bluuebunny/crossref_metadata_2025 huggingface dataset:
A comparison and review of three sets of classification criteria for systemic lupus erythematosus for distinguishing systemic lupus erythematosus from pure mucocutaneous manifestations in the lupus disease spectrum
Authors: Jin Hui , Huang Tao , Wu Ruifang , Zhao Ming , Wu Haijing , Long Hai , Yin Heng , Liao Jieyue , Luo Shuangyan , Liu Yu , Zhang Qing , Zhang Peng , Tan Yixin , Luo Shuaihantian , Huang Xin , Deng Yaxiong , Liao Wei , Duan Liu , Chen Jianbo , Zhou Yin , Yin Jinghua , Qiu Hong , Yuan Jin , Wang Zijun , Li Mengying , Wu Xiaoqi , Chen Lina , Cai Liangmin , Huang Cancan , Li Qianwen , Tang Bingsi , Yu Bihui , Li Xin , Gao Xiaofei , Hu Yixi , Ren Xiaolei , Xue Haofan , Wei Zhangming , Chen Jinwei , Li Fen , Ling Guanghui , Luo Hui , Zhao Hongjun , Yang Sen , Cui Yong , Lin Youkun , Yao Xu , Sun Lingyun , Guo Qing , Fang Hong , Zeng Kang , Deng Danqi , Zhang Jianzhong , Li Yuzhen , Pu Xiongming , Liao Xiangping , Dang Xiqiang , Huang Danlin , Liang Yumei , Sun Qing , Xie Hongju , Zeng Li , Huang Cibo , Diao Qingchun , Tao Juan , Yu Jianbin , Li Zhenlu , Xu Hanshi , Li Hui , Lai Wei , Liu Xiguang , Wu Jingjing , Li Tienan , Lei Tiechi , Sun Qiuning , Li Yanjia , Zhang Guoqiang , Huang Xin , Lu Qianjin
Published: October 2020

Although the original purpose of the systemic lupus erythematosus (SLE) classification criteria was to distinguish SLE from other mimic diseases, and to facilitate sample selection in scientific research, they have become widely used as diagnostic criteria in clinical situations. It is not known yet if regarding classification criteria as diagnostic criteria, what problems might be encountered? This is the first study comparing the three sets of classification criteria for SLE, the 1997 American College of Rheumatology (ACR’97), 2012 Systemic Lupus International Collaborating Clinics (SLICC’12) and 2019 European League Against Rheumatism/American College of Rheumatology (EULAR/ACR’19), for their ability to distinguish patients with SLE from patients with pure mucocutaneous manifestations (isolated cutaneous lupus erythematosus without internal disease, i-CLE) in the lupus disease spectrum. 1,865 patients with SLE and 232 patients with i-CLE were recruited from a multicenter study. We found that, due to low specificity, none of the three criteria are adept at distinguishing patients with SLE from patients with i-CLE. SLICC’12 performed best among the original three criteria, but if a positive ANA was removed as an entry criterion, EULAR/ACR’19 would performed better. A review of previous studies that compared the three sets of criteria was presented in this work.
Socio-economic disadvantage and resource distribution for mental health care: a model proposal and example application for Victoria, Australia
Authors: Meadows Graham , Shawyer Frances , Dawadi Shrinkhala , Inder Brett , Enticott Joanne
Published: October 2020

Objective:

A spreadsheet-based model for supporting equitable mental health resource distribution in Australia was developed, based on the Australian Health Survey (AHS) psychological distress findings associated with area socio-economic disadvantage (SED). An illustrative application is presented.

Method:

Stratum-specific psychological-distress rates for area SED quintiles are applied to local government areas, catchment areas and local health networks (LHNs). A case study applies the model to Victoria, including examining recommendations in the Royal Commission into Victoria’s Mental Health Services (RCVMHS) 2019 interim report for increases to bed stock in two LHNs.

Results:

Need-adjusted demand estimates considered as a ratio of raw population proportions for catchments range between 0.6 to 1.4 in Victoria. Applying the formula to the Royal Commission recommendations suggests the proposed distribution of beds is a reasonable correction for these two LHNs and indicates next expansion priorities for more equitable distribution to other LHNs.

Conclusions:

The spreadsheet, adaptable for other states and territories, could complement National Mental Health Services Planning Framework outputs and assist in evaluation, for instance, determining potential supply shortages in the tele-mental-health response to COVID-19. We outline research directions including consideration of the moral bases of value judgements and identification of other variables including their use in parameterisation and calibration.
Clinical update on managing media exposure and misinformation during COVID-19: recommendations for governments and healthcare professionals
Authors: Looi Jeffrey CL , Allison Stephen , Bastiampillai Tarun , Maguire Paul A
Published: October 2020

Objectives:

To provide a clinical update on the mechanisms of, and potential population mental health risks of, excessive media exposure and misinformation regarding the COVID-19 pandemic. To outline guidance for government, health services, psychiatrists and health professionals in managing mental health effects of COVID-19 media exposure.

