune checkpoints inhibitors confronts us with a whole range of novel immune-related adverse events. Skin toxicity is one of the most frequent adverse events. In this article, we report a case of anti-PD-1 induced late bullous pemphigoid (BP) with mucosal erosions and associated with a troublesome neurological disorder of undetermined origin in a patient with metastatic melanoma. Skin biopsy was essential to make the diagnosis and rapid initiation of systemic prednisolone played a role in favorable clinical outcome of BP. We will discuss the difficulty of early diagnosis of BP, its unusual association with neurological disorders, and the specific management of this particular dermatological entity.
Development of a Management Algorithm for Acute and Chronic Radiation Urethritis and Cystitis
Authors: Vanneste Ben G.L. , Van Limbergen Evert J. , Marcelissen Tom A. , van Roermund Joep G.H. , Lutgens Ludy C. , Arnoldussen Carsten W.K.P. , Lambin Philippe , Oelke Matthias
Published: June 2021

Objective: The purpose of this review was to summarize the current literature on the assessment and treatment of radiation urethritis and cystitis (RUC) for the development of an evidenced-based management algorithm. Material and Methods: The PubMed/MEDLINE database was searched by a multidisciplinary group of experts in January 2021. Results: In total, 48 publications were identified. Three different types of RUC can be observed in clinical practice: inflammation-predominant, bleeding-predominant, and the combination of inflammation- and bleeding-RUC. There is no consensus on the optimal treatment of RUC. Inflammation-predominant RUC should be treated symptomatically based on the existence of bothersome storage or voiding lower urinary tract symptom as well as on pain. When bleeding-predominant RUC has occurred, hydration and hyperbaric oxygen therapy (HOT) should be used first and, if HOT is not available, oral drugs instead (sodium pentosane polysulfate, aminocaproic acid, immunokine WF 10, conjugated estrogene, or pentoxifylline + vitamin E). If local bleeding persists, focal therapy of bleeding vessels with a laser or electrocoagulation is indicated. In case of generalized bleeding, intravesical installation should be initiated (formalin, aluminium salts, and hyaluronic acid/chondroitin). Vessel embolization is a less invasive treatment with potentially less complications and good clinical outcomes. Open- or robot-assisted surgery is indicated in patients with permanent, life-threatening bleeding, or fistulae. Conclusions: Treatment of RUC, if not self-limiting, should be done according to the type of RUC and in a stepwise approach. Conservative/medical treatment (oral and topic agents) should primarily be used before invasive (transurethral) treatments.
Associations of Obesity with Linear Growth and Puberty
Authors: Shalitin Shlomit , Gat-Yablonski Galia
Published: June 2021

Background: The prevalence of obesity in childhood has increased dramatically in recent decades with increased risk of developing cardiometabolic and other comorbidities. Childhood adiposity may also influence processes of growth and puberty. Summary: Growth patterns of obesity during childhood have been shown to be associated with increased linear growth in early childhood, leading to accelerated epiphyseal growth plate (EGP) maturation. Several hormones secreted by the adipose tissue may affect linear growth in the context of obesity, both via the growth hormone IGF-1 axis and via a direct effect on the EGP. The observation that children with obesity tend to mature earlier than lean children has led to the assumption that the degree of body fatness may trigger the neuroendocrine events that lead to pubertal onset. The most probable link between obesity and puberty is leptin and its interaction with the kisspeptin system, which is an important regulator of puberty. However, peripheral action of adipose tissue could also be involved in changes in the onset of puberty. In addition, nutritional factors, epigenetics, and endocrine-disrupting chemicals are potential mediators linking pubertal onset to obesity. In this review, we focused on interactions of obesity with linear growth and pubertal processes, based on basic research and clinical data in humans. Key Message: Children with obesity are subject to accelerated linear growth with risk of impaired adult height and early puberty, with its psychological consequences. The data highlight another important objective in combatting childhood obesity, for the prevention of abnormal growth and pubertal patterns.
Impact of Confinement in Patients under Long-Term Noninvasive Ventilation during the First Wave of the SARS-CoV-2 Pandemic: A Remarkable Resilience
Authors: Cantero Chloé , Pasquina Patrick , Dao Melissa Dominicé , Cedraschi Christine , Adler Dan , Plojoux Jérôme , Janssens Jean-Paul
Published: June 2021

