bluuebunny/crossref_metadata_2025 huggingface dataset:
Revolutionizing trade finance: leveraging the power of blockchain and AI in electronic letters of credit
Authors: Elahi Nezhad Moein , Rashidian Shima , Botta Consiglia
Published: July 2024

This article examines the innovative combination of blockchain and artificial intelligence (AI) technologies in the field of electronic letters of credit and international trade finance. It explores how the combined effect of this convergence may greatly improve the security, effectiveness, and clarity of trade finance procedures. The article presents a suggested framework for combining various technologies, focusing on important design considerations including security, trust, interoperability, and adherence to international trade norms. The technological design blends blockchain’s decentralized ledger with AI’s analytical capabilities, highlighting the need of smart contracts, data management, and application programming interfaces for smooth interoperability. The implementation plan and stages are meticulously detailed, emphasizing the systematic approach necessary for effective integration. The article also discusses the problems and dangers related to this technology integration, such as technical obstacles, regulatory compliance, security threats, stakeholder acceptance, and cost factors. The conclusion outlines the impact of blockchain and AI on trade finance, discusses their larger implications for international commerce, and advocates for the adoption of these advanced technologies by collective action. This article seeks to provide significant insights to financial institutions, policy-makers, technologists, and stakeholders in the trade finance sector, promoting the modernization of trade finance via new technology.
XVIAmerican Literature: The Twentieth Century
Authors: Gifford James , Peppard Anna , Kidder Orion Ussner , Rudder Adam , Velásquez Antonio
Published: July 2024

This chapter has nine sections: 1. Poetry; 2. Fiction 1900–1945; 3. Fiction since 1945; 4. Genre Fiction; 5. Drama; 6. Comics; 7. African American Writing; 8. Native Writing; 9. Latino/a, Asian American, and General Ethnic Writing. Section 1 is by James Gifford; section 2 will resume next year; section 3 will resume next year; section 4 is by James Gifford; section 5 will resume next year; section 6(a) is by Anna Peppard; section 6(b) is by Orion Ussner Kidder; section 7 is by Adam Rudder; section 8 will resume next year; section 9 is by Antonio Velásquez.

Very few titles were received for 2022 last year. This year includes more late arrivals than is typical.
A Novel Member of miR169 Family Negatively Regulates Maize Resistance Against Bipolaris maydis
Authors: Xie Shanshan , Li Han , Lu Jiale , Li Jing , Song Zheng , Jiang Haiyang
Published: July 2024

MicroRNAs (miRNAs) have been confirmed to play important roles in plant defense response. However, the key maize miRNAs involved in the defense response against Bipolaris maydis are very limited. In this study, a novel member of the miR169 family in response to B. maydis, named zma-miR169s, was discovered and investigated. The expression levels of pre-miR169s and zma-miR169s were significantly repressed during B. maydis infection. The CRISPR/Cas9-induced zma-miR169s mutant exhibited more resistance against B. maydis, whereas overexpression of zma-miR169s enhanced susceptibility, supporting that zma-miR169s might play a negative role in maize resistance. Moreover, RNA-seq and Gene Ontology analysis showed that differentially expressed genes were highly enriched in the oxidation-reduction process and plant hormone pathway. Hence, reactive oxygen species (ROS) and plant hormone levels were further investigated. ROS detection confirmed that the zma-miR169s mutant accumulated more ROS, while less ROS was detected in transgenic maize OE-miR169s. Furthermore, more remarkable changes in PR-1 expression levels and salicylic acid (SA) contents were detected in the zma-miR169s mutant compared with wild-type and transgenic maize during B. maydis infection. Additionally, nuclear transcription factors (NF-YA1 and NF-YA13) were identified as targets regulated by zma-miR169s through the agrobacterium-mediated transient expression method. Overexpression of ZmNF-YA13 enhanced Arabidopsis resistance to Pseudomonas syringae pv. tomato DC3000. Taken together, our results suggest that zma-miR169s negatively regulates maize defense responses by influencing ROS accumulation and the SA-dependent signaling pathway.
Baseline Sensitivity and Toxicity Mechanisms of Prochloraz to Alternaria alternata Strains Associated with Maize Leaf Blight in Heilongjiang Province in China
Authors: Shen Guijin , Teng Haolin , Sun Jingzheng , Xu Xi , Jiao Chenyang , Fan Xiaoya , Zhou Ping , Wang Xiangjing , Xiang Wensheng , Zhao Junwei
Published: July 2024

Alternaria species are fungal pathogens that can infect maize, causing leaf blight disease and significant economic losses. This study aimed to determine the baseline sensitivity to prochloraz of A. alternata isolates obtained from diseased maize leaves collected from Heilongjiang Province by assessing the half-maximal effective concentration (EC50) values. The EC50 values of prochloraz ranged from 0.0550 to 2.3258 μg/ml, with an average of 0.9995 ± 0.5192 μg/ml. At EC50 (1.2495 μg/ml) and 2EC50 (2.4990 μg/ml), prochloraz increased the number of mycelial offshoots, disrupted the cell membrane integrity of conidia and mycelia, and resulted in a reduced ergosterol content in the mycelia. Prochloraz significantly affected the mycelial cell membrane permeability and increased the malondialdehyde content and superoxide dismutase activity. No cross-resistance was detected between prochloraz and other fungicides. These data demonstrate that prochloraz is a promising fungicide for managing maize leaf blight caused by A. alternata and provide novel insights into understanding the mechanism of prochloraz toxicity against A. alternata isolates.
Catfish spine injury to the hand with transient lymphangitis
Authors: Carhart Philip , Espinosa James , Tandra Riya , Lucerna Alan
Published: July 2024

