bluuebunny/crossref_metadata_2025 huggingface dataset:
Understanding the Social and Emotional Dimensions of HIV Self-Management: A Qualitative Study of Newly Diagnosed People Living With HIV in Queensland, Australia
Authors: Hollingdrake Olivia , Dean Judith , Mutch Allyson , Lui Chi-Wai , Howard Chris , Fitzgerald Lisa
Published: May 2021

Understanding of HIV self-management increasingly focuses on treatment adherence and associated health-related behaviors, yet people living with HIV (PLWH) seldom perform these actions in a social vacuum. Thus, delivering comprehensive self-management support programs for PLWH requires an understanding of the social and emotional dimensions of HIV self-management. Through thematic analysis of in-depth interviews with 35 newly diagnosed PLWH, this descriptive qualitative study highlights these dimensions and their effect on experiences of HIV diagnosis and care. HIV self-management involves interpersonal interactions that affect efforts to seek support and reimagine one's personal identity in a changed reality. Managing disclosures and navigating stigma constitute everyday work for many PLWH. Because stigma continues to impede care engagement and well-being for PLWH, health practitioners must extend focus beyond viral suppression and prioritize support for emotional and social self-management. Nurses can create safe, nonstigmatizing spaces for conversations about HIV, uphold the rights of PLWH around disclosure, and ensure that PLWH are connected to peer support services.
Patulous Eustachian Tube Patients With Respiratory Fluctuation of Tympanic Membrane in Both Sitting and Supine Positions: A Sign of Severity of Disease?
Authors: Kusano Yusuke , Kawamura Yoshinobu , Ikeda Ryoukichi , Oshima Hidetoshi , Kikuchi Toshiaki , Kawase Tetsuaki , Katori Yukio , Kobayashi Toshimitsu
Published: May 2021

Objective:

The aim is to report four cases of patulous Eustachian tube (PET) patients with respiratory fluctuation of the tympanic membrane (TM) even in the supine position, and to examine the frequency and characteristics of such patients.

Patients:

There were 195 ears (99 right ears and 96 left ears) from 146 cases (56 male and 90 female subjects aged 8–88, average 48.0 ± 18.9 yrs) diagnosed with definite PET by diagnostic criteria proposed by Japan Otologic Society (JOS) between January 2017 and December 2019 at Sen-En Rifu Hospital. Patients who presented with respiratory fluctuation of the TM in both the sitting and supine positions were examined.

Main Outcome Measures:

Clinical patient records, the severity of subjective symptoms (PET handicap inventory-10 [PHI-10]), objective ET function tests (tubo-tympano-aerodynamic graphy [TTAG] and sonotubometry), and sitting three-dimensional computed tomography (3-D CT) were analyzed.

Results:

Six ears (3.1%) of four cases (2.7%) exhibited respiratory fluctuation of the TM, even in the supine position. In these six ears (four cases), the PHI-10 score ranged from 16 to 36 with three ears exhibiting PHI-10 score equal to or exceeding 26 (in the category of severe handicap). Sitting CT indicated the findings of completely open ET in only two ears. All ears but one were managed by conservative treatment.

Conclusion:

Respiratory fluctuation of the TM in both the sitting and supine positions was observed in 2.7% of the definite PET patients. Surprisingly, such findings can be an indication of neither the subjective nor objective severity of the disease. Therefore, even for PET patients with such findings, surgery should not be immediately proposed, but rather, conservative management should be undertaken first.
Novel extracorporeal magnetotransduction therapy with Magnetolith and high-energy focused electromagnetic extracorporeal shockwave therapy as bone stimulation therapy for scaphoid nonunion
Authors: Knobloch Karsten
Published: May 2021

Introduction:

The case report describes a non-invasive combination of novel Magnetolith Extracorporeal magnetotransduction therapy (EMTT) with high-energy focused extracorporeal shockwave therapy (ESWT) for scaphoid nonunion.

Patient concern:

In March 2020, a 31-year-old male presented with significant left wrist pain with the epicenter in the radial fossa, limiting daily activities and sports. Initial injury happened in 2005 when the patient was 16-years-old which was neglected. The first scaphoid non-union surgery took place in 2012 with bone-grafting and Herbert-screw. The second revision surgery took place in December 2019.

Diagnosis:

CT scan showed a non-healing atrophic bone graft in the scaphoid region.

Intervention:

In March/April 2020, combined novel Magnetolith (EMTT, 8  Hertz, 6000 shots, energy level 6/8) with high-energy focused electromagnetic ESWT (0.35mJ/mm2, 4000 shots, 4  Hertz) was performed in 3 sessions on a weekly interval to accelerate bony healing.

Outcomes:

Cone-beam CT in May 2020 (5 weeks after the last combined EMTT/ESWT treatment) revealing bony consolidation.

Conclusion:

The combination of novel non-invasive Magnetolith (EMTT) with focused high-energy ESWT for 3 sessions on a weekly interval can significantly improve bony healing in scaphoid nonunion. To the best of my knowledge, this is the first report to apply EMTT & ESWT for scaphoid nonunion after failed surgeries.
Using Lean Six Sigma to Increase the Effectiveness of an Evidence-Based Quality Improvement Program
Authors: Lavin Patricia , Vetter Mary Jo
Published: May 2021

Background:

Evidence-based quality improvement (EBQI) is an established methodology for identifying nursing practice changes that improve health care quality and safety. However, EBQI itself does not provide a framework for navigating the barriers to practice change.

Local Problem:

An EBQI program in an orthopedic specialty hospital fostered many successful quality improvement projects. However, program participants frequently encountered barriers to project implementation.

