bluuebunny/crossref_metadata_2025 huggingface dataset:
Assemblages of Necrophagous Blow Flies (Diptera: Calliphoridae) in Four Contrasting Ecoregions of Los Angeles County, California, United States
Authors: Cumming Royce T , Dufek Matias I
Published: July 2021

An ecological study to evaluate necrophagous species richness, abundance, and diversity was conducted in four contrasting ecoregions of Los Angeles County, California, United States: a highly anthropized area, two moderately populated areas, and a sparsely populated area. Our hypothesis states that there will be higher abundance of exotic species in greatly anthropized ecoregions and higher diversity of native calliphorid flies in sparsely populated sites. A total of 2,883 blow flies belonging to 12 species were captured from the four ecoregions. The exotic Chrysomya rufifacies (Macquart) (Diptera: Calliphoridae) was the most abundant species, representing 72.84% of all Calliphoridae collected. The highest abundance was in the highly anthropized ecoregion. Differences of the blow fly assemblages across environmentally and anthropically different ecoregions were found, and that the relative abundance of the exotic species increased with anthropization. Our results suggest that both anthropization and elevation alter the structure of blow fly assemblages, modifying the abundance and species richness of Calliphoridae. The results of this study support the hypothesis of biotic homogenization, since we found a higher proportional abundance of exotic species and lower diversity of native blow flies in ecoregions heavily modified by human action. Additionally, the hypothesis of intermediate disturbance was supported as the highest diversity was found in the ecoregion with moderate anthropization mixed with natural elements. This is the first study to conduct an intensive survey of the Calliphoridae assemblages in Los Angeles County, which can be potentially used as a tool in human and veterinary health and forensic sciences.
Reducing manual operation time to obtain a segmentation learning model for volume electron microscopy using stepwise deep learning with manual correction
Authors: Konishi Kohki , Nonaka Takao , Takei Shunsuke , Ohta Keisuke , Nishioka Hideo , Suga Mitsuo
Published: July 2021

Three-dimensional (3D) observation of a biological sample using serial-section electron microscopy is widely used. However, organelle segmentation requires a significant amount of manual time. Therefore, several studies have been conducted to improve organelle segmentation’s efficiency. One such promising method is 3D deep learning (DL), which is highly accurate. However, the creation of training data for 3D DL still requires manual time and effort. In this study, we developed a highly efficient integrated image segmentation tool that includes stepwise DL with manual correction. The tool has four functions: efficient tracers for annotation, model training/inference for organelle segmentation using a lightweight convolutional neural network, efficient proofreading and model refinement. We applied this tool to increase the training data step by step (stepwise annotation method) to segment the mitochondria in the cells of the cerebral cortex. We found that the stepwise annotation method reduced the manual operation time by one-third compared with the fully manual method, where all the training data were created manually. Moreover, we demonstrated that the F1 score, the metric of segmentation accuracy, was 0.9 by training the 3D DL model with these training data. The stepwise annotation method using this tool and the 3D DL model improved the segmentation efficiency of various organelles.
A pilot study to assess the need for new hospital pharmaceutical services in Algerian patients and physicians’ perspective
Authors: Chelghoum Mustapha , Khitri Walid , Kadouri Feriel , Chaouche Khedra
Published: July 2021

Objectives

The objective of this study was to assess the needs for pharmaceutical services from the perspectives of physicians and patients in the hospital setting and to contribute to the implementation of new hospital pharmacy activities.

Methods

A cross-sectional descriptive study was carried out among the doctors and patients encountered in hospital departments in Sidi Bel Abbès (Algeria); each service was evaluated using a Likert scale. Associated characteristics with an important need were evaluated by univariate analysis and binary logistic regression.

Key findings

All pharmaceutical services were important to the patients, particularly providing treatment advice and therapeutic education. Women presented an important need for insurance of the availability of pharmaceutical products (P = 0.02) and lifestyle and dietetic information (P = 0.05). High frequency of taking medication was associated with an important need for information about drug interactions (P = 0.005). Patient-oriented pharmaceutical services were not important to the physicians who considered drug information and therapeutic education to be the most important need.

Conclusions

To implement patient-centred services, it is important to improve the contact between pharmacists and physicians and to provide information about pharmaceutical services that can benefit patients. Implementation of new practices in university hospital is more feasible than in public health facilities.
Sevoflurane inhibits the apoptosis of hypoxia/reoxygenation-induced cardiomyocytes via regulating miR-27a-3p-mediated autophagy
Authors: Zhang Yang , Zhan Biming , Hu Ying , Chen Shibiao , Zhang Qin
Published: July 2021

Introduction

Sevoflurane (Sevo) prevents hypoxia/reoxygenation (H/R)-induced cardiomyocytes apoptosis. MiR-27a-3p expression is up-regulated in Sevo-treated hippocampal neurons.

Objective

This study explored whether the effect of Sevo on cardiomyocytes was mediated by miR-27a-3p.

Methods

The cardiomyocytes were cultured under H/R condition or pre-treated with Sevo, and further transfected with miR-27a-3p inhibitor or treated with an autophagy inhibitor 3-methyladenine (3-MA). Then the cell morphology was observed under an optical microscope. The cell viability and apoptosis were measured by MTT and flow cytometry. Expressions of miR-27a-3p, apoptosis-related, and autophagy-related factors were determined by western blot or RT-qPCR.

