bluuebunny/crossref_metadata_2025 huggingface dataset:
Isolation and Identification ofTrichoderma asperellum, the Novel Causal Agent of Green Mold Disease in Sweetpotato
Authors: Yang Yiling , Fang Boping , Feng Shujie , Wang Zhangying , Luo Zhongxia , Yao Zhufang , Zou Hongda , Huang Lifei
Published: December 2020

Postharvest disease is an important limiting factor for sweetpotato production. Recently, a new green mold disease was found in sweetpotato storage roots. To investigate the mechanism underlying the pathogenesis of the disease, the pathogen was isolated and identified based on morphological and molecular features, and its characteristics were further analyzed by pathogenic and antagonistic evaluations. The results showed that the isolated pathogen (CRI-Ta1) was identified as Trichoderma asperellum based on the similar growth and morphological features with Trichoderma spp., 99% homology of internal transcribed spacer (ITS) sequence, and membership to the same phylogenetic group with the model strain of T. asperellum (CBS 433.97). The pathogenic analysis revealed that CRI-Ta1 could cause green mold disease through wound infection on the storage roots and the strains reisolated from infected storage roots could cause disease in different sweetpotato varieties, which was fulfilled in Koch’s postulate. Moreover, CRI-Ta1 could also infect other common crop species, including chestnut, carrot, apple, pear, and others. It indicated that CRI-Ta1 was the pathogen to the storage roots of sweetpotato and had a wide host range. Additionally, in vitro antagonistic evaluation showed that CRI-Ta1 effectively inhibited the growth of common sweetpotato pathogens, including Fusarium solani and Rhizopus nigricans. However, further research is needed on the potential of CRI-Ta1 to control sweetpotato diseases in vivo. Collectively, our findings provided valuable insights into the characteristics of the T. asperellum CRI-Ta1 in sweetpotato and would be helpful to the prevention and control of sweetpotato green mold disease.
Relative Contribution of Windbreak, Copper Sprays, and Leafminer Control for Citrus Canker Management and Prevention of Crop Loss in Sweet Orange Trees
Authors: Behlau Franklin , Belasque José , Leite Rui P. , Filho Armando Bergamin , Gottwald Timothy R. , Graham James H. , Scandelai Luis H. M. , Primiano Isabela V. , Bassanezi Renato B. , Ayres Antonio J.
Published: December 2020

The management of citrus canker, caused by Xanthomonas citri subsp. citri, has been widely studied in endemic areas because of the importance of the disease in several citrus-producing countries. A set of control measures is well established, but no study has investigated the efficiency of each measure individually and their combination for disease suppression. This study comprised a 3-year field study to assess the relative contribution of three measures for the control of citrus canker and reduction of crop losses. Windbreak (Wb), copper sprays (Cu), and leafminer control (Lc) were assessed in eight different combinations in a split−split plot design. The orchard was composed of ‘Valencia’ sweet orange trees grafted onto ‘Rangpur’ lime. Casuarina cunninghamiana trees were used as Wb. Cu and Lc sprays were performed every 21 days throughout the year. Individually, Cu showed the highest contribution for canker control, followed by Wb. Lc had no effect on reducing citrus canker. Wb+Cu showed the highest efficiency for control of the disease. This combination reduced the incidence of diseased trees by approximately 60%, and the incidence of diseased leaves and fruit by ≥90% and increased the yield in 2.0- to 2.6-fold in comparison with the unmanaged plots. Cu sprays were important for reducing disease incidence and crop losses, whereas Wb had an additional contribution in minimizing the incidence of cankered, non-marketable fruit. The results indicated that the adoption of these measures of control may depend on the characteristics of the orchard and destination of the production.
Surgical Site Infection, Readmission, and Reoperation After Posterior Long Segment Fusion
Authors: Shlobin Nathan A. , Cloney Michael B. , Hopkins Benjamin S. , Kesavabhotla Kartik , Goergen Jack A. , Driscoll Conor , Svet Mark , Kelsten Max F. , Koski Tyler , Dahdaleh Nader S.
Published: December 2020

Study Design.

Retrospective case series.

Objective.

We sought to identify risk factors associated with surgical site infection (SSI) after posterior long segment spinal fusion (PLSF).

Summary of Background Data.

Patients who undergo PLSF may be at elevated risk of SSI. Identifying factors associated with SSI in these operations can help risk stratify patients and tailor management.

Methods.

We analyzed PLSFs—seven or more levels—at our institution from 2000 to 2015. Data on patients’ clinical characteristics, procedural factors, and antimicrobial management were collected. Multivariable analysis identified factors independently associated with outcomes of interest.

Results.

In 628 cases, SSI was associated with steroid use (P = 0.024, odds ratio [OR] = 2.54) and using cefazolin (P < 0.001, OR = 4.37) or bacitracin (P = 0.010, OR 3.49) irrigation, as opposed to gentamicin or other irrigation. Gram-positive infections were more likely with staged procedures (P = 0.021, OR 4.91) and bacitracin irrigation (P < 0.001, OR = 17.98), and less likely with vancomycin powder (P = 0.050, OR 0.20). Gram-negative infections were more likely with a history of peripheral arterial disease (P = 0.034, OR = 3.21) or cefazolin irrigation (P < 0.001, OR 25.47). Readmission was more likely after staged procedures (P = 0.003, OR = 3.31), cervical spine surgery (P = 0.023, OR = 2.28), or cefazolin irrigation (P = 0.039, OR = 1.85). Reoperation was more common with more comorbidities (P = 0.022, OR 1.09), staged procedures (P < 0.001, OR = 4.72), cervical surgeries (P = 0.013, OR = 2.36), more participants in the surgery (P = 0.011, OR = 1.06), using cefazolin (P < 0.001, OR = 3.12) or bacitracin (P = 0.009, OR = 3.15) irrigation, and higher erythrocyte sedimentation rate at readmission (P = 0.009, OR = 1.04). Washouts were more likely among patients with more comorbidities (P = 0.013, OR = 1.16), or who used steroids (P = 0.022, OR = 2.92), and less likely after cervical surgery (P = 0.028, OR = 0.24). Instrumentation removal was more common with bacitracin irrigation (p = 0.013, OR = 31.76).