Conclusions:

Social and traditional media businesses attract interest by reporting threats and negativity, and heavy media exposure during disasters is associated with increased depressive and post-traumatic symptoms. There are three main recommendations for mitigation of the adverse population mental health effects of excessive media exposure and misinformation. Clear, authoritative communication from governments, health authorities and health professionals is essential, combined with correction of misinformation and addressing mistrust. Specific warnings by governments, health authorities and clinicians of the potential adverse mental health consequences of excessive COVID-19 media consumption are needed. Limitation of exposure to media and disinformation regarding COVID-19 is crucial – the less, the better. Healthcare professionals can advise patients to check information once daily, and be guided by reliable public health authorities, as part of interventions for managing the mental health impact of COVID-19.
A Feasibility Study of a Volunteer Navigation Program in the Palliative Context
Authors: Duggleby Wendy , Pesut Barbara , Warner Grace , Ruiz Kathya Jovel , Nekolaichuk Cheryl , Ghosh Sunita , Hallström Lars , Fassbender Konrad , Swindle Jenny , Holroyd-Leduc Jayna , Jackman Deirdre , Woytkiw Terri
Published: October 2020

Older persons with serious illnesses living in rural communities are an underserved population. They often live with heavy symptom burden and poor quality of life with limited access to resources. Nav-CARE (Navigation: Connecting Accessing Resourcing and Engaging) was developed to specially train and mentor volunteer navigators who help connect older persons with serious illness to the resources and information they need.

Aims:

This mixed methods longitudinal study evaluated Nav-CARE for feasibility, acceptability, ease of use, and satisfaction by older persons and volunteers.

Methods:

Nine volunteer navigators visited 23 older persons with serious illness every 3 to 4 weeks for 1 year. Data were collected from volunteer navigators, and older person participants at baseline, during the year- long implementation and post implementation.

Results:

Volunteer navigators and older persons reported Nav-CARE was easy to use, feasible and acceptable. The majority of older persons agreed or strongly agreed that they were satisfied with the navigation services (100%; 8/8), that navigation services were important to them (87%; 7/8), that they would recommend the program to someone else (87%; 7/8), and would participate in the program again (75%; 6/8). Similarly, volunteer navigators reported 100% (9/9) satisfaction with the program, 100% (9/9) would recommend it to others, and 67% (6/8) would participate again.

Conclusions:

Nav-CARE appears to be a feasible, acceptable, and satisfactory program for older persons with serious illness and volunteer navigators.
Can Expressing Positivity Elicit Support for Negative Events? A Process Model and Review
Authors: Walsh Rebecca M. , Forest Amanda L.
Published: October 2020

Garnering support for distressing experiences is highly important, yet notoriously challenging. We examine whether expressing positive thoughts and feelings when seeking support for negative events can help people elicit support, and we present a theoretical process model that explains why it might do so. The model includes three support-eliciting pathways through which expressing positivity could increase support: by strengthening providers’ prorelational motives, increasing providers’ positive mood, and enhancing providers’ expected support effectiveness. It also includes a support-suppressing pathway through which expressing positivity could decrease support: by undermining providers’ appraisals of support seekers’ needs. After presenting the model and providing evidence for each indirect pathway, we review research regarding the direct pathway. We then consider various types of positivity, discuss possible moderators, and identify directions for future research. Our model highlights support seekers’ underemphasized role in shaping support receipt and provides a novel perspective on positive expressivity’s potential value in distress-related contexts.
Comparative morphometry of the temporomandibular joint in brachycephalic and mesocephalic cats using multislice CT and cone beam CT
Authors: Delesalle Quentin , Lopes António M , Gawor Jerzy P , Zani Davide , Pereira Hugo M , Mestrinho Lisa A
Published: October 2020

Objectives

The purpose of this study was to analyse and compare morphometric measurements of the temporomandibular joint (TMJ) in two groups of cats with brachycephalic and mesocephalic craniofacial skull conformations using multislice CT and cone beam CT.

Methods

CT records of 20 cats without TMJ pathology were included in the study, and were divided into two groups according to those with mesocephalic or brachycephalic skull conformation. Width and depth of the mandibular fossa, width and height of the head of the mandible, and two different angles were measured in 40 TMJs.

Results

TMJ conformation differed between groups: 3/6 parameters were statistically different. Brachycephalic cats had a significantly narrower mandibular fossa, a shorter head of the mandible and a wider angle of congruence (angle 2).

Conclusions and relevance

The results provide morphometric measurements that can serve as a reference tool for the veterinary radiologist and surgeon when TMJ evaluation is necessary. Moreover, the study identified significant differences between the two craniofacial skull conformations.
High SENP3 Expression Promotes Cell Migration, Invasion, and Proliferation by Modulating DNA Methylation of E-Cadherin in Osteosarcoma
Authors: Yang Pu , Liu Yan , Qi Yin Chao , Lian Zhang Hong
Published: October 2020

SENP3, a sentrin/SUMO2/3-specific protease, is recognized as a transcriptional factor that accumulates under cellular oxidative stress and plays a significant role in the removal of SUMO2/3 modification. In our study, we examined a TCGA dataset and found that the transcripts per million (TPM) value of SENP3 is high in sarcoma, including osteosarcoma (OS). We found that SENP3 was highly expressed in OS cancer tissues when compared with osteofibrous dysplasia tissues. The survival data of SENP3 in TCGA showed that the sarcoma patients with higher SENP3 expression levels showed poor prognosis. In vitro, SENP3 knockdown in OS cancer cells inhibited cell proliferation, migration, and invasion and induced apoptosis. In contrast, SENP3 overexpression reversed these effects. Next, we found that SENP3 inhibited the expression of E-cadherin (E-Cad) by increasing methylation of the E-Cad promoter. Finally, E-Cad expression was increased in the OS cell line MG63 following methylation, and the cell proliferation, migration, and invasion capacity were decreased. In summary, SENP3 played a significant role in OS carcinogenesis and may act as a potential biomarker in the diagnosis and treatment of OS.
Alternative route to a hypoglossal canal dural arteriovenous fistula in case of failed jugular vein approach
Authors: Dahl Rasmus Holmboe , Biondi Alessandra , Caterino Fortunato Di , Vitale Giovanni , Poulsgaard Lars , Benndorf Goetz
Published: October 2020