Background: During the first wave of the SARS-CoV-2 pandemic in Switzerland, confinement was imposed to limit transmission and protect vulnerable persons. These measures may have had a negative impact on perceived quality of care and symptoms in patients with chronic disorders. Objectives: To determine whether patients under long-term home noninvasive ventilation (LTHNIV) for chronic respiratory failure (CRF) were negatively affected by the 56-day confinement (March–April 2020). Methods: A questionnaire-based survey exploring mood disturbances (HAD), symptom scores related to NIV (S3-NIV), and perception of health-care providers during confinement was sent to all patients under LTHNIV followed up by our center. Symptom scores and data obtained by ventilator software were compared between confinement and the 56 days prior to confinement. Results: Of a total of 100 eligible patients, 66 were included (median age: 66 years [IQR: 53–74]): 35 (53%) with restrictive lung disorders, 20 (30%) with OHS or SRBD, and 11 (17%) with COPD or overlap syndrome. Prevalence of anxiety (n = 7; 11%) and depressive (n = 2; 3%) disorders was remarkably low. Symptom scores were slightly higher during confinement although this difference was not clinically relevant. Technical data regarding ventilation, including compliance, did not change. Patients complained of isolation and lack of social contact. They felt supported by their relatives and caregivers but complained of the lack of regular contact and information by health-care professionals. Conclusions: Patients under LTHNIV for CRF showed a remarkable resilience during the SARS-CoV-2 confinement period. Comments provided may be helpful for managing similar future health-care crises.
Association of Acute Kidney Injury with Outcomes in Patients Undergoing Transcatheter Mitral Valve Repair
Authors: Nazir Salik , Ahuja Keerat Rai , Kolte Dhaval , Gupta Tanush , Khera Sahil , Elmariah Sammy
Published: June 2021

Introduction: Although transcatheter mitral valve repair (TMVr) is a contrast-free procedure, prior single-center studies have demonstrated a high incidence of acute kidney injury (AKI) following TMVr. The main objective of this study was to examine risk factors for AKI, and its association with outcomes in patients undergoing TMVr. Methods: We queried the National Readmission Database to identify TMVr procedures performed between January 2014 and December 2017. Complex samples multivariable logistic and linear regression models were used to identify risk factors associated with AKI, as well as to determine the association between AKI and clinical outcomes (in-hospital mortality, index length of stay (LOS), 30-day all-cause readmissions, and 30-day heart failure [HF] readmissions). Results: Of 14,623 patients who underwent TMVr during the study period, 2,001 (13.6%) had a diagnosis of AKI. HF, chronic kidney disease, chronic liver disease, fluid/electrolyte disorder, weight loss, nonelective admission, cardiogenic shock, and bleeding/transfusion were independently associated with an increased risk of AKI. In patients undergoing TMVr, AKI was associated with an increased risk of in-hospital mortality (adjusted odds ratio [aOR], 4.94; 95% confidence interval [CI], 2.92–8.34), 30-day all-cause readmissions (aOR, 1.91; 95% CI, 1.49–2.46), 30-day HF readmissions (aOR, 2.30; 95% CI, 1.38–3.84), and longer index LOS (adjusted parameter estimate, 5.78; 95% CI, 5.26–6.41). Conclusion: AKI in the setting of TMVr is common and is associated with worse clinical outcomes. Further studies are needed to determine if optimizing renal function prior to TMVr may improve outcomes, as well as to understand the impact of TMVr itself on renal function.
Abdominal Panniculectomy Can Simplify Kidney Transplantation in Obese Patients
Authors: Promny Dominik , Hauck Theresa , Cai Aijia , Arkudas Andreas , Heller Katharina , Wullich Bernd , Apel Hendrik , Horch Raymund E. , Ludolph Ingo
Published: June 2021

