bluuebunny/crossref_metadata_2025 huggingface dataset:
Clear cell carcinoma of Mullerian origin in the urinary bladder: A rare entity
Authors: Garg Harshit , Nayak Brusabhanu , Nakra Tripti , Singh Prabhjot , Kaushal Seema
Published: January 2021

Mullerian neoplasms of the urinary system are rare but complex tumor-like lesions. The identification of the Mullerian neoplasm is crucial for patient management owing to its etiology, natural history, and prognosis. We present a case of a 42-year-old female with a history of three lower segment cesarean sections presenting with complaints of dysmenorrhea and suprapubic pain with no history of hematuria or any urinary symptoms. Magnetic resonance imaging revealed a 2 cm×2 cm exophytic lesion suspicious of being either a bladder lesion or an endometrial lesion infiltrating the urinary bladder. Cystoscopy and transurethral biopsy of this suspicious bladder tumor revealed a malignant tumor with papillary and tubulocystic architecture. Based on the overall histomorphological and immunohistochemical features, a diagnosis of clear cell carcinoma of Mullerian origin was made, and the patient underwent a total abdominal hysterectomy with bilateral salpingo-oophorectomy and partial cystectomy. The patient was kept on regular surveillance and showed no signs of recurrence at the one-year follow-up. Clear cell carcinoma of the bladder of Mullerian origin is a rare entity and is established on histopathology. Prompt diagnosis and a multidisciplinary approach are indispensable for management.

Level of evidence: Level 4.
Successful treatment of otodemodicosis due to Demodex cati with sarolaner/selamectin topical solution in a cat
Authors: Simpson Andrew C
Published: January 2021

Case summary

A 10-year-old spayed female Russian Blue cat was presented with a 3-month history of excessive otic discharge and scratching, only involving the right ear. Other than a moderate amount of ceruminous exudate present within the right ear on video-otoscopic examination, there were no other cutaneous abnormalities. The cat was deemed to be otherwise in good health based on physical examination and several laboratory profiles. A diagnosis of otodemodicosis was determined due to the presence of a large number of Demodex cati mites retrieved from cerumen. Treatment consisted only of monthly topical application of sarolaner/selamectin to the nape of the neck with a marked reduction in mite counts and otic pruritus after a single dose. Complete resolution was achieved after a total of four doses.

Relevance and novel information

This is the first report to describe the resolution of mite infestation owing to D cati after treatment with a sarolaner-containing spot-on product. In addition, to the best of the author’s knowledge, this is the first report of any isoxazoline product used in the successful treatment of demodicosis affecting the ear canal. In general, there is a lack of reports describing safe and effective treatments for feline otodemodicosis. Topically applied sarolaner/selamectin resulted in resolution of mites while avoiding any potential ototoxic events from medications applied directly into the ear, and provided a treatment that was easier to apply than oral or injectable macrocyclic lactones.
High-Performance Work Practices and Turnover Intention: Investigating the Mediating Role of Employee Morale and the Moderating Role of Psychological Capital
Authors: Obeng Anthony Frank , Zhu Yongyue , Quansah Prince Ewudzie , Ntarmah Albert Henry , Cobbinah Eric
Published: January 2021

This study examined the effects of high-performance work practices on turnover intention through the mediating role of employee morale. The study also examined the extent to which psychological capital could moderate the relationship between employee morale and turnover intention. With the aid of questionnaire administration, the study collected 469 valid responses from frontline employees in the hospitality sector of Ghana. Findings from the hierarchical regression analysis showed that training and empowerment had a significant influence on turnover intention. Training and reward also had a significant positive effect on job satisfaction. Empowerment, on the other hand, had a significant positive influence on affective organizational commitment. Both affective organizational commitment and job satisfaction significantly influenced turnover intention. Optimism and resilience moderated the relationship between affective organizational commitment and turnover intention. Also, self-efficacy moderated the relationship between job satisfaction and turnover intention. The study offers some implications and suggestions for future studies in the main text.
Development of a Positive Psychology Program (LAVENDER) for Preserving Medical Student Well-being: A Single-Arm Pilot Study
Authors: Cheung Elaine O , Kwok Ian , Ludwig Allison B , Burton William , Wang Xinzi , Basti Neha , Addington Elizabeth L , Maletich Carly , Moskowitz Judith T
Published: January 2021

Background

Mental health tends to worsen over the course of medical school, with steep declines in well-being in students’ clerkship year (M3). Positive emotion promotes adaptive coping to stress and may help preserve medical student well-being.

Objective

This study describes the development of LAVENDER (Leveraging Affect and Valuing Empathy for Nurturing Doctors’ Emotional Resilience), a program aimed at increasing positive emotion to preserve well-being in medical students.

Methods

We conducted a single-arm pilot of LAVENDER, a positive psychology intervention developed for medical students delivered in an interactive classroom format to a cohort of 157 third-year medical students at the Albert Einstein College of Medicine. Our primary outcome was the acceptability of LAVENDER. We also examined preliminary efficacy using measures of emotion, stress and burnout collected at each intervention session.

Results

LAVENDER showed good acceptability: 76% of participants agreed that the LAVENDER skills were useful and 72% agreed that they would recommend the LAVENDER program to others. Qualitative feedback suggested that medical students enjoyed the program and found the skills to be useful for coping with stress, but also reported the following barriers to engagement: lack of time to practice the skills, resistance to the mandatory nature of the wellness sessions, and difficulty integrating the skills in daily life. We did not find support for the preliminary efficacy of LAVENDER for improving medical student well-being in students’ clerkship year. Participants showed decreases in positive emotion and increases in symptoms of burnout over the intervention period ( ps < .01).