This case report describes a 45-year-old man whose left hand was skewered by a catfish spine while he was attempting to dehook the fish. Catfish spines can create punctures, lacerations, and foreign body injuries. The catfish spine generally is serrated, which can make removal difficult.
Benefits of dermoscopy in primary care
Authors: Middleton Hayden T. , Boswell Christopher L. , Strelow Brittany A. , Young Peter A. , Sartori-Valinotti Julio C. , Swanson David L.
Published: July 2024

Skin cancer is the most common cancer in the United States, with an estimated 9,500 new diagnoses made each day. Dermoscopy (also called dermatoscopy) is an established clinical approach to improving skin cancer evaluation. However, only 8% to 9% of primary care physicians use it, and no data are available for physician associate/assistant or NP use. This article reports a dermoscopy algorithm that primary care providers can use to increase the detection of skin cancer and reduce unnecessary referrals and biopsies.
Using structured communication to improve patient handoffs and reduce medical errors
Authors: Klocko David J.
Published: July 2024

Communication errors during transfer of care from one clinician to another are a major cause of medical errors. In 2006, The Joint Commission made handoff communications a national patient safety goal. In 2014, the Association of American Medical Colleges included giving and receiving a report to transfer a patient's care as one of the 13 core entrustable professional activities required for entry into residency programs. Communication is the key to successful transfer of patient care from one clinician to another during shift change. A structured method of communication used by all clinicians in high-stakes healthcare settings can ensure all vital information about a patient is given to the receiving clinician.
Can fracture liaison services prevent second fractures in patients with osteoporosis?
Authors: McKenna Robert E.
Published: July 2024

Patients who have had fractures are at increased risk for a second or fragility fracture. A fracture liaison service (FLS), often staffed or led by physician associates/assistants or NPs, may help reduce second fractures and patient mortality. This article reviews FLSs and their effectiveness.
Improving Neonatal Resuscitation Knowledge in Advanced Providers Through Simulation
Authors: Snarr Tory , Masciola Randee , Sayre Christine , Sharpe Elizabeth
Published: July 2024

Background:

Advanced neonatal resuscitation events are high-risk, low-volume critical situations. Healthcare systems have placed emphasis on improving resuscitation skills for advanced providers based on evidence showing that it can directly impact patient outcomes. Neonatal resuscitation program (NRP) renewal is only required every 2 years. This gap and low usage of skills can result in lack of competency and expertise leading to an increased risk of poor patient outcomes.

Purpose:

This project aimed to provide simulation education based on NRP curriculum for a large group of advanced providers at multiple level II, III, and IV neonatal intensive care units (NICUs) and to improve confidence and knowledge in advanced resuscitation.

Methods:

A high-fidelity mannequin was used to simulate a reproducible, critical scenario that spanned the entire NRP algorithm. NRP knowledge and the effectiveness of simulation on confidence and knowledge in neonatal resuscitation were measured.

Results:

The average knowledge score from the pretest to the posttest improved by 7%. Based on the simulation evaluation tool-modified (SET-M), debriefing was the most effective in improving confidence and knowledge. The neonatal nurse practitioners (NNPs) with the most years of clinical experience had the largest improvement in knowledge.

Implications for Practice and Research:

With the most experienced NNPs providing majority of coverage in the Level II NICUs, a correlation may be drawn that the effect of simulations on NRP knowledge has a greater impact on these groups due to the low exposure of advanced resuscitation events at these sites. Debriefing stood out as the most critical component of simulation.
The Lifelines Cohort Study: Prevalence of Tinnitus Associated Suffering and Behavioral Outcomes in Children and Adolescents
Authors: Meijers Sebastiaan M. , de Ruijter Jessica H. J. , Stokroos Robert J. , Smit Adriana L. , Stegeman Inge
Published: July 2024

Objectives:

Tinnitus in children and adolescents is relatively unexplored territory. The available literature is limited and the reported prevalence of tinnitus suffering varies widely due to the absence of a definition for pediatric tinnitus. The impact on daily life seems to be lower than in the adult population. It is unclear if children who suffer from tinnitus, like adults, also experience psychological distress like anxiety or depressive symptoms. A better understanding of tinnitus in children and its impact on daily life could provide more insight into the actual size of the problem and could give direction for future studies to investigate the cause of progression of tinnitus.

Design:

A cross-sectional study was performed using the Dutch Lifelines population-based cohort of people living in the north of the Netherlands. A total of 4964 children (4 to 12 years of age) and 2506 adolescents (13 to 17 years of age) were included. The presence of tinnitus suffering and behavioral outcomes were assessed with a single-item question and the Child Behavioral Checklist or the Youth Self Report questionnaire respectively. The associations of behavioral outcomes and tinnitus suffering were analyzed using univariate binary regressions.

Results:

The prevalence of tinnitus suffering in children was 3.3 and 12.8% in adolescents. Additionally, 0.3% of the children and 1.9% of the adolescents suffered a lot or extremely of their tinnitus. Externalizing and internalizing problems were associated with tinnitus in adolescents. Internalizing problems were associated with tinnitus in children.

