bluuebunny/crossref_metadata_2025 huggingface dataset:
Delaying an infliximab infusion by more than 3 days is associated with a significant reduction in trough levels but not with clinical worsening
Authors: Ben-Shatach Zohar , Ziv-Baran Tomer , Fudim Ella , Yavzori Miri , Picard Orit , Levartovsky Asaf , Selinger Limor , Weiss Batia , Kopylov Uri , Eliakim Rami , Ungar Bella
Published: March 2022

Background:

Higher infliximab trough levels (TLs) correlate with better clinical, inflammatory, and endoscopic outcomes among inflammatory bowel disease (IBD) patients. Although standard scheduled infliximab therapy regimen consists of infusions at pre-defined time-points (weeks 0, 2, 6, and every 8 weeks), short-period deviations from therapeutic schedule are common in ‘real life’, but the pharmacokinetic impact of these deviations has not been explored. In this study, we aim to determine whether short-period deviations from infusion schedule affect infliximab-TL.

Methods:

A retrospective analysis of all IBD patients receiving infliximab maintenance therapy every 8 weeks was conducted in a tertiary medical center. Patients with anti-drug antibodies, deliberate interval shortening and <3 sequential maintenance sera available were excluded. Associations between time since last infusion and TL were studied. Statistical analysis was performed using generalized estimating equations.

Results:

Out of over 10,000 sera, 2088 sera of 302 maintenance period stable infliximab-therapy-patients met inclusion criteria (median TL 4.1 μg/mL, interquartile range (IQR) 2.3–6.5 μg/mL). A delay beyond 3 days in infusion schedule (n > 59 days since last infusion) was found to significantly affect TL (mean difference in TL 0.9 μg/mL, 95% confidence interval (CI): 0.03–1.9 μg/mL, p < 0.04). Furthermore, among patients with delayed infusions, 80% had TL below 5 μg/mL, in comparison to 55% of patients who were not late (odds ratio (OR): 2.81, CI: 2.02–3.92, p < 0.0001).

Conclusion:

Real-life delays of ⩽3 days from infusion protocol can probably be allowed. Delays >3 days culminate in measurable decrease of TL, although effect on clinical outcome is unclear. This needs to be taken into account when interpreting drug-level test results.

A total of 2088 sera of 302 maintenance period inflammatory bowel disease (IBD) patients treated with infliximab were analyzed, to assess effect of small deviations from infusion schedule on TLs. A significant decline in patients’ trough level (TL) was noted as early as 3 days after scheduled infusion.
Failed induction of labor and associated factors in Adama Hospital Medical College, Oromia Regional State, Ethiopia
Authors: Demssie Enku Afework , Deybasso Haji Aman , Tulu Tewodros Mengistu , Abebe Dawit , Kure Mohammed Abdurke , Teji Roba Kedir
Published: March 2022

Background:

Failed induction of labor continues to be a public health challenge throughout the world. This failed induction of labor is associated with a higher rate of maternal and fetal morbidity because it increases the unwanted effect of emergency cesarean section. It is also associated with an increased risk of numerous adverse maternal and perinatal outcomes such as uterine rupture, nonreassuring fetal heart rate tracing, postpartum hemorrhage, stillbirth, and severe birth asphyxia. Thus, this study was aimed to assess the failed induction of labor and associated factors in the Adama Hospital Medical College, Oromia Regional State, Ethiopia.

Methods:

A facility-based cross-sectional study was conducted from 1 to 30 December 2020 in Adama Hospital Medical College, Ethiopia. A total of 379 women who underwent labor induction in the Adama Hospital Medical College from December 2019 to November 2020 were enrolled in the study. The participants’ charts were selected using a simple random sampling technique. Data were collected using a pretested and validated structured questionnaire. Descriptive statistics were carried out using frequency tables, proportions, and summary measures. Predictors were assessed using a multivariable logistic regression analysis model and reported using adjusted odds ratio with 95% confidence interval. Statistical significance was considered at a p value <0.05.

Results:

Of 379 induced labor included in the study, the proportion of failed induction was found to be 29.6% (95% confidence interval (25.2, 34.3)). Prelabor rupture of the membrane was found to be the most common indication for induction of labor (46.4%) followed by a hypertensive disorder of pregnancy (21.6%). In the final model of multivariable analysis, predictors such as: nulliparity (adjusted odds ratio = 2.32, 95% confidence interval (1.08, 5.02)), unfavorable cervical status (adjusted odds ratio = 3.46, 95% confidence interval (1.51, 7.94)), prelabor rupture of membrane (adjusted odds ratio = 2.60, 95% confidence interval (1.14, 5.91)), hypertensive disorder of pregnancy (adjusted odds ratio = 3.01;95% confidence interval (1.61, 558)), preinduction membrane status (adjusted odds ratio = 3.63; 95% confidence interval (1.48, 8.86)), and birth weight of greater than 4000 g (adjusted odds ratio = 4.33; 95% confidence interval (1.44, 13.02)) were statistically associated with failed induction of labor.