Conclusion

The current paper describes the development and a single-arm pilot test of LAVENDER, a positive psychology program tailored for medical students. Although we found preliminary evidence for the acceptability of LAVENDER, we did not find support for the preliminary efficacy. Lessons learned and next steps for the program are discussed.
Thought Conditioning: Inducing and Reducing Thoughts About the Aversive Outcome in a Fear-Conditioning Procedure
Authors: Zenses Ann-Kathrin , Baeyens Frank , Beckers Tom , Boddez Yannick
Published: January 2021

The human fear-conditioning paradigm is a widely used procedure to study anxiety. However, merely thinking about the aversive outcome is typically not measured in this procedure. This is surprising because thinking of an aversive event is of clinical relevance (e.g., in the form of intrusions) and theoretical interest. We present two preregistered studies that (a) included thinking of an aversive outcome as an additional dependent variable and (b) compared several interventions to reduce it. We found that mere thinking of an aversive outcome could be successfully conditioned. Among the participants who showed successful acquisition, extinction training was less successful in reducing it than counterconditioning. Presenting new additional outcomes also proved effective to reduce thoughts about the initial outcome when the new outcomes were positive stimuli. Including thinking of the aversive outcome as an additional dependent variable may serve to enhance the understanding of anxiety-related disorders and inform their treatment.
Supine Traction Versus Prone Bending Radiographs for Assessing the Curve Flexibility in Spinal Deformity
Authors: te Hennepe Niek , Spruit Maarten , Pouw Martin H. , Hinderks Marco , Heesterbeek Petra
Published: January 2021

Study Design:

Retrospective cohort study.

Objectives:

No consensus exists among surgeons on which radiologic method to prefer for the assessment of curve flexibility in spinal deformity. The objective of this study was to evaluate the difference in curve correction on supine traction radiographs versus prone side bending radiographs.

Methods:

A retrospective analysis of idiopathic scoliosis (IS), degenerative idiopathic scoliosis (DIS) and de novo degenerative lumbar scoliosis (DNDLS) patients was performed on supine traction as well as prone bending films (when available). Age, weight, traction force, diagnosis and Cobb angles of the primary and secondary curves were extracted. Differences in curve correction (percentages) on traction versus prone bending radiographs were analyzed for the primary and secondary curve. Subgroup analyses were performed for the 3 different diagnoses.

Results:

In total, 170 patients were eligible for inclusion. 43 were diagnosed with IS, 58 with DIS and 69 with DNDLS. For the primary curve, greater curve correction was obtained with bending in the DNDLS group ( P < 0.001). In the DIS group, there was a trend toward more correction on bending ( P = 0.054). In de IS group no difference was found. For the secondary curve, bending showed more curve correction in the IS and DIS group ( P = 0.002 and P <0.001). No difference was found in the DNDLS group.

Conclusion:

Compared to traction radiographs, bending radiographs better serve the purpose of curve flexibility assessment of IS, DIS and DNDLS spinal deformity, despite the fact that patients are exposed to more radiation.
Elucidation of Epigenetic Landscape in Coronary Artery Disease: A Review on Basic Concept to Personalized Medicine
Authors: Sumi Mamta P , Mahajan Bhawna , Sattar Real Sumayya Abdul , Nimisha  , Apurva  , Kumar Arun , Sharma Abhay Kumar , Ahmad Ejaz , Ali Asgar , Saluja Sundeep Singh
Published: January 2021

Despite extensive clinical research and management protocols applied in the field of coronary artery diseases (CAD), it still holds the number 1 position in mortality worldwide. This indicates that we need to work on precision medicine to discover the diagnostic, therapeutic, and prognostic targets to improve the outcome of CAD. In precision medicine, epigenetic changes play a vital role in disease onset and progression. Epigenetics is the study of heritable changes that do not affect the alterations of DNA sequence in the genome. It comprises various covalent modifications that occur in DNA or histone proteins affecting the spatial arrangement of the DNA and histones. These multiple modifications include DNA/histone methylation, acetylation, phosphorylation, and SUMOylation. Besides these covalent modifications, non-coding RNAs—viz. miRNA, lncRNA, and circRNA are also involved in epigenetics. Smoking, alcohol, diet, environmental pollutants, obesity, and lifestyle are some of the prime factors affecting epigenetic alterations. Novel molecular techniques such as next-generation sequencing, chromatin immunoprecipitation, and mass spectrometry have been developed to identify important cross points in the epigenetic web in relation to various diseases. The studies regarding exploration of epigenetics, have led researchers to identify multiple diagnostic markers and therapeutic targets that are being used in different disease diagnosis and management. Here in this review, we will discuss various ground-breaking contributions of past and recent studies in the epigenetic field in concert with coronary artery diseases. Future prospects of epigenetics and its implication in CAD personalized medicine will also be discussed in brief.
Phospholipase A2 receptor 1 promotes lung cell senescence and emphysema in obstructive lung disease
Authors: Beaulieu Delphine , Attwe Aya , Breau Marielle , Lipskaia Larissa , Marcos Elisabeth , Born Emmanuelle , Huang Jin , Abid Shariq , Derumeaux Geneviève , Houssaini Amal , Maitre Bernard , Lefevre Marine , Vienney Nora , Bertolino Philippe , Jaber Sara , Noureddine Hiba , Goehrig Delphine , Vindrieux David , Bernard David , Adnot Serge
Published: January 2021

Background

Cell senescence is a key process in age-associated dysfunction and diseases, notably chronic obstructive pulmonary disease (COPD). We previously identified phospholipase A2 receptor 1 (PLA2R1) as a positive regulator of cell senescence actingviaJanus kinase (JAK)/signal transducer and activator of transcription (STAT) signalling. Its role in pathology, however, remains unknown. Here, we assessed PLA2R1-induced senescence in COPD and lung emphysema pathogenesis.

