bluuebunny/crossref_metadata_2025 huggingface dataset:
Extension of Masses Involving the Lacrimal Sac to Above the Medial Canthal Tendon
Authors: Vahdani Kaveh , Gupta Tarang , Verity David H. , Rose Geoffrey E.
Published: February 2021

Purpose:

Retention mucoceles of the lacrimal sac almost always expand below the medial canthal tendon (MCT), whereas the very much rarer malignancies involving the lacrimal sac may progress to form a mass above the tendon. In this study, the incidence of malignancy was determined for patients with a preoperative decision to undergo biopsy for a clinically suspect, hard lacrimal sac mass, together with the proportion having a tumor extending above the MCT.

Methods:

Patients thought—on the basis of having a firm, immobile mass centered on the lacrimal sac fossa—to possibly have lacrimal sac malignancy were identified from a database of biopsies between 1989 and 2020. A retrospective review of their clinical, radiologic, and pathologic records was undertaken.

Results:

Fifty-three patients (24 male; 45%) underwent biopsy of atypical masses of the lacrimal sac, of which 47 of 53 (89%) extended above the MCT. Seventy-seven percent (41/53) patients had malignancy—26 primary carcinomas and 15 secondary tumors (14 lymphomas or hematopoietic and 1 neuroendocrine)—and 12 had benign conditions (6 transitional cell papillomatosis, 5 chronic inflammation, and 1 solitary fibrous tumor); all the benign pathologies extended above the MCT. The age at presentation and duration of symptoms was similar in patients with benign or malignant pathology. One-fifth of malignant lesions had pain, whereas all the benign conditions were painless, and acute dacryocystitis was relatively uncommon—occurring in only 13% of patients.

Conclusions:

If a firm and immobile lacrimal sac mass extends above the MCT, it has about a 74% chance of being malignant and, if pain is present, the lesion is more likely to be so. Clinically suspicious masses in the lacrimal sac fossa, whether benign or malignant, appear to present at the same age and with a similar duration of symptoms.
Anterior Lamellar Repositioning in the Management of Meibomian Gland Inversion Secondary to Meibomian Gland Dysfunction
Authors: Samia-Aly Emma , Barua Ankur R. , Patel Radhika P. , Mehta Purnima
Published: February 2021

Purpose:

To describe a simple alternative surgical approach to treat patients with Meibomian gland inversion (MGI; posterior migration of the Meibomian gland orifices) in the upper eyelid, secondary to cicatricial Meibomian gland dysfunction (MGD) not responding to maximal medical management.

Methods:

This was a retrospective, noncomparative, interventional case series of all patients with MGI not responding to conservative MGD treatment who underwent anterior lamellar repositioning through a skin crease incision with or without Blepharoplasty, between July 2017 and July 2019.

Results:

Eleven eyes of 7 patients were included in the study. All patients had a diagnosis of MGD with MGI and had been treated on average for 32 months with intensive medical therapy. Treatment included lubricants, topical ciclosporin 0.1%, topical steroids, and doxycycline. Despite intensive treatment, these patients remained symptomatic with persistent superior ocular surface staining. Following surgery, on average, the patients were followed for 23 months. Ten eyes (91%) had improvement of symptoms and superior ocular surface staining. All patients (100%) demonstrated improvement in the anatomical eversion of the eyelid margin and Meibomian gland orifice.

Conclusion:

A simple upper eyelid everting surgery with anterior lamellar repositioning can be effective in managing patients with MGI giving them symptomatic relief when all medical treatment fail. To the best of the authors’ knowledge, this is the first case series describing this simple surgical technique in the management of this subgroup of patients.
Risk Factors for New Onset Diplopia After Graduated Orbital Decompression
Authors: Stähr Kerstin , Eckstein Anja , Buschmeier Maren , Hussain Timon , Daser Anke , Oeverhaus Michael , Lang Stephan , Mattheis Stefan
Published: February 2021

Purpose:

The aim of the study was to identify possible risk factors for new onset diplopia in 20° of primary position (NOD PP) after orbital decompression. A predisposition for NOD has been established for patients with pre-existing diplopia in secondary gaze; therefore, the authors focused on patients without preoperative diplopia.

Methods:

Retrospective chart review of patients who underwent balanced orbital decompression between 2012 and 2019 due to Graves orbitopathy at the authors’ institution. Exclusion criteria were incomplete clinical data set, revision surgery, and medial or lateral decompression only. The following clinical parameters were evaluated preoperatively and postoperatively: Hertel exophthalmometry, objective measurement of misalignment using the prism-cover-test, assessment of the field of binocular single vision, and measurement of monocular excursions. In addition, the diameter of the extraocular eye muscles was measured in all preoperative CT scans.

Results:

We included 327 patients (612 orbits), 126 patients (242 orbits) had no preoperative diplopia. In patients with NOD PP (34%, n = 43/126), enlargement of the medial rectus muscle and restriction of abduction and elevation were significantly more frequent than in patients with no NOD PP. The degree of exophthalmos decrease positively correlated with postoperative squint angle.

Conclusion:

We were able to identify the diameter of the medial rectus muscle, restriction of abduction, and elevation as well as an extensive reduction of exophthalmos as risk factors for NOD PP in patients with no preoperative diplopia.
Caregivers’ willingness to pay for Alzheimer’s disease medications in Taiwan
Authors: Huang Mao-Hsuan , Tsai Chia-Fen , Lee Wei-Ju , Wang Wen-Fu , Jhang Kai-Ming , Wang Shuu-Jiun , Fuh Jong-Ling
Published: February 2021

Background:

Alzheimer’s disease (AD) exerts significant financial expenses on caregivers, and knowledge of caregivers’ support for out-of-pocket payment is of great importance for policymaking on the insurance coverage of future AD medication in Taiwan. We aimed to investigate caregivers’ willingness to pay (WTP) for a hypothetical curative AD medication and the effect of different factors on the amount of WTP.