Key findings

Sevo improved the abnormal morphology, promoted the cell viability and the expressions of Bcl-2 and miR-27a-3p, but reduced the apoptosis and Bax and C-caspase-3 levels of H/R-induced cardiomyocytes. MiR-27a-3p inhibitor had an effect opposite to Sevo on the cardiomyocytes and further counteracted the effect of Sevo on the H/R-induced cardiomyocytes. Downregulation miR-27a-3p increased the expression of Beclin 1 and the ratio of LC3B-II to LC3B-I in H/R-induced cardiomyocytes. Furthermore, 3-MA had an opposite effect to miR-27a-3p inhibitor and further counteracted the effect of the miR-27a-3p inhibitor on H/R-induced cardiomyocytes.

Conclusion

Sevo inhibited the apoptosis of H/R-induced cardiomyocytes via regulating miR-27a-3p-mediated autophagy.
Far Forward Behavioral Health Service Delivery in Future Combat Environments: A Qualitative Needs Assessment
Authors: Wilk Joshua E , Clarke-Walper Kristina M , Nugent Katie L , Curley Justin M , Crouch Coleen
Published: July 2021

Introduction

It is expected that future multi-domain operational (MDO) combat environments will be characterized by limited capabilities for immediate combat stress control support services for soldiers or immediate evacuation from theater. The operational requirements of the future battlefield make it unlikely that current models for behavioral health (BH) treatment could be implemented without significant adjustments. We conducted a qualitative study with Special Forces medics and operators and soldiers who had deployed to austere conditions in small groups in an effort to inform construction of a BH service delivery model for an MDO environment. The objectives of this study were (1) characterizing stressors and BH issues that were encountered and (2) describing mitigation strategies and resources that were useful or needed in these types of deployments.

Materials and Methods

Six focus groups were conducted at three army installations with 23 active duty soldiers, including three groups of medics using a semi-structured interview guide focused on stressors they encountered during deployments to austere conditions, and the impact of those stressors on mission and focus. Focus group recordings were transcribed, imported into NVivo software (version 12), and independently coded by two researchers. An analysis was then conducted to develop themes across participants. The study was reviewed by the Walter Reed Army Institute of Research Human Subjects Protection Board.

Results

Behavioral health concerns were commonly cited as a stressor in far forward environments. Other common stressors included ineffective or inexperienced leaders, as well as poor team dynamics (e.g., communication and cohesion). Four primary strategies were mentioned as mitigations for deployment stressors: leadership, morale, resilience training, and strength of the team. When asked about resources or training that would have helped with these types of deployments, participants frequently mentioned the availability of BH providers and development of new and realistic BH skills trainings for non-providers and leaders.

Conclusions

Current models for treating BH problems need to be adapted for the future MDO environments in which soldiers will be expected to deploy. Understanding what issues need to be addressed in these environments and how they can best be delivered is an important first step. This study is the first to use qualitative results from those who have already deployed to such environments to describe the stressors and BH issues that were most commonly encountered, the mitigation strategies used, and the resources that were useful or needed.
Heavy elements in barium stars
Authors: Roriz M P , Lugaro M , Pereira C B , Sneden C , Junqueira S , Karakas A I , Drake N A
Published: July 2021

New elemental abundances for the neutron-capture elements Sr, Nb, Mo, Ru, La, Sm, and Eu are presented for a large sample of 180 barium (Ba) giant stars, a class of chemically peculiar objects that exhibit in their spectra enhancements of the elements created by the s-process, as a consequence of mass transfer between the components of a binary system. The content of heavy elements in these stars, in fact, points to nucleosynthesis mechanisms that took place within a former asymptotic giant branch (AGB) companion, now an invisible white dwarf. From high-resolution ($R=48\, 000$) spectra in the optical, we derived the abundances either by equivalent width measurements or synthetic spectra computations, and compared them with available data for field giant and dwarf stars in the same range of metallicity. A re-determination of La abundances resulted in [La/Fe] ratios up to 1.2 dex lower than values previously reported in literature. The programme Ba stars show overabundance of neutron-capture elements, except for Eu, for which the observational data set behave similarly to field stars. Comparison to model predictions are satisfactory for second-to-first s-process peak ratios (e.g. [La/Sr]) and the ratios of the predominantly r-process element Eu to La. However, the observed [Nb, Mo, Ru/Sr] and [Ce, Nd, Sm/La] ratios show median values higher or at the upper limits of the ranges of the model predictions. This unexplained feature calls for new neutron capture models to be investigated.
Probabilistic distribution functions
Authors: Lau Jun Yan , Binney James
Published: July 2021

Observed clusters should be modelled by considering the distribution function (DF) to be a random variable that quantifies the degree of excitation of the system’s normal modes. A system of canonical coordinates for the space of DFs are identified so DFs can be weighted in a consistent way.
Classifier Using Pontine Radial Diffusivity and Symptom Duration Accurately Predicts Recurrence of Trigeminal Neuralgia After Microvascular Decompression: A Pilot Study and Algorithm Description
Authors: Willsey Matthew S , Mossner James M , Chestek Cynthia A , Sagher Oren , Patil Parag G
Published: July 2021

BACKGROUND

Preprocedure diffusion tensor magnetic resonance imaging (MRI) may predict the response of trigeminal neuralgia (TN) patients to Gamma Knife (Elekta AB) and microvascular decompression (MVD).

