bluuebunny/crossref_metadata_2025 huggingface dataset:
Resistance to Extinction of Evaluative Fear Conditioning in Delusion Proneness
Authors: Louzolo Anaïs , Lebedev Alexander V , Björnsdotter Malin , Acar Kasim , Ahrends Christine , Kringelbach Morten L , Ingvar Martin , Olsson Andreas , Petrovic Predrag
Published: June 2022

Delusional beliefs consist of strong priors characterized by resistance to change even when evidence supporting another view is overwhelming. Such bias against disconfirmatory evidence (BADE) has been experimentally demonstrated in patients with psychosis as well as in delusion proneness. In this fMRI-study, we tested for similar resistance to change and associated brain processes in extinction of fear learning, involving a well-described mechanism dependent of evidence updating. A social fear conditioning paradigm was used in which four faces had either been coupled to an unconditioned aversive stimulus (CS+) or not (CS−). For two of the faces, instructions had been given about the fear contingencies (iCS+/iCS−) while for two other faces no such instructions had been given (niCS+/niCS−). Interaction analysis suggested that individuals who score high on delusion-proneness (hDP; n = 20) displayed less extinction of evaluative fear compared to those with low delusion proneness (lDP; n = 23; n = 19 in fMRI-analysis) for non-instructed faces (F = 5.469, P = .024). The resistance to extinction was supported by a difference in extinction related activity between the two groups in medial prefrontal cortex and its connectivity with amygdala, as well as in a cortical network supporting fear processing. For instructed faces no extinction was noted, but there was a larger evaluative fear (F = 5.048, P = 0.03) and an increased functional connectivity between lateral orbitofrontal cortex and fear processing regions for hDP than lDP. Our study links previous explored BADE-effects in delusion associated phenotypes to fear extinction, and suggest that effects of instructions on evaluative fear learning are more pronounced in delusion prone subjects.
My Wellness Coach: evaluation of a mobile app designed to promote integrative health among underserved populations
Authors: Yuan Nicole P , Brooks Audrey J , Burke Molly K , Crocker Robert , Stoner Gates Matthew , Cook Paula , Chen Mei-Kuang , Bautista Juan , Petralba Patricia , Whitewater Shannon , Maizes Victoria
Published: June 2022

Underserved populations, including those from racial and ethnic groups and with low socioeconomic status, often lack access to mobile apps aimed at reducing health risk factors. This study evaluated the feasibility, acceptability, and preliminary effectiveness of the mobile app, My Wellness Coach (MWC), designed to promote behavior change in seven core areas of integrative health among underserved populations. Patients and staff were recruited from clinic and other settings. Some participants used MWC in a weekly group setting (n = 5); others on their own with support from a coordinator (n = 36). Health outcomes were assessed at baseline and 3 months. Mobile app ratings were collected at 5 weeks and 3 months. Goal setting data were analyzed at 3 months. Most participants (76%) set at least one goal, 71% created action steps for goals, and 29% completed a goal. Patients in the group setting had the highest rate of goal completion (60%) compared to patients (20%) and staff (27%) using the app on their own. Significant (p < .05) changes in pre- and post-test scores were documented for overall wellbeing, global physical health, BMI, vigorous physical activity, and eHealth literacy. Most participants (75%–91%) gave MWC high ratings for impact on behavior change, help seeking, intent to change, attitudes, knowledge, and awareness. This study documented preliminary evidence of the potential benefits of MWC among underserved communities. Future evaluations of Spanish and Android versions and comparisons between group and individual administration will inform implementation strategies for scaling MWC-based interventions to reach underserved communities nationally.
Improving active travel to school and its surveillance: an overlooked opportunity in health promotion and chronic disease prevention
Authors: George Stephanie M , Sliwa Sarah A , Cornett Kelly A , Do Van , Bremer Andrew A , Berrigan David
Published: June 2022

Increasing active travel to school (ATS) could reduce the deficit in youth physical activity participation; however, surveillance of ATS is limited. Given that ATS contributes to our understanding of children’s physical activity patterns nationwide, is influenced by local contexts and state laws, and occurs within communities, surveillance could be informative at the national, state, and local levels. Following a National Collaborative on Childhood Obesity Research workshop, this commentary offers insights into strengthening surveillance and data collection of ATS behavior as well as ATS environmental, policy, and program supports.
Assessment of genotoxic potential of the treated hospital wastewater using cytogenetic assays
Authors: Mathur Priyanka , Rani Kusum , Bhatnagar Pradeep
Published: June 2022