Background: Obesity is frequently present in patients suffering from end-stage renal disease (ESRD). However, overweight kidney transplant candidates are a challenge for the transplant surgeon. Obese patients tend to develop a large abdominal panniculus after weight loss creating an area predisposed to wound-healing disorders. Due to concerns about graft survival and postoperative complications after kidney transplantation, obese patients are often refused in this selective patient cohort. The study aimed to analyze the effect of panniculectomies on postoperative complications and transplant candidacy in an interdisciplinary setting. Methods: A retrospective database review of 10 cases of abdominal panniculectomies performed in patients with ESRD prior to kidney transplantation was conducted. Results: The median body mass index was 35.2 kg/m2 (range 28.5–53.0 kg/m2) at first transplant-assessment versus 31.0 kg/m2 (range 28.0–34.4 kg/m2) at panniculectomy, and 31.6 kg/m2 (range 30.3–32.4 kg/m2) at kidney transplantation. We observed no major postoperative complications following panniculectomy and minor wound-healing complications in 2 patients. All aside from 1 patient became active transplant candidates 6 weeks after panniculectomy. No posttransplant wound complications occurred in the transplanted patients. Conclusion: Abdominal panniculectomy is feasible in patients suffering ESRD with no major postoperative complications, thus converting previously ineligible patients into kidney transplant candidates. An interdisciplinary approach is advisable in this selective patient cohort.
Co-Occurrence of Chronic Mucocutaneous Candidiasis with Woolly Hair
Authors: Gaurav Vishal , Grover Chander
Published: June 2021

Chronic mucocutaneous candidiasis is an immunodeficiency state, inherited or acquired, characterized by recurrent and/or persistent candidiasis of skin, nails, and mucous membranes. Woolly hair is a congenital structural anomaly of scalp hair, characterized by light-colored, short, extremely kinky, and thin hair due to premature termination of anagen phase of hair cycle. Both conditions are known to present in syndromic and non-syndromic forms. We report the co-occurrence of both these conditions in a 10-year-old female child. The diagnosis was confirmed with clinical, trichoscopic, microbiologic, histopathologic, and laboratory evaluation, though mutational analysis could not be done due to resource constraints. The occurrence of both these diseases in the same individual has not been previously reported to the best of our knowledge. It could be a result of an association with ectodermal dysplasia.
Age-Related Macular Degeneration: Pathophysiology, Management, and Future Perspectives
Authors: Flores Rita , Carneiro Ângela , Vieira Miguel , Tenreiro Sandra , Seabra Miguel C.
Published: June 2021

Among older adults, age-related macular degeneration (AMD) is a prevalent disabling condition that begins as subtle visual disturbances and can progress to permanent loss of central vision. In its late neovascular form, AMD is treatable with inhibitors of vascular endothelial growth factor, the key driver of exudative disease. In the atrophic form, treatment remains elusive. This review addresses the natural history of AMD – through early, intermediate, and advanced disease stages – and concentrates on diagnosis and risk stratification, deficiencies of current treatments, and the promising findings of emerging therapies.
Clinical Characteristics and Predictors of In-Hospital Mortality in Patients With Cardiogenic Shock: Results From the RESCUE Registry
Authors: Yang Jeong Hoon , Choi Ki Hong , Ko Young-Guk , Ahn Chul-Min , Yu Cheol Woong , Chun Woo Jung , Jang Woo Jin , Kim Hyun-Joong , Kim Bum Sung , Bae Jang-Whan , Lee Sang Yeub , Kwon Sung Uk , Lee Hyun-Jong , Lee Wang Soo , Jeong Jin-Ok , Park Sang-Don , Lim Seong-Hoon , Cho Sungsoo , Park Taek Kyu , Lee Joo Myung , Song Young Bin , Hahn Joo-Yong , Choi Seung-Hyuk , Gwon Hyeon-Cheol
Published: June 2021

Background:

In the current era of mechanical circulatory support, limited data are available on prognosis of cardiogenic shock (CS) caused by various diseases. We investigated the characteristics and predictors of in-hospital mortality in Korean patients with CS.

