bluuebunny/crossref_metadata_2025 huggingface dataset:
Histopathological pulmonary findings of survivors and autopsy COVID-19 cases: A bi-center study
Authors: Chrabańska Magdalena , Mazur Agnieszka , Stęplewska Katarzyna
Published: November 2022

The coronavirus disease 2019 (COVID-19), caused by Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2), evolved into a global pandemic. As ACE2 on the surface of alveolar cells of the lung epithelium is one of the potential target receptors for SARS-CoV-2, the respiratory symptoms are the most common presentation of COVID-19. The aim of our study was to investigate the morphological findings in lung tissue after being infected by SARS-CoV-2 and compare histopathologic changes in patients with COVID-19 infection history who died to those who survived. We analyzed lung tissue samples from 9 patients who died from COVID-19 and from 35 patients with COVID-19 infection history who survived and had undergone lung surgery for different reasons. Most of histopathological changes in autopsy and survivors’ cases overlapped; however, they occurred with different frequency. The predominant histologic finding both in the case of the deceased and the survivors was patchy distribution of foamy macrophages in the alveolar spaces. In comparison with autopsy cases viral cytopathic-like changes in hyperplastic pneumocytes were rarely observed in the survivors’ lung tissue. Pulmonary edema, fibrin deposition within alveoli, bronchopneumonia, small vessel thrombosis and type II pneumocyte hyperplasia were also more often observed within autopsy cases. Life-threatening complications such as hyaline membrane formations and diffuse alveolar damage were present only within the deceased, whereas changes requiring enough time to progress to the fibrotic phase, such as organizing pneumonia, bronchiolization of the alveoli, and interstitial fibrosis were observed in the lung parenchyma only in survivors. Additionally, 14 cases of pulmonary pneumo-hematocele in patients with COVID-19 infection history who survived were observed. It is a newly observed entity in the form of a cystic lesion formed by large accumulation of blood and fibrin between the collapsed and rejected lung parenchyma and/or present with air–fluid levels. The thin wall of pneumo-hematocele is formed by the inter lobar interstitial fibroconnective tissue and has no epithelial lining or bronchial wall elements. As the COVID-19 pandemic continues, new complications following SARS-CoV-2 infection are identified. Newly observed entity in patients with COVID-19 infection history who survived is pulmonary pneumo-hematocele. The appearance of these lesion has become increasingly frequent.
Effectiveness and safety of auricular acupuncture for psoriasis: A protocol for systematic review and meta-analysis
Authors: Xue Kaiyuan , Wu Haiyuan , Jia Lidan , Yang Suqing
Published: November 2022

Background:

Psoriasis is a chronic, immune-mediated, polygenic skin disease that is common in clinical practice and often develops on the extremities, back, and scalp of patients. In that psoriasis lesions are stubborn and prone to recurrence, it has a serious impact on patients’ quality of life and is detrimental to their physical and psychological health. Auricular acupuncture is one of the traditional Chinese medical treatments, which has the advantages of low adverse effects and simple operation and has been widely used in clinical practice with good efficacy. However, there has been no systematic evaluation of auricular acupuncture in the treatment of psoriasis. This protocol aims to evaluate the effectiveness and safety of auricular acupuncture in patients with psoriasis.

Methods:

We will search the following 8 databases including PubMed, MEDLINE, EMBASE, Cochrane Library, CNKI, Wan Fang, VIP, and CBM databases for randomized controlled trials of auricular acupuncture treated psoriasis from their inception to 10 October 2022. We will analyze the data meeting the inclusion criteria with the RevMan V.5.4 software. Two authors will assess the quality of the study with the Cochrane systematic evaluation tool. Treatment effectiveness and the psoriasis area and severity index are defined as the main outcomes, and the additional outcomes include itchy, dermatology life quality index, relapse rate, and adverse events.

Results:

This study will review and evaluate the available evidence on the effectiveness and safety of auricular acupuncture for psoriasis.

Conclusions:

The results of this study will provide evidence for the effectiveness and safety of treating psoriasis, providing clinicians and patients with appropriate treatment options for this disease.
Successful rescue of renal transplantation with cardiac arrest after electrical storm: A case report
Authors: Li Hao , Xia Zhiping , Li Ling , Lu Zhongshan , Du Futian , Ye Qifa , Peng Guizhu
Published: November 2022

Rationale:

Most patients with end-stage chronic kidney disease are associated with complications such as renal hypertension, renal anemia, hyperkalemia, water-sodium retention, and disorders of acid-base balance after long-term renal replacement therapy, which can lead to increased cardiac burden, some degree of myocardial damage, and finally progress to arrhythmia and heart failure. These are the main reasons why patients with chronic kidney disease are prone to cardiovascular events after renal transplantation.

Patient concerns:

We report a case of sudden onset of ventricular fibrillation on the postoperative second day, with repeated electrical storm accompanied by cardiac arrest during resuscitation, a very long cardiopulmonary resuscitation (CPR) process of 5 hours and 14 minutes, and >20 cycles of cardiac defibrillation.

Diagnoses:

According to the patient history and resuscitation process, a diagnosis of ES with cardiac arrest after renal transplantation was formulated.

Intervention:

According to the American Heart Association guidelines for CPR and cardiovascular emergencies, resuscitation measures such as CPR, tracheal intubation, electric defibrillation, symptomatic medication, etc. were performed on the patient.