Conclusions:

The prevalence of tinnitus suffering in this sample of the general population is comparable to other population-based studies. A low percentage of children (0.3%) or adolescents (1.9%) suffered a lot or extremely of their tinnitus. Tinnitus suffering is associated with all behavioral outcome subscales in adolescents and with internalizing problems in children, although the effect sizes were very small. Future research should focus on achieving a consensus for the definition of pediatric tinnitus and on the development of a validated outcome measure.
Patient-reported outcomes in neuro-oncology
Authors: Scheepens Josien C.C. , Taphoorn Martin J.B. , Koekkoek Johan A.F.
Published: July 2024

Purpose of review

To provide up-to-date evidence on patient-reported outcomes (PROs) in neuro-oncology, with a focus on the core constructs of health-related quality of life (HRQoL) and the use of PROs in clinical trials and clinical practice.

[Supplemental Digital Content: Video Abstract PROs in Neuro-Oncology.mov]

Recent findings

PROs are gaining importance in brain tumor research and medical care. For patients with a brain tumor, core PRO constructs are pain, difficulty communicating, perceived cognition, seizures, symptomatic adverse events, physical functioning and role and social functioning, which are assessed through patient-reported outcome measures (PROMs). Initiatives have been taken to improve the reliability and robustness of PRO data, including standardization of items included in clinical trial protocols (the SPIRIT-PRO extension) and formulation of PRO priority objectives for use in clinical trials (the SISAQOL-Innovative Medicines Initiative). In brain tumor patients with cognitive impairment, caregiver-reported outcomes may complement or replace PROs to increase accuracy. The next key challenge will be to widely implement PROs and apply PRO data in clinical practice to benefit patients with brain tumors.

PROs are clinically relevant endpoints providing information only known by the patient. Standardization of the use of PROs in clinical trials and wide implementation in clinical practice is needed to improve HRQoL of brain tumor patients.
Evaluating the Internet as a Source of Information for Patients With Hidradenitis Suppurativa: A Review of Websites' Content, Insights Into Engagement, and Access
Authors: Karamitros Georgios , Antonios-Vlachos Georgios , Kok Charlene , Goulas Sofoklis , Lamaris Gregory A.
Published: July 2024

BACKGROUND

The Internet has become the primary information source for patients, with most turning to online resources before seeking medical advice.

OBJECTIVE

The aim of this study is to evaluate the quality of online information on hidradenitis suppurativa available to patients.

METHODS

The authors performed an Internet search using the search terms “hidradenitis suppurativa,” “hidradenitis suppurativa treatment,” “hidradenitis suppurativa surgery,” and “acne inversa.” They identified the initial 100 websites from Google, Yahoo, and Bing. Websites were evaluated based on the modified Ensuring Quality Information for Patients instrument.

RESULTS

Of the 300 websites, 95 (31.7%) were incorporated after accounting for the exclusion criteria: duplicate entries, websites not pertinent to the subject matter, websites inaccessible due to location restrictions or necessitating user accounts for access, websites in languages other than English, and websites originating from scientific publications directed at a scientific audience rather than the general population. Ensuring Quality Information for Patients scores ranged from 5 to 30/36, with a median of 17.

CONCLUSION

This analysis unveils a diverse array of websites that could confound patients navigating toward high-caliber resources. These barriers may hinder the access to top-tier online patient information and magnify disparities in referral rates, patient engagement, treatment satisfaction, and quality of life.
Carnitine is causally associated with susceptibility and severity of sepsis: a Mendelian randomization study
Authors: Zhang Qingju , Liu Xilong , Shen Qi , Wang Xingfang , Pang Jiaojiao , Chen Yuguo
Published: July 2024

Background

Energy metabolism disorders contribute to the development of sepsis. Carnitine is essential for fatty acid metabolism and energy production. Therefore, we aimed to explore whether there is a causal relationship between carnitine levels and sepsis.

Methods

Two-sample Mendelian randomization (MR) analysis was performed. The single nucleotide polymorphisms (SNPs) of carnitine from the genome-wide association (GWAS) study were used as exposure instrumental variables, and the susceptibility and severity of sepsis in the UK Biobank were used as outcomes. The inverse-variance weighted (IVW), MR-Egger, and weighted median methods were used to evaluate the causal relationship between exposure and outcomes. Heterogeneity was assessed using IVW and MR-Egger’s and Cochran’s Q tests, and pleiotropy was tested using the MR-Egger intercept and MR-PRESSO.

Results

Using the IVW method, a one-standard-deviation increase in genetically determined carnitine levels was found to be associated with increased susceptibility to sepsis in populations under 75 years of age (odds ratio [OR]: 2.696; 95% confidence interval [CI]: 1.127–6.452; P = 0.026) and increased severity of sepsis (OR: 22.31; 95% CI: 1.769–281.282; P = 0.016). Sensitivity analysis did not reveal heterogeneity or horizontal pleiotropy; therefore, the results indicated robustness.

Conclusion

Genetic susceptibility to increased carnitine levels in the blood may increase the susceptibility and severity of sepsis. Therefore, interventions at an early stage in patients with high carnitine levels may reduce the risk of developing sepsis.
Efficacy and safety of anticoagulation in cardiac arrest: a systematic review and meta-analysis
Authors: Zong Mengzhi , Tian Rui , Zhang Jiajun , Li Chuanbao , Chen Yuguo
Published: July 2024

Background

Evidence on the effectiveness of anticoagulation therapy in patients with cardiac arrest is scarce. We aimed to compare the effectiveness of anticoagulation therapy in patients with cardiac arrest by systematic evaluation and meta-analysis.