Methods:

The RESCUE study (Retrospective and Prospective Observational Study to Investigate Clinical Outcomes and Efficacy of Left Ventricular Assist Device for Korean Patients With CS) is a multicenter, retrospective, and prospective registry of patients that presented with CS. Between January 2014 and December 2018, 1247 patients with CS were enrolled from 12 major centers in Korea. The primary outcome was in-hospital mortality.

Results:

In-hospital mortality rate was 33.6%. The main causes of shock were ischemic heart disease (80.7%), dilated cardiomyopathy (6.1%), myocarditis (3.2%), and nonischemic ventricular arrhythmia (2.5%). Vasopressors were used in 1081 patients (86.7%). The most frequently used vasopressor was dopamine (63.4%) followed by norepinephrine (57.3%). An intraaortic balloon pump was used in 314 patients (25.2%) and extracorporeal membrane oxygenator in 496 patients (39.8%). In multivariable analysis, age ≥70years (odds ratio [OR], 2.73 [95% CI, 1.89–3.94],
P
<0.001), body mass index <25 kg/m
2
(OR, 1.52 [95% CI, 1.08–2.16],
P
=0.017), cardiac arrest at presentation (OR, 2.16 [95% CI, 1.44–3.23],
P
<0.001), vasoactive-inotrope score >80 (OR, 3.55 [95% CI, 2.54–4.95],
P
<0.001), requiring continuous renal replacement therapy (OR, 4.14 [95% CI, 2.88–5.95],
P
<0.001), mechanical ventilator (OR, 3.17 [95% CI, 2.16–4.63],
P
<0.001), intraaortic balloon pump (OR, 1.55 [95% CI, 1.07–2.24],
P
=0.020), and extracorporeal membrane oxygenator (OR, 1.85 [95% CI, 1.25–2.76],
P
=0.002) were independent predictors for in-hospital mortality.

Conclusions:

The in-hospital mortality of patients with CS remains high despite the high utilization of mechanical circulatory support. Age, low body mass index, cardiac arrest at presentation, amount of vasopressor, and advanced organ failure requiring various support devices were poor prognostic factors for in-hospital mortality.

Registration:

URL:
https://www.clinicaltrials.gov
; Unique identifier: NCT02985008.
Potential Role of Natriuretic Response to Furosemide Stress Test During Acute Heart Failure
Authors: Caravaca Pérez Pedro , Nuche Jorge , Morán Fernández Laura , Lora David , Blázquez-Bermejo Zorba , López-Azor Juan Carlos , de Juan Bagudá Javier , García-Cosío Carmena María Dolores , Escribano Subías Pilar , Salguero-Bodes Rafael , Arribas Ynsaurriaga Fernando , Delgado Juan F.
Published: June 2021

Background:

Poor natriuresis has been associated with a poorer response to diuretic treatment and worse prognosis in acute heart failure. Recommendations on how and when to measure urinary sodium (UNa) are lacking. We aim to evaluate UNa quantification after a furosemide stress test (FST) capacity to predict appropriate decongestion during acute heart failure hospitalization.

Methods:

Patients underwent an FST on day-1 of admission, and UNa was measured 2 hours after, dividing patients into low or high UNa based on the sample median value. A semiquantitative composite congestive score (CCS; 0–9) and NT pro-BNP (N-terminal pro-B-type natriuretic peptide) quantification were assessed before the FST and at day 5 after the FST.