Outcomes:

Finally, the patient was successfully resuscitated, after which the patient had stable respiratory circulation and no neurological complications. To our knowledge, this is the only reported case in which a patient survived with good neurologic outcomes after a resuscitation that lasted as long as 5 hours and 14 minutes.

Lessons:

This case of adequate resuscitation can provide experience and a basis for CPR of patients with in-hospital complications of cardiovascular events for a long time.
A typical case had rare immediate and delayed red man syndrome multiple times after norvancomycin injection: A case report
Authors: Zang Tianying , Liu Bingyang , Ma Lunkun , Tang Xiaojun
Published: November 2022

Background:

Red man syndrome (RMS) is an adverse effect of vancomycin that usually occurs within minutes to tens of minutes after infusion. Previous literature reported that RMS rarely occurs again after the infusion speed is controlled.

Methods:

We report a case of immediate and delayed RMS that presented with fever, persistent lower extremity rash, shock, lymphadenopathy and pulmonary edema. This patient subsequently diagnosed with Sjögren's Syndrome, the time from NVCM infusion to RMS onset of this case ranged from 10 minutes to 54 hours, which are all rare in clinic and hard to distinguish severe RMS and IgE-mediated anaphylaxis.

Results:

After multidisciplinary consultation, the patient was diagnosed with RMS based on clinical manifestations and laboratory results. Patients' symptoms, signs, body temperature and disease progress were monitored, and an active search for causes was conducted. After a 20-day treatment, all the symptoms disappeared, the patient was transferred to immunology department to treat SS.

Conclusion subsections:

We reported a patient repeatedly developed fever and even shock when the infusion speed is normal, which was rare and similar as anaphylaxis. Therefore, the progression of RMS and its differentiation from allergy need to be further studied.
The effect of stress coping styles on empathy level in students of medicine: A cross-sectional study
Authors: Kurtses Gürsoy Betül
Published: November 2022

We aimed to investigate the change in the ability of clinical empathy, which has a special importance in physician-patient relationship, during medical school years, and its relationship between stress coping styles. After the preliminary interview with 292 volunteer medical school students, the students were asked to answer the Hospital Anxiety Depression Scale, the Stress Coping Scale, and the student version of the Jefferson Doctor Empathy Scale. This study shows that the lowest median of the empathy level among medical school students was in the sixth year, and the decrease in empathy in the sixth year was mostly in the perspective taking component. When the relationship between empathy and coping styles with stress was examined, it was seen that self-confident approach was positively correlated with perspective taking (R = 0.182, P = .002) and standing in the patient’s shoes (R = 0.172, P = .003). It was observed that the helpless approach, which is one of the negative coping styles, was inversely correlated with standing in the patient’s shoes. As a result of the study, it was determined that the styles of coping with stress were related to the components of empathy, except for compassionate care. The self-confidence approach has an impact on the ability of standing in the patient’s shoes and perspective-taking. During medical education, focusing on the approaches that increase the student’s self-confidence against the stress will encounter throughout their professional life will undoubtedly increase the level of empathy.
The prognostic significance of prognostic nutritional index in gastrointestinal stromal tumors: A systematic review and meta-analysis
Authors: Li Zhenjie , Zhang Dengming , Mo Chunlin , Zhu Peijin , Fan Xiaoxi , Tang Tingyong
Published: November 2022

Background:

Risk assessment before treatment is important for gastrointestinal stromal tumors (GISTs), which will determine the priority of surgery or preoperative treatment. The prognostic nutritional index (PNI) is an integrated parameter consisting of serum albumin and lymphocyte count. Immunonutritional status defined in this manner is well-known to be closely linked to the prognosis of several other cancers. Nevertheless, the prognostic value of PNI specifically in GISTs has not been well-established. This study aimed to verify the prognostic role of PNI in patients with GISTs.

Methods:

A comprehensive literature search was conducted on medical databases up to June, 2022, and the raw data (hazard ratios and 95% confidence intervals [CIs]) focusing on the prognostic value of PNI in patients with GISTs regarding recurrence-free survival were extracted and synthesized adopting the random-effects model. This review was registered in the PROSPERO database (CRD42022345440).

Results:

A total of 8 eligible studies including 2627 patients with GISTs was analyzed and the pooled results confirmed that an elevated PNI was associated with a better recurrence-free survival (hazard ratio: 0.52, 95% CI: 0.40–0.68), with a moderate heterogeneity (I-square, 38%). The findings from subgroup analysis were consistent with the overall pooled results, and a sensitivity analysis, not the subgroup analysis, identified the source of heterogeneity.

Conclusion:

Elevated pretreatment PNI may be a useful indicator for assessing risk of recurrence in patients from China with GISTs. Studies in other countries and regions are needed to further verify the prognostic value of PNI in GISTs.
Biventricular repair of double-outlet left ventricle by handmade trileaflet-valved conduit: A case report
Authors: Alifu Ailixiati , Wang Haifan , Su Yuntian , Chen Renwei
Published: November 2022

Rationale:

Double-outlet left ventricle (DOLV) is a rare congenital cardiac malformation in which both great arteries arise entirely or predominantly from the left ventricle. An extracardiac conduit is the first surgical option for repairing DOLV, specifically because its placement of the extracardiac conduit can be customized to accommodate all possible anatomical variations. The bovine jugular veins and homograft valves are often used as conduits. There have been no reports on the use of handmade trileaflet-valved conduits for correcting DORV.