Hypoglossal canal dural arteriovenous fistulas (HC-DAVF) involve the anterior condylar vein (ACV) and anterior condylar confluence (ACC). They often present with tinnitus, bruit, and hypoglossal nerve palsy. The most common treatment in HC-DAVFs is transvenous embolization using coils and the most direct transvenous route is the trans-internal jugular vein access. When this approach is not feasible, a treatment attempt is possible through alternative routes. We report 2 patients with DAVFs involving the anterior condylar confluence. The first patient presented with pulsatile tinnitus and hypoglossal nerve palsy, and was treated by a standard transjugular approach. The second patient presented with pulse-synchronous bruit. Following an unsuccessful attempt of the transjugular approach, the fistulous point was reached via the deep cervical vein and complete occlusion was achieved by coil deployment. Both patients had complete regression of symptoms. Endovascular therapy is the elective treatment for HC-DAVFs and the transjugular approach is the most commonly used. The deep cervical vein (DCV) can be an alternative transvenous route when the transjugular approach fails.
COVID-19 and the global public health: Tiered pricing of pharmaceutical drugs as a price-reducing policy tool
Authors: Abbas Muhammad Zaheer
Published: October 2020

The current COVID-19 pandemic has put the problem of equitable access to health technologies in the limelight because governments, even in the economically advanced countries, are struggling to meet the health needs of their populations. Tiered pricing of innovative health technologies, which involves the division of markets into different tiers or groups, provides a legitimate policy tool to alleviate some of the COVID-19 financial burdens on global health systems. Differential pricing denotes the practice of companies to charge different prices for the same product depending on the different classes of purchasers. This paper examines the legality and practical significance of tiered pricing as a price-reducing policy option and discusses some of the key limitations of this important policy tool. This study proposes the adoption of a global framework for sustainable pricing and tiered pricing of innovative health technologies. The proposed global framework will help in achieving a balance between fair access and fair profit levels.
A literature review on network reliability analysis and its engineering applications
Authors: Gaur Vaibhav , Yadav Om Prakash , Soni Gunjan , Rathore Ajay Pal Singh
Published: October 2020

The applications of networks can be observed in numerous engineering realms mainly computers and communication, transportation, electric transmission and oil and gas distribution. Estimating the reliability of such networks is a critical task for the well-being of society as well as a nation. The paradigm of network reliability has evolved considerably over the past few decades. The purpose of this article is to present the developments in network reliability domain in a laconic manner. This paper discusses the various metrics used to evaluate network connectivity along with their mathematical backgrounds. The various algorithms namely State Enumeration, Sum of disjoint product, Minimal Cut Set, Factoring theorem, Cellular Automata, Subset Simulation, Percolation theory, Binary Decision Diagrams, and Universal Generating Functions are enumerated in this review study. The application part of algorithms with their advantages, limitations and scope are presented. Finally, the methodologies used for assessment of network reliability are discussed. This article aims at providing a holistic view of the network reliability practices, which may prove to be helpful for researchers across the globe.
Remembering war through images: Visual narratives of the Finnish Civil War in history textbooks from the 1920s to the 2010s
Authors: Hakoköngäs Eemeli , Kleemola Olli , Sakki Inari , Kivioja Virpi
Published: October 2020

The present study focuses on memory work in school textbook illustrations of the Finnish Civil War (1918). A thematic narrative analysis shows how the content and meanings conveyed through visual narratives have developed in the past century. Besides changes in specific narrative, the interpretation of the functions of themes shows a gradual change in the schematic narrative template: the hegemonic, victor’s narrative has been gradually replaced with alternative accounts since the 1950s. The defeated side has been represented in school textbooks since the 1950s, and since the 1990s, the narrative has evolved from pointing out the similarities between the two sides to arousing emotions of sympathy for the victims of the War. Since the 2000s, visual images have been used to highlight multi-perspectivity in history. This study shows how the cultural trauma and reconciliation process has been conveyed in educational material and how the narrative templates may dynamically change.
Tocilizumab and liver injury in patients with COVID-19
Authors: Serviddio Gaetano , Villani Rosanna , Stallone Giovanni , Scioscia Giulia , Foschino-Barbaro Maria Pia , Lacedonia Donato
Published: October 2020