Methods:

Lean Six Sigma (LSS) principles, tools, and strategies were incorporated into the EBQI program to help participants overcome organizational barriers to successful implementation.

Interventions:

LSS interventions included stakeholder alignment, process analysis, change management, project management, structured check-ins, mentoring, and organizational recognition.

Results:

The addition of LSS principles gave EBQI project leaders new tools for gaining executive support, securing resources, and overcoming organizational inertia to facilitate effective practice change.

Conclusions:

Lean Six Sigma can increase the effectiveness of an EBQI program.
A Scoping Review of the Impact of Downsizing on Survivors
Authors: Langster Holly J. , Cutrer Shelby
Published: May 2021

Dynamics in the workplace are tumultuous. Downsizing within organizations is one strategy to adjust staffing to volumes. Survivor demoralization and loss of trust in the organization are the primary outcomes of organizational downsizing. These deep emotional responses to psychological contract breach/violation result in decreased organizational citizenship behavior, decreased organizational commitment, decreased productivity, and employees who desire to work elsewhere.
Lessons Learned Using Logic Models to Design and Guide DNP Projects
Authors: Idzik Shannon , Buckley Kathleen , Bindon Susan , Gorschboth Susan , Hammersla Margaret , Windemuth Brenda , Bingham Debra
Published: May 2021

Background

A final culminating project that is derived from a practice immersion experience is a critical part of a doctor of nursing practice (DNP) program.

Problem

Many schools use well-designed quality improvement (QI) projects to meet this requirement, but there is no consensus on which QI methods and tools are the most effective for DNP students to demonstrate before graduation.

Approach

One Mid-Atlantic public university began using QI process models, one of which was a logic model, to guide their DNP projects. This led to subsequent changes in the curriculum, faculty preparation, and practice partner responsibilities.

Outcome

Many benefits and challenges were identified during the logic model implementation that may benefit other schools seeking to increase consistency and rigor. Although the learning process for students and faculty may be challenging, the outcomes included improved project conceptualization, clarity, concision, and feasibility of goal attainment.

Conclusions

Use of logic models expands DNP students' skills to develop and implement a successful project and supports clinical scholarship.
Nursing Education Amid a Pandemic
Authors: Amerson Roxanne , Fisher Beth , Bible Joe , Burgess Lena , Ravan Leslie , Ward Linda
Published: May 2021

Background

The unprecedented pandemic presented new stresses and challenges in nursing education impacting the mental health of nursing students.

Purpose

The purpose of this study was to evaluate the relationship between virtual learning and the mental health of nursing students.

Method

This study used a descriptive, cross-sectional design with a convenience sample of 256 nursing students enrolled in a baccalaureate program. Data were collected through an online survey using 2 screening tools for stress, anxiety, and depression.

Results

Mean sum Patient Health Questionnaire-4 scores and subscale scores suggest that more than 40% of students experienced mild to moderate levels of psychological distress. Mean sum Perceived Stress Scale-10 scores indicate 84% of students experienced moderate levels of stress, and 14% experienced high levels of stress.

Conclusions

During periods of societal crisis, faculty must be hypervigilant to the mental health needs of students.
Longitudinal evolution of physical activity during and after chemotherapy for breast cancer
Authors: Girouard Alice , Michel Alexandra , Ouellet Marie-Michèle , Guimond Anne-Josée , Ruel Sophie , Ivers Hans , Savard Josée
Published: May 2021

Background:

Previous research has found that, on average, breast cancer patients tend to become less active during chemotherapy and to increase slightly their physical activity (PA) level afterwards. However, patients may show distinct trajectories of PA during and after chemotherapy. Objectives were to: investigate the global evolution of PA before (T1), during (T2), and after chemotherapy (T3), as well as 3 (T4) and 6 (T5) months later; document the distinct trajectories of PA from T1-T5; and explore the moderating effect of the initial PA level on subsequent PA trajectories (T2-T5).

Methods:

Fifty breast cancer patients (M age = 55.1, SD = 10.4) wore an actigraph for 7 consecutive 24-hour periods to measure the time spent in moderate-to-vigorous PA and completed the Godin Leisure-Time Exercise questionnaire (GLTEQ) at 5 time points.

Results:

At baseline, participants showed an average of 8.8 minutes of objectively measured moderate-to-vigorous PA per week and a mean score of 20.4 (moderate PA) on the GLTEQ. A significant time effect (i.e., increase) was obtained on both measures when analyzing the total sample (P = .001; P = .021, respectively). Latent class growth modeling revealed 2 distinct trajectories (“mild-to-moderate PA” and “strenuous PA”) of PA for the subjective measure, and 4 trajectories (“very low and stable MVPA,” “very low and slightly increasing MVPA,” “very low and highly increasing MVPA,” and “low and slightly decreasing MVPA”) for the objective one. With regards to the moderating role of baseline PA levels, no significant group X time interactions were found for the subjective and objective measures (P = .077 and.10, respectively).

