bluuebunny/crossref_metadata_2025 huggingface dataset:
Relationships between litter size, sex ratio and within-litter birth weight variation in a sow herd and consequences on weaning performance
Authors: Zindove Titus J , Mutibvu Tonderai , Shoniwa Andrew C , Takaendesa Erica L
Published: August 2021

Routine selection for litter size has resulted in an increase in the proportion of lightweight piglets. There is a need to balance prolificacy with litter uniformity to maximize profit. A total of 3,465 piglets from 310 litter records obtained from 2016 until 2019 at the Pig Industry Board research unit, Arcturus, Zimbabwe were used to determine the relationships between litter size, sex ratio, and within-litter birth weight variation in the sow herd and consequences on performance at weaning. The regression procedure of SAS was used to determine the relationships between litter size, sex ratio, and within-litter birth weight variation. The regression procedure was also used to determine the relationships between number born alive, within-litter birth weight variation, and sex ratio, and litter performance traits at weaning. Parity of sow, year, and month of farrowing did not affect sex ratio (P > 0.05). The number born alive and number of piglets born had no relationship with sex ratio (P > 0.05). As the sex ratio increased, percent survival of piglets at weaning also increased linearly (P < 0.05). As the proportion of males in litters increased, within-litter birth weight variation and within-litter weaning weight variation increased reaching maximum as the proportion of males in litters approached 0.5 and then decreased onwards. As the proportion of males in litters approached 1, within-litter birth weight variation and within-litter weaning weight variation reached their least values. In conclusion, within-litter sex ratio does not vary with parity, year, and month of farrowing. Within-litter weight variation is highest in litters with equal number of male and female piglets and lowest in unisex litters. This implies that the production of unisex litters can help to reduce the variation in the weight of pigs at birth, weaning, and marketing which is one of the biggest economic challenges faced by pork producers.
Good Neighbor in the American Historical Imagination: Mexican American Intellectual Thought in the Fight for Civil Rights, 1930s–1940s
Authors: Mendoza Natalie
Published: August 2021

This article argues that historical narrative has held a significant role in Mexican American identity formation and civil rights activism by examining the way Mexican Americans in the 1930s and 1940s used history to claim full citizenship status in Texas. In particular, it centers on how George I. Sánchez (1906–1972), a scholar of Latin American education, revised historical narrative by weaving history and foreign policy together through a pragmatic lens. To educators and federal officials, Sánchez used this revisionist history to advocate for Mexican Americans, insisting that the Good Neighbor policy presented the United States with the chance to translate into reality the democratic ideals long professed in the American historical imagination. The example of Sánchez also prompts us to reexamine the historiography in our present day: How do we define the tradition and trajectory of Mexican American intellectual thought in U.S. history? This article posits that when Sánchez and other Mexican Americans thought about their community’s collective identity and civil rights issues through history, they were contributing to a longer conversation driven by questions about identity formation and equality that first emerged at the end of the U.S. War with Mexico in 1848. These questions remain salient in the present, indicating the need for a historiographic examination that will change how we imagine the tradition of intellectual thought in the United States.
6Science and Medicine
Authors: Ramos Adela , Spratt Danielle
Published: August 2021

Given the exigencies of the Covid-19 pandemic, we have chosen to focus our review of science and medicine studies to feature works that speak to three core concerns that have emerged from this global and sociopolitical health crisis. The monographs that we explore here grapple with the following related questions: (1) How we understand, prepare for, and succeed or fail in preventing and responding to pandemics in a global economy; (2) How the origins of health epidemics and pandemics are imbricated in Western imperial violence and global capitalist structures; (3) How the development, circulation, and protocols of public health, health-care systems, and modern medicine have emerged in response to colonialism, global expansion, and their attendant environmental and health crises. Readers will note that both works reviewed here take as given the undeniable influence of colonial legacies on conceptions and treatments of disease. To our mind, these works are additionally remarkable in the ways that they foreground subjects and methods, whether non-Western or nonhuman animal, that are typically subordinated or historically neglected in studies of the history of medicine.
Changes of Damage Associated Molecular Patterns in COVID-19 Patients
Authors: Fan Xing , Song Jin-Wen , Wang Si-Yu , Cao Wen-Jing , Wang Xiu-Wen , Zhou Ming-Ju , Yang Tao , Zhou Chun-Bao , Hou Jun , Zhang Ji-Yuan , Meng Fan-Ping , Shi Ming , Wang Fu-Sheng , Zhang Chao
Published: August 2021

Background:

The development of severe coronavirus disease 2019 (COVID-19) is associated with systemic hyperinflammation, which drives multi-organ failure and death. Disease deterioration tends to occur when the virus is receding; however, whether other factors besides viral products are involved in the inflammatory cascade remains unclear.

Methods:

Twenty-eight COVID-19 patients with laboratory-confirmed SARS-CoV-2 infection hospitalized at the Fifth Medical Center of Chinese PLA General Hospital from January 23 to February 20, 2020 and nine healthy donors during the same period were recruited in the study. COVID-19 patients were grouped as mild, moderate, severe based on disease severity. Plasma damage-associated molecular patterns (DAMPs), including high mobility group box 1 (HMGB1), calprotectin (S100A8/A9), surfactant protein A (SP-A), cold-inducible RNA-binding protein (CIRBP), and Histone H4 were detected by ELISA assay, and analyzed in combination with clinical data. Plasma cytokines, chemokines and lymphocytes were determined by flow cytometry.

