bluuebunny/crossref_metadata_2025 huggingface dataset:
Exploration and Validation of Behavioral Pain Measures and Physiological Pain Measures Factor Structure Extracted From the Pain Assessment Tool Item Scores for Infants Admitted to Neonatal Intensive Care
Authors: Ilhan Emre , Pacey Verity , Brown Laura , Spence Kaye , Galea Claire , Adams Roger , Hush Julia M.
Published: March 2021

Objective:

The objective of the study was to explore and then validate the factor structure of the Pain Assessment Tool (PAT).

Materials and Methods:

A retrospective medical record review was performed of all infants who were admitted to a neonatal intensive care unit between 2008 and 2018 and had 1 PAT assessment (n=2111). Scores on items of the PAT were collected. Infants were randomized to either the principal component analysis (n=1100) to explore the factor structure or confirmatory factor analysis (n=1011).

Results:

Infants in the 2 samples were demographically comparable. A 2-factor model, consisting of factors Behavioral and Physiological Pain Measures, was extracted, explaining 39.8% of the total variance. There was a low interfactor correlation (r=0.12), and both Behavioral (r=0.59) and Physiological Pain (r=0.37) Measures factor scores were correlated with nurses’ perception of pain scores. When the frequencies in the gestational age at birth categories were compared between upper and lower quartile score infants, there was more with pain at preterm than at term (χ2(3)=44.9, P<0.001) for the Physiological Pain Measures factor, whereas Behavioral Pain Measures frequency was higher at term than at preterm (χ2(3)=8.1, P<0.043). A similar pattern was observed for postmenstrual age at assessment categories: Behavioral Pain Measures (χ2(3)=41.8, P<0.001) Physiological Pain Measures (χ2(3)=46.1, P<0.001). The 2-factor correlated model performed better at explaining the observed variances: (χ2(13)=41.6, P<0.001) compared with rival models.

Discussion:

The PAT assesses both Behavioral Pain and Physiological Pain Measures, and these dimensions need to be considered separately when assessing pain in infants in the neonatal intensive care unit. Behavioral item scores may be insufficient for detecting pain in premature infants if used alone.
Hospital environmental influences and the rate of periprosthetic joint infections at a Canadian tertiary center: a retrospective chart review
Authors: Park Rosa , Wood Gavin C.A. , Hopman Wilma M. , Grant Heather J. , Yen David
Published: March 2021

Background:

As the demand for total joint arthroplasty is expected to increase substantially in the coming years, the reported incidence of periprosthetic joint infections (PJI) after total joint arthroplasty is also expected to increase. This study investigated both patient factors and hospital factors and their relation to rates of infection for total hip arthroplasty (THA) and total knee arthroplasty (TKA). To the authors’ knowledge, this is the first paper to investigate rates of hand washing and carpet removal to PJIs.

Methods:

Traditional sample size calculations based on effect sizes or differences were not applicable in this observational, retrospective study. The annual rate of irrigation and debridement (I&D) at our institution was calculated. Hospital environmental influences for carpet removal and hand hygiene were obtained from hospital archives. Patient risk factors were obtained from the electronic patient charting system (PCS).

Results:

The average rate of I&D for THA was 2.8% and TKA was 1.9%. Hospital environmental influences (carpet removal and hand hygiene) were not associated with the rates of I&D.

Conclusions:

Despite rates of hand hygiene at our institution being reported as having a greater than 90% success rate, we did not find any association between successful hand hygiene practices and rates of PJI. Our study revealed that the rate of infection for THA at our institution was nearly two to three times higher than what was reported in the literature, and we believe poor patient selection played a factor.

Level of Evidence:

Level III.
Hepatitis B core-related antigen reflects viral replication and protein production in chronic hepatitis B patients
Authors: Li Jun , Wu Zhao , Wang Gui-Qiang , Zhao Hong
Published: March 2021

Background:

Hepatitis B core-related antigen (HBcrAg) is a promising disease-monitoring marker for chronic hepatitis B (CHB). We investigated correlations between HBcrAg with antiviral efficacy and virological and histological variables.

Methods:

One hundred and forty-five CHB patients from the mainland of China between August 2013 and September 2016 who underwent liver biopsy received entecavir therapy and had paired liver biopsy at 78 weeks. We analyzed correlations between HBcrAg and virological and histological variables in hepatitis B e antigen (HBeAg)-positive and HBeAg-negative patients. We also explored the predictors of HBeAg loss after 78 weeks of antiviral therapy. Pearson correlation analysis and logistic forward stepwise regression were the main statistic methods.

Results:

HBeAg-positive patients (n = 93) had higher baseline HBcrAg (median 7.4 vs. 5.3 log10 U/mL P < 0.001) and greater HBcrAg declines (median 1.6 vs. 0.9 log10 U/mL P = 0.007) than HBeAg-negative patients after 78 weeks of therapy. At baseline, HBcrAg correlated with hepatitis B virus (HBV) DNA in both HBeAg-positive (r = 0.641, P < 0.001) and -negative patients (r = 0.616, P < 0.001), with hepatitis B surface antigen (HBsAg) in HBeAg-positive patients (r = 0.495, P < 0.001), but not with anti-hepatitis B virus core antibody (anti-HBc). Weak correlations existed between HBcrAg, histology activity index (HAI; r = 0.232, P = 0.025), and Ishak fibrosis score (r = −0.292, P = 0.005) in HBeAg-positive patients. At 78 weeks, significant correlations existed only between HBcrAg and anti-HBc in HBeAg-positive (r = −0.263, P = 0.014) and HBeAg-negative patients (r = −0.291, P = 0.045). Decreased HBcrAg significantly correlated with reduced HBV DNA (r = 0.366, P = 0.001; r = 0.626, P < 0.001) and HBsAg (r = 0.526, P = 0.001; r = 0.289, P = 0.044) in HBeAg-positive and -negative patients, respectively, and with reduced HAI in HBeAg-positive patients (r = 0.329, P = 0.001). Patients with HBeAg loss (n = 29) showed a larger reduction in HBcrAg than those without (median 2.3 vs. 1.3 log10 U/mL, P = 0.001). In multivariate analysis, decreased HBcrAg was an independent predictor of HBeAg loss (P = 0.005).

Conclusions:

HBcrAg reflects viral replication and protein production. Decreased HBcrAg could predict HBeAg loss after antiviral therapy.

Trial registration:

Clinical Trials.gov: NCT01962155; https://www.clinicaltrials.gov/ct2/show/NCT01962155?term=NCT01962155&draw=2&rank=1
Environmental Contaminant Body Burdens and the Relationship with Blood Pressure Measures Among Indigenous Adults
Authors: Zuk Aleksandra M. , Liberda Eric N. , Tsuji Leonard J.S.
Published: March 2021

Background:

Blood pressure (BP) increase cardiovascular disease (CVD) risk. Indigenous Canadians experience slightly higher CVD compared with nonIndigenous Canadians. This study examined the role of polychlorinated biphenyls (PCBs), other organic compound concentrations (OCs), and toxic metals on blood pressure measures among Indigenous Canadians.

Methods:

Using data from the Environment-and-Health Study, the sample was restricted to adults with valid BP measures and detectable body burden mixtures. In total, n = 759 participants were eligible, of which, n = 447(59%) were females. Principal Component Analysis (PCA) was used to reduce the complexity of the contaminant data. Orthogonal principal component (PC) variables, and sum (∑) of contaminant compounds were used as independent predictors in modified Poisson regression models with robust variance estimation, deriving prevalence ratios (PR) for hypertension, that is, systolic BP (SBP) ≥140 ml of mercury (mmHg), or diastolic BP ≥90 mm Hg. Additionally, using multivariable generalized linear regression, sex-stratified continuous SBP measure was regressed on ∑ contaminant compounds.

Results:

Two PCs were extracted from the PCA analysis. PCBs and OCs positively highly loaded on the first axis (PC-1). Lead loaded positively on the second (PC-2) axis. Hypertension was consistently associated with PC-1 across models, PR = 1.08 (95% confidence intervals = 1.003 to 1.172) fully adjusted model. Examining ∑ of contaminants, the strength of association with hypertension was strongest for ∑OCs compared with ∑PCBs. The measure of effect for continuous SBP measures with ∑ dichlorodiphenyltrichloroethane(p,p'-DDT) and dichlorodiphenyldichloroethylene(p,p’-DDE) concentrations although small was similar for both females and males, β = 0.04 (95% confidence intervals = 0.005 to 0.075) among females; however, for males the estimate is imprecise after adjusting for body mass index.

Conclusion:

This cross-sectional analysis found that PCBs and OCs were associated with associated prevalent hypertension; and exposure to OC pesticides, particularity DDT/DDE were found to be associated with prevalent SBP measures among females and not males.
Ocular Hypotension and Epiretinal Membrane as Risk Factors for Visual Deterioration Following Glaucoma Filtering Surgery
Authors: Chihara Etsuo , Chihara Tomoyuki
Published: March 2021

Precis:

Postsurgical hypotension at 1 week and the presence of an epiretinal membrane (ERM) were significant risk factors for the deterioration of postsurgical visual acuity (VA) at 3 and 12 months, respectively.

Purpose:

The purpose of this study was to assess the effects of an ERM and postsurgical hypotension <6 mm Hg at 1 week on postsurgical VA loss.

Patients and Methods:

A total of 69 patients (69 eyes) who underwent trabeculectomy with adjunctive mitomycin C between 2017 and 2019 (mean follow-up period: 22.8 mo) were enrolled, and 14 parameters that could be associated with the deterioration of VA at 3 and 12 months were studied.

Results:

There was a significant association between VA loss at 3 months and postsurgical intraocular pressure at 1 week (P=0.006 by multiple regression) and hypotony maculopathy (P=0.024 by Fisher exact test). However, this association was lost at 12 months. Instead of postsurgical hypotension, the presence of an ERM was significantly associated with VA loss at 12 months (P=0.035 by Fisher exact test, and P=0.023 by logistic regression).

Conclusions:

Postsurgical hypotension at 1 week was significantly associated with mid-term, but not long-term, postsurgical VA loss. The presence of an ERM, which was not a risk factor for mid-term acuity loss, was a significant risk factor for VA loss at 12 months.
Adherence to recent antibiotic guidelines for acute uncomplicated cystitis
Authors: Amayun Ira
Published: March 2021

Background:

In 2017, the Centers for Disease Control and Prevention (CDC) published guidelines for treating acute uncomplicated cystitis (AUC) with nitrofurantoin (NTF), sulfamethoxazole-trimethoprim (SMX-TMP), or fosfomycin (FM) as appropriate first-line agents.