Conclusion.

Patient factors, whether a procedure is staged, and choice of antibiotic irrigation affect the risk of SSI and ensuing management required.

Level of Evidence: 4
Surgical Correction of Scoliosis in Children with Severe Congenital Heart Disease and Palliated Single Ventricle Physiology
Authors: Cohen Lara L. , Przybylski Robert , Marshall Audrey C. , Emans John B. , Hedequist Daniel J.
Published: December 2020

Study Design.

Case series.

Objective.

In this study we focus on this group, and describe the largest cohort to date of single ventricle patients undergoing surgical correction of scoliosis at a single institution.

Summary of Background Data.

Outcomes of spinal surgery for patients with congenital heart disease (CHD) have evolved and most affected patients have uncomplicated procedures. The risk of perioperative complications remains highest in patients with single ventricle (“Fontan") physiology.

Methods.

We reviewed patients with single ventricle CHD and operative scoliosis repair over a 25-year span. Patients who had undergone a Fontan, bidirectional Glenn, and/or Kawashima procedure before operative scoliosis repair were included. Patients were excluded if they lacked preoperative cardiac care and/or sufficient medical history at our institution.

Results.

Twenty-three patients were included. The average age at surgery was 13.6 years (range, 5–23). Seventy percent of the cohort was female (16/23). The majority of patients underwent a Fontan before scoliosis surgery (20/23, 87%). Patients without intraoperative tranexamic acid (TXA) had a 67% complication rate (8/12) versus 36% (4/11) in those with intraoperative TXA (P = 0.29). There was a significant difference in estimated blood loss by weight (cc/kg) between non-TXA and TXA patients (P = 0.016). Twelve patients experienced complications (52%), all of which occurred postoperatively. There were no deaths, cerebrovascular events, adverse perioperative cardiac or hemodynamic complications, or wound infections. Using the Clavien-Dindo-Sink classification for postoperative complications, four patients had serious adverse events, including one permanent neurologic deficit.

Conclusion.

Spinal surgery for scoliosis has been performed in selected patients with single ventricle physiology at a single institution without mortality for 25 years. Operative blood loss may be reduced by routine use of TXA. Complications occur most commonly in the postoperative period, and can include pleural effusion.

Level of Evidence: 4
Thirty- and 90-day Readmissions After Spinal Surgery for Spine Metastases
Authors: Elsamadicy Aladine A. , Koo Andrew B. , David Wyatt B. , Zogg Cheryl K. , Kundishora Adam J. , Hong Christopher S. , Kuzmik Gregory A. , Gorrepati Ramana , Coutinho Pedro O. , Kolb Luis , Laurans Maxwell , Abbed Khalid
Published: December 2020

Study Design.

Retrospective cohort study.

Objective.

The aim of this study was to investigate differences in 30- and 90-day readmissions for spine metastases treated with decompression and/or fusion spine surgery in a nationwide readmission database.

Summary of Background Data.

Patients with metastases to the spine represent a particularly vulnerable patient group that may encounter frequent readmissions. However, the 30- and 90-day rates for readmission following surgery for spine metastases have not been well described.

Methods.

The Nationwide Readmission Database years 2013 to 2015 was queried. Patients were grouped by no readmission (non-R), readmission within 30 days (30-R), and readmission within 31 to 90 days (90-R). Weighted multivariate analysis assessed impact of treatment approach and clinical factors associated with 30- and 90-day readmissions.

Results.

There were a total of 4423 patients with a diagnosis of spine metastases identified who underwent spine surgery, of which 1657 (37.5%) encountered either a 30-or 90-day unplanned readmission (30-R: n = 1068 [24–.1%]; 90-R: n = 589 [13.3%]; non-R: n = 2766). The most prevalent inpatient complications observed were postoperative infection (30-R: 16.3%, 90-R: 14.3%, non-R: 11.5%), acute post-hemorrhagic anemia (30-R: 13.4%, 90-R: 14.2%, non-R: 14.5%), and genitourinary complication (30-R: 5.7%, 90-R: 2.9%, non-R: 6.2%). The most prevalent 30-day and 90-day reasons for admission were sepsis (30-R: 10.2%, 90-R: 10.8%), postoperative infection (30-R: 13.7%, 90-R: 6.5%), and genitourinary complication (30-R: 3.9%, 90-R: 4.1%). On multivariate regression analysis, surgery type, age, hypertension, and renal failure were independently associated with 30-day readmission; rheumatoid arthritis/collagen vascular diseases, and coagulopathy were independently associated with 90-day readmission.

Conclusion.

In this study, we demonstrate several patient-level factors independently associated with unplanned hospital readmissions after surgical treatment intervention for spine metastases. Furthermore, we find that the most common reasons for readmission are sepsis, postoperative infection, and genitourinary complications.