Methods

We assessed cell senescence in lungs and cultured lung cells from patients with COPD and controls subjected toPLA2R1knockdown,PLA2R1gene transduction and treatment with the JAK1/2 inhibitor ruxolitinib. To assess whetherPLA2R1upregulation caused lung lesions, we developed transgenic mice overexpressingPLA2R1(PLA2R1-TG) and intratracheally injected wild-type mice with a lentiviral vector carrying thePla2r1gene (LV-PLA2R1mice).

Results

We found thatPLA2R1was overexpressed in various cell types exhibiting senescence characteristics in COPD lungs.PLA2R1knockdown extended the population doubling capacity of these cells and inhibited their pro-inflammatory senescence-associated secretory phenotype (SASP). PLA2R1-mediated cell senescence in COPD was largely reversed by treatment with the potent JAK1/2 inhibitor ruxolitinib. Five-month-oldPLA2R1-TG mice exhibited lung cell senescence, and developed lung emphysema and lung fibrosis together with pulmonary hypertension. Treatment with ruxolitinib induced reversal of lung emphysema and fibrosis. LV-PLA2R1-treated mice developed lung emphysema within 4 weeks and this was markedly attenuated by concomitant ruxolitinib treatment.

Conclusions

Our data support a major role for PLA2R1 activation in driving lung cell senescence and lung alterations in COPD. Targeting JAK1/2 may represent a promising therapeutic approach for COPD.
Effectiveness of a specialised breathlessness service for patients with advanced disease in Germany: a pragmatic fast-track randomised controlled trial (BreathEase)
Authors: Schunk Michaela , Le Lien , Syunyaeva Zulfiya , Haberland Birgit , Tänzler Susanne , Mansmann Ulrich , Schwarzkopf Larissa , Seidl Hildegard , Streitwieser Sabine , Hofmann Miriam , Müller Thomas , Weiß Tobias , Morawietz Philipp , Rehfuess Eva Annette , Huber Rudolf Maria , Berger Ursula , Bausewein Claudia
Published: January 2021

Background

The effectiveness of the Munich Breathlessness Service (MBS), integrating palliative care, respiratory medicine and physiotherapy, was tested in the BreathEase trial in patients with chronic breathlessness in advanced disease and their carers.

Methods

BreathEase was a single-blinded randomised controlled fast-track trial. The MBS was attended for 5–6 weeks; the control group started the MBS after 8 weeks of standard care. Randomisation was stratified by cancer and the presence of a carer. Primary outcomes were patients’ mastery of breathlessness (Chronic Respiratory Disease Questionnaire (CRQ) Mastery), quality of life (CRQ QoL), symptom burden (Integrated Palliative care Outcome Scale (IPOS)) and carer burden (Zarit Burden Interview (ZBI)). Intention-to-treat (ITT) analyses were conducted with hierarchical testing. Effectiveness was investigated by linear regression on change scores, adjusting for baseline scores and stratification variables. Missing values were handled with multiple imputation.

Results

92 patients were randomised to the intervention group and 91 patients were randomised to the control group. Before the follow-up assessment after 8 weeks (T1), 17 and five patients dropped out from the intervention and control groups, respectively. Significant improvements in CRQ Mastery of 0.367 (95% CI 0.065–0.669) and CRQ QoL of 0.226 (95% CI 0.012–0.440) score units at T1 in favour of the intervention group were seen in the ITT analyses (n=183), but not in IPOS. Exploratory testing showed nonsignificant improvements in ZBI.

Conclusions

These findings demonstrate positive effects of the MBS in reducing burden caused by chronic breathlessness in advanced illness across a wide range of patients. Further evaluation in subgroups of patients and with a longitudinal perspective is needed.
Neutrophil dysfunction in bronchiectasis: an emerging role for immunometabolism
Authors: Giam Yan Hui , Shoemark Amelia , Chalmers James D.
Published: January 2021