Objective:

To evaluate whether provider adherence to prescribing NTF, SMX-TMP, or FM has improved since the 2017 CDC guidelines were released, and to examine outcomes relative to the use of prescribing guidelines.

Data source:

A literature review was conducted in compliance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis, and a systematic search for articles was conducted in the PubMed and Cochrane search engines using Boolean operators (AND, OR). The searches resulted in 56 published studies. After application of exclusion criteria, 11 peer-reviewed articles were ultimately included in this review.

Conclusion:

The review showed prescribers' increasing efforts to adhering to antibiotic prescription guidelines for treating AUC, such as the 2017 CDC guidelines. The studies presented strong evidence that NTF, SMX-TMP, and FM are equally efficacious and cost-effective for treating AUC without concern for antibiotic resistance. Studies that referenced prescription guidelines and local antibiotic resistance yielded desired patient outcomes in bacterial and symptom resolution and cost-effectiveness.

Implications for practice:

This article provides evidence and a platform for nurse practitioners to initiate collaborative efforts for structured AUC treatment guidelines in primary health care. To increase prescription adherence, electronic health records could be designed that would prompt prescribers to use updated local antibiotic resistance information and to use NTF, SMT-TMX, and FM as first-line agents.
An initiative to increase opioid overdose education and naloxone distribution for homeless veterans residing in contracted housing facilities
Authors: Rife Tessa , Tat Christina , Jones Jennifer , Pennington David L.
Published: March 2021

Background:

Up to 35% of veterans with opioid use disorder (OUD) are homeless, and veterans with OUD are nearly 29 times higher risk for homelessness; however, few are prescribed naloxone, an evidence-based intervention to reverse life-threatening opioid overdose.

Local problem:

Many housing facilities for homeless veterans contracted with the San Francisco Veterans Affairs Health Care System are located in neighborhoods with high rates of opioid overdose. No systematic interventions have been implemented to provide opioid overdose education and naloxone kits to veterans and staff at these facilities. This quality improvement (QI) initiative aimed to increase provision of opioid overdose education and naloxone for veterans and staff at contracted housing facilities.

Methods:

This was a prospective single-arm cohort QI intervention. All contracted veteran housing programs were included. Descriptive statistics evaluated results.

Interventions:

A total of 18 contracted veteran housing programs were contacted from July 2019 through January 2020 to schedule training.

Results:

Of those, 13 programs responded to outreach and 10 visits were completed at 8 housing facilities. Training was provided by pharmacist and nurse practitioner trainers to 26 staff members and 59 veterans. Naloxone was prescribed to 37 veterans.

Conclusions:

A pharmacist-led and nurse practitioner–led initiative was effective in increasing veteran and staff access to opioid overdose education and naloxone at >44% contracted veteran housing facilities. Challenges included lack of response from housing programs, low veteran turn out, and inability to provide naloxone to veterans not enrolled/ineligible for health care. Future initiatives should examine strategies to standardize access in homeless veterans' programs.
Experimentally evoked pain in Alzheimer's disease
Authors: Anderson Alison R. , Iversen W. Larkin , Carter Michael A. , Moss Karen O. , Cowan Ronald L. , Monroe Todd B.
Published: March 2021

Background:

Pain continues to be underrecognized and undertreated in Alzheimer's disease (AD) while existing guidance about pain assessment and management in dementia is not widespread. Brain regions involved in pain processing and modulation are damaged during AD, and the pain experience in AD is not well understood. Experimental pain studies using psychophysics can further our understanding of the pain experience in AD, which may lead to improved assessment and management of pain in people living with AD.

Objective:

A systematic review was conducted to explicate the current understanding of experimentally evoked pain in AD from primary research using psychophysical methods.

Data Sources:

Peer-reviewed publications were found via PubMed, CINAHL, and PsycINFO. A total of 18 primary research, peer-reviewed full articles that met inclusion criteria were included, representing 929 total participants.

Conclusions:

Experimentally evoked pain in people with AD demonstrates that despite cognitive impairment and a reduced ability to effectively communicate, individuals with AD experience pain similar to or more unpleasant than cognitively intact older adults. This may mean amplified pain unpleasantness in people with AD.

Implications for practice:

Our current best practices need to be widely disseminated and put into clinical practice. Self-report of pain continues to be the gold standard, but it is ineffective for noncommunicative patients and those unable to understand pain scales or instructions because of memory/cognitive impairment. Instead, pain treatment should be ethically initiated based on patient reports and behaviors, caregiver/surrogate reports, review of the medical record for painful conditions, analgesic trials, and regular reassessments.
Lung Navigation Ventilation Protocol to Optimize Biopsy of Peripheral Lung Lesions
Authors: Bhadra Krish , Setser Randolph M. , Condra William , Pritchett Michael A.
Published: March 2021

Background:

Computed tomography-to-body divergence caused by respiratory motion, atelectasis, diaphragmatic motion and other factors is an obstacle to peripheral lung biopsies. We examined a conventional ventilation strategy versus a lung navigation ventilation protocol (LNVP) optimized for intraprocedural 3-dimensional image acquisition and bronchoscopic biopsy of peripheral lung nodules.

Methods:

A retrospective, single center study was conducted in consecutive subjects with peripheral lung lesions measuring <30 mm. Effects of ventilation strategies including atelectasis and tool-in-lesion confirmation were assessed using cone beam computed tomography images. Diagnostic yield was also evaluated. Complications were assessed through 7 days.