Level of Evidence: 3
The Determination of the Efficacy of Neural Therapy in Conservative Treatment-resistant Patients with Chronic Low Back Pain
Authors: Yılmaz Ebru
Published: December 2020

Study Design.

A randomized clinical trial.

Objective.

The aim of this article is to determine the effectiveness of neural therapy (NT) in patients with chronic low back pain (LBP) who are resistant to medical and physical therapies.

Summary of Background Data.

Patients with LBP generally respond well to the treatment, whereas some cases do not improve via medical and physical therapies. Although trigger point injections (TPIs) may be an effective short-term treatment in selected patients with LBP, they are not recommended in patients with chronic LBP due to a long-lasting benefit not being demonstrated.

Methods.

Fifty patients, who had inadequate functional recovery and pain relief, with chronic LBP were randomly divided into two groups: Group 1, only single TPI; Group 2, NT. NT including local-segmental treatment (intradermal injections) on the lumbosacral region, 5 M injection (intradermal injections of the projection of the pelvic organs on the suprapubic region), pelvic plexus injection, i.v. injection (2 mL) for five sessions per a week. All patients in group 2 received the same kind of intervention every seance but interference field injections (injections into umbilicus for all patients and injections into scars resulting from vaccination and surgical operations such as cesarean section, if any) were also applied at the only first seance. The Visual Analog Scale (VAS) scores for current pain during activities and Roland Morris Disability Questionnaire (RMDQ) scores for disability were recorded at baseline and 1, 3, 6 months post-injection.

Results.

The VAS and RMDQ scores at 3 and 6 months were significantly lower in Group 2versusGroup 1 (P < 0.05).

Conclusion.

NT may be an alternative treatment option in patients with chronic LBP for pain relief and functional recovery in the long run.

Level of Evidence:2
The Association of “U.S. News & World Report” Hospital Rankings and Outcomes Following Anterior Cervical Fusions
Authors: Malik Azeem Tariq , Xie Jack J. , Drain Joseph P. , Yu Elizabeth , Khan Safdar N. , Kim Jeffery
Published: December 2020

Study Design.

Retrospective observational study.

Objective.

The aim of this study was to evaluate whether there are any differences in outcomes and costs for elective one- to three-level anterior cervical fusions (ACFs) performed at US News and World Report (USNWR) ranked and unranked hospitals.

Summary of Background Data.

Although the USNWR rankings are advertised by media and are routinely used by patients as a guide in seeking care, evidence regarding whether these rankings are reflective of actual clinical outcome remains limited.

Methods.

The 2010–2014 USNWR hospital rankings were used to identify ranked hospitals in “Neurosurgery” and “Orthopedics.” The 2010–2014 100% Medicare Standard Analytical Files (SAF100) were used to identify patients undergoing elective ACFs at ranked and unranked hospitals. Multivariable logistic regression and generalized linear regression analyses were used to assess for differences in 90-day outcomes and costs between ranked and unranked hospitals.

Results.

A total of 110,520 patients undergoing elective one- to three-level ACFs were included in the study, of which 10,289 (9.3%) underwent surgery in one of the 100 ranked hospitals. Following multivariate analysis, there were no significant differences between ranked versus unranked hospitals with regards to wound complications (1.2% vs. 1.1%; P = 0.907), cardiac complications (12.9% vs. 11.9%; P = 0.055), pulmonary complications (3.7% vs. 6.7%; P = 0.654), urinary tract infections (7.3% vs. 5.8%; P = 0.120), sepsis (9.3% vs. 7.9%; P = 0.847), deep venous thrombosis (1.9% vs. 1.3%; P = 0.077), revision surgery (0.3% vs. 0.3%; P = 0.617), and all-cause readmissions (4.7% vs. 4.4%; P = 0.266). Ranked hospitals, as compared to unranked hospitals, had a slightly lower odds of experiencing renal complications (7.0% vs. 4.9%; P = 0.047), but had significantly higher risk-adjusted 90-day charges (+$17,053; P < 0.001) and costs (+ $1695; P < 0.001).

Conclusion.

Despite the higher charges and costs of care at ranked hospitals, these facilities appear to have similar outcomes as compared to unranked hospitals following elective ACFs.

Level of Evidence: 3
SEQUENTIAL RETINAL THICKNESS ANALYSIS SHOWS HYDROXYCHLOROQUINE DAMAGE BEFORE OTHER SCREENING TECHNIQUES
Authors: Marmor Michael F. , Durbin Mary , de Sisternes Luis , Pham Brandon H.
Published: December 2020

Purpose:

We sought to determine the earliest diagnostic signs of hydroxychloroquine retinopathy up to the point of clinical recognition.

Methods:

Retrospective series of 6 patients (5 parafoveal disease; 1 pericentral disease) with at least 3 examinations over 3.5 years or more preceding diagnosis of HCQ retinopathy. Spectral domain optical coherence tomography (sdOCT) cross-sections, fundus autofluorescence (FAF) and visual fields were generated clinically. Stored sdOCT data were re-examined later to generate topographic ellipsoid zone (EZ) maps, minimum intensity (MI) analysis and sequential plots of regional retinal thickness. Retrospective series of six patients (5 parafoveal disease; one pericentral disease) with at least three examinations over 3.5 years or more preceding diagnosis of hydroxychloroquine retinopathy.