Methods

The PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) guidelines were followed. We searched PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials from database inception until December 31, 2022, comparing adjuvant anticoagulation to standard care during cardiac arrest. Odds ratios with 95% confidence intervals were calculated using a random-effects model. The population included adults with cardiac arrest in any setting. Pairs of investigators reviewed studies for relevance, extracted data, and assessed the risk of bias. This study was registered with PROSPERO (International Prospective Register of Systematic Reviews).

Results

Four studies were included in the final meta-analysis (1 randomized controlled trial, 1 nonrandomized controlled trial, and 2 observational studies). A total of 1374 patients (412 in the intervention group and 962 in the control group) were included. The results show that anticoagulant interventions increased return of spontaneous circulation compliance compared with control, improved neurological prognosis, and are potentially associated with in-hospital survival. The risk of bleeding in the intervention and control groups and 24-hour survival between these groups were not significantly different.

Conclusion

Anticoagulation during cardiac arrest was associated with achieving return of spontaneous circulation, improving survival to hospitalization, and potentially ameliorating neurologic prognosis in patients. Moreover, anticoagulation did not increase the incidence of bleeding events.
Bowman Layer Transplantation With Stromal Inclusion Using Femtosecond Laser: 3-Year Results
Authors: Estrada-Mata Aranza Guadalupe , Benedetti Sandner Mónica , García de Oteyza Gonzalo , Gutiérrez-García Diana Karla , Nishimura-Crespo Areli , De la Torre González Carlos Enrique , De Wit Carter Guillermo , García-Albisua Ana Mercedes
Published: July 2024

Purpose:

The aim of this study was to evaluate the 3-year clinical results of Bowman layer with stromal inclusion (Bowman layer) transplantation using femtosecond laser for patients with advanced keratoconus.

Methods:

This single-center retrospective study included 7 eyes of 7 patients diagnosed with progressive keratoconus who underwent Bowman layer transplantation with stromal inclusion between 2018 and 2020. Follow-up was carried out from the date of surgery until 36 months later. Bowman layer grafts were positioned into a mid-stromal pocket performed by a femtosecond laser and patients were evaluated up to 3 years after surgery.

Results:

Corneal flattening of 5.49 D (P = 0.0020) in Kmax was observed, increased in corneal pachymetry, and an improvement best-corrected visual acuity measured in logarithm of minimum angle of resolution (LogMAR) from 0.89 to 0.60 and tolerance to contact lens from 42% of the patients to 100% of them. Stabilization of the cornea was achieved in 100% with no further progression of the keratoconus; all surgical procedures were uneventful, and no complications were observed during the 3 years of follow-up.

Conclusions:

Bowman layer transplantation with stromal inclusion flattened the cornea improving best-corrected visual acuity and contact lens tolerance and stabilized keratoconus in 100% of the patients during 3 years of follow-up and may be a feasible option in patients with advanced and progressive KC to delay or avoid the need for PK or DALK.
Pentavalent Rotavirus Vaccine Coverage and Trends in Rotavirus Detection Before and After This Vaccination in Chengdu, China
Authors: Xiao Guoguang , Zhu Tingting , Wang Zhiling , Xie Xiaoping , Shu Min , Gao Shan , Wang Liyuan , Zhou Wei , Deng Jianjun , Xie Yongmei , Yu Fan
Published: July 2024

Pentavalent rotavirus vaccine (RV5) coverage and changes in rotavirus detection in the prevaccine and postvaccine era in Chengdu were investigated. The results showed that the coverage of RV5 had been increasing but still relatively low. Nevertheless, the dramatical decline in the rotavirus detection was observed after the introduction of RV5. Efforts to improve the coverage of rotavirus vaccination should continue to maximize the public health benefits.
Population Attributable Risk of Wheeze in 2–<6-Year-old Children, Following a Respiratory Syncytial Virus Lower Respiratory Tract Infection in The First 2 Years of Life
Authors: Madhi Shabir A. , Ceballos Ana , Cousin Luis , Domachowske Joseph B. , Langley Joanne M. , Lu Emily , Puthanakit Thanyawee , Rämet Mika , Tan Amy , Zaman Khalequ , Anspach Bruno , Bueso Agustin , Cinconze Elisa , Colas Jo Ann , D’Andrea Ulises , Dieussaert Ilse , Englund Janet A. , Gandhi Sanjay , Jose Lisa , Karhusaari Hanna , Kim Joon Hyung , Klein Nicola P. , Laajalahti Outi , Mithani Runa , Ota Martin O. C. , Pinto Mauricio , Silas Peter , Stoszek Sonia K. , Tangsathapornpong Auchara , Teeratakulpisarn Jamaree , Virta Miia , Cohen Rachel A.
Published: July 2024

Background:

There is limited evidence regarding the proportion of wheeze in young children attributable to respiratory syncytial virus lower respiratory tract infections (RSV-LRTI) occurring early in life. This cohort study prospectively determined the population attributable risk (PAR) and risk percent (PAR%) of wheeze in 2–<6-year-old children previously surveilled in a primary study for RSV-LRTI from birth to their second birthday (RSV-LRTI<2Y).

Methods:

From 2013 to 2021, 2-year-old children from 8 countries were enrolled in this extension study (NCT01995175) and were followed through quarterly surveillance contacts until their sixth birthday for the occurrence of parent-reported wheeze, medically-attended wheeze or recurrent wheeze episodes (≥4 episodes/year). PAR% was calculated as PAR divided by the cumulative incidence of wheeze in all participants.

