bluuebunny/crossref_metadata_2025 huggingface dataset:
Plasma Brain-Derived Tau in Prognosis of Large Vessel Occlusion Ischemic Stroke
Authors: Varela Ricardo , Gonzalez-Ortiz Fernando , Dias Alexandre , Knuth Nicoló Luca , Fonte Joana , Pinto Beatriz , Yuksekel Idil , Abreu Vasco , Silva Isabel , Igreja Liliana , Lopes Joana , Silva José , Dias Rafael , Filipe João Pedro , Malaquias Maria João , Moutinho Ana , Gabriel Denis , Aires Ana , Antunes Rui , Rocha José Pedro , Felgueiras Rui , Almendra Ricardo , Castro Pedro , Zetterberg Henrik , Magalhães Rui , Karikari Thomas K. , Correia Manuel , Blennow Kaj , Maia Luís F.
Published: July 2024

BACKGROUND:

Large vessel occlusion acute ischemic stroke prognosis improved following the 2015 endovascular therapy (EVT) trials. Blood-based biomarkers may improve outcome prediction. We aimed to assess plasma brain-derived tau (BD-Tau) performance in predicting post-EVT large vessel occlusion acute ischemic stroke outcomes.

METHODS:

We included 2 temporally independent prospective cohorts of anterior circulation in patients with large vessel occlusion acute ischemic stroke who successfully recanalized post-EVT. We measured plasma BD-Tau, GFAP (glial-fibrillary-acidic-protein), NfL (neurofilament-light-chain), and total-Tau upon admission, immediately, 24 hours, and 72 hours post-EVT. Twenty-four-hour neuroimaging and 90-day functional outcomes were independently assessed using the Alberta Stroke Program Early Computed Tomography Score (good outcome: >7 or unchanged) and the modified Rankin Scale (favorable outcome <3 or unchanged), respectively. Based on the first cohort (derivation), we built a multivariable logistic regression model to predict a 90-day functional outcome. Model results were evaluated using the second cohort (evaluation).

RESULTS:

In the derivation cohort (n=78, mean age=72.9 years, 50% women), 62% of patients had a good 24-hour neuroimaging outcome, and 45% had a favorable 90-day functional outcome. GFAP admission-to-EVT rate-of-change was the best predictor for early neuroimaging outcome but not for 90-day functional outcome. At admission, BD-Tau levels presented the highest discriminative performance for 90-day functional outcomes (area under the curve, 0.76 [95% CI, 0.65–0.87];
P
<0.001). The model incorporating age, admission BD-Tau, and 24-hour Alberta Stroke Program Early Computed Tomography Score achieved excellent discrimination of 90-day functional outcome (area under the curve, 0.89 [95% CI, 0.82–0.97];
P
<0.001). The score’s predictive performance was maintained in the evaluation cohort (n=66; area under the curve, 0.82 [95% CI, 0.71–0.92];
P
<0.001).

CONCLUSIONS:

Admission plasma BD-Tau accurately predicted 90-day functional outcomes in patients with large vessel occlusion acute ischemic stroke after successful EVT. The proposed model may predict functional outcomes using objective measures, minimizing human-related biases and serving as a simplified prognostic tool for AIS.
Design and Interrater Reliability of the Pediatric Version of the Race Scale: PedRACE
Authors: Turón-Viñas Eulàlia , Boronat Susana , Gich Ignasi , González Álvarez Verónica , García-Puig Montserrat , Camós Carreras Maria , Rodriguez-Palmero Agustí , Felipe-Rucián Ana , Aznar-Laín Gemma , Jiménez-Fàbrega Xavier , Pérez de la Ossa Natalia , Álvarez-Molinero Mireia , Barceló Irene , Brió Sonia , Casellas-Vidal Dolors , Coca-Fernández Elisabeth , Costa-Comellas Laura , Delgadillo-Chilabert Verónica , Díaz-Gómez Asunción , Díaz-Simal Laura , Dougherty-de Miguel Lucía , Escofet Conxita , Esteban Elisabeth , Gómez-Andrés David , González-Rioja Xoan , Molina-Anguita Cristina , Monlleó-Neila Laura , Paredes-Carmona Fernando , Pujol Montserrat , Raspall-Chaure Miquel , Renter-Valdovinos Luis , Sala-Colomina Júlia , Sensarrich Mireia , Solà Silvia , Soto Angels , Torrents Carme , Turon-Viñas Anna , Turon Marc , Valle-T-Figueras Jose Maria
Published: July 2024

BACKGROUND:

Acute ischemic stroke is a leading cause of pediatric death and disability. A clinical scale adapted for children can ensure early detection of candidates for urgent acute ischemic stroke treatment. The Rapid Arterial Occlusion Evaluation (RACE) scale for adults, which scores 5 items (facial palsy 0–2; arm motor function 0–2; leg motor function 0–2; head/gaze deviation 0–1; and aphasia or agnosia 0–2), has good sensitivity and specificity in detecting large vessel occlusion.

METHODS:

We adapted the previously validated RACE scale for use in children as the Pediatric RACE scale. This adapted scale was tested by prehospital/emergency room staff attending to patients covered by the Catalan Pediatric Stroke Code and child neurologists for its correlation with the Pediatric National Institutes of Health Stroke Scale and for interrater reliability.