OBJECTIVE

To test this hypothesis using pontine-segment diffusion tensor MRI radial diffusivity (RD), a known biomarker for demyelination, to predict TN recurrence following MVD.

METHODS

RD from the pontine segment of the trigeminal tract was extracted in a semiautomated and blinded fashion and normalized to background pontine RD. Following validation against published results, the relationship of normalized RD to symptom duration (DS) was measured. Both parameters were then introduced into machine-learning classifiers to group patient outcomes as TN remission or recurrence. Performance was evaluated in an observational study with leave-one-out cross-validation to calculate accuracy, sensitivity, specificity, and receiver operating characteristic curves.

RESULTS

The study population included 22 patients with TN type 1 (TN1). There was a negative correlation of normalized RD and preoperative symptom duration (P = .035, R2 = .20). When pontine-segment RD and DS were included as input variables, 2 classifiers predicted pain-free remission versus eventual recurrence with 85% accuracy, 83% sensitivity, and 86% specificity (leave-one-out cross-validation; P = .029) in a cohort of 13 patients undergoing MVD.

CONCLUSION

Pontine-segment RD and DS accurately predict MVD outcomes in TN1 and provide further evidence that diffusion tensor MRI contains prognostic information. Use of a classifier may allow more accurate risk stratification for neurosurgeons and patients considering MVD as a treatment for TN1. These findings provide further insight into the relationship of pontine microstructure, represented by RD, and the pathophysiology of TN.
Reduced Mortality With Ondansetron Use in SARS-CoV-2-Infected Inpatients
Authors: Bayat Vafa , Ryono Russell , Phelps Steven , Geis Eugene , Sedghi Farshid , Etminani Payam , Holodniy Mark
Published: July 2021

Background

The coronavirus disease 2019 (COVID-19) pandemic has led to a surge in clinical trials evaluating investigational and approved drugs. Retrospective analysis of drugs taken by COVID-19 inpatients provides key information on drugs associated with better or worse outcomes.

Methods

We conducted a retrospective cohort study of 10 741 patients testing positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection within 3 days of admission to compare risk of 30-day all-cause mortality in patients receiving ondansetron using multivariate Cox proportional hazard models. All-cause mortality, length of hospital stay, adverse events such as ischemic cerebral infarction, and subsequent positive COVID-19 tests were measured.

Results

Administration of ≥8 mg of ondansetron within 48 hours of admission was correlated with an adjusted hazard ratio for 30-day all-cause mortality of 0.55 (95% CI, 0.42–0.70; P < .001) and 0.52 (95% CI, 0.31–0.87; P = .012) for all and intensive care unit–admitted patients, respectively. Decreased lengths of stay (9.2 vs 11.6; P < .001), frequencies of subsequent positive SARS-CoV-2 tests (53.6% vs 75.0%; P = .01), and long-term risks of ischemic cerebral ischemia (3.2% vs 6.1%; P < .001) were also noted.

Conclusions

If confirmed by prospective clinical trials, our results suggest that ondansetron, a safe, widely available drug, could be used to decrease morbidity and mortality in at-risk populations.
Critical Review of the Scientific Evidence and Recommendations in COVID-19 Management Guidelines
Authors: Xie Jiaxing , Wang Zhufeng , Liang Jingyi , Lin Huimin , Yang Zhaowei , Wang Yingzhi , Liang Hanwen , Wu Hongkai , Chen Ruchong , Ou Younger , Wang Fengyan , Wang Yuan , Wang Yan , Luo Weizhan , Zhang Jianheng , Li Naijian , Li Zhengtu , Jiang Mei , Li Shiyue , Li Jing
Published: July 2021

Background

Little is known about the quality and potential impacts of the guidelines for coronavirus disease 2019 (COVID-19) management.

Methods

We systematically searched PubMed, Web of Science, Cochrane Library, guideline databases, and specialty society websites to evaluate the quality of the retrieved guidelines using the Appraisal of Guidelines for Research and Evaluation II.

Results

A total of 66 guidelines were identified. Only 24% were categorized as “recommended” for clinical practice. The 211 identified recommendations for COVID-19 management were classified into 4 topics: respiratory support (27), acute respiratory distress syndrome management (31), antiviral or immunomodulatory therapy (95), or other medicines (58). Only 63% and 56% of recommendations were supported by, respectively, assessment of the strength of the recommendations or level of evidence. There were notable discrepancies between the different guidelines regarding the recommendations on COVID-19 management.