The cytogenetic study using hospital effluent was carried out engaging three cytogenetic end points—chromosomal aberration (CA) assay, mitotic indices (MIs), and micronucleus (MN) Analysis. These bioassays were performed in hematopoietic bone marrow cells of Mus musculus. The experiment commenced with the collection of hospital effluent from the final outlet when wastewater gets collected after undergoing treatment by a multistep process. The pure treated sample water was collected at different times between March 2019 to January 2020 and was given ad libitum to mice at its low (90% dilution) and high (pure form), i.e. 100% concentration for 3 different durations i.e. 7, 15, and 30 days, respectively. The results indicated a significant (P < 0.01) decrease in the MI in all the groups but was more pronounced in the group which was given 100% concentrated sample water collected in the month of March 2019. Besides this, the major finding was presence of CAs like breaks, fragments, rings, and pulverization in bone marrow cells in different groups; however, the frequency of these aberrations varied from group to group. A significant (P < 0.01) increase in MN Induction and decreased ratio (P < 0.01) of polychromatic to normonochromatic erythrocytes were observed in samples collected in month of March both at 10% and 100% concentrations. However, decrease in the ratio was observed in the samples of September and January at low-concentration sample water. The results thus indicated that there was some lacuna in the treatment process earlier in the month of March, which was rectified to some extent in the subsequent months. Hence, the treated wastewater collected in the month of January next year was more suitable for its use than other samples. Summary: These findings thus draw attention toward ensuring efficiency of the treatment plant and quality of water by the hospital management before it being disposed off into the municipal supply; a step that can help society to live a healthy life. With these findings, it is conveyed that all the hospitals, diagnostic labs, and other health care establishments must pay utmost attention at liquid waste disposal mechanism to make environment pollution-free.
Phthalate Exposures and Placental Health in Animal Models and Humans: A Systematic Review
Authors: Seymore Talia N , Rivera-Núñez Zorimar , Stapleton Phoebe A , Adibi Jennifer J , Barrett Emily S
Published: June 2022

Phthalates are ubiquitous compounds known to leach from the plastic products that contain them. Due to their endocrine-disrupting properties, a wide range of studies have elucidated their effects on reproduction, metabolism, neurodevelopment, and growth. Additionally, their impacts during pregnancy and on the developing fetus have been extensively studied. Most recently, there has been interest in the impacts of phthalates on the placenta, a transient major endocrine organ critical to maintenance of the uterine environment and fetal development. Phthalate-induced changes in placental structure and function may have significant impacts on the course of pregnancy and ultimately, child health. Prior reviews have described the literature on phthalates and placental health; however to date, there has been no comprehensive, systematic review on this topic. Here, we review 35 papers (24 human and 11 animal studies) and summarize phthalate exposures in relation to an extensive set of placental measures. Phthalate-related alterations were reported for placental morphology, hormone production, vascularization, histopathology, and gene/protein expression. The most consistent changes were observed in vascular and morphologic endpoints, including cell composition. These changes have implications for pregnancy complications such as preterm birth and intrauterine growth restriction as well as potential ramifications for children’s health. This comprehensive review of the literature, including common sources of bias, will inform the future work in this rapidly expanding field.
Trajectories of Pain Severity and Interference Among Adolescent and Young Adults With Cancer
Authors: Darabos Katie , Li Yimei , O’Hagan Bridget , Palermo Toyna , King-Dowling Sara , Jubelirer Tracey , Huang Jing , Barakat Lamia P. , Schwartz Lisa A.
Published: June 2022

Objective:

Cancer-related pain is a pervasive concern among adolescent and young adults (AYA) with cancer and is an emerging long-term health concern. Few studies have examined the complex contributions to pain among AYA. We aimed to fill a gap by (1) identifying subgroups of AYA with distinct patterns of pain severity and interference over time and (2) explore possible predictors of these patterns.

Methods:

Daily text messages over a 9-week period were used to model group-based trajectory analyses of pain severity and interference by identifying subgroups of AYA who experience common patterns of changes in pain. Demographic, medical, physical symptom burden, and psychological distress were examined as possible predictors of these patterns.

Results:

AYA were on average 16.93 years old and 2.5 years since diagnosis. Subgroups of AYA were identified for pain severity and interference over time: high variability (37.7%; 37.7%, respectively), consistent high pain (35.8%; 18.9%, respectively), and consistent low pain (26.4%; 43.4%, respectively). AYA with greater psychological distress were more likely to belong to the high consistent pain severity and interference groups. AYA with greater physical symptoms were more likely to belong to the high consistent pain interference group. No significant associations between demographic/medical characteristics and trajectory subgroups were found.

Conclusions:

AYA with elevated physical and psychological symptoms were more likely to experience high consistent pain severity and pain interreference over time. Interventions aimed at reducing pain through focusing on teaching AYA how to alleviate physical symptoms and teaching coping skills to manage psychological distress may be beneficial.
Reexamining the Role of Postoperative ICU Admission for Patients Undergoing Elective Craniotomy: A Systematic Review*
Authors: Azad Tej D. , Shah Pavan P. , Kannapadi Nivedha V. , Rincon-Torroella Jordina , Xia Yuanxuan , Bernhardt Lydia J. , Hansen Landon J. , Materi Joshua , Raj Divyaansh , Jackson Christopher M. , Mukherjee Debraj , Gallia Gary L. , Weingart Jon , Suarez Jose I. , Brem Henry , Bettegowda Chetan
Published: June 2022

OBJECTIVES:

The standard-of-care for postoperative care following elective craniotomy has historically been ICU admission. However, recent literature interrogating complications and interventions during this postoperative ICU stay suggests that all patients may not require this level of care. Thus, hospitals began implementing non-ICU postoperative care pathways for elective craniotomy. This systematic review aims to summarize and evaluate the existing literature regarding outcomes and costs for patients receiving non-ICU care after elective craniotomy.

DATA SOURCES:

A systematic review of the PubMed database was performed following PRISMA guidelines from database inception to August 2021.

STUDY SELECTION:

Included studies were published in peer-reviewed journals, in English, and described outcomes for patients undergoing elective craniotomies without postoperative ICU care.

DATA EXTRACTION:

Data regarding study design, patient characteristics, and postoperative care pathways were extracted independently by two authors. Quality and risk of bias were evaluated using the Oxford Centre for Evidence-Based Medicine Levels of Evidence tool and Risk Of Bias In Non-Randomized Studies—of Interventions tool, respectively.