RESULTS:

The study included 50 children, 18 with confirmed strokes (7 acute ischemic strokes and 11 hemorrhagic strokes). Prehospital/emergency staff and child neurologists agreed fully regarding 82% of patients and 100% regarding head/gaze deviation and agnosia. The Pediatric RACE scale correlated strongly with the Pediatric National Institutes of Health Stroke Scale in evaluations by child neurologists (Spearman ρ, 0.852;
P
<0.001) and prehospital/emergency staff (Spearman ρ, 0.781;
P
<0.001). The median Pediatric RACE score was significantly higher in patients with large vessel occlusion (6.5; interquartile range, 6–7) than with other etiologies.

CONCLUSIONS:

Pediatric RACE, showing good interrater reliability and correlation with the Pediatric National Institutes of Health Stroke Scale, is a simple scale to detect candidates for pediatric acute stroke treatment, designed for both prehospital and in-hospital use by non-neurologist medical staff.
Characterisation of laminar and vascular spatiotemporal dynamics of CBV and BOLD signals using VASO and ME-GRE at 7T in humans
Authors: Dresbach Sebastian , Huber Renzo , Gülban Ömer Faruk , Pizzuti Alessandra , Trampel Robert , Ivanov Dimo , Weiskopf Nikolaus , Goebel Rainer
Published: July 2024

Interpretation of cortical laminar functional magnetic resonance imaging (fMRI) activity requires detailed knowledge of the spatiotemporal haemodynamic response across vascular compartments due to the well-known vascular biases (e.g., the draining veins). Further complications arise from the fact that the spatiotemporal haemodynamic response differs depending on the duration of stimulation. Information about haemodynamic response characteristics across different stimulus durations, cortical depth, and vascular compartments is crucial for future studies using depth-dependent cerebral blood volume (CBV) measurements, which promise higher specificity for the cortical microvasculature than the blood oxygenation level dependent (BOLD) contrast. To date, direct information about CBV dynamics with respect to stimulus duration, cortical depth, and vasculature is missing in humans. Therefore, we characterised the cortical depth-dependent CBV-haemodynamic responses across a wide set of stimulus durations with 0.9 mm isotropic spatial and 0.785 seconds effective temporal resolution in humans using slice-selective slab-inversion vascular space occupancy (SS-SI VASO). Additionally, we investigated signal contributions from macrovascular compartments using fine-scale vascular information from multi-echo gradient-echo (ME-GRE) data at 0.35 mm isotropic resolution. In total, this resulted in >7.5 hours of scanning per participant (n = 5). We have three major findings: (I) While we could demonstrate that 1 second stimulation is viable using VASO, more than 12 seconds stimulation provides better CBV responses in terms of specificity to the microvasculature, but durations beyond 24 seconds of stimulation may be wasteful for certain applications. (II) We observed that CBV responses were slightly delayed for superficial compared deeper layers for stimuli ≤4 seconds. (III) While we found increasingly strong BOLD signal responses in vessel-dominated voxels with longer stimulation durations, we found increasingly strong CBV signal responses in vessel-dominated voxels only until 4 second stimulation durations. After 4 seconds, only the signal from non-vessel-dominated voxels kept increasing. This might explain why CBV responses are more specific to the underlying neuronal activity for long stimulus durations.
Rehabilitation Frequency for Pediatric Patients With Burns in Acute Care
Authors: Reoli Rachel , Lenker Hallie
Published: July 2024

It is known that rehabilitation provides beneficial outcomes postburns. However, the frequency of therapy interventions is inconsistent, especially in the hospital setting. Our objective is to identify the frequency of rehabilitation interventions for pediatric patients with burns in acute care. Manuscripts were included if they addressed rehabilitation burn interventions for the pediatric population and reported intervention frequencies. Studies were excluded if they included adults and/or were beyond the acute care setting. We searched 6 databases for published literature, in the English language, from 2010 to April 2023. A total of 140 articles were found; however, only 8 met the inclusion criteria. Five studies met criteria for high-quality evidence, 3 for low quality. Frequency of rehabilitative therapy in the acute care setting was found to be variable, ranging from 1 day per week to 2 times per day. More research is needed to support optimum frequency.
The role of attachment orientations in capitalization and mattering among married couples
Authors: Kırımer-Aydınlı Fulya , Sümer Nebi
Published: July 2024

Why do some perceive a partner’s response as heartening while others interpret the same response as demoralizing? This study examined how attachment anxiety and avoidance influence perceived partner responses toward capitalization attempts (PRCA) and perceived mattering (PM) among married couples ( N = 103 dyads). Dyadic analyses delineating the actor and partner effects revealed that wives’ attachment avoidance predicted own PRCA, PM, and their husbands’ PRCA. Whereas husbands’ attachment avoidance predicted own PM and their wives’ PRCA and PM, husbands’ attachment anxiety predicted only their PRCA and PM. The interaction between wife and husband attachment anxiety also predicted the husbands’ PRCA and PM. Husbands, but not wives, perceived the lowest level of PRCA and PM when both couples had high attachment anxiety. The results were discussed in the context of the interplay between attachment orientations and partner responsiveness in Turkish culture.
Evaluation of health records management systems of Lagos State University Teaching Hospital, Nigeria
Authors: Arogunjo Richard Olalekan , Makinde Olayinka Babayemi
Published: July 2024