Patient concerns:

A 1-year old male was admitted for significant heart murmur and cyanosis, according to the results of transthoracic echocardiography, computed tomography angiography, and cardioangiography, and was diagnosed with DOLV and pulmonary stenosis.

Diagnosis and interventions:

The patient underwent biventricular repair with a handmade trileaflet-valved extracardiac conduit. The postoperative course was uneventful.

Outcome:

Three months after the surgery, TTF indicated mild right ventricular outflow obstruction and pulmonary valve regurgitation.

Lessons:

Correction of the left ventricular double outlet with a handmade trileaflet-valved conduit has been shown to have excellent performance, and long-term outcomes should be followed over time.
Posterior cerebral artery embolism resulting in bilateral paramedian thalamic infarction: A case report
Authors: Xie Shaowei , Han Ning , Chen Xingyu , Yin Kuochang , Xu Guodong , Dong Yanhong , Lv Peiyuan
Published: November 2022

Rationale:

Bilateral thalamic infarcts are not easily recognized, it have diverse clinical manifestations and relatively severe symptoms. It may leave long-term drowsiness, cognitive impairment, and speech impairment. We report a case of bilateral paramedian thalamic infarction with impaired consciousness as the main symptom. The digital subtraction angiography suggested that the left superior cerebellar artery and posterior cerebral artery (PCA) were occluded.

Patients concern:

A previously 67-year-old man was taken to our hospital after 9.5 hours of acute dizziness and loss of consciousness.

Diagnosis:

The cranial DWI + MRA suggested acute cerebral infarction in bilateral thalamus and bilateral midbrain, and the left posterior cerebral artery was not clearly visualized. The patient was diagnosed with posterior cerebral artery embolism.

Interventions:

A mechanical thrombectomy was performed.

Outcome:

The patient’s symptoms did not completely improve after revascularization, followed by fluctuating consciousness.

Lessons:

Recurrent lethargy in patients after endovascular treatment may be a clinical manifestation of damage to thalamic structures or due to the presence of ineffective recanalization.
A CARE-compliant article: A case report and literature review of IgG4-related lung disease
Authors: Ren Hongmei , Han Zhiqing , Zuo Xiaoming , Wang Jinping , Meng Siming , Zheng Cuixia
Published: November 2022

Rationale:

IgG4-related lung disease (IgG4-RLD) is an unusual disease, with various clinical manifestations and various chest imaging findings. The patients may have no respiratory symptoms. Therefore, diagnosis is challenging. This can easily cause misdiagnosis and mistreatment.

Patient concerns:

A 71-year-old male presented with chest pain, cough, and shortness of breath. Plain chest computed tomography scans showed multi-locus nodes at the center of the hilum.

Diagnosis:

Percutaneous lung biopsy was performed, and IgG4-RLD was diagnosed.

Interventions:

Prednisone was orally administered daily.

Outcomes:

The case’s symptoms improved. The patient was discharged from the hospital. After 2 months of reexamination, his symptoms were relieved. Reexamination of the chest computed tomography showed that multi-locus nodes of the lung were obviously absorbed compared with those before.

Lessons:

IgG4-RLD is a rare respiratory disease. It has atypical clinical manifestations and chest images. We report the first case of IgG4-RLD showing multi-locus nodes centered on the hilar, hypertrophic mucosa; as well as a narrow and even occluded lumen.
Once-daily Compared With Twice-daily Enoxaparin Maintenance Therapy Appears Safe and Efficacious in Pediatric Venous Thromboembolism
Authors: Gibson Amber , Montanez Natalie , Addy Katherine , Hashmi S. Shahrukh , Brown Deborah , Rodriguez Nidra , Menon Neethu , Srivaths Lakshmi
Published: November 2022

Introduction:

Once-daily enoxaparin (ODE), considered standard of care for venous thromboembolism (VTE) treatment in adults, has been infrequently assessed in children. To contribute available data to a limited field, we reviewed our center’s experience with ODE in treating pediatric VTE compared with twice-daily enoxaparin (TDE).

Materials and Methods:

A retrospective analysis of children and adolescents 18 years of age or below diagnosed with VTE and treated at our institution with ODE or TDE maintenance therapy between April 2015 and December 2020 was performed. Patient demographics, clinical and laboratory data pertaining to VTE diagnosis, and management were gathered from electronic medical records and compared between the 2 cohorts.

Results:

Seventy-one children met the eligibility criteria. All patients were initially treated with TDE for 2 weeks before transitioning to ODE maintenance therapy (n=39; 55%) or continuing with TDE dosing (n=32; 45%).

Extremity VTE was more common in ODE (P=0.051) versus pulmonary/intracardiac sites in TDE (P=0.002) when compared with other sites. Median enoxaparin dosing was 1.5 and 1.1 mg/kg/dose in ODE and TDE cohorts, respectively. Bleeding episodes were rare without any difference between the cohorts. Two patients (6%) were lost to follow up in TDE cohort. All evaluable patients in both cohorts had either complete/partial response (ODE n=35 [90%]; TDE n=24 [75%] or stable thrombus ODE n=4 [10%]; TDE n=6 [19%]).