Conclusion:

The prevalence of failed induction of labor was relatively high in this study area because more than a quarter of mothers who underwent induction of labor had failed induction. This calls for all stakeholders to adhere to locally available induction protocols and guidelines. In addition, pre-induction conditions must be a top priority to improve the outcome of induction of labor.
Proposal of sialyl Lewis x/a as prognostic biomarkers in clear cell renal cell carcinoma: A study on a cohort of 117 patients submitted to curative surgery
Authors: Tanio Makoto , Fukiage Yusuke , Muramoto Akifumi , Yokoyama Osamu , Kobayashi Motohiro
Published: March 2022

Objective:

Metastatic recurrence has been reported to occur in 20–30% of patients with clear cell renal cell carcinoma (ccRCC). Although the prognosis of these patients is poor, no marker has been established to predict metastatic potential and/or prognosis. Therefore, we investigated membrane expression of sialyl Lewis x (sLex) and sialyl Lewis a (sLea), which is generally considered to be associated with cancer metastasis.

Materials and methods:

We enrolled 117 patients who underwent curative surgery for RCC and were pathologically diagnosed as ccRCC. Immunohistochemistry for sLex and sLea was performed to evaluate the signal intensity on the cell membrane. We statistically analysed whether membrane expression of sLex/sLea is correlated with clinicopathological parameters and prognosis.

Results:

Of the 117 patients, 72 were classified as sLex-positive and 44 as sLea-positive. The sLex-positive group had significantly shorter progression-free survival (PFS) and overall survival (OS) than the negative group. Similarly, the sLea-positive group had significantly shorter PFS than the negative group, and it showed a trend towards a reduction of OS, although it did not reach statistical significance, a fact that could be due to the small sample size.

Conclusion:

Both sLex and sLea could be possible future prognostic indicators in ccRCC.

Level of evidence:

Level 3
Motions to instruct conferees as a majoritarian tool in the U.S. house
Authors: Ryan Josh M
Published: March 2022

The extent to which the policymaking process is majoritarian, rather than controlled by the majority party, is a fundamental question in U.S. congressional politics, and in collective choice institutions broadly. Previous research has examined whether some House rules empower the minority party to propose alternative legislation to the floor and circumvent the majority party’s agenda power. I argue the motion to instruct conferees allows the minority to influence policy during the conference process. Motions to instruct are the prerogative of the minority party, are frequently offered, and are frequently passed by the chamber. They substantially moderate conference bills as compared to those bills without a motion to instruct, suggesting that the procedure weakens majority party agenda power. Further, the minority may offer a motion to instruct intended to fail as a way of demonstrating policy extremity to voters, consistent with blame-game bargaining models.
STEADI Self-Report Measures Independently Predict Fall Risk
Authors: Ritchey Katherine , Olney Amanda , Chen Sunny , Phelan Elizabeth A.
Published: March 2022

Falls are a significant contributor to disability and death among older adults. Despite practice guidelines to increase falls screening in healthcare settings, preventive care for falls continues to be infrequently delivered. Simplifying screening by relying on self-report of balance, gait, or strength concerns, alone may increase the frequency of falls screening. We assessed the diagnostic accuracy of self-report measures of gait, strength, and balance from the Centers for Disease Control and Prevention’s Stopping Elderly Accidents, Deaths, and Injuries (STEADI) for identification of fall risk. The criterion standard for fall risk was the Timed Up-and-Go (TUG). Assessments were conducted with 95 adults aged 65 years or older in an outpatient osteoporosis clinic between May 2015 and September 2016. Receiver operating characteristic curve analysis found that two self-report questions (“I feel unsteady with walking” and “I need my arms to stand from a chair”) had high discriminatory ability (AUC 0.906; 95% CI 0.870–0.942) to identify those at high fall risk; additional questions did not substantially improve discrimination. These findings suggest that two self-report questions identify those at risk of falling who would benefit from interventions (e.g., physical therapy). Performance testing as part of routine falls screening of older persons in the outpatient setting may be unnecessary.
Chronic Mercury Poisoning: A Cause for Reversible Cardiomyopathy
Authors: Pavan D. , Dhulipudi Bhargavi , Bhakru Shweta , Yerra Anupama , Shaikh Farhan , Koneti Nageswara Rao
Published: March 2022

We report a case of dilated cardiomyopathy because of chronic mercury poisoning. A 12-year-old girl was repeatedly admitted with severe congestive heart failure. She received indigenous medication for vitiligo for several months. A transthoracic echocardiogram showed severe ventricular dysfunction (left ventricle fractional shortening: 14%). She had a stormy course in the hospital, complicated by ventricular arrhythmias and multiorgan dysfunction. Careful interrogation and analysis of local medication and patient serum showed high levels of mercury. She was treated with British anti-Lewisite. She improved over the period of time, and her left ventricle fractional shortening improved to 22%.
High-resolution post-earthquake recovery simulation: Impact of safety cordons
Authors: Hulsey Anne M , Baker Jack W , Deierlein Gregory G
Published: March 2022