Conclusions

The quality of the guidelines for COVID-19 management is heterogeneous, and the recommendations are rarely supported by evidence.
Radicalizing moral conservatism in herd immunity during COVID-19
Authors: Kahambing Jan Gresil
Published: July 2021

The concept of herd immunity during the coronavirus disease 2019 is constantly changing. The World Health Organization’s current focus is on vaccination. With ties to the bioethics of autonomy and exemptions to mandatory vaccinations, the problem is that moral conservatism tends not to cooperate in the rollouts. Radical means can be applied not just to the concept but also its application, emphasizing the need to depart from conservative hindrances to public health.
How to avoid fake COVID-19 vaccine passports as a travel requirement?
Authors: Rocha Ian Christopher N
Published: July 2021

The Philippines has recently eased its local travel restrictions among fully vaccinated individuals. Filipinos who wish to travel locally will only need to present their vaccination cards as their passports for interzonal and intrazonal movement within the country. However, a few days after the release of the new resolution pertaining to the coronavirus disease 2019 (COVID-19) vaccination card as a travel requirement, the Department of Health suggested to review the latest policy since many local government units expressed their disapproval in the new protocol. One of the issues raised is the authenticity of COVID-19 vaccination cards. These cards vary per local government and most of them do not have machine-readable codes nor security features. Thus, they can be easily falsified and counterfeited. In addition, the local governments do not have access to the national database of the COVID-19 vaccination status of every individual, which can be extremely challenging for them. In this correspondence, recommendations were provided to avoid fake COVID-19 vaccination cards as passports for travel purposes.
Toolbox Recommendations for Social Workers to Promote Successful Social Entrepreneurship
Authors: Nouman Hani , Cnaan Ram A
Published: July 2021

Social entrepreneurship in social work is presented in the literature as an important practice considering its ability to provide long-term, innovative, and creative interventions for social problems. However, many doubt the ability of social workers to act as social entrepreneurs. This study examined action strategies adopted by social workers who established innovative services to address social problems. Data were collected from qualitative in-depth interviews conducted with 23 successful social work entrepreneurs. Research findings revealed seven action strategies that have the potential to promote successful social entrepreneurship in social work: (1) coalition building, (2) legislative advocacy, (3) media use, (4) legislative tools, (5) active use of social network: “street smarts,” (6) development of a resource infrastructure, and (7) cultural norms and traditions. The study provides insight into the various ways to succeed in social work entrepreneurship; to identify opportunities in education and practice for entrepreneurship in social work; and to serve as an effective, innovative guide to address the complex social problems facing social workers.
Broadening the range of use cases for ivermectin – a review of the evidence
Authors: Kositz Christian , Bradley John , Hutchins Harry , Last Anna , D'Alessandro Umberto , Marks Michael
Published: July 2021

Ivermectin is a broad-spectrum antiparasitic agent that interferes with glutamate-gated chloride channels found in invertebrates but not in vertebrate species. Mass drug administration (MDA) with ivermectin-based regimes has been a mainstay of elimination efforts targeting onchocerciasis and lymphatic filariasis for more than 3 decades. More recently, interest in the use of ivermectin to control other neglected tropical diseases (NTDs) such as soil-transmitted helminths and scabies has grown. Interest has been further stimulated by the fact that ivermectin displays endectocidal efficacy against various Anopheles species capable of transmitting malaria. Therefore there is growing interest in using ivermectin MDA as a tool that might aid in the control of both malaria and several NTDs. In this review we outline the evidence base to date on these emerging indications for ivermectin MDA with reference to clinical and public health data and discuss the rationale for evaluating the range of impacts of a malaria ivermectin MDA on other NTDs.
Predictive Risk Models for Wound Infection-Related Hospitalization or ED Visits in Home Health Care Using Machine-Learning Algorithms
Authors: Song Jiyoun , Woo Kyungmi , Shang Jingjing , Ojo Marietta , Topaz Maxim
Published: July 2021

OBJECTIVE

Wound infection is prevalent in home healthcare (HHC) and often leads to hospitalizations. However, none of the previous studies of wounds in HHC have used data from clinical notes. Therefore, the authors created a more accurate description of a patient’s condition by extracting risk factors from clinical notes to build predictive models to identify a patient’s risk of wound infection in HHC.

METHODS

The structured data (eg, standardized assessments) and unstructured information (eg, narrative-free text charting) were retrospectively reviewed for HHC patients with wounds who were served by a large HHC agency in 2014. Wound infection risk factors were identified through bivariate analysis and stepwise variable selection. Risk predictive performance of three machine learning models (logistic regression, random forest, and artificial neural network) was compared.

RESULTS

A total of 754 of 54,316 patients (1.39%) had a hospitalization or ED visit related to wound infection. In the bivariate logistic regression, language describing wound type in the patient’s clinical notes was strongly associated with risk (odds ratio, 9.94; P < .05). The areas under the curve were 0.82 in logistic regression, 0.75 in random forest, and 0.78 in artificial neural network. Risk prediction performance of the models improved (by up to 13.2%) after adding risk factors extracted from clinical notes.

CONCLUSIONS

Logistic regression showed the best risk prediction performance in prediction of wound infection-related hospitalization or ED visits in HHC. The use of data extracted from clinical notes can improve the performance of risk prediction models.
The Influence of Sensation Level on Speech-Evoked Envelope Following Responses
Authors: Easwar Vijayalakshmi , Birstler Jen , Harrison Adrienne , Scollie Susan , Purcell David
Published: July 2021

Objectives:

To evaluate sensation level (SL)–dependent characteristics of envelope following responses (EFRs) elicited by band-limited speech dominant in low, mid, and high frequencies.

Design:

In 21 young normal hearing adults, EFRs were elicited by 8 male-spoken speech stimuli—the first formant, and second and higher formants of /u/, /a/ and /i/, and modulated fricatives, /∫/ and /s/. Stimulus SL was computed from behaviorally measured thresholds.