Conclusions:

Our results indicate that ODE, used after the initial TDE treatment period, is as safe and efficacious as TDE maintenance for the treatment of pediatric VTE. The difference in VTE sites may have contributed to the equal efficacy of both the cohorts. Future prospective studies in pediatric VTE are needed to validate these results.
Capgras Syndrome: In the Conscious and the Unconscious Mind
Authors: Chaudhry Serena , Weiss Ashley , Surdis Costandino , Garrett Michael
Published: November 2022

We report the successful psychotherapy and medical treatment of a patient with an atypical presentation of Capgras syndrome, in which the patient not only believed that his parents were impostors but also believed that the entirety of what others would consider consensual reality was in fact an impostor. He insisted that a complex delusional world in which he wished to reside was authentic reality. His delusions of misidentification waxed and waned in response to discernable social stressors, and at times, he seemed to have conscious insight into the delusional nature of his beliefs. This case raises questions about whether Capgras should be considered a stand-alone diagnosis or whether it should be placed within a wider spectrum of psychotic disorders. Excepting our current report, although there are numerous reports of the resolution of Capgras after treatment with neuroleptics, we are unaware of descriptions in the literature of the successful treatment of medication-resistant Capgras with a combination of individual psychotherapy and pharmacological management.
Effects of light on sleep in older adults: a scoping review
Authors: Jiang Lei , Zhou Baibing , Han Han
Published: November 2022

In light of the increase of aging populations, there is a need to focus on how older adults experience sleep disorders. This scoping review aimed to synthesize the features of the light and its effects on sleep in older adults. A total of 25 articles focusing on the effects of light on sleep among older adults were included. We synthesized light intensity, treatment duration, and the spectrum of light therapy as well as features of natural and artificial light that were used to improve sleep outcomes. Literature has shown evidence for the positive effects of light therapy on sleep in older adults. Older adults are, therefore, encouraged to receive frequent sunlight exposure and artificial lighting that accords with the cycle of their circadian rhythms.
Trends of multimorbidity status among the older Chinese population: findings from the Chinese Longitudinal Healthy Longevity Survey 2000 to 2018
Authors: Su Hexuan , Chen Yuming , Xu Huiwen , Wang Kaipeng , Luo Yan , Xu Beibei
Published: November 2022

Objectives:

This paper aimed to assess temporal trends and risk factors of multimorbidity among older Chinese adults from 2000 to 2018.

Methods:

A total of 51,326 participants aged 65–105 from the Chinese Longitudinal Healthy Longevity Survey (CLHLS) 2000–2018 were included. Multimorbidity was defined as the co-occurrence of 2 or more (up to 14) chronic conditions in a single person. The adjusted proportion of the number of chronic conditions by follow-up year was examined and described. The generalized estimating equation model including the natural cubic spline was used to predict the prevalence of multimorbidity. Associated factors were identified using generalized estimating equation models from 2000 to 2018. All analyses were conducted separately in 2 age groups: the young-old group (aged 65–79) and the older-old group (aged 80–105).

Results:

The adjusted multimorbidity prevalence for the young-old group increased from 23.9% in 2002 to 72.5% in 2014 and remained high at 46.3% in 2018; the adjusted prevalence for the older-old group increased from 63.4% in 2000 to 87.2% in 2011 and remained at 73.0% in 2018. Being female, having fewer educational years, a professional or technical occupation, and a history of smoking or drinking were associated with an increased risk for multimorbidity in young-old group; while in older-old group, being female, current smoker or drinker, and less engagement in social and leisure activity were associated with an increased risk for multimorbidity.

Conclusion:

The prevalence of multimorbidity first increases and then decreases for both age groups. Management of multimorbidity requires more attention from health policymakers, service providers, and educators of health professionals in China. Health systems should prioritize improving the management of older patients, especially women who have lower education levels.
Sex-specific gut microbiome profiles among preterm infants during the neonatal intensive care hospitalization
Authors: Chen Jie , Li Hongfei , Maas Kendra , Starkweather Angela , Chen Minghui , Cong Xiaomei
Published: November 2022

Objectives:

The gut microbiota among preterm infants is shaped by sex and feeding types. However, sex-specific weekly patterns of gut microbiome profiles among preterm infants during their neonatal intensive care unit (NICU) hospitalization remain unclear. This study aimed to investigate the effect of sex on the weekly development of preterm neonatal gut microbiota in the first 4 weeks of NICU hospitalization.

Methods:

This secondary data analysis included 28 preterm neonates with 261 stool samples collected from January 2014 to February 2015 in the Northeastern United States. The 16S rRNA V4 gene regions of the stool samples were sequenced and aligned against the SILVA 132 database by using Mothur 1.42.3. The sex-specific weekly diversity indexes and relative abundance of bacterial taxonomic composition were generated by Mothur and analyzed by R packages. Sex-specific weekly compositional patterns of the gut microbiome and predicted metabolic functions of gut microbiome profiles were compared, respectively.

Results:

In each week of the NICU hospitalization, preterm females and males had significantly distinguished β-diversity indices and compositions of gut microbiota. Both females and males had significantly enriched Bifidobacterium, a protection feature, in stool samples collected in the third week compared with those in the second week. The predicted metabolic pathways were significantly different between females and males in the second, third, and fourth week of the NICU hospitalization. Both females and males had significantly abundant pathways. Males consistently had more abundance of “lipopolysaccharide biosynthesis” than females in the second, third, and fourth week. Males also had a significant abundance of “membrane and intracellular structural molecules” and “glycan biosynthesis and metabolism” in the second and third week.