A framework is proposed to assess the impact of safety cordons on the recovery of community functions after an earthquake, using high-resolution geospatial information to simulate the damage, cordons, and recovery trajectories for buildings in the affected area. Ground motion maps are developed to characterize shaking intensities for regional building-level engineering assessments of damage, repair times, and recovery times to quantify the impact of access restrictions associated with cordons around tall buildings with impaired collapse safety. The results are presented as recovery curves that quantify the cumulative loss in building functionality across the community as a function of time following an earthquake. A case study considers recovery of office space in Downtown San Francisco, following a Mw7.2 event on the San Andreas Fault. For this scenario, an average of 219 community days of office functionality are lost in the first year, representing about 60% of the total office space capacity. About one-third of the loss is attributed to access restrictions associated with cordons around older tall buildings. The proposed framework can be used to investigate the efficacy of various mitigation strategies to expedite recovery. While the most effective strategy for mitigating the overall impact of cordon restrictions is to seismically retrofit older tall buildings that trigger cordons, other less expensive preparedness measures are shown to be effective, depending on the recovery time frame of interest. Specifically, recovery preparedness measures are generally more effective when evaluated for longer-term recovery targets (e.g. recovery of function after 12 months) compared with short-term targets (e.g. recovery after 4 months).
Deficiency of SARS-CoV-2 T-cell responses after vaccination in long-term allo-HSCT survivors translates into abated humoral immunity
Authors: Einarsdottir Sigrun , Martner Anna , Waldenström Jesper , Nicklasson Malin , Ringlander Johan , Arabpour Mohammad , Törnell Andreas , Wiktorin Hanna Grauers , Nilsson Staffan , Bittar Rudy , Nilsson Malin , Lisak Mikael , Veje Malin , Friman Vanda , Al-Dury Samer , Bergström Tomas , Ljungman Per , Brune Mats , Hellstrand Kristoffer , Lagging Martin
Published: March 2022

Recipients of allogeneic hematopoietic stem cell transplantation (allo-HSCT) for hematological diseases are at risk of severe disease and death from COVID-19. To determine the safety and immunogenicity of BNT162b2 and mRNA-1273 COVID-19 vaccines, samples from 50 infection-naive allo-HSCT recipients (median, 92 months from transplantation, range, 7-340 months) and 39 healthy controls were analyzed for serum immunoglobulin G (IgG) against the receptor binding domain (RBD) within spike 1 (S1) of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2; anti–RBD-S1 IgG) and for SARS-CoV-2–specific T-cell immunity, reflected by induction of T-cell–derived interferon-γ in whole blood stimulated ex vivo with 15-mer SI-spanning peptides with 11 amino acid overlap S1-spanning peptides. The rate of seroconversion was not significantly lower in allo-transplanted patients than in controls with 24% (12/50) and 6% (3/50) of patients remaining seronegative after the first and second vaccination, respectively. However, 58% of transplanted patients lacked T-cell responses against S1 peptides after 1 vaccination compared with 19% of controls (odds ratio [OR] 0.17; P = .009, Fisher’s exact test) with a similar trend after the second vaccination where 28% of patients were devoid of detectable specific T-cell immunity, compared with 6% of controls (OR 0.18; P = .02, Fisher’s exact test). Importantly, lack of T-cell reactivity to S1 peptides after vaccination heralded substandard levels (<100 BAU/mL) of anti–RBD-S1 IgG 5 to 6 months after the second vaccine dose (OR 8.2; P = .007, Fisher’s exact test). We conclude that although allo-HSCT recipients achieve serum anti–RBD-S1 IgG against SARS-CoV-2 after 2 vaccinations, a deficiency of SARS-CoV-2–specific T-cell immunity may subsequently translate into insufficient humoral responses.
Molecular landscape of IDH-mutant astrocytoma and oligodendroglioma grade 2 indicate tumor purity as an underlying genomic factor
Authors: Zhao Binghao , Xia Yu , Yang Fengchun , Wang Yaning , Wang Yuekun , Wang Yadong , Dai Congxin , Wang Yu , Ma Wenbin
Published: March 2022

Background

IDH-mutant astrocytoma and oligodendroglioma have an indolent natural history and are recognized as distinct entities of neoplasms. There is little knowledge on the molecular differences between IDH-mutant astrocytoma and oligodendroglioma grade 2. Therefore, we investigated the multiomics and clinical data regarding these two types of tumors.

Method

In silico analyses were performed around mRNA, somatic mutations, copy number alternations (CNAs), DNA methylation, microRNA (miRNA), epigenetics, immune microenvironment characterization and clinical features of the two types of gliomas. A diagnostic model incorporating tumor purity was further established using machine learning algorithms, and the predictive value was evaluated by receiver operative characteristic curves.

Results

Both types of gliomas shared chromosomal instability, and astrocytomas exhibited increased total CNAs compared to oligodendrogliomas. Oligodendrogliomas displayed distinct chromosome 4 (chr 4) loss, and subtyping of chr 7 gain/chr 4 loss (+ 7/− 4) presented the worst survival (P = 0.004) and progression-free interval (PFI) (P < 0.001). In DNA damage signatures, oligodendroglioma had a higher subclonal genome fraction (P < 0.001) and tumor purity (P = 0.001), and astrocytoma had a higher aneuploidy score (P < 0.001). Furthermore, astrocytomas exhibited inflamed immune cell infiltration, activated T cells and a potential response to immune checkpoint inhibitors (ICIs), while oligodendrogliomas were more homogeneous with increased tumor purity and decreased aggression. The tumor purity-involved diagnostic model exhibited great accuracy in identifying astrocytoma and oligodendroglioma.