Methods:

Informal caregivers of patients with AD and informants of patients with amnestic mild cognitive impairment (MCI) were included. An iterative bidding game technique, followed by a dichotomous choice question and a final open-ended question were used to elicit caregivers’ maximum WTP. The correlations between the WTP and characteristics of caregiver and patient were analyzed, including sex, educational level, severity of dementia, neuropsychiatric symptoms assessed by Neuropsychiatric Inventory, time needed to support patients assessed by Caregiver Activity Survey, and caregivers’ monthly income.

Results:

A total of 1134 informal caregivers of patients with AD or MCI were included. Caregivers of patients with AD were willing to pay for a curative AD medication, and their maximum WTP value was higher than informants of MCI patients. Among patients with AD and patients with MCI, caregivers’ monthly income was positively correlated with WTP. Apathy subsyndrome was the only factor correlated with percentage of WTP in caregiver’s income in the MCI group.

Conclusion:

Support for out-of-pocket WTP for a hypothetical curative AD medication was significantly related to caregiver’s income.
Iodine nutritional status of lactating women in northern Taiwan in 2019
Authors: Huang Chun-Jui , Cheng Cheng-Pin , Lee Lin-Hsuan , Chen Harn-Shen , Hwu Chii-Min , Tang Kam-Tsun , Shih Chiao-Wei , Yeh Chang-Ching , Yang Chen-Chang , Wang Fan-Fen
Published: February 2021

Background:

Pregnant and lactating women are vulnerable to iodine deficiency. This study was conducted to evaluate the iodine nutritional status of lactating women in northern Taiwan.

Methods:

Women recruited from Taipei Veterans General Hospital (TVGH) in 2019 provided a spot urine sample and completed a Food Frequency Questionnaire. The urinary iodine concentration (UIC) was measured by inductively coupled plasma mass spectrometry.

Results:

The overall median UIC in 198 women was 120.4 μg/L, indicating a sufficient iodine status. Univariate analysis revealed a lower median UIC in women of younger age (p = 0.004), who were not taking multivitamins (p = 0.004), not on a postpartum nourishment diet (p = 0.04), and whose infant received more breast milk (p = 0.004). The median UIC was <100 μg/L in the group aged 20 to 29 years (UIC: 74.4 μg/L) and in women whose infants’ diet was composed of >50% breast milk (UIC: 86.1 μg/L). A postpartum nourishment diet was followed by 73.7% (n = 146) of the women. Nevertheless, a significant decrease in the intake frequency of iodine-containing foods, including seaweeds (p < 0.001), seafood (p < 0.001), dairy products (p = 0.009), and multivitamins (p < 0.001) was observed compared with the intake noted in a previous survey of pregnant women in TVGH. Following multivariate analysis, only younger age (20-29 vs ≥30 years; odds ratio [OR]: 3.38; 95% confidence interval [CI]: 1.49-7.65), no use of multivitamin (OR: 1.89; 95% CI: 1.03-3.48), and infant diet composition (>50% breast milk vs <50% breast milk; OR: 2.93; 95% CI: 1.37-6.25) were independently associated with UIC < 100 μg/L.

Conclusion:

The results suggest that the iodine status in lactating women in northern Taiwan is adequate. However, iodine deficiency may continue to be present in certain subgroups, such as women of younger age and those who do not take multivitamins.
Saliva Pooling Strategy for the Large-Scale Detection of SARS-CoV-2, Through Working-Groups Testing of Asymptomatic Subjects for Potential Applications in Different Workplaces
Authors: Girón-Pérez Daniel Alberto , Ruiz-Manzano Rocío Alejandra , Benitez-Trinidad Alma Betsaida , Ventura-Ramón Guadalupe Herminia , Covantes-Rosales Carlos Eduardo , Ojeda-Durán Ansonny Jhovanny , Mercado-Salgado Ulises , Toledo-Ibarra Gladys Alejandra , Díaz-Reséndiz Karina Janice , Girón-Pérez Manuel Iván
Published: February 2021

Objective:

To perform an improved large-scale SARS-CoV-2 detection on pooled tests of asymptomatic workers.

Methods:

qRT-PCR validation of the SARS-CoV-2 detection in salivae samples and saliva pools and working-group saliva pooling and testing for SARS-CoV-2.

Results:

We found a high Cycle threshold correlation (r = 0.9099) between swabs and saliva samples. Then, through the pooling strategy, we detected that 18/360 (5%) of individual saliva samples were SARS-CoV-2 positive. Saliva-pooling efficiency (360 of test sample/30 individual PCR) was higher (5.45) than the reported for swabbing group-testing and we spared 82% of the PCR reagents as well as sampling and personal protection equipment.

Conclusion:

Through this simplified and less expensive procedure, we detected in a short time asymptomatic-infected SARS-CoV-2-carriers that were isolated from their co-workers, thus, this methodology can be implemented in different workplaces to ensure consumers that employees are not infectious.
Bilateral Cochlear Implantation in Children: Long-Term Outcome in the Adult Population With Special Emphasis on the Bilateral Benefit
Authors: Ehrmann-Müller Desiree , Shehata-Dieler Wafaa , Kurz Anja , Kühn Heike , Hagen Rudolf , Rak Kristen
Published: February 2021

Objective:

To investigate the benefit of bilateral cochlear implantation in adults, who had been implanted being a child under the age of 10 years.