Conclusions:

The evolution of PA during and after chemotherapy is variable across patients. However, it remains challenging for everyone to remain or be active during chemotherapy. More research is needed to design more effective PA intervention in this population.
Ammonia Exposure
Authors: Vadysinghe Amal Nishantha , Attygalle Uthpala , Ekanayake Ekanayake Mudiyanselage Kasun Bandara , Dharmasena Edurapotha Gamaralalage Inoka Amanthie
Published: May 2021

Exposure to high doses of ammonia gas can result in lethal injuries to humans. This case series presents 5 fatalities and an injured individual, caused by acute ammonia exposure, which occurred in the rubber industry. One of the fatalities and the survivor were reported in an incident of ammonia gas cylinder explosion, whereas the other 4 fatalities were accidentally exposed to gaseous ammonia, where they had started working at a reopened rubber factory that had been abandoned for a long time. Autopsy, scene investigation, and the toxicological findings of the deceased and the clinical forensic examination of the survivor revealed corrosive burns on the skin and the oropharynx, diffuse alveolar damage, and high level of ammonia in blood and the scene. These cases highlight how the comprehensive death investigation helps the forensic practitioner to conclude ammonia exposure as the cause of death/injury where there is a possibility of gas inhalation.
A Communication Guide for Pediatric Extracorporeal Membrane Oxygenation
Authors: Moynihan Katie M. , Purol Nick , Alexander Peta M. A. , Wolfe Joanne , October Tessie W.
Published: May 2021

Decision-making surrounding extracorporeal membrane oxygenation initiation and decannulation has become a key challenge in critical care. Nuanced communication skills and transparent discussions about prognosis are imperative during this lifesaving, yet high-risk and burdensome intervention. Serious illness conversation guides are proving beneficial for patients, families and staff to communicate uncertainty and facilitate shared decision-making toward goal-concordant care. While the literature emphasizes the imperative to provide guidance for clinicians, no practical guide exists for communicating serious illness and prognostic uncertainty when managing children supported with extracorporeal membrane oxygenation and their families. To address this gap, we propose a structured conversation guide for critical early timepoints during pediatric extracorporeal membrane oxygenation support relevant for all cannulations and subsequent iterative discussions toward decannulation. The overarching approach defines extracorporeal membrane oxygenation as a bridge or temporary support device, part of a larger therapeutic effort toward a specific goal or goals. The Day 0 talk at extracorporeal membrane oxygenation initiation is brief, disclosing the serious nature of needing this level of support, and sets clear expectations toward a goal. The Day 1 talk provides further details about benefits and burdens of extracorporeal membrane oxygenation, cultivates prognostic awareness about potential outcomes and elicits families’ goals of care with iterative discussions about how extracorporeal membrane oxygenation may promote these goals. If extracorporeal membrane oxygenation is no longer effective to achieve the intended goal, recommendations are provided for discontinuation of support. When death is anticipated or possible, end-of-life planning, contingencies, and escalation limits should be discussed. The communication framework presented can be adapted to unique institutional and clinical settings. Future research is required to investigate utility and potential barriers to implementation. We anticipate that structured conversations during extracorporeal membrane oxygenation support will facilitate clear expectations toward a common treatment goal, foster therapeutic relationships, ensure clinician alignment and consistent language, mitigate communication gaps, support bereavement, and minimize conflict.
Decision-Making, Ethics, and End-of-Life Care in Pediatric Extracorporeal Membrane Oxygenation: A Comprehensive Narrative Review
Authors: Moynihan Katie M. , Dorste Anna , Siegel Bryan D. , Rabinowitz Edon J. , McReynolds Andrew , October Tessie W.
Published: May 2021

Objectives:

Pediatric extracorporeal membrane oxygenation is associated with significant morbidity and mortality. We sought to summarize literature on communication and decision-making, end-of-life care, and ethical issues to identify recommended approaches and highlight knowledge gaps.

Data Sources:

PubMed, Embase, Web of Science, and Cochrane Library.

Study Selection:

We reviewed published articles (1972–2020) which examined three pediatric extracorporeal membrane oxygenation domains: 1) decision-making or communication between clinicians and patients/families, 2) ethical issues, or 3) end-of-life care.

Data Extraction:

Two reviewers independently assessed eligibility using Preferred Reporting Items for Systematic Reviews and Meta-Analyses methodology.

Data Synthesis:

Of 2,581 publications screened, we identified one systematic review and 35 descriptive studies. No practical guides exist for communication and decision-making in pediatric extracorporeal membrane oxygenation. Conversation principles and parent/clinician perspectives are described. Ethical issues related to consent, initiation, discontinuation, resource allocation, and research. No patient-level synthesis of ethical issues or end-of-life care in pediatric extracorporeal membrane oxygenation was identified.

Conclusions:

Despite numerous ethical issues reported surrounding pediatric extracorporeal membrane oxygenation, we found limited patient-level research and no practical guides for communicating with families or managing extracorporeal membrane oxygenation discontinuation.
Clinical Deterioration and Neurocritical Care Utilization in Pediatric Patients With Glasgow Coma Scale Score of 9–13 After Traumatic Brain Injury: Associations With Patient and Injury Characteristics
Authors: Soysal Elif , Horvat Christopher M. , Simon Dennis W. , Wolf Michael S. , Tyler-Kabara Elizabeth , Gaines Barbara A. , Clark Robert S. B. , Kochanek Patrick M. , Bayir Hülya
Published: May 2021

OBJECTIVES:

To define the clinical characteristics of hospitalized children with moderate traumatic brain injury and identify factors associated with deterioration to severe traumatic brain injury.

DESIGN:

Retrospective cohort study.

SETTING:

Tertiary Children’s Hospital with Level 1 Trauma Center designation.

PATIENTS:

Inpatient children less than 18 years old with an International Classification of Diseases code for traumatic brain injury and an admission Glasgow Coma Scale score of 9–13.