Results:

Of 1395 children included in the analyses, 126 had documented RSV-LRTI<2Y. Cumulative incidences were higher for reported (38.1% vs. 13.6%), medically-attended (30.2% vs. 11.8%) and recurrent wheeze outcomes (4.0% vs. 0.6%) in participants with RSV-LRTI<2Y than those without RSV-LRTI<2Y. The PARs for all episodes of reported, medically-attended and recurrent wheeze were 22.2, 16.6 and 3.1 per 1000 children, corresponding to PAR% of 14.1%, 12.3% and 35.9%. In univariate analyses, all 3 wheeze outcomes were strongly associated with RSV-LRTI<2Y (all global P < 0.01). Multivariable modeling for medically-attended wheeze showed a strong association with RSV-LRTI after adjustment for covariates (global P < 0.0001).

Conclusions:

A substantial amount of wheeze from the second to sixth birthday is potentially attributable to RSV-LRTI<2Y. Prevention of RSV-LRTI<2Y could potentially reduce wheezing episodes in 2–<6-year-old children.
The Role of Breastfeeding in Acute Respiratory Infections in Infancy
Authors: Vassilopoulou Emilia , Agostoni Carlo , Feketea Gavriela , Alberti Ilaria , Gianni Maria Lorella , Milani Gregorio Paolo
Published: July 2024

Background:

Acute respiratory infections (ARIs) affect the respiratory tract, are often caused by viruses such as respiratory syncytial virus and rhinovirus, and present symptoms such as coughing, fever, respiratory distress, and breathing difficulty. The global adherence to exclusive breastfeeding (BF) for the first 6 months of life has reached 44%, supported by the World Health Organization and United Nations International Children’s Emergency Fund efforts. BF provides vital nutrients and contributes to infant immune system development, protecting against infections. The role of BF in preventing and reducing complications of ARIs in infants is gaining attention, prompting a review of current data and future research needs. This review aims to summarize the evidence on the role of BF in reducing the risk and severity of ARIs in infants, elucidate the adaptations in breast milk composition during infections, and identify relevant research needs.

Methods and Results:

Human milk (HM) is rich in immunoglobulins, antimicrobial peptides, and immunomodulatory factors that protect against various pathogens, including respiratory viruses. Several studies have demonstrated that BF is associated with a significant reduction in hospitalization, oxygen requirements, and mortality in infants with ARIs. The effectiveness of BF varies according to the specific respiratory virus, and a longer duration of exclusive BF appears to enhance its protective effect. It is documented that the composition of HM adjusts dynamically in response to infections, fortifying the infant’s immune defenses. Specific immunological components of HM, including leukocytes and immunoglobulins, increase in response to infection in the infant, contributing to the enhancement of the immune defense in infants. Immune-boosting microRNAs enhance immune transfer to the infants and promote early gut maturation, and the HM microbiome along with other factors modifies the infant’s gut microbiome and immune system.

Conclusions:

BF defends infants from respiratory infections, and the investigation of the microRNAs in HM offers new insights into its antiviral properties. The promotion of BF, especially in vulnerable communities, is of paramount importance in alleviating the global burden of ARIs in infancy.
Respiratory Syncytial Virus Hospital Admission Rates and Patients’ Characteristics Before the Age of 2 Years in England, 2015–2019
Authors: Fonseca Maria João , Hagenaars Saskia , Bangert Mathieu , Flach Clare , Hudson Richard D.A.
Published: July 2024

Background:

A granular understanding of respiratory syncytial virus (RSV) burden in England is needed to prepare for new RSV prevention strategies. We estimated the rates of RSV hospital admissions before the age of 2 years in England and described baseline characteristics.

Methods:

A birth cohort of all infants born between March 1, 2015, and February 28, 2017 (n = 449,591) was established using Clinical Practice Research Datalink-Hospital Episode Statistics. Case cohorts included infants with admission for (1) RSV, (2) bronchiolitis, (3) any respiratory tract infection (RTI) <24 months and (4) RSV predicted by an algorithm <12 months. Baseline characteristics were described in the case and comparative cohorts (infants without corresponding admission). Cumulative incidence and admission rates were calculated. Multiple linear regression was used to estimate the proportion of RTI healthcare visits attributable to RSV.

Results:

The RSV-coded/RSV-predicted case cohorts were composed of 4813/12,694 infants (cumulative incidence: 1.1%/2.8%). Case cohort infants were more likely to have low birth weight, comorbidities and to be born during RSV season than comparative cohort infants, yet >77% were term-healthy infants and >54% were born before the RSV season. During the first year of life, 11.6 RSV-coded and 34.4 RSV-predicted hospitalizations occurred per 1000 person-years. Overall, >25% of unspecified lower RTI admissions were estimated to be due to RSV.

Conclusions:

In England, 1 in 91 infants had an RSV-coded admission, likely underestimated by ~3-fold. Most infants were term-healthy infants born before the RSV season. To decrease the total burden of RSV at the population level, immunization programs need to protect all infants.
Acute Focal Bacterial Nephritis without Pyuria: A Peculiar Subtype of Urinary Tract Infection
Authors: Tu Juan , Lin Tiantian , Li Huarong , Chen Chaoying
Published: July 2024

Acute focal bacterial nephritis (AFBN) without pyuria is a subtype of urinary tract infection in children, often leading to diagnostic challenges. The clinical characteristics of 6 children diagnosed with AFBN, who exhibited an absence of pyuria, were retrospectively summarized and compared with the control group consisting of 49 hospitalized AFBN children with pyuria. The cases of AFBN without pyuria presented with more severe inflammatory responses and were predisposed to complications, such as sepsis and neurologic abnormalities.
Pilomatrixoma of the Periorbital Region: A Retrospective Review
Authors: Sidhu Amitouj S. , Allende Alexandra , Gal Andrew , Tumuluri Krishna
Published: July 2024

Purpose:

Pilomatrixoma is a benign cutaneous adnexal tumor that differentiates toward hair follicle cells. It infrequently occurs in the periorbital region. In the periorbital area, it is often located in the upper eyelid and eyebrow region. Periorbital pilomatrixoma is often misdiagnosed clinically and is less common than other benign skin tumors. In this retrospective review, we evaluate the demographic, clinical, and histopathological data of patients with periorbital pilomatrixoma, treated from 2010 to 2023.