Results:

Fifty subjects were included (25 per group) with 27 nodules in the conventional group and 25 nodules in the LNVP group. Atelectasis was assessed by 2 blinded readers: [reader 1 (R1) and reader 2 (R2)]. Atelectasis was more prevalent in the conventional ventilation group, both for dependent atelectasis (R1: 64% and R2: 68% vs. R1: 36% and R2: 16%, P=0.00014) and sublobar/lobar atelectasis (R1: 48% and R2: 56% vs. R1: 20% and R2: 32%, P=0.01). Similarly, the target lesion was obscured due to atelectasis more often in the conventional ventilation group (R1: 36% and R2: 36% vs. R1: 4% and R2: 8%, P=0.01). Diagnostic yield was 70% for conventional ventilation and 92% for LNVP (P=0.08).

Conclusion:

LNVP demonstrated markedly reduced dependent and sublobar/lobar atelectasis and lesions either partially or completely obscured by atelectasis compared with conventional ventilation. Future prospective studies are necessary to understand the impact of protocolized ventilation strategies for bronchoscopic biopsy of peripheral lung lesions.
Clinical and central hemodynamic characteristics of early adulthood isolated diastolic hypertension: a comparison with isolated systolic hypertension
Authors: Kim Sunwon , Kim Jin-Seok , Kim Woohyeun , Ahn Jeong-Cheon
Published: March 2021

Objectives

Knowledge on early adulthood isolated diastolic hypertension (IDH) is limited. We compared the clinical and central hemodynamic characteristics of early adulthood IDH, isolated systolic hypertension (ISH) and normotension.

Methods

A total of 509 untreated young adults (18–35 years) who underwent ambulatory blood pressure monitoring (ABPM; ABPM cohort), 148 who underwent both ABPM and applanation tonometry (ABPM-tonometry cohort) and 26 newly recruited normotensives were analyzed. Their pulse wave images were analyzed after categorizing them into type A vs. B vs. C.

Results

In the ABPM cohort (men, 86.6%), systolic–diastolic hypertension was the most common subtype (68.0%), while IDH was the rarest (5.1%). The subtype composition showed age-dependency; the proportion of IDH and systolic–diastolic hypertension increased across the age tertiles, while that of ISH declined. Patients with IDH were significantly older and shorter than those with ISH. Despite having a significantly lower 24-h average systolic blood pressure (SBP), patients with IDH exhibited discordantly high central systolic blood pressures at levels comparable to those of patients with ISH. Pulse pressure amplification was the lowest in patients with IDH and highest in those with ISH (P < 0.001), accounting for the discordance. Augmentation index differed significantly between them (P < 0.016). The waveform composition differed across the subtypes (type A vs. B/C: IDH = 61.5 vs. 38.5%; ISH = 3.0 vs. 97.0%; normotension = 30.8 vs. 69.2%, P < 0.001); the averaged waveform plots demonstrated a clear morphological disparity between IDH (type A) and ISH (type B/C).

Conclusions

Early adulthood IDH is a unique entity clearly distinguishable from ISH in terms of clinical and central hemodynamic characteristics.
Serrated Lesion Detection in a Population-based Colon Screening Program
Authors: Chu Jenny E. , Hamm Jeremy , Gentile Laura , Telford Jennifer J. , Schaeffer David F.
Published: March 2021

Background:

Serrated lesions give rise to 15% to 30% of all colorectal cancers, driven predominantly by the sessile serrated polyp (SSP). Fecal immunochemical test (FIT), has low sensitivity for SSPs. SSP detection rate (SSPDR) is influenced by performance of both endoscopists and pathologists, as diagnosis can be subtle both on endoscopy and histology.

Goals:

To evaluate the SSPDR in a population-based screening program, and the influence of subspecialty trained pathologists on provincial reporting practices.

Study:

The colon screening program database was used to identify all FIT-positive patients that received colonoscopy between January 2014 and June 2017. Patient demographics, colonoscopy quality indicators, pathologic diagnoses, and FIT values were collected. This study received IRB approval.

Results:

A total of 74,605 colonoscopies were included and 26.6% had at least 1 serrated polyp removed. The SSPDR was 7.0%, with 59% of the SSPs detected having a concurrent conventional adenoma. The mean FIT value for colonoscopies with only serrated lesions was less than that for colonoscopies with a conventional adenoma or colorectal cancer (P<0.0001). Centers with a gastrointestinal subspecialty pathologist diagnosed proportionally more SSPs (P<0.0001), and right-sided SSPs than centers without subspecialists.

Conclusions:

Serrated lesions often occur in conjunction with conventional adenomas and are associated with lower FIT values. Knowledge of the characteristics of SSPs is essential for pathologists to ensure accurate diagnosis of SSPs.
Rebleeding after hemoclip versus argon plasma coagulation for gastrointestinal angiodysplasias: a retrospective multicenter study
Authors: Ismail Bahaaeldeen , Alayoubi Mhd Suhaib , Abdelwadoud Moaz , Castro Fernando J.
Published: March 2021

Background

Hemoclips are utilized for treating bleeding gastrointestinal angiodysplastic lesions (GIADs); however, the supporting evidence is limited.

Aims

Our aim is to evaluate the efficacy of hemoclips in preventing bleeding secondary to GIADs compared to argon plasma coagulation (APC).