MEASUREMENTS AND RESULTS:

We queried the National Trauma Data Bank for our institutional data and identified 177 patients with moderate traumatic brain injury from 2010 to 2017. These patients were then linked to the electronic health record to obtain baseline and injury characteristics, laboratory data, serial Glasgow Coma Scale scores, CT findings, and neurocritical care interventions. Clinical deterioration was defined as greater than or equal to 2 recorded values of Glasgow Coma Scale scores less than or equal to 8 during the first 48 hours of hospitalization. Thirty-seven patients experienced deterioration. Children who deteriorated were more likely to require intubation (73% vs 26%), have generalized edema, subdural hematoma, or contusion on CT scan (30% vs 8%, 57% vs 37%, 35% vs 16%, respectively), receive hypertonic saline (38% vs 7%), undergo intracranial pressure monitoring (24% vs 0%), were more likely to be transferred to inpatient rehabilitation following hospital discharge (32% vs 5%), and incur greater costs of care ($25,568 vs $10,724) (all p < 0.01). There was no mortality in this cohort. Multivariable regression demonstrated that a higher Injury Severity Score, a higher initial international normalized ratio, and a lower admission Glasgow Coma Scale score were associated with deterioration to severe traumatic brain injury in the first 48 hours (p < 0.05 for all).

CONCLUSIONS:

A substantial subset of children (21%) presenting with moderate traumatic brain injury at a Level 1 pediatric trauma center experienced deterioration in the first 48 hours, requiring additional resource utilization associated with increased cost of care. Deterioration was independently associated with an increased international normalized ratio higher Injury Severity Score, and a lower admission Glasgow Coma Scale score.
Endometrial Carcinoma as the Presenting Malignancy in a Teenager With a Pathogenic TP53 Germline Mutation: A Case Report and Literature Review
Authors: Irshaid Lina , Clark Mitchell , Fadare Oluwole , Finberg Karin E. , Parkash Vinita
Published: May 2021

Patients with germline TP53 mutations are characterized by the occurrence of multiple early-onset malignancies. The characteristic syndrome is Li-Fraumeni syndrome (OMIM # 151623), an autosomal dominant disorder typified by premenopausal breast carcinoma, adrenal cortical tumors, bone and soft tissue sarcomas, leukemias, and tumors of the brain and spinal cord. Gynecologic malignancies are uncommonly reported in families harboring TP53 mutations, and the predominant tumor type reported is ovarian. Uterine carcinoma has been reported only a handful of times in patients with germline TP53 mutations, none as a presenting tumor in a teenager. We report on an 18-year-old patient who presented with grade 3, high-stage endometrioid endometrial carcinoma. Sequencing detected a single-nucleotide substitution in the TP53 gene (NM_000546.6:c.818G>A), encoding the missense substitution p.Arg273His (R273H) in both the tumor and normal tissue, consistent with a germline mutation. We discuss the biology of the TP53 gene and p53 protein, with emphasis on the R273H mutation. We also review the literature on endometrial carcinoma in patients with germline TP53 mutations.
LBP Protects Hepatocyte Mitochondrial Function Via the PPAR-CYP4A2 Signaling Pathway in a Rat Sepsis Model
Authors: Song Zichen , Meng Leilei , He Zhixiang , Huang Jing , Li Fang , Feng Jingjing , Jia Zhuoran , Huang Yue , Liu Wei , Liu Anding , Fang Haoshu
Published: May 2021

Objectives:

To explore the role of LPS binding protein (LBP) in metabolism and optimize sepsis treatment.

Design:

A sepsis model was established by injecting LPS into LBP−/− rats and WT rats and observing changes in the liver over time (0, 1, 6, and 24 h).

Setting:

Detecting liver inflammation and injury. Optimizing the treatment of sepsis.

Subjects:

WT rats and LBP−/− rats.

Interventions:

We established a sepsis model by injecting LPS intravenously.

Measurements and main results:

First, we induced sepsis in WT and LBP−/− rats with LPS. The rats were sacrificed, and serum and liver samples were collected at 1, 6, and 24 h after LPS injection. We found that the deletion of LBP reduced LPS-induced liver inflammation and injury at 1 and 6 h. Ballooning degeneration was clearly present in LBP−/− rat livers at 24 h after LPS injection. We found that mitochondrial damage and reactive oxygen species (ROS) levels were higher in LBP−/− rat livers than in WT rat livers at 24 h after LPS injection. According to the transcriptomic results, the peroxisome proliferator-activated receptor (PPAR) pathway may be the reason for lesions in LBP−/− rats. To further investigate the function of PPARα in sepsis, we inhibited mTOR with rapamycin and examined mitochondrial injury and ROS levels. The levels of mitochondrial damage and ROS were reduced after LBP−/− rats were pretreated with rapamycin in the context of LPS-induced sepsis. Inhibiting CYP4a2, one of the PPARα-target gene products, reduced the level of LPS-induced ROS in LBP−/− rats.

Conclusion:

LBP protects hepatic mitochondria against LPS-induced damage via the LBP-PPARα-CYP4a2 signaling pathway.
Cancer After Pediatric Kidney Transplantation: A Long-term Single-center Experience in Japan
Authors: Yabuuchi Tomoo , Miura Kenichiro , Shimizu Satoru , Kaneko Naoto , Ishizuka Kiyonobu , Kanda Shoichiro , Chikamoto Hiroko , Akioka Yuko , Fujieda Mikiya , Hattori Motoshi
Published: May 2021

Background.

The cancer incidence, types, and risk factors after pediatric kidney transplantation (KT) have been reported in the United States, Canada, Europe, Australia, and New Zealand. However, no information is available about cancer in pediatric KT recipients in Asian countries.

Methods.

Children aged <20 y who underwent initial KT from 1983 to 2016 were analyzed. We compared the cancer incidence with that in the general Japanese population using standardized incidence ratio and examined posttransplant cancer risk using Cox proportional hazards models.