DATA SYNTHESIS:

In total, 1,131 unique articles were identified through the database search, with 27 meeting inclusion criteria. Included articles were published from 2001 to 2021 and included non-ICU inpatient care and same-day discharge pathways. Overall, the studies demonstrated that postoperative non-ICU care for elective craniotomies led to length of stay reduction ranging from 6 hours to 4 days and notable cost reductions. Across 13 studies, 53 of the 2,469 patients (2.1%) intended for postoperative management in a non-ICU setting required subsequent care escalation.

CONCLUSIONS:

Overall, these studies suggest that non-ICU care pathways for appropriately selected postcraniotomy patients may represent a meaningful opportunity to improve care value. However, included studies varied greatly in patient selection, postoperative care protocol, and outcomes reporting. Standardization and multi-institutional collaboration are needed to draw definitive conclusions regarding non-ICU postoperative care for elective craniotomy.
Eyelid Reanimation with Free Platysma Graft: Final Stage of Reconstruction after Gunshot Wound to Face
Authors: Hart Justin , Gupta Rohun , Chaiyasate Kongkrit
Published: June 2022

Patients with gunshot wounds to the face have massive soft tissue and bony damage from projectile and blast injuries. They often require multiple, staged reconstructive surgeries with cross-facial nerve grafting and free muscle flap for re-establishment of facial expression. Injury to or total loss of the facial nerve and branches can result in loss of function of the orbicularis oculi muscle, which leads to the loss of protective mechanisms of eyelid function and blink reflex. The purpose of this article is to provide a literature review and discussion of eyelid reanimation after facial paralysis and to discuss our surgical technique with free platysma muscle grafts of the eyelid. The patient is a 45-year-old man with a history of a gunshot wound to the right face. He underwent multiple reconstructive surgeries in the past, and in preparation for eyelid reanimation, he underwent a cross-facial nerve graft from the left temporal branch to the right eyelid. At initial postoperative evaluation, the patient was able to close his right eye with minimal lagophthalmos, and at 3-month follow-up, he exhibited stronger blinking reflex. This case demonstrates that a free platysma graft with direct neurotization with cross-facial nerve graft fascicles can be utilized for restoration of spontaneous eyelid animation. However, there may be failure of neurotization and inability of the spontaneous blink reflex to be present. Despite these limitations, we still recommend the utilization of free platysma graft to provide upper eyelid reanimation through cross-facial nerve graft.
Effectiveness of Preoperative Symptom Screening in Identifying Pediatric SARS-CoV-2 Infections: A Retrospective Cohort Analysis
Authors: McNamara Catherine T. , Nuzzi Laura C. , White Ava G. , Massey Gabrielle G. , Miller Stephanie D. , Taghinia Amir H. , Labow Brian I.
Published: June 2022

Introduction:

Evidence-based protocols identifying COVID-19 cases in pediatric preoperative settings are lacking. With COVID-19 positioned to remain a threat to children, this study examines effectiveness of preoperative COVID-19 symptom screening in pediatric patients.

Methods:

This retrospective cohort study included hospital billing/medical record queries of (1) procedures performed under conscious sedation/general anesthesia and (2) laboratory-confirmed COVID-19 (+) cases from April 6, 2020, to June 15, 2020. Descriptive analyses were performed for demographic, procedural, symptom, and COVID-19 test result data obtained from medical records. Bivariate analyses examined associations between SARS-CoV-2 test results and symptom, demographic, and procedural data.

Results:

Among 2900 surgical cases, median (interquartile range) age was 8.1 (12.8) years. The majority were male (n = 1609, 55.5%), white (n = 1614, 55.7%), and not Hispanic/Latino (n = 1658, 57.2%). Additionally, 85.4% (n = 2412) of cases were non-emergent. Fifteen COVID-19 (+) cases were identified, for a 0.5% positivity rate. COVID-19 positivity was not associated with sex, American Society of Anesthesiologists physical status, or preoperative symptom status. Notably, 92.9% (n = 13) of COVID-19 (+) cases were asymptomatic. COVID-19 (+) patients were significantly older (15.6 years) than COVID-19 (−) patients (8.0 years). Patients who were not white, were Hispanic/Latino, or had a relatively lower economic status, were more likely to test positive.

Conclusions:

Preoperative symptom screenings insufficiently identified COVID-19 (+) patients. During outbreaks, testing protocols should be implemented to identify COVID-19 (+) patients. Future research should examine if observations are similar for other variants, and how health disparities associate with COVID-19.
Intimate Partner Violence–Related Brain Injury Among Colombian Women
Authors: Quiroz Molinares Nathalia , Navarro Segura Maria Camila , de los Reyes-Aragón Carlos José , Joseph Annie-Lori C. , Vangel Mark , Valera Eve M.
Published: June 2022

Objective:

The aim of this study was to assess the prevalence of brain injury (BI) and its relationship to cognitive and psychological outcomes in women survivors of intimate partner violence (IPV) in Colombia, South America.

Setting:

Women's shelters and organizations in Barranquilla, Colombia.

Participants:

Seventy women from the city of Barranquilla, Colombia, who experienced any form of IPV.

Design:

Cross-sectional, retrospective.

Main Measures:

Participants were administered the computerized EMBRACED neuropsychological battery to assess learning, working and long-term memory, cognitive flexibility, and processing speed. Participants also completed measures of psychological symptoms. Partner violence severity was assessed with a semistructured interview for survivors of domestic violence. Presence and severity of IPV-related BI were assessed using the Brain Injury Severity Assessment (BISA).