Results:

Spectral domain optical coherence tomography cross-sections and fields showed similar sensitivity; fundus autofluorescence was not helpful. In parafoveal cases, EZ topography and minimum intensity analysis were no more reliable. Sequential thickness plots from four parafoveal cases showed dramatic retinal thinning across the posterior pole beginning 4 years to 5 years before clinical diagnosis, with parafoveal regions thinning even faster. The pericentral case showed thinning only outside the central macula. Peripheral EZ loss was more dramatic with EZ topography than sdOCT cross-sections.

Conclusion:

Sequential retinal thickness plots reveal definitive thinning years before current diagnostic procedures. We hope that OCT manufacturers will develop software to display such measurements. Ellipsoid zone topography was not more sensitive than sdOCT cross-sections, but important for recognizing pericentral disease.
Prolonged Detection of SARS-CoV-2 in a Patient With the Development of New Clinical Symptoms
Authors: Awoniyi Amaka , Rohm Zachery , Paranjape Neha , Arinze Folasade
Published: December 2020

We present a case of a 65-year-old woman with a persistently positive nasopharyngeal swab for severe acute respiratory syndrome coronavirus 2 PCR who developed new complications of coronavirus disease 2019 (COVID-19) 63 days from illness onset. She presented with intermittent fevers, fluctuating disorientation, gait instability, diffuse corticospinal tract signs, and acute venous thromboembolism. No alternate diagnosis was identified. This case highlights the potential for prolonged SARS-CoV-2 PCR positivity and persistent multisystem complications (particularly neurological), even after several months of initial COVID-19 diagnosis.
Outcomes of Orthopedic Hardware-Related Infection Treated Via a Public Teaching Hospital Outpatient Parenteral Antimicrobial Therapy Program
Authors: Valinetz Ethan , Beeler Cole , Erdman Sharon M.
Published: December 2020

Background

Orthopedic hardware-related infection (OHRI) is associated with high morbidity and cost with limited published data describing outpatient parenteral antimicrobial therapy (OPAT) for its treatment. This study was conducted to evaluate clinical outcomes, complications, and risk factors for treatment failure in OHRI patients treated with OPAT.

Methods

Electronic medical records of adults receiving OPAT for OHRI between July 1, 2009 and March 1, 2015 were retrospectively reviewed. Demographic, medical, infection-specific, and drug-specific data were collected for each patient. Patients were categorized as cure or failure using standardized definitions. Safety was evaluated through adverse drug event and line complication monitoring; readmission rates were recorded.

Results

Fifty patients with OHRI (mean age, 51.5 ± 12.6 years; 56% male) received OPAT for a mean duration of 41.4 ± 6.9 days. Thirty-one patients received OPAT in the presence of retained hardware—15 (48%) achieved clinical cure and 16 (52%) experienced failure; 3 patients (10%) experienced early (within 4 weeks) failure requiring unanticipated surgery. Twenty-four patients with retained hardware received oral suppressive antibiotics after OPAT until hardware removal; 3 nonadherent patients experienced failure. Nineteen patients received OPAT after hardware removal—14 (74%) achieved clinical cure and 5 (26%) experienced failure. Five patients (10%) experienced adverse drug event and 4 patients (8%) developed line complications resulting in readmission for 3 patients (6%) and alternate therapy for 4 patients (8%).

Conclusions

Outpatient parenteral antimicrobial therapy is safe and effective for OHRI, especially after hardware removal. Retention of hardware and nonadherence to oral suppression were associated with failure.
Fitness to Administer Influenza Vaccine by Pharmacists in the UAE
Authors: Abdalla Amal , Thomas Dixon , McKeirnan Kimberly , Khalifa Sherief
Published: December 2020

Backgrounds

The new United Arab Emirates (UAE) drug law permits pharmacists to administer medicines, including vaccines, after proper training. Pharmacists in many other countries have been successfully administering vaccinations for many years but not in the UAE. The objective of this study is to assess the competence of pharmacists who participated in one of the first influenza vaccination training programs in the UAE.

Methods

A pre-post interventional quasi-experimental study was designed to measure the beliefs and knowledge of pharmacists before and after participating in the influenza vaccination training. Skills were measured only after the training. The training included 2 lectures followed by hands-on skills-based vaccine administration training. The pharmacists' intramuscular injection skills were assessed using Objective Structured Clinical Examination stations. The Student t test and analysis of variance statistical tests were conducted using SPSS software version 26 to determine the difference in knowledge, skill, and beliefs.

Results

Of 26 enrolled candidates, 16 have participated and completed the program, all the final participants achieved the passing score on the posttest and their scores were higher compared with the pretest. Participants' beliefs of knowledge and the knowledge itself improved significantly after the training. Scores of Objective Structured Clinical Examination stations were consistently high for all the participants.

Conclusions

A comprehensive training with achievement of learning outcomes is a proof of fitness to practice influenza vaccination, an important new skill for pharmacists in the UAE. All the study participants successfully completed the training program, achieved the passing score and showed a fitness to administer flu vaccine.
Pneumococcal Mastitis With Septicemia in a Pregnant Woman With Systemic Lupus Erythematosus
Authors: Kano Yasuhiro , Takamatsu Akane , Honda Nanase , Miike Satoshi , Honda Hitoshi
Published: December 2020

Purulent mastitis due to Streptococcus pneumoniae is extremely rare and is thought to be transmitted to the mother from the respiratory tract of the child during breastfeeding. We report herein a case of a 37-year-old, pregnant, Japanese patient in her third trimester with systemic lupus erythematosus (SLE) who presented with bacteremic pneumococcal mastitis despite the absence of lactation. Previous studies suggested that a marked susceptibility to S. pneumoniae among patients with SLE may play an important role in the development of severe infections due to this organism. Clinicians should be aware of this susceptibility and the importance of pneumococcal vaccination for patients with SLE.
Cytomegalovirus Reactivation After Bendamustine-Based Chemotherapy
Authors: Aggarwal Abhimanyu , Cretara Anthony , Ford Katya , Steingart Richard , Walker Durane
Published: December 2020