Results.

A total of 356 children (median age, 11.7 y; interquartile range, 5.0–17.6) received KT with a follow-up period of 4466 person-years. The median age of cancer onset was 18.5 y (interquartile range, 8.0–32.3), and 13 cancers occurred in 12 patients (3.4%). Two patients died from cancer. The most common cancers were posttransplant lymphoproliferative disorders (PTLDs) (38.5%). The median time to PTLD and non-PTLD diagnosis after KT was 0.6 and 16.4 y, respectively. There was no occurrence of skin cancer. The posttransplant cancer incidence was 9.9 times higher than that in the general age-matched population (standardized incidence ratio = 9.9; 95% confidence interval, 4.80-18.39). The cumulative cancer incidence was 5.3% in 20 y after KT, which is lower than that reported in previous studies. We could not identify any risk factors for all cancer after KT in all patients, whereas subgroup analysis in 264 patients with available data of recipient Epstein-Barr virus serological status showed that recipient Epstein-Barr virus-negative serology was an independent risk factor for cancer development.

Conclusions.

The incidence of cancer is higher in Japanese pediatric KT recipients than in the general population. The cumulative incidence of cancer after KT was lower in our population than that previously reported. This may be because there was no skin cancer observed in the Japanese pediatric KT recipients in our study.
The state of telemedicine for persons with Parkinson's disease
Authors: van den Bergh Robin , Bloem Bastiaan R. , Meinders Marjan J. , Evers Luc J.W.
Published: May 2021

Purpose of review

The COVID-pandemic has facilitated the implementation of telemedicine in both clinical practice and research. We highlight recent developments in three promising areas of telemedicine: teleconsultation, telemonitoring, and teletreatment. We illustrate this using Parkinson's disease as a model for other chronic neurological disorders.

Recent findings

Teleconsultations can reliably administer parts of the neurological examination remotely, but are typically not useful for establishing a reliable diagnosis. For follow-ups, teleconsultations can provide enhanced comfort and convenience to patients, and provide opportunities for blended and proactive care models. Barriers include technological challenges, limited clinician confidence, and a suboptimal clinician-patient relationship. Telemonitoring using wearable sensors and smartphone-based apps can support clinical decision-making, but we lack large-scale randomized controlled trials to prove effectiveness on clinical outcomes. Increasingly many trials are now incorporating telemonitoring as an exploratory outcome, but more work remains needed to demonstrate its clinical meaningfulness. Finding a balance between benefits and burdens for individual patients remains vital. Recent work emphasised the promise of various teletreatment solutions, such as remotely adjustable deep brain stimulation parameters, virtual reality enhanced exercise programs, and telephone-based cognitive behavioural therapy. Personal contact remains essential to ascertain adherence to teletreatment.

The availability of different telemedicine tools for remote consultation, monitoring, and treatment is increasing. Future research should establish whether telemedicine improves outcomes in routine clinical care, and further underpin its merits both as intervention and outcome in research settings.
New developments in myotonic dystrophies from a multisystemic perspective
Authors: Montagnese Federica , Schoser Benedikt
Published: May 2021

Purpose of review

The multisystemic involvement of myotonic dystrophies (DMs) intricates disease monitoring, patients’ care and trial design. This update of the multifaceted comorbidities observed in DMs aims to assist neurologists in the complex management of patients and to encourage further studies for still under-investigated aspects of the disease.

Recent findings

We reviewed the most recent studies covering pathogenesis and clinical aspects of extra-muscular involvement in DM1 and DM2. The largest body of evidence regards the cardiac and respiratory features, for which experts’ recommendations have been produced. Gastrointestinal symptoms emerge as one of the most prevalent complaints in DMs. The alteration of insulin signaling pathways, involved in gastrointestinal manifestations, carcinogenesis, muscle function, cognitive and endocrinological aspects, gain further relevance in the light of recent evidence of metformin efficacy in DM1. Still, too few studies are performed on large DM2 cohorts, so that current recommendations mainly rely on data gathered in DM1 that cannot be fully translated to DM2.

Extra-muscular manifestations greatly contribute to the overall disease burden. A multidisciplinary approach is the key for the management of patients. Consensus-based recommendations for DM1 and DM2 allow high standards of care but further evidence are needed to implement these recommendations.
Safety of Continuous Erector Spinae Catheters in Chest Trauma: A Retrospective Cohort Study
Authors: White L.D , Riley B. , Davis K. , Thang C. , Mitchell A. , Abi-fares C. , Basson W. , Anstey C.
Published: May 2021