Results:

Thirty-one percent of women sustained at least one BI during an abusive relationship, and 10% sustained repetitive BIs. Furthermore, BI was negatively associated with measures of long-term and working memory, cognitive flexibility, as well as a trending (P = .05) positive association with depression. With the exception of the relationship between BI and cognitive flexibility, which was substantially reduced and no longer significant, all of these relationships were nearly identical in strength when controlling for abuse severity, socioeconomic status, and educational level.

Conclusion:

These data are the first to specifically examine IPV-related BI in relation to cognitive and psychological functioning in a sample of Colombian women. These data add cross-cultural knowledge to the limited work in this area that has largely focused on women in North America.
Different Exposure Metrics of Rotating Night-Shift Work and Serum Lipid Profiles Among Steelworkers
Authors: Wang Lihua , Zhang Shengkui , Yu Miao , Feng Hongman , Li Xiaoming , Yuan Juxiang
Published: June 2022

Objectives

To examine the association and potential mediators between rotating night shift work and serum lipid profiles in Chinese steelworkers.

Methods

Different exposure metrics of night shifts collected through face-to-face personal interviews. Serum lipid profiles were measured using an automatic biochemical analyzer. Generalized linear models and mediation analyses were used to analyze the main associations.

Results

Compared with day workers, the total cholesterol level in night-shift workers increased in those with 13 to 20 years of night shifts and in those with average frequency of four or more night shifts per month. The association between the duration of night shifts and the total cholesterol level was mediated by systolic and diastolic blood pressure and body mass index.

Conclusions

Rotating night-shift work for 13 to 20 years was associated with an increase in the total cholesterol levels in steelworkers, and blood pressure and body mass index may be involved in the causal pathway.
Biological Embedding of Psychosocial Stressors Within a Sample of Canadian Firefighters
Authors: Igboanugo Somkene , Chaurasia Ashok , Bigelow Philip L. , Mielke John G.
Published: June 2022

Objective

We wanted to determine whether the biological embedding of perceived psychosocial stress could be observed within a sample of Canadian firefighters.

Methods

We collected sociodemographic and general health–related information from 58 firefighters. In addition, measures of work-related and general life psychosocial stress, perceived social support, and physiological parameters thought to reflect the embedding of stress were gathered and analyzed using analysis of variance and linear regression models.

Results

Despite observing a positive relationship between psychosocial stress and allostatic load, the association was not significant; however, age did significantly predict allostatic load (B= 0.09,P= 0.04). Notably, our participants reported abundant social support that was inversely associated with perceived stress.

Conclusions

Although perceived stress did not significantly affect allostatic load in our sample, high levels of social support may have provided an important countervailing force.
Low Job Control and Racial Disparities in Breastfeeding
Authors: Whitley Margaret D. , Ro Annie , Choi BongKyoo
Published: June 2022

Background

Low job control may predict shorter breastfeeding (BF) among working mothers and may contribute to racial disparities in BF.

Methods

We used demographic, employment, and health data for n = 631 observations from the Panel Study of Income Dynamics. Job control scores came from a job-exposure matrix.

Using path analysis, we assessed whether job control predicted BF and mediated Black-White BF differences. We controlled for education, working hours, marital status, and low birthweight.

Results

Lower job control predicted decreased odds of BF for at least 6 months (odds ratio, 0.61; 95% confidence interval, 0.31–0.90; reference, no BF). Low job control explained 31% of the Black-White difference for both shorter-term and longer-term BF.

Conclusions

Low job contributes to shorter BF and to BF disparities by race. Intervening to enhance job control could improve BF.
Validation of the KANG KC-2850 oscillometric upper-arm ambulatory blood pressure monitor in general population according to the Association for the Advancement of Medical Instrumentation/European Society of Hypertension/International Organization for Standardization universal standard
Authors: Liu Kui , Ma Yi-Fei , Wang Yan , Zhang Yang , Li Lin-Yi , Zhang Jie-Qiong , Jiang Jun , Chen Rui-Lin , Wan Yi
Published: June 2022

Objective

To evaluate the accuracy of the KANG KC-2850 ambulatory blood pressure monitor (ABPM) for clinical blood pressure (BP) measurement according to the Association for the Advancement of Medical Instrumentation/European Society of Hypertension/International Organization for Standardization (AAMI/ESH/ISO) universal standard (ISO 81060-2:2018).

Methods

BP was sequentially measured and compared with a standard mercury sphygmomanometer in 85 eligible participants. A standard adult cuff (22–3232 cm) was used for test device measurements. A total of 255 comparison pairs were obtained and analyzed according to the Association for the Advancement of Medical Instrumentation/European Society of Hypertension/International Organization for Standardization (AAMI/ESH/ISO universal standard.

Results

The standard requirements were followed precisely. For the validation Criterion 1, the mean ± SD of the differences between the test device and reference BP readings was −1.12 ± 5.01 and −0.33 ± 4.52 mmHg for SBP and DBP, respectively. For Criterion 2, the SD of the averaged BP differences between the test device and reference BP per subject was 3.59 and 3.60 mmHg for SBP and DBP, respectively.

Conclusion

The KANG KC-2850 ABPM met all the requirements for validation by the AAMI/ESH/ISO universal standard and can be recommended for clinical use in general population.
The research of SARIMA model for prediction of hepatitis B in mainland China
Authors: Zhao Daren , Zhang Huiwu , Cao Qing , Wang Zhiyi , Zhang Ruihua
Published: June 2022

Hepatitis B virus infection is a major global public health concern. This study explored the epidemic characteristics and tendency of hepatitis B in 31 provinces of mainland China, constructed a SARIMA model for prediction, and provided corresponding preventive measures.