Methods

This retrospective study included patients with bleeding gastric, small bowel or colonic GIADs that were endoscopically treated between January 2009 and November 2016. Patients that received hemoclips as monotherapy or in combination were compared to a randomly selected similar number of patients treated with APC.

Results

We included 157 patients that underwent APC and 141 who received hemoclips. During a median follow-up of 17 months, those with hemoclips had a 32.6% rebleeding vs. 46.5% in the APC group (P = 0.017). On multivariate regression analysis, use of hemoclips was not a significant predictor of rebleeding when compared to APC; hemoclips monotherapy (HR, 0.92; 95% CI, 0.54–1.59) and hemoclips combination (HR, 0.65; 95% CI, 0.41–1.01). When the multivariate analysis was restricted to subjects that resumed antithrombotics after endoscopy, rebleeding risk was lower when hemoclips were used in combination (HR, 0.46; 95% CI, 0.25–0.84) compared to APC. We noted a similar effect in the antithrombotic subgroup even after propensity score matching (HR, 0.51; 95% CI, 0.27–0.95).

Conclusion

Treatment modality was not a significant predictor of rebleeding when studied for the entire population. However, the risk of rebleeding was lower with hemoclips combination therapy compared to APC in patients that resumed antithrombotic therapy, suggesting a potential role for a combined approach in this subgroup of patients.
Point-of-Care Detection of Nonadherence to Antiretroviral Treatment for HIV-1 in Resource-Limited Settings Using Drug Level Testing for Efavirenz, Lopinavir, and Dolutegravir: A Validation and Pharmacokinetic Simulation Study
Authors: Hermans Lucas E. , Nijhuis Monique , Tempelman Hugo A. , Houts Tom , Schuurman Rob , Burger David M. , Wensing Annemarie M. J. , Heine Rob Ter
Published: March 2021

Background:

Virological failure during antiretroviral treatment (ART) may indicate the presence of drug resistance, but may also originate from nonadherence. Qualitative detection of ART components using drug level testing may be used to differentiate between these scenarios. We aimed to validate and implement qualitative point-of-care drug level tests for efavirenz (EFV), lopinavir (LPV), and dolutegravir (DTG) in rural South Africa.

Methods:

Qualitative performance of immunoassays for EFV, LPV, and DTG was assessed by calculating limit of detection (LoD), region of uncertainty, and qualitative agreement with a reference test. Minimum duration of nonadherence resulting in a negative drug level test was assessed by simulation of treatment cessation using validated population pharmacokinetic models.

Results:

LoD was 0.05 mg/L for EFV, 0.06 mg/L for LPV, and 0.02 mg/L for DTG. Region of uncertainty was 0.01–0.06 mg/L for EFV, 0.01–0.07 mg/L for LPV, and 0.01–0.02 mg/L for DTG. Qualitative agreement with reference testing at the LoD in patient samples was 95.2% (79/83) for EFV, 99.3% (140/141) for LPV, and 100% (118/118) for DTG. After simulated treatment cessation, median time to undetectability below LoD was 7 days [interquartile range (IQR) 4–13] for EFV, 30 hours (IQR 24–36) for LPV, and 6 days (IQR 4–7) for DTG.

Conclusions:

We demonstrate that qualitative ART drug level testing using immunoassays is feasible in a rural resource-limited setting. Implementation of this technology enables reliable detection of recent nonadherence and may allow for rapid and cost-effective differentiation between patients in need for adherence counseling and patients who require drug resistance testing or alternative treatment.
A Deep Learning Approach to Visualize Aortic Aneurysm Morphology Without the Use of Intravenous Contrast Agents
Authors: Chandrashekar Anirudh , Handa Ashok , Lapolla Pierfrancesco , Shivakumar Natesh , Uberoi Raman , Grau Vicente , Lee Regent
Published: March 2021

Background:

Intravenous contrast agents are routinely used in CT imaging to enable the visualization of intravascular pathology, such as with abdominal aortic aneurysms. However, the injection is contraindicated in patients with iodine allergy and is associated with renal complications.

Objectives:

In this study, we investigate if the raw data acquired from a noncontrast CT image contains sufficient information to differentiate blood and other soft tissue components. A deep learning pipeline underpinned by generative adversarial networks was developed to simulate contrast enhanced CTA images using noncontrast CTs.

Methods and Results:

Two generative models (cycle- and conditional) are trained with paired noncontrast and contrast enhanced CTs from seventy-five patients (total of 11,243 pairs of images) with abdominal aortic aneurysms in a 3-fold cross-validation approach with a training/testing split of 50:25 patients. Subsequently, models were evaluated on an independent validation cohort of 200 patients (total of 29,468 pairs of images). Both deep learning generative models are able to perform this image transformation task with the Cycle-generative adversarial network (GAN) model outperforming the Conditional-GAN model as measured by aneurysm lumen segmentation accuracy (Cycle-GAN: 86.1% ± 12.2% vs Con-GAN: 85.7% ± 10.4%) and thrombus spatial morphology classification accuracy (Cycle-GAN: 93.5% vs Con-GAN: 85.7%).