Bronchiectasis is a heterogenous disease with multiple underlying causes. The pathophysiology is poorly understood but neutrophilic inflammation and dysfunctional killing of pathogens is believed to be key. There are, however, no licensed therapies for bronchiectasis that directly target neutrophilic inflammation. In this review, we discuss our current understanding of neutrophil dysfunction and therapeutic targeting in bronchiectasis. Immunometabolic reprogramming, a process through which inflammation changes inflammatory cell behaviour by altering intracellular metabolic pathways, is increasingly recognised across multiple inflammatory and autoimmune diseases. Here, we show evidence that much of the neutrophil dysfunction observed in bronchiectasis is consistent with immunometabolic reprogramming. Previous attempts at developing therapies targeting neutrophils have focused on reducing neutrophil numbers, resulting in increased frequency of infections. New approaches are needed and we propose that targeting metabolism could theoretically reverse neutrophil dysfunction and dysregulated inflammation. As an exemplar, 5' adenosine monophosphate (AMP)-activated protein kinase (AMPK) activation has already been shown to reverse phagocytic dysfunction and neutrophil extracellular trap (NET) formation in models of pulmonary disease. AMPK modulates multiple metabolic pathways, including glycolysis which is critical for energy generation in neutrophils. AMPK activators can reverse metabolic reprogramming and are already in clinical use and/or development. We propose the need for a new immunomodulatory approach, rather than an anti-inflammatory approach, to enhance bacterial clearance and reduce bronchiectasis disease severity.
Endothelial cells in the pathogenesis of pulmonary arterial hypertension
Authors: Evans Colin E. , Cober Nicholas D. , Dai Zhiyu , Stewart Duncan J. , Zhao You-Yang
Published: January 2021

Pulmonary arterial hypertension (PAH) is a devastating disease that involves pulmonary vasoconstriction, small vessel obliteration, large vessel thickening and obstruction, and development of plexiform lesions. PAH vasculopathy leads to progressive increases in pulmonary vascular resistance, right heart failure and, ultimately, premature death. Besides other cell types that are known to be involved in PAH pathogenesis (e.g.smooth muscle cells, fibroblasts and leukocytes), recent studies have demonstrated that endothelial cells (ECs) have a crucial role in the initiation and progression of PAH. The EC-specific role in PAH is multi-faceted and affects numerous pathophysiological processes, including vasoconstriction, inflammation, coagulation, metabolism and oxidative/nitrative stress, as well as cell viability, growth and differentiation. In this review, we describe how EC dysfunction and cell signalling regulate the pathogenesis of PAH. We also highlight areas of research that warrant attention in future studies, and discuss potential molecular signalling pathways in ECs that could be targeted therapeutically in the prevention and treatment of PAH.
ERS International Congress 2020: highlights from the Epidemiology and Environment Assembly
Authors: van der Plaat Diana A. , Rantala Aino K. , Alif Sheikh M. , Karadoğan Dilek , Cai Yutong , Dumas Orianne
Published: January 2021

In this article, early career members of the Epidemiology and Environment Assembly of the European Respiratory Society (ERS) summarise a selection of five sessions from the ERS 2020 Virtual International Congress. The topics covered include risk factors for chronic respiratory diseases over the life course, from early life origins to occupational exposures in adulthood, and the interplay between these risk factors, including gene–environment interactions. Novel results were also presented on smoking prevention and potential risks of vaping. Finally, the challenges and opportunities for epidemiological and environmental research brought by the coronavirus disease 2019 (COVID-19) pandemic were a major topic of this year's congress.
Inhibition of mitochondrial carrier homolog 2 (MTCH2) suppresses tumor invasion and enhances sensitivity to temozolomide in malignant glioma
Authors: Yuan Qiuyun , Yang Wanchun , Zhang Shuxin , Li Tengfei , Zuo Mingrong , Zhou Xingwang , Li Junhong , Li Mao , Xia Xiaoqiang , Chen Mina , Liu Yanhui
Published: January 2021

Background

Malignant glioma exerts a metabolic shift from oxidative phosphorylation (OXPHOs) to aerobic glycolysis, with suppressed mitochondrial functions. This phenomenon offers a proliferation advantage to tumor cells and decrease mitochondria-dependent cell death. However, the underlying mechanism for mitochondrial dysfunction in glioma is not well elucidated. MTCH2 is a mitochondrial outer membrane protein that regulates mitochondrial metabolism and related cell death. This study aims to clarify the role of MTCH2 in glioma.

Methods

Bioinformatic analysis from TCGA and CGGA databases were used to investigate the association of MTCH2 with glioma malignancy and clinical significance. The expression of MTCH2 was verified from clinical specimens using real-time PCR and western blots in our cohorts. siRNA-mediated MTCH2 knockdown were used to assess the biological functions of MTCH2 in glioma progression, including cell invasion and temozolomide-induced cell death. Biochemical investigations of mitochondrial and cellular signaling alternations were performed to detect the mechanism by which MTCH2 regulates glioma malignancy.

Results

Bioinformatic data from public database and our cohort showed that MTCH2 expression was closely associated with glioma malignancy and poor patient survival. Silencing of MTCH2 expression impaired cell migration/invasion and enhanced temozolomide sensitivity of human glioma cells. Mechanistically, MTCH2 knockdown may increase mitochondrial OXPHOs and thus oxidative damage, decreased migration/invasion pathways, and repressed pro-survival AKT signaling.