This study evaluated the health records management systems of Lagos State University Teaching Hospital (LASUTH). A survey research methodology with a quantitative approach was employed using a questionnaire. The study covered the healthcare providers and medical records officers. After the employment of a two-stage sampling technique, a sample size of 394 respondents constituted the study population. Data were collected from August 2022 to June 2023. The analysis of the responses was univariate using frequency, percentage and mean. The major findings detected the successes and failures of the Manual and Electronic Health Records Management Systems, notwithstanding the overall favourable use. Moreover, the study showed a positive agreement with the seven DeLeon and McLean Model variables that measured user experience. The study recommended that the LASUTH authority needs to consciously work on curbing the concerns that are the root causes of records management challenges and the implementation of records management systems.
Sheffield Junior Art Department and how the Junior Art Department shaped the arts, crafts and design careers of its pupils and of its teachers in mid-twentieth-century Britain
Authors: Cartwright Julyan H. E.
Published: July 2024

The institution that was the Junior Art Department (JAD) and its role in teaching children who went on to have successful careers in the arts, crafts, and design in mid-twentieth century Britain have been little documented. Here I recall the nature of JADs in the United Kingdom during the postwar period, with the Sheffield Junior Art Department as a case study. I characterise the JAD movement in the context of British education at the time. I discuss the artists and craftspeople the JADs encouraged and the student–teacher relationship it engendered. I record Sheffield Junior Art Department, how it and its teachers influenced the pupils who passed through it and how in turn the school influenced its teachers’ careers both teaching and making craftwork in mid-twentieth-century Britain. I hope that this essay might contribute to debates on the values both of the specialist teaching of gifted pupils and of the arts and crafts for everyone.
An anti-geoeconomics of climate change
Authors: Inverardi-Ferri Carlo
Published: July 2024

This essay develops a critique of emerging narratives on the geoeconomics of climate change. In recent years a growing policy agenda on climate change that can be listed under the rubric of geoeconomics has emerged in the literature. This scholarship is characterised by persistent imaginaries that articulate geopolitical fears and geoeconomic hopes over nature and society. The key argument mobilised in this discourse is that ecological shifts raise considerable threats, some of which are geopolitical in nature. At the same time, they also represent tremendous geoeconomic opportunities for businesses in terms of new industries such as in the area of the energy transition. Analysing dominant narratives and providing examples from the photovoltaic industry, this essay develops an anti-geoeconomics of climate change that links the sites of production to those of reproduction and aims to reverse the order between the positions of power where climate change is discussed and the places where it is embodied and lived.
“Divisive” Education Legislation in the Midwest: A Critical Epistemic Policy Analysis
Authors: Rodriguez Gabriel , Chase Sarah , Tanchuk Nicolas , Gebhart Nancy
Published: July 2024

This interview-based study examines how justice-oriented K-12 administrators and teachers in Iowa make sense of the recent state-level education policy, H.F. 802. Synthesizing literature on Critical Policy Analysis and epistemic justice, we introduce Critical Epistemic Policy Analysis to understand the micro-level impact of divisive education legislation on efforts to create just and inclusive schools. Findings highlight a sociopolitical terrain with ambivalent and shallow equity commitments, deteriorating support for equity work in schools, and a need to grapple with questions of divisiveness and solidarity in justice-oriented educational activism.
An internal variable model of macroscopic twin boundary dynamics
Authors: Berezovski Arkadi
Published: July 2024

Depending on whether the experiments are quasi-static or fast dynamics, the measured twin boundary velocity values range from zero to the material’s sound speed. The twin boundary velocity is not yet predicted theoretically in the continuum mechanics framework. The extension of continual description is provided in the paper by means of internal variables. It is shown that a diffusional slow motion of twin boundaries can be represented using a single internal variable. The dual internal variable technique is employed for the description of the fast dynamics of twin boundaries.
Formability limits due to local buckling in thin-walled square tubes
Authors: Almeida I.M. , Magrinho J.P. , Silva M.B. , Martins P.A.F.
Published: July 2024

This article focuses on the identification and quantification of the formability limits due to local buckling in thin-walled square tubes subjected to axial compression. The methodology involves subjecting a series of thin-walled square tubular specimens of varying lengths to axial compression to detect sudden changes in the evolution of in-plane strains over time and determine the critical strain values at the onset of local buckling. Digital image correlation is employed to monitor the evolution of the thin-walled surfaces and the in-plane strains during axial compression. Finite element analysis is utilized to create digital twins of the thin-walled square tubes subjected to axial compression. The overall methodology is based on a previously developed technique that was successfully applied to thin-walled circular tubes and results validate its effectiveness in determining, for the first time, the formability limits of thin-walled square tubes due to local buckling in principal strain space.
How to defeat miscarriage stigma: from ‘breaking the silence’ to Reproductive Justice
Authors: Browne Victoria
Published: July 2024