Study Design:

Retrospective data analysis.

Setting:

Tertiary referral center with a large cochlear implant program.

Main Outcome Measures:

Speech understanding in the Freiburg monosyllabic words in quiet and the HSM sentence test in quiet and in background noise.

Patients:

Seventy-seven bilaterally cochlear implantation implanted adults.

Results:

Bilateral cochlear implantation in children under the age of 10 years results in a significant benefit in speech comprehension in adulthood. In addition, a dependency regarding the time between the implantations and speech intelligibility was found.

Conclusion:

The results emphasize the benefit of bilateral cochlear implantation with a short interval between the operations in young children not only during formative years but also in adulthood.
Acute flywheel exercise does not impair the brachial artery vasodilation in healthy men of varying aerobic fitness
Authors: Zubac Damir , Obad Ante , Ivančev Vladimir , Valić Zoran
Published: February 2021

Background

The cardiovascular response to variable load exercise on a flywheel ergometer is still unknown.

Objective

This study examined the effects of flywheel exercise on cardiovascular response and brachial artery vasodilation capacity in healthy, active men.

Methods

In this cross-sectional study, nineteen men (20–57 years old) completed three laboratory visits, including a ramp exercise test to determine their maximal oxygen uptake JOURNAL/blpmo/04.03/00126097-202106000-00008/inline-graphic1/v/2023-09-27T234149Z/r/image-tiff max, and exercise intervention on a flywheel ergometer set at 0.075 kg·m2moment of inertia. After the ramp test cessation, all participants were allocated into aerobically untrained (n= 10) and trained (n= 9) groups. Throughout the flywheel exercise, cardiovascular demands were continuously monitored via Finapres, while a pre/postflow-mediated dilation (FMD) assessment was performed using ultrasound imaging.

Results

There were no differences observed between the groups in their anthropometrics, age or resting brachial artery diameter, while the JOURNAL/blpmo/04.03/00126097-202106000-00008/inline-graphic2/v/2023-09-27T234149Z/r/image-tiff max was ~15% higher (P= 0.001) in trained compared to aerobically untrained group. The cardiovascular response to the flywheel exercise was similar between the groups, with peak mean arterial pressure and heart rate readings reaching ~160 mmHg and ~140 bpm, respectively. The flywheel exercise did not impair the FMD (%) response, which was comparable between the groups (P= 0.256). When these data were pooled, the regression analysis showed an inverse relationship among FMD (%), age (β = −0.936,P= 0.001) and JOURNAL/blpmo/04.03/00126097-202106000-00008/inline-graphic3/v/2023-09-27T234149Z/r/image-tiff max. (β = −0.359,P= 0.045).

Conclusion

Although aerobic fitness alone does not directly explain the FMD response to flywheel exercise, aerobically untrained individuals, as they get older, tend to have lower brachial artery FMD.
Investigation of Cushing’s and subclinical Cushing’s syndromes using adrenocortical scintigraphy
Authors: Okada Yukinori , Matsushita Shoichiro , Yamaguchi Keiichiro
Published: February 2021

Objectives

This study assessed the factors related to the intake rate of adrenocortical scintigraphy in Cushing’s and subclinical Cushing’s syndromes, in addition to the methods for differentiating between the two.

Methods

Clinical findings, blood sampling, and adrenocortical scintigraphy collected at St. Marianna University School of Medicine from 1 January 2010 to 31 December 2019 were used to diagnose initial-onset Cushing’s syndrome and subclinical Cushing’s syndrome, and patients who underwent 131I-NP-59 adrenocortical scintigraphy were used as study subjects.

Results

A total of 24 (8 male and 16 female) patients were selected. Of them, 7 had Cushing’s syndrome and 17 had subclinical Cushing’s syndrome. A correlation coefficient of −0.474 (P = 0.026) was determined between the intake rate after 7 days and adrenocorticotropic hormone levels. Intake rates after 5 days were 0.51% and 0.31% for Cushing’s and subclinical Cushing’s syndromes, respectively, and were statistically significant (P = 0.03). Intake rates after 7 days were 0.47% and 0.30% for Cushing’s and subclinical Cushing’s syndromes, respectively, and were statistically significant (P = 0.04). Receiver operating characteristic analysis results of Cushing’s and subclinical Cushing’s syndromes for intake rates after 7 days were as follows: cutoff value, 0.248; area under curve, 0.769; and 95% confidence interval, 0.561–0.977.

Conclusion

There were differences in the intake rates of adrenocortical scintigraphy between the Cushing’s syndrome group and subclinical Cushing’s syndrome group, making it possible to differentiate between the two using the intake rate.
Delayed kidney transplantation in combined liver-kidney transplantation
Authors: Ekser Burcin , Goggins William C.
Published: February 2021

Purpose of review

To review the impact of delayed kidney transplantation approach in combined (simultaneous) liver-kidney transplantation (CLKT).

Recent findings

CLKT offers a life-saving procedure for patients with both end-stage liver disease and chronic kidney disease or prolonged acute kidney injury. It is the most common multiorgan transplant procedure in the US accounting for 9–10% of all liver transplants performed. The number of CLKT has also been increasing in other countries with a better understanding of hepato-renal syndrome. US is the only country which implemented a national allocation policy for CLKT in 2017. Due to the different physiological needs of liver and kidney allografts immediately after transplantation, delayed kidney transplantation approach in CLKT has been introduced for the first time by the Indiana Group, naming it as ‘the Indiana Approach’. Over the years, many other groups in the US and in Europe published better outcomes in CLKT using the delayed kidney transplantation approach with the support of hypothermic machine perfusion.