Conclusion:

This pipeline implements deep learning methods to generate CTAs from noncontrast images, without the need of contrast injection, that bear strong concordance to the ground truth and enable the assessment of

important clinical metrics. Our pipeline is poised to disrupt clinical pathways requiring intravenous contrast.
Prevention of Firearm Violence Through Specific Types of Community-based Programming
Authors: Bonne Stephanie L. , Violano Pina , Duncan Thomas K. , Pappas Peter A. , Baltazar Gerard A. , Dultz Linda A. , Schroeder Mary E. , Capella Jeanette , Hirsh Michael , Conrad-Schnetz Kristen , Rattan Rishi , Como John J. , Jewell Sarah , Crandall Marie L.
Published: March 2021

Objective:

The purpose of this review was to provide an evidence-based recommendation for community-based programs to mitigate gun violence, from the Eastern Association for the Surgery of Trauma (EAST).

Summary Background Data:

Firearm Injury leads to >40,000 annual deaths and >115,000 injuries annually in the United States. Communities have adopted culturally relevant strategies to mitigate gun related injury and death. Two such strategies are gun buyback programs and community-based violence prevention programs.

Methods:

The Injury Control and Violence Prevention Committee of EAST developed Population, Intervention, Comparator, Outcomes (PICO) questions and performed a comprehensive literature and gray web literature search. Using GRADE methodology, they reviewed and graded the literature and provided consensus recommendations informed by the literature.

Results:

A total of 19 studies were included for analysis of gun buyback programs. Twenty-six studies were reviewed for analysis for community-based violence prevention programs. Gray literature was added to the discussion of PICO questions from selected websites. A conditional recommendation is made for the implementation of community-based gun buyback programs and a conditional recommendation for community-based violence prevention programs, with special emphasis on cultural appropriateness and community input.

Conclusions:

Gun violence may be mitigated by community-based efforts, such as gun buybacks or violence prevention programs. These programs come with caveats, notably community cultural relevance and proper support and funding from local leadership.

Level of Evidence: Review, Decision, level III.
The MEK Inhibitor Trametinib Suppresses Major Histocompatibility Antigen-mismatched Rejection Following Pancreatic Islet Transplantation
Authors: Tada Seiichiro , Anazawa Takayuki , Shindo Takero , Yamane Kei , Inoguchi Kenta , Fujimoto Nanae , Nagai Kazuyuki , Masui Toshihiko , Okajima Hideaki , Takaori Kyoichi , Sumi Shoichiro , Uemoto Shinji
Published: March 2021

Background.

Potential adverse effects, such as functional impairment of islets, render conventional immunosuppressive drugs unsuitable for use in islet transplantation. In addition, as a single therapy, they cannot prolong islet allograft survival. Here, we investigated the utility of the mitogen-activated protein kinase inhibitor trametinib and asked whether it ameliorates acute rejection of transplanted islets without the need for conventional immunosuppressants.

Methods.

Islets from fully major histocompatibility complex-mismatched BALB/c mice were transplanted into streptozotocin-induced diabetic C57BL/6 mice via the portal vein. These mice received trametinib or vehicle (orally) for 28 days. Isolated islets from BALB/c mice were incubated in vitro with different concentrations of trametinib to determine viability and function.

Results.

Trametinib (0.1 and 0.3 mg/kg) prolonged graft survival significantly (P = 0.0007 and P = 0.005, respectively) when compared with vehicle. Histologic analyses revealed that cellular infiltration of the graft by lymphocytes was inhibited significantly on day 7 (P < 0.05). In addition, trametinib suppressed functional differentiation of naive CD4+ T cells in recipients. Expression of mRNA encoding inflammatory cytokines interleukin (IL)-2, tumor necrosis factor α, and interferon γ in recipients treated with trametinib was also inhibited (P < 0.001, P < 0.05, and P < 0.01, respectively). Trametinib also increased production of IL-4 and IL-10 (P < 0.05 and P = 0.20, respectively). In vitro, islets incubated with different concentrations of trametinib exhibited no harmful effects with respect to viability and function.

Conclusions.

Trametinib delayed islet graft rejection by inhibiting functional differentiation of naive CD4+ T cells and regulating inflammatory cytokines. Trametinib might be a promising candidate for maintenance immunosuppressive therapy after allogeneic islet transplantation.
Immunomodulatory streptococci that inhibit CXCL8 secretion and NFκB activation are common members of the oral microbiota
Authors: Myers Sarah , Do Thuy , Meade Josephine L. , Tugnait Aradhna , Vernon Jon J. , Pistolic Jelena , Hancock Robert E. W. , Marsh Philip D. , Trivedi Harsh M. , Chen Dandan , Devine Deirdre A.
Published: March 2021

Introduction. Oral tissues are generally homeostatic despite exposure to many potential inflammatory agents including the resident microbiota. This requires the balancing of inflammation by regulatory mechanisms and/or anti-inflammatory commensal bacteria. Thus, the levels of anti-inflammatory commensal bacteria in resident populations may be critical in maintaining this homeostatic balance.

Hypothesis/Gap Statement. The incidence of immunosuppressive streptococci in the oral cavity is not well established. Determining the proportion of these organisms and the mechanisms involved may help to understand host-microbe homeostasis and inform development of probiotics or prebiotics in the maintenance of oral health.

Aim. To determine the incidence and potential modes of action of immunosuppressive capacity in resident oral streptococci.

Methodology. Supragingival plaque was collected from five healthy participants and supragingival and subgingival plaque from five with gingivitis. Twenty streptococci from each sample were co-cultured with epithelial cells±flagellin or LL-37. CXCL8 secretion was detected by ELISA, induction of cytotoxicity in human epithelial cells by lactate dehydrogenase release and NFκB-activation using a reporter cell line. Bacterial identification was achieved through partial 16S rRNA gene sequencing and next-generation sequencing.