Conclusion

This study addresses the similarities and differences between IDH-mutant astrocytoma and oligodendroglioma grade 2 and facilitates a deeper understanding of their molecular features, immune microenvironment, tumor purity and prognosis. The diagnostic tool developed using machine learning may offer support for clinical decisions.
Development of resilience indicator traits based on daily step count data for dairy cattle breeding
Authors: Poppe Marieke , Mulder Han A. , van Pelt Mathijs L. , Mullaart Erik , Hogeveen Henk , Veerkamp Roel F.
Published: March 2022

Background

Resilient animals are minimally affected by disturbances, such as diseases and heat stress, and quickly recover. Daily activity data can potentially indicate resilience, because resilient animals likely keep variations due to disturbances that threat animal homeostasis at a low magnitude. We used daily step count of cows to define resilience indicators based on theory, exploratory analysis and literature, and then investigated if they can be used to genetically improve resilience by estimating heritability and repeatability, and genetic associations with other resilience-related traits, i.e. health traits, longevity, fertility, and body condition score (BCS).

Results

Two groups of resilience indicators were defined: indicators describing (1) mean step count at different lactation stages for individual cows, and (2) fluctuations in step count from individual step count curves. Heritability estimates were highest for resilience indicators describing mean step count, from 0.22 for the 2-week period pre-partum to 0.45 for the whole lactation. High mean step count was consistently, but weakly, genetically correlated with good health, fertility, and longevity, and high BCS. Heritability estimates of resilience indicators describing fluctuations ranged from 0.01 for number of step count drops to 0.15 for the mean of negative residuals from individual curves. Genetic correlations with health traits, longevity, fertility, and BCS were mostly weak, but were moderate and favorable for autocorrelation of residuals (− 0.33 to − 0.44) and number of step count drops (− 0.44 to − 0.56) with hoof health, fertility, and BCS. Resilience indicators describing variability of residuals and mean of negative residuals showed strong genetic correlations with mean step count (0.86 to 0.95, absolute), which suggests that adjustment for step count level is needed. After adjustment, ‘mean of negative residuals’ was highly genetically correlated with hoof health, fertility, and BCS.

Conclusions

Mean step count, autocorrelation and mean of negative residuals showed most potential as resilience indicators based on resilience theory, heritability, and genetic associations with health, fertility, and body condition score. Other resilience indicators were heritable, but had unfavorable genetic correlations with several health traits. This study is an important first step in the exploration of the use of activity data to breed more resilient livestock.
EnsembleFam: towards more accurate protein family prediction in the twilight zone
Authors: Kabir Mohammad Neamul , Wong Limsoon
Published: March 2022

Background

Current protein family modeling methods like profile Hidden Markov Model (pHMM),k-mer based methods, and deep learning-based methods do not provide very accurate protein function prediction for proteins in the twilight zone, due to low sequence similarity to reference proteins with known functions.

Results

We present a novel method EnsembleFam, aiming at better function prediction for proteins in the twilight zone. EnsembleFam extracts the core characteristics of a protein family using similarity and dissimilarity features calculated from sequence homology relations. EnsembleFam trains three separate Support Vector Machine (SVM) classifiers for each family using these features, and an ensemble prediction is made to classify novel proteins into these families. Extensive experiments are conducted using the Clusters of Orthologous Groups (COG) dataset and G Protein-Coupled Receptor (GPCR) dataset. EnsembleFam not only outperforms state-of-the-art methods on the overall dataset but also provides a much more accurate prediction for twilight zone proteins.

Conclusions

EnsembleFam, a machine learning method to model protein families, can be used to better identify members with very low sequence homology. Using EnsembleFam protein functions can be predicted  using just sequence information with better accuracy than state-of-the-art methods.
Comparative analysis of complete Ilex (Aquifoliaceae) chloroplast genomes: insights into evolutionary dynamics and phylogenetic relationships
Authors: Xu Kewang , Lin Chenxue , Lee Shiou Yih , Mao Lingfeng , Meng Kaikai
Published: March 2022

Background

Ilex (Aquifoliaceae) are of great horticultural importance throughout the world for their foliage and decorative berries, yet a dearth of genetic information has hampered our understanding of phylogenetic relationships and evolutionary history. Here, we compare chloroplast genomes from across Ilex and estimate phylogenetic relationships.

Results

We sequenced the chloroplast genomes of seven Ilex species and compared them with 34 previously published Ilex plastomes. The length of the seven newly sequenced Ilex chloroplast genomes ranged from 157,182 bp to 158,009 bp, and contained a total of 118 genes, including 83 protein-coding, 31 rRNA, and four tRNA genes. GC content ranged from 37.6 to 37.69%. Comparative analysis showed shared genomic structures and gene rearrangements. Expansion and contraction of the inverted repeat regions at the LSC/IRa and IRa/SSC junctions were observed in 22 and 26 taxa, respectively; in contrast, the IRb boundary was largely invariant. A total of 2146 simple sequence repeats and 2843 large repeats were detected in the 41 Ilex plastomes. Additionally, six genes (psaC, rbcL, trnQ, trnR, trnT, and ycf1) and two intergenic spacer regions (ndhC-trnV and petN-psbM) were identified as hypervariable, and thus potentially useful for future phylogenetic studies and DNA barcoding. We recovered consistent phylogenetic relationships regardless of inference methodology or choice of loci. We recovered five distinct, major clades, which were inconsistent with traditional taxonomic systems.