Current mortality rate in patients with COVID-19 disease is about 2%, whereas 5% of patients require admission to the intensive care unit. It is assumed that interleukin (IL)-6 may be involved in the pathogenesis of severe COVID-19 infections; therefore, in the absence of a specific antiviral therapy, some authors have suggested that tocilizumab – a drug used to block the signal transduction pathway of IL-6 – could have beneficial effects in the management of severe COVID-19 disease. However, mild-to-moderate elevation in transaminases and drug-induced liver injury have been observed in patients treated with tocilizumab. We present seven cases of patients with elevated liver enzymes [up to five times the upper limit of normal (ULN)] at baseline who received tocilizumab for life-threatening COVID-19 disease. All patients had no history of liver or pulmonary disease and were admitted for acute hypoxemic respiratory failure, dyspnea and fever due to COVID-19 bilateral pneumonia. IL-6 was available in six patients, and was significantly increased particularly in those with severe impairment of lung function. All patients received tocilizumab (8 mg/kg/day) for two consecutive days because of lack of improvement after hydroxychloroquine, azithromycin and lopinavir/ritonavir treatment. After tocilizumab administration, clinical condition rapidly improved and liver function test normalized within 3 weeks of treatment. Tocilizumab may be effective for the treatment of severe COVID-19 disease, even in patients with elevated liver function tests. Further studies are needed to evaluate the impact of tocilizumab use on liver function tests in patients with pre-existing chronic liver disease.
HDMTX-based polychemotherapy including intraventricular therapy in elderly patients with primary CNS lymphoma: a single center series
Authors: Seidel Sabine , Kowalski Thomas , Margold Michelle , Baraniskin Alexander , Schroers Roland , Martus Peter , Schlegel Uwe
Published: October 2020

Background:

To investigate outcome and toxicity of high-dose systemic methotrexate (HDMTX)-based polychemotherapy and intracerebroventricular (ICV) chemotherapy via an Ommaya reservoir in elderly patients with primary central nervous system lymphoma (PCNSL).

Methods:

We performed a retrospective analysis on patients ⩾65 years with first diagnosis of PCNSL admitted to our center between January 2015 and December 2019. These patients were treated with a standardized chemotherapy protocol in case of absent contraindications for HDMTX-based chemotherapy. The protocol contained induction therapy with systemic rituximab, methotrexate and ifosfamide and consolidation treatment with systemic cytarabine (AraC) and ICV methotrexate, prednisolone and AraC.

Results:

Of a total of 46 patients seen in this period, 3 did not qualify for HDMTX. Thus, 43 patients were included in this analysis. Median age was 74 years (range 65–86), median Karnofsky performance score was 50 (range 20–90). Of the 43 patients, 32 (74.4%) completed treatment including ICV therapy. Complete remission/complete remission unconfirmed was achieved in 26 of 43 patients (60.5%), partial response (PR) in 3 (7%); 5 (11.6%) had progressive disease, and 3 (7.0%) died due to treatment-related complications; in the remaining 6 (14.0%) therapy could not be completed. Median progression free survival was 16 months (95% confidence interval 8–24 months) and median overall survival had not been reached after a median follow up of 23 months (range 1–52 months); the 75th percentile survival time was 12 months. No Ommaya reservoir infection was observed. Complications of ICV treatment were pericatheter leucencephalopathy in two patients and surgical scar dehiscence with cerebrospinal fluid leak in one patient.

Conclusion:

Toxicity of HDMTX plus ICV chemotherapy for elderly patients with PCNSL was manageable and outcome was excellent for patients treated with this protocol.
Influence of the Medial Malleolus Osteotomy on the Clinical Outcome of M-BMS + I/III Collagen Scaffold in Medial Talar Osteochondral Lesion (German Cartilage Register/Knorpelregister DGOU)
Authors: Gottschalk Oliver , Baumbach Sebastian Felix , Altenberger Sebastian , Körner Daniel , Aurich Matthias , Plaass Christian , Ettinger Sarah , Guenther Daniel , Becher Christoph , Hörterer Hubert , Walther Markus
Published: October 2020

Objective

Osteochondral lesions of the talus are common injuries, with one of the leading treatment options being the M-BMS (matrix-augmented bone marrow stimulation) + I/III collagen scaffold. Osteotomy of the medial malleolus is not unusual but presents the risk of malunion or irritation by hardware. The aim of the study was to analyze data from the German Cartilage Society (Knorpelregister DGOU) to evaluate the influence of medial malleolar osteotomy on clinical results of M-BMS + I/III collagen scaffold.

Design

The ankle module of the Cartilage Register includes a total of 718 patients, while 45 patients met the inclusion criteria. Patients were treated with an M-BMS + I/III collagen scaffold of the medial talus, 30 without and 15 with an osteotomy of the medial malleolus. The follow-up evaluations included FAAM (Foot and Ankle Ability Measure), FAOS (Foot and Ankle Outcome Score), and VAS (visual analogue scale).

Results

Forty-five patients (22 male, 23 female) aged between 18 and 69 years (mean: 34 years) were included in this study. Between preoperative and 12 months postoperative, we noted a significant improvement in FAAM-ADL (Activity of Daily Living) ( P = 0.004) as well as FAOS-Pain ( P = 0.001), FAOS-Stiffness ( P = 0.047), FAOS-ADL ( P = 0.002), FAOS-Sport ( P = 0.001), and FAOS Quality of Life ( P = 0.009). There was no significant difference between patients who underwent an osteotomy or not.