Results. CXCL8 secretion was inhibited by 94/300 isolates. Immunosuppressive isolates were detected in supragingival plaque from healthy (4/5) and gingivitis (4/5) samples, and in 2/5 subgingival (gingivitis) plaque samples. Most were Streptococcus mitis/oralis. Seventeen representative immunosuppressive isolates all inhibited NFκB activation. The immunosuppressive mechanism was strain specific, often mediated by ultra-violet light-labile factors, whilst bacterial viability was essential in certain species.

Conclusion. Many streptococci isolated from plaque suppressed epithelial cell CXCL8 secretion, via inhibition of NFκB. This phenomenon may play an important role in oral host-microbe homeostasis.
The causal effect of serum vitamin D concentration on COVID-19 susceptibility, severity and hospitalization traits: a Mendelian randomization study
Authors: Cui Zhiyong , Tian Yun
Published: March 2021

Background

Evidence supporting the role of vitamin D in the coronavirus disease 2019 (COVID-19) pandemic remains controversial.

Methods

We performed a two-sample Mendelian randomization (MR) analysis to analyze the causal effect of the 25-hydroxyvitamin D [25(OH)D] concentration on COVID-19 susceptibility, severity and hospitalization traits by using summary-level GWAS data. The causal associations were estimated with inverse variance weighted (IVW) with fixed effects (IVW-fixed) and random effects (IVW-random), MR-Egger, weighted median and MR Robust Adjusted Profile Score (MR.RAPS) methods. We further applied the MR Steiger filtering method, MR Pleiotropy RESidual Sum and Outlier (MR-PRESSO) global test and PhenoScanner tool to check and remove single nucleotide polymorphisms (SNPs) that were horizontally pleiotropic.

Results

We found no evidence to support the causal associations between the serum 25(OH)D concentration and the risk of COVID-19 susceptibility (IVW-fixed: odds ratio [OR] = 0.9049, 95% confidence interval [CI] 0.8197∼0.9988, p = 0.0473), severity (IVW-fixed: OR = 1.0298, 95% CI 0.7699∼1.3775, p = 0.8432) and hospitalized traits (IVW-fixed: OR = 1.0713, 95% CI 0.8819∼1.3013, p = 0.4878) using outlier removed sets at a Bonferroni-corrected p threshold of 0.0167. Sensitivity analyses did not reveal any sign of horizontal pleiotropy.

Conclusions

Our MR analysis provided precise evidence that genetically lowered serum 25(OH)D concentrations were not causally associated with COVID-19 susceptibility, severity or hospitalized traits. Our study therefore did not provide evidence assessing the role of vitamin D supplementation during the COVID-19 pandemic. High-quality randomized controlled trials are necessary to explore and define the role of vitamin D supplementation in the prevention and treatment of COVID-19.
Explanatory latent representation of heterogeneous spatial maps of task-fMRI in large-scale datasets
Authors: Zabihi Mariam , Kia Seyed Mostafa , Wolfers Thomas , de Boer Stijn , Fraza Charlotte , Soheili-Nezhad Sourena , Dinga Richard , Llera Arenas Alberto , Bzdok Danilo , Beckmann Christian F. , Marquand Andre
Published: March 2021

Finding an interpretable and compact representation of complex neuroimage data can be extremely useful for understanding brain behavioral mapping and hence for explaining the biological underpinnings of mental disorders. Hand-crafted representations, as well as linear transformations, may not accurately reflect the significant variability across individuals. Here, we applied a data-driven approach to learn interpretable and generalizable latent representations that link cognition with underlying brain systems; we applied a three-dimensional autoencoder to two large-scale datasets to find an interpretable latent representation of high dimensional task fMRI image data. This representation also accounts for demographic characteristics, achieved by solving a joint optimization problem that simultaneously reconstructs the data and predicts clinical or demographic variables. We then applied normative modeling to the latent variables to define summary statistics (‘latent indices’) to find a multivariate mapping to non-imaging measures. We trained our model with multi-task fMRI data derived from the Human Connectome Project (HCP) that provides whole-brain coverage across a range of cognitive tasks. Next, in a transfer learning setting, we tested the generalization of our latent space on UK Biobank data as an independent dataset. Our model showed high performance in terms of age and predictions and was capable of capturing complex behavioral characteristics and preserving the individualized variabilities using a highly interpretable latent representation.
Rapid review of social contact patterns during the COVID-19 pandemic
Authors: Liu Carol Y. , Berlin Juliette , Kiti Moses C. , Fava Emanuele Del , Grow André , Zagheni Emilio , Melegaro Alessia , Jenness Samuel M. , Omer Saad , Lopman Benjamin , Nelson Kristin
Published: March 2021

Background

Physical distancing measures aim to reduce person-to-person contact, a key driver of transmission of respiratory infections such as SARS-CoV-2. In response to unprecedented restrictions on human contact during the COVID-19 pandemic, a number of studies measured social contact patterns under the implementation of physical distancing measures. This rapid review aims to synthesize empirical data on the changing social contact patterns during the COVID-19 pandemic.

Method

We conducted a systematic review using PubMed, Medline, Embase and Google Scholar following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We descriptively compared the distribution of contacts observed during the pandemic to pre-COVID data across countries to explore changes in contact patterns during physical distancing measures.