The erector spinae block is an efficacious analgesic option for the management of rib fracture related pain. Despite there being minimal published data specifically addressing the safety profile of this block, many societies have made statements regarding its safety and its use as an alternative to traditional regional anaesthesia techniques in patients at risk of complications. The primary aim of this study was to characterise the safety profile of erector spinae plane block catheters by determining the incidence of early complications. The secondary aims of this study was to characterise the incidence of late adverse events, as well as, the erector spinae plane block catheter failure rate. We analysed electronic medical record data of patients who had an erector spinae plane block catheter inserted for the management of rib fractures between November 2017 to September 2020. To assess early adverse events data collection included hypotension, hypoxaemia, local anaesthetic systemic toxicity and pneumothorax thought to be associated with erector spinae plane block catheter insertion. Late complications included catheter site infection and catheter site haematoma. Two hundred and twenty four patients received a total of 244 continuous erector spinae catheters during the study period. Following the insertion of the erector spinae there were no immediate complications such as hypotension, hypoxia, local anaesthetic toxicity or pneumothorax. Of all blocks inserted 7.7% were removed due to catheter failure (OR = 8.4 per 100 catheters; 95%CI = 5.1 to 13.9 per 100 catheters). This resulted in a failure rate of 1.9 per 1000 catheter days (95%CI = 1.1 to 6.7 catheter days). Late complications included two erythematous catheter sites and two small haematomas not requiring intervention. The odds of a minor late complication was 16.7 per 1,000 catheters (95%CI = 6.1 to 45.5 per 1,000 catheters). In conclusion, this study supports the statements made by regional anaesthesia societies regarding the safety of the erector spinae plane block. Based on the results presented in this population of trauma patients, the erector spinae plane block catheter is a low risk analgesic technique which may be performed in the presence of abnormal coagulation status or systemic infection.
Cellular immunity predominates over humoral immunity after the first dose of COVID-19 vaccines in solid organ transplant recipients
Authors: Schmidt Tina , Klemis Verena , Schub David , Schneitler Sophie , Reichert Matthias C. , Wilkens Heinrike , Sester Urban , Sester Martina , Mihm Janine
Published: May 2021

Knowledge on the vaccine-induced cellular and humoral immunity and on immunogenicity of vector-based and mRNA vaccines in solid organ transplant recipients is limited. Therefore, SARS-CoV-2 specific T-cells and antibodies were analyzed in 40 transplant recipients and 70 age-matched controls after the first dose of vector-based or mRNA vaccines. Plasmablasts and SARS-CoV-2 specific CD4 and CD8 T-cells were quantified using flow-cytometry. Specific antibodies were analyzed by ELISA and neutralization assay. SARS-CoV-2 specific antibodies and T-cells were induced in both groups with significantly lower levels in patients. While antibodies were detected in 80% of controls and 5.3% of patients, specific CD4 and/or CD8 T-cells were more frequently found in both controls (84.3%) and patients (23.7%). The two vaccine types showed notable differences, as IgG and neutralizing activity were more pronounced after mRNA vaccination (p<0.0001 each), whereas CD4 and CD8 T-cell levels were higher after vector vaccination (p=0.009; p<0.0001). Plasmablast numbers were significantly higher in controls and correlated with SARS-CoV-2 specific IgG- and CD4 T-cell levels. In conclusion, assessment of antibodies is not sufficient to identify COVID-19-vaccine responders. Together with differences in immunogenicity among vaccines, this necessitates combined analysis of humoral and cellular immunity to reliably assess responders among immunocompetent and immunocompromised individuals.
A novel protein signature from plasma extracellular vesicles for non-invasive differential diagnosis of idiopathic pulmonary fibrosis
Authors: Adduri Raju SR , Cai Kai , Alzate Karen V , Vasireddy Ravikiran , Miller Jeffrey W , de Frías Sergio Poli , de Frías Fernando Poli , Horimasu Yasushi , Iwamoto Hiroshi , Hattori Noboru , Zhang Yingze , Gibson Kevin F. , Pal Anoop K , Nicastro Daniela , Li Lily , Cherian Sujith , Sholl Lynette M , Schwartz David A , Kass Daniel J , Rosas Ivan O , Konduru Nagarjun V
Published: May 2021

Background

Idiopathic pulmonary fibrosis (IPF) is a fibrosing interstitial pneumonia of unknown etiology often leading to respiratory failure. Over half of IPF patients present with discordant features of usual interstitial pneumonia on high-resolution computed tomography at diagnosis which warrants surgical lung biopsy to exclude the possibility of other interstitial lung diseases (ILDs). Therefore, there is a need for non-invasive biomarkers for expediting the differential diagnosis of IPF.

Methods

Using mass spectrometry, we performed proteomic analysis of plasma extracellular vesicles (EVs) in a cohort of subjects with IPF, chronic hypersensitivity pneumonitis, nonspecific interstitial pneumonitis, and healthy subjects (HS). A five-protein signature was identified by lasso regression and was validated in an independent cohort using ELISA. We evaluated the concordance between plasma EV proteome and the lung transcriptome data. Lastly, we compared the molecular pathways overrepresented in IPF by differentially expressed proteins and transcripts from EVs and lung tissues, respectively.

Results

The five-protein signature derived from mass spectrometry data showed area under the receiver operating characteristic curve of 0.915 (95%CI: 0.819-1.011) and 0.958 (95%CI: 0.882-1.034) for differentiating IPF from other ILDs and from HS, respectively. We also found that the EV protein expression profiles mirrored their corresponding mRNA expressions in IPF lungs. Further, we observed an overlap in the EV proteome- and lung mRNA-associated molecular pathways.

Conclusions

We discovered a plasma EV-based protein signature for differential diagnosis of IPF and validated this signature in an independent cohort. The signature needs to be tested in large prospective cohorts to establish its clinical utility.
Risk assessment of COVID-19 epidemic resurgence in relation to SARS-CoV-2 variants and vaccination passes
Authors: Krueger Tyll , Gogolewski Krzysztof , Bodych Marcin , Gambin Anna , Giordano Giulia , Cuschieri Sarah , Czypionka Thomas , Perc Matjaz , Petelos Elena , Rosińska Magdalena , Szczurek Ewa
Published: May 2021

Background

The introduction of COVID-19 vaccination passes (VPs) by many countries coincided with the Delta variant fast becoming dominant across Europe. A thorough assessment of their impact on epidemic dynamics is still lacking.