Conclusion

Our findings challenge traditional circumscriptions of the genus Ilex and provide new insights into the evolutionary history of this important clade. Furthermore, we detail hypervariable and repetitive regions that will be useful for future phylogenetic and population genetic studies.
Salivary bacterial signatures in depression-obesity comorbidity are associated with neurotransmitters and neuroactive dipeptides
Authors: Aleti Gajender , Kohn Jordan N. , Troyer Emily A. , Weldon Kelly , Huang Shi , Tripathi Anupriya , Dorrestein Pieter C. , Swafford Austin D. , Knight Rob , Hong Suzi
Published: March 2022

Background

Depression and obesity are highly prevalent, often co-occurring conditions marked by inflammation. Microbiome perturbations are implicated in obesity-inflammation-depression interrelationships, but how the microbiome mechanistically contributes to pathology remains unclear. Metabolomic investigations into microbial neuroactive metabolites may offer mechanistic insights into host-microbe interactions. Using 16S sequencing and untargeted mass spectrometry of saliva, and blood monocyte inflammation regulation assays, we identified key microbes, metabolites and host inflammation in association with depressive symptomatology, obesity, and depressive symptomatology-obesity comorbidity.

Results

Gram-negative bacteria with inflammation potential were enriched relative to Gram-positive bacteria in comorbid obesity-depression, supporting the inflammation-oral microbiome link in obesity-depression interrelationships. Oral microbiome was more highly predictive of depressive symptomatology-obesity co-occurrences than of obesity or depressive symptomatology independently, suggesting specific microbial signatures associated with obesity-depression co-occurrences. Mass spectrometry analysis revealed significant changes in levels of signaling molecules of microbiota, microbial or dietary derived signaling peptides and aromatic amino acids among depressive symptomatology, obesity and comorbid obesity-depression. Furthermore, integration of the microbiome and metabolomics data revealed that key oral microbes, many previously shown to have neuroactive potential, co-occurred with potential neuropeptides and biosynthetic precursors of the neurotransmitters dopamine, epinephrine and serotonin.

Conclusions

Together, our findings offer novel insights into oral microbial-brain connection and potential neuroactive metabolites involved.
Left atrial reservoir strain as a predictor of cardiac outcome in patients with heart failure: the HaFaC cohort study
Authors: Bouwmeester Sjoerd , van der Stam Jonna A. , van Loon Saskia L. M. , van Riel Natal A. W. , Boer Arjen-Kars , Dekker Lukas R. , Scharnhorst Volkher , Houthuizen Patrick
Published: March 2022

Background

The left atrium (LA) is a key player in the pathophysiology of systolic and diastolic heart failure (HF). Speckle tracking derived LA reservoir strain (LASr) can be used as a prognostic surrogate for elevated left ventricular filling pressure similar to NT-proBNP. The aim of the study is to investigate the correlation between LASr and NT-proBNP and its prognostic value with regards to the composite endpoint of HF hospitalization and all-cause mortality within 1 year.

Methods

Outpatients, sent to the echocardiography core lab because of HF, were enrolled into this study. Patients underwent a transthoracic echocardiographic examination, commercially available software was used to measure LASr. Blood samples were collected directly after the echocardiographic examination to determine NT-proBNP.

Results

We included 174 HF patients, 43% with reduced, 36% with mildly reduced, and 21% with preserved ejection fraction. The study population showed a strong inverse correlation between LASr and log-transformed NT-proBNP (r = − 0.75, p < 0.01). Compared to NT-proBNP, LASr predicts the endpoint with a comparable specificity (83% vs. 84%), however with a lower sensitivity (70% vs. 61%).

Conclusion

LASr is inversely correlated with NT-proBNP and a good echocardiographic predictor for the composite endpoint of hospitalization and all-cause mortality in patients with HF.

Trial registration:https://www.trialregister.nl/trial/7268
Comparing the prehospital NEWS with in-hospital ESI in predicting 30-day severe outcomes in emergency patients
Authors: Saberian Peyman , Abdollahi Atefeh , Hasani-Sharamin Parisa , Modaber Maryam , Karimialavijeh Ehsan
Published: March 2022

Background

In Iran, the emergency departments (EDs) have largely adopted the emergency severity index (ESI) to prioritize the emergency patients, however emergency medical services (EMS) mainly triage the patients based on the paramedics’ gestalt. The National Early Warning Score (NEWS) is a recommended prehospital triage in the UK. We aimed to compare prehospital NEWS and ED ESI for predicting severe outcomes in emergency patients.

Methods

An observational study was conducted in a university-affiliated ED between January and April 2021. Adult patients who arrived in the ED by EMS were included. EMS providers calculated the patients' NEWS upon arriving on the scene using an Android NEWS application. In the ED, triage nurses utilized the ESI algorithm to prioritize patients with higher clinical risk. Then, Research nurses recorded patients' 30-day severe outcomes (death or ICU admission). Finally, The prognostic properties of ESI and NEWS were evaluated.

Results

One thousand forty-eight cases were included in the final analysis, of which 29 (2.7%) patients experienced severe outcomes. The difference between the prehospital NEWS and ED ESI in predicting severe outcomes was not statistically significant (AUC = 0.825, 95% CI: 0.74–0.91 and 0.897, 95% CI, 0.83–0.95, for prehospital NEWS and ESI, respectively).