Results:

Plasma levels of HMGB1 (38292.3 ± 4564.4 vs. 32686.3 ± 3678.1, P = 0.002), S100A8/A9 (1490.8 ± 819.3 vs. 742.2 ± 300.8, P = 0.015), and SP-A (6713.6 ± 1708.7 vs. 5296.3 ± 1240.4, P = 0.048) were increased in COVID-19 patients compared to healthy donors, while CIRBP (57.4 ± 30.7 vs. 111.9 ± 55.2, P = 0.004) levels decreased. Five DAMPs did not vary among mild, moderate, and severe patients. Moreover, SP-A levels correlated positively with inflammatory cytokines and negatively with time elapsed after symptom onset, whereas CIRBP showed an opposite pattern.

Conclusions:

These findings suggest SP-A may involve in the inflammation of COVID-19, while CIRBP likely plays a protective role. Therefore, DAMPs represent a potential target in the prevention or treatment of COVID-19.
Scoping Review of Distributed Practice in Nursing Education
Authors: Dunnack Hayley J. , Van Hoof Thomas J. , Banfi Valori , Polifroni E. Carol
Published: August 2021

AIM

The aim of this study was to describe the status of distributed practice in research of nursing education.

BACKGROUND

The science of learning has compiled evidence-based strategies that should be integral to nursing education. One long-standing strategy, distributed practice, involves spacing, placing cognitive breaks between study or practice sessions with priority information.

METHOD

Reviewing literature published over 20 years at every level of nursing education, the authors conducted a scoping review to determine the extent to which research of nursing education includes attention to distributed practice.

RESULTS

In the 13 articles meeting criteria, distributed practice was most common in continuing professional development, with an emphasis in learning psychomotor skills. Study authors used a variety of terms and descriptions in referring to the strategy.

CONCLUSION

By way of research, distributed practice appears underutilized in nursing education, especially at prelicensure and graduate levels, and could benefit from clear and consistent use of terminology.
Mode of Delivery in Monochorionic Compared With Dichorionic Twin Pregnancies
Authors: Lesser Henry N. , Rebarber Andrei , Fox Nathan S.
Published: August 2021

OBJECTIVE:

To compare mode of delivery between monochorionic and dichorionic twin pregnancies.

METHODS:

This was a retrospective cohort study of women undergoing delivery of diamniotic twins in a single maternal–fetal medicine practice in New York City between 2005 and 2021. We compared baseline characteristics and delivery outcomes between monochorionic and dichorionic gestations. The primary outcome was mode of delivery. For monochorionic–diamniotic twin pregnancies at or after 34 weeks of gestation, we also compared neonatal outcomes between women who did and did not attempt vaginal delivery. Data were analyzed using the χ2 test, Fisher exact test, and t test when appropriate.

RESULTS:

A total of 1,121 diamniotic twin pregnancies were identified, of which 202 (18%) were monochorionic and 919 (82%) were dichorionic. Mode of delivery did not differ between monochorionic and dichorionic pregnancies, both in the overall cohort (cesarean delivery rate 61% vs 63%, P=.54) and in the subgroup of women who attempted vaginal delivery (cesarean delivery rate 22% vs 21%, P=.80). For patients with a vaginal delivery of twin A, the mode of delivery for twin B did not differ between the groups. Among the patients with monochorionic pregnancies at or after 34 weeks of gestation, neonatal outcomes did not differ between women who did and did not attempt vaginal delivery.

CONCLUSION:

Monochorionic–diamniotic pregnancies are not at an increased risk of cesarean delivery when compared with their dichorionic–diamniotic counterparts.
Intrapartum Resuscitation Interventions for Category II Fetal Heart Rate Tracings and Improvement to Category I
Authors: Reddy Uma M. , Weiner Steven J. , Saade George R. , Varner Michael W. , Blackwell Sean C. , Thorp John M. , Tita Alan T.N. , Miller Russell S. , Peaceman Alan M. , McKenna David S. , Chien Edward K. S. , Rouse Dwight J. , El-Sayed Yasser Y. , Sorokin Yoram , Caritis Steve N. ,   for the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) Maternal-Fetal Medicine Units (MFMU) Network
Published: August 2021

OBJECTIVE:

To evaluate intrapartum resuscitation interventions and improvement in category II fetal heart rate (FHR) tracings.

METHODS:

This secondary analysis of a randomized trial of intrapartum fetal electrocardiographic ST-segment analysis included all participants with category II FHR tracings undergoing intrauterine resuscitation: maternal oxygen, intravenous fluid bolus, amnioinfusion, or tocolytic administration. Fetal heart rate pattern-recognition software was used to confirm category II FHR tracings 30 minutes before intervention and to analyze the subsequent 60 minutes. The primary outcome was improvement to category I within 60 minutes. Secondary outcomes included FHR tracing improvement to category I 30–60 minutes after the intervention and composite neonatal outcome.

RESULTS:

Of 11,108 randomized participants, 2,251 (20.3%) had at least one qualifying intervention for category II FHR tracings: 63.7% improved to category I within 60 minutes and 50.5% improved at 30–60 minutes. Only 3.4% underwent cesarean delivery and 4.1% an operative vaginal delivery for nonreassuring fetal status within 60 minutes after the intervention. Oxygen administration was the most common intervention (75.4%). Among American College of Obstetricians and Gynecologists-defined subgroups that received oxygen, the absent FHR accelerations and absent–minimal FHR variability subgroup (n=332) was more likely to convert to category I within 60 minutes than the FHR accelerations or “moderate FHR variability” subgroup (n=1,919) (77.0% vs 63.0%, odds ratio [OR] 2.0, 95% CI 1.4–2.7). The incidence of composite neonatal adverse outcome for category II tracings was 2.9% (95% CI 2.2–3.7%) overall; 2.8% (95% CI 2.0–3.8%) for improvement to category I within 60 minutes (n=1,433); and 3.2% (95% CI 2.1–4.6%) for no improvement within 60 minutes (n=818). However, the group with improvement had 29% lower odds for higher level neonatal care (11.8% vs 15.9%, OR 0.71, 95% CI 0.55–0.91).