Results:

Median UNa after FST in the 65 patients included was 113 (97–122) mmol/L. At day 5, a lower proportion of patients with a low UNa reached a 30% decrease in NT-proBNP levels (21 [66%] for low UNa versus 31 [94%] for high UNa;
P
=0.005) and an appropriate grade of decongestion (CCS<3) (20 [62%] for low UNa versus 32 [97%] for high UNa;
P
<0.001). A UNa>83 mmol/L 2 hours after FST had a 96% sensitivity to predict an NT-proBNP reduction ≥30% and 95% to predict a CCS<3 at day 5. Low UNa patients presented a lower cumulative diuresis and weight loss and presented more often with prolonged hospitalization, worsening heart failure, and readmission because of acute heart failure or death at 6 months.

Conclusions:

Low natriuresis after an FST identified patients at a higher risk of an inadequate diuretic response and an inappropriate decongestion. FST-guided diuretic treatment might help to improve decongestion, shorten hospitalizations, and to reduce adverse outcomes.
Deep Learning to Predict Cardiac Magnetic Resonance–Derived Left Ventricular Mass and Hypertrophy From 12-Lead ECGs
Authors: Khurshid Shaan , Friedman Samuel , Pirruccello James P. , Di Achille Paolo , Diamant Nathaniel , Anderson Christopher D. , Ellinor Patrick T. , Batra Puneet , Ho Jennifer E. , Philippakis Anthony A. , Lubitz Steven A.
Published: June 2021

Background:

Classical methods for detecting left ventricular (LV) hypertrophy (LVH) using 12-lead ECGs are insensitive. Deep learning models using ECG to infer cardiac magnetic resonance (CMR)-derived LV mass may improve LVH detection.

Methods:

Within 32 239 individuals of the UK Biobank prospective cohort who underwent CMR and 12-lead ECG, we trained a convolutional neural network to predict CMR-derived LV mass using 12-lead ECGs (left ventricular mass-artificial intelligence [LVM-AI]). In independent test sets (UK Biobank [n=4903] and Mass General Brigham [MGB, n=1371]), we assessed correlation between LVM-AI predicted and CMR-derived LV mass and compared LVH discrimination using LVM-AI versus traditional ECG-based rules (ie, Sokolow-Lyon, Cornell, lead aVL rule, or any ECG rule). In the UK Biobank and an ambulatory MGB cohort (MGB outcomes, n=28 612), we assessed associations between LVM-AI predicted LVH and incident cardiovascular outcomes using age- and sex-adjusted Cox regression.

Results:

LVM-AI predicted LV mass correlated with CMR-derived LV mass in both test sets, although correlation was greater in the UK Biobank (r=0.79) versus MGB (r=0.60, P<0.001 for both). When compared with any ECG rule, LVM-AI demonstrated similar LVH discrimination in the UK Biobank (LVM-AI c-statistic 0.653 [95% CI, 0.608 -0.698] versus any ECG rule c-statistic 0.618 [95% CI, 0.574 -0.663], P=0.11) and superior discrimination in MGB (0.621; 95% CI, 0.592 -0.649 versus 0.588; 95% CI, 0.564 -0.611, P=0.02). LVM-AI-predicted LVH was associated with incident atrial fibrillation, myocardial infarction, heart failure, and ventricular arrhythmias.

Conclusions:

Deep learning-inferred LV mass estimates from 12-lead ECGs correlate with CMR-derived LV mass, associate with incident cardiovascular disease, and may improve LVH discrimination compared to traditional ECG rules.
Deep Learning–Based Automated Echocardiographic Quantification of Left Ventricular Ejection Fraction: A Point-of-Care Solution
Authors: Asch Federico M. , Mor-Avi Victor , Rubenson David , Goldstein Steven , Saric Muhamed , Mikati Issam , Surette Samuel , Chaudhry Ali , Poilvert Nicolas , Hong Ha , Horowitz Russ , Park Daniel , Diaz-Gomez Jose L. , Boesch Brandon , Nikravan Sara , Liu Rachel B. , Philips Carolyn , Thomas James D. , Martin Randolph P. , Lang Roberto M.
Published: June 2021