Conclusion

Our findings indicated that prehospital NEWS compares favorably with ED ESI in predicting 30-day severe outcomes in emergency patients.
Activities-specific performance frequency can accurately detect fallers in elderly populations: an alternative method for quantifying activity restrictions
Authors: Chen Lin Y. , Wang Jing X. , Chen Ying Y. , Yang Ya J. , Yao Jia J. , Shen Xia
Published: March 2022

Background

The high prevalence of falling among older adults constitutes a major public and clinical health concern. Many elderly persons may develop activities-specific restriction due to the risk of falling. This highlights the need for relevant evaluative tools.

Methods

This cross-sectional study used activities-specific performance frequency indicators to quantify activity restrictions in elderly participants, with all measures based on items from the Activities-Specific Balance Confidence (ABC) scale. Specifically, we tested for correlations between activities-specific performance frequency and balance confidence, functional balance/mobility, and fall history. There were 88 elderly participants, including 28 with stroke, 30 with Parkinson’s disease, and 30 with no neurological diseases. In addition to their activities-specific performance frequency measures, we collected a series of demographic and health-related characteristics from each participant. We analyzed between-group differences in activities-specific performance frequency and other demographic and health-related characteristics via the one-way analysis of variance and Kruskal-Wallis test. Next, we used the Spearman’s rank correlation test and binary logistic regression to investigate the correlations between activities-specific performance frequency and demographic/other health-related characteristics.

Results

There were significant group differences in performance frequency for all ABC activity items except for walking around the house, average ABC scores, and functional balance/mobility among normal older adults, participants with strokes and those with Parkinson's disease. Activities-specific performance frequency showed stronger correlations with activities-relevant functional mobility (r=0.250-0.713 for 15 items with significant correlations, 13 activity items with r≧0.4) than with balance confidence (r=0.279-0.668 for 13 items with significant correlations, 10 activity items with r≧0.4). The performance frequency of walking in crowds/bumped was the most sensitive measure for predicting fallers (odd ratio=3.310, p<0.05).

Conclusions

This study proposed and validated the usage of activities-specific performance frequency as an alternative method for quantifying activity restrictions among older adults.
Rv3737 is required for Mycobacterium tuberculosis growth in vitro and in vivo and correlates with bacterial load and disease severity in human tuberculosis
Authors: Li Qing , Peng Zhangli , Fu Xuefeng , Wang Hong , Zhao Zhaoliang , Pang Yu , Chen Ling
Published: March 2022

Background

Rv3737 is the sole homologue of multifunctional transporter ThrE in Mycobacterium tuberculosis (Mtb). In this study, we aimed to investigate whether this transporter participates in vitro and in vivo survival of Mtb.

Methods

To characterize the role of Rv3737, we constructed and characterized a Mtb H37RvΔRv3737. This strain was evaluated for altered growth rate and macrophage survival using a cell model of infection. In addition, the comparative analysis was conducted to determine the association between Rv3737 mRNA expression and disease severity in active pulmonary TB patients.

Results

The H37RvΔRv3737 strain exhibited significantly slow growth rate compared to H37Rv-WT strain in standard culture medium. Additionally, the survival rate of H37Rv-WT strain in macrophages was 2 folds higher than that of H37RvΔRv3737 at 72 h. A significantly higher level of TNF-α and IL-6 mRNA expression was observed in macrophages infected with H37RvΔRv3737 as compared to H37Rv-WT. Of note, Rv3737 expression was significantly increased in clinical Mtb isolates than H37Rv-WT. The relative expression level of Rv3737 was positively correlated with lung cavity number of TB patients. Similarly, the higher Rv3737 mRNA level resulted in lower C(t) value by Xpert MTB/RIF assay, demonstrating that a positive correlation between Rv3737 expression and bacterial load in TB patients.

Conclusions

Our data takes the lead in demonstrate that the threonine transporter Rv3737 is required for in vitro growth and survival of bacteria inside macrophages. In addition, the expression level of Rv3737 may be associated with bacterial load and disease severity in pulmonary tuberculosis patients.
On the accuracy of short-term COVID-19 fatality forecasts
Authors: Antulov-Fantulin Nino , Böttcher Lucas
Published: March 2022

Background

Forecasting new cases, hospitalizations, and disease-induced deaths is an important part of infectious disease surveillance and helps guide health officials in implementing effective countermeasures. For disease surveillance in the US, the Centers for Disease Control and Prevention (CDC) combine more than 65 individual forecasts of these numbers in an ensemble forecast at national and state levels. A similar initiative has been launched by the European CDC (ECDC) in the second half of 2021.

Methods

We collected data on CDC and ECDC ensemble forecasts of COVID-19 fatalities, and we compare them with easily interpretable “Euler” forecasts serving as a model-free benchmark that is only based on the local rate of change of the incidence curve. The term “Euler method” is motivated by the eponymous numerical integration scheme that calculates the value of a function at a future time step based on the current rate of change.

Results

Our results show that simple and easily interpretable “Euler” forecasts can compete favorably with both CDC and ECDC ensemble forecasts on short-term forecasting horizons of 1 week. However, ensemble forecasts better perform on longer forecasting horizons.