Public discussions of miscarriage in the UK frequently describe it as a stigmatised phenomenon that is ‘shrouded in silence’. And in turn, ‘breaking the silence’ is presented as the means of defeating the stigma. In this article, however, I argue that it is time to abandon the ‘breaking the silence’ frame. This is not only because it overstates the public silence it condemns, but also because it is rooted in an inadequate understanding of stigma, which keeps us stuck in a cycle of talking more, rather than doing more, about miscarriage, and failing to connect miscarriage as a feminist issue with wider struggles for social justice. Drawing on critical sociologies of stigma developed by Imogen Tyler and others, I propose a paradigm shift: from a narrow liberal understanding of miscarriage stigma as a problem of social norms that can be alleviated through ‘breaking the silence’ and ‘awareness raising’, to a critical ‘stigma power’ approach which understands miscarriage stigma as a ‘machinery of inequality’ that fulfils a core function for patriarchal, racialised, neoliberal capitalist power structures, and hence requires transformative socioeconomic solutions. To this end, I call for a new research and activism agenda that fully incorporates miscarriage within the wider movement for Reproductive Justice.
Embodied leisure experiences of nature-based activities for people living with dementia
Authors: Owen Steven , Page Stephen , Ledingham Katie , Price Stephan , Connell Joanne , Quinn Catherine , Clare Linda
Published: July 2024

Purpose

This article adopts an embodiment lens to explore the individual leisure experiences of people living with dementia when engaging in nature-based pursuits. It focuses on how people living with dementia frame their everyday experiences of nature and how these are shaped by any cognitive challenges and/or other comorbidities affecting physical health.

Design/methodology/approach

Taking a phenomenological research approach, we interviewed 15 people living with dementia and 15 family carers of people with dementia to explore how people with dementia engage with nature as a subjective leisure experience. We analysed their accounts using reflexive thematic analysis.

Findings

The findings reveal how people living with dementia frame their experiences of nature-based pursuits through three interlinked themes of ‘bodily feelings and emotions’, ‘sense of self and identity’ and ‘connectivity to others’.

Originality/value

The paper contributes to knowledge by examining through the lens of embodiment a neglected and overlooked dimension of everyday leisure: how nature is encountered, negotiated and enjoyed. The paper illustrates how nature and the outdoors may help people living with dementia to continue to enjoy prior leisure pursuits and thus achieve a degree of continuity in their everyday lives.
The Voting Potential of Bündnis Sahra Wagenknecht
Authors: Thomeczek Jan Philipp
Published: July 2024

A new challenger seeks to enter the German party system: Bündnis Sahra Wagenknecht (BSW). With her new party, former Die Linke politician Sahra Wagenknecht combines a left-authoritarian profile (economically left-leaning, but culturally conservative) with anti-US, pro-Russia and anti-elitist stances. This article provides the first large-n academic study of the voter potential of this new party by using a quasi-representative sample (n = 6,000) drawn from a Voting Advice Application-like dataset that comes from a website designed to explore the Bündnis Sahra Wagenknecht’s positions. The results show that congruence with foreign policy positions and anti-elitism are strong predictors of the propensity to vote for the Bündnis Sahra Wagenknecht. In contrast, social/welfare and immigration policies are less predictive for assessing the party’s potential. Among the different socio-demographic groups, the Bündnis Sahra Wagenknecht has a strong potential among baby boomers, the less educated and East Germans. Regarding party voters, the Bündnis Sahra Wagenknecht is favoured by supporters of some minor parties like dieBasis, Freie Wähler and Die PARTEI, but also non-voters. Among the established parties, the party’s potential is high among Die Linke voters and, to a lesser extent, voters of the Social democrats (SPD) and Alternative for Germany (AfD). A potential below the average is reported for the supporters of the Liberals (FDP) and Christian Democrats (CDU/CSU) and most clearly for Green and Volt voters.
Addressing human factors in the recognition and management of local anaesthetic systemic toxicity
Authors: Curtain Niamh EB , Gugelmin-Almeida Debora
Published: July 2024

In the perioperative environment, local anaesthetics are commonly administered to patients to provide analgesia and anaesthesia for a large range of surgical procedures. Although rare, their use can result in systemic toxicity, which is a life-threatening complication, underscoring the importance of early recognition and prompt management to mitigate patient risks. This article evaluates the impact of human factors and other aspects such as insufficient monitoring, errors in drug administration and poor adherence to safety protocols on the development and management of local anaesthetic systemic toxicity and provides practical considerations to minimise its occurrence.
Clavipectoral fascial plane block for clavicle fracture surgery: A case report
Authors: Pereira Cândida Sofia , Ferros Catarina , Dinis Inês , Pereira Dulce , Miguel Diogo , Vico Manuel
Published: July 2024

Background:

Regional anaesthesia can be an attractive alternative anaesthetic approach in clavicle surgery, but it requires the peripheral block of multiple cervical and brachial nerves that transmit nociceptive information. Deep cervical plexus blocks, as paravertebral nerve block, can lead to severe side effects, such as unilateral diaphragmatic paralysis.

Case report:

A 66-year-old male patient, American Society of Anesthesiologists physical status III, was scheduled for open reduction and internal fixation of the right clavicle with plates and screws after a high-energy trauma. Pre-anaesthetic evaluation revealed right hemopneumothorax and bilateral rib fractures. We decided to perform regional anaesthesia (superficial cervical plexus block and clavipectoral fascial plane block), combined with dexmedetomidine perfusion to avoid invasive mechanical ventilation and prevent additional pulmonary complications. The surgical procedure was successfully completed without any further anaesthesia requirements. The patient remained comfortable during the postoperative period.