CONCLUSION:

Nearly two thirds of category II FHR tracings improved to category I within 60 minutes of intervention with a relatively low overall rate of the composite neonatal adverse outcome.

FUNDING SOURCE:

Funded in part by Neoventa Medical.
Vacuum-Induced Tamponade for Treatment of Postpartum Hemorrhage
Authors: Haslinger Christian , Weber Kathrin , Zimmermann Roland
Published: August 2021

BACKGROUND:

Postpartum hemorrhage is a main cause of maternal mortality worldwide, with rising incidence, thus demanding new treatment approaches. Intrauterine balloon systems with application of intrauterine vacuum are a promising new method.

METHOD:

All women treated with vacuum-induced tamponade using a modified balloon system were included in this single-center study. Aiming to reduce uterine size for control of postpartum hemorrhage, the intrauterine balloon was filled to 50–100 mL and connected to a vacuum device. Success rate of vacuum-induced tamponade, defined as no need for additional interventional treatment, was analyzed by etiology of postpartum hemorrhage and time period of use.

EXPERIENCE:

Vacuum-induced tamponade was applied in 66 women. Success rate was 86% in women with uterine atony (n=44) and 73% in women with postpartum hemorrhage due to placental pathology (n=22). Success rate improved over the study period, culminating in a success rate of 100% in women with postpartum hemorrhage due to uterine atony in the second half of the observation period (n=22).

CONCLUSION:

This observational study supports our pathophysiologic understanding of uterine atony: to treat an atonic uterus, uterine volume must be reduced, leading to coiling of the uterine spiral arteries and, hence, reduced blood loss.
Assessing Research Misconduct in Randomized Controlled Trials
Authors: Li Wentao , Bordewijk Esmée M. , Mol Ben W.
Published: August 2021

Randomized controlled trials (RCTs) serve as the pillar of evidence-based medicine and guide medical practice. Compromised data integrity in RCTs undermines the authority of this valuable tool for science and puts patients at risk. Although a large number of retractions due to data issues in obstetrics and gynecology have occurred in the past few years, many problematic RCTs could still go uncovered because in general there is insufficient willingness to envisage and confront research misconduct. In this article, we discuss the necessity of assessing research misconduct, summarize methods that have been applied in detecting previous cases of misconduct, and propose potential solutions. There is no established mechanism to monitor feedback on published articles and the current system that handles potential research misconduct is unsatisfactory. Fortunately, there are methods to assess data integrity in RCTs both with and without individual participant data. Investigations into research misconduct can be facilitated by assessing all publications from a leading author or author group to identify duplication and patterns of ongoing misconduct. There is a pressing need to improve the mechanism that investigates data manipulation. The mechanism that handles misconduct should prioritize the interests of patients and readers rather than trial authors and their institutions. An equally urgent issue is to establish mechanisms that prevent compromised trials from polluting evidence synthesis or misguiding practice.
Human Papillomavirus Testing in the Last Cervical Screening Round at Age 60–64 Years
Authors: Schroll Jeppe Bennekou , Serizawa Reza Rafiolsadat , Rebolj Matejka
Published: August 2021

OBJECTIVE:

To compare the real-life screening outcomes after cytology was replaced by human papillomavirus (HPV) testing for women aged 60–64 years.

METHODS:

Using the Danish national pathology register, we compared screening outcomes during two consecutive calendar periods, one where women were screened with cytology and one where most women were screened with HPV testing. Our primary outcomes were the proportions of women with positive test results, high-grade cervical intraepithelial neoplasia (CIN 2 or worse), and cervical cancer.

RESULTS:

Women screened during the HPV testing period were more likely to have a positive screening test result than were women screened during the cytology period (relative proportion 2.80, 95% CI 2.65–2.96). The detection of CIN 2 or worse was also increased (relative proportion 1.54, 95% CI 1.31–1.80), whereas there was no increase in screen-detected cervical cancer diagnoses (relative proportion 1.27, 95% CI 0.76–2.12). Within the first 4 years after a negative screening test result, including 168,477 woman-years at risk after a negative screen result in the HPV period and 451,421 woman-years after a negative screen result in the cytology period, the risk of a cervical cancer diagnosis was approximately 4 per 100,000 woman-years and was similar for both screening tests (relative risk 0.99, 95% CI 0.41–2.35).

CONCLUSION:

Human papillomavirus testing led to more positive screening test results and diagnoses of high-grade CIN lesions. Few women were diagnosed with cervical cancer after a negative screening test result.
A Review of Prenatal Care Delivery to Inform the Michigan Plan for Appropriate Tailored Health Care in Pregnancy Panel
Authors: Barrera Chloe M. , Powell Allison R. , Biermann Chloe Ramirez , Siden Yoni , Nguyen Buu-Hac , Roberts Suni Jo , James LaTeesa , Chopra Vineet , Peahl Alex
Published: August 2021

OBJECTIVE:

To perform a literature review of key aspects of prenatal care delivery to inform new guidelines.