Conclusions:

Sex shaped the weekly patterns of preterm neonatal gut microbiome profiles during the first 4 weeks of the NICU hospitalization. Further clinical interventions should consider the distinct gut microbiota compositions and predicted functional profiles between female and male preterm neonates.
A Pediatric Cervical Spine Clearance Guideline Leads to Fewer Unnecessary Computed Tomography Scans and Decreased Radiation Exposure
Authors: Douglas Geoffrey P. , McNickle Allison G. , Jones Stephanie A. , Dugan Mark C. , Kuhls Deborah A. , Fraser Douglas R. , Chestovich Paul J.
Published: November 2022

Objectives

Physical examination and computed tomography (CT) are useful to rule out cervical spine injury (CSI). Computed tomography scans increase lifetime cancer risk in children from radiation exposure. Most CSI in children occur between the occiput and C4. We developed a cervical spine (C-spine) clearance guideline to reduce unnecessary CTs and radiation exposure in pediatric trauma patients.

Methods

A pediatric C-spine clearance guideline was implemented in September 2018 at our Level 2 Pediatric Trauma Center. Guidance included CT of C1 to C4 to scan only high-yield regions versus the entire C-spine and decrease radiation dose. A retrospective cohort study was conducted comparing preguideline and postguideline of all pediatric trauma patients younger than 8 years screened for CSI from July 2017 to December 2020. Primary endpoints included the following: number of full C-spine and C1 to C4 CT scans and radiation dose. Secondary endpoints were CSI rate and missed CSI. Results were compared using χ2 and Wilcoxon rank-sum test with P < 0.05 significant.

Results

The review identified 726 patients: 273 preguideline and 453 postguideline. A similar rate of total C-spine CTs were done in both groups (23.1% vs 23.4%, P = 0.92). Full C-spine CTs were more common preguideline (22.7% vs 11.9%, P < 0.001), whereas C1 to C4 CT scans were more common post-guideline (11.5% vs 0.4%, P < 0.001). Magnetic resonance imaging utilization and CSIs identified were similar in both groups. The average radiation dose was lower postguideline (114 vs 265 mGy·cm−1; P < 0.001). There were no missed CSI.

Conclusions

A pediatric C-spine clearance guideline led to increasing CT of C1 to C4 over full C-spine imaging, reducing the radiation dose in children.

Level of Evidence

Level IV, therapeutic.
Ultrasound-Guided Supraclavicular Brachial Plexus Blocks Performed by Pediatric Emergency Medicine Physicians for Painful Orthopedic Procedures in a Pediatric Emergency Department—A Case Series
Authors: Shahar-Nissan Keren , Berant Ron , Ganor Lior , Katzir Yair
Published: November 2022

Ultrasound-guided brachial plexus blocks are a common pain-reducing technique in the operating room and are also performed in the emergency department, primarily in adults. Performing brachial plexus blocks in the pediatric emergency department by pediatric emergency medicine physicians is yet to become common practice and may pose various challenges.

Objective

The aim of this study was to describe our experience with ultrasound-guided supraclavicular brachial plexus blocks performed by pediatric emergency physicians for the purpose of forearm fracture reductions in the emergency department.

Methods

We present a case series of 15 pediatric patients aged 7 to 17 years undergoing ultrasound-guided supraclavicular blocks.

Results

All blocks resulted in adequate analgesia. No procedural complications were observed.

Conclusions

We conclude that in select pediatric cases ultrasound-guided brachial plexus blocks can be a safe, swift, and efficient means of pain management and procedural analgesia. This approach obviates the need for sedation, thus shortening the time lag between presentation and the reduction procedure, as well as overall length of stay.
Development and Evaluation of the Ally Sexual and Gender Minority Diversity and Inclusion Training at the Centers for Disease Control and Prevention
Authors: Thomas Erin V. , Jennings Melissa A. , Kidder Daniel P. , Fechter-Leggett Ethan D. , Bautista Gregorio J. , Johns Michelle M. ,   Ally Training Committee
Published: November 2022

Context:

The Centers for Disease Control and Prevention (CDC) developed a workforce training on sexual and gender minorities (SGMs).

Objective:

This article describes the evaluation of the training.

Design:

Participants completed pre- and posttest surveys. After the pilot evaluation, some improvements were made to the curriculum and to the pre- and posttest questionnaires. Participants in subsequent (implementation) training were similarly asked to complete pre- and posttest questionnaires.

Setting:

CDC.

Participants:

CDC staff.

Main Outcome Measures:

Participants' knowledge, ally identity, and perceptions of SGMs.

Results:

Pilot and implementation training data showed increases in participant knowledge of 44% and 49%, respectively, increases in ally identity of 11% and 14%, respectively, and increases in positive perceptions of SGM of 25% and 31%, respectively.