Several groups have shown that delayed kidney transplantation in CLKT is a safe procedure with better outcomes in graft(s) and patient survival.
I Wouldn't Let it Get to Me
Authors: Dove-Medows Emily , Thompson Lucy , McCracken Lindsey , Kavanaugh Karen , Misra Dawn P. , Giurgescu Carmen
Published: February 2021

Purpose:

Non-Hispanic Black women in the United States experience disproportionately higher rates of adverse birth outcomes including preterm birth and low birth weight infants compared with White women. Racial discrimination has been associated with these adverse outcomes. However, not all Black women experience discrimination in the same way. The majority of studies that report on the relationship between racial discrimination and maternal health have used quantitative methods that may present a monolithic understanding of this relationship. Qualitative methods, specifically those that incorporate intersectionality, may illuminate the nuances in pregnant Black women's experiences of discrimination. We present a qualitative analysis of Black women's experiences of racial discrimination and pregnancy to shed light on some of these complexities.

Study Design and Methods:

Qualitative interviews that addressed racial discrimination and pregnancy were conducted as part of a larger study of pregnant Black women that examined social support, neighborhood disorder, and racial discrimination. Interviews were coded for descriptions of racial discrimination and within and across case analysis was conducted.

Results:

Women described varying experiences of racial discrimination in different contexts. Shielding emerged as a recurring theme in women's accounts of dealing with racial discrimination during pregnancy.

Clinical Implications:

Nurses engaged in maternity care need an understanding of how pregnant Black women experience racial discrimination in different ways. Black women may be likely to take personal responsibility for managing discrimination-related stress in pregnancy as a consequence of direct experiences of discrimination. Nurses can support pregnant Black women by recognizing varied experiences of racial discrimination, and by not blaming them for experiences or potential resultant outcomes.
Sudden Unexpected Postnatal Collapse Resulting in Newborn Death in the United States
Authors: Anderson Tatiana M. , Ferres Juan M. Lavista , Ramirez Jan-Marino , Mitchell Edwin A.
Published: February 2021

Background:

The sudden collapse of an apparently healthy newborn, or sudden unexpected postnatal collapse (SUPC) is fatal in about half of cases. Epidemiological characteristics of sudden unexpected infant death (SUID) in the first week of life differ from those in the postperinatal age group (7-365 days).

Aim:

To describe the characteristics of SUPC resulting in neonatal death.

Methods:

We analyzed the Centers for Disease Control and Prevention Birth Cohort Linked Birth/Infant Death Data Set (2003-2013: 41,125,233 births and 37,624 SUIDs). SUPC was defined as infants born ≥35 weeks gestational age, with a 5-minute Apgar score of ≥7, who died suddenly and unexpectedly in the first week of life.

Results:

Of the 37,624 deaths categorized as SUID during the study period, 616 met the SUPC criteria (1.5/100,000 live births). Eleven percent occurred on the first day of life and nearly three quarters occurred during postnatal days 3-6. SUPC deaths differed statistically from SUID deaths occurring 7-364 days of age, in particular for sex, marital status, and live birth order.

Implications:

These data support the need for adequate nurse staffing during the immediate recovery period and for the entire postpartum stay as well as nurse rounding for new mothers in the hospital setting.
Maternal Sepsis
Authors: Sundin Courtney Stanley , Rigg Kendall , Ellis Kathleen Kistner
Published: February 2021

Purpose:

The current adult definition of sepsis and septic shock, as developed in 1992, does not adequately define sepsis in the pregnant and peripartum women due to the alteration of sepsis presentation in the maternal population. The purpose of this study was to determine potential causative factors for sepsis with the aim of prevention and reducing morbidity and mortality.

Study Design and Methods:

A descriptive observational design via a retrospective medical record review was used with a convenience sample of 22 women who were identified after admission as having sepsis. The setting was the labor and delivery unit of a large urban hospital in Fort Worth, Texas, with over 5,000 births per year.

Results:

The most common diagnoses related to maternal sepsis included urinary tract infections, endometritis, chorioamnionitis, and wound infections. Main causative agents identified were predominantly Escherichia coli (E. coli), followed by group B streptococcus (GBS), and group A streptococcus (group A strep). The most prevalent presenting symptom was hypothermia or hyperthermia, followed by tachycardia. Primary laboratory results included above and below normal white blood cell count and elevated lactate levels. Sixty-four percent of patients diagnosed with sepsis were readmitted postpartum and 41% gave birth via cesarean.

Clinical Implications:

Findings are applicable for nursing care and maternal sepsis protocol development. Early identification of mothers at risk for maternal sepsis and tool development for early diagnosis would be beneficial to support the ongoing work on decreasing maternal morbidity and mortality that have a devastating effect on women, their families, and their health care team. Early warning signs of sepsis can be shared by nurses with new mothers and their families as part of routine postpartum discharge teaching so they know when to call their primary health care provider and when to seek care in person.
Intrapartum and Postpartum Management of Intra-amniotic Infection
Authors: Ryan Emma S. , Varvoutis Megan , Kuller Jeffrey A. , Dotters-Katz Sarah
Published: February 2021

Importance

Intra-amniotic infection (IAI) is a common condition with potentially devastating maternal and neonatal complications. However, there are incomplete data regarding the most effective antimicrobial treatment regimen for this condition.