Conclusion

The results show a significant improvement in patients’ outcome scores following a M-BMS + I/III collagen scaffold. No statistical difference was noted among those undergoing medial malleolar osteotomy.
Reduced health-care utilization among people with chronic medical conditions during coronavirus disease 2019
Authors: Malhotra Chetna , Chaudhry Isha , Ozdemir Semra , Finkelstein Eric Andrew
Published: October 2020

The coronavirus disease 2019 (COVID-19) outbreak may impact the health-care-seeking behaviour of people with pre-existing chronic medical conditions. We aimed to assess the extent, reasons and correlates of reduced health-care utilization among people with chronic medical conditions in Singapore during the COVID-19 pandemic. We administered a web-survey to a panel of residents between 31 March and 14 April 2020. We assessed the proportion of participants with self-reported chronic conditions that missed their health-care appointment during the outbreak either voluntarily (demand driven) or because it was cancelled by their provider (supply driven). We performed a logistic regression to examine the association of voluntarily missing the health-care appointment with participants’ age and risk perceptions. Of the 1017 surveyed participants, 349 reported at least one chronic medical condition. Of these, 40% reported missing their health-care appointment during the COVID-19 outbreak. Of these, 72% did so voluntarily, and 39% reported that it was cancelled by their provider. Younger participants, those with a greater worry of contracting COVID-19 and those with a higher perceived risk of dying due to COVID-19 were more likely to miss their health-care appointments voluntarily. These results highlight the need to ensure continuity of care for people with chronic medical conditions in order to avoid the long-term impact on their health and mortality.
A training program for fibromyalgia management: A 5-year pilot study
Authors: Bodéré Céline , Cabon Mathilde , Woda Alain , Giroux-Metges Marie-Agnès , Bodéré Youenn , Saliou Philippe , Quinio Bertrand , Misery Laurent , Le Fur-Bonnabesse Anais
Published: October 2020

We studied the effects of a specific cardio training program lasting 5 years on pain and quality of life in fibromyalgia patients.

Method:

An observational longitudinal pilot study was conducted in 138 fibromyalgia women. Fibromyalgia women recruited were asked to carry out three sessions per week, each lasting 45 min, of moderate-intensity continuous training (64%–75% Maximal Heart rate [HRmax]). During the first year, the patients progressively increased their training intensity. During the last 2 years, the patients were asked to associate moderate-intensity continuous training and high-intensity interval training (85%–90% HRmax). Pain on a visual analog scale, anxiety and depression state on the Hospital Anxiety and Depression Scale, impact of fibromyalgia on daily life using the Fibromyalgia Impact Questionnaire, heart rate and sleep quality (visual analog scale) were assessed at baseline and each year for 5 years.

Results:

Forty-nine patients dropped out in the first year. Depending on their training status, the remaining 89 patients were retrospectively assigned to one of the three groups: Active (moderate-intensity continuous training), Semi-Active (one or two sessions, low-intensity continuous training <60% HRmax) and Passive (non-completion of training), based on their ability to comply with the program. Alleviation of all symptoms ( p < 0.0001) was observed in the Active group. Increasing exercise intensity enhanced the effects obtained with moderate-intensity continuous training. Significant change in the Fibromyalgia Impact Questionnaire ( p < 0.0001) and depression (Hospital Anxiety and Depression Scale; p < 0.0001), and no significant decrease in pain were noted in the Semi-Active group. No effect of the training was observed in the Passive group.

Conclusion:

The study intervention associated with multidisciplinary care alleviated pain, anxiety and depression, and improved both quality of life and quality of sleep, in fibromyalgia patients.
Thrombocytopenia in 737 adult intensive care unit patients: A real-world study of associated factors, drugs, platelet transfusion, and clinical outcome
Authors: Zhang Man-ka , Xu Tian-qi , Zhang Xiao-jing , Rao Zhi-guo , He Xiao-xu , Wu Mei-qing , Li Zhou-ping , Liu Yin , Yang Jing-cheng , Gong Yi-fan , Tang Ming , Xue Xiao-yan
Published: October 2020

Objective:

We aimed to identify and represent factors associated with thrombocytopenia in intensive care unit, especially the pathogens and drugs related to severe and extremely thrombocytopenia. Then, we aim to compare the mortality of platelet transfusion and non-transfusion in patients with different degrees of thrombocytopenia.

Methods:

We identified all thrombocytopenic patients in intensive care unit by using platelet-specific values and then extracted electronic health records from our Hospital Information System. Data were statistically analyzed with t test, chi-square test, and logistic regression.

Results:

We found that infections (32.7%) were the most frequent cause associated with thrombocytopenia, followed by sepsis shock (3.93%) and blood loss (2.99%). Meanwhile, antifungals ( p = 0.002) and bacterial infection ( p = 0.037) were associated with severe and extremely severe thrombocytopenia. Finally, we found that the mortality of platelet transfusion and non-transfusion in patients was statistically significant for patients with platelet counts between 30 and 49/nL (χ2 = 9.719, p = 0.002).

Conclusion:

Infection and sepsis emerged as two primary factors associated with thrombocytopenia in intensive care unit. Meanwhile, antifungals and bacterial infection were associated with platelet counts less than 49/nL. Finally, platelet transfusion may be associated with reduced mortality in patients with platelet counts between 30 and 49/nL.
Different retinopathy of prematurity severity and outcomes in triplets: A case report
Authors: Bin Amro Ashwaq , Alnuaimi Rawdha , Chan Tin , Alali Abeer
Published: October 2020