Conclusion:

Regional anaesthesia for clavicle surgeries has the advantage of promoting non-opioid free anaesthesia. Effective pain control enhances patient satisfaction and reduces the length of stay in hospital. In our case report, a combined superficial cervical plexus block and clavipectoral fascial plane block was a safe and effective regional anaesthetic approach.
Story-ing AI – mini-narrative patterns of contemporary online science journalism
Authors: Molek-Kozakowska Katarzyna
Published: July 2024

This study explores the range of discursive patterns used to present artificial intelligence as a revolutionary but controversial technology in online science journalism. It uses a triangulated dataset of over a hundred recent mini-narratives sourced from New Scientist, Nature daily briefings, and Scientific American to reconstruct typical storylines in the thematic domains of research, business, and society, and to map their narrative trajectories (utopian, dystopian). The qualitative analysis uses the categories of agency, sentiment, point of view, and news value to capture these outlets’ contributions to the evolving sociotechnical imaginary of AI technologies. While acknowledging some risks of AI technologies, elite commercial science journalism highlights the benefits and celebrates the scientific advancements produced with or by AI. Also, AI technologies are communicated strategically to increase newsworthiness, through diverse complications in storylines with oscillating sentiments and a focus on impacts and novelty. This tends to prime news recipients to accept the inevitable technological progress and normalizes algorithms as increasingly independent research-performing agents.
Case Method Teaching, Strategic Storytelling, and Social Change: A Pilot Evaluation of an Online Course to Address Colourism in Malaysia
Authors: Santoso Monique , Chua Sook Ning , Radzi Aifa Muhammad , Kong Yi Fen , Chwa Cindy , Raffoul Amanda , Craddock Nadia , Austin S. Bryn
Published: July 2024

Colourism is the discriminatory practice of favoring lighter skin over darker skin. It perpetuates social disparities and drives skin-lightening products (SLP) use globally, including in Malaysia. This study presents the results of an innovative 3 week online training course designed to equip health professionals and educators who work with youth in Malaysia with the knowledge and skills to combat colourism and the use of dangerous SLPs through strategic storytelling. We recruited a diverse group of learners ( N = 19) and assessed their knowledge and attitudes of colourism and use of SLP before and after the course. We also assessed student engagement and collected qualitative acceptability data. The course incorporated case method teaching, interactive case delivery, strategic storytelling methods, and team collaboration elements through digital platforms to facilitate course engagement and learning. Our findings indicate significant improvements in learners’ knowledge and concern regarding skin-shade discrimination and SLP usage pre- to post-course. Learners reported their intention to use strategic storytelling techniques for public health advocacy around colourism and use of SLPs. Qualitative learner feedback highlighted the positive aspects of the course, including its realism and the importance of collaborative learning with professionals from diverse fields to combat prevailing sociocultural issues. While this study offers valuable insights into the effectiveness of this innovative training approach, it also identifies areas of future improvements as suggested by learners, such as the need to increase content diversity, enhance communication channels, and extend time for discussion. This course provides a promising model for addressing colourism-related issues in Malaysia.
Evidence-based decision-making is a social endeavor
Authors: HakemZadeh Farimah , Rousseau Denise M.
Published: July 2024

Evidence-based decision-making (EBDM)—using the best available evidence from multiple sources to make informed decisions—is critical to the successful functioning of any organization. Much of the literature on EBDM has focused on the decision-maker as an individual. Yet to be most efficient and effective, EBDM requires extensive communication with others. Our review of the body of research on EBDM shows that it is typical for several individuals and groups to contribute to evidence-based decisions. These varied participants provide the skills and knowledge needed to incorporate diverse types of evidence into the decision process. We have found that conversations and interactions through three distinct networks contribute to successful EBDM. These networks consist of decision-makers and their staff and either (a) researchers in a relevant field; (b) stakeholders in the community or organization; or (c) colleagues with similar responsibilities and challenges, which we call communities of practice. Building social connections with people in each of these networks enhances a person’s ability to make good decisions for an organization. It is therefore imperative that organizations engaging in EBDM have ongoing programs and policies geared toward creating and maintaining these three critical connections.
Anterior Versus Lateral Skull Base Fractures: Differences in Hospital Course and Need for Surgery
Authors: Shah Rema , Almeida Mariana N. , Liu Christina , Wride Mitchel , Lockwood Donovan , Lee Jonathan , Lee Yan
Published: July 2024

Background:

Skull base fracture management depends on location, severity, and can range from observation to surgical intervention.  A comparison between the different locations of skull base fractures, namely anterior versus lateral, with regards to hospital length of stay (LOS), need for intensive care, and surgery has not been studied.

Methods:

Patients with skull base fractures between 2012 and 2019 were reviewed. Demographics and inpatient events were collected. Multivariate logistic and linear regressions evaluated the association between fracture location, multiple traumas, loss of consciousness, and mechanism of injury with hospital course and sequalae.