Cytomegalovirus (CMV) is a DNA hepadnavirus, commonly implicated in reactivation disease after immunosuppression, especially in solid-organ and stem cell transplant patients. Bendamustine is an alkylating chemotherapeutic agent introduced into the management of hematological malignancies within the last decade. Few reports have raised potential concern for CMV reactivation disease after bendamustine therapy involving, but not limited to, the gastrointestinal tract, lungs, retina, and viremia. Cytomegalovirus reactivation in such instances should be added to the differential diagnoses for febrile nonneutropenic immunocompromised patients. Here, we report a case of an elderly gentleman recently diagnosed with mantle cell lymphoma who was started on chemotherapy with rituximab, bendamustine, and dexamethasone and developed CMV colitis and viremia after just 2 cycles of chemotherapy.
Capnocytophaga canimorsus Meningitis Complicating a Remote Dog Bite
Authors: Kusulja Marija , Atelj Anita , Butić Iva , Krajinović Vladimir , Vukelić Dalibor
Published: December 2020

Capnocytophaga canimorsus is a rare cause of disease in humans. This article reports a case of C. canimorsus meningitis in an adult previously immunocompetent woman but with concurrent influenza A infection. The diagnosis was made from a blood and cerebrospinal fluid culture using DNA sequencing, and the patient recovered well after a 21-day course of ceftriaxone. Based on our case report and other available literature on the subject, implications of exposure history, empirical bacterial meningitis treatment, and dog bite prevention are discussed.
Extracorporeal Membrane Oxygenation for Coronavirus Disease 2019: Crisis Standards of Care
Authors: Agerstrand Cara , Dubois Richard , Takeda Koji , Uriel Nir , Lemaitre Philippe , Fried Justin , Masoumi Amirali , Cheung Eva W. , Kaku Yuji , Witer Lucas , Liou Peter , Gerall Claire , Klein-Cloud Rafael , Abrams Darryl , Cunningham Jennifer , Madahar Purnema , Parekh Madhavi , Short Briana , Yip Natalie H. , Serra Alexis , Beck James , Brewer Michael , Fung Kenmund , Mullin Dana , Oommen Roy , Stanifer Bryan Payne , Middlesworth William , Sonett Joshua , Brodie Daniel
Published: December 2020

The coronavirus disease 2019 (COVID-19) pandemic has placed extraordinary strain on global healthcare systems. Use of extracorporeal membrane oxygenation (ECMO) for patients with severe respiratory or cardiac failure attributed to COVID-19 has been debated due to uncertain survival benefit and the resources required to safely deliver ECMO support. We retrospectively investigated adult patients supported with ECMO for COVID-19 at our institution during the first 80 days following New York City’s declaration of a state of emergency. The primary objective was to evaluate survival outcomes in patients supported with ECMO for COVID-19 and describe the programmatic adaptations made in response to pandemic-related crisis conditions. Twenty-two patients with COVID-19 were placed on ECMO during the study period. Median age was 52 years and 18 (81.8%) were male. Twenty-one patients (95.4%) had severe ARDS and seven (31.8%) had cardiac failure. Fifteen patients (68.1%) were managed with venovenous ECMO while 7 (31.8%) required arterial support. Twelve patients (54.5%) were transported on ECMO from external institutions. Twelve patients were discharged alive from the hospital (54.5%). Extracorporeal membrane oxygenation was used successfully in patients with respiratory and cardiac failure due to COVID-19. The continued use of ECMO, including ECMO transport, during crisis conditions was possible even at the height of the COVID-19 pandemic.
Extracorporeal Membrane Oxygenation and Extracorporeal Cardiopulmonary Resuscitation for a COVID-19 Pediatric Patient: A Successful Outcome
Authors: Alfoudri Huda , Shamsah Mohammad , Yousuf Beena , AlQuraini Nasayem
Published: December 2020

Pediatric population have been affected by the Coronavirus disease 2019 (COVID-19) to a much smaller scale compared with the adult population. The severity of the disease is variable ranging from mild form of pneumonia to severe acute respiratory distress syndrome (ARDS) that necessitates admission to the intensive care unit (ICU) requiring a maximal level of organ support. Failure of the maximum support through mechanical ventilation can lead to the consideration of a higher level of organ support through extracorporeal membrane oxygenation (ECMO). We present a case of an 8 years old girl, who presented with severe ARDS secondary to COVID-19 pneumonia for which a venovenous-ECMO (VV ECMO) was initiated. This was followed by the patient developing cardiac arrest, which was managed with extracorporeal cardiopulmonary resuscitation (ECPR). The patient was also given thrombolytic therapy during the ECPR because of high clinical suspicion for pulmonary embolism. Venovenous-arterial ECMO was then continued and the patient was successfully weaned off both VA and VV ECMO and discharged home with full neurologic recovery. This encouraging result will hopefully lead to more consideration of this lifesaving therapy for severe cardiac and respiratory failure secondary to COVID-19 in pediatric patients.
Viscoelastic Coagulation Monitor as a Novel Device to Assess Coagulation at the Bedside. A Single-Center Experience During the COVID-19 Pandemic
Authors: Panigada Mauro , Meli Andrea , Scotti Eleonora , Properzi Paolo , Brioni Matteo , Kamel Shady , Ghirardello Stefano , Scudeller Luigia , Dalton Heidi J. , Grasselli Giacomo
Published: December 2020