Monthly hepatitis B case data from mainland China from 2013 to 2020 were obtained from the website of the National Health Commission of the People's Republic of China. Monthly data from 2013 to 2020 were used to build the SARIMA model and data from 2021 were used to test the model.

Between 2013 and 2020, 9,177,313 hepatitis B cases were reported in mainland China. SARIMA(1,0,0)(0,1,1)12 was the optimal model and its residual was white noise. It was used to predict the number of hepatitis B cases from January to December 2021, and the predicted values for 2021 were within the 95% confidence interval.

This study suggests that the SARIMA model simulated well based on epidemiological trends of hepatitis B in mainland China. The SARIMA model is a feasible tool for monitoring hepatitis B virus infections in mainland China.
Comparison of lidocaine and ropivacaine stellate ganglion blockade in treating upper limb postherpetic neuralgia
Authors: Fan Zhouhong , Zheng Xin , Li Dongbai , Chen Haopeng , Li Lingchao
Published: June 2022

To provide a basis for treating postherpetic neuralgia (PHN), we compared the efficacy of lidocaine and ropivacaine stellate ganglion block (SGB) in PHN treatment in the upper limbs.

Data from 252 patients with upper-limb PHN were retrospectively analyzed. The lidocaine group (n = 118) was treated with oral pregabalin capsules 75 mg twice a day, tramadol hydrochloride sustained release tablets 100 mg twice a day, and amitriptyline 25 mg once at night combined with ultrasound-guided lidocaine SGB; the ropivacaine group (n = 134) was orally administered the same medicines combined with ultrasound-guided ropivacaine SGB. The visual analog scale (VAS), self-rating anxiety scale (SAS), and adverse reactions were compared between the groups before treatment and at 1 week, 1 month, and 3 months after treatment.

There were no significant differences between the lidocaine and ropivacaine groups in terms of sex, age, height, weight, and pain duration (P > .05). There was no significant difference between the groups in VAS and SAS scores before treatment (P > .05). At 1 week, 1 month, and 3 months after ultrasound-guided SGB treatment, the VAS and SAS scores were significantly lower in the ropivacaine group than in the lidocaine group (P < .05). There were no significant differences between the groups in terms of adverse reactions (P > .05).

For ultrasound-guided SGB treatment of upper limb PHN, ropivacaine is superior to lidocaine. Ultrasound-guided ropivacaine SGB is safe and effective for the treatment of upper limb PHN.
Relapse of cryoglobulinemic vasculitis with new-onset severe renal involvement in two patients following mRNA COVID-19 vaccination
Authors: Vornicu Alexandra , Berechet Andreea , Frățilă Georgiana , Obrişcă Bogdan , Jurcuţ Ciprian , Ismail Gener
Published: June 2022

Rationale:

Since mass-scale severe acute respiratory syndrome coronavirus 2 vaccination, there have been case reports of several immune-mediated reactions, including new-onset and flares of glomerular disorders following immunization with mRNA coronavirus disease 2019 vaccines. Here, we report two cases, the first to our knowledge, of relapsing cryoglobulinemic vasculitis with new-onset severe renal involvement following mRNA coronavirus disease 2019 vaccination.

Patient concerns:

The relapse of the cutaneous and the new onset of severe renal involvement of cryoglobulinemic vasculitis occurred three weeks after the second dose of the mRNA Moderna coronavirus disease 2019 vaccination and two days after the first dose of mRNA Pfizer coronavirus disease 2019 vaccination in the first and second patient, respectively.

Diagnosis:

Kidney biopsies were performed. The first pacient's kidney biopsy showed a membranoproliferative pattern of glomerular injury with extensive mesangial and endocapillary hypercellularity, while severe endothelial swelling, loss of fenestrations and widening of subendothelial space were identified by electron-microscopy. The second patient's kidney biopsy was consistent with cryoglobulin associated membrano-proliferative pattern of glomerular injury.

Interventions:

Our patients were managed with a combination of immunosuppressants consisting of corticosteroids, Cyclophosphamide and Rituximab with a favourable outcome at the end of the induction period.

Outcomes:

Clinical and immunological response was achieved in both patients after four months of follow-up.

Lessons:

The temporal association of the relapse of the cryoglobulinemic vasculitis to mRNA coronavirus disease 2019 vaccination suggest that the vaccine might have been a trigger for the reactivation of the disease in our cases. This possible association should be acknowledged by physicians in order to provide optimal monitoring and treatment in case of reactivation of the disease post-immunization.
Morbidity and Associated Factors of Depressive Disorder in Patients With Parkinson's Disease
Authors: Lee Yu , Chiou Yu-Jie , Chang Yung-Yee , Hung Chi-Fa , Chen Ying-Fa , Lin Tsu-Kung , Wang Liang-Jen
Published: June 2022