Methods

Here, we propose the VAP-SIRS model that considers possibly lower restrictions for the VP holders than for the rest of the population, imperfect vaccination effectiveness against infection, rates of (re-)vaccination and waning immunity, fraction of never-vaccinated, and the increased transmissibility of the Delta variant.

Results

Some predicted epidemic scenarios for realistic parameter values yield new COVID-19 infection waves within two years, and high daily case numbers in the endemic state, even without introducing VPs and granting more freedom to their holders. Still, suitable adaptive policies can avoid unfavorable outcomes.

Conclusions

While VP holders could initially be allowed more freedom, the lack of full vaccine effectiveness and increased transmissibility will require accelerated (re-)vaccination, wide-spread immunity surveillance, and/or minimal long-term common restrictions.

Plain language summary

Assessing the impact of vaccines, other public health measures, and declining immunity on SARS-CoV-2 control is challenging. This is particularly true in the context of vaccination passes, whereby vaccinated individuals have more freedom of making contacts than unvaccinated ones. Here, we use a mathematical model to simulate various scenarios and investigate the likelihood of containing COVID-19 outbreaks in example European countries. We demonstrate that both Alpha and Delta SARS-CoV-2 variants inevitably lead to recurring outbreaks when measures are lifted for vaccination pass holders. High revaccination rates and a lowered fraction of the unvaccinated population increase the benefit of vaccination passes. These observations are important for policy making, highlighting the need for continued vigilance, even where the epidemic is under control, especially when new variants of concern emerge.
Acute biliary pancreatitis management during the COVID-19 pandemic
Authors: Colak Elif , Ciftci Ahmet Burak
Published: May 2021

Objective

To analyze acute biliary pancreatitis (ABP) management during the COVID-19 pandemic.

Methods

This was a retrospective cohort study conducted with ABP patients during two discrete periods: a control period from March 16, 2019, through March 15, 2020 (period 1); and a COVID-19 era between March 16, 2020, and March 15, 2021 (period 2).

Results

A total of 89 patients with ABP were identified, 58 in period 1 and 31 in period 2, which equates to a 46.6% reduction. The mean age of the patients was 62.75±16.59 years, and 51 (57.3%) of the patients were female. qSOFA and WSES scores are significantly higher in the patients in period 2 (p=0.031, p=0.032). There were no significant differences regarding hematological parameters except lactate. Lactate levels were significantly higher in period 2 (p=0.012). Twenty-two patients (37.9%) in period 1 and six (19.3%) patients in period 2 underwent cholecystectomy (p=0.072). Cholecystectomy was performed laparoscopically in 18 (81.8%) patients in period 1 and in five (83.3%) patients in period 2 (p=0.932). There were no significant differences regarding surgical intervention between the two periods. Three patients were diagnosed COVID-19 in period 2. All of these patients died. The severity of ABP was significantly worse in SARS-CoV-2-positive patients, with over 100% of patients in this group developing severe pancreatitis. Six patients (10.3%) in period 1, 10 (32.2%) patients in period 2 were admitted in ICU (p=0.010). The median length of stay was 5 (1-40) days in period 1 and 4 (2-75) days in period 2 (p= 0.641). The hospital mortality rate was 3.4% and 19.3% in period l and period 2, respectively. Mortality was significantly higher in period 2 (p=0.012).

Conclusion

During the COVID-19 outbreak, a significant decrease in the number of patients with ABP and increased severity was observed. Additionally, it can be said that SARS-CoV-2 infection has a mortal course in patients with ABP. Analysis and evaluation of ABP patients during the pandemic period is important to draw conclusions that will help confront future health crises.
Do people with low back pain walk differently? A systematic review and meta-analysis
Authors: Smith Jo Armour , Stabbert Heidi , Bagwell Jennifer J. , Teng Hsiang-Ling , Wade Vernie , Lee Szu-Ping
Published: May 2021

Objective

To identify differences in biomechanics during gait in individuals with acute and persistent low back pain compared with back-healthy controls.

Design

Systematic review

Data Sources

A search was conducted in PubMed, CINAHL, SPORTDiscus, and PsycINFO in June 2019 and was repeated in December 2020.

Eligibility criteria

Studies were included if they reported biomechanical characteristics of individuals with and without low back pain during steady-state or perturbed walking and running. Biomechanical data included spatiotemporal, kinematic, kinetic, and electromyography variables. The reporting quality and potential for bias of each study was assessed. Data were pooled where possible to compare the standardized mean differences (SMD) between groups.

Results

Ninety-seven studies were included. Two studies investigated acute pain and the rest investigated persistent pain. Eight studies investigated running gait. 20% of studies had high reporting quality/low risk of bias. In comparison with back-healthy controls, individuals with persistent low back pain walked more slowly (SMD -0.59 [95% CI -0.77 to -0.42]) and with shorter stride length (−0.38 [-0.60 to -0.16]). There were no differences in the amplitude of motion in the thoracic or lumbar spine, pelvis, or hips in individuals with LBP. During walking, coordination of motion between the thorax and the lumbar spine/pelvis was significantly more in-phase in the LBP groups (−0.60 [-0.90 to -0-.30]), and individuals with LBP exhibited greater amplitude of activation in the paraspinal muscles (0.52 [0.23 to 0.80]).