Objective

This article aims to review the current evidence and recommendations for intrapartum and postpartum management of IAI.

Evidence Acquisition

Original research articles, review articles, and guidelines on IAI were reviewed.

Results

Numerous known risk factors for IAI exist, some of which are modifiable. Serious neonatal complications can result from exposure to IAI including increased risk of preterm birth and neonatal death. Possible maternal complications include increased risk of cesarean delivery, postpartum hemorrhage, and postpartum endometritis. Antibiotics are the mainstay of treatment for IAI for both mothers and neonates, although there is no consensus on which antimicrobial agents are best and the appropriate duration of therapy.

Conclusions and Relevance

Monitoring patients for signs of IAI, proper treatment, and communication of the diagnosis with the pediatric team are essential for preventing maternal and neonatal complications of IAI. More research is needed to determine the proper treatment regimens for both mothers diagnosed with IAI and their neonates.

Target Audience

Obstetricians and gynecologists, family physicians

Learning Objectives

After participating in this activity, the provider should be better able to assess the etiology, risk factors, and current guidelines for diagnosis of IAI; describe the maternal and neonatal complications of IAI; and outline the current recommendations for management of IAI in the intrapartum and postpartum periods.
Prevalence of and Risk Factors for Oral Human Papillomavirus Infection With Multiple Genotypes in the United States
Authors: Bui Thanh Cong , Tran Ly Thi-Hai , Thai Thuy Nhu , Shete Sanjay S. , Vidrine Damon J. , Sturgis Erich M.
Published: February 2021

Background

This study investigated the prevalence of and risk factors for oral human papillomavirus (HPV) infection with multiple genotypes in the United States.

Methods

Data were from the nationally representative 2009–2012 National Health and Nutrition Examination Survey. This analysis comprised 9257 participants for whom data on oral HPV (37 genotypes) and associated risk factors were available.

Results

The weighted prevalence of multitype (2–6 types) oral HPV infection was 1.5% (2.5% for men, 0.4% for women) in the whole sample and 19.7% (22.0% for men, 12.1% for women) in those who had any type of oral HPV positivity. Most multitype oral HPV cases (83.8%) harbored one or more oncogenic types. In the adjusted multinominal logistic regression model, being male (relative risk ratio [RRR] = 3.69; 95% confidence interval [CI], 1.57–8.65), being a current cigarette smoker (RRR = 2.57; 95% CI, 1.23–5.36), and having a new sex partner in the past year (RRR = 2.10; 95% CI, 1.03–4.28) were associated with an increased risk of multitype oral HPV infection over single-type HPV infection.

Conclusions

Men, smokers, and those who had new sexual partners were at a significantly higher risk for multitype oral HPV infection.
Resistance to Ceftriaxone and Azithromycin in Neisseria gonorrhoeae Isolates From 7 Countries of South America and the Caribbean: 2010–2011
Authors: Thakur Sidharath Dev , Araya Pamela , Borthagaray Graciela , Galarza Patricia , Hernandez Alina Llop , Payares Daisy , Sanabria Cruz Olga Marina , Carvallo Maria Elena Trigoso , Corredor Aura Helena , Dillon Jo-Anne R.
Published: February 2021

Seven countries in Latin America and the Caribbean report on (2010 and 2011) the susceptibility of 2235 isolates of Neisseria gonorrhoeae to 6 antibiotics. Thirteen isolates had ceftriaxone minimum inhibitory concentrations (MICs) of 0.125 to ≥ 0.25 mg/L. The percentage of resistant isolates to the following antibiotics was: azithromycin, 1.0% to 1.7%; ciprofloxacin, 42.1% to 36.2%; penicillin, 31% to 35%; tetracycline, 21.8% to 22.6%.
Sudden Unexpected Death in a Child From Acute Myeloid Leukemia
Authors: Fenu Elena M. , O'Neill Stacey S. , Insuasti-Beltran Giovanni , Pettenati Mark J. , Giffen Mark , Harrison William T.
Published: February 2021

Acute myeloid leukemia can rarely cause sudden, unexpected death in children. Presentation may be non-specific and death may occur in children with no prior medical history. Herein we present the case of a previously healthy 2-year and 2 month-old White girl, who on autopsy, was found to have acute myeloid leukemia with KMT2A rearrangement extensively involving all major thoracic and abdominal organs. This case is presented to the forensic community to discuss the presentation and findings in sudden death caused by acute leukemia. The case highlights when acute leukemia should enter the differential as a potential cause of death, as well as potential resources available in the postmortem workup of acute leukemias.
Finding the Optimal Alternative for Immediate Hypersensitivity to Low-Osmolar Iodinated Contrast
Authors: Sohn Kyoung-Hee , Seo Jang-ho , Kang Dong-Yoon , Lee Suh-Young , Kang Hye-Ryun
Published: February 2021

Objectives

Avoiding culprit agents is recommended for subjects who have had previous hypersensitivity reaction (HSR) to low-osmolar contrast media (LOCM). However, the guidelines for choosing optimal alternatives have not been determined. We investigated the outcomes of reexposure in patients with previous immediate HSRs to provide a safe option.

Materials and Methods

The outcomes of reexposure were assessed in a cohort with previous LOCM-associated HSR based on skin testing results and the presence of a common N-(2,3-dihydroxypropyl) carbamoyl side chain.