Conclusion

Our work establishes the relationship between MTCH2 expression and glioma malignancy, and provides a potential target for future interventions.
Photoelectrical Properties Investigated on Individual Si Nanowires and Their Size Dependence
Authors: Hu Xiaofeng , Li Shujie , Jiang Zuimin , Yang Xinju
Published: January 2021

Periodically ordered arrays of vertically aligned Si nanowires (Si NWs) are successfully fabricated with controllable diameters and lengths. Their photoconductive properties are investigated by photoconductive atomic force microscopy (PCAFM) on individual nanowires. The results show that the photocurrent of Si NWs increases significantly with the laser intensity, indicating that Si NWs have good photoconductance and photoresponse capability. This photoenhanced conductance can be attributed to the photoinduced Schottky barrier change, confirmed by I–V curve analyses. On the other hand, electrostatic force microscopy (EFM) results indicate that a large number of photogenerated charges are trapped in Si NWs under laser irradiation, leading to the lowering of barrier height. Moreover, the size dependence of photoconductive properties is studied on Si NWs with different diameters and lengths. It is found that the increasing magnitude of photocurrent with laser intensity is greatly relevant to the nanowires’ diameter and length. Si NWs with smaller diameters and shorter lengths display better photoconductive properties, which agrees well with the size-dependent barrier height variation induced by photogenerated charges. With optimized diameter and length, great photoelectrical properties are achieved on Si NWs. Overall, in this study the photoelectrical properties of individual Si NWs are systematically investigated by PCAFM and EFM, providing important information for the optimization of nanostructures for practical applications.
Auto-HMM-LMF: feature selection based method for prediction of drug response via autoencoder and hidden Markov model
Authors: Emdadi Akram , Eslahchi Changiz
Published: January 2021

Background

Predicting the response of cancer cell lines to specific drugs is an essential problem in personalized medicine. Since drug response is closely associated with genomic information in cancer cells, some large panels of several hundred human cancer cell lines are organized with genomic and pharmacogenomic data. Although several methods have been developed to predict the drug response, there are many challenges in achieving accurate predictions. This study proposes a novel feature selection-based method, named Auto-HMM-LMF, to predict cell line-drug associations accurately. Because of the vast dimensions of the feature space for predicting the drug response, Auto-HMM-LMF focuses on the feature selection issue for exploiting a subset of inputs with a significant contribution.

Results

This research introduces a novel method for feature selection of mutation data based on signature assignments and hidden Markov models. Also, we use the autoencoder models for feature selection of gene expression and copy number variation data. After selecting features, the logistic matrix factorization model is applied to predict drug response values. Besides, by comparing to one of the most powerful feature selection methods, the ensemble feature selection method (EFS), we showed that the performance of the predictive model based on selected features introduced in this paper is much better for drug response prediction. Two datasets, the Genomics of Drug Sensitivity in Cancer (GDSC) and Cancer Cell Line Encyclopedia (CCLE) are used to indicate the efficiency of the proposed method across unseen patient cell-line. Evaluation of the proposed model showed that Auto-HMM-LMF could improve the accuracy of the results of the state-of-the-art algorithms, and it can find useful features for the logistic matrix factorization method.

Conclusions

We depicted an application of Auto-HMM-LMF in exploring the new candidate drugs for head and neck cancer that showed the proposed method is useful in drug repositioning and personalized medicine. The source code of Auto-HMM-LMF method is available in https://github.com/emdadi/Auto-HMM-LMF.
The prognostic value of MELD-XI in elderly patients with ST-segment elevation myocardial infarction: an observational study
Authors: He Song-jian , Weng Jian-xin , Chen Hai-jun , Li Hua-qiu , Guo Wen-qin , Cao Qian , Xu Shuai , Yan Hong-bing , Peng Chang-nong
Published: January 2021

Background

The model for end-stage liver disease excluding international normalized ratio (MELD-XI) is a simple score for risk assessment. However, the prognostic role of MELD-XI and its additional value to current risk assessment in elderly patients with ST-segment elevation myocardial infarction (STEMI) undergoing percutaneous coronary intervention (PCI) is uncertain.

Methods

In all, 1029 elderly patients with STEMI undergoing PCI were consecutively included and classified into three groups according to the TIMI risk score: low-risk (≤ 3, n = 251); moderate-risk (4–6, n = 509); and high-risk (≥ 7, n = 269) groups. Multivariate analysis was performed to identify risk factors for adverse events.

Results

The overall in-hospital mortality was 5.3% and was significantly higher in the high-risk group (1.2% vs. 3.3% vs. 13.0%, p < 0.001). The optimal cut-off of the TIMI risk score and MELD-XI for in-hospital death was 7 and 13, respectively. MELD-XI was associated with in-hospital (adjusted odds ratio = 1.09, 95% CI = 1.04–1.14, p = 0.001) and one-year (adjusted hazard ratio = 1.05, 95% CI = 1.01–1.08, p = 0.005) mortality independently of the TIMI risk score. Combining TIMI risk score and MELD-XI exhibited better predictive power for in-hospital death than TIMI risk score (area under the curve [AUC] = 0.810 vs. 0.753, p = 0.008) or MELD-XI alone (AUC = 0.810 vs. 0.750, p = 0.018). Patients with TIMI risk score ≥ 7 and MELD-XI ≥ 13 had the worst prognosis.

Conclusion

MELD-XI could be considered as a risk-stratified tool for elderly patients with STEMI undergoing PCI. It had an additive prognostic value to TIMI risk score.
Why do healthcare professionals fail to escalate as per the early warning system (EWS) protocol? A qualitative evidence synthesis of the barriers and facilitators of escalation
Authors: O’Neill S. M. , Clyne B. , Bell M. , Casey A. , Leen B. , Smith S. M. , Ryan M. , O’Neill M.
Published: January 2021

Background

Early warning systems (EWSs) are used to assist clinical judgment in the detection of acute deterioration to avoid or reduce adverse events including unanticipated cardiopulmonary arrest, admission to the intensive care unit and death. Sometimes healthcare professionals (HCPs) do not trigger the alarm and escalate for help according to the EWS protocol and it is unclear why this is the case. The aim of this qualitative evidence synthesis was to answer the question ‘why do HCPs fail to escalate care according to EWS protocols?’ The findings will inform the update of the National Clinical Effectiveness Committee (NCEC) National Clinical Guideline No. 1 Irish National Early Warning System (INEWS).