Viscoelastic coagulation monitor (VCM) is a portable device developed to evaluate the viscoelastic properties of whole blood activated by contact with glass. In this study, VCM was employed to analyze the viscoelastic profiles of 36 COVID-19 intensive care patients. Full anticoagulant dose heparin (unfractionated [UFH]; low molecular weight [LMWH]) was administrated to all patients. The association between VCM and laboratory parameters was retrospectively analyzed. The administration of UFH-influenced VCM parameters prolonging clotting time (CT) and clot formation time (CFT) and reducing angle (alpha) and amplitudes of the VCM tracings (A10, A20, and maximum clot firmness [MCF]) compared with LMWH therapy. A tendency toward hypercoagulation was observed by short CT and CFT in patients receiving LMWH. Clotting time was correlated with UFH dose (Spearman’s rho = 0.48, p ≤ 0.001), and no correlation was found between CT and LMWH. All VCM tracings failed to show lysis at 30 and 45 minutes, indicating the absence of fibrinolysis. A10, A20, and MCF exhibited very-good to good diagnostic accuracy for detecting platelet count and fibrinogen above the upper reference limit of the laboratory. In conclusion, VCM provided reliable results in COVID-19 patients and was easy to perform with minimal training at the bedside.
Acute severe respiratory syndrome coronavirus-2 treatment overview for pediatrics
Authors: Murphy Mark E. , Clay Gwendolyn , Danziger-Isakov Lara , Schulert Grant , Paulsen Grant C.
Published: December 2020

Purpose of review

The novel severe respiratory syndrome coronavirus-2 (SARS-CoV-2) virus has caused a world-wide pandemic with devastating effects. Fortunately, most children display only mild-to-moderate symptoms, but there are a subset that will have severe symptoms warranting treatment. This review evaluates the current evidence for antiviral and anti-inflammatory treatment of acute SARS-COV-2 infections, including coronavirus disease 2019 in pediatrics.

Recent findings

Treatment recommendations continue to evolve with emerging results from clinical trials. Initial therapies were tailored to repurposed medications, and have now transitioned toward more specific antiviral therapy. In addition to specific antiviral therapy, there is also support to modulate the immune system and reduce inflammatory damage seen in coronavirus disease 2019. Much of the data result from adult studies with subsequent extrapolation to pediatrics.

Recommended therapy will continue to adapt as results return from clinical trials. A continued commitment from the National Institutes of Health and research community to assist in determining optimal therapies for pediatric patients is essential. Until then, most recommendations will likely be informed from the results seen in adult populations.
Beyond Bean Counting: Gathering and Using Data to Drive Improvements
Authors: DeVries Michelle
Published: December 2020

Data collection of process and outcome measures for vascular access procedures and devices is recommended in all relevant guidelines and standards. A variety of strategies for achieving these objectives and how the findings can be aggregated and presented to improve patient care is discussed, along with a review of specific recommendations.
Visual Function in Eyes with Intermediate AMD with and without Retinal Pigment Abnormalities
Authors: Schneck Marilyn E. , Lott Lori A. , Haegerstrom-Portnoy Gunilla , Hewlett Susan , Gauer Bonnie M. , Zaidi Ali
Published: December 2020

SIGNIFICANCE

In intermediate AMD, a simple, clinically feasible vision test of sensitivity to radial deformation is significantly more impaired in eyes with hyperpigmentation than in eyes with large drusen but normal retinal pigmentation, consistent with the former's increased risk of progression to advanced AMD. This ongoing longitudinal study will determine whether this vision measure is predictive of progression to advanced AMD.

PURPOSE

This study aimed to determine whether simple, clinically feasible psychophysical measures distinguish between two levels of intermediate AMD that differ in their risk of progression to advanced AMD: eyes with large macular drusen and retinal pigment abnormalities versus eyes with large macular drusen without pigment abnormalities. Abnormal pigmentation in the presence of large drusen is associated with a higher risk of development of advanced AMD.

METHODS

Each eye of 39 individuals with the same form of intermediate AMD in both eyes was tested monocularly on a battery of vision tests. The measures (photopic optotype contrast sensitivity, discrimination of desaturated colors, and sensitivity to radial deformation [shape discrimination hyperacuity]) were compared for both dominant and nondominant eyes. ANOVA with eye (dominant or nondominant) as a within-subject factor and retinal status (pigmentary abnormalities present or absent from the macula) as a between-subject factor was used to determine statistical significance.

RESULTS

Sensitivity to radial deformation was significantly reduced in eyes with large drusen and pigment changes compared with eyes with large drusen and normal retinal pigmentation (−0.40 ± 0.04 vs. −0.61 ± 0.02, respectively; F = 13.31, P = .001).

CONCLUSIONS

In the presence of large macular drusen, performance on a shape discrimination task is related to the presence versus absence of abnormal retinal pigmentation, being poorer in the higher-risk group, supportive of the measure's potential to predict progression to advanced AMD.
A Comparison of Foveal and Peripheral Contour Interaction and Crowding
Authors: Marten-Ellis Stephanie M. , Bedell Harold E.
Published: December 2020

SIGNIFICANCE

Performance on clinical tests of visual acuity can be influenced by the presence of nearby targets. This study compared the influence of neighboring flanking bars and letters on foveal and peripheral letter identification.