Results:

There were 134 patients (74.6% male) with skull base fractures (67 anterior and 67 lateral), with an average age of 44.2 years. The mechanism of injury was more likely to be MVCs in anterior fractures and falls in lateral fractures (MVC: 56.7% vs 34.3%; falls: 28.4% vs 44.8%, P = .03). Patients with anterior fractures were more likely to undergo any surgery ( P < .002), and surgeries for facial fractures ( P < .005), but less likely to need ICU care ( P = .01). When admitted, patients with anterior skull base fractures had longer ICU stays ( P = .03). They were also more likely to experience vision difficulties whereas patients with lateral fractures were more likely to experience hearing loss ( P = .02).

Conclusion:

Patients with lateral skull base fractures are more likely to require an ICU admission compared to anterior fractures, but anterior fractures are more likely to need surgery and have longer ICU stays when admitted. A better understanding of the expected hospital course for patients based on skull base fracture location can improve care-coordination, hospital resource management and patient counseling.
Alliance A061202: ixazomib, pomalidomide, and dexamethasone for patients with lenalidomide-refractory MM in first relapse
Authors: Voorhees Peter , Suman Vera , Efebera Yvonne , Raje Noopur , Tuchman Sascha , Rodriguez Cesar , Laubach Jacob , Bova-Solem Misty , Carlisle Destin , Usmani Saad , McCarthy Philip , Richardson Paul G.
Published: July 2024

Optimal therapy for the growing number of patients with lenalidomide (LEN)-refractory multiple myeloma in their first relapse remains poorly defined. We therefore undertook a randomized phase 2 study to evaluate the efficacy and safety of combining the oral proteasome inhibitor ixazomib (IXA) with pomalidomide (POM) and dexamethasone (DEX) in this patient population. The overall response rate (ORR) for POM-DEX was 43.6%, and for IXA-POM-DEX, it was 63.2%. The depth of response, measured by the attainment of at least a very good partial response, favored triplet therapy over doublet therapy (28.9% vs 5.1%; P = .0063). A preplanned interim analysis after 75% of the progression events had occurred demonstrated an improvement in progression-free survival (PFS) that favored IXA-POM-DEX and that crossed the predefined boundary of superiority, leading to release of the study results. With additional follow-up, the median PFS for POM-DEX was 7.5 months (95% confidence interval [CI], 4.8-13.6 months) vs 20.3 months for IXA-POM-DEX (95% CI, 7.7-26.0 months; hazard ratio, 0.437; upper 90% bound = 0.657). The ORR and median PFS for 26 of 30 eligible patients who crossed over from the doublet to the triplet therapy at disease progression was 23.1% and 5.6 months, respectively. Overall survival was similar between the 2 groups. More hematologic toxicities were seen with the triplet therapy, but nonhematologic adverse events were similar between the 2 arms. Our data support further testing of this all-oral triplet therapy in comparison with current standard triplet therapy in the context of phase 3 studies for patients with LEN-refractory disease at first relapse. This trial was registered at www.clinicaltrials.gov as #NCT02004275.
Genotypic and phenotypic characteristics of Acinetobacter baumannii isolates from the people’s hospital of Qingyang City, Gansu province
Authors: Chen Jiali , Wang Yang , Zhang Na , Li Juan , Liu Xiong
Published: July 2024

Background

Acinetobacter baumannii (A. baumannii) is a common opportunistic pathogen in hospitals that causes nosocomial infection. In order to understand the phenotypic and genotypic characteristics of A. baumannii isolates, we sequenced and analyzed 62 A. baumannii isolates from a hospital in Gansu province.

Results

Non-repeated 62 A. baumannii isolates were collected from August 2015 to November 2021. Most isolates (56/62) were resistant to multiple drugs. All the 62 A. baumannii isolates were resistant to aztreonam and contained blaADC-25 gene which exists only on chromosome contigs. The 62 isolates in this study were not clustered in a single clade, but were dispersed among multiple clades in the common genome. Seven sequence types were identified by Multilocus sequence type (MLST) analysis and most isolates (52/62) belonged to ST2. The plasmids were grouped into 11 clusters by MOB-suite.

Conclusions

This study furthers the understanding of A. baumannii antimicrobial-resistant genotypes, and may aid in prevention and control nosocomial infection caused by drug-resistant A. baumannii.
Multiplex array analysis of circulating cytokines and chemokines in COVID-19 patients during the first wave of the SARS-CoV-2 pandemic in Milan, Italy
Authors: Calvo-Alvarez Estefanía , D’Alessandro Sarah , Zanotta Nunzia , Basilico Nicoletta , Parapini Silvia , Signorini Lucia , Perego Federica , Maina Kevin Kamau , Ferrante Pasquale , Modenese Annalisa , Pizzocri Pierluigi , Ronsivalle Andrea , Delbue Serena , Comar Manola
Published: July 2024

Background

The systemic inflammatory syndrome called “cytokine storm” has been described in COVID-19 pathogenesis, contributing to disease severity. The analysis of cytokine and chemokine levels in the blood of 21 SARS-CoV-2 positive patients throughout the phases of the pandemic has been studied to understand immune response dysregulation and identify potential disease biomarkers for new treatments. The present work reports the cytokine and chemokine levels in sera from a small cohort of individuals primarily infected with SARS-CoV-2 during the first wave of the COVID-19 pandemic in Milan (Italy).