Methods:

A retrospective analysis of periorbital pilomatrixoma cases treated during a period of 13 years was performed. Deidentified data in relation to the age at surgical excision, gender, location, size, histopathological features, treatment, and recurrence were collected. All histological slides were reviewed by an attending histopathologist.

Results:

A total of 77 cases of periorbital pilomatrixoma were diagnosed by histopathological examination and treated from 2010 to 2023. A slight female preponderance (56%) was noted, and the majority of cases (52%) were presented in the first 2 decades of life. The left periorbital region was involved in 45.5% of cases, and 54.5% in the right. The upper lid was the most affected site. Two cases of recurrence were reported. No malignant transformation was noted.

Conclusions:

Pilomatrixoma is an uncommon benign periorbital tumor, commonly misdiagnosed clinically. Ophthalmologists and surgeons should suspect pilomatrixoma in the periorbital region, especially in children or young adults. Complete surgical excision is curative, and recurrence is rare.
Evaluation of the Efficacy of Therapeutic and Prophylactic Anticoagulation in COVID-19 Patients With Venous Catheter and Its Correlation With Clinical Outcomes
Authors: Negaresh Mohammad , Ghobadi Hassan , Hoseininia Saeed , Samadi Takaldani Ali Hossein , Javanshir Nima , Iranijam Effat , Aslani Mohammad Reza
Published: July 2024

Introduction

The COVID-19 disease was first detected in December 2019, and since then, various treatments have been used to manage it. One such treatment method is therapeutic plasma exchange. This method involves implanting a venous catheter, which increases the risk of venous thromboembolism (VTE). Other risk factors for VTE include infections like COVID-19, inflammation, or malignancy.

Materials and Methods

In this retrospective study, patients with acute respiratory syndrome caused by COVID-19 who were hospitalized and had venous catheters inserted for therapeutic plasma exchange were enrolled. The prophylactic anticoagulant dose was started for all patients, and after the diagnosis of VTE, it was changed to the therapeutic dose. Patients' information, including demographic data, clinical information, and laboratory findings, was extracted from patients' records and recorded in a checklist designed for each patient.

Results

From a total of 168 patients, 26 were diagnosed with VTE (pulmonary embolism in 5 patients and deep vein thrombosis in 21 patients). The prevalence of VTE in COVID-19 patients with the venous catheter was 15.4%. The right femoral vein was the most used route for catheterization and had the highest occurrence of venous thromboses. The patients diagnosed with thrombosis showed a lower mortality rate, higher D-dimer and lactate dehydrogenase levels, and lower platelet counts.

Conclusions

This study showed a higher risk of VTE and subclinical thrombosis in COVID-19 patients with venous catheters. Continuous screening, higher doses of anticoagulants, and early removal of venous catheters are critical in preventing VTE and mortality.
Central nervous system active medication use in Medicare enrollees receiving home health care: association with chronic pain and anxiety level
Authors: Raji Mukaila A. , Shah Rohan , Westra Jordan R. , Kuo Yong-Fang
Published: July 2024

No comparative effectiveness data exist on nonopioid analgesics and nonbenzodiazepine anxiolytics to treat pain with anxiety. We examined the relationship between drug class and central nervous system (CNS) active drug polypharmacy on pain and anxiety levels in Medicare enrollees receiving home health (HH) care. This retrospective cohort study included enrollees with diagnoses and 2+ assessments of pain and anxiety between HH admission and discharge. Three sets of linear regression difference-in-reduction analyses assessed the association of pain or anxiety reduction with number of drugs; drug type; and drug combinations in those with daily pain and daily anxiety. Logistic regression analysis assessed the effect of medication number and class on less-than-daily pain or anxiety at HH discharge. A sensitivity analysis using multinomial regression was conducted with a three-level improvement to further determine clinical significance. Of 85,403 HH patients, 43% received opioids, 27% benzodiazepines, 26% gabapentinoids, 32% selective serotonin reuptake inhibitors, and 8% serotonin and norepinephrine reuptake inhibitors (SNRI). Furthermore, 75% had depression, 40% had substance use disorder diagnoses, and 6.9% had PTSD diagnoses. At HH admission, 83%, 35%, and 30% of patients reported daily pain, daily anxiety, and both, respectively. Central nervous system polypharmacy was associated with worse pain control and had no significant effect on anxiety. For patients with daily pain plus anxiety, pain was best reduced with one medication or any drug combination without opioid/benzodiazepine; anxiety was best reduced with combinations other than opiate/benzodiazepine. Gabapentinoids or SNRI achieved clinically meaningful pain control. Selective serotonin reuptake inhibitors provided clinically meaningful anxiety relief.
Beyond the chronic pain stage: default mode network perturbation depends on years lived with back pain
Authors: Heukamp Nils Jannik , Moliadze Vera , Mišić Mina , Usai Katrin , Löffler Martin , Flor Herta , Nees Frauke
Published: July 2024