Summary/Conclusion

There is moderate to strong evidence that individuals with persistent LBP demonstrate impairments in walking gait compared with back-healthy controls.
HISTOPATHOLOGICAL AND IMMUNOHISTOCHEMICAL PROGNOSTIC FACTORS IN HIGH-GRADE NON-ENDOMETRIOID CARCINOMAS OF THE ENDOMETRIUM (HG-NECs). IS IT POSSIBLE TO IDENTIFY SUB-GROUPS AT INCREASED RISK?
Authors: Vellone Valerio Gaetano , Paudice Michele , Biatta Chiara Maria , Scaglione Giulia , Barra Fabio , Ferrero Simone , Greppi Marco , Paleari Laura , Marcenaro Emanuela ,   Gyn DMT
Published: May 2021

Endometrial cancer is an emerging disease with an increase in prevalence of aggressive histotypes in recent years. In the present study potential histopathological and immunohistochemical prognostic markers are investigated

Consecutive cases of high grade non-endometrioid carcinoma (HG-NEC) of the endometrium were considered. Each surgical specimen has been routinely processed, the most representative block has been selected for immunohistochemistry and tested for ER, PR, ki67, p53, E-cadherin, β-catenin, Bcl-2 and cyclin D1. For each immunomarker the percentage of positive tumor cells were evaluated (%) and dichotomized as low and high according to the distribution in the study population. Follow-up was collected for disease-free survival (DFS) and overall survival (OS).

33 cases were eligible: 19 resulted FIGO I-II, 14 resulted FIGO III-IV. 12 patients suffered a recurrent disease (mean follow-up 24.6 months); 8 patients died of the disease (mean follow-up 26.6 months).

Women with recurrent disease demonstrated a significant higher bcl2% (35.84±30.96% vs 8.09±11.56% p=0.0032) while DOD patients had higher ki67% (75±13.09% vs 58.6±19.97% p=0.033) and bcl2% of border significance (34.37±34.99% vs 13±17.97% p=0.078).

As expected FIGO III-IV had a worse DFS (HR=3.34; 95%CI:1.1-10.99; p=0.034) and OS (HR=5.19; 95%CI: 1.27-21.14 p= 0.0217). Bcl2-high patients (bcl2>10%) demonstrated a significant worse DFS (HR=9.11; 95%CI: 2.6-32.4; p=0.0006) and OS (HR=7.63; 95%CI:1.7-34; p=0.0084); also PR low patients (PR≤10%) had a significant worse DFS (HR=3.74; 95%CI:1.2-11.9; p=0,02).

HG-NEC represent an heterogeneous group of endometrial aggressive neoplasms with a worrisome prognosis often at an advanced stage at presentation. Bcl2 and PR may represent promising markers to identify a sub-group of patients having an even worse prognosis requiring a careful and close follow-up.
Post-acute COVID-19 syndrome and its prolonged effects: An updated systematic review
Authors: Malik Jahanzeb , Zaidi Syed Muhammad Jawad , Iqbal Raafe , Khan Kashif , Ali Muhammad , Rana Abdul Sattar , Waqar Ali Umer , Ishaq Uzma
Published: May 2021

Objective

This systematic review aimed at estimating the demographics, clinical characteristics, and prevalence of post-acute COVID-19 symptoms in view of published literature that studied prolonged clinical manifestations after recovery from acute COVID-19 infection.

Methods

After protocol setting, relevant articles were searched on various databases including PubMed, Medline, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), Embase, and Web of Sciences using MeSH keywords.

Results

Out of the 153 articles reviewed, 21 articles qualified for the final analysis. The most common persistent clinical manifestations were fatigue (54.11%), dyspnea (24.38%), alopecia (23.21%), hyperhidrosis (23.6%), insomnia (25.98%), anxiety (17.29%), and arthralgia (16.35%). In addition to these symptoms, new-onset hypertension, diabetes, neuropsychiatric disorders, and bladder incontinence were also reported.

Conclusion

Clinical features of post-acute COVID-19 infection can manifest even after 60 days of initial infection. Multidisciplinary care along with regular follow-up must be provided to such patients.
Impact of BNT162b first vaccination on the immune transcriptome of elderly patients infected with the B.1.351 SARS-CoV-2 variant
Authors: Knabl Ludwig , Lee Hye Kyung , Wieser Manuel , Mur Anna , Zabernigg August , Knabl Ludwig , Rauch Simon , Bock Matthias , Schumacher Jana , Kaiser Norbert , Furth Priscilla A. , Hennighausen Lothar
Published: May 2021

Fast-spreading variants of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) energize the COVID-19 pandemic. The B.1.351 variant carrying the escape mutation E484K in the receptor binding domain is of particular concern due to reduced immunological protection following vaccination. Protection can manifest as early as 10 days following immunization with full protection two weeks following the second dose, but the course is not well-characterized for variants. Here, we investigated the immune transcriptome of six elderly individuals (average age 82 yr.) from an old people’s home, who contracted B.1.351, with four having received the first dose of BNT162b eight to 11 days prior to the onset of COVID-19 symptoms. The patients were hospitalized and received dexamethasone treatment. Immune transcriptomes were established from PBMCs approximately 10 and 35 days after the onset of COVID-19 symptomology. RNA-seq revealed a more intensive immune response in vaccinated patients as compared to unvaccinated ones. Specifically, transcription factors linked to the JAK/STAT pathway, interferon stimulated genes, and genes associated with innate antiviral immunity and COVID-19-SARS-CoV-2 infection were highly enriched in vaccinated patients. This rendered the transcriptomes of the older vaccinated group significantly different than older unvaccinated individuals infected at the same institution and more similar to the immune response of younger unvaccinated individuals (age range 48-62) following B.1.351 infection. All individuals in this study whether vaccinated or not were hospitalized due to B.1.351 infection and one vaccinated patient died illustrating that although an enhanced immune response was documented infection it was insufficient to protect from disease. This highlights the need for maintaining physical distancing and prevention measures throughout the time course of vaccination in older adults.