DATA SOURCES:

A comprehensive review of Ovid MEDLINE, Elsevier's Scopus, Google Scholar, and ClinicalTrials.gov.

METHODS OF STUDY SELECTION:

We included studies addressing components of prenatal care delivery (visit frequency, routine pregnancy assessments, and telemedicine) that assessed maternal and neonatal health outcomes, patient experience, or care utilization in pregnant individuals with and without medical conditions. Quality was assessed using the RAND/UCLA Appropriateness Methodology approach. Articles were independently reviewed by at least two members of the study team for inclusion and data abstraction.

TABULATION, INTEGRATION, AND RESULTS:

Of the 4,105 published abstracts identified, 53 studies met inclusion criteria, totaling 140,150 participants. There were no differences in maternal and neonatal outcomes among patients without medical conditions with reduced visit frequency schedules. For patients at risk of preterm birth, increased visit frequency with enhanced prenatal services was inconsistently associated with improved outcomes. Home monitoring of blood pressure and weight was feasible, but home monitoring of fetal heart tones and fundal height were not assessed. More frequent weight measurement did not lower rates of excessive weight gain. Home monitoring of blood pressure for individuals with medical conditions was feasible, accurate, and associated with lower clinic utilization. There were no differences in health outcomes for patients without medical conditions who received telemedicine visits for routine prenatal care, and patients had decreased care utilization. Telemedicine was a successful strategy for consultations among individuals with medical conditions; resulted in improved outcomes for patients with depression, diabetes, and hypertension; and had inconsistent results for patients with obesity and those at risk of preterm birth.

CONCLUSION:

Existing evidence for many components of prenatal care delivery, including visit frequency, routine pregnancy assessments, and telemedicine, is limited.
Therapeutic effects of vitamin D and IL-22 on methotrexate-induced mucositis in mice
Authors: Yilmaz Ebru , Azizoglu Zehra Busra , Aslan Kubra , Erdem Serife , Haliloglu Yesim , Suna Pinar Alisan , Yay Arzu Hanim , Deniz Kemal , Tasdemir Abdulkadir , Per Sedat , Unal Ekrem , Karakukcu Musa , Patiroglu Turkan
Published: August 2021

Mucositis is a common side effect of cancer therapies and transplant conditioning regimens. Management of mucositis involves multiple approaches from oral hygiene, anti-inflammatory, anti-apoptotic, cytoprotective, and antioxidant agents, to cryo-therapy, physical therapy, and growth factors. There is room for novel, affordable treatment options, or improvement of currently available therapies. Vitamin D has been shown to regulate mucosa-resident cell populations such as Th17 or innate lymphoid cells and critical mucosal cytokine IL-22; however, their therapeutic potential has not been put to test in preclinical mouse models. In this study, we aimed to test the therapeutic potential of vitamin D injections and IL-22 overexpression in a murine model of chemotherapy-induced mucositis. Balb/c mice were given daily intraperitoneal injections of vitamin D. Mucositis was induced by methotrexate. Another group received IL-22 plasmid via hydrodynamic gene delivery. Weight loss and intestinal histopathology, intestinal levels of cytokines IL-22, IL-17A, GM-CSF, IL-23, IFN-γ, TNF-α, and IL-10, and number of intestinal lamina propria B cell, neutrophil, and total innate lymphoid cells were quantified. Daily vitamin D injections ameliorated intestinal inflammation and elevated intestinal IL-22 levels compared with control groups. Temporal overexpression of IL-22 by hydrodynamic gene delivery slightly increased intestinal IL-22 but failed to confer significant protection from mucositis. To our knowledge, this is the first experimental demonstration in an animal model of mucositis of therapeutic use of vitamin D and IL-22 supplementation and our results with vitamin D suggest it may have merit in further trials in human mucositis patients.
Filipino Nurses' Feedback on Using a Web-Based Medication Management System
Authors: Floresca Hanna Monique A. , Diño Michael Joseph S. , Ong Irvin L. , Orte Christian Jay S. , Aggari Michael I.
Published: August 2021

A common medication safety strategy involves a Web-based medication management system. Still, there is no consensus about its acceptance and usability, even more so among nurses in the Philippines. Thus, this pilot study used a mixed-methods design to explore the nurses' feedback (N = 26) about Web-based medication management system in a telehealth hospital. Their acceptance, perceived usability, and experience of Web-based medication management system were assessed using the Unified Theory of Acceptance and Use of Technology model, Post Study System Usability Questionnaire, and semistructured interview guide, respectively. Results showed nurses agreed on their acceptance of Web-based medication management system (M = 3.72 [SD = 0.69]) and slightly agreed on its usability (M = 5.18 [SD = 1.02]). It also generated the Nursing Capsule of Web-based medication management system use that combines the quantitative model with age and length of practice as significant predictors and the qualitative interaction vortex with three themes (i.e., engaging, enabling, and exciting). These findings emphasized the need for effective technological adaptation to advance nursing practice and patient care.
SUBHYALOID HEMORRHAGE IN EVANS SYNDROME
Authors: Guillaume Georges I. , O'Bryhim Bliss E. , Saini Surbhi , Lueder Gregg T.
Published: August 2021

Purpose:

Evans syndrome is a rare disorder characterized by autoimmune hemolytic anemia and immune thrombocytopenia. We report the first case of ophthalmic involvement in a pediatric patient with Evans syndrome, in which painless vision loss was the presenting symptom.