Results:

At 30 dB SL, the amplitude and phase coherence of fricative-elicited EFRs were ~1.5 to 2 times higher than all vowel-elicited EFRs, whereas fewer and smaller differences were found among vowel-elicited EFRs. For all stimuli, EFR amplitude and phase coherence increased by roughly 50% for every 10 dB increase in SL between ~0 and 50 dB.

Conclusions:

Stimulus and frequency dependency in EFRs exist despite accounting for differences in audibility of speech sounds. The growth rate of EFR characteristics with SL is independent of stimulus and its frequency.
Text Captioning Buffers Against the Effects of Background Noise and Hearing Loss on Memory for Speech
Authors: Payne Brennan R. , Silcox Jack W , Crandell Hannah A. , Lash Amanda , Ferguson Sarah Hargus , Lohani Monika
Published: July 2021

Objective:

Everyday speech understanding frequently occurs in perceptually demanding environments, for example, due to background noise and normal age-related hearing loss. The resulting degraded speech signals increase listening effort, which gives rise to negative downstream effects on subsequent memory and comprehension, even when speech is intelligible. In two experiments, we explored whether the presentation of realistic assistive text captioned speech offsets the negative effects of background noise and hearing impairment on multiple measures of speech memory.

Design:

In Experiment 1, young normal-hearing adults (N = 48) listened to sentences for immediate recall and delayed recognition memory. Speech was presented in quiet or in two levels of background noise. Sentences were either presented as speech only or as text captioned speech. Thus, the experiment followed a 2 (caption vs no caption) × 3 (no noise, +7 dB signal-to-noise ratio, +3 dB signal-to-noise ratio) within-subjects design. In Experiment 2, a group of older adults (age range: 61 to 80, N = 31), with varying levels of hearing acuity completed the same experimental task as in Experiment 1. For both experiments, immediate recall, recognition memory accuracy, and recognition memory confidence were analyzed via general(ized) linear mixed-effects models. In addition, we examined individual differences as a function of hearing acuity in Experiment 2.

Results:

In Experiment 1, we found that the presentation of realistic text-captioned speech in young normal-hearing listeners showed improved immediate recall and delayed recognition memory accuracy and confidence compared with speech alone. Moreover, text captions attenuated the negative effects of background noise on all speech memory outcomes. In Experiment 2, we replicated the same pattern of results in a sample of older adults with varying levels of hearing acuity. Moreover, we showed that the negative effects of hearing loss on speech memory in older adulthood were attenuated by the presentation of text captions.

Conclusions:

Collectively, these findings strongly suggest that the simultaneous presentation of text can offset the negative effects of effortful listening on speech memory. Critically, captioning benefits extended from immediate word recall to long-term sentence recognition memory, a benefit that was observed not only for older adults with hearing loss but also young normal-hearing listeners. These findings suggest that the text captioning benefit to memory is robust and has potentially wide applications for supporting speech listening in acoustically challenging environments.
The role of immunomodulatory medications in the treatment of COVID-19
Authors: Sattui Sebastian E. , Crow Mary K. , Navarro-Millán Iris
Published: July 2021

Purpose of review

Given the role of inflammation in severe forms of COVID-19, glucocorticoids and disease-modifying antirheumatic drugs (DMARDs) have been assessed as potential COVID-19 therapies.

Recent findings

Randomized controlled trials (RCTs) have shown that glucocorticoids reduce mortality in severe COVID-19. RCTs of DMARDs have shown mixed results varying on intervention and inclusion criteria. DMARDs, including colchicine or biologic agents, may improve COVID-19 outcomes in specific patient populations.

Glucocorticoids are an effective treatment for the management of severe COVID-19. Further studies are needed to better define the patient populations who could benefit from DMARD use, as well as provide guidance regarding the timing of these interventions.
Update in familial Mediterranean fever
Authors: Ozen Seza
Published: July 2021

Purpose of review

Familial Mediterranean fever (FMF) is the prototypic autoinflammatory disease. Although the gene associated with the disease was identified 24 years ago, we still have to learn about the pathogenesis of its inflammation and the variation in the phenotype. In this review, we discuss some recent findings in FMF, such as changes in our understanding of the genetics, aims to define new criteria, and factors contributing to the disease presentation.

Recent findings

We finally have learned why a mutation causing this disease was selected in ancient times; MEFV gene mutations confer resistance to the microbe of plague. A group of experts have outlined recommendations for the analysis of the genetics of FMF. These recommendations complement the new classification criteria, which includes genetic results. In the past year, a number of studies have addressed the contributing factors to the inflammation caused by the mutations in pyrin; this has included epigenetic studies as well. Finally, we have long-term data for the use of anti-IL1 treatment in colchicine-resistant patients.

We now have recommendations for assessing genetic analysis of the MEFV gene and how to reliably classify a patient as FMF. We await further data to understand the contributing genetic and environmental factors that affect the inflammation and final phenotype in FMF and the extent of the disease presentation.
Clinical Characteristics and In-Hospital Mortality of Cardiac Arrest Survivors in Brazil: A Large Retrospective Multicenter Cohort Study
Authors: Kurtz Pedro , Storm Christian , Soares Marcio , Bozza Fernando , Maciel Carolina B. , Greer David M. , Bastos Leonardo S. L. , Melo Ulisses , Mazza Bruno , Santino Marcelo S. , Seabra Lannes Roberto , de Moraes Ana Paula Pierre , Passos Joel Tavares , Moralez Giulliana Martines , Santos Robson Correa , Machado Maristela Medeiros , Saturnino Saulo Fernandes , Mendes Ciro Leite , Oswaldo Vianna Arthur , Salluh Jorge
Published: July 2021

OBJECTIVES:

Data on cardiac arrest survivors from developing countries are scarce. This study investigated clinical characteristics associated with in-hospital mortality in resuscitated patients following cardiac arrest in Brazil.