Results

Among 482 skin tests, 38.7% (31/80), 45.8% (99/216), and 64.0% (119/186) of mild, moderate, and severe index HSRs showed positivity to at least 1 LOCM, of which 62.8% showed positivity to at least 2 different LOCM. The overall recurrent HSRs were reduced from 43.8% upon reexposure to the culprit LOCM to 12.3% upon using nonculprit skin test negative LOCM (P = 0.004); those with severe index HSRs exhibited a significant reduction (11.3% vs 100%), but those with non-severe HSRs to LOCM did not. In subjects with severe index HSRs, the skin test cross-reactivity between LOCM was associated with sharing the common side chain (20.7% vs 11.5%, P = 0.003), and the recurrence rate of HSRs was effectively reduced by avoiding the common side chain (24.0% vs 7.8%, P = 0.039). However, these differences were not observed in those with non-severe index HSRs.

Conclusions

In patients who experienced a severe index HSR to LOCM, skin test negative LOCM without a common side chain could be suggested as an option for safe reexposure.
Short-term Effects of Canceled Elective Procedures Due to COVID-19
Authors: Tran Linda Diem , Rose Liam , Urech Tracy , Dalton Aaron , Wu Siqi , Vashi Anita A.
Published: February 2021

Objective:

To determine whether delayed or canceled elective procedures due to COVID-19 resulted in higher rates of ED utilization and/or increased mortality.

Summary of Background Data:

On March 15, 2020, the VA issued a nationwide order to temporarily pause elective cases due to COVID-19. The effects of this disruption on patient outcomes are not yet known.

Methods:

This retrospective cohort study used data from the VA Corporate Data Warehouse. Surgical procedures canceled due to COVID-19 in 2020 (n = 3326) were matched to similar completed procedures in 2018 (n = 151,863) and 2019 (n = 146,582). Outcome measures included 30- and 90-day VA ED use and mortality in the period following the completed or canceled procedure. We used exact matching on surgical procedure category and nearest neighbor matching on patient characteristics, procedure year, and facility.

Results:

Patients with elective surgical procedures canceled due to COVID-19 were no more likely to have an ED visit in the 30- [Difference: –4.3% pts; 95% confidence interval (CI): –0.078, –0.007] and 90 days (–0.9% pts; 95% CI: –0.068, 0.05) following the expected case date. Patients with cancellations had no difference in 30- (Difference: 0.1% pts; 95% CI: –0.008, 0.01) and 90-day (Difference: –0.4% pts; 95% CI: –0.016, 0.009) mortality rates when compared to similar patients with similar procedures that were completed in previous years.

Conclusions:

The pause in elective surgical cases was not associated with short-term adverse outcomes in VA hospitals, suggesting appropriate surgical case triage and management. Further study will be essential to determine if the delayed cases were associated with longer-term effects.
Single-cell RNA sequencing reveals a novel cell type and immunotherapeutic targets in papillary thyroid cancer
Authors: Wang Zhengshi , Rixiati Youlutuziayi , Jiang Wenli , Ye Chen , Huang Caiguo , Tang Chuangang , Yin Zhiqiang , Jiao Binghua
Published: February 2021

Papillary thyroid cancer (PTC) is the most common thyroid malignancy. Although PTC usually has a favorable prognosis, some aggressive PTC subtypes and lymph node (LN) metastasis contribute to high rates of recurrence and poor clinical outcomes. We analyzed single-cell RNA sequencing (scRNA-seq) data from 15 samples, including primary tumors of PTC, metastatic LNs, and paracancerous tissues. After quality filtering, 28,205 cells were detected. Of these, 13,390 cells originated from 7 tumor tissues, 2,869 cells from 2 metastatic LNs, and 11,945 cells from 6 paracancerous tissues. The increase in the proportion of CD4+ Tregs may be a key factor responsible for the immunosuppressive property of PTC. A novel cell type was identified, named Protective EGR1+CD4+ T cell, which might be antagonistic to the CD4+ Tregs and inhibit the formation of the immunosuppressive microenvironment and tumor immune evasion. Inhibitory checkpoints TIGIT and CD96 were found to be better targets than PD-1 for immune therapy in PTC patients with LN metastasis. For PTC patients without LN metastasis, however, PD-1, TIGIT, and CD96 could be suitable targets of immunotherapy. These findings would contribute to the further understanding of molecular mechanisms resulting in occurrence and development of PTC, and provide a theoretical rationale for targeted therapy and immunotherapy.
A prospective evaluation of the analytical performance of GENECUBE® HQ SARS-CoV-2 and GENECUBE® FLU A/B
Authors: Kiyasu Yoshihiko , Akashi Yusaku , Sugiyama Akio , Takeuchi Yuto , Notake Shigeyuki , Naito Asami , Nakamura Koji , Ishikawa Hiroichi , Suzuki Hiromichi
Published: February 2021

Background

Molecular tests are the mainstay for detecting severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). However, their accessibility can be limited by the long examination time and inability to evaluate multiple samples at once. This study evaluated the analytical performance of the newly developed rapid molecular assays GENECUBE® HQ SARS-CoV-2 and the GENECUBE® FLU A/B.

Method

This prospective study was conducted between December 14, 2020, and January 9, 2021, at a polymerase chain reaction (PCR) center. Samples were collected from the nasopharynx with flocked swabs. Molecular tests were performed with the GENECUBE® system and reference reverse transcription (RT)-PCR, and the results of the two assays were compared.