Method:

A 15-year-old girl presented with acute painless loss of vision in her right eye and was found to have bilateral subhyaloid hemorrhages.

Results:

She was treated with intravenous steroids and transitioned to hydroxychloroquine. Her retinal hemorrhages resolved and her vision improved.

Conclusion:

Nontraumatic subhyaloid hemorrhage is a rare cause of vision loss in children. Evans syndrome should be considered in the differential diagnosis of such patients when hematologic abnormalities are present.
Association between dementia and hepatitis B and C virus infection
Authors: Choi Hyo Geun , Soh Jae Seung , Lim Jae Sung , Sim Song Yong , Lee Suk Woo
Published: August 2021

Several viral infections are known to increase the risk of dementia through brain cell damage and systemic infection. The association between hepatitis B and C virus (HBV and HCV) infections and dementia was evaluated using a national sample cohort from South Korea. Using the national cohort study from the Korean National Health Insurance Service, we extracted data for patients with HBV or HCV infection and for matched control participants. The controls were matched to the patients according to age, sex, income, region of residence, and past medical histories. The incidence of HCV infection was higher in the dementia group (1.0% [113/11,228]) than in the control group (0.8% [364/44,912], P = .043). However, there was no difference in the incidence of HBV infection in the dementia and control groups. The adjusted odds ratio (OR) for HCV infection was 1.25 (95% confidence interval [CI] = 1.01–1.54, P = .043) in the dementia group. According to the subgroup analysis by sex, the adjusted ORs for HCV infection were 1.04 (95% CI = 072–1.49, P = .851) in men and 1.38 (95% CI = 1.06–1.79, P = .016) in women. We concluded that the incidence of HCV infection was higher (with a higher OR) in women with dementia than in matched control participants in South Korea.
Formula to estimate left atrial volume using antero-posterior diameter in patients with catheter ablation of atrial fibrillation
Authors: Sangsriwong Muktapha , Cismaru Gabriel , Puiu Mihai , Simu Gelu , Istratoaie Sabina , Muresan Lucian , Gusetu Gabriel , Cismaru Andrei , Pop Dana , Zdrenghea Dumitru , Rosu Radu
Published: August 2021

In patients undergoing atrial fibrillation (AF) ablation, an enlarged left atrium (LA) is a predictor of procedural failure as well as AF recurrence on long term. The most used method to assess LA size is echocardiography-measured diameter, but the most accurate remains computed tomography (CT).

The aim of our study was to determine whether there is an association between left atrial diameters measured in echocardiography and the left atrial volume determined by CT in patients who underwent AF ablation.

The study included 93 patients, of whom 60 (64.5%) were men and 64 (68.8%) had paroxysmal AF, who underwent AF catheter ablation between January 2018 and June 2019. Left atrial diameters in echocardiography were measured from the long axis parasternal view and the LA volume in CT was measured on reconstructed three-dimensional images.

The LA in echocardiography had an antero-posterior (AP) diameter of 45.0 ± 6 mm (median 45; Inter Quartile Range [IQR] 41–49, range 25–73 mm), longitudinal diameter of 67.5 ± 9.4 (median 66; IQR 56–88, range 52–100 mm), and transversal diameter of 42 ± 8.9 mm (IQR 30–59, range 23–64.5 mm). The volume in CT was 123 ± 29.4 mL (median 118; IQR 103–160; range 86–194 mL). We found a significant correlation (r = 0.702; P < .05) between the AP diameter and the LA volume. The formula according to which the AP diameter of the LA can predict the volume was: LA volume = AP diam3 + 45 mL.

There is a clear association between the left atrial AP diameter measured on echocardiography and the volume measured on CT. The AP diameter might be sufficient to determine the increase in the volume of the atrium and predict cardiovascular outcomes.
Early use of tocilizumab in patients with severe pneumonia secondary to severe acute respiratory syndrome coronavirus 2 infection and poor prognostic criteria
Authors: Sánchez-Rovira Pedro , Pérez-Chica Gerardo , Ortega-Granados Ana Laura , Aguilar-García Josefa , Díaz-Beltrán Leticia , Gálvez-Montosa Fernando , García-Verdejo Francisco , Luque-Caro Natalia , Quero-Blanco Cristina , Fernández-Navarro Mónica , Rodríguez-Sánchez Agustín , Ruiz-Bailén Manuel , Yaguez-Mateos Luis , Marín-Pozo Juan Francisco , Sierra-Torres María Isabel , Lacárcel-Bautista Celia , Duro-Ruiz Gaspar Jesús , Duro-Fernández María Ángeles , García-Alegría Javier , Herrero-Rodríguez Carmen
Published: August 2021

The coronavirus disease 2019 (COVID-19) pandemic, caused by severe acute respiratory syndrome coronavirus 2, keeps spreading globally. Evidence suggests that a subgroup of patients with severe symptomatology might have cytokine storms, which increases mortality. The use of interleukin-6 (IL-6) inhibitors may help in controlling the pathological immune response to the virus. Tocilizumab, a monoclonal antibody against IL-6, stands as an optional treatment for COVID-19 patients presenting this inflammatory hyper-response.

We conducted a retrospective, observational, cohort study including 50 patients affected by COVID-19 with severe pneumonia and poor prognosis criteria, who have also undergone standard treatment; 36 of these patients additionally received tocilizumab in an early stage. The need for intensive care unit (ICU) admission, mortality, recovery of respiratory function, and improvement of biochemical and hematological parameters were compared between cohorts.