PURPOSE

Contour interaction and crowding refer to an impairment of visual resolution or discrimination produced by different types of flanking stimuli. This study compared the impairment of percent correct letter identification that is produced in normal observers when a target letter is surrounded by an array of four flanking bars (contour interaction) or four flanking letters (crowding).

METHODS

Performance was measured at the fovea and at eccentricities of 1.25, 2.5, and 5° for photopic (200 cd/m2) and mesopic stimuli (0.5 cd/m2) and a range of target-to-flanker separations.

RESULTS

Consistent with previous reports, foveal contour interaction and crowding were more pronounced for photopic than mesopic targets. However, no statistically significant difference existed between foveal contour-interaction and crowding functions at either luminance level. On the other hand, flanking bars produced much less impairment of letter identification than letter flankers at all three peripheral locations, indicating that crowding is more severe than contour interaction in peripheral vision. In contrast to the fovea, peripheral crowding and contour-interaction functions did not differ systematically for targets of photopic and mesopic luminance.

CONCLUSION

The similarity between foveal contour interaction and crowding and the dissimilarity between peripheral contour interaction and crowding suggest the involvement of different mechanisms at different retinal locations.
Negative Fusional Vergence Is Abnormal in Children with Symptomatic Convergence Insufficiency
Authors: Scheiman Mitchell M. , Alvarez Tara L. , Cotter Susan A. , Kulp Marjean T. , Sinnott Loraine T. , Plaumann Maureen D. , Jhajj Jasleen ,   the Convergence Insufficiency Treatment Trial Investigator Group
Published: December 2020

SIGNIFICANCE

Deficits of disparity divergence found with objective eye movement recordings may not be apparent with standard clinical measures of negative fusional vergence (NFV) in children with symptomatic convergence insufficiency.

PURPOSE

This study aimed to determine whether NFV is normal in untreated children with symptomatic convergence insufficiency and whether NFV improves after vergence/accommodative therapy.

METHODS

This secondary analysis of NFV measures before and after office-based vergence/accommodative therapy reports changes in (1) objective eye movement recording responses to 4° disparity divergence step stimuli from 12 children with symptomatic convergence insufficiency compared with 10 children with normal binocular vision (NBV) and (2) clinical NFV measures in 580 children successfully treated in three Convergence Insufficiency Treatment Trial studies.

RESULTS

At baseline, the Convergence Insufficiency Treatment Trial cohort's mean NFV break (14.6 ± 4.8Δ) and recovery (10.6 ± 4.2Δ) values were significantly greater (P < .001) than normative values. The post-therapy mean improvements for blur, break, and recovery of 5.2, 7.2, and 1.3Δ, respectively, were statistically significant (P < .0001). Mean pre-therapy responses to 4° disparity divergence step stimuli were worse in the convergence insufficiency group compared with the NBV group for peak velocity (P < .001), time to peak velocity (P = .01), and response amplitude (P < .001). After therapy, the convergence insufficiency group showed statistically significant improvements in mean peak velocity (11.63°/s; 95% confidence interval [CI], 6.6 to 16.62°/s), time to peak velocity (−0.12 seconds; 95% CI, −0.19 to −0.05 seconds), and response amplitude (1.47°; 95% CI, 0.83 to 2.11°), with measures no longer statistically different from the NBV cohort (P > .05).

CONCLUSIONS

Despite clinical NFV measurements that seem greater than normal, children with symptomatic convergence insufficiency may have deficient NFV when measured with objective eye movement recordings. Both objective and clinical measures of NFV can be improved with vergence/accommodative therapy.
High Rates of Uncorrected Vision Conditions among Schoolchildren in Rural Queensland, Australia
Authors: Cox Rebecca A. , Read Scott A. , Hopkins Shelley , Wood Joanne M.
Published: December 2020

SIGNIFICANCE

This study is the first to report high rates of uncorrected vision conditions among Australian secondary schoolchildren living in a rural area and to comment on the rate of eye examinations undertaken on Australian Indigenous children. Uncorrected vision problems that continue throughout the school years have significant implications for children's quality of life and education.

PURPOSE

This study aimed to investigate the prevalence of uncorrected vision conditions among Australian schoolchildren.

METHODS

Participants included 280 students from rural primary and secondary schools (aged 4 to 18 years), of whom 40% identified as being of Aboriginal and/or Torres Strait Islander descent (Indigenous). All participants underwent an eye examination including measurements of monocular distance and near visual acuity, assessment of accommodative and vergence function, stereoacuity, color vision, and cycloplegic autorefraction. A parental questionnaire was used to determine whether the child had previously had his/her eyes examined.

RESULTS

The overall prevalence of uncorrected vision conditions in this population was 35%. The odds of previously having had an eye examination were 2.3× higher for non-Indigenous compared with Indigenous children despite both groups exhibiting high rates of uncorrected vision conditions (Indigenous, 31 [29%]; non-Indigenous, 66 [40%]; χ2
1 = 3.24, P = .07). Of the children who had significant refractive error (Indigenous, 23 [21%]; non-Indigenous, 49 [30%]; χ2
1 = 2.70, P = .10), 82% were uncorrected, and only 39% of Indigenous children and 54% of non-Indigenous children had previously had an eye examination.