DESIGN:

Retrospective analysis of prospectively collected data.

SETTING:

Ninety-two general ICUs from 55 hospitals in Brazil between 2014 and 2015.

PATIENTS:

Adult patients with cardiac arrest admitted to the ICU.

INTERVENTIONS:

None.

MEASUREMENTS AND MAIN RESULTS:

We analyzed 2,296 patients (53% men; median 67 yr (interquartile range, 54–79 yr]). Eight-hundred patients (35%) had a primary admission diagnosis of cardiac arrest suggesting an out-of-hospital cardiac arrest; the remainder occurred after admission, comprising an in-hospital cardiac arrest cohort. Overall, in-hospital mortality was 83%, with only 6% undergoing withholding/withdrawal-of-life support. Random-effects multivariable Cox regression was used to assess associations with survival. After adjusting for age, sex, and severity scores, mortality was associated with shock (adjusted odds ratio, 1.25 [95% CI, 1.11–1.39]; p < 0.001), temperature dysregulation (adjusted odds ratio for normothermia, 0.85 [95% CI, 0.76–0.95]; p = 0.007), increased lactate levels above 4 mmol/L (adjusted odds ratio, 1.33 [95% CI, 1.1–1.6; p = 0.009), and surgical or cardiac cases (adjusted odds ratio, 0.72 [95% CI, 0.6–0.86]; p = 0.002). In addition, survival was better in patients with probable out-of-hospital cardiac arrest, unless ICU admission was delayed (adjusted odds ratio for interaction, 1.63 [95% CI, 1.21–2.21]; p = 004).

CONCLUSIONS:

In a large multicenter cardiac arrest cohort from Brazil, we found a high mortality rate and infrequent withholding/withdrawal of life support. We also identified patient profiles associated with worse survival, such as those with shock/hypoperfusion and arrest secondary to nonsurgical admission diagnoses. Our findings unveil opportunities to improve postarrest care in developing countries, such as prompt ICU admission, expansion of the use of targeted temperature management, and implementation of shock reversal strategies (i.e., early coronary angiography), according to modern guidelines recommendations.
Noninvasive Ventilation and Outcomes in Bronchiolitis*
Authors: Shanahan Kristen H. , Monuteaux Michael C. , Nagler Joshua , Bachur Richard G.
Published: July 2021

OBJECTIVES:

Evaluation of potential benefits of noninvasive ventilation for bronchiolitis has been precluded in part by the absence of large, adequately powered studies. The objectives of this study were to characterize temporal trends in and associations between the use of noninvasive ventilation in bronchiolitis and two clinical outcomes, invasive ventilation, and cardiac arrest.

DESIGN:

Multicenter retrospective cross-sectional study.

SETTING:

Forty-nine U.S. children’s hospitals participating in the Pediatric Health Information System database.

PATIENTS:

Infants under 12 months old who were admitted from the emergency department with bronchiolitis between January 1, 2010, and December 31, 2018.

MEASUREMENTS AND MAIN RESULTS:

Primary outcomes were rates of noninvasive ventilation, invasive ventilation, and cardiac arrest. Trends over time were assessed with univariate logistic regression. In the main analysis, hospital-level multivariable logistic regression evaluated rates of outcomes including invasive ventilation and cardiac arrest among hospitals with high and low utilization of noninvasive ventilation. The study included 147,288 hospitalizations of infants with bronchiolitis. Across the entire study population, noninvasive and invasive ventilation increased between 2010 and 2018 (2.9–8.7%, 2.1–4.0%, respectively; p < 0·001). After adjustment for markers of severity of illness, hospital-level noninvasive ventilation (high vs low utilization) was not associated with differences in invasive ventilation (5.0%, 1.8%, respectively, adjusted odds ratio, 1.8; 95% CI, 0·7–4·6) but was associated with increased cardiac arrest (0.36%, 0.02%, respectively, adjusted odds ratio, 25.4; 95% CI, 4.9–131.0).

CONCLUSIONS:

In a large cohort of infants at children’s hospitals, noninvasive and invasive ventilation increased significantly from 2010 to 2018. Hospital-level noninvasive ventilation utilization was not associated with a reduction in invasive ventilation but was associated with higher rates of cardiac arrest even after controlling for severity. Noninvasive ventilation in bronchiolitis may incur an unintended higher risk of cardiac arrest, and this requires further investigation.
Race Does Not Impact Sepsis Outcomes When Considering Socioeconomic Factors in Multilevel Modeling
Authors: Vazquez Guillamet M. Cristina , Dodda Sai , Liu Lei , Kollef Marin H. , Micek Scott T.
Published: July 2021

OBJECTIVES:

To determine whether race is a major determinant of sepsis outcomes when controlling for socioeconomic factors.