Result

Among 1065 samples, 81 (7.6%) were positive for SARS-CoV-2 on the reference RT-PCR. Three showed discordance between GENECUBE® HQ SARS-CoV-2 and the reference RT-PCR; the total, positive and negative samples of concordance for the two assays were 99.7%, 100%, and 99.7%, respectively. All discordant cases were positive for GENECUBE® HQ SARS-CoV-2 and negative for the reference RT-PCR. SARS-CoV-2 was detected from all three samples by another molecular assay for SARS-CoV-2. For the GENECUBE® FLU A/B, the total, positive and negative samples of concordance for the two assays were 99.5%, 100%, and 99.1%.

Conclusion

The GENECUBE® HQ SARS-CoV-2 and GENECUBE® FLU A/B demonstrated sufficient analytical performance to detect SARS-CoV-2 and influenza virus A/B.

Key points

We prospectively evaluated the analytical performance of the newly developed rapid molecular assays GENECUBE® HQ SARS-CoV-2 and the GENECUBE® FLU A/B. The two assays showed >99% concordance rate compared with a reference PCR, which indicated their sufficient analytical performance to detect SARS-CoV-2 and influenza virus A/B.
The Trade-off Between Prioritization and Vaccination Speed Depends on Mitigation Measures
Authors: Agarwal Nikhil , Komo Andrew , Patel Chetan , Pathak Parag , Ünver M. Utku
Published: February 2021

Calls for eliminating prioritization for SARS-CoV-2 vaccines are growing amid concerns that prioritization reduces vaccination speed. We use an SEIR model to study the effects of vaccination distribution on public health, comparing prioritization policy and speed under mitigation measures that are either eased during the vaccine rollout or sustained through the end of the pandemic period. NASEM’s recommended prioritization results in fewer deaths than no prioritization, but does not minimize total deaths. If mitigation measures are eased, abandoning NASEM will result in about 134,000 more deaths at 30 million vaccinations per month. Vaccination speed must be at least 53% higher under no prioritization to avoid increasing deaths. With sustained mitigation, discarding NASEM prioritization will result in 42,000 more deaths, requiring only a 26% increase in speed to hold deaths constant. Therefore, abandoning NASEM’s prioritization to increase vaccination speed without substantially increasing deaths may require sustained mitigation.
Syntheses and solid-state structures of two cofacial (bis)dipyrrin dichromium complexes in different charge states
Authors: Carsch Kurtis , Elder Shelby E. , Dogutan Dilek K. , Nocera Daniel G. , Yang Junyu , Zheng Shao-Liang , Daniel Timothy , Betley Theodore A.
Published: February 2021

The dichromium Pacman complex (tBudmx)Cr2Cl2·C4H10O (1) [(tBudmx)H2is a dimethylxanthene-bridged cofacial (bis)dipyrrin, C49H58N4O] was synthesized by salt metathesis using anhydrous CrCl2and previously reported (tBudmx)K2. Treatment of1with two equivalents of the reductant potassium graphite afforded K2(tBudmx)Cr2Cl2(thf)3·0.5C4H10O·0.5C4H8O (thf is tetrahydrofuran, C4H8O) (2), with both potassium ions intercalated between the pyrrolic subunits. Comparison of the solid-state structures for1and2reveals minimal changes in the primary coordination sphere of each Cr ion, with notable elongation of the dipyrrin C—C and C—N bonds upon reduction, consistent with computational support for a ligand-based reduction.
A redetermination of the structure and Hirshfeld surface analysis of poly[diaquadi-μ-hydroxido-tetrakis(μ-nicotinato N-oxide)tricopper(II)]
Authors: Mirzaei Masoud , Bazargan Maryam , Ebtehaj Pouria , Mague Joel T.
Published: February 2021

The product obtained from the reaction of pyridine-2,3-dicarboxylic acid and hydrated copper(II) chloride in hot aqueous NaOH solution was determined by low temperature X-ray diffraction to be [Cu3(C6H4NO3)4(OH)2(H2O)2]
n
or [Cu3(μ-OH)2(μ-nicNO)4(H2O)2]
n
(nicNO is pyridine-3-carboxylate N-oxide), a structure obtained from room temperature data and reported previously. The present determination is improved in quality and treatment of the H atoms. A Hirshfeld surface analysis of the intermolecular interactions is presented.
2-Amino-4-(4-chloro-1-ethyl-2,2-dioxo-1H-benzo[c][1,2]thiazin-3-yl)-7,7-dimethyl-5-oxo-5,6,7,8-tetrahydro-4H-chromene-3-carbonitrile: single-crystal X-ray diffraction study and Hirshfeld surface analysis
Authors: Shyshkina Mariia O. , Lega Dmitry A. , Goryachiy Volodymyr D. , Shemchuk Ludmila M. , Levashov Dmitriy V. , Shemchuk Leonid A.
Published: February 2021

In the title compound, C22H22ClN3O4S, which has potential non-steroidal anti-inflammatory activity, the benzothiazine and cyclohexenone rings both adopt a distorted sofa conformation while the 4H-pyrane ring adopts a very flattened sofa conformation. The two bicyclic fragments are skewed to each other, with the dihedral angle between their least-squares planes being 72.8 (1)°. In the crystal, the molecules form a hydrogen-bonded chain parallel to theaaxis due to N—H...O and N—H...Cl hydrogen bonds. Neighbouring chains are linked by C—H...N, C—H...O and π–π stacking interactions. Hirshfeld surface analysis was used to investigate the importance of the different types of intermolecular interactions whose contributions are: H...H = 44.7%, O...H/H...O = 21.8%, N...H/H...N = 11.9%, C...H/H...C = 9.5%, Cl...H/H...Cl = 7.2%. Parts of the molecule,viz. the phenyl ring and the ethyl side chain, are equally disordered over two sets of sites.
Relation between educational qualifications and occupations/incomes in a globalised world: focusing on Nepalese youth
Authors: Ezaki Naruho
Published: February 2021

Purpose

Globalisation drives many people to seek overseas employment. However, research on the relation between educational attainment and occupations/incomes mostly focuses on domestic workers while excluding overseas migrant workers. Therefore, the present study includes overseas migrant labourers and aims to examine the relation between educational attainment and occupations/incomes and gender disparity within this relation in Nepal.