Conclusions

Using the current rate of change in incidences as estimates of future incidence changes is useful for epidemic forecasting on short time horizons. An advantage of the proposed method over other forecasting approaches is that it can be implemented with a very limited amount of work and without relying on additional data (e.g., data on human mobility and contact patterns) and high-performance computing systems.
Human rhinoviruses prevailed among children in the setting of wearing face masks in Shanghai, 2020
Authors: Jia Ran , Lu Lijuan , Li Shu , Liu Pengcheng , Xu Menghua , Cao Lingfeng , Su Liyun , Xu Jin
Published: March 2022

Background

Human rhinovirus (HRV) is the predominant etiological agent of the common cold in children and adults. A recent study showed that the inhibitory effect of face masks on viral shedding of HRV was less prominent than that on other respiratory viruses. Considering that most Chinese people have worn face masks in public area since the outbreak of coronavirus disease 2019, we aimed to find out whether HRV prevailed among children in 2020 and demonstrate the details of the epidemiological features of HRV under such a special circumstance.

Methods

We summarized the incidences of various respiratory virus infections in patients who visited the Children’s Hospital of Fudan University during 2018–2020, and genotyped HRV positive nasopharyngeal specimens collected from 316 inpatients and 72 outpatients that visited the hospital in 2020.

Results

There was a major prevalence of HRV among children in the latter half of 2020, with a clear seasonality that HRV-As prevailed in summer while HRV-Cs in autumn. HRV-As were more prone to cause severe lower respiratory tract infections (LRTI), while HRV-Cs were closely associated with childhood wheezing. The predominant genotypes were A11, A28, A47, A82, A101, C40 and C43. Notably, A21, A82 and A101 took up larger proportions in severe cases than in non-severe cases.

Conclusions

Our findings described a major prevalence of HRVs among children in 2020, which highlight the unique transmitting pattern of HRV and help to narrow the targets for antiviral strategies.
Local tuning of radiomics-based model for predicting pathological response to neoadjuvant chemoradiotherapy in locally advanced rectal cancer
Authors: Tang Bin , Lenkowicz Jacopo , Peng Qian , Boldrini Luca , Hou Qing , Dinapoli Nicola , Valentini Vincenzo , Diao Peng , Yin Gang , Orlandini Lucia Clara
Published: March 2022

Purpose

This study aims to further enhance a validated radiomics-based model for predicting pathologic complete response (pCR) after chemo‑radiotherapy in locally advanced rectal cancer (LARC) for use in clinical practice.

Methods

A generalized linear model (GLM) to predict pCR in LARC patients previously trained in Europe and validated with an external inter-continental cohort (59 patients), was first examined with further 88 intercontinental patient datasets to assess its reproducibility; then new radiomics and clinical features, and validation methods were investigated to build a new model for enhancing the pCR prediction for patients admitted to our department. The patients were divided into training group (75%) and validation group (25%) according to their demographic. The least absolute shrinkage and selection operator (LASSO) logistic regression was used to reduce the dimensionality of the extracted features of the training group and select the optimal ones; the performance of the reference GLM and enhanced models was compared through the area under curve (AUC) of the receiver operating characteristics.

Results

The value of AUC of the reference model was 0.831 (95% CI, 0.701–0.961), and 0.828 (95% CI, 0.700–0.956) in the original and new validation cohorts, respectively, showing a reproducibility in the applicability of the GLM model. Eight features were found to be significant with LASSO and used to establish an enhanced model. The AUC of the enhanced model of 0.926 (95% CI, 0.859–0.993) for training, and 0.926 (95% CI, 0.767–1.00) for the validation group shows better performance than the reference model.

Conclusions

The GLM model shows good reproducibility in predicting pCR in LARC; the enhanced model has the potential to improve prediction accuracy and may be a candidate in clinical practice.
Bilateral paralysis of peroneal nerve after COVID-19 disease: a case report
Authors: Morawiec Natalia , Chyra Daria , Boroń Adrianna , Adamczyk Bożena , Jaroszewicz Jerzy , Sobala-Szczygieł Barbara , Adamczyk-Sowa Monika
Published: March 2022

Background

COVID-19, caused by a novel coronavirus SARS-CoV 2 has rapidly developed into pandemic. This infectious disease affecting mainly respiratory system may cause multiple systemic disorders. With increasing number of new infected patients there are more and more cases with neurological complications secondary to COVID-19.

Case presentation

Here we present a case of 67-years old Polish male with previously no comorbidities, who has developed bilateral paralysis of peroneal nerve after SARS-CoV 2 infection. Prior to the hospitalization he presented cough and fever and weakness. RT-PCR was reported positive for COVID-19 infection. Then he developed pneumonia and respiratory failure with bilateral lung consolidations on radiological examination. Laboratory findings revealed elevated levels of D-dimer, CRP, AspAT, GGTP, PCT and serum glucose. After discharge from hospital he was diagnosed with thrombophlebitis and prediabetes on follow-up visits. Due to problems with walking, numbness of toes and involuntary muscle spasms in hands, the patient went to the Neurological Outpatient Clinic. After neurological examination bilateral paralysis of peroneal nerve was revealed.

Conclusions

In this report we want to highlight one of the unexpected presentations of SARS-CoV 2 infection and emphasize the importance of neurological examination in COVID-19 patients.
“Once you get one maternal death, it's like the whole world is dropping on you”: experiences of managing maternal mortality amongst obstetric care providers in Ghana
Authors: Stabnick Anna , Yeboah Michael , Arthur-Komeh Johnny , Ankobea Frank , Moyer Cheryl A. , Lawrence Emma R.
Published: March 2022

Background

Maternal mortality has a significant global impact, especially in low-resource settings. Little prior research has been conducted on the potential effects of poor maternal outcomes on the personal and professional well-being of healthcare providers. This study explores the in-depth experiences and perspectives of obstetric providers in Ghana who work in a setting with frequent maternal mortalities.