DESIGN:

Retrospective cohort study.

SETTING:

Barnes-Jewish Hospital a 1,350 bed academic medical center.

PATIENTS:

Eleven-thousand four-hundred thirty-two patients hospitalized between January 2010 and April 2017 with sepsis and septic shock.

INTERVENTIONS:

Multilevel random effects modeling was employed whereby patients were nested within ZIP codes. Individual patient characteristics and socioeconomic variables aggregated at the ZIP code level (education, employment status, income, poverty level, access to healthcare) were included in the model.

MEASUREMENTS AND MAIN RESULTS:

In hospital mortality, length of stay, need for vasopressors, and mechanical ventilation were the main endpoints. Black patients had more comorbidities than White patients except for cirrhosis and malignancy. In unadjusted comparisons, White individuals were more likely to require mechanical ventilation and had higher mortality rates and longer hospital stays for both low- and high-income groups. When nesting within ZIP codes and accounting for socioeconomic variables, race did not have a significant effect on mortality. Non-White races had lower odds ratio for mechanical ventilation.

CONCLUSIONS:

Our study demonstrates that race is not an independent risk factor for sepsis mortality, as well as sepsis-related length of stay. We should expand our inquiry into determinants of sepsis outcomes by including socioeconomic variables.
The Women's Study for the Alleviation of Vasomotor Symptoms (WAVS): a randomized, controlled trial of a plant-based diet and whole soybeans for postmenopausal women
Authors: Barnard Neal D. , Kahleova Hana , Holtz Danielle N. , del Aguila Fabiola , Neola Maggie , Crosby Lelia M. , Holubkov Richard
Published: July 2021

Objective:

This study aimed to assess the effects of the combination of a low-fat plant-based diet and soybeans on the frequency and severity of menopausal hot flashes.

Methods:

Postmenopausal women (n = 38) reporting two or more hot flashes/day were randomly assigned to a low-fat, vegan diet, including ½ cup (86 g) of cooked soybeans daily, or to no diet changes for 12 weeks. Frequency and severity of hot flashes were recorded using a mobile application, and vasomotor, psychosocial, physical, and sexual symptoms were assessed using the Menopause-Specific Quality of Life Questionnaire. Significance was assessed using t-tests (continuous outcomes) and chi-squared/McNemar tests (binary outcomes).

Results:

Total hot flashes decreased 79% in the intervention group (P < 0.001) and 49% in the control group (P = 0.002; between-group P = 0.01). Moderate-to-severe hot flashes decreased 84% in the intervention group (P < 0.001) and 42% in the control group P = 0.009; between-group P = 0.01). From 0 to 12 weeks, 59% (10/17) of intervention-group participants reported becoming free of moderate and severe hot flashes (P = 0.002). There was no change in this variable in the control group (between-group P < 0.001). The Menopause-Specific Quality of Life Questionnaire revealed significantly greater reductions in the intervention group in vasomotor (P < 0.0001), psychosocial (P = 0.04), physical (P < 0.002), and sexual (P = 0.01) domains.

Conclusions:

The combination of a low-fat, vegan diet and whole soybeans was associated with reduced frequency and severity of hot flashes and improved quality of life in vasomotor, psychosocial, physical, and sexual domains in postmenopausal women. During the 12-week study period, the majority of intervention-group participants became free of moderate-to-severe hot flashes.

Video Summary:
http://links.lww.com/MENO/A785.
Impact of menopausal status on risk of metastatic recurrence of breast cancer
Authors: Lao Chunhuan , Elwood Mark , Kuper-Hommel Marion , Campbell Ian , Lawrenson Ross
Published: July 2021

Objective:

Menopausal status at diagnosis is an important factor for the management of breast cancer in younger women, and may affect the prognosis for these women. We aim to examine the association of menopausal status and risk of metastatic relapse for stage I-III breast cancer.

Methods:

We included women diagnosed with stage I-III breast cancer at 45 to 55 years in the Auckland and Waikato Breast Cancer Registers. Cumulative incidence of metastatic relapse was examined by age group and by menopausal status after stratifying by estrogen receptor (ER) and progesterone receptor (PR) status. Cox proportional hazards model was used to estimate the adjusted hazard ratio of metastatic relapse by menopausal status after adjustment for age, ethnicity, year of diagnosis, socioeconomic status, public/private hospital treatment, mode of detection, cancer stage, grade and human epidermal growth factor receptor 2 status.

Results:

We have identified 5,309 eligible women: 2,799 premenopausal, 929 perimenopausal, and 1,581 post-menopausal. There was significant difference in risk of metastatic recurrence between menopausal statuses for ER+ and/or PR+ cases, with a 10-year cumulative incidence of 11.2% for premenopausal, 12.4% for perimenopausal, and 15.6% for postmenopausal women. The adjusted hazard ratio of metastatic recurrence for postmenopausal compared to premenopausal women was 1.38 for ER+ and/or PR+ cases. Age did not affect the risk of metastatic relapse for ER+ and/or PR+ cases but affected the risk for ER- and PR- cases with a hazard ratio of 0.94 per year.