Most patients were men, non-smokers and the most frequently reported comorbidities were hypertension and diabetes. Recurrent symptoms were fever, cough, and dyspnoea. 54.8% of patients from the tocilizumab group needed intubation, while in the control group 85.7% needed it. Treatment with tocilizumab significatively increased IL-6 levels, (554.45; CI 95% 186.69, 1032.93; P < .05) while C-reactive protein mean levels were reduced (–108.19; CI 95% –140.15, –75.33; P < .05), but no significant difference was found between cohorts. In comparison with the controls, tocilizumab reduced mortality (25.0% vs 42.9%, P = .021) and the number of ICU admissions (63.9% vs 100.0%, P = .021). 44.1% of patients treated with tocilizumab showed favorable radiological evolution, when compared with 15.4% of patients from the control group.

Tocilizumab may improve clinical symptoms and mitigate deterioration observed in severe COVID-19 patients, and could be considered as an effective therapeutic option in subjects experiencing a significant inflammatory response to the disease.
Usefulness of the capsule endoscopy Crohn's disease activity index in assessing the necessity of early additional treatment in patients with Crohn's disease in clinical remission
Authors: Miyazu Takahiro , Ishida Natsuki , Takano Ryosuke , Tamura Satoshi , Yamade Mihoko , Hamaya Yasushi , Tani Shinya , Iwaizumi Moriya , Osawa Satoshi , Furuta Takahisa , Sugimoto Ken
Published: August 2021

The Capsule Endoscopy Crohn's Disease Activity Index (CECDAI) was recently reported as a new scoring system to evaluate the mucosal lesions of patients with Crohn's disease (CD). We investigated whether CECDAI is useful for assessing the necessity of early additional treatment in patients with CD in clinical remission.

Twenty-one patients with small intestinal CD in clinical remission underwent capsule endoscopy (CE). The CECDAI and Lewis score (LS) were used to evaluate the intestinal lesions. We analyzed the correlations between several biomarkers and CECDAI or LS and examined the changes in therapeutic regimens based on the CECDAI.

CE identified intestinal abnormalities in most CD patients in clinical remission: 81.0% and 85.7%, as assessed using CECDAI and LS, respectively. A significant positive correlation was observed between the CDAI and LS (P = .025), as well as between CDAI and CECDAI (P = .014) in these cases. Compared to LS, CECDAI scores were more evenly distributed. No significant correlations were observed between endoscopic scores and serum markers, including CRP, hemoglobin, and albumin levels. Additional treatment was performed significantly more often in patients with moderate-severe disease activity (CECDAI ≥5.8) (P = .012) than in those with normal (CECDAI <3.5) and mild (3.5≤CECDAI<5.8) disease activity. Resection of the small intestine did not affect the small bowel transit time or CE score.

CECDAI is useful in evaluating mucosal lesions in small bowel CD patients in clinical remission and helps in assessing the requirement for additional treatment for these patients, including those who undergo intestinal resection.
The clinical significance of neutrophil-lymphocyte ratio in patients treated with hemodialysis complicated with lung infection
Authors: Li Ling-Lin , Yang Yu-Qiong , Qiu Min , Wang Li , Yuan Hong-Ling , Zou Ren-Chao
Published: August 2021

The goal of this work was to investigate the potential significance of neutrophil-lymphocyte ratio (NLR) in patients treated with maintenance hemodialysis (MHD).

Herein, we retrospectively reviewed the electronic medical records of 100 patients with end-stage renal failure who were treated with MHD. All patients enrolled in this study met the inclusion criteria and were followed. The differences in each indicator between the two groups were compared using the Wilcoxon rank-sum test. On the other hand, Spearman correlation and logistic regression analysis were used to explore the correlation and risk factors for pulmonary infection between NLR and other indicators. Finally, we determined the optimal cut-off values for NLR, hypersensitive c-reactive protein (hs-CRP), and procalcitonin (PCT) diagnosis of pulmonary infection using the receiver operating characteristic curve.

We found that NLR was positively correlated with age, PCT, hs-CRP, and hospital stay, but negatively correlated with hemoglobin, red blood cell, and Albumin. The expression levels of PCT, hs-CRP, and NLR in the infected group decreased significantly than those before treatment. Multiple regression analysis revealed that NLR is an important independent risk factor for MHD patients with pulmonary infection. Additionally, receiver operating characteristic curve analysis showed that the sensitivity, specificity, and area under the curve were 87.76%, 100%, and 0.920 when using NLR combined with hs-CRP to predict pulmonary infection in MHD patients, whereas that of NLR combined with PCT were 87.76%, 96.08%, and 0.944, respectively.

Findings from this study suggested that NLR is an independent risk factor for MHD patients with pulmonary infection, which can effectively predict pulmonary infection. Moreover, sensitivity and specificity were greatly enhanced when using NLR combined with PCT/hs-CRP to predict pulmonary infection in MHD patients.
Preserved corneal lamellar transplantation for infectious and noninfectious scleral defects
Authors: Jung Young-ho , Yoon Chang Ho , Kim Mee Kum
Published: August 2021

Rationale

: Reinforcement of thinned or necrotizing sclera has been conducted using various materials, including allogeneic sclera, allogenic cornea, amniotic membrane, fascia lata, pericardium, periosteum, and perichondrium. Among them, good outcomes have traditionally been obtained using preserved scleral grafts. However, scleral patch grafts have complications such as graft retraction, thinning, dehiscence, and necrosis. Furthermore, to promote epithelial healing, scleral patch grafting must be accompanied by procedures such as amniotic membrane transplantation (AMT) or grafting using conjunctival flaps or autografts. Recently, acellular preserved human corneas have been used in various ophthalmic surgeries, with emerging evidence supporting its use for treating scleral defects as an option that does not require AMT or conjunctival autografting. We investigated whether corneal patch grafting would show wound healing and tectonic success rate outcomes comparable to those of existing techniques.