Background:

We have recently tested an automated machine-learning algorithm that quantifies left ventricular (LV) ejection fraction (EF) from guidelines-recommended apical views. However, in the point-of-care (POC) setting, apical 2-chamber views are often difficult to obtain, limiting the usefulness of this approach. Since most POC physicians often rely on visual assessment of apical 4-chamber and parasternal long-axis views, our algorithm was adapted to use either one of these 3 views or any combination. This study aimed to (1) test the accuracy of these automated estimates; (2) determine whether they could be used to accurately classify LV function.

Methods:

Reference EF was obtained using conventional biplane measurements by experienced echocardiographers. In protocol 1, we used echocardiographic images from 166 clinical examinations. Both automated and reference EF values were used to categorize LV function as hyperdynamic (EF>73%), normal (53%–73%), mildly-to-moderately (30%–52%), or severely reduced (<30%). Additionally, LV function was visually estimated for each view by 10 experienced physicians. Accuracy of the detection of reduced LV function (EF<53%) by the automated classification and physicians’ interpretation was assessed against the reference classification. In protocol 2, we tested the new machine-learning algorithm in the POC setting on images acquired by nurses using a portable imaging system.

Results:

Protocol 1: the agreement with the reference EF values was good (intraclass correlation, 0.86–0.95), with biases <2%. Machine-learning classification of LV function showed similar accuracy to that by physicians in most views, with only 10% to 15% cases where it was less accurate. Protocol 2: the agreement with the reference values was excellent (intraclass correlation=0.84) with a minimal bias of 2.5±6.4%.

Conclusions:

The new machine-learning algorithm allows accurate automated evaluation of LV function from echocardiographic views commonly used in the POC setting. This approach will enable more POC personnel to accurately assess LV function.
Propagation of Topographic Rossby Waves in the Deep Basin of the South China Sea Based on Abyssal Current Observations
Authors: Zheng Hua , Zhu Xiao-Hua , Zhang Chuanzheng , Zhao Ruixiang , Zhu Ze-Nan , Liu Zhao-Jun
Published: June 2021

Topographic Rossby waves (TRWs) are oscillations generated on sloping topography when water columns travel across isobaths under potential vorticity conservation. From our large-scale observations from 2016 to 2019, near-65-day TRWs were first observed in the deep basin of the South China Sea (SCS). The TRWs propagated westward with a larger wavelength (235 km) and phase speed (3.6 km day−1) in the north of the array and a smaller wavelength (80 km) and phase speed (1.2 km day−1) toward the southwest of the array. The ray-tracing model was used to identify the energy source and propagation features of the TRWs. The paths of the near-65-day TRWs mainly followed the isobaths with a slightly downslope propagation. The possible energy source of the TRWs was the variance of surface eddies southwest of Taiwan. The near-65-day energy propagated from the southwest of Taiwan to the northeast and southwest of the array over ~100–120 and ~105 days, respectively, corresponding to a group velocity of 4.2–5.0 and 10.5 km day−1, respectively. This suggests that TRWs play an important role in deep-ocean dynamics and deep current variation, and upper-ocean variance may adjust the intraseasonal variability in the deep SCS.
A Total Error Approach for Validating Event Data
Authors: Althaus Scott , Peyton Buddy , Shalmon Dan
Published: June 2021