Conclusions:

Women with earlier age at menopause, and ER+ and/or PR+ stage I-III breast cancer were more likely to develop metastatic breast cancer. Age increased the risk of metastatic relapse for women with ER− and PR− disease, but not for ER+ and/or PR+ cancers.
Increased Retinal Vessel Tortuosity Associated With Crimean-Congo Hemorrhagic Fever in Children
Authors: Yalinbas Duygu , Komurluoglu Ayca , Bozali Erman
Published: July 2021

Background:

To evaluate the ocular symptoms and findings of children diagnosed with Crimean-Congo hemorrhagic fever (CCHF).

Methods:

In this prospective study, children diagnosed with CCHF who underwent a complete ophthalmologic examination during the hospitalization period were included.

Results:

Twenty-four children with a mean age of 12.4 ± 3.6 years were included study. The most common ocular finding was conjunctival hyperemia and was observed in 50% of patients. Nine (37.4%) children had abnormalities in fundus examination. Two (8.3%) of them had dilated retinal veins, and 7 (29.1%) had tortuous retinal vessels. No significant difference was found between mild to moderate and severe disease groups in terms of ocular symptoms and ophthalmologic examination findings (P > 0.05, for all).

Conclusions:

The increased retinal vessel tortuosity was detected as a fundus examination finding in children with CCHF. Both ophthalmologists and pediatricians should be aware of the various ocular manifestations of CCHF for rapid diagnosis and management.
Mohs Micrographic Surgery
Authors: Mastacouris Nicole , Mafee Mariam
Published: July 2021

Mohs micrographic surgery is a specialized surgical technique that involves serial excision of locally invasive, recurrent, or ill-defined skin cancers with complete histological examination of surgical margins. Originally developed by Dr. Frederic E. Mohs in the 1930s, it began as in situ tissue fixation with zinc chloride and healing by secondary intention and has evolved to fresh tissue surgical excision with subsequent reconstruction. Despite continuous advancements made in the field, the underlying principle of Mohs surgery remains the same: one surgeon acting as a pathologist to ensure complete tumor removal while minimizing the resection of healthy tissue. Mohs surgery is considered the gold standard for treatment of various cutaneous tumors and can be performed on an outpatient basis within a single day. The tumor is excised, mapped, and processed with frozen, horizontal sections for immediate histological evaluation and subsequent surgical staging in the location of a positive margin. This article serves as a review of Mohs surgery for dermatology nurses and offers an overview of the history of the procedure, clinical indications, preoperative assessments, surgical technique, reconstructive modalities, and postoperative care.
HTLV-1 associated acute adult T-cell lymphoma/leukemia presenting as acute liver failure in Micronesian
Authors: Ghaffari-Rafi Arash , Rho Young Soo , Hall Andrew , Villanueva Nicolas , Nogi Masayuki
Published: July 2021

Rationale:

Malignant infiltration accounts for 0.5% of acute liver failure cases, with non-Hodgkin's lymphoma the predominant cause. Adult T-cell lymphoma/leukemia (ATLL) is a rarer source of acute hepatitis, with only 3 cases reported and all resulting in immediate deterioration with death. ATLL rises from human T-lymphocytic virus-1 (HTLV-1), commonly found in Japan (southern and northern islands), the Caribbean, Central and South America, intertropical Africa, Romania, and northern Iran. In Micronesia, HTLV-1 infection amongst native-born is absent or exceedingly rare.

Patient Concerns:

A 77-year-old Marshallese man presented to the emergency department with a 1-week history of generalized weakness, fatigue, and nausea. The physical exam revealed a cervical papulonodular exanthem and scleral icterus.

Diagnosis:

Laboratory studies were remarkable for aspartate-aminotransferase of 230 IU/L (reference range [RR]: 0–40), alanine-aminotransferase of 227 IU/L (RR: 0–41), alkaline phosphatase of 133 IU/L (RR: 35–129), and total bilirubin of 4.7 mg/dL (RR: 0–1.2), supporting acute liver injury. Platelet count was 11.6x104/μL (RR: 15.1–42.4 × 104), hemoglobin was 13.8 g/dL (RR: 13.7–17.5), and white blood cell count was 7570/μL (RR: 3800–10,800) with 81.8% neutrophils (RR: 34.0–72.0) and 10.4% lymphocytes (RR: 12.0–44.0). The peripheral blood smear demonstrated abnormal lymphocytes with occasional flower cell morphology. HTLV-1/2 antibody tested positive. The skin and liver biopsies confirmed atypical T-cell infiltrate. The diagnosis of ATLL was established.

Interventions:

The patient elected for palliative chemotherapy with cyclophosphamide, vincristine, and prednisone (CVP). He began antiviral treatment with zidovudine 250 mg bis in die (BID) indefinitely. Ursodiol and cholestyramine were added for his hyperbilirubinemia.

Outcomes:

Four weeks from admission, the patient returned to near baseline functional status and was discharged home.

Lessons:

This case highlights that ATLL can initially present as isolated acute hepatitis, and how careful examination of peripheral blood-smear may elucidate hepatitis etiology. We also present support for utilizing ursodiol with cholestyramine for treating a hyperbilirubinemia. Moreover, unlike prior reports of ATLL presenting as liver dysfunction, combined antiviral and CVP chemotherapy was effective in this case. Lastly, there are seldom demographic reports of HTLV-1 infection from the Micronesian area, and our case represents the first indexed case of HTLV-1-associated-ATLL presenting as acute liver failure in a Marshallese patient.