Parkinson's disease (PD) is a progressive, neurodegenerative disorder and is commonly comorbid with depression. The aim of this cross-sectional study was to assess morbidity and associated factors of depression in patients with PD. In total, 181 patients with PD were enrolled and assessed using the Mini-International Neuropsychiatric Interview. Of the sample, 51% had at least one psychiatric diagnosis. The most prevalent psychiatric disorder was depressive disorder (27.6%), followed by rapid eye movement sleep behavior disorder (9.9%), insomnia disorder (8.8%), and adjustment disorder (2.8%). Severity of anxiety, suicide risk, and anxiolytics/hypnotics use were factors associated with depressive disorder in PD patients. Furthermore, severity of anxiety was significantly linked with suicide risk. We suggest that use of a standardized structured interview for early detection of depression in PD patients is crucial. Anxiety, anxiolytics/hypnotics use, depression, and suicide risks are interrelated and warrant clinical concerns regarding PD patients.
Case Report: Multiple Ocular Manifestations Assisted in the Diagnosis of Systemic Sarcoidosis
Authors: Zhu Miao-Miao , Ba Xiao-qun , Liu Lan
Published: June 2022

SIGNIFICANCE

Sarcoidosis is a variable, multisystem granulomatous disease, which can affect many organs including the lungs, lymph nodes, and eyes. It is difficult to differentiate sarcoidosis and tuberculosis because of their similar clinical and pathological features.

PURPOSE

This study aimed to describe a sarcoidosis case with typical ocular and systemic manifestations combined with suspected tuberculosis infection.

CASE REPORT

A 30-year-old Chinese man, initially diagnosed with tuberculosis, presented with typical ocular sarcoidosis during antituberculosis therapy. The ocular surface, anterior chamber, anterior chamber angle, ciliary body, vitreous, optic disc, and lacrimal gland of the patient all exhibited manifestations of sarcoidosis, although optic disc involvement has rarely been reported. Typical ocular sarcoidosis manifestations and positive responses to corticosteroid therapy of the patient helped us reach the diagnosis of systemic sarcoidosis. The patient was followed up for 48 months and showed significant improvement of miliary nodules and lymph nodes in both lungs. However, the appearance of uveitis in the right eye persisted because of nonadherence to steroid treatment.

CONCLUSIONS

This case shows the importance of ophthalmic evaluation in the diagnosis and management of sarcoidosis and supports a possible role of Mycobacterium tuberculosis in the pathogenesis of sarcoidosis.
Association of Pathogen Type With Outcomes of Children Encountering Community-Acquired Pediatric Septic Shock
Authors: Salud Derek , Reeder Ron W. , Banks Russell K. , Meert Kathleen L. , Berg Robert A. , Zuppa Athena , Newth Christopher J. , Hall Mark W. , Quasney Michael , Sapru Anil , Carcillo Joseph A. , McQuillen Patrick S. , Mourani Peter M. , Varni James W. , Zimmerman Jerry J. ,   for the Life After Pediatric Sepsis Evaluation (LAPSE) Investigators
Published: June 2022

OBJECTIVES:

To determine the association of pathogen type with mortality, functional status, and health-related quality of life (HRQL) among children at hospital discharge/1 month following hospitalization for septic shock.

DESIGN:

Secondary database analysis of a prospective, descriptive cohort investigation.

SETTING:

Twelve academic PICUs in the United States.

PATIENTS:

Critically ill children, 1 month to 18 years old, enrolled from 2013 to 2017.

INTERVENTIONS:

None.

MEASUREMENTS AND MAIN RESULTS:

Association of clinical outcomes with pathogen type was assessed for all patients and separately for surviving patients enrolled in the primary Life After Pediatric Sepsis Evaluation (LAPSE) investigation. For this secondary analysis, we predicted that age would be associated with pathogen type and outcomes, and accordingly, it was incorporated as a confounding variable in primary analyses. Among 389 children enrolled with septic shock, at 1 month/hospital discharge, we observed no statistically significant differences in relation to pathogen types for the composite outcome mortality or substantial new functional morbidity: no causative organism identified (27% [28/103]), pure viral infections (26% [24/91]), pure bacterial/fungal infections (25% [31/125]), and bacterial/fungal+viral coinfections (33% [23/70]). Similarly, we observed no statistically significant differences in relation to pathogen types for the composite outcome, mortality, or persistent serious deterioration of HRQL: no causative organism identified (43% [44/103]), pure viral infections (33% [30/91]), pure bacterial/fungal infections (46% [57/125]), and bacterial/fungal+viral coinfections (43% [30/70]). However, we did identify statistically significant associations between pathogen type and the outcome ventilator-free days (p = 0.0083) and PICU-free days (0.0238).

CONCLUSIONS:

This secondary analysis of the LAPSE database identified no statistically significant association of pathogen type with composite mortality and morbidity outcomes. However, pathogen type may be associated with PICU resources employed to treat sepsis organ dysfunction. Ultimately, pediatric septic shock was frequently associated with adverse patient-centered, clinically meaningful outcomes regardless of infectious disease pathogen type.
Bivalirudin or Unfractionated Heparin for Anticoagulation in Pediatric Patients on Continuous Flow Ventricular Assist Device Support: Single-Center Retrospective Cohort Study
Authors: Puri Kriti , Tunuguntla Hari P. , Hensch Lisa A. , Loh JiaHoi , Hui Shiu-Ki , Razavi Asma , Tume Sebastian C. , Humlicek Timothy J. , Denfield Susan W. , Spinner Joseph A. , Choudhry Swati , Price Jack F. , Dreyer William J. , Adachi Iki , Teruya Jun
Published: June 2022

Objectives:

Bivalirudin is a direct thrombin inhibitor that is being increasingly used for anticoagulation in children after ventricular assist device (VAD) implantation. While the data on bivalirudin use in pulsatile flow VADs are growing, reports on its use in patients on continuous flow (CF) VAD as well as comparisons of associated outcomes with unfractionated heparin (UFH) remain limited.