Understanding how useful any particular set of event data might be for conflict research requires appropriate methods for assessing validity when ground truth data about the population of interest do not exist. We argue that a total error framework can provide better leverage on these critical questions than previous methods have been able to deliver. We first define a total event data error approach for identifying 19 types of error that can affect the validity of event data. We then address the challenge of applying a total error framework when authoritative ground truth about the actual distribution of relevant events is lacking. We argue that carefully constructed gold standard datasets can effectively benchmark validity problems even in the absence of ground truth data about event populations. To illustrate the limitations of conventional strategies for validating event data, we present a case study of Boko Haram activity in Nigeria over a 3-month offensive in 2015 that compares events generated by six prominent event extraction pipelines—ACLED, SCAD, ICEWS, GDELT, PETRARCH, and the Cline Center’s SPEED project. We conclude that conventional ways of assessing validity in event data using only published datasets offer little insight into potential sources of error or bias. Finally, we illustrate the benefits of validating event data using a total error approach by showing how the gold standard approach used to validate SPEED data offers a clear and robust method for detecting and evaluating the severity of temporal errors in event data.
Impact of Frailty on Clinical Outcomes and Hospitalization Costs Following Elective Colectomy
Authors: Hadaya Joseph , Mandelbaum Ava , Sanaiha Yas , Benharash Peyman
Published: June 2021

Background

Frailty has been increasingly recognized as a risk factor for inferior surgical outcomes and greater resource use. The present study evaluated the impact of a coding-based frailty tool on outcomes of elective colectomy in a national cohort.

Study Design

Adults undergoing elective colectomy were identified in the 2016-17 Nationwide Readmissions Database. Frailty was defined using the Johns Hopkins 10-domain coding-based binary tool. Generalized linear models were used to examine the association of frailty with in-hospital mortality, nonhome discharge, hospitalization duration (LOS), and inflation-adjusted costs. Kaplan-Meier survival analysis and log-rank test was used to compare readmissions up to 1-year.

Results

Of 133 175 patients, 10.6% were considered frail. The most common resections were sigmoid (43.9%) and right (34.7%) while total colectomy was least common (2.8%). After adjustment, frailty was associated with greater odds of mortality (3.2, 95% CI 2.8-3.8) and nonhome discharge (6.0, 95% CI 5.5-6.4) as well as a $13,400-increment (95% CI 12,400-14,400) in costs and 4.4-day (95% CI 4.1-4.6) increase in LOS. Nonelective readmissions at 30 days were greater in frail than non-frail groups (14.7% vs. 10.4%, P < .001).

Conclusion

Frailty is associated with inferior clinical outcomes and increased resource use following elective colectomy. Inclusion of frailty in risk models may facilitate risk stratification and shared decision-making.
Non-Selective Thoracic Computed Tomography in Trauma Patients Results in Injury Severity Score Inflation
Authors: Alaniz Leonardo , Muttalib Omaer , Hoyos Juan , Figueroa Cesar , Barrios Cristobal
Published: June 2021

Introduction

Extensive research relying on Injury Severity Scores (ISS) reports a mortality benefit from routine non-selective thoracic CTs (an integral part of pan-computed tomography (pan-CT)s). Recent research suggests this mortality benefit may be artifact. We hypothesized that the use of pan-CTs inflates ISS categorization in patients, artificially affecting admission rates and apparent mortality benefit.

Methods

Eight hundred and eleven patients were identified with an ISS >15 with significant findings in the chest area. Patient charts were reviewed and scores were adjusted to exclude only occult injuries that did not affect treatment plan. Pearson chi-square tests and multivariable logistic regression were used to compare adjusted cases vs non-adjusted cases.

Results

After adjusting for inflation, 388 (47.8%) patients remained in the same ISS category, 378 (46.6%) were reclassified into 1 lower ISS category, and 45 (5.6%) patients were reclassified into 2 lower ISS categories. Patients reclassified by 1 category had a lower rate of mortality ( P < 0.001), lower median total hospital LOS ( P < .001), ICU days ( P < .001), and ventilator days ( P = 0.008), compared to those that remained in the same ISS category.