Conclusion:

These results suggest that the CDC Ally Training may be a useful tool for improving staff knowledge and perceptions of SGM people.
Comparative Evaluation of 2 Work Experience Approaches for Predominantly Black Youth in a Rural Community: Implications for Public Health Workforce Development
Authors: Frerichs Leah , Smith Cambray , Hoover Stephanie , Robinson-Ezekwe Nicole , Khanna Anisha , Ellerby Brian , Joyner Linda , Wynn Mysha , Wrenn Jonina , Stith Doris , Tessler Lindau Stacy , Corbie Giselle
Published: November 2022

Context:

In order to create a more diverse workforce, there is a need to involve historically excluded youth in public health–related work. Youth involvement in asset-based work experience approaches is especially relevant for rural areas with workforce shortages.

Objective:

To explore the public health workforce development implications of community-based career exploration and asset mapping work experience from the perspective of Black youth.

Design:

We used qualitative in-depth interviews with youth, aged 14 to 22 years, who participated in a work experience program anchored in several rural counties in southeastern United States. A phenomenological lens was applied for qualitative analyses with iterative, team-based data coding. Participants were also surveyed pre- and postprogram to supplement findings.

Program:

A rural community-based organization's work experience program consisted of 2 tracks: (1) Youth Connect—a career exploration track that included work placement within community agencies; and (2) MAPSCorps—a track that employs youth to conduct asset mapping for their community.

Results:

We interviewed 28 of 31 total participants in the 2 tracks. We uncovered 4 emergent profiles in how youth described shifts in their perceptions of community: (1) Skill Developers; (2) Community Questioners; (3) Community Observers; and (4) Community Enthusiasts. In comparing between tracks, youth who participated in work experience that involved asset mapping uniquely described increased observation and expanded view of community resources and had greater increases in research self-efficacy than youth who participated only in career exploration.

Conclusion:

Asset mapping work experience that is directly placed in rural communities can expose Black youth to and engage them in essential public health services (assessing and mobilizing community assets) that impact their community. This type of program, directly integrated into rural communities rather than placed near academic centers, could play a role in creating a more diverse public health workforce.
Marginal Engagement: The Adverse Experiences of White Women and People of Color Alumni at a PWI School of Public Health
Authors: Jones Lauren L. , Martin Skky , Leider Jonathon P.
Published: November 2022

The University of Minnesota (UMN) School of Public Health (SPH) asked graduates about their experiences as students and as alumni. Of 1186 respondents indicating gender, 140 were women who self-identified as members of a marginalized group. Fifty-one percent of these respondents were White women. Compared with White women, Black, Indigenous, and people of color (BIPOC) women were more likely to report that they felt they did not belong, were uncomfortable, or experienced bias and/or discrimination in their program, although the results were not statistically significantly different at P < .05. Survey results show a clear difference in experience between White and BIPOC alumni. The results indicate a need to improve cultural competence/humility, along with a need to move away from what may be construed as White-centered events, pedagogy, and leadership. With this evidence, the UMN SPH has an opportunity to improve our outreach strategies and initiatives.
Low Preoperative Serum Creatinine is Common and Associated With Poor Outcomes After Nonemergent Inpatient Surgery
Authors: Loria Anthony , Glance Laurent G. , Melucci Alexa D. , Boodry Courtney , Justiniano Carla F. , Dunne Richard F. , Mustian Karen M. , Becerra Adan Z. , Jusko Todd A. , Temple Larissa K. , Fleming Fergal J.
Published: November 2022

Objective:

To assess the association between low preoperative serum creatinine and postoperative outcomes.

Background:

The association between low creatinine and poor surgical outcomes is not well understood.

Methods:

We identified patients with creatinine in the 7 days preceding nonemergent inpatient surgery in the American College of Surgeons National Surgical Quality Improvement Program database from 2005 to 2020. Multivariable logistic regression was used to examine the association between creatinine and 30-day mortality and major complications.

Results:

Of 1,809,576 patients, 27.8% of males and 23.5% of females had low preoperative serum creatinine, 14.6% experienced complications, and 1.2% died. For males, compared with the reference creatinine of 0.85 to 1.04, those with serum creatinine ≤0.44 had 55% increased odds of mortality [ adjusted odds ratio (aOR), 1.55; 95% CI, 1.29-1.86] and 82% increased odds of major complications (aOR, 1.82; 95% CI, 1.69-1.97). Similarly, for females, compared with the reference range of 0.65 to 0.84, those with serum creatinine ≤0.44 had 49% increased odds of mortality (aOR, 1.49; 95% CI, 1.32-1.67) and 76% increased odds of major complications (aOR, 1.76; 95% CI, 1.70-1.83). These associations persisted for the total cohort, among those with mildly low albumin, and for those with creatinine values measured 8 to 30 days preoperatively.

Conclusions:

A low preoperative creatinine is common and associated with poor outcomes after nonemergent inpatient surgery. A low creatinine may help identify high-risk patients who may benefit from further evaluation and optimization.
Routine Assessment of Surgical Resident Wellness-Related Concerns During Biannual Review
Authors: Siu Margaret , Tashjian David B , Fernandez Gladys L , Isotti Joy , Seymour Neal E
Published: November 2022

Background:

Surgery residency confers stress burdens on trainees. To monitor and mitigate areas of concerns, our education team implemented a six-item biannual survey querying potential stressors. We reviewed the initial five-year experience to assess for trends and improve efforts in maintaining well-being.