Methods

A systematic search of the published and grey literature was conducted (until February 2018). Data extraction and quality appraisal were conducted by two reviewers independently using standardised data extraction forms and quality appraisal tools. A thematic synthesis was conducted by two reviewers of the qualitative studies included and categorised into the barriers and facilitators of escalation. GRADE CERQual was used to assess the certainty of the evidence.

Results

Eighteen studies incorporating a variety of HCPs across seven countries were included. The barriers and facilitators to the escalation of care according to EWS protocols were developed into five overarching themes: Governance, Rapid Response Team (RRT) Response, Professional Boundaries, Clinical Experience, and EWS parameters. Barriers to escalation included: Lack of Standardisation, Resources, Lack of accountability, RRT behaviours, Fear, Hierarchy, Increased Conflict, Over confidence, Lack of confidence, and Patient variability. Facilitators included: Accountability, Standardisation, Resources, RRT behaviours, Expertise, Additional support, License to escalate, Bridge across boundaries, Clinical confidence, empowerment, Clinical judgment, and a tool for detecting deterioration. These are all individual yet inter-related barriers and facilitators to escalation.

Conclusions

The findings of this qualitative evidence synthesis provide insight into the real world experience of HCPs when using EWSs. This in turn has the potential to inform policy-makers and HCPs as well as hospital management about emergency response system-related issues in practice and the changes needed to address barriers and facilitators and improve patient safety and quality of care.
Derivation and validation of the ED-SAS score for very early prediction of mortality and morbidity with acute pancreatitis: a retrospective observational study
Authors: Miller Joseph , Wu Yiyang , Safa Rawan , Marusca Georgiana , Bhatti Sandeep , Ahluwalia Guneet , Dandashi Jad , Acevedo Harold Gomez , Farook Naureen , Scott Ashley , Nair Vidhya , Adhami Angie , Dueweke Jeffrey , Hebbar Sudarshan , Ekstrom Leeland
Published: January 2021

Background

Existing scoring systems to predict mortality in acute pancreatitis may not be directly applicable to the emergency department (ED). The objective of this study was to derive and validate the ED-SAS, a simple scoring score using variables readily available in the ED to predict mortality in patients with acute pancreatitis.

Methods

This retrospective observational study was performed based on patient data collected from electronic health records across 2 independent health systems; 1 was used for the derivation cohort and the other for the validation cohort. Adult patients who were eligible presented to the ED, required hospital admission, and had a confirmed diagnosis of acute pancreatitis. Patients with chronic or recurrent episodes of pancreatitis were excluded. The primary outcome was 30-day mortality. Analyses tested and derived candidate variables to establish a prediction score, which was subsequently applied to the validation cohort to assess odds ratios for the primary and secondary outcomes.

Results

The derivation cohort included 599 patients, and the validation cohort 2011 patients. Thirty-day mortality was 4.2 and 3.9%, respectively. From the derivation cohort, 3 variables were established for use in the predictive scoring score: ≥2 systemic inflammatory response syndrome (SIRS) criteria, age > 60 years, and SpO2 < 96%. Summing the presence or absence of each variable yielded an ED-SAS score ranging from 0 to 3. In the validation cohort, the odds of 30-day mortality increased with each subsequent ED-SAS point: 4.4 (95% CI 1.8–10.8) for 1 point, 12.0 (95% CI 4.9–29.4) for 2 points, and 41.7 (95% CI 15.8–110.1) for 3 points (c-statistic = 0.77).

Conclusion

An ED-SAS score that incorporates SpO2, age, and SIRS measurements, all of which are available in the ED, provides a rapid method for predicting 30-day mortality in acute pancreatitis.
A survey of the involvement of primary care doctors in HIV prevention and care in a low-prevalence, high-income setting
Authors: Tam Greta , Wong Ngai Sze , Lee Shui Shan
Published: January 2021

Background

In high-income countries with a low HIV prevalence, primary care doctors are likely the first point of medical contact for people at high risk of HIV. One of the key factors for successful implementation of preventive measures is the cooperation of primary healthcare providers. Hong Kong’s population mostly seek primary care in the private sectors. Our study evaluated the involvement of private primary healthcare providers in HIV prevention and care.

Methods

A cross-sectional postal structured questionnaire was administered to 1102 private primary care doctors in Hong Kong in December 2017. Responses were received via postal mail, fax or online. Non-respondents received a phone-call reminder to complete the survey. Descriptive analyses were performed for all the question items. Chi-square test was used to assess the association between participants’ level of involvement in HIV prevention and care and their demographics and medical practice characteristics.