Patient presentation

: Three patients presented with intractable ocular pain. Slit-lamp examination showed marked scleral thinning at the nasal side.

Diagnosis

: Scleral thinning progressed with conservative treatment; microbial staining and culturing were performed. Infectious or non-infectious scleritis was diagnosed according to slit-lamp examination and microbial culture results.

Interventions

: A preserved corneal lamellar patch was grafted at the scleral thinning area.

Outcomes

All patients achieved tectonic success with reduction of inflammation following corneal patch grafting. Two patients achieved complete re-epithelialization within 7 days, while 25 days were required for the third patient. No patients experienced graft thinning, rejection, or infection.

Lessons

: Our report suggests the feasibility of using acellular preserved human cornea patch grafts to reinforce inflammatory scleral defects and obtain successful outcomes in terms of wound healing. This technique shows a comparable tectonic success rate and superior effect on scleral defect healing without the need for adjunctive AMT or conjunctival autografting.
Associations of serum soluble klotho and fibroblast growth factor 23 with carotid artery calcification in patients undergoing continuous ambulatory peritoneal dialysis
Authors: Guo Naifeng , Chen Xu , Cao Yingjie , Lu Guoyuan
Published: August 2021

This study aimed to assess the associations of serum soluble klotho and fibroblast growth factor 23 (FGF-23) with the occurrence of carotid artery calcification. Peritoneal dialysis patients treated from June 2018 to June 2019 were retrospectively analyzed. They were divided into the carotid artery calcification and non-carotid artery calcification groups according to color Doppler ultrasound findings. Basic indicators in both groups were compared, and the influencing factors of carotid artery calcification were analyzed by logistic regression. Among the 73 continuous ambulatory peritoneal dialysis (CAPD) patients enrolled, 40 (54.8%) had carotid artery calcification. Significant differences were found in age (68.85 ± 7.45 vs 46.62 ± 5.51 years), dialysis time (8.15 ± 1.42 vs 6.02 ± 1.14 months), klotho amounts (325.56 ± 41.15 vs 436.65 ± 45.58 pg/mL) and FGF-23 levels (114.45 ± 15.56 vs 70.15 ± 12.23 pg/mL) between the carotid artery calcification and non-carotid artery calcification groups (all P < .001). The above factors were associated with carotid artery calcification occurrence in univariate analysis. Multivariate analysis showed that elevated age (odds ratio [OR] = 1.55, 95% confidence interval [CI] 1.13–1.74; P = .025) and FGF-23 (OR = 2.16, 95% CI 2.01–2.44; P = .042), and lower klotho (OR = 0.66, 95% CI 0.47–0.85; P = .036) were independent risk factors for carotid artery calcification in CAPD. Serum FGF-23 and age are risk factors for carotid artery calcification in patients with CAPD, whereas klotho is a protective factor.
Durable response to immunotherapy plus chemotherapy in a patient with untreated, brain-metastatic, EGFR exon 20 insertion mutation lung adenocarcinoma
Authors: Nong Jingying , Gu Yanfei , Yao Shuyang , Zhang Yi
Published: August 2021

Rational:

Epidermal growth factor receptor (EGFR) 20 exon insertion is the second most common EGFR aberrations in non-small cell lung cancer (NSCLC). Despite some novel EGFR inhibitors, clinically obtainable management for this subset of patients remains an unmet need. there are no previous reports of upfront combination therapy with immunotherapy and chemotherapy for lung adenocarcinoma with brain metastasis harboring EGFR 20 insertion.

Patient concerns:

A 56-year-old man who sought care for dry cough was diagnosed with lung adenocarcinoma with brain metastases indicating a poor prognosis.

Diagnosis:

Next-generation sequencing of lung biopsied tissue revealed an EGFR exon 20 in-frame insertion (P772_H773insYNP+H773Y).

Interventions:

The patient started treatment of pemetrexed and carboplatin plus programmed cell death-1 inhibitor sintilimab in November 2019.

Outcomes:

The patient achieved partial responses both intra- and extra-cranially. After 6 cycles of treatment, the patient accepted sintilimab plus pemetrexed every 3 weeks as maintenance therapy, which was well-tolerated without any toxicity and is still ongoing after 18 months since initiation of 1st-line treatment.

Lessons:

This is the first case report of the clinical benefit of upfront immune checkpoint inhibitors (ICIs) plus chemotherapy for a brain metastatic NSCLC patient harboring EGFR exon 20 insertion mutation. Further study is needed to validate the predictor involved in responders to ICIs-based therapy with EGFR mutations.
Combined argon laser peripheral iridoplasty and Nd: YAG laser shock wave therapy for recurrent XEN gel stent obstruction due to iris incarceration
Authors: Rho Seungsoo , Lim Su-Ho
Published: August 2021

Introduction:

Despite its proven effectiveness and safety profile, the XEN Gel Stent (Allergan Inc., CA, USA) has a small lumen and is therefore likely to become occluded by fibrin, a blood clot, or even the iris. However, few studies have investigated XEN-iris occlusion and how to manage this condition. We describe the first case report of recurrent XEN gel stent obstruction by iris incarceration, which was resolved following a combined treatment with argon laser peripheral iridoplasty (ALPI) and low-energy neodymium-doped yttrium aluminum garnet (Nd: YAG) laser shock wave treatment.