Methods:

Surgery residents from all postgraduate years were asked to complete a survey of common concerns, prioritizing them in order of importance. Ranked items were 1) needs of family/friends, 2) nonwork time for study, 3) financial concerns, 4) personal well-being needs, 5) concerns for clinical performance, and 6) administrative demands. Changes were trended over ten review periods. Results were analyzed using Kruskal-Wallis test.

Results:

333 surveys were completed, rendering a 96.5% completion rate. Rankings changed significantly for nonwork time for study (p=0.04), personal well-being needs (p=0.03) and concerns for clinical performance (p=0.004). Nonwork time for study and concerns on clinical performance were consistently ranked as top two stressors over study period, except for Spring 2020. Personal well-being needs ranked highest in Spring 2020; 41% of residents placed this as top two rankings. A decrease in concerns for clinical performance was observed in Spring 2020, corresponding to the COVID-19 pandemic emergency declaration.

Conclusion:

Surgery residents generally prioritized time for study and concerns for assessment of clinical performance as highest areas of concern. With the occurrence of a pandemic, increased prioritization of personal well-being was observed. Used routinely with biannual reviews, the survey was able to identify plausible changes in resident concerns. Determination of levels of actual stress and actual association with the pandemic requires additional study.
Loneliness and mood disorders: consequence, cause and/or unholy alliance?
Authors: Giacco Domenico
Published: November 2022

Purpose of review

People with persistent depressive disorders and with bipolar disorder are more likely to feel lonely than people in the general population. This evidence update focused on studies in the last 2 years, characterized by the COVID-19 pandemic and consequent social distancing directives.

Recent findings

Longitudinal studies identified that people who feel lonely are more likely to become depressed or to experience relapse of mood disorders. There is emerging evidence that feelings of loneliness or mandatory social isolation can precede manic episodes. Hence the relationship between loneliness and mood disorders is complex and bidirectional. Interventions were developed to reduce loneliness in people with mental health problems, including depressive disorders, through cognitive modification and/or supported socialisation. No loneliness-focused interventions have been specifically tailored to people with bipolar disorder.

Studies carried out before and during the COVID-19 pandemic found that feelings of loneliness can be both consequences and precursors of persistent depression and bipolar disorder. Mood symptoms and loneliness have a cumulative negative effect on physical and mental health outcomes. Conceptual overlaps and relations between loneliness and mood symptoms should be clarified in qualitative studies. Theory-driven intervention models should be developed and tested in methodologically robust studies.
Neurostimulation as a treatment for mood disorders in patients: recent findings
Authors: Afshari Masoud , Belzung Catherine , Bloch Solal
Published: November 2022

Purpose of review

The use of neurostimulation to treat mood disorders dates back to the 1930s. Recent studies have explored various neurostimulation methods aimed at both restoring a healthy brain and reducing adverse effects in patients. The purpose of this review is to explore the most recent hypotheses and clinical studies investigating the effects of stimulating the brain on mood disorders.

Recent findings

Recent work on brain stimulation and mood disorders has focused mainly on three aspects: enhancing efficacy and safety by developing new approaches and protocols, reducing treatment duration and chances of relapse, and investigating the physiological and pathological mechanisms behind treatment outcomes and possible adverse effects.

This review includes some of the latest studies on both noninvasive techniques, such as transcranial magnetic stimulation, magnetic seizure therapy, transcranial direct current stimulation, transcranial alternating current stimulation, electroconvulsive treatment, and invasive techniques, such as deep brain stimulation and vagus nerve stimulation.

Brain stimulation is widely used in clinical settings; however, there is a lack of understanding about its neurobiological mechanism. Further studies are needed to understand the neurobiology of brain stimulation and how it can be used to treat mood disorders in their diversity, including comorbidities with other illnesses.
Population-specific facial traits and diagnosis accuracy of genetic and rare diseases in an admixed Colombian population
Authors: Echeverry Luis Miguel , Candelo Estephania , Gómez Eidith , Solís Paula , Ramírez Diana , Ortiz Diana , González Alejandro , Sevillano Xavier , Cuéllar Juan Carlos , Pachajoa Harry , Martínez-Abadías Neus
Published: November 2022

Up to 40% of genetic and rare disorders (RD) present facial dysmorphologies. Visual assessment of facial gestalt is commonly used for clinical diagnosis, health management and treatment monitoring. Quantitative approaches to facial phenotypes are more objective and provide first diagnoses of RD with relatively high accuracy, but are mainly based on populations of European descent, disregarding the influence of population ancestry. Here we assessed the facial phenotypes associated to four genetic disorders in a Latino-American population from Colombia. We recorded the coordinates of 18 facial landmarks in 2D images from 79 controls 51 pediatric individuals diagnosed with Down (DS), Morquio (MS), Noonan (NS) and Neurofibromatosis type 1 (NF1) syndromes. We quantified facial differences using Euclidean Distance Matrix Analysis (EDMA) and assessed the diagnostic accuracy of Face2gene, an automatic deep learning algorithm with widespread use in the clinical practice.