Conclusion

Injury Severity Score inflation artificially increases survival rate, perpetuating the increased use of pan-CTs. This artifact has been propagated by outdated mortality prediction calculation methods. Thus, prospective evaluations of algorithms for more selective CT scanning are warranted.
Increased Mortality in Underinsured Penetrating Trauma Patients
Authors: Alaniz Leonardo , Billimek John , Figueroa Cesar , Nahmias Jeffry T. , Barrios Cristobal
Published: June 2021

Introduction

It remains unclear whether an increased mortality risk in uninsured patients exists across Injury Severity Score (ISS) classifications. We hypothesized that penetrating trauma self-pay patients would have a similarly increased mortality risk across all ISS categories.

Methods

The National Trauma Data Bank (2013-2015) was queried for patients presenting with penetrating firearm, explosive, or stab wound injuries. 115 651 patients were identified and a stratified multivariable logistic regression model was used.

Results

In the >15 ISS group, self-pay patients had a lower median total hospital Length of Stay (LOS) (3 vs 8, P < .001), lower median Intensive Care Unit LOS (1 vs 3, P < .001), and lower median ventilator days (0 vs 1, P < .001). Self-pay patients had an increased risk for mortality compared to patients with private insurance in both the ≤15 ISS group (OR 2.68, P < .001) and >15 ISS group (OR 1.56, P < .001).

Conclusion

Uninsured patients have an increased mortality risk in both low and high ISS groups. A higher mortality risk among uninsured patients in the high ISS group can be explained by decreased resource availability and lower ICU days and ventilator time. However, more studies are needed to determine why there is an even greater mortality risk among uninsured patients with mild ISS.
A Smartphone Application for Teamwork and Communication in Trauma: Pilot Evaluation “in the Wild”
Authors: Catchpole Ken , Privette Alicia , Roberts Laura , Alfred Myrtede , Carter Brittan , Woltz Erick , Wilson Dulaney , Crookes Bruce
Published: June 2021

Objective

To evaluate the potential for a smartphone application to improve trauma care through shared and timely access to patient and contextual information.

Background

Disruptions along the trauma pathway that arise from communication, coordination, and handoffs problems can delay progress through initial care, imaging diagnosis, and surgery to intensive care unit (ICU) disposition. Implementing carefully designed and evaluated information distribution and communication technologies may afford opportunities to improve clinical performance.

Methods

This was a pilot evaluation “in the wild” using a before/after design, 3 month, and pre- post-intervention data collection. Use statistics, usability assessment, and direct observation of trauma care were used to evaluate the app. Ease of use and utility were assessed using the technology acceptance model (TAM) and system usability scale (SUS). Direct observation deployed measures of flow disruptions (defined as “deviations from the natural progression of an procedure”), teamwork scores (T-NOTECHS), and treatment times (total time in emergency department [ED]).

Results

The app was used in 367 (87%) traumas during the trial period. Usability was generally acceptable, with higher scores found by operating room (OR), ICU, and neuro and orthopedic users. Despite positive trends, no significant effects on flow disruptions, teamwork scores, or treatment times were observed.

Conclusions

Pilot trials of a clinician-centered smartphone app to improve teamwork and communication demonstrate potential value for the safety and efficiency of trauma care delivery as well as benefits and challenges of “in-the-wild” evaluation.
Phenotypic Proximity: Colorism and Intraracial Discrimination among Blacks in the United States and Brazil, 1928 to 1988
Authors: Dupree-Wilson Teisha
Published: June 2021

The level of colorism that developed among blacks in the United States (U.S.) and Brazil, during the 20th century, gave rise to intense altitudes of intraracial discrimination. This distinct form of discrimination was based on proximity to whiteness and white privilege. This essay will illustrate how attitudes toward complexion, within the black community, are a direct consequence and perpetual remnant of the white supremacy and racial hierarchy that developed in colonized societies. Colorism manifested itself in different forms in Brazil and in the U.S. However, the level of black-on-black discrimination that it spawned was grounded in the belief that one’s immediacy to whiteness created a vehicle for upward mobility.