Research has indicated that the default mode network (DMN) is perturbated in patients with chronic pain when compared with healthy controls, and this perturbation is correlated with the duration of pain during the chronic pain stage. It remains unclear whether DMN adaptations manifest during the subacute pain stage and progress over time because of the duration of pain experience, rather than being a specific correlate of the chronic pain stage. Furthermore, information regarding whether these adaptations are related to cognitive processes of adaptation is lacking. To this end, we examined the DMN in 31 patients with chronic back pain (CBP), 77 patients with subacute back pain (SBP), as well as 39 healthy pain-free controls (HC) applying a graph-theoretic network approach on functional resting-state magnetic resonance imaging. Beyond the comparison between groups, we used a linear analysis considering the years lived with pain (YLP) across all patients with back pain and additionally performed a mediation analysis of the role of cognitive pain coping. In line with previous studies, we found significant DMN perturbation in CBP compared with HC. However, this did not apply to the comparison of CBP with SBP. Instead, we observed a positive correlation between DMN perturbation and YLP. This was significantly mediated by coping attitudes towards pain. Default mode network perturbation may thus reflect neural adaptation processes to pain experience rather than a single correlate of the chronic pain stage and be modulated by cognitive adaption. This points to potentially underinvestigated significant adaptation processes that could enable more fine-grained patient stratification.
The type, duration, and severity of pretransplant kidney injury predict prolonged kidney dysfunction after liver transplantation
Authors: Dixon Wesley , Feng Sandy , Roll Garrett R. , Tavakol Mehdi , Fenton Cynthia , Cullaro Giuseppe
Published: July 2024

Chronic kidney disease (CKD) is a major complication of liver transplantation (LT) associated with substantial morbidity and mortality. Knowing the drivers of post-LT kidney dysfunction—with a granular focus on the type, duration, and severity of pre-LT kidney disease—can highlight intervention opportunities and inform dual-organ allocation policies. We retrospectively analyzed predictors of safety net kidney after liver transplant (KALT) eligibility and kidney replacement therapy (KRT) for > 14 days after LT. Among 557 recipients of adult deceased-donor LT, 49% had normal kidney function, 25% had acute kidney injury (AKI), and 25% had CKD±AKI at the time of LT. A total of 36 (6.5%) qualified for KALT and 63 (11%) required KRT > 14 days. In univariable analysis, factors associated with KALT eligibility and KRT > 14 days, respectively, included stage 3 AKI (OR 7.87; OR 7.06), CKD±AKI (OR 4.58; OR 4.22), CKD III-V duration (OR 1.10 per week; OR 1.06 per week), and increasing CKD stage (stage III: OR 3.90, IV: OR 5.24, V: OR 16.8; stage III: OR 2.23, IV: OR 3.62, V: OR 19.4). AKI stage I-II and AKI duration in the absence of CKD were not associated with the outcomes. Pre-LT KRT had a robust impact on KALT eligibility (OR 4.00 per week) and prolonged post-LT KRT (OR 5.22 per week), with 19.8% of patients who received any pre-LT KRT ultimately qualifying for KALT. Eligibility for KALT was similar between those who received 0 days and ≤ 14 days of KRT after LT (2.1% vs. 2.9%, p = 0.53). In conclusion, the type, duration, and severity of pre-LT kidney dysfunction have unique impacts on post-LT kidney-related morbidity, and future research must use these novel classifications to study mitigation strategies.
Association of intravenous digoxin use in acute heart failure with rapid atrial fibrillation and short-term mortality according to patient age, renal function, and serum potassium
Authors: Miró Òscar , Martín Mojarro Enrique , Lopez-Ayala Pedro , Llorens Pere , Gil Víctor , Alquézar-Arbé Aitor , Bibiano Carlos , Pavón José , Massó Marta , Strebel Ivo , Espinosa Begoña , Mínguez Masó Silvia , Jacob Javier , Millán Javier , Andueza Juan Antonio , Alonso Héctor , Herrero-Puente Pablo , Mueller Christian ,   on behalf of the investigators of the ICA-SEMES research group
Published: July 2024

Background

Intravenous digoxin is still used in emergency departments (EDs) to treat patients with acute heart failure (AHF), especially in those with rapid atrial fibrillation. Nonetheless, many emergency physicians are reluctant to use intravenous digoxin in patients with advanced age, impaired renal function, and potassium disturbances due to its potential capacity to increase adverse outcomes.

Objective

We investigated whether intravenous digoxin used to treat rapid atrial fibrillation in patients with AHF may influence mortality in patients with specific age, estimated glomerular filtration rate (eGFR), and serum potassium classes.

Design

A secondary analysis of patients included in in the Spanish EAHFE cohort, which includes patients diagnosed with AHF in the ED.

Setting

45 Spanish EDs.

Participants

Two thousand one hundred ninety-four patients with AHF and rapid atrial fibrillation (heart rate ≥100 bpm) not receiving digoxin at home, divided according to whether they were or were not treated with intravenous digoxin in the ED.

Outcome

The relationships between age, eGFR, and potassium with 30-day mortality were investigated using restricted cubic spline (RCS) models adjusted for relevant patient and episode variables. The impact of digoxin use on such relationships was assessed by checking interaction.