Quantitative comparisons indicated that individuals diagnosed with DS and MS were associated with the most severe phenotypes, with 58.2% and 65.4% of facial traits significantly different as compared to controls. The percentage decreased to 47.7% in NS and to 11.4% in NF1. Each syndrome presented a characteristic pattern of facial dysmorphology, supporting the potential of facial biomarkers for disorder diagnosis. However, our results detected population-specific traits in the Colombian population as compared to the facial gestalt described in literature for DS, NS and NF1. When clinical diagnosis based on genetic testing was used to verify the diagnosis based on 2D facial pictures, our results showed that Face2Gene accuracy was very high in DS, moderate in NS and NF1, and very low in MS, with low gestalt similarity scores in highly admixed individuals. Our study underscores the added value of precise quantitative comparison of facial dysmorphologies in genetic and rare disorders and the need to incorporate populations with diverse contributions of Amerindian, African and European ancestry components to further improve automatic diagnostic methods.
Activation of the renin-angiotensin-aldosterone system is attenuated in hypertensive compared to normotensive pregnancy
Authors: Shoemaker Robin , Poglitsch Marko , Huang Hong , Vignes Katherine , Srinivasan Aarthi , Cockerham Cynthia , Schadler Aric , Bauer John A. , O’Brien John M.
Published: November 2022

Hypertension during pregnancy increases the risk for adverse maternal and fetal outcomes, but mechanisms of pregnancy hypertension are not precisely understood. Elevated plasma renin activity and aldosterone concentrations play an important role in the normal physiologic adaptation to pregnancy. These effectors are reduced in patients with pregnancy hypertension, creating an opportunity to define features of the renin-angiotensin-aldosterone system (RAAS) that are characteristic of this disorder. In the current study, we used a novel LC-MS/MS-based methodology to develop comprehensive profiles of RAAS peptides and effectors over gestation in a cohort of n=74 pregnant women followed prospectively for the development of gestational hypertension and pre-eclampsia (HYP, n=27) versus remaining normotensive (NT, n=47). In NT pregnancy, the plasma renin activity surrogate, (PRA-S, calculated from the sum of [angiotensin I] + [angiotensin II) and aldosterone concentrations significantly increased from first to third trimester, accompanied by a modest increase in concentrations of angiotensin peptide metabolites. In contrast, in HYP pregnancies PRA-S and angiotensin peptides were largely unchanged over gestation, and third trimester aldosterone concentrations were significantly lower compared to NT pregnancies. Results indicate that the predominate features of pregnancies that develop HYP are stalled or waning activation of the RAAS in the second half of pregnancy (accompanied by unchanging levels of angiotensin peptides) and attenuated secretion of aldosterone.
Algorithm for Predicting Valvular Heart Disease from Heart Sounds in an Unselected Cohort
Authors: Waaler Per Niklas , Melbye Hasse , Schirmer Henrik , Johnsen Markus Kreutzer , Dønnem Tom , Ravn Johan , Andersen Stian , Davidsen Anne Herefoss , Aviles-Solis Juan Carlos , Stylidis Michael , Bongo Lars Ailo
Published: November 2022

Background

Although neural networks have shown promise in classifying pathological heart sounds (HS), algorithms have so far either been trained or tested on selected cohorts which can result in selection bias. Herein, the main objective is to explore the ability of neural networks to predict valvular heart disease (VHD) from recordings in an unselected cohort.

Methods and results

Using annotated HSs and echocardiogram data from 2124 subjects from the Tromsø 7 study, we trained a recurrent neural network to predict murmur grade, which was subsequently used to predict VHD. Presence of aortic stenosis (AS) was detected with sensitivity 90.9%, specificity 94.5%, and area-under-the-curve (AUC) 0.979 (CI:0.963-0.995). At least moderate AS was detected with AUC 0.993 (CI:0.989-0.997). Moderate or greater aortic and mitral regurgitation (AR and MR) were predicted with AUC 0.634 (CI:0.565-703) and 0.549 (CI:0.506-0.593) respectively, which increased to 0.766 and 0.677 when adding clinical variables as predictors.

Excluding asymptomatic cases from the positive class increased sensitivity to AR from 54.9% to 85.7%, and sensitivity to MR from 55.6% to 83.3%. Screening jointly for at least moderate regurgitation or presence of stenosis resulted in detection of 54.1% of positive cases, 60.5% of negative cases, 97.7% of AS cases (n=44), and all 12 MS cases.

Conclusions

Despite the cohort being unselected, the algorithm detected AS with performance exceeding performance achieved in similar studies based on selected cohorts. Detection of AR and MR based on HS audio was unreliable, but sensitivity was considerably higher for symptomatic cases, and inclusion of clinical variables improved prediction significantly.
Heterogeneity in network structure switches the dominant transmission mode of infectious diseases
Authors: Kollepara Pratyush K. , Chisholm Rebecca H. , Miller Joel C.
Published: November 2022

Several recent emerging diseases have exhibited both sexual and non-sexual transmission modes (Ebola, Zika and mpox). In the recent mpox outbreaks, transmission through sexual contacts appears to be the dominant mode of transmission. Motivated by this, we use an SIR-like model, to argue that an initially dominant sexual transmission mode can be overtaken by casual transmission at later stages, even if the basic casual reproduction number is less than one. Our results highlight the risk of intervention designs which are informed only by the early dynamics of the disease.

Significance Statement

The purpose of this article is to explore the risk from secondary transmission routes of diseases which spread through sexual contact. This is important because infectious diseases such as Ebola, Zika and mpox spread through both sexual transmission and other modes of transmission. Our results suggest that a secondary transmission route which is not dominant in the initial stages, can significantly alter the course of the epidemic and lead to more infections than expected in the later stages of the epidemic.