Results

The response rate was 17.9% (197/1102). Most of the respondents were Chinese (95%) and have obtained their primary medical qualifications in Hong Kong (72%). More than half of the doctors have practiced in the private sector for more than 20 years (54%). Six aspects were used to evaluate practices or involvements in HIV prevention or care: Most of the responding doctors had offered advice (61%) and/or HIV test (76%) to patients with high-risk behaviors. However, fewer doctors had diagnosed HIV (27%), provided care for HIV positive patients (21%), reported HIV cases (19%) or prescribed antiretrovirals (4%). Nine (4.5%) did not answer all six questions on their practices or involvements in HIV prevention or care. The remaining respondents were then categorized into no/low involvement group and high involvement group. Overall,71% had no/low involvement (133/188) compared to 29% who had high involvement (55/188). Factors associated with high involvement included being in the 50–59 age group (OR: 2.48, 95% CI: 1.12–5.5), and belonging to a large practice (OR: 3.16, 95% CI: 1.4–7.12).

Conclusions

Overall, most private primary care doctors in Hong Kong have no or low involvement in HIV prevention and care. However, most were willing and experienced in providing general preventive services, such as HIV testing and advice.
Efficacy of a novel hemostatic adhesive powder in patients with upper gastrointestinal tumor bleeding
Authors: Shin Jongbeom , Cha Boram , Park Jin-Seok , Ko Weonjin , Kwon Kye Sook , Lee Jin-Woo , Kim Hyung Kil , Shin Yong Woon
Published: January 2021

Background

Gastrointestinal tumor bleeding remains a clinical challenge because it is difficult to treat with conventional endoscopic hemostatic options. Recently, an endoscopic hemostatic powder (UI-EWD) was developed and reported to provide effective control of upper gastrointestinal bleeding. The aim of current study was to evaluate the feasibility and efficacy of this novel hemostatic powder in tumor bleeding.

Methods

A total of 41 consecutive patients with upper gastrointestinal tumor bleeding were included. UI-EWD was applied in all patients as an auxiliary hemostatic method as a salvage therapy or monotherapy during endoscopic treatment. Hemostasis success rates, adverse event related to UI-EWD, and rates of re-bleeding were evaluated.

Results

In all cases, UI-EWD application was successful at tumor bleeding sites. Immediate hemostasis occurred in 40/41 (97.5%) patients, and re-bleeding within 28 days occurred in 10 of 40 (22.5%) patients that achieved initial hemostasis. The success rate of immediate hemostasis for UI-EWD monotherapy was 100% (23/23). The re-bleeding rate at 28 days after UI-EWD monotherapy was 26.1% (6/23). No adverse events associated with UI-EWD application were encountered.

Conclusions

The success rate of UI-EWD for immediate hemostasis in cases of GI tumor bleeding was excellent and UI-EWD produced promising results with respect to the prevention of re-bleeding. Based on these results, we suggest that UI-EWD be considered an effective salvage therapy or even monotherapy for GI tumor bleeding.
Pure SARS-CoV-2 related AVDS (Acute Vascular Distress Syndrome)
Authors: Jounieaux Vincent , Basille Damien , Abou-Arab Osama , Guillaumont Marie-Pierre , Andrejak Claire , Mahjoub Yazine , Rodenstein Daniel Oscar
Published: January 2021

Background

SARS-CoV-2 virus which targets the pulmonary vasculature is supposed to induce an intrapulmonary right to left shunt with an increased pulmonary blood flow. Such vascular injury is difficult to observe because it is hidden by the concomitant lung injury. We report here what may be, to the best of our knowledge, the first case of a pure Covid-19 related Acute Vascular Distress Syndrome (AVDS).

Case presentation

A 43-year-old physician, tested positive for Covid-19, was addressed to the emergency unit for severe dyspnoea and dizziness. Explorations were non informative with only a doubt regarding a sub-segmental pulmonary embolism (no ground-glass lesions or consolidations related to Covid-19 disease). Dyspnoea persisted despite anticoagulation therapy and normal pulmonary function tests. Contrast-enhanced transthoracic echocardiography was performed which revealed a moderate late right-to-left shunt.

Conclusions

This case report highlights the crucial importance of the vascular component of the viral disease. The intrapulmonary shunt induced by Covid-19 which remains unrecognized because generally hidden by the concomitant lung injury, can persist for a long time. Contrast-enhanced transthoracic echocardiography is the most appropriate test to propose in case of persistent dyspnoea in Covid-19 patients.
Examining Australian public perceptions and behaviors towards a future COVID-19 vaccine
Authors: Seale Holly , Heywood Anita E. , Leask Julie , Sheel Meru , Durrheim David N. , Bolsewicz Katarzyna , Kaur Rajneesh
Published: January 2021

Background

As immunisation program launches have previously demonstrated, it is essential that careful planning occurs now to ensure the readiness of the public for a COVID-19 vaccine. As part of that process, this study aimed to understand the public perceptions regarding a future COVID-19 vaccine in Australia.

Methods

A national cross-sectional online survey of 1420 Australian adults (18 years and older) was undertaken between 18 and 24 March 2020. The statistical analysis of the data included univariate and multivariable logistic regression model analysis.

Results

Respondents generally held positive views towards vaccination. Eighty percent (n = 1143) agreed with the statement that getting myself vaccinated for COVID-19 would be a good way to protect myself against infection. Females (n = 614, 83%) were more likely to agree with the statement than males (n = 529, 78%) (aOR = 1.4 (95% CI: 1.1–1.8); P = 0.03), while 91% of those aged 70 years and above agreed compared to 76% of 18–29-year-olds (aOR = 2.3 (95% CI:1.2–4.1); P = 0.008). Agreement was also higher for those with a self-reported chronic disease (aOR = 1.4 (95% CI: 1.1–2.0); P = 0.04) and among those who held private health insurance (aOR = 1.7 (95% CI: 1.3–2.3); P < 0.001). Beyond individual perceptions, 78% stated that their decision to vaccinate would be supported by family and friends.