Results

We identified 12 studies that reported social contact patterns during the COVID-19 pandemic. The majority of studies (11/12) collected data during the initial mitigation period in the spring of 2020 marked by government-declared lockdowns and the most stringent physical distancing measures. Some studies collected additional data after relaxation of initial mitigation. Most study settings reported a mean of between 2-5 contacts per person per day, a substantial reduction compared to pre-COVID rates which ranged from 7-26 contacts per day in similar settings. This reduction was particularly pronounced for contacts outside of the home. Consequently, levels of assortative mixing by age substantially declined. After relaxation of initial mitigation, mean contact rates subsequently increased but did not return to pre-COVID levels. Increases in contacts post-relaxation were driven by working-age adults.

Conclusion

Information on changes in contact patterns during physical distancing measures can guide more realistic representations of contact patterns in mathematical models for SARS-CoV-2 transmission.
The efficacy and safety of remdesivir in the treatment of patients with COVID-19: a systematic review and meta-analysis
Authors: Lou Lixiang , Zhang Hui , Li Zeqing , Tang Baoming , Li Zhaowei
Published: March 2021

Background

The global total of COVID-19 cases will reach 20 million this week, with 750,000 deaths. It has spread to more than 200 countries and regions around the world. At present, the global pandemic continues to rise and continues to spread worldwide. It is necessary to explore the effective and safe treatment of COVID-19 as soon as possible. Remdesiviras was an antiviral agent with therapeutic potential, but it was still controversial.

Objective

Through systematic review and meta-analysis, to evaluate the effect and safety of remdesivir in the treatment of patients with COVID-19, and will provide a reliable reference for the treatment of COVID-19.

Methods

We used the following search string: “COVID-19” [Mesh], “remdesivir” [Mesh], “randomized controlled trial” [Mesh]. We used the Medical Subject Heading (MeSH) terms and corresponding keywords to make the search strategy. We searched six databases, PubMed, EMBASE, Cochrane Library, Web of Science, clinical trials.gov and chictr.org.cn. Data analyses were conducted by using the software Review Manager 5.3 and STATA version 14.0.

Results

Our systematic search identified 5 meta-analyses of RCTs, including 1782 patients with COVID-19.The clinical improvement of remdesivir in the treatment of COVID-19 was superior to the placebo-controlled group (relative risk (RR) =1.17, 95% confidence interval (CI)=1.07-1.29, p=0.0009). The following are the Single-Arm Study, Meta-analysis results. The pooled prevalence of clinical improvement significant findings was 62% (95% CI = 59-65%, p=0.00), during treatment of COVID-19 with remdesivir. The incidence rates of Acute kidney injury, Hepatic enzyme increased, Any serious adverse event were 5% (95%CI=3-7%, p=0.00), 11%(95%CI=5-16%, p=0.00), 22%(95%CI=18-27%, p=0.00), respectively, and the mortality was 13%(95%CI=8-19%, p=0.00), during treatment of COVID-19 with remdesivir.

Conclusion

This analysis confirms that remdesivir is effective in the clinical improvement of COVID-19 patients, and the rate of clinical improvement was 62%. In addition, adverse events and mortality should also be paid attention to. Future research should aim that more large-scale studies were needed to confirm the results, to further elucidate the underlying mechanisms.
Clinical characteristics of COVID-19 in children and adolescents: a systematic review and meta-analysis
Authors: Lou Lixiang , Zhang Hui , Tang Baoming , Li Ming , Li Zeqing , Cao Haifang , Li Jian , Chong Yuliang , Li Zhaowei
Published: March 2021

Background

Although the number of COVID-19 (coronavirus disease 2019) cases continues to increase globally, there are few studies on the clinical characteristics of children and adolescents with COVID-19.

Objective

To conduct a comprehensive systematic evaluation and meta-analysis of the clinical characteristics of COVID-19 in children and adolescents to better guide the response to the current epidemic.

Methods

We searched PubMed, Embase, the Cochrane Library, Web of Science, CNKI (Chinese database), Clinical Trials.gov and chictr.org.cn (China). The methodological quality of the included literature was evaluated using the Quality Assessment Tool for Case Series Studies. Meta-analysis was performed using STATA 14.0. Heterogeneity was assessed by the Q statistic and quantified using I2. We used fixed-effects or random-effects models to pool clinical data in the meta-analysis. Publication bias was evaluated by the Begg’s test.

Results

We analyzed 49 studies involving 1627 patients. In the pooled data, the most common clinical symptoms were fever (56% [0.50−0.61]) and cough (45% [0.39−0.51]). The most common laboratory abnormalities were elevated procalcitonin (40% [0.23−0.57]), elevated lactate dehydrogenase (31% [0.19−0.43]), increased lymphocyte count (28% [0.17−0.42]), increased creatine kinase (28% [0.18− 0.40]), and elevated C-reactive protein (26% [0.17−0.36]). The most common abnormalities determined by computed tomography were lower-lobe involvement (56% [0.42-0.70]), ground-glass opacities (33% [0.25−0.42]), bilateral pneumonia (32% [0.24-0.40]), patchy shadowing (31% [0.18-0.45]), and upper lobe involvement (30% [0.20-0.41]).

Conclusion

Disease severity among children and adolescents with COVID-19 was milder than that among adult patients, with a greater proportion of mild and asymptomatic cases, and thus, the diagnosis of COVID-19 and control of the infection source are more challenging.