Design/methodology/approach

This study conducted interview surveys with teachers and home-visit surveys with the subjects and their families based on the school records to collect information such as educational attainment, current occupation, monthly income, etc. The study compared occupations and incomes by educational attainment and gender and analysed the trend. Gender disparity in average monthly incomes was also analysed.

Findings

The results of this study registered almost no difference in the proportions of mental labour and high incomes for both males and females at the primary to secondary education echelons. Surprisingly, the average monthly incomes of females were around 60% or less than the remunerations offered to male workers with equivalent educational qualifications. This disparity does not narrow even at the higher educational classifications. Moreover, the disparity is widening even more by overseas migrant labour.

Originality/value

Since this study gathered extensive data on individual youth and did not rely on secondary data, it was possible to perform an in-depth analysis and accurately portray the real situation faced by Nepalese youth. Moreover, by including overseas migrant labourers, the study could examine the relation between educational attainment and occupations/incomes not only in the domestic market but also in the global market.
Democratic leadership as a political weapon: competition between fictions and practices
Authors: Metz Rudolf
Published: February 2021

Purpose

This article aims to analyze possible interpretations of democratic leadership by revealing the implicit leadership theory (ILT) of a moral, a material and a political ideal of democracy, namely deliberative–participatory democracy (DPD), aggregative–pluralist democracy (APD) and leader democracy (LD). As special “filters,” ILT helps the author to organize and compare conflicting premises and assumptions democratic theories hold about exemplary leadership and followership.

Design/methodology/approach

In order to reconstruct the possible meanings of ideal leadership (challenges and political knowledge) and the ideal followership (power relations, interactions and roles) portrayed by theories, the article sets a specific template for conceptual analysis.

Findings

The author argues that there is a contest over the meaning of democratic leadership. Political leaders use leadership fictions as political weapons to mobilize possible followers, legitimize their actions and discredit opponents. The article creates a heuristic typology providing a “plural” or nonessentialist reading of actual political situations and democratic practices.

Originality/value

The literature usually aims to find an absolute moral understanding of leadership fitted in democracy or to reconcile the idea of leadership with democracy. Extending J. Thomas Wren's approach, this article examines competing fictions of democratic leadership by blending leadership and democracy theories.
Banking sector openness and entrepreneurship
Authors: Ghosh Amit
Published: February 2021

Purpose

Using an extensive data set of 137 nations spanning the period 2002–2014, this paper aims to examine the effect of banking sector openness on entrepreneurship, as measured by new business entry rate.

Design/methodology/approach

The paper uses a panel data estimation framework covering 137 nations during 2002–2014. This study uses fixed effects, two-stage instrumental variables, two-step systems-generalized method of moments and difference-in-difference estimation methodologies.

Findings

Greater banking sector openness significantly increases new business formations. This paper finds a one-unit increase in the share of non-residential bank loans leads to 1.25 new business start-ups in the average nation. Likewise, a unit increase in the ratio of external to domestic deposits raises new business formation by 1.31 new businesses. Furthermore, the positive impact of banking sector openness on entrepreneurial activities is strengthened in nations with deeper financial markets, ones with better business environments to start a business and those with higher economic growth and development.

Practical implications

These findings have key implications for policy measures on both institutional business entry reforms and banking sector openness and the interaction between the two. From a policy perspective, the results show greater banking sector openness can only maximize its benefits on entrepreneurship in the presence of an effective institutional framework and sound macroeconomic fundamentals in host nations. It is also imperative that policymakers simplify regulations for the entry of new businesses. Additionally, achieving higher economic growth rates and greater economic affluence should allow both current and potential business owners to respond better to changes in financing conditions like greater access to loans from foreign banks.

Originality/value

Entrepreneurship and new business formation are central to any economic and business activity in a nation. The entrance of new firms into an economy creates jobs, fosters research, diffusion of knowledge and innovation and contributes to economic growth. Liberalizing a nation’s banking industry may represent an invaluable source of capital for new entrepreneurs and foster the creation of new companies. However, there is scant literature that has empirically examined the impact of opening up a nation’s banking sector on new business formations.
Draw your organization! A solution-focused theory-method for business school challenges and change
Authors: Roth Steffen
Published: February 2021

Purpose

This study aims to present a solution-focused approach to current problems and criticisms faced by business schools.

Design/methodology/approach

To facilitate the required shift from problems to solutions, this study outlines a theory method and demonstrates how it has informed my teaching at Financial Times (FT)-ranked business schools and other institutions of higher education in two subjects and on three continents.

Findings

The study reports on two student exercises showing that even advanced business school students confuse organizations with political economic hierarchies.

Originality/value

The study concludes that business schools pursuing a smart specialization strategy by challenging this reductionist view may turn into new schools of management distinguished by a broader, multifunctional concept of themselves and their impact on their environment.