In this case report, we discuss the presentation of retinopathy of prematurity in triplets born at 25 + 3 weeks gestational age of whom each had a different birth weight, weight gain and treatment requirements. Triplet A weighed 800 g and his retinopathy of prematurity had resolved with no intervention. Triplet B weighed 630 g at birth and he required bilateral intravitreal ranibizumab injection at 32 + 6 weeks. Triplet C weighed 520 g and required bilateral intravitreal ranibizumab injection at 36 weeks, but after 5 weeks he had recurrence which was treated with bilateral diode laser. Triplet C had the poorest weight gain. The main differences between the triplets are the birth weight and the weight gain. Furthermore, refraction was performed at 10 months; triplet A had a hyperopia of +1.25 spherical equivalent in both eyes, triplet B had mild myopia of −0.25 spherical equivalent and triplet C had a myopia of −3.00 spherical equivalent in the right eye and −2.75 spherical equivalent in the left eye.
Life-threatening COVID-19 presenting as stroke with antiphospholipid antibodies and low ADAMTS-13 activity, and the role of therapeutic plasma exchange: A case series
Authors: Alharthy Abdulrahman , Faqihi Fahad , Balhamar Abdullah , Memish Ziad A , Karakitsos Dimitrios
Published: October 2020

We present a case series of three patients with COVID-19 who were admitted to our intensive care unit due to acute respiratory distress syndrome, brain infarction, pulmonary embolism, and antiphospholipid antibodies. We applied therapeutic plasma exchange on all cases. On intensive care unit admission, all patients had low (<10) Glasgow Coma Scale, and central nervous imaging showed multiple brain infarctions. COVID-19 was confirmed by reverse transcriptase polymerase chain reaction assays. Patients underwent rescue therapeutic plasma exchange using the Spectra OptiaTM Apheresis System (Terumo BCT Inc., USA), which operates with acid-citrate dextrose anticoagulant as per Kidney Disease Improving Global Outcomes 2019 guidelines. A dose of 1.5 plasma volume was used for the first dose and then 1 plasma volume daily for a total of five doses. Plasma was replaced with Octaplas LG® (Octapharma AG, USA), which is an artificial fresh frozen plasma product that has undergone viral inactivation by prion reduction technology. We administered ARDS-net/prone positioning ventilation, empiric antiviral treatment, therapeutic anticoagulation, and intensive care unit supportive care. Laboratory tests showed lymphocytopenia; elevated levels of D-dimer, fibrinogen, total bilirubin, C-reactive protein, lactate dehydrogenase, and ferritin; as well as low levels of ADAMTS-13 activity and antibody. Serology tests depicted positive IgM and IgG antiphospholipid antibodies (anti-cardiolipin and anti-β2-glycoprotein I antibodies). No side effects of therapeutic plasma exchange were recorded. After the completion of therapeutic plasma exchange, patients improved clinically and gradually recovered neurologically (after 27–32 days). To conclude, in life-threatening COVID-19, especially when immune dysregulation features such as antiphospholipid antibodies exist, therapeutic plasma exchange could be an effective rescue therapy.
Graft Function, Albuminuria, and the Risk of Hemorrhage and Thrombosis After Kidney Transplantation
Authors: Jeong Rachel , Quinn Robert R. , Ravani Pietro , Ye Feng , Sood Manish M. , Massicotte-Azarniouch David , Tonelli Marcello , Hemmelgarn Brenda R. , Lam Ngan N.
Published: October 2020

Background:

Compared to the general population, kidney transplant recipients are at increased risk of hemorrhage and thrombosis. Whether this risk is affected by graft function and albuminuria is unknown.

Objective:

To determine the association between graft function and albuminuria and the risk of post-transplant hemorrhage and thrombosis.

Design:

Retrospective cohort study.

Setting:

We used linked health care databases in Alberta, Canada.

Patients/sample/participants:

We included adult kidney transplant recipients from 2002 to 2015 with a functioning graft at 1 year.

Measurements:

Estimated glomerular filtration rate (eGFR) and albuminuria measurements at 1 year post-transplant were used to categorize recipients (eGFR: ≥45 vs. <45 mL/min/1.73 m2; albuminuria: absence vs. presence). We determined the rates of post-transplant hemorrhage and venous thrombosis based on validated diagnostic and procedural codes.

Methods:

We determined the association between categories of eGFR and albuminuria and post-transplant hemorrhage and venous thrombosis using Poisson regression with log link.

Results:

Of 1284 kidney transplant recipients, 21% had an eGFR <45 mL/min/1.73 m2 and 40% had presence of albuminuria at 1 year post-transplant. Over a median follow-up of 6 years, there were 100 hemorrhages (12.6 events per 1000 person-years) and 57 venous thrombosis events (7.1 events per 1000 person-years). The age- and sex-adjusted rate of hemorrhage and thrombosis was over 2-fold higher in recipients with lower eGFR and presence of albuminuria compared to higher eGFR and no albuminuria (hemorrhage: incidence rate ratio, IRR, 2.6, 95% confidence interval [CI]: 1.5-4.4, P = .001; thrombosis: IRR, 2.3, 95% CI: 1.1-5.0, P = .046).

Limitations:

Complete relevant medication information, such as anticoagulants, were not available in our datasets. Due to sample size, this study was underpowered to conduct a fully adjusted analysis.

Conclusion:

Among kidney transplant recipients, lower eGFR and presence of albuminuria at 1 year post-transplant were associated with an over 2-fold higher risk of hemorrhage and venous thrombosis. Graft function and albuminuria at 1 year post-transplant are important prognostic factors in determining risk of post-transplant hemorrhage and venous thrombosis. Further research, including medication data, are needed to further delineate outcomes and safety.