Design:

Retrospective cohort study.

Setting:

Single tertiary-quaternary referral center.

Patients:

All patients less than 21 years old on CF-VAD support who received bivalirudin or UFH for anticoagulation between the years 2016 and 2020.

Interventions:

Not applicable.

Measurements and Main Results:

Clinical characteristics compared between the cohorts included time to target range of anticoagulation, markers of hemolysis, and prevalence of hemocompatibility-related adverse events such as major hemorrhagic complications, ischemic stroke, and pump thrombosis. In 42 unique patients (41 HeartWare HVAD [Medtronic, Minneapolis, MN], one HeartMate 3 LVAD [Abbott Laboratories, Abbott Park, IL]) during the study period, a total of 67 encounters of IV anticoagulation infusions (29 UFH and 38 bivalirudin) were retrospectively reviewed. In comparison with use of UFH, bivalirudin was associated with lesser odds of major bleeding complications (odds ratio [OR], 0.29; 95% CI, 0.09–0.97; p = 0.038). We failed to identify any difference in odds of major thrombotic complications (OR, 2.53; 95% CI, 0.47–13.59; p = 0.450). Eight of the patients (28%) on UFH were switched to bivalirudin due to hemorrhagic or thrombotic complications or inability to achieve therapeutic anticoagulation, while two of the patients (5%) on bivalirudin were switched to UFH due to hemorrhagic complications. Bivalirudin was used for a “washout” in eight cases with concern for pump thrombosis—six had resolution of the pump thrombosis, while two needed pump exchange.

Conclusions:

Use of bivalirudin for anticoagulation in patients on CF-VAD support was associated with lesser odds of hemorrhagic complications compared with use of UFH. Bivalirudin “washout” was successful in medical management of six of eight cases of possible pump thrombosis.
Exploratory Use of Glycoprotein IIb/IIIa Inhibition in Prevention of Blalock-Taussig Shunt Thrombosis*
Authors: Piekarski Breanna L. , Rogers Jenna , Zurakowski David , Thiagarajan Ravi , Emani Sitaram M.
Published: June 2022

OBJECTIVES:

Morbidity and mortality related to modified Blalock-Taussig shunt (mBTTS) thrombosis remain a significant risk. Platelet inhibition following mBTTS may reduce this risk. However, oral antiplatelet agents have variable absorption following surgery. We determine risk factors for mBTTS thrombosis and hypothesize that IV glycoprotein IIb/IIIa inhibitor (tirofiban) as a bridge to oral aspirin reduces the rate of shunt thrombosis in the immediate postoperative period. End points within the 14-day follow-up period include mBTTS thrombosis, overall thrombosis, bleeding, length of stay, and mortality.

DESIGN:

Retrospective, Institutional Review Board–approved cohort study.

SETTING:

Single-center cardiac ICU.

PATIENTS:

Patients under the age of 18 who had an mBTTS placed within the study period of January 2008 to December 2018 were included.

INTERVENTIONS:

Patients were divided into two groups: standard of care (SOC) anticoagulation alone and SOC with tirofiban as a bridge to oral aspirin.

MEASUREMENTS and MAIN RESULTS:

Freedom from mBTTS thrombosis was estimated using the Kaplan-Meier method. A multivariable predictive model using the four most significant risk factors was developed using logistic regression. A total of 272 patients were included: 36 subjects in the SOC/tirofiban group and 236 in the SOC group. Shunt thrombosis occurred in 26 (11%) SOC group with zero in SOC/tirofiban group (p = 0.03). The median time to thrombosis was 0 days (range, 0–12 d). The area under the curve for the predictive model (anticoagulation group, history of coagulopathy, intraoperative shunt clipping, and shunt size/weight ratio) is 0.790 (p < 0.001). Prevalence of bleeding and mortality was not significantly different between the groups.

CONCLUSIONS:

Highest risk for shunt thrombosis following mBTTS occurs within the first few days after surgical procedure. Tirofiban is a safe addition to SOC and may be an effective strategy to prevent early mBTTS thrombosis.
Predictors of Emergency Department Opioid Use Among Adolescents and Young Adults
Authors: Ruskin Daniel , Rasul Rehana , McCann-Pineo Molly
Published: June 2022

Objective

It is well established that adolescents and young adults are increasingly vulnerable to the effects of early opioid exposures, with the emergency department (ED) playing a critical role in such introduction. Our objective was to identify predictors of ED opioid administration (ED-RX) and prescribing at discharge (DC-RX) among adolescent and young adults using a machine learning approach.

Methods

We conducted a secondary analysis of ED visit data from the National Hospital Ambulatory Medical Care Survey from 2014 to 2018. Visits where patients were aged 10 to 24 years were included. Predictors of ED-RX and DC-RX were identified via machine learning methods. Separate weighted logistic regressions were performed to determine the association between each predictor, and ED-RX and DC-RX, respectively.

Results

There were 12,693 ED visits identified within the study time frame, with the majority being female (58.6%) and White (70.7%). Approximately 12.3% of all visits were administered an opioid during the ED visit, and 11.5% were prescribed one at discharge. For ED-RX, the strongest predictors were fracture injury (odds ratio [OR], 5.24; 95% confidence interval [CI], 3.73–7.35) and Southern geographic region (OR, 3.01; 95% CI, 2.14–4.22). The use of nonopioid analgesics significantly reduced the odds of ED-RX (OR, 0.46; 95% CI, 0.37–0.57). Fracture injury was also a strong predictor of DC-RX (OR, 5.91; 95% CI, 4.24–8.25), in addition to tooth pain (OR, 5.47; 95% CI, 3.84–7.69).