CONCLUSIONS

These findings suggest that high rates of uncorrected vision conditions are present among Australian primary and secondary schoolchildren from a rural area and highlight that Indigenous children are much less likely to have had an eye examination. Understanding factors that affect the rate of eye examinations and compliance with spectacle correction must be addressed given the potential impact of these vision conditions.
Indicators for Assessing the Quality of Refractive Error Care
Authors: Lee Ling , Burnett Anthea M. , D'Esposito Fabrizio , Fricke Tim , Nguyen Long Tien , Vuong Duong Anh , Nguyen Hien Thi Thu , Yu Mitasha , Nguyen Ngoc Viet My , Huynh Ly Phuong , Ho Suit May
Published: December 2020

SIGNIFICANCE

Quality refractive error care is essential for reducing vision impairment. Quality indicators and standardized approaches for assessing the quality of refractive error care need to be established.

PURPOSE

This study aimed to develop a set of indicators for assessing the quality of refractive error care and test their applicability in a real-world setting using unannounced standardized patients (USPs).

METHODS

Patient outcomes and three quality of refractive error care (Q.REC) indicators (1, optimally prescribed spectacles; 2, adequately prescribed spectacles; 3, vector dioptric distance) were developed using existing literature, refraction training standards, and consulting educators. Twenty-one USPs with various refractive errors were trained to visit optical stores across Vietnam to have a refraction, observe techniques, and order spectacles. Spectacles were assessed against each Q.REC indicator and tested for associations with vision and comfort.

RESULTS

Overall, 44.1% (184/417) of spectacles provided good vision and comfort. Of the spectacles that met Q.REC indicators 1 and 2, 62.5 and 54.9%, respectively, provided both good vision and comfort. Optimally prescribed spectacles (indicator 1) were significantly more likely to provide good vision and comfort independently compared with spectacles that did not meet any indicator (good vision: 94.6 vs. 85.0%, P = .01; comfortable: 66.1 vs. 36.3%, P < .01). Adequately prescribed spectacles (indicator 2) were more likely to provide good comfort compared with spectacles not meeting any indicator (57.7 vs. 36.3%, P < .01); however, vision outcomes were not significantly different (85.9 vs. 85.0%, P = .90). Good vision was associated with a lower mean vector dioptric distance (P < .01) but not with comfort (P = .52).

CONCLUSIONS

The optimally prescribed spectacles indicator is a promising approach for assessing the quality of refractive error care without additional assessments of vision and comfort. Using USPs is a practical approach and could be used as a standardized method for evaluating the quality of refractive error care.
Fully autonomous mouse behavioral and optogenetic experiments in home-cage
Authors: Hao Yaoyao , Thomas Alyse M. , Li Nuo
Published: December 2020

Goal-directed behaviors involve distributed brain networks. The small size of the mouse brain makes it amenable to manipulations of neural activity dispersed across brain areas, but existing optogenetic methods serially test a few brain regions at a time, which slows comprehensive mapping of distributed networks. Laborious operant conditioning training required for most experimental paradigms exacerbates this bottleneck. We present an autonomous workflow to survey the involvement of brain regions at scale during operant behaviors in mice. Naïve mice living in a home-cage system learned voluntary head-fixation (>1 hour/day) and performed difficult decision-making tasks, including contingency reversals, for 2 months without human supervision. We incorporated an optogenetic approach to manipulate activity in deep brain regions through intact skull during home-cage behavior. To demonstrate the utility of this approach, we tested dozens of mice in parallel unsupervised optogenetic experiments, revealing multiple regions in cortex, striatum, and superior colliculus involved in tactile decision-making.
Development of next-generation sequencing-based sterility test
Authors: Yue Jianhui , Chen Chao , Jing Xiaohuan , Ma Qiwang , Li Bo , Zhang Xi
Published: December 2020

The sterility testing methods described in pharmacopoeias require an incubation period of 14 days to obtain analysis results. An alternative method that can significantly shorten the detection time and improve the accuracy is in urgent need to meet the sterility testing requirements of regenerative medicine products with a short shelf life. In this study, we developed the next-generation sequencing-based sterility test (NGSST) based on sequencing and multiple displacement amplification. The NGSST can be finished within 48 hours with five steps including whole genome amplification, sequencing, alignment, sterility testing report, and microorganism identification. We use RPKM ratio to minorize the influence of environmental bacteria and determine its cutoff based AUC curve. The NGSST showed high sensitivity in reporting contaminates at 0.1 CFU in supernatant of biological product or 1 CFU in cell suspension. Furthermore, we identified microorganisms in 5 primary umbilical cord mesenchymal stem cell samples that were tested positive by BacT/ALERTR 3D. Overall, the NGSST can serve as a promising alternative for sterility testing of biological products.
ASIC3-dependent spinal cord nociceptive signaling in cutaneous pain induced by lysophosphatidyl-choline
Authors: Pidoux Ludivine , Delanoe Kevin , Lingueglia Eric , Deval Emmanuel
Published: December 2020

Lysophosphatidyl-choline (LPC), a member of the phospholipid family, has recently emerged as an interesting new player in pain. It has been proposed to mediate pain through Acid-Sensing Ion Channel 3 (ASIC3), a pain-related channel mainly expressed in peripheral sensory neurons. LPC potentiates ASIC3 current evoked by mild acidifications, but can also activate the channel at physiological pH, and its local injection in rodents evokes ASIC3-dependent pain. We combine herein vivorecordings of spinal cord neuron activity with subcutaneous LPC injection to analyze the mechanism of action associated with the LPC-induced, ASIC3-dependent pain in peripheral and spinal cord neurons. We show that a single cutaneous injection of LPC exclusively affects the nociceptive pathway. It evokes an ASIC3-dependent short-term sensitization of nociceptive fibers that drives hyperexcitability of projecting neurons within the dorsal spinal cord without apparent central sensitization.