Trial registration:

Not applicable (cohort study).
Importance of early treatment decisions on future income of multiple sclerosis patients
Authors: Kavaliunas Andrius , Manouchehrinia Ali , Gyllensten Hanna , Alexanderson Kristina , Hillert Jan
Published: October 2020

Background

Early initiation of disease-modifying treatment (DMT) is associated with better disability outcomes in multiple sclerosis (MS). However, little is known of how treatment decisions affect socio-economic outcomes.

Objective

To estimate the long-term impact of early initiation of DMT on the income of MS patients.

Methods

In total, 3610 MS patients were included in this register-based cohort study. We measured the association between the time to treatment and the outcome, defined as time from treatment initiation to a 95% decrease in annual earnings compared to each patient´s baseline level. Additionally, the association between time to treatment and increase of social benefits (sickness absence, disability pension) was investigated. A Cox model was adjusted for sex, onset age, education, family situation, country of birth, living area, and disability.

Results

MS patients initiating treatment later had a higher risk of reaching the outcome- those who started treatment after 2 years from MS onset lost 95% of their earnings sooner (HR, 1.19; 95% CI, 1.04–1.37). Furthermore, risk to receive an annual compensation of SEK 100,000 (≈EUR 10,500) was higher for the delayed treatment group.

Conclusion

Early treatment initiation in MS is associated with better socioeconomic outcome, adding to previous studies showing benefits regarding disability.
Measuring Process Capability in a Hospital by Using Lean Six Sigma Tools—A Case Study in Bangladesh
Authors: Chyon, BSc Fuad Ahmed , Ahmmed, BSc Md Sazol , Shuvo, BSc Md Karimul Alim , Suman, BSc Md Nazmul Hasan , Hossain, PhD Md Mosharraf
Published: October 2020

Bangladesh’s government had been constantly conscious of its health-care system. As a result, the health-care system had seen a significant rise in quality in the past few years. The Lean Six Sigma concept is used to boost up the productivity as well as the quality of products or services. The purpose of this article was to measure the process capability in the health-care system by lean tools. In this study, we selected the dialysis unit as our investigation area where we applied the Six Sigma DMAIC (Define, Measure, Analysis, Improve, and Control) model which had been structured step by step, respectively. Furthermore, different tools of Total Quality Management, Statistical Quality Control and Lean manufacturing like SIPOC (Supplier, Input, Process, Output, and Customer) diagram, P Control chart, Fishbone diagram, and Pareto analysis had been performed in different phases of the DMAIC model. Measuring process capability using the DMAIC model helped to identify the problems associated with the dialysis unit and also recommendations were developed based on investigation and analysis. These recommendations will help the hospital management to overcome all problems and increase service rate and patient safety in the dialysis unit.
Axicabtagene ciloleucel for relapsed or refractory lymphoma after prior treatment with a different CD19-directed CAR T-cell therapy
Authors: Chow Victor A. , Gopal Ajay K. , Gauthier Jordan , Tseng Yolanda D. , Turtle Cameron J. , Maloney David G. , Shadman Mazyar
Published: October 2020

Key Points

No meaningful responses were observed when axicabtagene ciloleucel was used for progression after a different CD19-directed CAR T cell. Further research is needed to understand how to sequence cell-based therapies for relapsed/refractory large B-cell lymphomas.
Successful transfer of anti–SARS-CoV-2 immunity using convalescent plasma in an MM patient with hypogammaglobulinemia and COVID-19
Authors: Luetkens Tim , Metcalf Ryan , Planelles Vicente , Zheng Yue , Larragoite Erin T. , Spivak Emily S. , Spivak Adam M. , Steinbach Mary , Blaylock Robert C. , Avila Stephanie V. , Hankey Kim G. , Martins Thomas B. , Slev Patricia R. , Mannuel Heather D. , Sajadi Mohammad , Rapoport Aaron P. , Atanackovic Djordje
Published: October 2020

Key Points

A severely immunocompromised patient with MM and COVID19 who received a convalescent plasma product showed SARS-CoV-2 clearance. The convalescent plasma showed humoral immunity against all structural SARS-CoV-2 proteins, which was successfully transferred to the patient.
Two cases of penile strangulation: varied presentations and vastly different outcomes
Authors: Agrawal Mayank , Gite Venkat Arjun , Sankapal Prakash
Published: October 2020

Background

Penile strangulation by various metallic and non-metallic objects is a true urological emergency that requires prompt emergency management. The cases in this report will help in highlighting the varied presentations one can face in the emergency department. Management of such cases at times needs out-of-the-box thinking and improvised skills as resources to remove the foreign body are often scarce within the hospital.

Case presentation

We present two such cases of penile strangulation in adult patients. Both patients presented to us in the emergency department, one with a large metallic cone and another with a rubber band constricting their penises. Both the patients had hugely different grades of injuries and were managed accordingly. Both the patients required different methods to remove the constriction objects as per the need of the situation. One of the patients required total penectomy with permanent perineal urethrostomy; however, in the other case, we were able to save the penis.