Conclusions

Machine learning methodologies were able to identify predictors of ED-RX and DC-RX, which can be used to inform ED prescribing guidelines and risk mitigation efforts among adolescents and young adults.
Neuromuscular Electrical Stimulation of Upper Extremities in Patients with Cerebral Palsy: A systematic review and Meta-Analysis of Randomized Controlled Trials
Authors: Ou Chih-Hung , Shiue Chian-Chuan , Kuan Yi-Chun , Liou Tsan-Hon , Chen Hung-Chou , Kuo Ting-Ju
Published: June 2022

Objective

To assess the effects of neuromuscular electrical stimulation on the upper extremities of patients with cerebral palsy.

Design

We searched PubMed, Cochrane, Embase, and Scopus databases for randomized controlled trials examining the effects of neuromuscular electrical stimulation on the upper extremities of children with cerebral palsy.

Results

Eight randomized controlled trials (n = 294) were included in the meta-analysis. Compared with traditional physical therapy, sensorimotor training and task-oriented training, constraint-induced movement therapy, dynamic bracing, and conventional robot-assisted therapy, neuromuscular electrical stimulation in combination with these therapies resulted in significantly greater functional scale scores (standardized mean difference (SMD): 0.80; 95% confidence interval [CI]: 0.54–1.06), muscle strength of upper extremities (SMD: 0.57; 95% CI: 0.25–0.88), and spasticity of upper extremities (relative risk [RR]: 2.53; 95% CI: 1.46–4.39) (SMD: −0.18; 95% CI: −0.29 to −0.06) but did not improve the wrist range of motion (SMD: 0.43; 95% CI: −0.04–0.91). In addition, the effect of neuromuscular electrical stimulation on functional scale scores remained after 3 months of follow-up (SMD: 0.68; 95% CI: 0.16–1.2).

Conclusion

Neuromuscular electrical stimulation effectively improved hand function, muscle strength, and spasticity in patients with cerebral palsy.
Kabul airport suicide bombing attack: Mass casualty management at the EMERGENCY NGO Hospital
Authors: Spagnolello Ornella , Esmati Shekiba , Amiri Abdul Fahim , Shahir Mir Abdul Azim , Gatti Sofia , Portella Gina , Langer Martin
Published: June 2022

BACKGROUND

Terrorist attacks with large numbers of civilian victims are not uncommon in war-torn countries, and present a unique challenge for health care facilities with limited resources. However, these events are largely underreported and little is known about how the mass casualty events (MCEs) are handled outside of a military setting.

METHODS

This study is a retrospective analysis of the MCE which ensued the Kabul Airport suicide attack (August 26, 2021) at the Kabul EMERGENCY NGO Hospital (Afghanistan).

RESULTS

Within 6 hours, 93 causalities presented at our hospital. Of them, 36 severe injured were admitted. Mean age was 30.8 years (SD, 10.1 years). The most common injury mechanism was shell fragments. The most common injury site was head (63%; 23/36), followed by limbs (55.5%; 20/36) and thoracoabdominal region (30.5%; 11/36). Combined injuries occurred in 38.9% of cases. Patients receiving surgery presented more combined injuries in comparison with patients receiving only medical treatment (47.1% vs. 31.6%). Thoracoabdomen (25.0% vs. 15.4%) and/or extremity injury (42.9% vs. 28.6%) were more prevalent in the surgical group. Thirty major surgical procedures were carried out on 17 patients in the 9 hours following the first arrival. The rate of intensive care unit/high dependency unit admission was 36.1% and the 30-day in-hospital mortality was 16.6% (6/36). All deaths were recorded in the first 24 hours, and none of them received surgery.

CONCLUSION

A large number of wounded patients must be anticipated after suicide bombing attacks. The authors report the challenges faced and key aspects of their management of MCEs.

LEVEL OF EVIDENCE

Prognostic/Epidemiological; Level IV.
Emerging strategies for environmental decontamination of the nosocomial fungal pathogen Candida auris
Authors: Bandara H. M. H. N. , Samaranayake L. P.
Published: June 2022

Candida auris is a recently emerged multidrug-resistant fungal pathogen that causes life-threatening infections to the human population worldwide. Recent rampant outbreaks of C. auris in coronavirus disease 2019 (COVID-19) patients, together with outbreaks in over 45 countries, highlight its threat to patients and healthcare economies. Unlike other pathogenic Candida species, C. auris is capable of surviving in abiotic surfaces of healthcare facilities for prolonged periods, leading to increased risk of transmission within nosocomial settings. C. auris is resistant to multiple classes of antifungal agents, forms dry biofilms and transmits independently to regional epicentres, making its eradication from nosocomial environment arduous. The lack of strategies for environmental decontamination of C. auris from nosocomial settings is evident from the generic guidance and recommendations provided by leading global healthcare bodies. Therefore, this minireview discusses the current guidelines for environmental decontamination of C. auris and compounds and strategies currently under investigation for potential future use. While established guidelines recommend the use of products mainly consisting of sodium hypochlorite and hydrogen peroxide, initial works have been reported on the promising anti-C. auris properties of various other compounds and some biocompatible alternatives. Further validation of these approaches, coupled up with environmentally friendly decontamination protocols, are warranted to achieve superior elimination of C. auris from healthcare settings.