Conclusion

This study presents an early indication of public perceptions towards a future COVID-19 vaccine and represents a starting point for mapping vaccine perceptions. To support an effective launch of these new vaccines, governments need to use this time to understand the communities concerns and to identify the strategies that will support engagement.
Substitution of citrate with tissue plasminogen activator (rt-PA) for catheter lock does not improve patency of tunnelled haemodialysis catheters in a randomised trial
Authors: Richtrova Pavlina , Mares Jan , Kielberger Lukas , Klaboch Jan , Eiselt Jaromir , Reischig Tomas
Published: January 2021

Backround

The study aim was to establish if substitution of citrate with rt-PA for catheter lock once weekly can reduce the incidence of catheter-related blood stream infections (CR-BSI) or improve patency of tunneled haemodialysis catheters.

Methods

All incident patients undergoing insertion of a tunneled haemodialysis catheter were screened and included except those suffering infection or using oral anticoagulation. Study participants were randomized into two arms according to the solution applied as catheter lock: receiving either trisodium citrate (Citra-LockTM 4%) only or rt-PA (Actilyse® 1 mg/ml) on the middle session each week with citrate used on the first and third sessions. The incidence of CR-BSI (confirmed by positive blood culture), catheter non-function (complete obstruction), and malfunction (blood flow < 250 ml/min) was recorded. Statistical significance was tested with ANOVA, post hoc analysis was performed by means of multiple linear regression.

Results

Totally, 18 patients were included and followed during 655 haemodialysis sessions. No episode of CR-BSI was detected while 6 catheter non-functions (0.9% sessions) and 101 malfunctions (15.4% sessions) were recorded. The incidence of both events was equal between the study arms: 4 non-functions and 55 malfunctions in the rt-PA arm and 2 non-functions and 46 malfunctions in the citrate arm (p = 0.47 and p = 0.24, respectively). Additionally, the mean blood flow achieved did not differ significantly between the arms: 326 ± 1,8 and 326 ± 1,9 ml/min (p = 0.95) in rt-PA and citrate arms, respectively. Post hoc analysis identified time elapsed since previous session (β = 0.12, p = 0.005) and malfunction on previous session (β = 0.25, p < 0.001) as significant factors affecting the occurrence of malfunction. By contrast, the study arm, rt-PA application on previous session, and catheter vintage did not enter the model.

Conclusion

Substitution of citrate with rt-PA for catheter lock does not reduce the incidence of catheter malfunction neither does it affect the blood flow achieved during haemodialysis. Catheter patency is related rather to the time interval between sessions and to previous malfunction (thus probably reflecting undefined individual factors). The incidence of CR-BSI within pre-selected haemodialysis population is sporadic (less than 1 per 4.3 patient years in our sample).

Trial registration

Australian New Zealand Clinical Trials Registry, ACTRN12612000152820. Retrospectively registered 03/02/2012.
Thermographic follow-up of postherpetic neuralgia (PHN) subsequent to Ramsay Hunt syndrome with multicranial nerve (V, VII, VIII and IX) involvement: a case report
Authors: Liao Yuan-Mei , Lu Hai-Feng , Xie Peng , Zhao Ying , Han Qiu , Zhang Qian-Xi , Zuo Xiao-Hua , Si Yan-Na , Bao Hong-Guang
Published: January 2021

Background

Ramsay Hunt syndrome (RHS) is caused by a reactivation of varicella-zoster virus (VZV) infection, and it is characterized by the symptoms of facial paralysis, otalgia, auricular rash, and/or an oral lesion. Elderly patients or immunocompromised patients, deep pain at the initial visit and no prompt treatment are significant predictors of postherpetic neuralgia (PHN). When PHN occurs, especially involved cranial polyneuropathy, multiple modalities should be administered for patients with the intractable PHN. The use of thermography in the follow-up of PHN secondary to RHS with multicranial nerve involvement has not yet been described yet in the literature.

Case presentation

The patient was a 78-year-old man with the chief complaint of a 3-month history of PHN secondary to RHS with polycranial nerve (V, VII, VIII, and IX) involvement. Multimodality therapy with oral gabapentin, pulsed radiofrequency (PRF) application to the Gasserian ganglion for pain in the trigeminal nerve region, linear-polarized near-infrared light irradiation for pain in the facial nerve region, and 2% lidocaine spray for pain in the glossopharyngeal nerve region was used to the treat patient, and follow-up evaluations included thermography. This comprehensive treatment obviously improved the quality of life, resulting in considerable pain relief, as indicated by a decrease in the numerical rating scale (NRS) score from 9 to 3 and a decrease in thermal imaging temperature from higher to average temperature on the ipsilateral side compared with the contralateral side. Lidocaine spray on the tonsillar branches of the glossopharyngeal nerve resulted in an improvement in odynophagia, and the NRS score decreased from 9 to 0 for glossopharyngeal neuralgia after three applications.

Conclusion

Although the use of thermography in the follow-up of RHS with multiple cranial nerve (V, VII, VIII, and IX) involvement is very rare, in this patient, thermal imaging showed the efficacy of combination therapy (oral gabapentin, 2% lidocaine sprayed, PRF application and linear-polarized near-infrared light irradiation) and that is a good option for treatment.