Methods

This is a qualitative study of semi-structured interviews conducted at the Komfo Anokye Teaching Hospital in Ghana. Participants were obstetric healthcare providers, defined as midwives, house officers currently rotating on the obstetrics/gynecology service, and obstetrician/gynecologists at any training or practice level (residents, fellows, and specialists). Interviews were audio-recorded, transcribed verbatim, and uploaded into NVivo for qualitative analysis. Using the Attride-Stirling qualitative model, an incremental and iterative process was used to code interviews with keyword phrases and develop a framework of organizing and global themes.

Results

Interviews were conducted with 27 participants—15 midwives and 12 physicians (three obstetrician/gynecologist residents, six obstetrician/gynecologist specialists, and three house officers), with sample size determined by data saturation. Obstetric providers’ experiences in a setting with frequent maternal mortalities were dependent on their level of preparedness to manage maternal mortalities and the workplace environment. Providers’ level of preparedness was dependent on both the training they had received on the medical management of obstetric emergencies, as well as a lack of training on the mental health aspects of coping with maternal mortality. The impact of the workplace environment was dependent on systems failures and limited resources, blame from colleagues and supervisors, and a lack of support in the workplace. In turn, obstetric providers’ experiences managing frequent maternal mortalities impacted their clinical care performance and mental health.

Conclusions

Maternal deaths have profound personal and professional impacts on the healthcare providers who manage them. A large need exists for additional institutional training and support for obstetric providers who manage maternal mortality, especially in low-resource settings like Ghana.
Massive ascites due to lupus peritonitis in a patient with pre-eclampsia and systemic lupus erythematosus: a case report
Authors: Sugai Shunya , Suda Kazuaki , Tamegai Kana , Haino Kazufumi , Nakatsue Takeshi , Narita Ichiei , Enomoto Takayuki , Nishijima Koji
Published: March 2022

Background

Patients with systemic lupus erythematosus (SLE) are associated with pre-eclampsia. Pre-eclampsia can have systemic manifestations, such as ascites. Lupus peritonitis, a rare condition in patients with SLE, can also cause ascites.

Case presentation

A 31-year-old woman, primigravida, with SLE had a blood pressure of 170/110 mmHg and proteinuria at 29 weeks of gestation. She was diagnosed with pre-eclampsia. Her blood pressure was stabilized by an antihypertensive drug. At 30 weeks of gestation, a cesarean section was performed for maternal safety because of decreased urine output and massive ascites. Postoperatively, re-accumulation of ascites was observed. On the fourth postoperative day, ascites (approximately 3 L) was discharged from the cesarean section wound. A decrease in serum complement concentrations was observed, and she was diagnosed as having lupus peritonitis. The steroid dose was increased and she recovered well thereafter.

Conclusions

Ascites occurs in pre-eclampsia and SLE, but determining which of these conditions causes ascites can be difficult. However, careful observation is necessary because of the differences in treatment of these two conditions.
Adverse effects of cell-free and concentrated ascites reinfusion therapy for malignant ascites: a single-institute experience
Authors: Tsubokura Misato , Adegawa Yuko , Kojima Minoru , Tanosaki Ryuji , Ohtake Ryuzaburo , Kase Yuki , Iwashita Nao , Kasane Moemi , Nakabayashi Saori , Takeuchi Sayaka , Kato Ken , Boku Narikazu , Kanemitsu Yukihide , Okusaka Takuji , Fujimoto Hiroyuki , Yonemori Kan , Ishiki Hiroto , Kawamura Kimihiko , Satomi Eriko , Matsushita Hiromichi
Published: March 2022

Background

Cell-free and concentrated ascites reinfusion therapy (CART) is a strategy for improving various intractable symptoms due to refractory ascites, including hypoalbuminemia. CART has recently been applied in the treatment of cancer patients. This study was performed to assess the safety of CART in a single cancer institute.

Methods

We retrospectively reviewed 233 CART procedures that were performed for 132 cancer patients in our institute.

Results

The median weight of ascites before and after concentration was 4,720 g and 490 g (median concentration rate, 10.0-fold), The median amounts of total protein and albumin were 64.0 g and 32.6 g (median recovery rates, 44.9% and 49.0%), respectively. Thirty-three adverse events (AEs) were observed in 22 (9.4%) of 233 procedures; 30 of these events occurred after reinfusion. The most common reinfusion-related AEs were fever (13 events) and chills (10 events). Univariate analyses revealed no significant relationships between the frequency of AEs and age, sex, appearance of ascites, weight of harvested and concentrated ascites, the ascites processing rate (filtration and concentration), weight of saline used for membrane cleaning, amount of calculated total protein for infusion, or prophylaxis against AEs; the reinfusion rate of ≥ 125 mL/h or ≥ 10.9 g/h of total protein affected the frequency of AEs, regardless of the prophylactic use of steroids.

Conclusions

The observed AEs were mainly mild reactions after reinfusion, which were related to a reinfusion rate of volume ≥ 125 mL/h, a simple indicator in practice, or total protein ≥ 10.9 g/h. Although our study was retrospective in nature and undertaken in a single institute, this information may be helpful for the management of cancer patients with refractory malignant ascites using CART.