Conclusion

Penile strangulation needs urgent medical attention and timely removal of the offending object. Grade of injuries and complications are directly proportional to the type of object and the duration of the strangulation. The non-metallic objects are easy to cut and remove. However, one should be aware of the challenges and the complications in managing metallic foreign bodies which at times may need out-of-the-box thinking, like use of motorized cutting tools.
Patterns of household and personal care product use by the Korean population: implications for aggregate human exposure and health risk
Authors: Han Eun Jeong , Choi KeunOh , Sim Seunghye , Choi Junyeong , Uhm Yoonhee , Kim Soonbok , Lim Eunkyung , Lee YoungJoo
Published: October 2020

Background

Household and personal care products (H&PCPs) are used frequently in the domestic environment. Different types of H&PCPs often contain the same chemicals and have potential for aggregate exposure. Therefore, product use patterns should be investigated to assess exposure and health risk.

Results

A nationwide survey was conducted in Korea to examine the use of 16 types of H&PCPs, to obtain data that can be used for such assessments. The initial analysis focused on identifying usage patterns, such as the frequency of use and amount of product used per application. Then, co-use in 16 product categories were analyzed. Family size, marital status and age were, respectively, recognized as the critical demographic factor for classification of the frequency of use in laundry products, cleaning products and shower products. In laundry products, cleaning products and shower products, frequent H&PCPs co-use patterns according to demographical factor were recognized. Chances of exposure of chemical ingredients to participants were investigated based on the usage of individual products. 32 chemicals among all investigated ingredients were identified to be potentially exposed to more than half of the participants, and 21 chemicals are classified above Class 4 in acute toxicity.

Conclusions

Personal preference was not observed both in the use frequency and the amount per application of H&PCPs, among all participants. Instead, household duties were found to be associated with the yearly use frequency of household care products. In addition, the yearly chemical profiles of individual consumer were obtained, and the chemicals that have multiple chances of exposure and concomitant health risk in daily life were identified. The results provide the overview of distribution of chemicals in daily life, and essential ground for aggregate exposure assessment in Korea.
Liver transcriptome profiling and functional analysis of intrauterine growth restriction (IUGR) piglets reveals a genetic correction and sexual-dimorphic gene expression during postnatal development
Authors: Gao Hongmei , Zhang Longchao , Wang Ligang , Liu Xin , Hou Xinhua , Zhao Fuping , Yan Hua , Wang Lixian
Published: October 2020

Background

Intrauterine growth restriction (IUGR) remains a major problem associated with swine production. Thus, understanding the physiological changes of postnatal IUGR piglets would aid in improving growth performance. Moreover, liver metabolism plays an important role in the growth and survival of neonatal piglets.

Results

By profiling the transcriptome of liver samples on postnatal Days 1, 7, and 28, our study focused on characterizing the growth, function, and metabolism in the liver of IUGR neonatal piglets. Our study demonstrates that the livers of IUGR piglets were associated with a series of complications, including inflammatory stress and immune dysregulation; cytoskeleton and membrane structure disorganization; dysregulated transcription events; and abnormal glucocorticoid metabolism. In addition, the abnormal liver function index in the serum [alanine aminotransferase (ALT), aspartate aminotransferase (AST), and total protein (TP)], coupled with hepatic pathological and ultrastructural morphological changes are indicative of liver damage and dysfunction in IUGR piglets. Moreover, these results reveal the sex-biased developmental dynamics between male and female IUGR piglets, and that male IUGR piglets may be more sensitive to disrupted metabolic homeostasis.

Conclusions

These observations provide a detailed reference for understanding the mechanisms and characterizations of IUGR liver functions, and suggest that the potential strategies for improving the survival and growth performance of IUGR offspring should consider the balance between postnatal catch-up growth and adverse metabolic consequences. In particular, sex-specific intervention strategies should be considered for both female and male IUGR piglets.
Arabidopsis paralogous genes RPL23aA and RPL23aB encode functionally equivalent proteins
Authors: Xiong Wei , Chen Xiangze , Zhu Chengxin , Zhang Jiancong , Lan Ting , Liu Lin , Mo Beixin , Chen Xuemei
Published: October 2020

Background

In plants, each ribosomal protein (RP) is encoded by a small gene family but it is largely unknown whether the family members are functionally diversified. There are two RPL23a paralogous genes (RPL23aA and RPL23aB) encoding cytoplasmic ribosomal proteins in Arabidopsis thaliana. Knock-down of RPL23aA using RNAi impeded growth and led to morphological abnormalities, whereas knock-out of RPL23aB had no observable phenotype, thus these two RPL23a paralogous proteins have been used as examples of ribosomal protein paralogues with functional divergence in many published papers.

Results

In this study, we characterized T-DNA insertion mutants of RPL23aA and RPL23aB. A rare non-allelic non-complementation phenomenon was found in the F1 progeny of the rpl23aa X rpl23ab cross, which revealed a dosage effect of these two genes. Both RPL23aA and RPL23aB were found to be expressed almost in all examined tissues as revealed by GUS reporter analysis. Expression of RPL23aB driven by the RPL23aA promoter can rescue the phenotype of rpl23aa, indicating these two proteins are actually equivalent in function. Interestingly, based on the publicly available RNA-seq data, we found that these two RPL23a paralogues were expressed in a concerted manner and the expression level of RPL23aA was much higher than that of RPL23aB at different developmental stages and in different tissues.

Conclusions

Our findings suggest that the two RPL23a paralogous proteins are functionally equivalent but the two genes are not. RPL23aA plays a predominant role due to its higher expression levels. RPL23aB plays a lesser role due to its lower expression. The presence of paralogous genes for the RPL23a protein in plants might be necessary to maintain its adequate dosage.