Results

Among the 27 cytokines and chemokines investigated, a significant higher expression of Interleukin-9 (IL-9), IP-10 (CXCL10), MCP-1 (CCL2) and RANTES (CCL-5) in infected patients compared to uninfected subjects was observed. When the change in cytokine/chemokine levels was monitored over time, from the hospitalization day to discharge, only IL-6 and IP-10 showed a significant decrease. Consistent with these findings, a significant negative correlation was observed between IP-10 and anti-Spike IgG antibodies in infected individuals. In contrast, IL-17 was positively correlated with the production of IgG against SARS-CoV-2.

Conclusions

The cytokine storm and the modulation of cytokine levels by SARS-CoV-2 infection are hallmarks of COVID-19. The current global immunity profile largely stems from widespread vaccination campaigns and previous infection exposures. Consequently, the immunological features and dynamic cytokine profiles of non-vaccinated and primarily-infected subjects reported here provide novel insights into the inflammatory immune landscape in the context of SARS-CoV-2 infection, and offer valuable knowledge for addressing future viral infections and the development of novel treatments.
Emergence of heteroresistance to carbapenems in Gram-negative clinical isolates from two Egyptian hospitals
Authors: Al-Shebiny Alaa G. , Shawky Riham M. , Emara Mohamed
Published: July 2024

Background

Antimicrobial resistance is a global concern, linking bacterial genotype and phenotype. However, variability in antibiotic susceptibility within bacterial populations can lead to misclassification. Heteroresistance exemplifies this, where isolates have subpopulations less susceptible than the main population. This study explores heteroresistance in Gram-negative bacteria, distinguishing between carbapenem-sensitive isolates and stable heteroresistant isolates (SHIs).

Methods

A total of 151 Gram-negative clinical isolates including Klebsiella pneumoniae, Pseudomonas aeruginosa, Escherichia coli, Acinetobacter baumannii and Proteus mirabilis from various sources were included. Heteroresistant isolates and their stability were detected by disc-diffusion technique while genotypic analysis was carried out by PCR and efflux activity was assessed by ethidium bromide (EtBr)-agar cartwheel method.

Results

A total of 51 heteroresistant subpopulations were detected, producing 16 SHIs upon stability-detection. Amplified resistance genes and EtBr-agar cartwheel method showed a significant difference between resistant subpopulations and their corresponding-sensitive main populations.

Conclusion

Genotypic analysis confirmed that genetic mutation can lead to resistance development although the main populations were sensitive, thereby leading to treatment failure. This is a neglected issue which should be highly considered for better treatment outcomes.
Follow up study of symptomatic human cystic echinococcosis treatment with albendazole and praziquantel, in Uruguay
Authors: Rosa Daniel Da , Figueredo Elisa , Rosas Michel , Goñi Fernando
Published: July 2024

Background

Cystic echinococcosis (CE) is a chronic disease considered a neglected one. Cystic echinococcosis is endemic in Uruguay and the region. Surgery, using various technical approaches, has the potential to safely remove the cyst(s) and lead to a complete cure in a high number of patients with simple forms of CE. However, surgery may be impractical in patients with multiple cysts in several organs, high surgical risk, or in patients with previous multiple surgeries. In these cases, the pharmacological treatment with the benzimidazolic drug Albendazole (ABZ) alone or combined with Praziquantel (PZQ), has been promising as the best choice to achieve improvement or cure.

Methods

In this study, we analyze the results obtained on the anti-parasitic treatment of 43 patients diagnosed with CE between the years 2003 and 2020. Patients were treated before and/or after surgery with ABZ or the combination ABZ/PZQ. The standardize protocol of the anti-parasitic drug treatment before surgery was 7 days, 15 days or 1 month depending on the urgency and availability of the surgical procedure. All cases that involved confirmed locations on lungs underwent immediate surgery with minimal pre-treatment when possible. After surgery, the standardize protocol of anti-parasitic drug treatment consisted of six cycles of 30 days each and resting intervals of 15 days in between. ABZ was used in all cases, administered orally, twice daily, at a total dosage of 15 mg/kg/day, with food high in fat content for improved absorption. The follow up was carried out according to WHO-IWGE guidelines for 5 years.

Results

Of the 43 patients fourteen were ≤ 15 years of age and had a differentiated pre-surgical treatment. From the ≥ 16 years of age, 36 completed the treatments and the 5 years follow up. Four patients changed geographical locations, without a forwarding contact, after the post-surgery treatment. No patient died during the study. Of the 36 patients that completed the study, 32 were treated only with ABZ; 93.75% achieved treatment success as determined by improvement or cure, and 6.25% treatment failure determined by no change or worsening. The last four patients received the ABZ/PZQ combination therapy and achieved 100% treatment success.

Conclusion

The pharmacological treatment resulted in a good option not only as palliative but also as potentially curative. The main relevance of its use was in cases with previous multiple surgeries or surgeries with potential life-threatening complications due to the number and location of cysts and concurrent comorbidities. A follow-up of at least 5 years would be recommended to assure remission and control of the transmission. More randomized trials are needed to provide clear clinical evidence of different pharmacological treatments for CE.
Retrospective study on the dengue fever outbreak in Puntland State, Somalia
Authors: Jama Saaid Said , Abshir Said Nuriye , Jama Jibril Said , Abdi Mohamed Mohamud
Published: July 2024

Background

Dengue infection is a mosquito-borne, endemic viral disease, particularly in developing countries. Here, we report the results of the clinicodemographic, serologic profile and the monthly occurrence of a recent dengue fever outbreak in Puntland State (Somalia).