Patient information:

A 74-year-old Korean male underwent uncomplicated XEN gel stent implantation and presented with low intraocular pressure (IOP) with a well-functioning filtering bleb during the first postoperative week. On postoperative day 10, the XEN lumen was occluded by the iris and demonstrated an IOP spike of 33 mmHg. Despite the use of pilocarpine, the iris incarceration persisted. Therefore, surgery to reposition the XEN stent was attempted using a gonio-prism and intraocular forceps. After the first revision surgery, the IOP and stent position were stable for 2 weeks. However, recurrent partial obstruction of the stent by the iris, pigment dispersion into the intraluminal space, and an elevated IOP of 24 mmHg were observed later.

Diagnosis:

Recurrent XEN gel stent occlusion by the iris and intraluminal pigment dispersion.

Interventions:

Combined ALPI and low energy Nd: YAG laser shock wave therapy.

Outcomes:

IOP dropped from 24 mmHg to 10 mmHg immediately and continued to be well-controlled until 3 months later (range: 8–12 mmHg).

Conclusions:

To the best of our knowledge, this is the first case report of the efficacy of combined laser treatment for relieving recurrent XEN implant occlusion by the iris. This combination laser treatment might be a relatively safe rescue treatment to restore the patency of a XEN gel stent occluded by the iris, even in cases with recurrent XEN stent obstruction after surgical repositioning.
Case Report/Case Series: Rare case of anti-LGI1 limbic encephalitis with rapidly progressive dementia, psychiatric symptoms, and frequently seizures
Authors: Wu Haiyan , Mei Fan , Liu Lixin , Zhang Li , Hao Hongjun , Zhang Shouzi
Published: August 2021

Rationale:

Anti leucine-rich glioma inactivated 1 (LGI1) limbic encephalitis (LE) is rare autoimmune encephalitis, characterized by acute or subacute cognitive impairment, faciobrachial dystonic seizures, mental disorders, and refractory hyponatremia. As a type of treatable rapidly progressive dementia with a good prognosis, early, and accurate diagnosis is essential. We present a case of anti-LGI1 LE who was initially misdiagnosed with Alzheimer disease because his clinical manifestations were similar to Alzheimer disease.

Patient concerns:

A male patient presenting with rapidly progressive dementia, faciobrachial dystonic seizures, psychiatric disturbance, and refractory hyponatremia was admitted. The scores of Mini-Mental State Examination, Montreal Cognitive Assessment, and Neuropsychiatric Inventory were 19/30, 16/30, and 91/144, respectively. Brain magnetic resonance images indicated moderate atrophy of the hippocampus and abnormally hyperintensities in the left medial temporal and hippocampus.

Diagnosis:

The patient was diagnosed with anti-LGI1 LE based on the presence of LGI-1 antibodies in the cerebrospinal fluid and serum and clinical manifestations.

Interventions:

Patient was treated with glucocorticoid against LGI1, antiepileptic drug, cholinesterase inhibitors, and other adjuvant therapy.

Outcomes:

The patient showed marked improvement on immunotherapy. Clinical symptoms were disappeared and the LGI-1 antibodies in cerebrospinal fluid and serum were both negative at the time of discharge.

Conclusions:

Recognition of the specific symptoms and LGI-1 antibody test will be helpful for the early diagnosis, prompt immunotherapy, and good prognosis. This case raises the awareness that rapidly progressive dementia with frequent seizures could be caused by immunoreactions.
Association between human immunodeficiency virus serostatus and the prevalence of atrial fibrillation
Authors: Osuji Ngozi , Haberlen Sabina A. , Ashikaga Hiroshi , Brown Todd T. , Feinstein Matthew J. , Witt Mallory D. , Magnani Jared W. , Soliman Elsayed Z. , Wu Katherine C. , Post Wendy S.
Published: August 2021

Atrial fibrillation (AF) leads to increased risk for stroke. Human immunodeficiency virus (HIV) is associated with cardiovascular disease (CVD), although it is unclear if HIV is associated with AF. The purpose of this study was to evaluate the association between HIV serostatus and the prevalence of AF in the Multicenter AIDS Cohort Study.

A cross sectional study was conducted among 1674 HIV-infected (HIV+) and uninfected (HIV–) men who completed resting 12-lead electrocardiograms, and/or ambulatory electrocardiogram monitoring. Multivariable logistic regression was used to evaluate the association between AF, defined as the presence of either AF or atrial flutter, and HIV+ serostatus. Associations were adjusted for demographic variables, and then also for CVD risk factors.

HIV+ men were younger than HIV– men (median 55.5 vs 61.7 years, P < .001) and were more frequently African-American (30.5% vs 17.8%, P < .001). Most HIV+ men (81%) had undetectable viral load. The age and race adjusted prevalence of AF was 3.0% in HIV+ and 3.3% in HIV– men. There was only 1 case of AF among African-American men. There were no associations between AF and HIV serostatus after adjusting for demographic factors (odds ratio 0.76; 95% CI 0.37 to –1.58; P = .47) or after further adjustment for CVD risk factors (odds ratio 0.84; 95% CI 0.39 to –1.81; P = .66).

We found no association between HIV and AF in this cohort in which viral replication among the HIV+ men is generally suppressed. The overall prevalence of AF was low and was rare in African-American men.