Main results

The median age of the patients was 82 years [interquartile range (IQR) = 76–87], 61.4% were women, 65.2% had previous episodes of atrial fibrillation, and the median heart rate at ED arrival was 120 bpm (IQR = 109–135). Digoxin and no digoxin groups were formed by 864 (39.4%) and 1330 (60.6%) patients, respectively. There were 191 deaths within the 30-day follow-up period (8.9%), with no differences between patients receiving or not receiving digoxin (8.5 vs. 9.1%,P = 0.636). Although analysis of RCS curves showed that death was associated with advanced age, worse renal function, and hypo- and hyperkalemia, use of intravenous digoxin did not interact with any of these relationships (P = 0.156 for age,P = 0.156 for eGFR;P = 0.429 for potassium).

Conclusion

The use of intravenous digoxin in the ED was not associated with significant changes in 30-day mortality, which was confirmed irrespective of patient age or the existence of renal dysfunction or serum potassium disturbances.
Diagnostic accuracy of point-of-care cardiac ultrasound for acute coronary syndromes in patients presenting with chest pain to the emergency department: a single-center prospective study
Authors: Bima Paolo , Agishev Ilya , Fucile Ilaria , de Stefano Giuliano , Morello Fulvio , Mueller Christian , Nazerian Peiman ,   on behalf of the WINFOCUS study group
Published: July 2024

Background and importance

The diagnostic accuracy of focused cardiac ultrasound (FoCUS) performed in patients presenting to the emergency department (ED) with chest pain is currently unknown.

Objective

The objective of this study was to assess the diagnostic accuracy of regional wall motion abnormalities detected with FoCUS for non-ST-elevation acute coronary syndrome (NSTE-ACS) diagnosis.

Design

A Single-center prospective observational study conducted in 2022 in the ED of the University Hospital Careggi, Italy.

Setting and participants

Adult patients presenting to the ED with acute nontraumatic chest pain were enrolled, irrespective of the presence of previous regional wall motion abnormalities. Patients with ST-segment elevation myocardial infarctions and patients with hemodynamic instability were excluded. FoCUS was performed at presentation by a trained ED physician.

Outcome measures and analysis

The final diagnosis of NSTE-ACS vs. alternative diagnosis was adjudicated by an ED physician blinded to FoCUS results after a 30-day follow-up. To assess if regional wall motion abnormalities were an independent predictor of NSTE-ACS, a multivariable logistic regression model was built. Diagnostic performance measures were calculated. A sensitivity analysis considering only type-1 NSTEMIs (i.e. plaque rupture/thrombosis) was conducted.

Main results

Among 686 patients, NSTE-ACS was adjudicated in 106 (15.5%) patients, 67 of which were NSTEMIs. A total of 87 (12.7%) patients had regional wall motion abnormalities detected by FoCUS, which were an independent predictor of NSTE-ACS in the multivariable logistic regression analysis. Regional wall motion abnormalities had a sensitivity of 42.5% (33.0–51.9), a specificity of 92.8% (90.6–94.9), a negative predictive value of 89.8% (87.4–92.2), and a positive predictive value of 51.7% (41.2–62.2), for NSTE-ACS. Results were consistent in the sensitivity analysis.

Conclusions

In ED patients with chest pain and no ST elevation, the detection of regional wall motion abnormalities was a predictor of NSTE-ACS. Despite a high specificity, which indicated a possible role of FoCUS in the rule-in of NSTE-ACS, sensitivity was too low to allow a safe rule-out using FoCUS results alone.
Hospital Presumptive Eligibility Emergency Medicaid Programs
Authors: Knowlton Lisa Marie , Arnow Katherine , Trickey Amber W. , Tran Linda D. , Harris Alex H.S. , Morris Arden M. , Wagner Todd H.
Published: July 2024

Background:

Lack of health insurance is a public health crisis, leading to foregone care and financial strain. Hospital Presumptive Eligibility (HPE) is a hospital-based emergency Medicaid program that provides temporary (up to 60 d) coverage, with the goal that hospitals will assist patients in applying for ongoing Medicaid coverage. It is unclear whether HPE is associated with successful longer-term Medicaid enrollment.

Objective:

To characterize Medicaid enrollment 6 months after initiation of HPE and determine sociodemographic, clinical, and geographic factors associated with Medicaid enrollment.

Design:

This was a cohort study of all HPE approved inpatients in California, using claims data from the California Department of Healthcare Services.

Setting:

The study was conducted across all HPE-participating hospitals within California between January 1, 2016 and December 31, 2017.

Participants:

We studied California adult hospitalized inpatients, who were uninsured at the time of hospitalization and approved for HPE emergency Medicaid. Using multivariable logistic regression models, we compared HPE-approved patients who enrolled in Medicaid by 6 months versus those who did not.

Exposures:

HPE emergency Medicaid approval at the time of hospitalization.

Main Outcomes and Measures:

The primary outcome was full-scope Medicaid enrollment by 6 months after the hospital's presumptive eligibility approval.

Results:

Among 71,335 inpatient HPE recipients, a total of 45,817 (64.2%) enrolled in Medicaid by 6 months. There was variability in Medicaid enrollment across counties in California (33%–100%). In adjusted analyses, Spanish-preferred–language patients were less likely to enroll in Medicaid (aOR 0.77, P<0.001). Surgical intervention (aOR 1.10, P<0.001) and discharge to another inpatient facility or a long-term care facility increased the odds of Medicaid enrollment (vs. routine discharge home: aOR 2.24 and aOR 1.96, P<0.001).

Conclusion:

California patients who enroll in HPE often enroll in Medicaid coverage by 6 months, particularly among patients requiring surgical intervention, repeated health care visits, and ongoing access to care. Future opportunities include prospective evaluation of HPE recipients to understand the impact that Medicaid enrollment has on health care utilization and financial solvency.