Methodology

We analyzed the data of 956 dengue-suspected patients who were investigated using the rapid diagnostic testing (RDT) method for detecting NS1 (dengue virus non-structural protein) and IgM antibodies employing the SD Biosensor Dengue Dou NS Ag and IgM test kit (Germany) at the Puntland Public Health Referral Laboratory from November 21, 2022, to May 27, 2023.

Results

We found that 118 cases were positive for dengue among the suspected patients enrolled in the present study. Of these cases, 76.2% were dengue NSI positive, 13.6% were dengue IgM positive, and 10.2% were both NSI and IgM positive. The number of females and males in the confirmed cases was equal, and most (48.3%) were aged 20 years or less. 43.1% of them lived in the Nugal region, particularly in Garowe. Clinically, fever was the most frequent symptom (88.9%). The cases peaked in December 2022 but dropped from January to March, with a slight rise in February, and then increased in April and May 2023.

Conclusion

This study highlights the clinicodemographic characteristics, seroprevalence, and monthly occurrence of dengue in Puntland. We recommend improving vector control measures, enhancing case management, strengthening dengue surveillance, developing an early warning system, and conducting future studies to characterize the circulating strains.
Association between the use of statins and in-hospital mortality risk in patients with sepsis-induced coagulopathy during ICU stays: a study based on medical information mart for intensive care database
Authors: Yao Yan , Zhao Xi , Wang Mengjue , Zhou Fanfan , Li Chengfeng , Le Xudong , Zhang Siquan
Published: July 2024

Background

The objective of this study was to explore the correlation between statin administration in the intensive care unit (ICU) setting and the in-hospital mortality risk of patients suffering from sepsis-induced coagulopathy (SIC).

Methods

Utilizing a retrospective cohort study design, this investigation collected data from the Medical Information Mart for Intensive Care (MIMIC)-IV spanning 2008 to 2019. The diagnosis of SIC was established based on a SIC score of 4 or above. Statin usage during the ICU period was extracted from the prescription records based on the keywords of statin medications. The primary endpoint analyzed was the in-hospital mortality within the ICU, characterized by any death occurring during the ICU admission.

Results

During the follow-up, which had a median duration of approximately 7.28 days, 18.19% of the 4,777 SIC patients died in the ICU. Statin was linked with a decrease in the risk of in-hospital mortality for SIC patients in the ICU [hazard ratio (HR): 0.73, 95% confidence interval (CI): 0.60–0.89, P = 0.002]. Relative to rosuvastatin, the use of atorvastatin (HR: 0.54, 95% CI: 0.34–0.85, P = 0.008) or simvastatin (HR: 0.55, 95% CI: 0.33–0.92, P = 0.024), as well as combinations of multiple statins (HR: 0.36, 95% CI: 0.15–0.86, P = 0.022), was associated with a reduction in ICU in-hospital mortality risk. Subgroup analysis also suggested that the use of atorvastatin, simvastatin, or a combination of statins had an advantage over rosuvastatin in reducing ICU in-hospital mortality in SIC patients older than 65 years of age or SIC patients with respiratory failure or cardiogenic shock (all P < 0.05).

Conclusion

The present study supports the potential benefits of statin use in mortality in SIC patients during ICU stays. The study encourages clinicians to consider the benefits of statins and supports the ongoing exploration of statins for enhanced outcomes in critical care settings.
Communicating the diagnosis of spinal muscular atrophy in endogamous vs. non-endogamous regions
Authors: Fernandes Isabella Araujo Mota , Menezes Renata Oliveira Almeida , Rego Guilhermina
Published: July 2024

Introduction

The high prevalence of endogamy, or inbreeding, in northeastern Brazil, is due to historical and cultural factors, with large families living in cities far from the coast and subject to low socioeconomic and infrastructure levels. This breeding practice results in low genetic variability with an increased prevalence of rare autosomal recessive and neurodegenerative diseases, such as spinal muscular atrophy (SMA).

Objective

Understanding the impact of communicating the diagnosis of SMA on the mental health of patients and their families and the differences between the Northeast (endogamous region) and the other regions of Brazil (non-endogamous ones).

Methods

Cross-sectional study obtained through a structured questionnaire about the moment of receiving the SMA diagnosis, containing the Impact of Event Scale-Revised.

Results and discussion

The sample consisted of 100 volunteers from all regions of Brazil, 47 patients diagnosed with SMA and 53 family members present at the time of the diagnosis. There was a predominance of females (83%) and homogeneity between the groups for the variables gender, age, color, education, religion, and SMA subtype (1, 2, 3, and 4). The Northeast region, representing 43% of the sample, despite being less economically favored, showed greater satisfaction with medical care and inclusion in health services, with less self-reported psychological trauma and fewer signs of post-traumatic stress disorder (PTSD) related to the moment of receiving the diagnosis. The non-endogamous regions, in turn, reported the presence of strong waves of emotion, sleep problems, feelings of irritability, anger, and the presence of bad thoughts related to this situation.

Conclusion

The feeling of inclusion in health services and satisfaction with medical care in the endogamous region had a positive impact on the mental health of those involved, reducing psychological trauma and signs of PTSD arising from the communication of the SMA diagnosis.